Concussion, early onset dementia and CTE

First topic message reminder :

https://www.theguardian.com/sport/2020/dec/08/steve-thompson-former-rugby-union-players-dementia-landmark-legal-case?CMP=Share_AndroidApp_Other

That first link is an article in the Guardian about a potential legal case being brought against World Rugby, the RFU and WRU by 8 former players (all under the age of 45) with early onset dementia brought on by probable CTE. The players named publicly thus far are Steve Thompson, Michael Lipman and Alix Popham.

https://www.theguardian.com/sport/2020/dec/08/steve-thompson-interview-world-cup-rugby-union-dementia-special-report

That second link is a Guardian interview with Thompson, who's only 42, about his experiences with early onset dementia. Somber reading.

https://www.bbc.co.uk/sport/rugby-union/59142623

Carl Hayman has been diagnosed with early-onset dementia at only 41-years-old. He has also joined the lawsuit from former players against governing bodies.

Hayman is one of my favourite ever players. Whenever naming a 'greatest ever XV' I tend to struggle a bit at TH for a standout but usually plump for Hayman as at his peak I think he was the best I saw. Such horrible news.

Hayman says he had a bad drink problem during his last days at Toulon. He was also convicted of domestic assault. Hard not to wonder if concussions contributed to his mental instability.

Good new episode of the Rugby Reloaded podcast looks at concussion. It's only ten minutes long:

https://open.spotify.com/episode/55R32ZI0vagDV5OHrZRNY6?si=bab5cf989aa849cd

Podcast host, Tony Collins, was retained by law firm Rylands to look at the history of how Rugby Union has viewed concussion. Rylands are acting on behalf of the players bringing a case against World rugby and national unions.

Collins reveals people in rugby were worried about concussion as long ago as the 1970s. During the amateur era, you could find a lot of medical practioners playing the sport to high levels, so the concern was led on both playing and administration fronts.

Rugby actually approved some protocols in 1991 where a concussed player would stand down for three weeks. A further concussion in the season would require a three month break, while a third would see a long break from all forms of contact sport.

Collins has a second part coming up where he looks at why Rugby Union moved to weaker concussion protocols. Presumably, the onset of professionalism was a key factor.

Most people in rugby probably have a sense that concussion is only a recent concern, as Head Injury Assessments were first trialled in 2012. If Collins is right that the sport had looked at the issue fifty years ago, and had even adopted a framework 30 years ago, then you can see why administrators are concerned at therir potential exposure to lawsuits.

And at a time where we saw 3 instances of teams attacking with players suffering head knocks right in front, and that's not even the ones like Ryan which were clocked but perhaps too slowly? Well done to Pearce this weekend but surely there should be a medic of some form sat beside the TMO and able to review instances straight away and have a direct line to the ref to stop play?

What i did not understand about the England v Ireland game was clearly a head on head collision. But if Ewels did not get the red card would he of been sent off for an HIA ass well Ryan?

majesticimperialman wrote:What i did not understand about the England v Ireland game was clearly a head on head collision. But if Ewels did not get the red card would he of been sent off for an HIA ass well Ryan?

Have you had a few of those?

This was a yellow in Super Rugby today. Probably a red up here.

https://twitter.com/SaffasRugby/status/1507250460612300800

The tackled played failed his HIA.

And they're complaining its a yellow on that thread. Some people are really slow on the uptake.

Red all day long

Saw this on Walesonline. Didn't realise that there was a head injury review panel, so that at least is a step forward. Doesn't seem to add much bite though. Would be interested to know who or which incidents are picked up through this, can't find any detail on it. You'd expect that there would be a few occasions to use this during the latest tournament including the Sinckler incident, and the few occasions where you had disagreements between officials, drs and union staff (though none quite as bad as the England u20s):

'The Six Nations' failure to take disciplinary action over Tomas Francis' HIA incident has been witheringly called out by two medical experts.

