Aged only 41, former All Blacks rugby international Carl Hayman has been diagnosed with early onset dementia and probable chronic traumatic encephalopathy, reports The Guardian. He has also joined a growing list of players in a class action suit against the administrators of the game internationally.
As reported previously in MedicalBrief, a UK group class action for negligence was launched late last year, following diagnoses of early onset dementia among a number of retired players. The initial legal action, now which has drawn at least 150 British players, was started by nine rugby internationals who had the same diagnose Hayman has recently received: early onset dementia and probable Chronic Traumatic Encephalopathy (CTE). At the time, their lawyers said they represented more than 100 players and it was thought similar actions might follow in other rugby-playing countries like South Africa, Australia and New Zealand.
Following extensive testing in England that led to his diagnosis, Hayman has joined the landmark lawsuit being prepared for 150 former professional rugby players that claims rugby’s governing bodies, including World Rugby, failed to protect players from the risks caused by concussions.
All Blacks assistant coach John Plumtree expressed his regret at Hayman’s situation.
“It’s really sad,” Plumtree said. “Carl is a 45-Test All Black and he’s done a lot for New Zealand rugby. It’s a real sad situation if he’s struggling with dementia at such an early age.”
Despite Hayman being the latest modern-day athlete to reveal extensive brain damage from contact sport, Plumtree believes rugby, and the All Blacks, have taken major strides in attempting to mitigate the effects of repeated head knocks.
“We look at our laws now they really protect the head,” he said. “It has changed a lot. There’s greater awareness around it in all parts of the organisation, from the top level down to us as coaches. We’re trying to minimise the accidents around the head as much as we can and we know the game is under pressure to do that.
“We’ve got a responsibility as coaches to make sure the game is safe.”
World Rugby recently adopted independent concussion consultants to support the graduated return to play process in the elite game, and has issued guidelines around reducing contact in training. These include limiting full contact to 15 minutes per week; 40 minutes of controlled contact utilising tackle shields and pads, and 30 minutes of live set piece training with lineouts, scrums and mauls at a high intensity.
The recommendations could soon be mandated, with Test teams potentially obliged to follow guidelines if they wanted to compete at the 2023 World Cup.
Plumtree said training measures the All Blacks adopt to minimise contact include using tackle shields rather than players to practise cleanout drills, and closing the distance between contacts to reduce impact.
“It’s all designed to look after the players and train the perfect technique,” he said. “The head is a protected place and those types of conversations are talked about all the time.”
Research background
A UK biomarker study showed that 23% of elite adult rugby players had abnormalities in brain structure, and half showed an unexpected change in brain volume, wrote MedicalBrief in the same report. Although this was a small study, it added pressure on world sports bodies to act to minimise concussion, after the release of a British parliamentary report that was scathing of the failure of football and rugby authorities to tackle the issue.
The most recent study, part of the Drake Rugby Biomarker Study, was led by Imperial College London. The Drake Foundation funds research early onset dementia among retired players suspected to be caused by repeated blows to the head. Foundation founder James Drake said: “Since rugby was professionalised in the 1990s, the game has changed beyond all recognition. Players are now generally bigger and more powerful, so we have to be mindful of all the ramifications that increased impacts will have on their bodies.
“I am not convinced the game is safer now than it was when I started the Foundation in 2014. More must be done to protect players, and without delay.”
According to the Imperial College study, the research found a significant proportion of the rugby players had signs of abnormalities to the white matter, in addition to abnormal changes in white matter volume, over time. White matter is the ‘wiring’ of the brain, and helps brain cells communicate with each other.
The study, which took place between July 2017 and September 2019, assessed 41 male players, and three female. All underwent an MRI brain scan, and around half then had a second MRI scan a year later. The study used two advanced types of MRI called susceptibility weighted imaging and diffusion tensor imaging to examine the structure of blood vessels and the white matter.
The study assessed long-term changes in MRI images of professional rugby players, who were compared with athletes in non-collision sports, as well as non-athletes. Among the group of rugby players, 21 were assessed shortly after a mild head injury, or a mild traumatic brain injury. These types of head injuries, which often cause concussions, are the most common reported match injury – accounting for one in five injuries.
The results showed that 23% of all of the rugby players showed abnormalities to their cell axons (the ‘wires’ of brain cells), or small tears in blood vessels. These tears cause small leaks in the brain, called microbleeds. These changes were seen in both players with and without a recent head injury.
In addition, the scans provide evidence for unexpected changes in white matter volume across the whole group of rugby players, which could indicate a longer-term effect of these abnormalities to connections in the brain.
At the time, former England scrum-half Kyran Bracken, speaking on behalf of the Progressive Rugby group, said: “I hope the findings will be a watershed in the approach to the management and research of concussion in sport, and expect to see sporting bodies being held accountable for the duty of care their employees have a right to expect.” Progressive Rugby also called on World Rugby to “urgently address the current elite return to play protocols, which we maintain are not fit for purpose”.
Hayman, who played 45 Tests for the All Blacks between 2001-2007, during which time he was considered the best tighthead prop in the game, said rugby had taken an irreversible toll on his brain.
He became one of the world’s highest paid players when he joined English club Newcastle and Toulon, winning three European titles with the French team, before retiring in 2015 after playing some 450 professional games.
“I spent several years thinking I was going crazy. At one stage that’s genuinely what I thought. It was the constant headaches and all these things going on that I couldn’t understand,” he said.
The Guardian reports that harrowing accounts of the effects of his early-onset dementia included alcohol abuse, suicidal thoughts and erratic behaviour; the latter leading to a suspended prison sentence in France after he admitted to charges of domestic violence.
According to a University of South Wales study published in MedicalBrief in September, just one season of professional rugby could cause a decline in a player’s blood flow to the brain and cognitive function. The research, reported by the BBC, also suggested that repetitive contact events, rather than only concussions, from playing rugby had caused the declines seen in so many players.
See more from MedicalBrief archives:
Lawyers circle as yet another study links rugby to brain abnormalities
Professional rugby players’ brains can be affected in single season
Young rugby players: Blood-brain barrier damage may occur even with mild head trauma
UK parliamentary inquiry into link between sport and long-term brain injury