Two more named in Players' dementia action

The legal action against rugby union’s authorities took a decisive step forward on Thursday when the firm representing nine players diagnosed with long-term brain injuries sent pre-action letters of claim to World Rugby, the Rugby Football Union and the Welsh Rugby Union. Rylands Law also revealed the identities of two more of the nine players involved in the test cases alongside Steve Thompson, Alix Popham and Michael Lipman. They are the former Wales under-20 centre Adam Hughes and the former England under-21 back-row Neil Spence.

The development comes as the former England captain Dylan Hartley spoke out about the lack of teaching in rugby around the risk of dementia. “From when I started until last week, I didn’t know dementia was a potential outcome for any rugby player,” Hartley said on RugbyPass’ Offload podcast. “That wasn’t educated or taught to us.” Hartley admitted he is having his “own problems” with concussion in retirement, but said he does not want to reveal more about them.

Neil Spence during his playing career at Rotherham.
‘A side of me is lost for ever’: two more rugby players on their brain injuries

Hughes, 30, is the youngest player involved in the action so far. He has been diagnosed with “having brain injuries and post-concussion symptoms”, and has been told he is on a “similar medical trajectory” to Popham, Lipman, Thompson and Spence, who have all been diagnosed with early-onset dementia and probable chronic traumatic encephalopathy. Hughes played for the Dragons, Bristol and Exeter between 2010-18, and his experience throws doubt on the argument that the game has become significantly safer in the past decade.

Hughes was forced to retire at the age of 28 after a particularly severe concussion and is now working as a financial adviser. “It was just one head knock too many. I was finding it more and more difficult to recover from each and every bang to the head,” he said. He reports being knocked out eight times in his career. “At first it was the bigger concussions where I was completely knocked out that took me ages to recover from then over the time even the smaller ones started to have an impact. For the sake of my health, I had to bring it to a halt.”

One of Hughes’s former coaches, Rob Baxter at Exeter, said last week the game’s approach to head injuries has improved so much in the years since Thompson, Lipman and Popham retired that “there’s almost very little value in trying to compare the two”. Hughes, who played for the Chiefs in 2014-15, told a different story. “For me, I think the biggest issue around concussions was attitude. It was often treated like a weakness if you don’t dust yourself down and carry on.”

He added that “the game still has a very long way to go in terms of education about concussion”.

Adam Hughes (left), pictured in action for Dragons in 2016, retired age 28 after a severe concussion.
Adam Hughes (left), pictured in action for Dragons in 2016, retired age 28 after a severe concussion. Photograph: Huw Evans/Shutterstock

Four more players involved in the test cases have decided to remain anonymous. Rylands Law is already representing around 100 former rugby players and said 30 more have been in contact since the involvement of Thompson, Popham and Lipman was revealed by the Guardian last week.

In a statement World Rugby, the RFU and the WRU said: “We have been deeply saddened to hear the brave personal accounts from former players. Rugby is a contact sport and while there is an element of risk to playing any sport, rugby takes player welfare extremely seriously and it continues to be our number one priority. 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 recognised and led to many other team sports accepting our guidance. We will continue to use medical evidence and research to keep evolving our approach.”

Sir Bill Beaumont, the chairman of World Rugby, added: “As a player who retired on medical advice in the early 1980s, I care deeply about the welfare of all players. As an administrator, I will do all I can to maintain the confidence and wellbeing of those who play the game.”

The pre-action letters of claim set out the broad allegations upon which the cases are based. They state the governing bodies had a duty “to take such steps and to devise and implement such rules and regulations as were required in order to remove, reduce or minimise the risks of permanent brain damage as a consequence of the known and foreseeable risk of concussive and sub-concussive injuries”.

They also allege the risks of concussions and sub-concussive injuries were “known and foreseeable”, listing 24 failures on the part of World Rugby, RFU and WRU. The governing bodies have a maximum of three months from the date of acknowledgment of the letters of claim to provide their initial responses.

Concussion risks in rugby may be even greater for women than for men

Experts are warning that female athletes could be more likely than men to develop sports-related dementia

 

“The right side of my face and body went numb, I lost the ability to use my right arm, I couldn’t speak,” the 34-year-old prop recalls. And yet she says that she struggled to get an accurate diagnosis. Khaldi spent two weeks in and out of hospital, being told she was suffering from tension headaches and migraines: “The pain was blinding, I couldn’t function.”

