What now for rugby as dementia risks become clearer?

The motto of the 20x20 campaign that aimed to increase participation in women’s sport acknowledged a thin but tangible link between elite action and the grassroots – if she can’t see it, she can’t be it. Finding a way to maintain that connection is vital to rugby’s future.

Everyone has seen the game’s popularity balloon over the last decade. But no one wants to be one of its casualties.

Accounts of how a group of former professional players, including the England World Cup winning hooker, Steve Thompson, have been diagnosed with early onset dementia are harrowing and provoked a sense of foreboding.

There can hardly be a player who has heard Thompson's horrific tale – a 42-year-old ex-elite athlete who can't remember his finest hour at the 2003 World Cup – and not pondered the future with some degree of fear.

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If awareness of the science of chronic traumatic encephalopathy has increased elsewhere, then rugby and other contact sports here are playing catch-up. It means the first generations of professional rugby players in particular find themselves filling an unwanted role of test subject.

Those who have made a career out of making and taking impacts, living on a near-daily basis with the pervasive risk of concussion, are relatively few. But legal action taken by Thompson and the others against rugby’s authorities could presage many more such claims in future.

The lawyer representing them has offered that up to 50 per cent of former players in the professional era could end up with neurological complications. It doesn’t mean early onset dementia is the prospect for everyone. But who wouldn’t be scared?

It makes for an appalling long-term vista in terms of rugby and the health of those who play it for a living. And inevitably that translates into a bleak outlook for the game in general and the vast majority that just play for fun.

Unarguable

The odds on making it as a professional player are long, maybe as long as the statistical probability remains of anyone getting a degenerative brain disease in early middle-age. But the logic of sidestepping such a gamble in the first place, and rugby as a whole, will strike many as unarguable.

What parent, faced with a youngster eager to try out the game, could be blamed for looking at such harrowing evidence and concluding that rugby’s risks are much too great to get involved in the first place.

It's a couple of years since I commented on four childish words increasingly inducing parental panic: 'can I play rugby?'. Much of the reaction was furious. But if participation depends on aspiration, can anyone dream of reaching the top and still ignore the potential cost?

If elite professionals, the role models for everyone else, are nervous then only the witless can’t stop to pause and ponder about playing.

Clearly it’s not just a rugby issue. Concussion and neurodegenerative disease are fast becoming a pressing matter in all contact sports.

One study has found how soccer players are three-and-a-half times more likely to die of such a disease than members of the general population of the same age. The simple act of heading a ball has become fraught with anxiety.

Accidental collisions of the sort that left Joe Canning concussed in last month’s All-Ireland hurling semi-final are enough to make anyone wince. It underlined how head injuries are all but inevitable when physical clashes are part of any game.

However, such collisions are the whole point of rugby. The game is about contact. Removing physical danger detaches the very elements that make it attractive to many people in the first place. Take out the physical and the obvious question is what’s left?

Steps have been taken to dilute the physical. High tackles are being closely policed. Head Injury Assessments are taken a lot more seriously than they were. But penalising high tackles doesn’t mean they won’t happen. Presuming a rule prevents a stray boot presumes way too much.

Besides, we are assured that concussions aren’t where the real problem lies. Instead it is repeated sub-concussive impacts, such as hitting a tackle-bag umpteen times in practice, or the sort of routine tackling that goes almost unnoticed in any game, whatever the level.

How to avoid them and keep the game as we know it is a quandary too great for pat answers.

Right to choose

Many in rugby – perhaps those sitting in the stands most of all – will try to put such concerns into a wider context of an individual’s right to choose. And despite the complexities tied up in any duty of care debate it is correct that no one is ever forced at gunpoint to play anything.

Much will probably come down to straightforwardly presenting the facts and the risks involved and allowing people to make their own personal decisions.

Rugby’s long-term prospects, though, are tied up in selling the game to the coming generations – a difficult task considering the current generation of role-model professionals are having to come to terms with the health implications of having played the game at elite level.

There is also the unsettling reality that the science on CTE is still evolving. The finest medical opinions 20 years ago appeared largely ignorant of the dangers of bulked-up athletes repeatedly smashing into each other.

The more we learn, the more fraught the outlook seems to be. Any medic ruling out more evidence emerging that makes the whole exercise seem even more risky is foolishly smug. Even then there will be professionals who weigh up the risks and continue to play, believing the odds favour them.

However, it’s hard not to suspect such anxiety will only deepen and continue to reverberate throughout the game. Seeing such apprehension at the top is likely to mean others carefully weigh up the risks and consider, perhaps, that they can do without aspiring towards being such a statistical gamble.