NRL great had head-knock brain disease

NRL great Paul Green’s shocking brain results show the former Cowboys’ coach was silently suffering a crippling disease.

Paul Green while the Cowboys coach. Picture: AAP Image/Michael Chambers

NRL great Paul Green was suffering from a “severe form” of chronic traumatic encephalopathy, a crippling brain disease linked to repeated head knocks at the time of his death.

Professor Michael Buckland, who examined Green’s brain, revealed the former rugby league star and Cowboys premiership winning coach was suffering “a high stage” of CTE when he took his own life in August this year.

Professor Buckland found an alarming build-up of a protein called tau, a sign of CTE, that had spread far and “deep” into the 49-year-old’s brain.

“Paul had one of the more severe forms of pure CTE we‘ve seen,” Professor Buckland said.

“Paul had a build up of tau in pretty much every block of the brain cortex we looked at, which is unusual for someone of his age.

“There were ten regions where it clearly fulfilled all the diagnostic criteria for CTE.”

CTE can only be diagnosed after death.

Green’s sudden death rocked the rugby league world in August and there was an immense outpouring of grief following his shock passing.

Professor Buckland said upon examining Green’s brain in his laboratory at Australian Sports Brain Bank at the Royal Prince Alfred Hospital in Sydney, he could see that Green had been living with CTE for “quite a while”.

The premiership winning Cowboys coach, who played 162 games and won the Rothmans medal, had a “high stage” grade of the brain disease, which also could be classified as ‘stage three’ CTE. Professor Buckland said it can lead to impulsive behaviour and impaired judgment.

“My feeling is he would have been symptomatic for some time and he was a smart guy, a remarkable man, with a lot of diverse interests,” Buckland said. “I suspect he would have been coping with stuff he didn’t understand for quite a while. He didn‘t have mental health problems; he just couldn’t control stuff that was going on in his head.”

After Green died suddenly, showing “no signs” of depression, in the midst of grief his wife Amanda agreed to donate his brain to Australian Sports Brain Bank which is managed by Professor Buckland.

Amanda and Paul Green in Townsville

Amanda Green has opened up about how shocking her husband‘s sudden death was and said while the diagnosis didn’t take away the “sadness and the pain” it has brought some “peace” to her and her children Emerson, 13, and Jed, 10.

“I look back and I see he was doing these things that weren‘t Paul,” Amanda says. “Over the last few years he had at times difficulty controlling his emotions, impaired judgement, a lowered tolerance and displayed impulsive behaviour.”

Symptoms of CTE can also include; memory loss, poor cognitive function, mood and behaviour issues, many people develop depression and a significant number dementia.

Professor Buckland said his forensic analysis of Green’s brain showed clumps of “tau” all throughout his brain.

“There was a fairly heavy burden of tau in the cortex and after that it also spread to other structures of the brain, particularly the hippocampus, which is involved in memory and thinking,” Professor Buckland said. “I then found it in some deeper regions of the brain as well. Not only did he have CTE lesions, with this evidence of spread, it caused me to diagnose high stage CTE.”

No one can say exactly how may head knocks he suffered. Green played in an era where playing on after a knock was a badge of honour, but he did endure a severe facial injury which ended his career. Amanda said he had to have extensive surgery and a number of plates inserted in his face.

Bulldogs great Steve Folkes, who passed away from a heart condition at 59, was the first rugby league player to be diagnosed with CTE also found to have stage three of the brain disease. Folkes played 245 first-grade appearances for Canterbury between 1978 and 1991.

Folkes’ main CTE sign, presented as memory loss to his immediate family.

“Paul’s brain was very similar to what Steve Folkes’ presented with,” Professor Buckland said, who also examined Folkes’ brain post-mortem.

AFL footballers Danny Frawley, 56, and Shane Tuck, 38, who took their own lives, were both diagnosed with CTE post-mortem. Geelong great Polly Farmer in 2019 was diagnosed with CTE following his passing and was suffering alzheimer‘s when he died.

Professor Buckland praised Amanda Green for choosing to donate Paul’s brain in the midst of grief, and the family also asked for donations to be made to the ASBB in lieu of flowers raising nearly $30,000 for research.

“It is an incredible gesture for a family to donate a loved one‘s brain, especially when they are in the depths of grief,” Buckland said. “Obviously, the Green family were looking for answers but they also immediately understood how this could also help others.”

She hopes Green’s diagnosis will lead to a greater conversation and education about the disease.

“My goal is to shine a light on Paul‘s diagnosis in the hope that we can advance our approach to detection, education, treatment and support for people suffering from CTE,” Green said. “The Greens are a rugby league family, so it would be comforting for us if Paul’s legacy can improve the experience for those who play the game.”

“I applaud the NRL for the improvements they are making to the game in regards to concussion and protecting from grassroots to the professional level.”

Buckland believes the sporting codes should have more conversations around limiting tackling in professional practice, the NFL has had protocols in place for over a decade, as well as considering limiting tackling until the age of 12 in children’s sports.

For more information about CTE and the Australian Sports Brain Bank, to make a financial donation in honour of Paul Green, or to register to donate your brain, visit: www.brainbank.org.au