A head injury review panel last week ruled that the 29-year-old tighthead should have been "immediately and permanently removed from play" after a clash of heads with team-mate Owen Watkin in the game against England at Twickenham on February 26. Francis was shown staggering after the incident and using a post to apparently support himself.

He was taken off for a head injury assessment, conducted by the independent matchday doctor, which he passed and he played on until the 56th minute. After working his way through relevant protocols, the player then started against France in the next Six Nations round.


A number of recommendations were put forward by the investigating group (you can read the outcome of the report here ), but no sanctions were levelled against anyone, with the matter effectively declared closed without publicly revealing what went wrong.

All of which has left some prominent figures in the field of rugby injuries less than impressed

Speaking to The Rugby Paper, Professor John Fairclough and Dr Barry O’Driscoll spoke out strongly. “It’s an absolute disgrace,” said Fairclough, who used to work with the Welsh Rugby Union and is now part of the Progressive Rugby lobby group concerned with demanding better protection for players.

“We are surprised and dismayed that they seem to have trivialised a very serious matter by saying: 'We don’t need to go any further.’ Instead they should be asking a simple question. How did this happen? I do not know of any medical evidence which says that Tomas Francis was fit to play, not just in the England match but in the French one 13 days later.”

Dr O’Driscoll, a long-time critic of World Rugby’s concussion policy, told of his great surprise at the Six Nations organisation announcing they wouldn’t be “taking any subsequent disciplinary action” over the affair. “This is a most abject hearing into an injured patient,” he said. “It’s disgraceful.”


It didn't end there. Progressive Rugby as a group put out a statement calling for an urgent review of the head injury assessment protocol and suggested an opportunity had been missed to make the professional game safer: “While we all like to think we play at the same intensity as the All Blacks, the truth is that physical collisions at the top end are colossal and unrelenting.

“Just one more reason why it makes no sense that community rugby has a 19-day minimum stand-down following concussion, but under the six-stage Graduated Return to Play elite players can, and do, return to play in just six days. So, in our view this review is another golden opportunity missed.”

https://twitter.com/StanSportRugby/status/1507323589401317377?t=NyyZneNOoi_-ylwlpfWldQ&s=19

This has been downgraded to less than a red. Utterly bizarre and ignores the laws and protocols for judging it. World Rugby needs to get a grip and force the Southern hemisphere to play to the correct laws.

BBC:

Elite players will face an increased minimum period of 12 days out of action following concussions in a change to protocol announced by World Rugby.

From 1 July, the majority of players diagnosed with concussion are set to miss their next match.

It follows the latest rugby-specific research by World Rugby's independent concussion working group.

Currently, a player can play a week after a failed head injury assessment if they pass return-to-play protocols.

"The evolved approach will see players with a history of concussion or who are removed from a match with obvious concussion symptoms, sit out from play for a minimum of 12 days, likely missing their next competitive match," World Rugby said.

"No player will return earlier than the seventh day after injury, and any player's return will need to be approved by an independent concussion consultant."

The new rules will come into effect while home nations England, Scotland, Wales and Ireland are on Test tours overseas this summer.

A player is determined to have a history of concussion if they have had a concussion diagnosis in the previous three months, three concussions diagnosed in the previous 12 months, been diagnosed with five concussions in their career or taken longer than 21 days to recover from a previous concussion.

World Rugby's chief medical officer Eanna Falvey added: "It is going to be a new mindset for coaches and players.

"Our approach means it is now overwhelmingly likely a player diagnosed with a concussion won't play in their team's next match.

"World Rugby firmly believes that scientific evidence supports our protocols, but we are continually monitoring and testing them to ensure that they are fit for the modern game.

"We recognise that there are differences in concussion symptoms and concussion history, and this process enables us to further protect elite players by individualising their rehabilitation.

"It also keeps in place all the benefits of the previous protocols, which have been so successful in beginning to tackle under-reporting of symptoms which evidence shows that, while improving, remains an issue."

