The doctor and ex-WWE wrestler warning about concussion in rugby

With the Six Nations beginning again this week, rugby is back in the national and international spotlight. In recent years the sport has seen massive global growth, but with that has come increasing concern that the physicality of the modern game is leaving players with long term problems.

It’s an issue that first emerged more than a decade ago in American football, after the brains of former players were examined and shown to have evidence of Chronic Traumatic Encephalopathy (CTE). CTE is a brain condition believed to be linked to repeated head injuries and impacts to the head, and concussions.

Some common symptoms of CTE can include trouble concentrating or focusing, headaches, and short-term memory problems.

World Rugby has been attempting to address those concerns and minimise concussions by changing rules and introducing new protocols, such as an obligatory head injury evaluation time period.

It requires any player who displays signs of concussion during a match such as loss of consciousness, loss of balance or being dazed, to be permanently removed from the pitch and not return to play within 12 days.

But is it possible to make rugby sufficiently safe?

Katie Hannon spoke to Dr Christopher Nowinski, an American neuroscientist to try to get an answer to that question.

“The one thing that I like about the rugby protocol is that minimum ten minutes evaluation time,” he said.

“We don’t have that in the NFL or other sports, and I do think that does help give time for adrenaline to wear off and players more time to reflect, and self-report.

Dr Nowinski has first-hand knowledge of the dangers of head injuries. He played American football at college level while studying at Harvard University, and after graduation became a professional wrestler with the WWE.

In 2006, he wrote a book called ‘Head Games: Football’s Concussion Crisis’ and has since dedicated his life to addressing head injuries in sport. He co-founded the Concussion Legacy Foundation in 2007, a non-profit organisation dedicated to improving the lives of those impacted by concussion and CTE.

He told Katie Hannon how a bang to the head he suffered while working as a professional wrestler eventually led to him discovering the true extent of his own previous concussions, and how they could cause him problems in the future.

“I ran into Bubba Ray Dudley’s [WWE wrestler] boot in the corner, just too fast… and it just took my head off. When I hit the ground – it was probably entirely my fault – I forgot where I was,” Dr Nowinski said.

“I said, ‘I don’t know what’s happening,’ I don’t remember the match, and they told me what to do next. We just finished the match, and at that time I felt just awful. I rolled out of the ring… and I went and hid, and put my head in my hands, just waiting for this to go away, and it didn’t.”

“The next day, when I showed up to the arena, still feeling so bad… and I saw people with what I considered to be real injuries getting ready to work. And I was like, ‘I’m not gonna take the day off because I feel like I have the flu or a headache,’ that just wasn’t enough. So, I just kept going.”

LISTEN: Dr Christopher Nowinski speaks to Katie Hannon on Upfront: The Podcast

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The Harvard graduate said the only reason he stopped working in professional wrestling is because he developed REM behavior disorder, which is a sleep disorder in which you physically act out vivid, often unpleasant, dreams.

“The night after the last time I wrestled, I woke up on the floor of a hotel room after apparently acting out a dream, standing on the bed, climbing the wall, jumping through a nightstand, and waking up for none of this.”

“Once I woke on the floor with this chaos around me, I was like, ‘oh God, I think something’s wrong.’ Then I told them [the WWE], and they were like, ‘you’re not getting back in the ring until we figure out what’s wrong.’ And that was the end.”

This led Chris Nowinski on a journey to understand what was going on.

“I had these daily headaches and I couldn’t go back to work. I just started reading – I would go to the Harvard Medical School Library, and I photocopied every study ever on concussions and I read them all to try to figure out could I find something to get me better, and what’s really going on here?”

Chris Nowinski went on to co-found the Concussion Legacy Foundation with Dr. Robert Cantu.

He says there remains a culture of working through concussion in many contact sports.

“We’ve made small improvements here and there, which I’m glad we have, but at the highest levels in most sports we’re not even close to where we should be,” he said.

“[It is] based on the ethics of creating this system under which guys like me are recruited, because we’re big and strong and fast and thrown out there to go damage our brains without the proper education or protections,” Dr Nowinski said.

He says that the risks of rugby are not that dissimilar from the risks of American football.

“You have a very high concussion rate because people get hit in the head making tackles. You also have a very high repetitive head impact rate, as you’re involved in so many collisions,” he told Katie Hannon.

Dr Nowinski has welcomed some of the changes made by rugby’s governing bodies to address concerns about concussion and head injuries. He notes such risks are not specific to rugby alone and believes that education and awareness are key.

“If you’re heading a soccer ball, you are at risk for CTE, and it’s just a question of how many times you’re hit. If you’re going to start now and you’re successful, you better hope you minimise those hits each year, or else you’re going to be at a super high risk.”

Asked whether he would let his own children play contact sports, he says he is reticent.

“I would be nervous about putting my son into American football. I probably never will, because he’s going to be like me: big and strong and fast, and if he starts, he’s going to play through college,” he said.

“That’s going to be at least ten years and in ten years – as we play it today – most of the guys that we study have had CTE. So, he’s not going to play because I know he’ll be successful.”

The former professional wrestler says that sports people from around the world get in touch with him constantly.

Those who he has been in contact with include Steve Thompson, the 42-year-old former British and Irish Lions rugby player, who won more than 70 caps for England during his career.

Thompson was diagnosed with early onset dementia and suspected CTE in 2020.

He is one of dozens of former rugby players who have taken a case to the UK High Court against World Rugby, the English Rugby Football Union and the Welsh Rugby Union, alleging the governing bodies failed to take reasonable steps to protect players from injury caused by repetitive impacts, while three former Irish rugby stars issued legal proceedings against the IRFU over alleged concussion injuries in September 2022.

“I spent a few days with Steve Thompson when he pledged his brain to our new brain bank at Oxford University,” Dr Nowinski said.

“Hearing his story and understanding how he’s lost jobs and everything because of his cognition… it made me more passionate about trying to extend our influence there to make the game safer.”

Listen to Chris Nowinski speaking to Katie Hannon on Upfront: The Podcast here, on Apple Podcasts and on Spotify.