At the last count, in 2014, there were 1,339 people in the UK between the ages of 30 and 44 who had been diagnosed with dementia – or 0.0001% of the 13 million in that age group, or one in every 9,500. The startling news that former professional rugby players from that demographic have been diagnosed with the condition presents rugby with a reality it has dared not face until now.
Even if the 11 (eight of whom are joining a new legal action) turn out to be the only ones, which is next to inconceivable given we know of another 90 with likely symptoms – and this before those players had gone public, this before some have even reached middle age – they represent nearly 1% of the roughly 1,500 players from that age group who played professionally in England and Wales in the 15 years after rugby union went open. Assuming the incidence rate derived from the 2014 Dementia UK report has remained constant, the chances of that same wider population of 13m returning 10 or more cases from a sample of 1,500 are a shade under one in 10 trillion. For 11 or more, the chances are so small that a regular spreadsheet cannot cope and defaults to a probability of zero.
In other words, this is not a coincidence, and it is rugby’s problem. No amount of smooth-talking from the sport’s authorities, or platitudes about the need for further research, can controvert what is in plain sight. There is a link between rugby and degenerative neurological disorders. At this point, it must also be asserted that this association is probably with professional rugby, but there is likely to be a sliding scale, which could reach down into the ever-more punishing community game too.
It seems the key event is the sudden leap to full-time professionalism of elite rugby union in the mid-1990s. A generation of players, now barely at middle age, thus became the first to play an entire career full-time. In so doing, they assumed a toll of physical attrition unlike that of any previous.
Close enough to the amateur era and its unreconstructed ways, that period of early professionalism may even prove to have been exceptionally punishing, certainly in terms of the toll of training throughout the week. Clubs and unions are smarter now with their approach to preparation, but the intensity of the 80 minutes on matchday, fuelled by that ever-improving method, has continued to escalate and shows no signs of abating.
Within the last decade, rugby has tried to put its house in order regarding concussion. The transformation in the culture surrounding head injury and the “old school” virtue of toughing it out has been swift, even impressive. But perhaps the most alarming possibility of all is that concussion, as defined variously each time experts in the worldwide Concussion in Sport Group meet, which is every four years, is at best only part of the problem.
There is a conviction in the scientific community, all but unchallenged by credible independent researchers, that chronic traumatic encephalopathy (CTE), the disease once known as dementia pugilistica but now recognised as a problem well beyond boxing, is not caused by those few events that trigger a “concussion” but by the cumulative toll of repeated blows to the head, including the almost-uncountable sub-concussive impacts we see in rugby. “The idea that you have to lose consciousness for damage to have been caused is a common misconception,” says Prof Damian Bailey of the University of South Wales. “It only causes confusion. All impacts to the body, let alone those direct to the head, have the potential to cause some degree of functional or structural modification to the brain. More than 90% of concussions do not involve loss of consciousness.”
Such a conclusion would raise both codes of rugby into the highest risk category of the world’s major sports. The dramas that have played out in American football over the question of concussion have been watched with disquiet by rugby, but the suspicion the intensity of head collisions in the NFL is of a different order has allayed some of the fears. If the repetitive-blow hypothesis holds true, if the damage is a function of the number of impacts as well as the intensity, rugby suddenly becomes even more dangerous.
Governing bodies can demand as many red cards as they see fit, but a sport with so many moving parts cannot avoid the repetitive shaking of players’ brains
There is no way of avoiding repetitive blows to the head, and lots of them, in rugby as currently played. Governing bodies can demand as many red cards as they see fit, or even implement actual law changes to lower the height of a legal tackle, but a sport with so many moving parts in a team, all commissioned to crash into each other at high speed, whether at tackle, ruck or set piece, cannot avoid the repetitive shaking of its players’ brains.
The recent shift of the paradigm in football regarding headers offers no comfort, either. No one is knocked out by heading a football, but it seems increasingly likely there is a link there too between the bang-bang-bang of head with object and a raised incidence of neurological complications in later life.
Rugby is now confronted with how early “later life” can be. For any of professionalism’s first generation to be diagnosed with dementia when barely into their 40s – and not even as old as that for some of the others with symptoms – is an ethical burden of immense weight for a sport to bear.
All rugby players accept, as do those who play so many other sports, that there will be repercussions in later life for their bodies. But the progressive loss of their minds, the erosion of who they are, was never part of the bargain and certainly not within a few years of retirement.
A case of dementia is defined as early by a diagnosis before the age of 65 and accounts for approximately 5% of all cases. How many more of just this particular generation of players will have been added to rugby’s ledger as they age in the next 25 years? Or even as they are emboldened to come forward in the next few weeks and months, now that others have gone public?
There is no way of knowing yet. Of course, any burden borne by what we must ardently hope is a small minority of the elite will be offset by the self-evident benefits that team sports confer across all of society, emotionally and culturally every bit as much as physically.
But this is an uncomfortable bargain for a sport to strike. What is non-negotiable is the risks of a career in rugby are made clear to those considering one – and this must happen well before science, in its painstakingly meticulous manner, is able to declare definitively how the mechanics of these injuries work, a clear conception of which remains elusive. As long as players know, a sport’s conscience may remain clear.
The trouble is, such transparency comes with a weighty burden of its own. To declare these risks is, effectively, to advertise them. The implications for a sport’s image among the wider population are dire. We are put in mind of smoking, an ever-vanishing pastime once embraced without a thought. We are put in mind of boxing.
As society becomes cleaner, more health-conscious, more self-improving, so its tastes change. The great dilemma for a collision sport is that the cleaner, healthier and more improved its players become, the more dangerous they are to each other. No one has done any of this on purpose, but rugby’s paradox is no less ruinous for that – to itself or, it now seems certain, to at least some of the brains of its players.