Kind of an over-due and common sense approach, seems to me. This was already a policy at my club for over a decade, dating back to when I was coaching age groups when my kids were in it.

doctor_grey wrote:Kind of an over-due and common sense approach, seems to me.  This was already a policy at my club for over a decade, dating back to when I was coaching age groups when my kids were in it.

Billy Vunipola was regarded as a concussion risk after his knock on Saturday, to the extent Jones speculated he might not even be available for selection. While doctors subsequently cleared him, he's now getting on a long haul flight. If we really want to play safe, perhaps the stand-down time ought to include training and air travel. There was something similar with LCD going on the Lions tour, though that was even more egregious as he was down to play.

Now we just need to educate all the fans who claim that he game has gone soft - if these protocols aren't implemented, and the directives on had contact strictly enforced, there won't be a full contact version of rugby being played in 10 years.

Those saying that the game has gone soft should look back at what the game was pre professionalism - players were smaller, less physically developed and the game was generally played much slower. Defence was not organised but basically relied on one-on-one cover and generally quite passive tackling.

The game has to evolve for player safety reasons, it's just unfortunate that going through this evolution has led to a lot of sendings off for careless / thoughtless rather than intentionally dangerous play.

Carl Hayman is 42.

https://www.nzherald.co.nz/sport/former-all-black-carl-hayman-opens-up-on-life-with-dementia/MUUOJ4A3Q66UKYIMODVIGBPIOM/

Former All Black Carl Hayman has spoken publicly for the first time since revealing last year he is living with early onset dementia.

Speaking on TVNZ's Seven Sharp as part of a dementia awareness event 'A Light in the Darkness', Hayman spoke about his life with the brain condition.

The 42-year-old father of four, who played 46 tests for the All Blacks between 2001 and 2007, says he was prepared to live with a sore knee or sore back for the rest of his days after rugby, but to have a medical specialist tell him he had dementia is something he never thought he would need to deal with.

"I've got various symptoms from changes in mood, to forgetfulness to constant headaches. It was pretty much zapping the life out of me really," Hayman said.

"It's been incredibly tough, but it's a matter of accepting that my brain energy is half full compared to other people, so I need to be careful about what I use that energy on. I need to plan my day, not take too much on and have little achievable goals for the day.

"Having that understanding and the tools to help deal with things, has really given me hope to move forward, in terms of having a productive future."

Hayman revealed last year that he was diagnosed with early-onset dementia and probable chronic traumatic encephalopathy (CTE).

Once considered the best tighthead prop and highest-paid player in rugby, Hayman told Dylan Cleaver's The Bounce of his diagnosis and the emotional roller-coaster ride he's been on since retiring from rugby in 2015.

"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," Hayman said.

That state of mind led Hayman down a road of 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.

In December 2020, two former All Blacks, Hayman and Geoff Old, told the Herald they had been in contact with British-based lawyers about their post-playing medical conditions.

Hayman initially declined offers to be tested to ascertain any damage to his brain over the course of his playing career. However, he relented after thinking of how his story could help fellow and future players.

Dementia Auckland CEO Martin Bremner said he is incredibly grateful for the courage and sincerity displayed by Hayman.

"Our goal is to bring the same level of awareness and acceptance to dementia that John Kirwan has done for mental health in recent years, and Carl has taken a massive first step in helping us achieve that.

That's horrible news.

A point that I haven't really fully thought about until I just read it is also how much of a nightmare will games be across the hemispheres this summer. There are some horrible tackles going unpunished down south, much worse than the ones over the last couple of weeks in England. Players are going to get annoyed at inconsistencies, refs are going to get it in the neck and we'll have to put up with the Co commentators mangling the laws even more than we're used to from Dallaglio.

Rugby Fan wrote:

doctor_grey wrote:Kind of an over-due and common sense approach, seems to me.  This was already a policy at my club for over a decade, dating back to when I was coaching age groups when my kids were in it.

