Alix Popham: the dangers of repeat concussion

One man who knows about the devastating impact that repeated bangs to the head can have all too well is the former Wales rugby union international, Alix Popham. He was diagnosed with early onset dementia in 2020, when he was just 40. In the years since his diagnosis, Alix co-founded the Head for Change charity -  which seeks to raise awareness about brain health in sport.

Alix - It's a strange, strange feeling. Rugby was my life from the age of four. And to achieve all that I did, I am proud. I just wish I knew what I know now whilst I played the game.

James - Rugby's obviously a game all about full physical commitment. You were a prime proponent of that. To what extent though, were you aware at the time that you were putting yourself in harm's way?

Alix - Well, we weren't given any education really on the word concussion. I don't like using it because it softens what it is. It's a TBI, a traumatic brain injury. We weren't told much about that issue. It was almost treated as a joke when you were doing analysis sessions of the game or training. You would see somebody stumble around and they would rewind it and play it again and yeah it wasn't taken seriously. So this is where things need to change.

James - If you don't mind me asking, when did the first signs of your dementia start to become apparent to you? Was it while you were still playing?

Alix - No. So, as I said, I didn't know a lot about concussion or traumatic brain injury. I thought that I had two big KOs that were my concussions. So I didn't think I was that unlucky. I started talking to players that I played with, players I played against my mum and dad, people I knew and they were saying, what about that one, what about that one? What about that one? And I had no recollection of those. And they were the ones that were in games because my friends and family didn't come and watch us train. So there would've been more, but the big one in all of this is the silent killer and the sub-concussive hits. And that is literally every contact that you're involved in is causing a small amount of damage. And the amount of contact we did as players during my career was insane. And those are the things that we can control with current players so that the future is in a lot better position.

James - Mm-hmm. <affirmative>, when it comes to your diagnosis, what was the story there? How did you go about first seeking a test?

Alix - Yeah, I was most probably in denial. My short-term memory was terrible. Taking in information, audio and visual, reading emails and things like that was really bad. And I was putting it down to everyday stress, kids, new business, everything like that. That was middle of 2019 and my wife Mel, was trying to get me to go to the doctors and I was just putting it off and kicking the can down the road. And then I went on a bike ride that I've got into cycling since finishing playing. And it's a loop I've done many times from my house. And I got lost on this bike ride and it was a scary moment, phoned Mel, and ended up cycling back the way I just came and the following day went to the doctors. This was September, 2019 and that's where the testing started with the scan that ended up picking up the five areas of damage on my brain.

James - Wow. So the penny dropped. What did the doctor say and what was it like to deal with that news?

Alix - Well, it was the middle of lockdown April, 2020. In a strange way, it was a relief that there was something showing on the scans and with my neuropsychological memory testing and all that it was below average for my age and it just gave me some answers. Obviously it was great news, but I've put things in place and tried different therapies and things like that to help and support me really. So yeah, it was a mixture and I've had a bit of a roller coaster with emotions for the first couple of months after that diagnosis.

James - That's completely understandable.

Alix - Yeah. And unfortunately I've talked to hundreds of ex-players, and that was one of the first things when I had my diagnosis, I can't be the only one. And then I started talking to players I played with and against and over 50% of them were struggling in some way, shape or form. The neurologist who's diagnosed in the players believes 80% of the people, players from my generation, will have brain damage, some sort of brain damage.

James - Steve Thompson, the England international rugby player has spoken of the enormous help you were when he was going through his diagnosis, but you're raising awareness in other ways as well, aren't you?

Alix - I was learning on the job really because there was no real information out there. Support for somebody in a family of somebody who was 40 years of age and that's why Head for Change was born. And the support that we give because some players wouldn't have contacted their GP that you need a neuropsychologist, you need an occupational therapist. And putting those things in place, you need to be active and just get those simple things in place to make a difference. And I know from emails and messages I've had off people, we have been a great support to the ex-players and their families.

James - What an amazing thing to have done. So what does a safe future for rugby look like? Can that even exist?

Alix - The conversations we are having now in rugby were happening in boxing a hundred years ago. In 1977, they realized traumatic brain injuries in rugby were an issue and it just was pushed under the carpet and wasn't taken seriously and that information wasn't fed to everybody who played. There has been more noise and awareness since myself, Steve Thompson and Michael Lipman went public almost two and a half years ago. But there's still a lot more that we need to do. And for me, the game on a Saturday is as safe as it can be. There's a couple of areas around the ruck substitutions that you could look at to make it safer, but what we want to change in the game is what happens during the week and shouldn't be left down to the player of 'do you have symptoms anymore?' Because most rugby players are, rugby players in general, are gladiators and all they want to be is on that field and they're not going to show weakness. They're fighting for their next contract. They're fighting to keep themselves in the team or they want to be in the team also. The length of the season in rugby is a 10, 11 month season. So their brains are permanently inflamed from all the contact they're doing week to week. So there's a lot that we can do to make the game safer that currently isn't happening. I'm passionate about this. I still love rugby. I want it to survive, but it needs to be in a safer position because the number of parents that are sending their kids to rugby at the moment is going down. And I don't want that to happen. But I wouldn't send my kids at the moment in the present state of rugby. Rugby needs to get this right.