Concussion in sport, the challenges

Hey guys, Andy here. I recently spoke about For the Love of the Game, my portrait project, partnering with Sam Peters, focusing on concussion in sport. A project on concussion in sport may sound straight forward but it is not without insignificant challenges; sports science and medicine, player behaviour, sporting governing bodies, and commercial interests all have a voice and interest in what is said.

Firstly, sports science can potentially to be introverted at a number of levels. Individual sports both look at their injuries in isolation as well as also denying their sport has direct links to conditions which may occur in other sports. That is to say both ‘if this injury occurs in our sport, there is no link to the same injury incurred in another sport as the manner in which the injuries occurred are not the same’ as well as ‘how can this sport be responsible for this condition if the condition can also be found elsewhere’. Secondly doctors and specialists may hoard and protect their findings in order to achieve individual recognition. Thirdly there is the issue of the medical privacy of players who may not wish their injuries to become part of medical studies and risk their injuries becoming public knowledge. The result of these silos is a reluctance to share information which, in turn, limits understanding of concussion and the illnesses and diseases which may originate from it.

England rugby captain Lewis Moody was diagnosed with Motor Neurone Disease (MND) in October 2025, however there is no proven direct link between the disease and his rugby career. That said research suggests extreme endurance sports and exercise, including long-distance cross-country skiing, may be associated with a higher risk of developing amyotrophic lateral sclerosis (ALS/MND), particularly among elite athletes. However in regards to concussion, it is important to take a step back, pointing fingers at individual diseases (such as MND in this instance) ignores the wider picture and collective facts and figures that players and athletes experience where the common denominator is repetitive head trauma.

Other challenges include the players themselves and player behaviour; they must be removed from the decision making process if suspected of a concussion. Players of all levels and ages are, by nature, competitive. This is the nature of sport; players competing to win and demonstrating their sporting prowess and ability over others. Players will, especially when medals and trophies are within their reach, insist on their fitness and ability to play and downplay any injuries (there are rare exceptions). In such situations it is imperative an independent arbiter exists to look after the best interest of players with medical advice not solely on offer from a team doctor. This is because the neutrality of a doctor or other medical professional can not be guaranteed if their salary, their wage, or their livelihood is dependent on an organisation urging them to return a potentially injured or concussed player to play.

A recent case in point is the Tongan born rugby league player Eli Katoa and events during an international match against New Zealand in November 2025. Despite a significant blow to the head during the warm up, Eli started the match and consequently suffered two more blows to the head while playing. He underwent and passed a Head Injury Assessment (HIA), by his team doctors, after the warm up incident, and he subsequently passed his second HIA, by an independent doctor, after the first blow during the match. He returned to the pitch only to be hit in the head for a third time during the second half at which stage he was mandatorily removed from the field. While on the sidelines he then experienced seizures before being rushed to hospital where he was operated on to drain fluid from his brain. Following the incident Eli was officially ruled out for the entire 2026 season.

What of the duty of care, the legal obligation to act with reasonable care and skill to avoid causing foreseeable harm to others? The issue is not as straight forwards as it may appear as clearly a governing body should protect players, but the challenges are what happens when, not if (at a professional level), there are commercial contracts in place? When a deal is worth millions a year or hundreds of millions over the course of a contract, brands will want to see star players on the pitch as well as promoting these players in advertisements in order to generate sales. In such instances it is naïve to believe that money does not talk and sway decisions. There is an argument to suggest players are expendable, with a queue of young talent keen to represent their country lining up around the block, while the the number of international sports brands with deep pockets is more limited. Maintaining positive PR, today, means all negative press and stories are denied until there is overwhelming evidence to the contrary; on a sporting level this means governing bodies and brands will claim duty of care and best efforts to protect players as their default position. However it is important to look at what people do, not just what they say.

The International Rugby Board (IRB), the predecessor to today’s World Rugby (WR) the governing body for the sport of rugby union, introduced concussion rules in 2012. These included a head injury assessment (HIA) and a six day return to play protocols, both of which were trialled at the Junior World Cup that year, leading to the resignation of Dr Barry O’Driscoll, the medical advisor. O’Driscoll argued a 15-minute period to assess for suspected concussion was unfit for purpose given the 48 hour window in which symptoms of concussion can occur. He further argued the six day return to play was dangerously below the previous three week stand down period and that the trials were irresponsible given the brains of those being trailed (ie youth level) are at that age still developing and require additional protection. “So obviously done for commercial reasons,” O’Driscoll said in 2021, “The HIA and return to play protocols have no scientific standing.” 

Thus, for years, rugby has claimed to be following the science, but is it? When a sports body says, “We are following the science”, are they really? Who funded the science; is the science independent or is there a bias and, if so, what is it?

Today there is more pressure than ever for teams to play more, to field their best players to generate as many views or eyeballs as possible, on traditional and social media channels alike. Alongside this pressure is the pressure from sponsors want positive associations with teams and players, in order to sell product and merchandise, who prefer to avoid negative associations with any diseases that players may suffer from playing due to risk of decreased sales. Success breeds success and vice versa.

Thus the challenges of concussion in sport are not negligible with current science only being able to tell us so much. Lewis Moody is one of more than 1,100 people in the UK diagnosed with MND annually; if there’s a public perception that rugby players are especially prone to the disease, perhaps it is because the players who have been diagnosed have helped raise awareness about it. Rob Burrow CBE (rugby league), Doddie Weir and Ed Slater (both rugby union) are other examples of recent rugby players who have suffered from and raised awareness about MND. Thus more research in the form of longer studies, bigger studies and better-funded studies is necessary. In the meantime promoting awareness and education of the risks of concussion in sport, encouraging better paths to recovery and safe return to play protocols must be the path to take. Last summer Ireland and British and Irish Lions rugby player Garry Ringrose openly reported concussions symptoms, rather than trying to play through them, withdrawing from the second and third tests against Australia. This was a significant set back for a player in form with his actions being called momentous. Hopefully this will be a precedent followed by others.