Hoani
Smith, Lincoln
University, New Zealand; Dion
Enari, UNITEC
Institute of Technology, and Phil
Borell, University
of Canterbury
When former All Black
Sonny Bill Williams spoke from hospital before his recent neck
surgery, his message was not simply about pain. It was a
warning to young athletes and their parents about the physical
price that can come with a professional sporting career.
The professional boxer and retired dual-code
international player was preparing for his fourth neck
operation, but made a wider point that health
consequences don’t always end after a career playing
sports.
While he had no regrets, acknowledging that
a rugby career provides income,
identity, opportunity, community and pride, he said no
organisations were checking in on him or paying his bills
for health consequences from his playing days.
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His comments point to a question sport is yet to
answer: who carries the cost when an athlete’s body keeps
paying after the final whistle?
The health cost of
playing rugby
Concussion usually dominates the
discussion about long-term player welfare. That attention is
justified and concerns
about repeated head impacts have reshaped rugby’s
safety debates.
But concussion is only one part of
a broader picture. Retired athletes can also live with
osteoarthritis, chronic pain, reduced mobility, hip
replacements, back pain, mental health challenges and the
loss of identity that can follow
a career in elite sport.
Research suggests
these problems are not isolated. A New Zealand Rugby health
study found former rugby players reported more serious
injuries, higher rates of osteoarthritis and higher levels
of hazardous alcohol use than former non-contact sport
players.
International research points in the same
direction. A scoping
review found retired male elite rugby players had higher
prevalence of osteoarthritis, mild cognitive disorders,
depression and hazardous alcohol use than control groups. A
2025
study also found each previous shoulder or knee surgery
was associated with roughly double the odds of
osteoarthritis in that joint later in life.
Many
former players transition well and value what the game gave
them. The broader consideration must be how sport can keep
its benefits while taking seriously the long-term harms some
players experience.
Mental adjustments to sports
retirement
There is also the psychological side of
retirement. Professional athletes can lose structure,
status, income and a sense of belonging and who they are. A
recent
study of retired elite rugby players found athletic
identity and psychological flexibility were linked to
wellbeing after retirement.
New Zealand is not
starting from nothing. Professional players are life members
of the Rugby Players Association, with support during their
careers, while overseas and in long-term retirement. Services include mental
wellbeing, career advice, financial education, retirement
services and professional networks.
The new 2026–28
agreement between New Zealand Rugby and the Rugby
Players Association also expands medical, life and trauma
insurance for players in Super Rugby Aupiki, New Zealand’s
premier professional women’s rugby union.
These
are important developments, but gaps remain in the current
system to help players living with osteoarthritis, chronic
pain, repeated surgeries and mental health challenges that
may appear years after a contract ends.
Getting
cover for gradual conditions
The Accident
Compensation Corporation (ACC) plays a major role in
New Zealand’s sport injury system. It covers
accident-related injuries and can help with treatment,
rehabilitation and financial support.
But ACC
does not cover everything. Gradual conditions can be more
difficult to get cover if they are treated as age-related,
degenerative, pre-existing or not clearly linked to a
covered injury. Some work-related gradual injuries can be
covered – including tendinitis from overuse caused by
heavy lifting at work or knee osteoarthritis caused by
carpet laying – but each claim requires evidence that work
tasks or the work environment caused
or contributed to the injury.
Private health
insurance is not always a fallback. Pre-existing conditions
are commonly excluded unless cover is specifically agreed.
Some policies never cover pre-existing hip, knee or back
issues, nor reconstructive
or reparative surgery.
This creates a grey
zone. A retired player may have pain and need surgery or
joint replacements connected to years of professional sport,
but these may not fit ACC requirements, private insurance or
player-welfare systems.
A recent
article develops an ethical framework for asking when,
if ever, society is justified in tolerating foreseeable
sport-related harm because sport is considered to be in the
“public interest”.
This does not mean athletes
should simply put up with the harm. Rather, it asks what
responsibilities sport has if it relies on public-interest
arguments to accept risks that would be unacceptable in
other settings, especially when those risks are known and
can affect players long after retirement.
Rugby
brings people together and the benefits of professional
sport are shared widely. However, we should also be asking
how the ongoing costs are shared.
The question is
not simply whether rugby can ever be safe; collision sports
will always involve risk. A better question asks what
long-term player welfare should look like when some risks
are foreseeable, repeated and increasingly well
documented.
This might mean stronger transition
planning, long-term health monitoring, clearer medical
support or case management to help retired players navigate
ACC, insurance and public health systems.
Rugby
does not need to be risk-free to be ethical. But if the game
continues to provide entertainment that generates revenue
and national pride, it is reasonable to ask what
responsibilities remain when the playing days are
over.
For some athletes, the bill arrives long
after retirement.
Hoani
Smith, Lecturer in Sport Management and Sport Science,
Lincoln
University, New Zealand; Dion
Enari, Associate Professor, Ngā Wai a Te Tūī (Maori
and Indigenous Research Centre) and School of Healthcare and
Social Practice, UNITEC
Institute of Technology, and Phil
Borell, Senior Lecturer (Above the Bar), Aotahi School
of Maori and Indigenous Studies, University
of Canterbury
This article is
republished from The
Conversation under a Creative Commons license. Read the
original
article.
