Rugby and dementia: striking the balance between risk and reward

Almost by definition, few things are more tragic than the fallen hero. Whether age has wearied them or the years condemned. Whether through defeat or some catastrophic loss of the powers that briefly placed them in the pantheon, the Greeks had a word for it; Pathos. Elegy. Sometimes even nemesis. There is, in them, a touch of Icarus so far do they fall.

The sad tale of Ryan Jones, former British Lion and captain of Wales, revealed only last week, is a case study in the superman to whom kryptonite has been shown. 6’ 5”, 18 stone, and in tears because, at the age of 41, he has been diagnosed with early onset dementia and chronic traumatic encephalopathy (CTE) in “one of the worst cases” doctors have seen.

The symptoms – from the mood swings to the memory loss to the inarticulate rage – are tragic and unrecoverable. He is, in the great scheme, a young man and, in his charge as a father are six children. 

He is just the latest on a list of players whose entire top-class career was spent in the professional era of rugby union and who, by their early forties are showing the signs. Carl Hayman, the All Black, Steve Thompson, England’s World Cup-winning hooker who can no longer remember the match itself. Or his children’s names. On it goes.

Meanwhile, Gloucester’s Ed Slater has become the latest high-profile player to be diagnosed with Motor Neurone Disease (MND). Correlation is not causation but it’s a worrying development.

The facts of the sport at that level are stark. According to a recent Amazon documentary on the pre-season preparation of recent Premiership winners Harlequins, a car accident at 40mph will produce forces of around 40Gs. The highest recorded force of impact on a rugby field is 205Gs.  

A scrum produces 14,100 Newtons of force, more than a Formula 1 car – at 13,120 Newtons. The average player is 4” taller and a stone and a half heavier than in 1974. If you want an example, think of Nemani Nadolo, a Fijian, who at 6’ 5” and 21 stone plays on the wing for Leicester. Rory Underwood, England’s record-breaking try-scorer who also played on the wing for Tigers in the 80s and early 90s, stands at 5’ 8” and played at about 13 stone 4lbs. 

Pro rugby gives the powerful impression of being a sport eating itself. It requires of participants almost superhuman preparation and ever greater feats of speed and size, dimension and endurance. But there is, however, a lurking truth. As Jones himself told The Sunday Times,  “I lived 15 years of my life like a superhero and I’m not.”

Little wonder then that the Drake Foundation, an organisation set up to investigate and mitigate head injury in sports recently called for an end to contact rugby in state schools. It is the latest to call for this and similar moves. 

The motivations of the Foundation are not in question. Lewis Moody, an England World Cup-winning flanker whose play was so fearless that it earned him the nickname “Mad Dog”, is their ambassador. I’ve met Moody and he is an engaged and engaging character whose views are very much to be respected. 

However, here we part ways and the reasons are numerous.

First, there is the sustained focus on rugby as opposed to other common sports which record higher rates of general injury. These include football and basketball where twist or break injuries to the lower limb are commonplace.

This is also true of those involving catastrophic injury to the skull, brain and spine of which one can takes one’s pick from the likes of equestrianism – Superman actor Christopher Reeve or journalist Melanie Reid being high profile examples – or, indeed, leisure skiing of which racing driver Michael Schumacher was a victim. 

Little wonder that the Drake Foundation focused on parental perception as one of the principle drivers of its call for the state school ban saying a majority of parents are concerned about its impact on their child’s health.  A perception in no way helped by Steve Thompson saying he would not let his children play.

But a matter of perception it is: “Rugby union should not be a compulsory activity given it has a perceived high risk of injury and is an unnecessary risk for children in physical education” as the academics involved themselves concede. At the same time, though, as the  BMJ points out that “direct catastrophic injuries are relatively rare in youth sports activities” which is a matter of fact.

How that manifests itself is exemplified by my wife who is always worried when my son pulls on his boots but spent her own youth taking half a ton of beast over show jumping fences and cross-country jumps. Cross country hurdles do not collapse on impact, hitting them can cartwheel that same horse onto its rider if not sharp out of the stirrups. The consequences hardly bear thinking about but my daughter has followed her mother in taking a horse over jumps.  

