lix Popham calls it D-day. “We were in the middle of bloody lockdown, couldn’t go anywhere, couldn’t see anybody.” So he was at home with his wife, Mel. And the phone rang. “They told us to sit down and then they said: ‘Sorry, it’s not good news.’”
At the age of 40, Popham had been diagnosed with early onset dementia and probable chronic traumatic encephalopathy (“probable” because the diagnosis can be confirmed only by a post-mortem). He was surprised to find he felt relieved “because I wasn’t going mad. It wasn’t all in my head. I wasn’t making things up.” Later he felt anger, too, anger that the game he loves, and had given his life to, had, it seems, led to this.
If you saw Popham play, you will remember him. He was a hard-charging back-rower with a shock of bright blond hair, who hit each tackle as if it was the last he would ever make. That was the way he learned to do it when he was growing up. “The saying is ‘whoever wins the physical battle wins the game’ and that was my driving force every time I stepped on the field, in matches and also in training.” They taught him that if he went into a tackle half-hearted he could end up getting injured: “You had to go 100%, all the time.” So that is what he did, through 20-some years of rugby, in which he won 33 caps for Wales and had spells at Newport, Leeds, Llanelli and Brive.
They showed his last Test match on TV during lockdown, Wales against England at Twickenham in 2008, the first match of the famous grand slam. He watched it with Mel and their three kids. He knows he played in it, that Wales won, but not much more. “I’ve got no recollection of being in the game, I can’t remember being on the bus, being in the stadium.”
A lot of his career is like that. “My memories of rugby are made-up, from people telling me things or seeing pictures or watching clips.” He can remember stuff from when he was a kid “but lots of my career I just know I played for these clubs at that time, but I can’t remember a lot else about it”.
He knows he met Nelson Mandela before a Test against South Africa in 2003, but only because he has a photo of it. He was knocked out cold during the game and only woke up after the match. His neuropsychologist told him his brain must have been so inflamed it was as if “he had the camera but there was no film in it”.
Last year, the problems started to seep into his everyday life. Little things at first, stuff he could shrug off. His wife would send him out to buy milk, but when he got to the shop he’d forgotten what she wanted, or she would send him to get cash from her bank account and he would forget her pin. He would find it hard to concentrate when more than one person was talking, couldn’t tune into a conversation if the TV was on in the background. And he found he was becoming unusually snappy and aggressive. He would slam doors when they rowed, once he even tore off the bannister. And then he would feel guilty. “I would think to myself: ‘What the fuck was all that about?’” Often, the next day, he couldn’t remember what the row was about. He felt a lot of anxiety, too, which he wasn’t used to. All of a sudden he was checking his emails over 10 times or more before he pressed send.
Mel wanted him to see a doctor. He told her not to worry, that it was just he was feeling stress. Then he had the blackout. He was out on a bike ride, a 25-mile loop he had done countless times. Halfway round, he had no idea where he was. He stopped, sat on the side of the road, called home, and Mel told him to cycle back the way he came. The next day he made an appointment to see his GP. It was the first of many, in the NHS and then in private care. There were MRI scans, DTI scans, meetings with doctors, neurologists and neuropsychologists. Then D-day. And suddenly, it all started to make sense.
Is rugby union more dangerous than we thought?
As ever with the brain, there is much we cannot know for sure. These diagnoses are a deeply unsettling development in players so young. The gathering of what science likes to call “hard data” takes many years and many studies, which is small comfort to those living with any repercussions in the here and now. It was not until 2019 that science established a raised incidence of mortality by neurodegenerative disease among professional footballers of the 20th century. Rugby is likely looking at a stronger association. Most players, we must hope, will be unaffected. The reality is we will start to find out only as they age. And, even then, is any risk simply a function of playing the sport or of other factors?
Rugby is 150 years old. Why is this a problem now?