Billy Vunipola was regarded as a concussion risk after his knock on Saturday, to the extent Jones speculated he might not even be available for selection. While doctors subsequently cleared him, he's now getting on a long haul flight. If we really want to play safe, perhaps the stand-down time ought to include training and air travel. There was something similar with LCD going on the Lions tour, though that was even more egregious as he was down to play.

Thanks for bringing this up.  Evidence is not bullet-proof but I would not want him on a flight to the other end of the world just a few days after possible concussion.  His next game, if selected, would be two weeks from his last one.  He can afford to wait a few days.  With LCD it was within a week, which caused quite a few people to ask legitimate medical questions and file concerns with the appropriate medical authorities.  

When someone has an accident or medical procedure, patients are advised not to travel by air (usually not at all).  The reason is the lower cabin pressure can enable bleeding.  Why would a brain injury be any different?  If not more restrictive?  Ain't rocket science.

dummy_half wrote:Now we just need to educate all the fans who claim that he game has gone soft - if these protocols aren't implemented, and the directives on had contact strictly enforced, there won't be a full contact version of rugby being played in 10 years.

Those saying that the game has gone soft should look back at what the game was pre professionalism - players were smaller, less physically developed and the game was generally played much slower. Defence was not organised but basically relied on one-on-one cover and generally quite passive tackling.

The game has to evolve for player safety reasons, it's just unfortunate that going through this evolution has led to a lot of sendings off for careless / thoughtless rather than intentionally dangerous play.

Can't agree more.  The changes around head trauma are long overdue.  From where we were: No medical oversight, fights, fishhooks, gouging, poor skills (top level practicing only 2x per week), high tackles, low tackles, tackles just below the belt, horse-collar tackles, sub-standard physical conditioning, looking at concussion (or many other injuries) as a sign of weakness, and so on.  As you say, mate, no evolution, no Rugby.  Full stop.

Part of the problem was when there was the initial real attention to head trauma, the people who had to formulate head trauma policy all came from the amateur days, and, frankly, were totally out of their depth, capability, or interest.  And this was when many other sports had engaged with head trauma and were already looking for their path forward.  Except for Rugby.

From the BBC, I think this will generate good data. Will look forward to the next season's report:

The Rugby Football Union (RFU), has confirmed that from next season all players in the men's Premiership, women's Premier 15s and in England representative teams will be offered instrumented mouthguards that can help detect concussion.

It comes after research, which involved Harlequins men's side, Bristol Bears women and the Red Roses, showed the mouthguards were able to measure the frequency and magnitude of head contact and head accelerations.

"The findings will be an important addition to rugby's head injury management and prevention efforts, and will improve player management and welfare policies in the future across the elite game," said Phil Winstanley, rugby director at Premiership Rugby.

Reports from the Professional Rugby Injury Surveillance Project (PRISP) and Women's Rugby Injury Surveillance Project (WRISP) for the 2020-21 season showed concussion was the most common form of match injury, accounting for 28% of injuries in men and 26% in women.

Saliva tests that can help diagnose concussion will continue in the Premiership and Premier 15s, and the samples will now be collected in the 2022-23 season as a potential marker of recovery from head injuries.

The Guardian has an interview with Carl Hayman and his partner, Kiko Matthews. Here's Matthews speaking.

https://www.theguardian.com/sport/2022/jun/25/carl-hayman-i-was-a-commodity-in-rugby-now-im-paying-the-price

“I started going out with someone who I’ve got a baby and a business with, who then gets diagnosed with CTE, which is this long-term, life-changing pain in the arse. It takes over everyone’s lives completely. Every day Carl’s head hurts. Every day he struggles to remember what he’s doing. He has regular bouts of anger and then regret for his anger. He doesn’t want to be here. I’m not enjoying him being here …”

The only recourse at such times is the reminder to self that this is a disease at work, not the person with whom you chose to share your life. The tenderness returns to Matthews’ voice as she describes what is happening in Hayman’s brain.