Steve Thompson, meanwhile, has a particular reason for saying what he does and, given his terrible circumstances, he can hardly be blamed. However, the children of John Gallagher (New Zealand), Michael Lynagh (Australia), Emile N’Tamack and Alain Penaud (France), Gavin Hastings (Scotland) , Steve Ojomoh, (England) and Phil De Glanville (England) are all enjoying top class careers to name but a few. 

I met recently with Gallagher and if concerns there were at his son joining Bath they were masked by considerable and understandable pride.  In other words, other authoritative views and instincts are available.

Then there is the exclusive point of seeking to confine the reduction of contact to the state sector handing, as it does further advantage to independent schools who already boast state-of the-art facilities and an increasing number of coaches of recent professional vintage. 

It is an odd call and occasionally makes me wonder whether something else hides behind the broad over-emphasis on rugby as uniquely dangerous. Whether that is some unarticulated kick against its elitist image or some endeavour to drive back the last vestiges of the masculinity of the proxy battlefield, I’m not entirely sure. Either way it’s misguided.

Cricket illustrates why. Its almost total retreat from the state sector has left it the domain of private and public schools where competition is ferocious for talent and who, if the Daily Telegraph is to be believed,  now offer 110% bursaries for the right boy. In other words, paid to play.

Former England captain Mike Atherton joins his colleague Andrew Flintoff in lamenting the status of cricket as “the most elitist sport in Britain” in The Times claiming: “The lack of cricket in state schools means that luck or family connection is the way to connect with the game.” All in an age where sport so publicly espouses diversity.

Paradoxically meantime, cricket, which has a long and sad association with depression and suicide as well as controversies surrounding head injury – including a death from a misjudged short ball – faces no sustained lobby of the form rugby faces. 

This, of course, is partly the perception – that word again – that cricket is genteel and partly because to do so would be to extrapolate the specifics of top class problems onto the generality of an enormously popular grass roots sports where death by bouncer is mercifully unknown and the pressures of endless overseas tours and scrutinised performance negligible.

Yet those who see rugby as risk are trying to project the very specific dangers of a very particular spell of professionalism onto the game as a whole, and particularly onto schoolboy rugby. 

The argument is that it is sustained and repeated minor head injury rather than the single knock-out that gives us Jones or Thompson. Since then, head injury protocols, independent medical assessment, reduction of contact training sessions and a remorseless focus on tackle technique are changing behaviour.

At junior level, coaches, and I have been one, are constantly reminded of the “if in doubt, sit it out” principle behind Headcase, the RFU’s guidance on concussion management. And rightly so. Nobody, appropriately, in their right mind would resist sensible steps towards mitigation. 

Neither though do we hear enough about the other part of the equation. That sport is a huge element in community cohesion. That its beneficial impacts on mental as well as physical health at a time when the young seem disproportionately to suffer from isolation, depression and obesity are unarguable.    

Sports ability to add structure, discipline and purpose to young lives, particularly those of young boys and men who are often short of all three at a key stage of their development is unparalleled. I have seen it save.

In other words, balance. Rugby is a collision sport. Inherent in its nature is risk as an inescapable fact. But also reward. 

In this, it is only a microcosm of a society that has lost the ability properly to assess the realities behind an extrapolation from the specific to the general or to understand that the essential nature of our lives from crossing the road to going on a ski holiday is a constant exercise in balancing what we gain against what we might lose.  

We see it in the way we are constantly hectored and the beast beneath the surface of the lockdown instinct, showing its coils again in the recent heatwave. We see it too in the precautionary principles that dominate so much of life and science.

Most of all it’s in failing to understand the relative. A fact etched into my memory since an overwrought man in a pub held forth on the dangers of eating beef during the BSE crisis while holding a pint and smoking a fag. 

I am not cavalier. I too, worry. That’s a parent’s job. And I know too that every sportsman has their secret superstitious rituals as protection against the inherent dangers of what they do.

But most will never be a Ryan Jones. Most will never have the reward of a Lions cap, a professional contract and an international captaincy. Most will never run the risk either.