By the time Alix Popham had reached his late 30s, he was finding some day-to-day tasks confusing and difficult.
Popham’s wife, Mel, would have a conversation with her husband and an hour later he would have “no recollection,” he tells CNN Sport.
“I was putting it down to kids, everyday living – I was making excuses,” says Popham, now a 44-year-old father of three and business owner.
Then in September 2019, Popham went on a bike ride, got lost and blacked out.
A former professional rugby union player, Popham started playing the sport at the early age of four and it quickly became his life.
“By the age of six, seven, I realized, and people realized, that I was pretty good at it,” Popham, who played for top clubs in France, Wales and England and represented his home country, Wales, at two Rugby World Cups.
“My memory of playing and specific games … is not really there. I’ve got no feelings or memories of being in stadiums,” he says.
Lenny Woodard followed a similar trajectory to Popham, starting rugby at 10.
Both men went on to earn a living from the sport they loved.
By the time they had reached their 40s, their professional sporting careers ended and both Woodard and Popham, and their families, soon noticed something was very wrong.
Woodard worked as a salesman and began experiencing similar issues to his compatriot.
“I was losing track of conversations. People were telling me something and then I forgot what they said, I’d have to ask them to repeat the question,” says Woodard, who represented Wales in the two rugby codes of union and league.
“I’d forget their name, even though I’d been speaking to them two minutes before,” Woodard, 47, says.
Both men saw doctors, and within months, were given the same devastating news: not only did they have early onset dementia, but also, probable chronic traumatic encephalopathy (CTE), a neurodegenerative disease associated with repeated head trauma.
Popham was just 40 and Woodard 45.
The neurodegenerative brain disease CTE, which can only be formally diagnosed after death and autopsy, is pathologically marked by an abnormal buildup of a protein called Tau, in the brain that can disable neuropathways and lead to a variety of clinical symptoms, including memory loss, confusion, impaired judgment, aggression, depression, anxiety, impulse control issues and sometimes suicidal behavior.
Popham and Woodard are two of more than 450 current and former rugby players who have now joined a lawsuit to take legal action against global governing body World Rugby and the national governing bodies of England and Wales, the Rugby Football Union (RFU) and the Welsh Rugby Union (WRU).
Lawyers for the plaintiffs say there was a failure to protect them from permanent injury caused by repeated head injuries and concussions during their careers.
These governing bodies, the claimants allege, “were negligent in failing to take reasonable action in order to protect players from permanent injury caused by repetitive concussive and sub-concussive blows,” according to a press release sent to CNN Sport by attorneys for the plaintiffs.
Richard Boardman, the lawyer representing the claimants, told CNN Sport that this is causing an “existential threat” to the game.
In a joint statement sent to CNN Sport, World Rugby, the RFU and WRU said they could not comment on the ongoing legal proceedings.
“Player welfare has been and will continue to be our top priority and we constantly strive to safeguard our players, acting on the science and evidence, enacting our six-point plan to make rugby the most progressive sport in the world in this area,” they said.
The organizations noted that the sport’s Head Injury Assessment (HIA) during games, which follow a three-stage process to assist with the identification, diagnosis and management of head impact events with the potential for a concussion – are 90% accurate when diagnosing a concussion, citing a paper published in the Springer scientific journal.
But experts warn that such protocols don’t really address the issue of playing collision-based sports and repeated head trauma.
“As far as the brain is concerned, it doesn’t matter what sport is played,” Michael Grey, a neuroscientist at the University of East Anglia, told CNN Sport. “If we get a knock to the body that causes a wobble of the brain inside the cranium, that’s going to produce some damage.”
Chris Nowinski, an advisor to the National Football League Players Association (NFLPA) and founding CEO of the Concussion Legacy Foundation told CNN Sport that head injury protocols need to go beyond treating concussion.
“There’s a very straight linear correlation between head impacts and CTE. And there’s studies that will suggest for every one concussion the American football player suffers, they’ll have 300 hits that are harder than that concussion,” he said.
