This evening in Paris the 2019 Six Nations Championship will get under way with a much anticipated game between Wales and France. It is the beginning of almost two months of international rugby union that will keep its millions of fans transfixed across Europe and beyond, especially because there is a World Cup in Japan later in the year.
Late on Sunday evening (UK time), Super Bowl LIII, the championship of the National Football League (NFL), will take place in Atlanta, Georgia when the New England Patriots take on the Los Angeles Rams. By many measures, it is the biggest single sports event of the year.
As one season begins, another reaches its climax. The two sports have many differences: American football players are required to wear helmets and padding, rugby players are not; rugby is a fluid game that runs more or less continuously for 80 minutes, American football is staccato, with many short bursts of highly organised action for 60 minutes spread over two hours or more. But they have one defining feature in common: bone-shaking physical contact between players trained to a high pitch of physical strength and fitness. And there lies the threat to the future of both of them.
The “hits” are violent and unrelenting as increasingly huge players collide at speed. Injury is an accepted part of both sports, but the overarching concern is the long-term consequences for athletes who are exposed to blows and bodily collisions that would hospitalise normal human beings.
These extraordinary sportsmen, although they are rewarded extravagantly at the highest levels of the game, are being damaged too. And the extent to which that damage can extend and worsen over time, long after the players have retired or been forced to retire, is only now beginning to be understood. Public awareness, particularly of the risk of head injuries, is growing. The numbers playing the sports are beginning to drop and the signs are already there at junior and youth level. The question arises: will the insurance industry become the decisive player for both?
Uninsurable and unplayable?
The warning has been sounded by William Primps, an insurance lawyer from the New York firm Locke Lord and counsel to the North American group of Chief Risk Officers. “Players are getting bigger,” he says. “Helmet technology has improved tremendously. But when you have a massive fast-moving body hitting another fast-moving body, that is the fundamental problem; the total deceleration causing the brain to contact the skull. Helmets cannot protect against that. The long-term concern for football in America is that it may just become uninsurable and once uninsurable, unplayable.”
As the evidence mounts about the long-term harm to both rugby and NFL players, doubt is receding – and with it the willingness of insurers to do business in either sport. “Overall I think there is a real threat to the viability of contact sports,” Primps confirms. “Our thinking is shaped by the impact of asbestos claims on insurers’ balance sheets in the 1980s and to an extent tobacco – long-standing practices that people thought were OK and tolerable but were risks which resulted in ruinous liabilities. Threats and risk are very real. I am not sure whether the insurance market is drying up but there would appear to be a very real threat.”
Berkley Entertainment insures the vast majority of the 32 teams in the NFL. A spokesman would not comment on specific sums but accepted that concussion and related issues have pushed up the cost of insurance. He would not comment on reports that Berkley had doubled its excess on policies to $1 million in head trauma cases.
Rugby players in the English Premiership are insured through Aviva. Club players get £100,000 if they are seriously injured and unable to play rugby again, and England players get a £150,000 pay-out for a career-ending injury, but these sums do not cover even a year’s salary for many players; the average England player earns more than £300,000 a year from his club. Damian Hopley, the RPA chief executive, says this huge discrepancy is one which the union must address.
“For us the most important thing is the levels of cover,” he said. “It is a basic fundamental welfare tenet that cover should match salaries at the very minimum. It has fallen on deaf ears at Twickenham. The England players generate 80 per cent of the union’s revenue yet they cannot see fit to insure them to an appropriate level.”
Size and speed are growing
Rugby players are growing in size. Rugby backs are now the size of the forwards of yesteryear, a trend begun in the mid-1990s by Jonah Lomu, the first real giant in every sense, of the game. A recent survey has shown that international rugby players are now on average 40lb heavier than their counterparts of 60 years ago. The average weight of the England squad playing Ireland on Saturday is more than 225lb. The French pack that is playing Wales will weigh a collective 2,000lb. That’s almost a ton of French beef that will be stampeding across the Paris turf.
The theory remains that size increases injury risk and, with longer ball-in-play times and therefore a greater number of tackles (which is where 76 per cent of concussions occur), the logic seems clear. But according to Ross Tucker, a science and research consultant for World Rugby, there is no evidence of that, at least not yet.
“When we did our concussion study we sought to see whether a big player tackling a small player was more likely to result in an injury and whether size imbalances are responsible,” he said. “We couldn’t find that. It is a simple theory but incredibly difficult to prove. If you reduce player sizes the game will be faster but speed is also a factor in injury.”
There is a tackle every ten seconds in a rugby match. With an extra five minutes of playing time that equates to a further 30 tackles a game. “The paradox is how the injury rates have stayed the same,” Tucker continued. “Per thousand tackles you are less likely to be injured now than five years ago. So how does that fit with the theory that bigger means more injuries? It doesn’t, at least not yet. That is the perception, however, and awareness drives perception.”