An MRI scan four weeks later found a cerebrospinal fluid leak from the brain. After a month of intense recovery, including an epidural blood patch through her spinal cord, Khaldi was cleared to play rugby again by a neurologist.

She had kept in contact with the team doctor, yet her coaches were unaware of her head trauma. Feeling her place in a Premiership team was under threat, Hannah’s mental health suffered and, ultimately, she left for another club and eventually chose to stop playing in the Premiership.

Al-Khaidi’s experience may be extreme but developments from the men’s game have left her concerned for the future. Earlier this month the Guardian revealed that lawyers acting on behalf of a group of nine former international players, including the England World Cup winner, Steve Thompson, lodged letters of claim with rugby’s authorities for negligence with the players suffering symptoms of neurodegenerative disease including early onset dementia.

Yet while the discussion of concussion in sport is almost exclusively focused on men, while making a radio documentary earlier this year I was shocked to find that women are twice as likely to get concussions, experience more intense symptoms, and take longer to recover.

Now experts are warning that female athletes could be more likely than men to develop effects such as sports-related dementia. “There is no reason not to believe that we will see these kinds of problems in women in the future or even more so,” said Dr Michael Grey from the University of East Anglia, who studies neuroplasticity and neurorehabilitation, particularly with respect to acquired brain injury.

The link between concussion and early onset dementia shows it is not an injury to be taken lightly, yet it is not known why women are more prone to concussion. Dr Grey, who is leading the SCORES project at UEA (which stands for Screening Cognitive Outcomes after Repetitive head impact Exposure in Sport), a study looking at the cognitive function of former professional athletes compared to non-sporting professionals, said hormonal difference between the two sexes could be an explanation.

Hannah al-Khaldi pictured before a match for Lebanon’s national team. Khaldi suffered a serious head injury playing in top flight of domestic women’s rugby.
Hannah al-Khaldi pictured before a match for Lebanon’s national team. Khaldi suffered a serious head injury playing in top flight of domestic women’s rugby. Photograph: Hannah al-Khaldi.

 

Women’s rugby is one of the fastest growing sports in the UK and concussion accounted for a fifth of all injuries in the 2017-18 women’s Premiership season. The higher concussion rate in women could also be attributed to the whiplash effect, given that women have comparatively weaker neck muscles than men, meaning that female players do not have as much control over their heads during contact, when the majority of head injuries occur.

As a rugby player I have seen for myself the conversation around head injury grow in recent years and it inspired me to create a documentary about concussion in the women’s game. Things are now beginning to change.

Another elite player, the DMP Sharks wing Igemi Ekoku, who experienced long-term symptoms from concussion that have left her unsure if she will ever play again, is calling for change. “There needs to be greater transparency and awareness on the potential long-term effects of concussion, on how they can affect a player’s life,” she said.

Ekoku, who played for the club for the past two Premiership seasons, suffered an accident during training in February that left her unconscious. She was rushed to hospital where a CT scan showed nothing out of the ordinary, but like Khaldi and many others, her symptoms showed later. Over the next month, Ekoku developed exercise intolerance as a result of post-concussion syndrome, which deteriorated during lockdown.

Soon, she found washing her hair or even standing up would exhaust her and trigger intense headaches. “Before my injury I was the fittest I’d ever been, and my life revolved around rugby and the gym.” Now she says she is having to adapt to a life where she is no longer fully independent.

Like Khaldi, and as more studies are being conducted around concussion, she is concerned around health conditions that could develop in later life as a result of her rugby injuries.

Both women hope that the sport of rugby can learn from their experiences. They admit that players accept there is a risk in such a high contact sport, but say they need to be fully aware of how an injury can change your life. Both are sympathetic to the male players’ lawsuit, but at the moment their motivation is education.

Khaldi was approached by a sports injury lawyer to see if she wanted to make a claim as her injury prevented her from working for two months. She decided not to take any legal action, saying: “I don’t want to try and take money away from an already underfunded club and sport.”

Ekoku added: “I think the RFU’s approach to head injury is good but as more evidence comes out about the long-term effects of concussion, rugby will have to adapt.”

 

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