“The way it has been explained to us is that you’ve only got so much energy to use in a day. When you have a brain injury, rather than a brain connection going from A to B, which is two calories, yours has to go from A to Z to X to Q, P, R and B – and that takes up 20 to get the same outcome. You and I can have this conversation and it’s not even registering on our calorie count, but for Carl, his eyes are going, ‘I need to focus,’ his ears, ‘I need to listen’, then he has to process, then he has to speak. To do that, his poor brain has to go all around the stops, because there’s a big block of protein that’s built up in there, stopping the connections.”

Inevitably, executive function declines. Hayman is meant to run the boatshed side of their business, while Matthews runs the commercial, but increasingly she is doing both. “You send him shopping, and he comes back with half the things you need, and you can see the pain on his face from the shopping that he’s sort of half-done. It’s the same with buying oil for the boat or life-jackets. Just let me do it. The repercussions and the pain it puts him through and what I have to do to rectify whatever he’s done – it’s just easier if I do it.”

BBC:

New Zealand Rugby has admitted Ireland prop Jeremy Loughman should not have been allowed back on the field during Wednesday's game against the Maori All Blacks after sustaining a heavy blow to the head.

Loughman went off for a head injury assessment (HIA) less than two minutes into the game, but returned having been passed fit to continue by an independent match doctor.

He was taken off permanently at half-time following advice from the Irish medical team.

"We have identified a gap in communications, which meant critical video evidence was not fully accounted for as part of the head injury assessment process undertaken by the independent match day medical team," said New Zealand Rugby medical manager Karen Rasmussen.

"We will be reinforcing the full HIA process and protocols for the remainder of the series to ensure video evidence is communicated more accurately between independent match day medical staff to enable them to make the right call with regards to player safety."

Munster loose-head Loughman appeared unsteady on his feet after the early collision and was temporarily replaced by Cian Healy.

He returned to the field to finish the first half, but the change was made permanent at the interval before Healy himself was forced off with an injury.

While Healy has been passed fit for a place on the bench in Ireland's first Test against New Zealand on Saturday, Loughman is unavailable as he continues to follow return-to-play protocols.

Last month World Rugby introduced new legislation that will see elite players face an increased minimum period of 12 days out of action following concussions.

Attempts to address the issues of head injuries and concussion within the game continue, with England's governing body the Rugby Football Union offering all players in the men's Premiership, women's Premier 15s and in England representative teams instrumented mouthguards that can help detect concussion.

No 7&1/2 wrote:
Loughman went off for a head injury assessment (HIA) less than two minutes into the game, but returned having been passed fit to continue by an independent match doctor.

Munster loose-head Loughman appeared unsteady on his feet after the early collision and was temporarily replaced by Cian Healy.

He returned to the field to finish the first half, but the change was made permanent at the interval before Healy himself was forced off with an injury.

Last month World Rugby introduced new legislation that will see elite players face an increased minimum period of 12 days out of action following concussions.
.

I just pulled a few sentences here - and thanks for putting this up.  

My understanding of the new rules also include a permanent send-off for any player who appears unsteady after impact, regardless of the HIA exam result. I haven't seen the rules in writing yet, but will certainly need to confirm.  Does anyone have it?  As I understand the new rules, this case would have been a clear violation.  And if I am right, how did this happen?  And I don't care for the bloviating excuses I have seen in the media so far.

Yes doc, not even sure they were even just included, there was another instance of this in the Ireland NZ game too where someone stumbled getting up, when that happens they are supposed to be withdrawn; no further checks necessary.

https://www.world.rugby/the-game/player-welfare/medical/concussion/hia-protocol

Not concussion per se but Barrett has escaped a citing for his should ruck clearance to POM as well.

Will be interesting/scary to see if England try to get round the 12 day stand down for Curry.

