Seventeen years after retirement, Jon Sleightholme keeps himself in fine shape, cycling and hiking and running a successful business, so when the former England wing sat in a university laboratory and was told his bone density had diminished, it came as something of a jolt.

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Sleightholme was one of over 250 retired rugby union and league players who took part in an independent Durham University study assessing the frequency and impact of injuries.

The first tranche of research – published on July 16 – found that former players were up to seven times more likely to sustain an injury, and up to nine times more likely to suffer the continued effects of injury than age-matched control subjects who had never played contact sport. 

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Osteoarthritis was more than twice as common in the rugby players and most had suffered a concussion during their careers. Brain injury data is currently being analysed and Dr Karen Hind, the study’s lead author, is excited about what the early findings indicate, although they will not be released for several months. 

Sleightholme, whose son Ollie plays for Northampton Saints, is unsettled by the lack of care for retired players nursing long-term injuries. Their access to leading medical treatment often vanishes as soon as their contracts expire.

“There absolutely does need to be more aftercare for retired players and this study shines a light on that,” the 47-year-old told RugbyPass. “It’s only going to get more challenging; you’re only going to get more players suffering the long-term effects of injuries.

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“Let me just say, we wouldn’t change it for the world – in most cases, the boys loved what they have done. It’s not rugby players complaining. It’s about people understanding that you are in this environment where everything is done for you and the minute you retire, all of that goes. 

“Most guys don’t know how to book an appointment at the doctor because they have never had to. Things like medical insurance, a lot of the injuries you had as a rugby player, you won’t be able to get cover for – pre-existing conditions with joints and whatnot. I know a lot of players who have struggled and been left high and dry.

“There are some quite alarming results in this study that we need to focus on. It’s primarily tested my generation of players who have retired in the last 10-15 years. Since then, the game has evolved again to be this phenomenal high-speed collision sport. 

“The medical treatment for these guys is probably better than ever, but the long-term effects and the challenges post-retirement are still there. Where do they get that support long-term? That’s a huge dilemma for the sport to address.”

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Each former player, including Sleightholme, completed a lengthy health questionnaire and then attended the laboratory for a series of tests. Blood samples were collected, cardiovascular examinations were done, fat measurements taken, bones and joints analysed. Subjects were aged between 21 and 82, but the majority were in their forties, and many had played professional rugby union.

The study, published in the academic journal Sports Medicine, received no funding from the sports’ governing bodies. Thus, unlike previous attempts to release certain player welfare data, it was not subject to interference from administrators.

“It was quite an eye-opener to go through the tests and actually see what was happening to my body several years after I retired,” said Sleightholme, who scored ten tries in 50 starts for Northampton. “It showed a number of things which alarmed me. It showed degeneration in the quality of my bones. A lot of that was down to the fact that because of back and knee injuries I was managing, I’d stopped running and doing weight training.

“I started cycling, like a lot of my peer group, because our joints are all stuffed. Cycling is really good for cardiovascular fitness but it doesn’t do a lot for your bone density. I’ve not really been anywhere near a weights room since I retired. It was alarming to see that the quality of my bones was deteriorating.

“They said that when I was in the middle of my rugby career weight training and running a lot, my bone density would probably be higher than the average person. As a retired player, because of managing injuries, my bone density was probably worse than the average person and it is clearly linked to osteoarthritis, the degeneration of your bones and joints.”

These findings compelled Sleightholme to – cautiously – take up running again and include bodyweight exercises in his training regime. He knows he is nowhere near as grievously afflicted as a number of his contemporaries. The injury rate concerns Dr Hind, who specialises in bone and body composition and retired athlete health. The game, she claimed, is inflicting too much damage on its prized athletes. 

“From what we’ve found the levels of injury are unacceptable,” she said. “They are too high, especially across a career. These guys are not machines. When they retire from rugby they have a life after playing. It’s really important to ensure they have a better quality of life when they retire. That will involve trying to prevent these recurrent injuries but also improving the management of the injuries post-retirement, strategies looking at how players can best be supported when they retire.

“There needs to be a lot more emphasis on the management of injuries. It’s too much for the human body to take year after year, to the point where they have to retire because their body can’t take any more and they are struggling to play football with their kids. It needs to be given a lot more concern from governing bodies. They need to be taking this really seriously.”

In a bid to reduce concussion, World Rugby have implemented a lower legal tackle height and harsher penalties for those who break it, but both Dr Hind and Sleightholme want more to be done. They support imposing a limit on contact training sessions, such as the NFL introduced in 2011.

“We know from research elsewhere that the tackle is the major cause of injury, so perhaps there needs to be consideration given to reducing the volume of contact in training and making sure there is adequate rest between seasons and international matches as well,” suggested Dr Hind. 

“You might want to consider the number of players on the pitch, which has been suggested before. When players move from club to club, their injury history and that knowledge doesn’t move. They might keep that information to themselves because they don’t want their new club to know.

“Players need to feel comfortable about the injuries they have sustained and have the appropriate medical support to prevent them from recurring. These are suggestions and it’s for the governing bodies to work out themselves. But we need to think about how to make players safe when they are playing.”

During testing, the researchers encountered numerous players who felt abandoned after retiring, left to manage chronic injuries and seek potentially costly treatment. This is Sleightholme’s greatest worry, a lack of support for those who empty themselves for club and country and are then cast aside.

“As a rugby player, you don’t want for access to the best medical treatment and advice you could ask for because essentially you are a commodity and they want you out on the pitch as soon as you can,” he said. “The minute you retire, that goes. You can’t just go to see the doctor, the physio, the nutritionist, all of this support around you. And it’s sometimes not immediately post-retirement that you need support.

“If you were still playing and needed an operation, you would clearly get that operation and it would be paid for. The game is facing a financial crisis and there will be loads of guys nursing ankles, knees, shoulders that you would manage as you were playing, but they are now out of contract and are going to be that situation.

“That is where the game needs to support those players who need those operations, that physiotherapy, particularly if they are then retiring and they want to live a normal life. It’s a tricky situation pinpointing exactly who needs to pay for it and each case will be different, but we’re in absolutely no doubt that the responsibility lies with the teams those players played for to pick up those medical costs so these guys can live as much of a normal life as possible in retirement.”

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