World rugby authorities face a group class action for negligence following diagnoses of early onset dementia among retired players allegedly caused by repeated blows to the head, writes MedicalBrief. It is speculated that similar actions may follow in other rugby-playing countries like South Africa, Australia and New Zealand and has implications also for football.
The initial legal action, with eight England and Wales players, is in process, although papers are yet to be served. BBC News reports that all eight players to have come forward so far have been diagnosed by neurologists at King's College, London, with early onset dementia and probable Chronic Traumatic Encephalopathy (CTE). Their lawyers say they already represent more than 100 players.
Global governing body World Rugby told BBC Sport: "While not commenting on speculation, World Rugby takes player safety very seriously and implements injury-prevention strategies based on the latest available knowledge, research and evidence."
The England Rugby Football Union (RFU), 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.
"The Union has played an instrumental role in establishing injury surveillance, concussion education and assessment, collaborating on research as well as supporting law changes and law application to ensure proactive management of player welfare."
If successful, the case could have profound repercussions for the future of rugby union and potentially other sports such as rugby league and football, which is dealing with its own controversy over the links between heading the ball and dementia.
The players are to seek compensation for the physical and emotional repercussions they are suffering, the impact on their employment prospects and the cost of care they and their families will likely incur in the years to come. They are have presented list of measures to change the game which they call the "15 commandments", which include limiting the amount of contact in training, a reduction in tactical substitutions and several measures designed to improve the detection of brain injury and the care of those affected.
Richard Boardman, from law firm Rylands, is leading the action.
"We are now in a position where we believe the governing bodies across the rugby world are liable for failing to adequately protect their players on this particular issue," he said. "Depending on how many people come forward, the case could be worth tens of millions, maybe even hundreds of millions.
"Right now we're representing over 100 former players but we expect many more to get in contact."
Dr Willie Stewart, who with his team at Glasgow University has been leading research around dementia in football, is confident there is an issue in rugby union.
"There is no question if you look at the data across all the sports in all the regions whether they be football, rugby, American football, I've looked at brains from people from all these different sports.
"The difficulty we have is gathering enough experience from former rugby players to be able to say with certainty, but I think you would be foolish to ignore it. "
The Guardian notes the heightened rate of dementia among England’s other World Cup winners, the team of 1966, has brought to attention the risks of heading the ball. Nobby Stiles and Jack Charlton died this year with dementia, since when the family of Jack’s brother Sir Bobby have announced the same diagnosis. Rugby’s legal action echoes that in American football, where the NFL agreed in 2013 to pay damages to some former players, expected to amount to more than $1bn.
Steve Thompson, former England hooker, former England team-mate Michael Lipman, ex-Wales international Alix Popham and five other retired players are the first group of players to have had testing.
Thompson, 42, who played in every England match when they won the 2003 World Cup says in an interview with The Guardian: "I can't remember any of those games. It's frightening. It's like I'm watching the game with England playing and I can see me there – but I wasn't there, because it's not me," he said.
The report says that Thompson has become forgetful: "He forgets directions, which bits of a book he has read and what TV shows he’s watched. Sometimes he even forgets his wife’s name. 'I could look at Steph sometimes. And she says it’s like I’m a complete blank … The name’s gone. Gone.'
Thompson is convinced constant head knocks during matches and training are to blame. "When we first started going full-time in the mid-1990s, training sessions could quickly turn into full contact," he said.
"There was one session when the scrummaging hadn't gone quite right and they made us do a hundred live scrums. When it comes to it, we were like a bit of meat, really.
"The whole point of us doing this is to look after the young players coming through. I don't want rugby to stop. It's been able to give us so much, but we just want to make it safer. It can finish so quickly, and suddenly you've got your whole life in front of you."
The game in those early professional years had a brutal culture, Thompson says. “They had us for that Six Nations period, and the autumn internationals, and they literally just beasted you until you fell apart.” They were back in training two days after they won the World Cup. A lot of them played for their clubs the next weekend. It made him feel like “a bit of meat”. But he was so anxious about being dropped that he got on with it.
He guesses a lot of players from that era may end up having similar problems. “I can see the numbers being high, especially for the first players to come through, what, ’96‑97 up to the mid-2000s, really.” He could see attitudes were changing by the end of his career. “The 2011 World Cup camp was completely different to the 2003 World Cup camp. In 2011 it was a lot more technical, whereas in 2003 you just had to beast yourself.”
The BBC writes that CTE is the disease discovered by Dr Bennet Omalu in American football player Mike Webster, and the subject of the film Concussion starring Will Smith. It can develop when the brain is subjected to numerous small blows or rapid movements – sometimes known as sub-concussions – and is associated with symptoms such as memory loss, depression and progressive dementia.
The disease can only be diagnosed in a brain after death, but some experts believe if history of exposure is evaluated, it is reasonable to conclude that the risk increases. The embryonic nature of the science around the issue could play a key part in the success or failure of the overall case.
Dr Ann McKee, from Boston University, is the leading neurologist in CTE and was instrumental in bringing about change in the NFL. She and others have faced scepticism within sport, from those who believe more research is needed before further changes are introduced.
The issue of concussion in sport has been debated extensively over the past few years. The links between heading a football and degenerative brain disease have even forced rule changes at youth level. In England, Scotland and Northern Ireland, children aged 11 and under are no longer allowed to head the ball in training. There are also limits to heading frequency at higher age group levels.
Extracts from a Q&A in The Guardian on the issue
Is rugby union more dangerous than we thought?
These diagnoses are a deeply unsettling development in players so young. 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.
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. Current attempts to change the nature of the game are likely to prove hopelessly peripheral. There is no easy answer to that.
[link url="https://www.bbc.com/sport/rugby-union/55201237"]Full BBC News report[/link]
[link url="https://www.theguardian.com/sport/2020/dec/08/steve-thompson-former-rugby-union-players-dementia-landmark-legal-case"]Full The Guardian report[/link]
[link url="https://www.theguardian.com/sport/2020/dec/08/steve-thompson-interview-world-cup-rugby-union-dementia-special-report"]Full The Guardian interview with Steve Thompson[/link]
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[link url="https://www.medicalbrief.co.za/archives/post-concussion-problems-springbok-flyhalfs-rugby-career/"]Post-concussion problems end Springbok flyhalf's rugby career[/link]
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[link url="https://www.medicalbrief.co.za/archives/study-on-concussion-in-rugby-inconclusive/"]NZ study on concussion in ruby inconclusive[/link]
[link url="https://www.medicalbrief.co.za/archives/rugby-link-with-neuro-degenerative-disease/"]Rugby link with neurodegenerative disease[/link]