No 7&1/2 wrote:Yes doc, not even sure they were even just included, there was another instance of this in the Ireland NZ game too where someone stumbled getting up, when that happens they are supposed to be withdrawn; no further checks necessary.

https://www.world.rugby/the-game/player-welfare/medical/concussion/hia-protocol

Not concussion per se but Barrett has escaped a citing for his should ruck clearance to POM as well.

Will be interesting/scary to see if England try to get round the 12 day stand down for Curry.

Here is the line I was looking for:
Players displaying obvious on-pitch signs of concussion (Criteria 1) are immediately and permanently removed from play, and the completion of the off-field screening tool is not required.
Although written to give a little wiggle room, in the end it is pretty straight-forward.  

The 12 day stand-down not written into the regulations yet (or here).

Thanks, mate!

The 12 day is not written into these but it is in operation since 1st July.

Sexton is apparently ok to play...

https://www.bbc.co.uk/sport/rugby-union/62048243

Guardian: Progressive Rugby, the lobby group of former players and medical practitioners for improved treatment of brain injuries in rugby, has condemned the selection of Johnny Sexton for Ireland’s second Test against New Zealand in Dunedin on Saturday, insisting it demonstrates a “failing” in concussion protocols.

Sexton was removed after half an hour of Ireland’s 42-19 defeat in the first Test last Saturday for a head injury assessment (HIA), which he failed. A directive from World Rugby only a week earlier had insisted that under incoming protocols, any player “with a history of concussion or who has been removed from a match with obvious concussion symptoms will sit out of competitive action for a minimum of 12 days”.

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After Sexton’s selection for this weekend, seven days after his brain injury, a statement from Progressive Rugby said: “Elite players who fail an in-game HIA1 have, by definition, displayed cognitive dysfunction requiring their removal. In our view, this is sufficient evidence, regardless of subsequent testing, to exercise extreme caution for the good of both their short and long-term health. This caution must be further amplified in players with a history of brain injury, as evidence is they are at higher risk of sustaining further concussions and other injuries.”

Sexton’s concussion history has long been a subject of concern, with one doctor who used to treat him at Racing 92 speculating in public in February 2021 that Sexton had suffered as many as 30 concussions in his career. Whatever the actual figure, the 37-year-old’s propensity to suffer brain injury is well known. If the new protocols were to have any teeth, his return to play, barely a week after they had been issued, would represent as poignant a case study as any.

This comes in the wake of continuing question marks about the HIA protocol itself, the process by which players’ brain injuries are assessed. This Ireland tour supplied critics with further cause for complaint when their prop Jeremy Loughman was passed fit to continue after staggering from a collision in the early moments of the midweek match against the Maori.

“Regrettably, the HIA is being exposed,” Progressive Rugby’s statement went on to say. “Last week the process again failed to diagnose a clear and obvious brain injury [Loughman], while three days later we are told it has identified a phantom one [Sexton]. The fact is there remains no examination by any expert that can demonstrate a brain has healed and is not at risk of further damage. As such, if player welfare is truly the game’s number one priority, the only option must be to err on the side of caution – otherwise the new elite protocols are failing in their key purpose.”

World Rugby’s new protocols were announced with much fanfare surrounding the minimum 12-day graduated return to play for anyone with a concussion history or who suffered obvious concussion symptoms, but the small print revealed the only actual change to the previous was to extend the minimum from six days to seven for those with no history or symptoms. It now appears that, in practice, even a player with a history of concussion as long as Sexton’s can return on day seven.

Sexton was removed from the first Test at Eden Park after slipping and colliding with Sam Cane’s legs. Ireland’s head coach, Andy Farrell, later said the fly-half had passed stages of the HIA process, with the assistant coach, Mike Catt, declaring soon afterwards that Sexton was “good to go”.

If you are Johnny Sexton, now you know who really has your back and who is using you like yesterday's condom. You may not realise it now. But you will.  

