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David Flatman: Rugby must adapt to survive the concussion crisis

Wednesday 17 March 2021

The sport needs to try a different kind of conversion if it is to endure in light of concussion, and links to early onset dementia. Players need answers, and to be brave in confronting the reality of the game we love

One day last year, I couldn’t remember whether the mayonnaise went in the fridge or in the cupboard. We’ve all been there at one point or another. However, as a former professional rugby player, I may have paused for that little bit longer than your average person.

The reason: all the talk of early onset dementia and its possible association with playing rugby. This now all-encompassing topic has been around for a good few years, and I’d been discussing it with my girlfriend a couple of days before my “mayonnaise moment”. I reported my forgetfulness to her. She immediately burst into tears. It quickly became quite scary.

Just a few days later, the Steve Thompson, Michael Lipman and Alix Popham interviews were published – in which they revealed details about the brain injuries they’d suffered during their professional careers and the legal claim they were bringing against the sport’s authorities for negligence. The timing was eerie.

I’d just started having the conversation in my household, and then suddenly – bang – the lads have got early onset dementia. We are the same age, we played in the same period, in the same teams a lot of the time. My gut response to reading the interviews wasn’t one of complete surprise. It was more a stomach-churning confirmation of something I’d been loosely afraid of for a year or two.

That fear wasn’t based on any diagnosis or particular episodes. I’d relatively recently retired as a professional rugby player, after which my marriage had fallen apart and I’d ended up watching a lot of Netflix about former American Footballers whose lives had fallen apart as a result of a brain disease called Chronic Traumatic Encephalopathy, or CTE. As I watched and listened to all the emerging documentaries, radio shows and interviews I started to connect the dots for myself. 

Of course, I asked, “Shit, is that me? Is it going to be all of us?” Though I wasn’t getting violent or anything extreme, I’d forget where to put the teaspoons or had other such “symptoms” that made me question myself. I knew that this thing can start in the most unsuspecting way. I can’t deny it’s really scary looking across the room at your children and girlfriend thinking, “We’re meant to have another 50 years together, what the hell’s going to happen?”

I work to keep some perspective, and realise people who do not have dementia forget where to put the teaspoons too. But hearing about my peers, former teammates – men who’ve been through all the same physical punishment that I have – has brought everything into very sharp focus.

Within the professional player community, there has been both scepticism and push-back against the claims that Thompson and the others were abused and neglected. In WhatsApp groups, some former pros who feel fine are questioning whether the claimants could be motivated by the prospect of an insurance payout. For me, some of that criticism is understandable. It’s a defence mechanism born out of the fact that most of my cohort could never afford to admit that they were vulnerable. Their careers were forged on the notion of their invincibility.

One of the lines that former players are sticking to is that they “knew what they were signing up for”. That, by putting ourselves in the mixer as rugby players, we also knew our risk of getting dementia in our forties. It’s a position I reject absolutely. We knew playing rugby for a living was dangerous, but we were mostly worried about our knees, our shoulders, our backs – damage that would stop us playing, not that would ultimately stop us thinking. Dementia was never discussed. Believe me, it’s being discussed now.

There are some serious questions that need to be answered. For me, I need to get tested, and think everyone with concerns from every level of the sport should be able to ask “what’s happening with my brain?” and get an accurate answer. 

For some, there’s a question about whether people pulling the strings in the sport knew what was happening to us. There were warning signs from across the Atlantic in 2013, when a $765m settlement with former players suffering neurodegenerative diseases meant the epidemic there was kept quiet. Going back earlier, doctors worked round the clock to take care of us, but they never mentioned CTE or dementia. 

Did people in charge of our bodies know more than they told us about the risk to our brains and future mental health? Did they themselves not know enough, and did they do all they possibly could to find out? That’s probably for the witnesses, committees and lawyers to thrash out. For me, this moment is about finding the best way forward for the sport that I love and doing justice to everyone else who loves playing and watching it.

Let’s get one thing absolutely clear: I do not believe rugby should be banned. But there’s a reckoning coming on many different levels. Compulsory rugby in schools is on the way out; contact will be minimised in early years and in training; and what’s absolutely paramount is that the sport is coached well and safety stays as the number one priority.

There is always an element of risk in rugby. That is part of what people playing and watching it find so enthralling. The sport prides itself on the fact you have to be brave to take to a rugby field – whether it’s a soggy pitch near Sutton or the lawn inside Twickenham. 

The main thing we desperately need now is not more bullish courage, but a balanced conversation about how to move forward. We need to be brave in confronting the truth.

World Rugby, to their credit, have tweaked laws in the past to protect people’s necks, backs, shoulders and knees. Now we are seeing the brain take centre stage. That is right and proper. On occasion, those legal changes have been to the detriment of the overall spectacle – but so be it. Some things are more important.

Violence in terms of fighting and other foul play has been all but eradicated and the next step is to reduce concussions while making sure when they happen – and they will happen – they are managed appropriately. There have already been some steps forward there in recent years.

Once the Union starts making money again from packed stadia, we must see a bigger percentage of that revenue channelled towards independent research into ways to protect rugby players’ brains. On top of that, they need to find out what’s happening to boys and girls, men and women on a daily, weekly basis. The pandemic has shown us that if you give some very clever people enough money to do the research they need to do, it accelerates our learning hugely. 

I’d also call for calm now. The attitude towards these serious injuries is really very different from how it was in the “old days” – which really aren’t that old when you look at the 2003 World Cup team. 

At the moment, transparency about concussion and dementia is growing, but not complete. We need more statistics, from outside the pro game too. We need level heads and to look clearly at the risks. Former players who argue they knew what they were getting into are doing a disservice to the informed consent which has to take place in the current game. That attitude is bullshit, but so too is one that would just have us “ban rugby”. Neither of those positions does justice to the complexity and importance of this issue.

David Flatman is a former England international, who also played club rugby for Saracens and Bath, and now comments regularly on the sport for ITV.

Can more be done to keep rugby safe, or do we need to ban it altogether? Catch up on our ThinkIn