Nowinski, a World Wrestling Entertainment (WWE) wrestler turned neuroscientist, explains that because the brain doesn’t have pain nerves, a person can’t necessarily feel when it’s being damaged, and therefore, most brain injuries don’t produce the symptoms that would be detected by a HIA.
Nowinski told CNN Sport that in most professional sports, head injury protocols are “not designed to be safe: they’re designed to allow the business of the game to move forward in a way that is agreeable for the players.”
Ann McKee, director of the Boston University CTE Center has also previously told CNN Sport that “subclinical hits – the non-concussive injuries that aren’t detected – you don’t pull the player off the field, and they can be in the hundreds or even the thousands in a single season.”
Boardman, who is representing the rugby claimants, told CNN Sport: “We believe that up to 50% of elite players that play post 1995, when the sport went professional, will end up with some kind of neurological impairment.”
Rugby is split into two main codes, rugby league and rugby union, which went professional in 1995. Since the sport went professional, players have become stronger, bigger and faster. In 1955, mean male player body mass was 84.8 kilograms (about 187 pounds). By 2015, it had increased by 24.3% to 105.4 kilograms (232 pounds), according to a study published in the British Medical Journal Open Sport & Exercise Medicine.
The rugby lawsuit comes a decade after the NFL reached a $765 million settlement in a case involving more than 4,500 players who accused the league of failing to warn and protect them from the long-term risks of repetitive traumatic brain injuries, despite being aware of the evidence and associated risks.
The NFL denied any wrongdoing, but according to NFL.com, commissioner Roger Goodell told lawyers to “do the right thing for the game and the men who played it.”
To date, NFL parties have paid out over $1 billion in monetary awards as part of the program.
The agreement provides up to $5 million per retired player for serious medical conditions associated with repeated head trauma.
The NFL publicly acknowledged a connection between American football and CTE for the first time in 2016.
Boardman told CNN Sport that rugby players face regular head trauma on a scale far greater than those in the NFL, given that more games are played and contact in training is not limited like it is in American football.
“That’s why we believe rugby is on a scale unlike NFL, unlike football [soccer], any other contact sport,” he said.
Grey, the neuroscientist, says that many sports governing bodies – including rugby – continue to distance themselves from CTE. World Rugby denies this, saying in a statement that it “constantly reviews all of the available evidence and our track record consistently shows that we follow the latest scientific data and expert opinion.”
Their attitude, Grey says, resembles: “It’s not our problem. It’s American football. It’s ice hockey. It’s these high-impact sports that have the problem. Well, we know now that’s not true.”
“They’ve taken a very, very long time to get on board with the notion that we need to reduce the incidence of injury in practice and in play. And they’ve really come along with this kicking and screaming,” he said.
“It’s the business of the game that seems to be far more important than the player welfare,” Grey adds.
McKee tells CNN Sport that, when it comes to sports leagues and head injury, “there’s a generalized denial that it’s an issue.”
A new study from the University of Glasgow, Boston University and the University of Sydney which looked at the post-mortem brain exams of 31 former amateur and elite rugby union players found CTE in 68% of the brains, which had been donated for research purposes.
Researchers found that the risk of CTE pathology was associated with the length of a player’s career, noting that each additional year of play added 14% to the risk of CTE – regardless of whether a player was amateur or elite and their position or level of participation. The men whose brains were donated for study had an average rugby career length of around 18 years.
And in a 2022 study from the University of Glasgow, researchers found the risk of developing neurodegenerative disease later in life among former Scottish international rugby union players was nearly triple that of people with the same socio-demographic profile.
The paper, which looked at 412 Scottish former international male rugby players aged 30 and above and 1,236 members of the public who had been matched for age, sex and socioeconomic status, found that the rugby players’ risk of a dementia diagnosis over time was just over twice as high.
Meanwhile, their risk of developing Parkinson’s disease by the time of a follow-up with researchers was three times as high, and that of motor neurone disease (MND) or amyotrophic lateral sclerosis (ALS) 15 times as high.
