With former players taking legal action over the issue of degenerative brain diseases, rugby could be at the tip of a very large iceberg as it continues to come to terms with the impact of concussion in the sport.
Among the ex-internationals putting forward a legal case against the game’s governing bodies are Steve Thompson, Michael Lipman and Alix Popham.
All three are in their early 40s and have recently been diagnosed with early onset dementia and probable chronic traumatic encephalopathy (CTE) — a progressive, degenerative brain disease caused by repeated hits to the head.
“This is something I will be battling forever and ultimately, I won’t win,” said Lipman. “I am a walking time bomb. I feel like I am treading on eggshells with myself.”
Thompson, meanwhile, says his memory has deteriorated to the extent that he can’t remember playing for England in the 2003 Rugby World Cup final, let alone even being in Australia for the tournament.
“We fear at this stage a potential epidemic based on what our experts have seen to date in terms of our own experiences, as well as many of the studies that they have read across the sporting world,” Richard Boardman, the lawyer co-ordinating the case, told CNN Sport.
In a joint statement, World Rugby, England’s Rugby Football Union (RFU) and the Welsh Rugby Union (WRU) said it would be “inappropriate to comment” on specifics of the legal proceedings but added that it was “deeply saddened to hear the brave personal accounts from former players” and that “rugby takes player welfare extremely seriously and it continues to be our number one priority.”
Thompson and Lipman are among a group of nine former players suing the governing bodies, but a wider group of more than 100 players — aged from their 20s to 50s, many of whom are showing signs of neurological complications — are also interested in pursuing legal action, according to Boardman.
A pre-action letter of claim was delivered to World Rugby, the RFU and the WRU on Thursday by law firm Rylands Law, which alleges that the risk of concussions for the players were “known and foreseeable.”
It’s a dynamic that has led to comparisons with the NFL.
CTE’s association with American football has been well-documented since it was first discovered by Dr. Bennet Omalu in the brain of former NFL player Mike Webster 18 years ago.
In 2015, a class-action lawsuit was settled between the NFL and more than 5,000 former players, providing up to $5 million per retired player for serious medical conditions associated with repeated head trauma.
Rugby, which only turned professional in 1995, is now confronted with a legal case of its own.
According to leading neuropathologist Dr. Ann McKee, who has examined the brains of athletes across a number of sports including over 1,000 American football players, says the symptoms shown by rugby players are similar to what she has seen in other sports.
“The symptoms are very reminiscent of what we see in American football players and soccer players, and we’ve actually seen it in rugby players as well,” she told CNN Sport.
“And the pathology is also very similar. What we don’t know is the prevalence — we don’t know the prevalence among former rugby players.”
Financial compensation for the players — many of whom have young families to support — is one part of the legal battle.
Another is to make the game safer moving forward, which is why the ex-players putting forward the case have also created a set of 15 “commandments” they would like to see implemented by governing bodies.
“The number one thing which seems to be particularly low hanging fruit is the regulation of contact in training,” Boardman added.
“As far as the players are concerned, that doesn’t appear to be much of a hurdle to implement, and it shouldn’t cost too much money.
“Every guy that is doing this has a deep love for the game, and they absolutely want to ensure the survival of the game going forward.”
In 2011, the NFL limited the number of full-contact padded practice sessions during the regular season to 14, with 11 of those conducted during the first 11 weeks of the season.
Stricter regulation of contact training could be on the way for rugby, too.
“Part of the issue with limiting contact training is you need a scientific answer as to how much is too much, and that’s always been difficult to get,” Christian Day, player liaison officer for the Rugby Players Association who retired from professional rugby in 2018, told CNN Sport.
“I wonder if this is the moment where we don’t need a figure, we just say that there is too much, we need to reduce that and see where that takes us.”
Day added that rugby’s growing association with neurological disorders will “undoubtedly” lead people to question playing the game at amateur level, but also said the legal case could prove a “watershed moment.”
“Rugby is a contact sport at the end of the day … people love not only to watch that physicality, but our members speak about how much they enjoy it themselves,” he said.
“We have to try and adapt the game. We have to try and keep moving in terms of what we’re doing and building in these layers of protection for the players.”
The statement from the sport’s three governing bodies continued: “As a result of scientific knowledge improving, rugby has developed its approach to concussion surveillance, education, management and prevention across the whole game.
“We have implemented coach, referee and player education and best practice protocols across the game and rugby’s approach to head injury assessments and concussion protocols has been recognized and led to many other team sports adopting our guidance.
“We will continue to use medical evidence and research to keep evolving our approach.”
According to World Rugby’s concussion guidance, a player with concussion or suspected concussion at all levels of the game should be immediately and permanently removed from training or the field of play and should be medically assessed.
Elite adult teams also operate a Head Injury Assessment protocol during games to help identify, diagnose and manage the impact of head injuries.
Assessing the impact
Former South Africa international Alistair Hargreaves, who retired from rugby four years ago due to concussion, felt he was “well-managed” as a player.
“I was very aware of the risks of concussion,” he told CNN Sport.
“I think I was probably quite studious about what concussion was, what it meant and what the repercussions of repeated concussion were.”
Hargreaves has had conversations with lawyers about his concussion-enforced retirement, but decided it wasn’t something he wanted to pursue.
“I see these cases (like Thompson and Lipman) come out and I get a million messages from friends and colleagues to say, well, have you seen this? How do you feel?” he added.
“I find it incredibly sad and emotional to see the cases and the stories of people coming out that are having symptoms.
“To date, I’ve been fine. But yes, I do worry about it. But, you know, is the glass half empty or half full? A lot of the information that I’ve got is, well, we don’t know what the impact of long-term concussion really is.”
In 2017, Dr. McKee co-authored a study that found CTE in 99% of deceased NFL players’ brains. A leading figure in sport’s understanding of concussion and CTE, she wants more to be done to monitor the effects of head impacts on current and former players.
“We are still not dealing with the acute injuries in a conscientious manner,” she said.
“We are treating the concussion; we have identified concussion and concussion management has improved tremendously over the last decade and they’ve made leaps and bounds there.
“But we’re not assessing the players in a quantitative and precise way to check to see if they are developing abnormalities in their neuropsych tests or on their neuroimaging tools that are available to us.
“We need to keep track of these players and make sure they’re not going down this road to what ultimately will be a debilitating, dementing disease.”