THERE’S AN UGLY TRUTH in rugby union. No matter the amount of protective equipment used, or the amount of rule changes brought into place, head injuries are a pervasive and often unavoidable blight on the sport, with an impact that extends far beyond the playing field. Andrew Coombs is the latest victim of this malevolent truth, announcing he’s been diagnosed with dementia and probable chronic traumatic encephalopathy (CTE), at just 39 years of age.
Coombs, a former utility forward who was part of the Welsh team that won the Six Nations in 2013, broke the news of his diagnosis on social media. “Eight months ago, I was diagnosed with dementia and probable chronic traumatic encephalopathy after suffering symptoms for around four years,” he said. “It was a challenging decision to seek medical advice. However, understanding the changes happening within me became imperative. The diagnosis was a heart breaking one, but it answered many questions that had been lingering in my mind and worrying me for so long.”
In addition to the announcement of his diagnosis, Coombs also announced he is one of 295 former rugby players seeking damages in a legal case against World Rugby, the Rugby Football Union and the Welsh Rugby Union. Former England captain Phil Vickery and former Wales fly-half Gavin Henson have also waived their anonymity and have been revealed as members of the action.
The players are alleging the governing bodies were negligent in their duty of care towards them, failing to implement reasonable measures to prevent head injuries and protect players’ health and safety. Coombs addressed the governing bodies’ culpability in his statement. “I do question those who were responsible for managing the health risks associated with repetitive head collisions and concussions,” he said.
Is rugby more dangerous than other sports?
Head injuries are not endemic to rugby, but they occur more frequently than in any other sport. Concussion rates are measured in terms of injuries per 1,000 athlete exposures—athlete exposures being games and practices. Rugby leads all sports in this category, with a rate of 3 injuries per 1000 athlete exposures. American football is next, with 2.5 per 1000. In junior rugby, the rate of concussion jumps even higher, with 4.18 injuries per 1000 exposures amongst participants aged under 18.
Rugby’s governing bodies are working to minimise the risk of head injuries. In 2018, Rugby Australia’s National Safety Committee introduced new protocols to address the issue. Players who show signs of a concussion during a game must now leave the playing field, take no further part in the match, and go through rigorous off-field medical testing and recovery processes.
For many, like Coombs, the changes are too little too late.
Can dementia occur in young people?
According to the World Health Organisation, dementia most commonly occurs in people aged 65 or older and frequently impacts people who are overweight, have high blood pressure, or physically inactive lifestyles. Coombs doesn’t meet those criteria and is otherwise physically fit and healthy—given that he was still playing professional sport just seven years ago.
Dementia can occur in younger people, albeit in extremely rare cases, when it’s known as early onset dementia. Frequent cases of head injuries can lead to a higher chance of developing early onset dementia and CTE. This means that athletes like Coombs, who are involved in contact sports and face prolonged exposure to situations where head injuries are common, are perhaps most at risk. With that in mind, it is difficult to see Coombs’ dementia originating from anything other than the head injuries he sustained while playing rugby.
The retired players’ case against rugby’s governing bodies is expected to go to trial in 2024. The result of the trial could set a precedent to be followed in other sports.