World Rugby noted that its concussion protocols have evolved and have been revised in 2012, 2014, 2019, 2021 and 2022 to increase substitution time and adapt tests for concussion.
“The temporary substitution time period has proven successful in assisting medical staff to assess and make an informed decision regarding the removal of players when suspected concussion is not clear,” states World Rugby on its site.
“The entire process includes strict side-line assessment based on the best available evidence and rigid follow-up procedures.”
And, in October, World Rugby announced it will advance the Head Injury Assessment (HIA) by introducing in-game alerts linked to smart mouthguards “to show if a player has experienced a high level of acceleration which could lead to an injury.”
However, Woodard and Popham, the former rugby players, both point out that there is a pressure to carry on playing even after having sustained a head injury.
In the late 90s and early 2000s, “unless your leg was hanging off, you were encouraged to stay on regardless of what happened,” Woodard explains.
“That stigma still exists to a certain extent today, although it’s been radically improved in the last 10 years or so.”
Popham adds: “Rugby players, they’re gladiators – especially at the moment with a shortage of clubs and jobs out there – they don’t want to miss a game because they’re fighting until their next contract … But it needs to be taken out of the players’ hands.”
Many fans believe that the same players who are seeking compensation have the potential to ruin the sport, according to Woodward and Popham.
“There’s a lot of people who are judging us because they think we’re attacking the game. And what we’re actually trying to do is make the game safer,” Woodard explains.
“People are going to comment on this, things like: ‘My mom had dementia, and she never had any compensation,’ stuff like that. Your mom was diagnosed at 70. I’m in my early 40s. There’s a huge difference.”
Woodard says he is now dealing with a steep decline in his cognitive function.
“When I go back up to Wales to pick my children up, if I want to take them to a park or a trampoline park or something of interest to them, I can’t compute how to get there, even though I lived in Wales for over 40 years of my life,” he says. “Whereas five years ago, I could do it perfectly.”
Both men are adamant that more needs to be done to protect future and current players.
Popham says that this doesn’t just extend to the professional game, with children playing the sport every day.
“Parents aren’t told this. My mom broke down when I got my diagnosis, saying she shouldn’t have sent me to rugby. I said, ‘You weren’t told, you weren’t informed.’ And that’s still the case to this day. I don’t think parents are told the correct information on this issue.”
Governing bodies England Rugby and Welsh Rugby Union have codes of practice indicating how contact in youth rugby should be managed by coaches, and which age groups can play together.
The latest study from Boston University’s CTE Center shows “that CTE can start in very young athletes who only play amateur sports,” said McKee, co-author of the study, said of the paper published in the journal JAMA Neurology.
The study of 152 brains from athletes who were under 30 at the time of their death discovered more than 60 cases of CTE, with the youngest person diagnosed with CTE in the study only 17.
The majority of those diagnosed were amateur athletes who played sports including soccer, football, ice hockey, rugby and amateur and professional wrestling at the youth, high school and collegiate levels.
Woodard says that he has seen other former players in their 40s start to deteriorate and is aware that men in his cohort have died by suicide or been institutionalized for mental health conditions.
“Psychologically, I try not to think about it. The way I’ve decided to approach this is: the serious decline might never happen.”
Woodard adds he accepts that, in 10 or 15 years, he might be unable to care for himself and have to be admitted to a care home.
Still, he says, when he hears of suicides and mental health issues in players of his age or from his cohort, “you can get yourself in a whole spiral of doom.”
Experts are clear that they don’t want to discourage people from playing sports.
“We could be getting people off the pitch when we recognize they are concussed. And we should be teaching players about the dangers of concussion,” said Grey.
Nowinski, the NFLPA advisor, adds: “With all the reforms the NFL has made, it has never been more profitable and more popular than it is today.
“Hopefully, the lesson for rugby here is: you can make radical changes to the game, to make it safer, more ethical and protect the next generation.”