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Head trauma: The dark shadow looming at the heart of contact sport

More than half of the 1966 England football World cup team were later diagnosed with dementia. Members of the rugby World Cup winning side in 2003 can no longer remember their triumph. For many of our sporting legends, success comes at the highest price of all – the loss of their selves.

illustration of a rugby ball

Illustration: Edward Tuckwell

“The bigger they are the harder they fall,” Lloyd Jones’s father Peter would often say about rugby players. Peter had played rugby from the age of 15 in the amateur era and was a former Neath and Llanelli back-row forward. He was a hard hitter, known for his physicality and fitness on the pitch. Peter Jones is also the first British ex-rugby player known to have died with the disease Chronic Traumatic Encephalopathy (CTE), caused by blows to the head. 

The disease has been around since the 1920s when its foundations were laid in boxing and a condition called punch drunk syndrome, or dementia pugilistica, when boxers displayed neurological symptoms after experiencing repetitive head trauma. It was later catapulted into the mainstream with the film Concussion that immortalised the work of Dr Bennet Omalu, who carried out postmortems of prominent NFL players and found the same disease. It was a damning discovery that years later would result in a $765 million (£588m) settlement agreement for former players. 

Now the critical conversations on CTE involve football, including the dementia diagnoses of over half of the 1966 England World Cup team and the debate on banning heading, and rugby with its growing player litigation led by England hooker Steve Thompson MBE and Wales flanker Alix Popham, who both received life-shattering dementia and probable CTE diagnoses aged 40. Thompson cannot remember winning the World Cup [in 2003]. 

CTE is caused by repetitive impacts to the head that can be defined as either concussive or sub-concussive. Concussive blows typically cause immediate symptoms: dizziness or blackout. The impact can cause the brain to shake violently or bounce around or twist inside the skull, creating chemical changes within it and sometimes stretching and damaging brain cells to the point where they no longer work properly. 

A sub-concussive blow does not result in a clinical concussion, meaning that there are no immediate symptoms. And yet sub-concussive blows are believed to have adverse long-term effects in some individuals, particularly if there are repetitive occurrences or those suffering are not removed from play for adequate recovery. The clinical features of CTE are progressive, leading to dramatic changes in mood, behaviour and cognition, and yet the first signs generally appear years after a brain injury has occurred. Once it starts, there is no stopping it. Like dementia, there is no treatment or cure for CTE.

Peter Jones’s symptoms began in his late fifties. “Strong, gregarious and playful,” is how Lloyd would describe his father, but he had become forgetful. He would lose his way home. He was repeatedly turning the plugs on and off around the house. His inhibitions were wavering, Lloyd remembers. His father was becoming a stranger. 

“He had been larger than life, a huge character always joking,” Lloyd tells me. “But then he’d just become quiet, like there was nobody there any more.”

Once his family had made the decision to put him in a care home, they noticed Peter was hobbling around – at first they put this down to years of carpentry and over two decades in an “intense career” on the Rugby pitch.

“But when we went to get him checked, the doctor said he needed a hip replacement, he was at the worst stage of pain possible.” Lloyd tells me, “You could see the hip bones just grinding together. It was unbelievable. The pain would have been immense. He just didn’t know how to tell us.” 

A Delicate Game: Brain Injury, Sport and Sacrifice by Hana Walker-Brown is out now
(Hodder & Stoughton, £20)

I immediately think of my own father pre-hip operation, how he couldn’t help but vocalise the agony it was causing him – the sharp intake of breath with every step or misplaced position on the sofa, in the car, even at rest he was hurting – he knew it and so did we. 

But Peter Jones couldn’t communicate that he was in pain. He had forgotten how to. His hip became infected and he was admitted to hospital, where he contracted Covid-19 and died in 2021. His brain was examined postmortem by Dr Willie Stewart and the family were given a diagnosis of CTE. As a result, Lloyd Jones has joined the legal fight on concussion and, while he still loves rugby, he doesn’t want it to ruin anyone else’s life. “Dad lost his life long before his death,” he says. “In those last 10 years even though he was alive, he had gone. His mind and soul were gone.” 

Every day, a new story emerges, new diagnoses are given and new headlines are written. Poor head injury protocol is being reassessed while calls for action ring out over Twitter. While the news agenda can and does move on, there are families all across the world who cannot. 

Hana Walker-Brown is a writer and filmmaker

You can buy A Delicate Game from the Big Issue shop on bookshop.org, which helps to support The Big Issue and independent bookshops

This article is taken from The Big Issue magazine. If you cannot reach your local vendor, you can still click HERE to subscribe to The Big Issue today or give a gift subscription to a friend or family member.You can also purchase one-off issues from The Big Issue Shop or The Big Issue app, available now from the App Store or Google Play.

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