Landmark study reveals extent of rugby league brain injury crisis

A landmark study has found that 31 rugby league players have been diagnosed with the degenerative brain disease chronic traumatic encephalopathy (CTE).

Rugby league players in their 20s, 30s and 40s have been found to suffer from a degenerative brain disease that can only be diagnosed after death.

They included decorated league footballer and NRL coach Paul Green, 49, and Manly Sea Eagles player Keith Titmuss, who was just 20 when he died.

The ABC has obtained the latest statistics based on the first 150 studies of the brains of people involved in contact sports conducted at the Australian Sports Brain Bank.

Of the 51 rugby league player brains donated to the brain bank, 31 were found to have CTE. They played at different levels of the game: from amateur to professional.

The paper was presented by molecular biologist and data scientist Jennifer Cropley at the International Sports Concussion Conference in Melbourne on Tuesday.

The only cause of CTE is repeated blows to the head and body. Symptoms may include memory loss, impulsivity, anxiety and anger.

The disease has been found in several athletes who have committed suicide, but experts say more research is needed to establish a “causal” link.

“I feel a huge responsibility”

The widow of former league star Paul Green, Amanda Green, is calling on all types of clashes to do more for the next generation of players.

Experts have repeatedly called for a football code banning contact for under-14s.

Ms Green has called for more people to donate their brains to help understand the disease and wants more awareness of the issue.

“Now that we know what to do about this disease, I feel a huge responsibility, as we all do, to protect the brain health of the next generation of young athletes,” Ms. Green said.

“I owe it to my kids and their sports-loving friends. We must ensure that they do not make the same mistakes as our generation. The key here is to pledge our brains and support the incredible and potentially life-saving work of the Australian Sports Brain Bank.”

Ms Green said she had “no idea” what CTE was until her husband died.

“I played professional sports at the highest level in this country and did not understand this disease that we now know as CTE,” she said.

“It wasn’t normal, I didn’t know what CTE was and after Paul was diagnosed I kept calling for more education on the issue. People needed to understand this disease so that no one else suffers in silence.”

Green committed suicide in 2022.

Ms Green said that after learning about the disease, she saw that her husband had shown signs of CTE before he died.

“After receiving Paul’s diagnosis from [sports brain bank director] “Professor Michael Buckland mentioned that Paul had one of the most severe cases of CTE that he had ever seen, but because of Paul’s intelligence there was a possibility that he was masking a number of his symptoms, but the symptoms that I saw were symptoms of anxiety, impatience, he was impulsive in his decision making, he definitely had a lower level of tolerance and quite heightened emotions,” she said.

“These were changes that I noticed over time and which I attributed to the stress of his job.”

Swinburne University professor Alan Pearce, author of a paper outlining the latest rugby league statistics, said more needed to be done to protect players.

“Given that rugby league is a collision sport, it is not surprising that we found that over 60 per cent of rugby league sponsors had CTE, but this tells us that we need to start making changes,” he said.

“Introducing contact restrictions in rugby league is a good start, but rugby league and all contact and collision sports must also start moving to non-contact versions for under-14s.

“The Keith Titmuss result: stage two CTE at age 20 tells us that it is not a disease of old people.

“Keith passed away in 2020, and his brain findings show that the risk of CTE begins at the youth sports level.

“Keith played junior rugby league from the age of five and then became a schoolboy in rugby union, and his brain work shows the effect of this.”

Titmuss played as a schoolboy at Newington College in Sydney and suffered repeated head impacts over 15 years of playing youth contact sport.

Titmuss died from heatstroke following Manly Sea Eagles training in 2020.

His CTE diagnosis was revealed in 2024 and prompted warnings that major football codes were not doing enough to protect young athletes. His parents Lafoe and Paul donated his brain for research.

The latest rugby league statistics follow a Four Corners report in June which revealed 33 Australian Rules footballers had been diagnosed with CTE and revealed the extent of the AFL’s brain injury crisis.

The Four Corners report prompted WorkSafe Victoria and WorkSafe WA to investigate footballer safety incidents.

Last month, a Boston University study found that at least one in four former NFL players who died between 2016 and 2021 had CTE.

The NRL has been contacted for comment.

Watch Four Corners’ full investigation into the AFL’s brain injury crisis on the channel ABC iview.