If these cases of dementia are symptomatic of a new phenomenon, the key development appears to be when elite rugby players went full-time in the 1990s. Not only did the physical toll of the 80 minutes intensify dramatically, players were subjected to contact training throughout the week. A group of players intend to pursue a legal case against the rugby authorities claiming they were owed a duty of care given emerging evidence of the dangers.
Aren’t players better managed now?
Yes. Training is much more sophisticated than in the wild west of the early years of the professional era. Awareness and treatment of head injury has also been transformed in the last decade. Alas, with better preparation of players, the intensity of the 80 minutes on the field has continued to escalate. There is no way of knowing if the net effect of this relative shift in load from the week to the weekend mitigates the risks.
What can rugby do?
This is probably/hopefully a problem restricted to the elite game, where the attrition rates are so much higher. Certain measures are already in place since the Thompson generation played. Head injury must be managed ever more carefully. Science is on the cusp of developing technologies to detect brain injury more effectively and swiftly, but this could be a double-edged sword if it goes on to reveal a much higher incidence than previously thought. Current attempts to change the nature of the game are likely to prove hopelessly peripheral. There is no easy answer to that.
He still has regular appointments with a neuropsychologist and an occupational therapist. They have been helping the family learn how to live the best lives they can. Mel was staying overnight in London one day a week for her work, but one night when she was away he forgot the grill was on and started a fire in the kitchen. So she decided it was best to stay at home. They make sure they are always in the same room when they need to talk. He has a diary of things he needs to do each day, half hour by half hour. And he has given up alcohol and started learning techniques to help him deal with his stress and anxiety.
He has been doing a lot of talking, too. Not only to doctors but also to friends from his playing days, former teammates and opponents. He knows he is not the only one struggling. “I thought I’ll reach out to boys I played with and against in my circle. I’ve done that and over 50% of them are struggling in some way. Some are worse than me, unfortunately.” He thinks a lot of them could have been wrongly diagnosed. “They have gone to their GPs and been told: ‘You’re depressed, here’s antidepressants, now go away.’” He was lucky that his own GP also worked in neurology and sent him for an MRI scan. Even so it was only when he had DTI scans away from the NHS that he was able to get fully diagnosed.
He wonders how different it all might be if he knew then what he knows now. “But in our day it was sniffing salts and shrug it off.”
It’s not only the concussions he is worried about, it’s all the blows. His consultant asked him to make a rough count of the tackles, carries and clean-outs he made in every game and training session. “He thinks minimum I’ve had over 100,000 sub-concussions. Minimum. And that’s just my professional career. I started playing when I was four.” One of his neurologists explained it like this: “Every contact causes a little bit of damage to your brain. Look at it like a leaking tap. If it drips once or twice on a piece of mud there’d be no mark, but if it drips for 14 years there would be a lot of damage. And there is a lot of damage showing on my scans.”
However despite it all, he still loves rugby. “All my life, every day since I was four, it’s been rugby, rugby, rugby. And there’s so many amazing things that you get from it.” But he’s angry it is not safer, angry there are people playing now who may end up in the same position he is in. He rattles off three changes he believes the authorities could make tomorrow. The first is to provide each player with a mandatory health check every year, including brain scans. The second is to improve insurance provision after retirement. The third is to limit contact training, which the NFL started doing nine years ago. “Why would they think it’s not going to happen in rugby, when the NFL put that in place in 2011?”
“How I look at life is this: if somebody is having a kicking on the side of the street I would pull over and try and stop what was going on. And I’m frustrated at the moment with what’s happening, because it feels like the governing bodies are driving past that person being beaten up. Because they know what the problems are, and they can so easily solve so many of them.” There still are going to be concussions, he says, and freak accidents, because it is a contact sport. Like a lot of former players, Popham carries scars from playing it. His upper body is “buggered”, but he always knew that was the risk. “You know you are signing up for that. Same for all the guys I’ve spoken to. We knew our bodies were going to be in bits when we retired. But we had no clue our brains were as well.”