An obvious solution would be to try to slow the game down. But that has its own knock-on effects. “That is not such an attractive product for watching on television or for fans in stadiums. There is a tension that exists between safety and spectacle. How do you improve safety without compromising the spectacle and without fans saying the game, whether it be rugby or American football, has gone soft? We will be trying to address that in our next meeting in March.”
Figures produced by World Rugby show that the ball is in play for an average of 41 minutes; that is five minutes more than five years ago. A study last November published in the BMJ Open Sport & Exercise Medicine Journal, said: “Injury severity is increasing and this may be linked to greater forces (caused by greater body mass) occurring in contact. Rugby’s law-makers should adjust the rules to encourage speed and skill at the expense of mass.”
The number of concussions and enforced retirements is rising. Only last week Pat Lambie, the South Africa international, had to quit the sport at the age of 28 after suffering multiple concussions. The Rugby Football Union’s annual injury audit for 2017 showed that concussion was the number one problem.
NFL is playing catch-up
Neither the multibillion-dollar NFL nor World Rugby is blind to the dangers. Both are taking steps to reduce the risks to the players and the sports. Increasingly, the two organisations are working together. World Rugby is regarded as a leader not only in its openness in publishing its injury data from the 22 tournaments that take place under its auspices but also the depth of its research. But for both sports their knowledge is not yet what it should be. Chris Nowinski, an adviser to the NFL Players’ Association who runs the Concussion Legacy Foundation in Boston, estimates that 50 per cent of the 20,000 former NFL players still alive could have chronic traumatic encephalopathy (CTE) or other disorders that have yet to manifest themselves.
Representatives of the NFL and World Rugby met most recently a fortnight ago in Paris. The NFL is playing catch-up in terms of its analysis compared with rugby but with the massive resources at its disposal it now spends $60 million a year on concussion research and has introduced a slew of rule changes to promote player safety. It has also sponsored a “Heads Up” programme. Roger Goodell, the NFL commissioner, has said the focus is to take the head out of the game and “to make sure we are using the helmet as protection and it is not being used as a weapon”. World Rugby’s budget is a tenth of that, so collaboration is vital.
Fear of dementia or Alzheimer’s
The first case of brain disease in a former NFL player was reported in 2005. In 2016 Jeff Miller, the NFL’s executive vice-president of health and safety initiatives, acknowledged the link between football and CTE. CTE is the big threat but no one knows yet how big. Examination of the brains of 111 former NFL players at Boston University revealed that 110 showed evidence of CTE. The fear is that current players will eventually develop dementia or Alzheimer’s or at the very least demonstrate symptoms such as depression. In the 2017-18 season, there was a 16 per cent increase in concussions. As a result, an NFL spokeswoman said, a three-pronged initiative was being introduced which amended pre-season practices, reducing the number of hits and introducing better helmets to reduce head impact severity and rule changes, including modifications to the kick-off. These have resulted in a 29 per cent decrease in concussions in the 2018-19 regular season, she said.
In October, World Rugby and the NFL took part in the International Collision Sports Conference in London. Tucker talks of the waterfall effects of concussion. “For me it is the number one issue and we are committed to [dealing with it],” he said.
$1 billion to settle claims
The cost of insurance, and even its availability, are time bombs on which American football may be sitting. And what happens in America often has a ripple effect further afield. The NFL has already set aside more than $1 billion to settle claims from former players, and it is not only the professional leagues that are being affected; premiums and excess charges are rising for colleges, schools and local leagues too. In a blog written last year Joe Cellura, president of North American Casualty at Allied World Insurance, made clear his beliefs about the expanding liability of sports concussions.
“For those in the business of insuring liabilities, brain trauma is an emerging latent exposure the likes of which the insurance industry has not seen in decades,” he wrote. “Comparisons to the asbestos crisis are unavoidable; tackling the risk requires a major league commitment from our industry. Managing the concussion risk is a work in progress. Brain science is increasingly black and white. It clearly evidences the long-term damage of concussions, including Alzheimer’s, dementia and CTE.”
Alec Fairly, CEO of the Fairly Group, a Texas risk management firm whose clients include the NFL, said last month: “If you’re football, hockey or soccer, the insurance industry does not want you. Basically the world has left the market place.”
Chris Nowinski said that at NFL level most of the changes that could be made have been. “The problem is those changes haven’t been adopted at football at every level,” he says. In terms of playing numbers, participation has dropped in 40 states among boys aged 14-17 because of the risks and because other all-year-round sports such as soccer are making inroads into the NFL’s traditional playing base.
“We’ve noticed especially that former football players are not letting their kids play the game,” Nowinski added. “They see the damage that has happened to them and their friends.”
As the big games kick off this weekend, that is a particularly sobering statement.