He and George North are the poster children for athletes not taken care of professionally and responsibly.   Neither are idiots.  They do need seriously good advice, however.    

After all the attention.  The IRFU must be totally insane.

As I said elsewhere Johnny Sexton will have dementia withing 10 -15 years

I hope I'm wrong I fear I'm right

The way he has continued to be played after serious head knocks is disgraceful

30 concussions? That's appalling. Never mind this weekend, he shouldn't be playing at all.

Just read that former Wales backrower and captain Ryan Jones has been diagnosed with dementia at 41 years of age A bit of a heartbreaking interview with him too

Terrible news. And you still see idiots trying to argue against the steps taken to reduce this.

Awful news. Rugby needs serious reform or it will collapse as a sport.

I vaguely knew Alix Popham. I have known Ryan Jones for years, so whilst all these stories are sad, this one really hits home, because I actually really know somebody affected by it now.

This week, I also had my PT session in work and my boss said about Steve Thompson and how he was looking for a certain photo, due to what has happened there too. It’s all so awful. I hope things change soon, as there are too many people suffering with this now, to have inconsistent reffing and people blagging HIAs still.

RiscaGame wrote:I vaguely knew Alix Popham. I have known Ryan Jones for years, so whilst all these stories are sad, this one really hits home, because I actually really know somebody affected by it now.

This week, I also had my PT session in work and my boss said about Steve Thompson and how he was looking for a certain photo, due to what has happened there too. It’s all so awful. I hope things change soon, as there are too many people suffering with this now, to have inconsistent reffing and people blagging HIAs still.

The odd thing, and this is anecdotal from my own experience, but I think the overall numbers of cases of head trauma are lower, let's say, than 10 or 20 years ago.  Can't quantify my experiences without going back to my records, but the athletes I have seen when working the sidelines/touchlines of Rugby, American Football, and occasionally at schools level ice hockey, basketball, etc. appear lower across the board.  Some of this comes from an exam and some from observation. The numbers appear worse because each case is now being counted, monitored, mostly treated, and publicised.  To me this is what we should have been doing for 20 years instead of people trying to minimise the data collection, bury the data, and overall ignore the problem, whilst our players didn't receive the proper care. And it is still one of the most important issues to tackle in Rugby, same as in other sport.  

This is a radical change in Rugby, though most American sport, especially at the schools levels have already been there.  NFL covering up was not helpful.  

The good thing is that it is finally taken seriously by a lot more people in positions to affect change  And almost every incident is public now, which to me, is important.  Instead of displaying Rugby as violent sport destined to induce a range of transitory or permanent brain impairments, it shows Rugby as a sport trying (slow to the fight and struggling in many pockets still) to get ahead of it and take care of our players.

Whenever athletes make physical and emotional sacrifices to attain greatness in sport, we always tend to say of their achievements "No-one can ever take that away from you". Yet that's exactly what dementia does, as well as robbing the players of a fulfilling life after the sport. It's not a cost they bear alone. It causes real distress for their families.

Watching the Irish players celebrate a historic series win, you can't help but wonder if any will feel in the future that the price wasn't worth paying. Hearing about players like Steve Thompson, Carl Heyman, Alix Popham and Ryan Jones takes the shine off watching matches now.

So far, we haven't heard much about the incidence of early onset dementia outsde players from English-speaking countries. There are surely cases in France, which will be a big deal, as it's also currently the richest market.

You start looking at the example of former French captain Marc Cécillon, who murdered his wife. While a person can have addiction problems, and violent tendencies, without having sustained brain injuries (and no-one has spoken about dementia in his case), it does raise a flag.

The solution is to reduce the number of games that players play per year...but that affects the coffers, so the business interests are going to be affected....

Andy Powell making a prat of himself on this subject is no surprise.

The interview with Ryan Jones in the Times was a sobering read

Doubling down by offering to fight Gareth Anscombe's wife was a further low point for him.

Yeah Powell sounds like an absolute ********.

