Many elite athletes live with health impacts long after they retire. Should they carry all the costs?

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.

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.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.