Sport and dementia: ‘Something needs to happen now’

As former rugby players take legal action, experts warn that authorities in many sports must do more to prevent head injuries

Steve Thompson in action against Scotland at Twickenham in 2011.
Steve Thompson in action against Scotland at Twickenham in 2011. Photograph: Matthew Impey/Rex
Steve Thompson in action against Scotland at Twickenham in 2011. Photograph: Matthew Impey/Rex
Sun 13 Dec 2020 04.30 EST

In the 1980s and 1990s, Crispin Cormack, a full-back who could also play fly-half, turned out for Pontypridd, Cardiff Quins and London Welsh, and toured Australia with Wales.

These days he is a lawyer specialising in personal injury claims. Last week, in the wake of the revelation that a group of former professional players were taking legal action against the game’s authorities for their alleged failure to protect them from risks that caused concussions, his phone started ringing.

Other former players were wondering if they might bring a claim themselves, questions that triggered conflicting emotions. “It’s a difficult one isn’t it?” he said. “Being an ex-rugby player, I don’t doubt there were times I was concussed and played on when I shouldn’t have. It’s an emotive subject. You have this crossover – there’s me wanting to play and be on the pitch and then there’s the issues we have now, how those decisions to play on are coming to haunt some players.”

Cormack suggested that he would probably refer the players to Rylands Law, the firm bringing the action on behalf of the 11 ex-professionals who include 2003 England World Cup winner Steve Thompson, former Wales flanker Alix Popham and England flanker Michael Lipman, all of whom have been diagnosed with early onset dementia.

The firm, which last week also confirmed that it was bringing a claim on behalf of the families of 40 former professional footballers with early onset dementia, is working with a group of 110 former rugby players overall. The youngest is in their mid-20s, the oldest in their fifties.

Richard Boardman, the solicitor acting for the rugby players, said the firm had been building the case for more than a year.

The NFL has made efforts to limit head impacts.
The NFL has made efforts to limit head impacts. Photograph: Brynn Anderson/AP

“We believe that up to potentially 50% of all former rugby union players that played in the professional era could end up with neurological complications. We are not saying it’s 50% guaranteed, nor are we saying that all the neurological complications will be dementia. There’s guys with epilepsy and post-concussion syndrome and various other difficulties.”

Boardman has been labelled an ambulance-chaser but he insisted the action was not about money.

Rather, he said his clients wanted to make the game safer for future generations, as well as ensuring financial security for their families.

He drew a comparison with the NFL in the US, which introduced changes in 2011 amid widespread concern about player safety. As a result, American football players have limited contact in training, an approach he believes professional rugby should copy.

Boardman asked: “Why, in deepest darkest February, six or seven months into the season, are they practising scrummaging? By then they are already battle-hardened.”

The professional era, he believes, has dramatically increased the number of contacts in the game, leading to greater risk of head injuries.

“If you were in Alix’s generation, and a back-rower, you were set around 50 contacts a game. Nowadays I imagine it is 60, 70 or above. If you are dinging your head every time you do that and doing that in training as well, then, if you’ve got a 10-month season, and a 10- or 15-year career, whether you are suffering from concussions or not, that accumulation of sub-concussions, that gentle dinging of the head, whatever you want to call it, it adds up to guys retiring with hundreds of thousands of dingings of the head.”

Repetitive knocks to the head have been linked to CTE – chronic traumatic encephalopathy – a progressive degenerative disease of the brain which was identified in American football players by forensic pathologist Dr Bennet Omalu, a discovery that brought dramatic changes to the NFL.

But some question the evidence for CTE.

Boardman said: “You are either Israel or Palestine in terms of which side of the argument you are on. But we’ve still clinically diagnosed them [the former players] with dementia. They are in a bad way.”

“You can speculate but there is no test until someone has passed away and they can operate on the brain,” Cormack said. “In American football they were lucky to be able to operate on players who had played in the NFL and find out there was this consistent disease. Rugby hasn’t got that database, but what they are saying is, having tested these eight players, they are showing the same signs as what was shown in the NFL case. How you prove that is going to be incredibly interesting.”

One of the leading authorities on concussion and sport is Dr Willie Stewart, consultant neuropathologist at the Queen Elizabeth university hospital, Glasgow, who carried out the landmark Field study that found footballers were three-and-a-half times more likely to die of neurodegenerative disease than the average person. He said there was “no credible researcher looking at brain injury and dealing with neurodegeneration who doesn’t recognise that CTE is a problem”.

However, he said some parties wanted to sow confusion. “There are some people, largely affiliated to sports or sports research, who like to inject some doubt or scepticism into it, but they have no credible evidence. Sadly, we’ve seen this degenerative brain pathology in boxers for many, many decades and now we’re seeing it increasingly in rugby players, American footballers, [association] footballers, ice hockey players, the list goes on and on. But what unites that list is exposure to head injuries and head impact.”

Cormack suggested the case might have consequences for the amateur game, too.

“The million-dollar question: what about [the] grassroots? You should have a doctor close by, but I would bet a lot of clubs struggle with that. If Jonny or Jenny gets a knock on the head, you’re down to the coach saying, ‘I don’t think you should carry on.’”

Stewart said he had evidence of CTE in amateur rugby players.

“I’ve seen quite a number of rugby players in the last five to 10 years with CTE pathology in the brain, and none of them has been professional – they all come from the amateur era.”

Focusing on high-profile examples of early onset dementia among elite sports stars missed the big picture, Stewart suggested.

“People are hearing reports and seeing things like ‘50% of players will have brain diseases’ and if you are a former professional rugby player you’ll be thinking ‘well, that’s that’ and the consequences are horrific.

“I’ve been contacted by quite a number of rugby players in the last week who are worried that they are developing the same problems. We don’t want them backed into a corner thinking they have irreversible, untreatable, degenerative brain diseases.”

He drew a comparison with football, where stories of high-profile individuals who had dementia at an early age generated fears that young onset dementia was common.

“The risk of degenerative brain disease is three and a half times higher in former footballers than it is in the population control, but the number of people in their 40s from the population getting dementia is vanishingly small, so three and a half times of a vanishingly small number is still a vanishingly small number.”

Stewart added: “I worry [that] what we end up with is a slightly skewed view that this is a plague on 40-year-old former rugby players, as opposed to a small number of very real, unfortunately tragic cases. But the rest of their peers may live to their 60s and 70s and be dealing with dementia then.”

It will only be then that the true impact of the game turning professional in the mid-1990s will become apparent.

“There’s no question that in the modern professional era in rugby there has been an explosion in the frequency of head impacts and concussions,” said Stewart, who called on the game’s authorities to act.

“It’s not good enough to tweak the tackle law and come back in a year or two and see if that’s made any difference. Something needs to happen now, before the game is stopped completely.

“If they don’t do anything in 2021 they will be judged very harshly in 10 or 20 years.”

The Rugby Football Union (RFU), which runs the sport in England, has said: “The RFU has had no legal approach on this matter. The union takes player safety very seriously and implements injury prevention and injury treatment strategies based on the latest research and evidence.”