It's odd because he seems to retweet the people who call him out on it! Does he not understand what he's retweeting?! That these people are disagreeing with him and calling him insensitive and stupid???

Andy Powell has depression, clearly for him it manifests into anger and besides that he's never been too bright. No excuse for his behaviour, he could do with stepping away from social media for a while and work on improving himself.

Yep, the Powell situation is a sad case study of sportsman keeping their profile after retirement not always being a good thing. They get their profile for being good at sport. When they retire those skills become immediately, and brutally to be fair, useless to them unless they can turn the experience to other facets of the game such as coaching, punditry, etc. Despite those skills becoming useless they still have a profile due to those skills they can no longer utilise. Having a platform when you've got the mental health problems and if we're honest lack of intelligence of Powell isn't a healthy thing whatsoever.

I don't want to make light of the concussion issues, but I do wonder if Andy Powell himself has had one too many knocks to the head? I say that slightly in jest, but also seriously - if he has depression, as Mikey suggests, then that is one of the symptoms of CTE I think. And anger issues. He was in a very combative position, and he made a bit of a name for himself for the powerful runs, big hits and generally bashing into people. As an all action number 8 I would expect him to have received a fair number of head injuries over the years.

It's incredibly important to note that CTE isn't solely linked to concussion. There is growing research that DAI (diffuse axonal injury) occur from sub concussive impacts as well.

In short axons are the portion of the neuron that carries impulses away from the cell body. When the head rapidly accelerates or decelerates those axons can shear leading to lesions in the brain. That's a DAI.

If, as the research is showing, this happens from sub concussive impacts the build up of those over a contact sportsman's career could be devastating even if we can massively reduce concussions - that's a big if currently too. Longer term rugby at the very least will need to look at starting kids on frequent contact later and limiting contact training in the week for seniors. Beyond that huge reductions in the matches played will be necessary too.

king_carlos wrote:It's incredibly important to note that CTE isn't solely linked to concussion. There is growing research that DAI (diffuse axonal injury) occur from sub concussive impacts as well.

In short axons are the portion of the neuron that carries impulses away from the cell body. When the head rapidly accelerates or decelerates those axons can shear leading to lesions in the brain. That's a DAI.

If, as the research is showing, this happens from sub concussive impacts the build up of those over a contact sportsman's career could be devastating even if we can massively reduce concussions - that's a big if currently too. Longer term rugby at the very least will need to look at starting kids on frequent contact later and limiting contact training in the week for seniors. Beyond that huge reductions in the matches played will be necessary too.

To your point exactly, mate, I have tried to avoid the term concussion and use head trauma instead unless that is exactly what we see or know.  Any time a body gets jostled strongly enough the brain moves inside the skull and it's the rapid acceleration followed by the impact which causes the trauma.  

And you make a great point - barely mentioned - that the neural connections can be damaged as well.  And that becomes harder to diagnose and treat and for the patient it can have more ramifications.  

We had a summer Rugby festival in my club just yesterday, Morris v. Morris.  With some of the old boys who don't make it out so much, it almost scares the merde out of me.

Rugby Fan wrote:Whenever athletes make physical and emotional sacrifices to attain greatness in sport, we always tend to say of their achievements "No-one can ever take that away from you". Yet that's exactly what dementia does, as well as robbing the players of a fulfilling life after the sport. It's not a cost they bear alone. It causes real distress for their families.

This is one of the single finest descriptions of mental illness that I have ever read. Ever.

Great to see that Doody Weir is still in peoples thoughts, starting to really struggle to do anything himself now, but awarded an honorary degree from Abertay University.

https://www.theguardian.com/sport/2022/jul/25/case-against-rugby-union-governing-bodies-on-dementia-destined-for-courts

The big thing will be....Can they prove this is directly linked with rugby?

The defending solicitors will surely show that so many people non rugby (or sporting) based suffer from these syndromes also.

It will be very interesting to see how this pans out.