By Tim Lewis The Observer,

Rugby is a tough, physical sport and injuries are a major part of it. But are the risks too high? Should we stop our children playing the game?

School of hard knocks: it’s estimated that two-thirds of all rugby injuries happen in the tackle. Photograph posed by model. Special effect make-up by Hannah Phillips. Photograph: Levon Biss for the Observer

Sedbergh, a near-medieval public school nestled among steepling fells in Cumbria, is a 6am-run-and-bracing-shower sort of institution. Over centuries, it has hewn an abundance of military strategists, statesmen and polar explorers. Mostly, however, it has been a production line for brilliant rugby players. Four Old Sedberghians have captained England – one of them was Will Carling – and it has turned out a Scotland skipper, too. In 1993 a rugby ball from the school was taken into space aboard the Discovery shuttle. Sedbergh is coeducational now, but still instils in young people its motto: Dura Virum Nutrix – “A stern nurse of men”.

James Gray, a 12-year-old in his final year at Casterton, Sedbergh Preparatory School, fully intends to join those ranks of rugby greats. His father David was both a keen player and a coach, and James can’t remember when the sport wasn’t part of his life. “I probably first picked up a rugby ball when I was a few months old,” he thinks. Aged five, he joined Barnard Castle rugby club, his local team, and started playing tag rugby, where opponents try to swipe a swatch of cloth from their waistband instead of tackling. He moved on to playing contact rugby when he was nine.

James’s idols are Jonny Wilkinson and Martin Johnson, and, like the latter, he ended up with the bigger boys in the forwards, playing second row. He wasn’t especially fast, but he was tall and fiercely determined. He was also an astute reader of the game, with a knack for popping up in the right place. James was selected for the 1st XV of his prep school a year early, aged 11.

But if James does achieve his ambitions it will be quite a story, one that stretches the imagination. A year ago he was playing for his school away against Royal Grammar School, Newcastle. It was a warm, sunny afternoon and in the second half, close to the touchline, a messy bundle of bodies formed a ruck. James piled in, much as he had done countless times already that day, but on this occasion his neck twisted and his body contorted awkwardly. When the game moved on, James didn’t.

Rugby is a contact sport and now, at the highest levels, a thudding and sometimes shocking collision sport. Injuries, everyone accepts, are an inevitable part of the game. But increasingly there is concern that rugby has become too dangerous. At the senior level, repetitive, concussive blows are beginning to be linked to dementia and long-term brain damage. Schoolboys, meanwhile, are becoming bigger and more powerful, but their bones remain as fragile as ever.

Twelve months later, there is little to indicate what James has been through. He walks well and has a mischievous smile. But straight after the injury, he spent four months, on and off, in hospital. He was in a wheelchair, then an extensive neck brace and only returned to school in February, after six months away. This summer he finally took steps again at his full height, but he still doesn’t have complete sensation down the right side of his body. “That may or may not come back, we don’t know,” admits Emma Gray, his mother.

James is quietly confident it will return. In hospital he read Rugby World magazine obsessively and downloaded the sport’s rules on to an iPad in case he wanted to be a referee one day. He also set himself a goal: he would run a mile to raise money for injured rugby players less fortunate than himself. At first he couldn’t cover 200m without stopping, but he trained harder than ever and completed the mile in March, cheered on by his schoolmates. He’d hoped to raise £200 but ended up collecting £25,000 in sponsorship. Ian Botham pledged money, so did rugby legend Will Greenwood, another Old Sedberghian, of course.

“I’ve had ups and downs this year,” says James. “But what I like about rugby is that you basically become a big family. If I had a choice between never playing rugby and not having the injury or playing rugby and having the injury, I’d definitely say playing the rugby. And, if I play my cards right, yeah, I hopefully will get back to it one day.”

‘The authorities see it as a battle rather than a rational discussion’: Allyson Pollock

‘The authorities see it as a battle rather than a rational discussion’: Allyson Pollock

Emma Gray, a lawyer and mother to three boys, shows no emotion as her son makes this defiant statement. She was standing less than five metres from James when he crumpled on the field. At the time she was preternaturally calm, though she did find her composure sometimes slipped at the hospital. When James leaves the room, she recalls: “He grabbed hold of my hand and said: ‘Mummy, I can’t feel you’ and that’s when we realised that the whole of his right-hand side had been affected. He said that it felt like there was a piece of thick paper between my hand and his face.

“Nights were hard for me because I didn’t know what was going to happen,” Gray continues. “But I never ever let him see me cry. Never. I did have my moments – I would take myself off to the bathroom – but I knew if he saw that I wasn’t in control then he would worry about things.”

It seems natural to ask: wouldn’t Gray be terrified to let James run out on a rugby pitch again? She thinks for a moment, shakes her head. “The first game or two would be quite hard emotionally because of all he’s been through,” she says. “It’s not that it might happen again, but purely because I’d be so proud of what he has gone through and has been able to achieve. I know that run hurt him, every step of the way it hurt. He wasn’t walking well for a week following it, but he was so determined to do it, and that’s what makes me proud.”

One mother who reached a different conclusion was Allyson Pollock. A decade ago her eldest son suffered a spate of injuries playing rugby for his school in Scotland. First he bust his nose, then his leg was broken in a tackle and finally, aged 16, his cheekbone was shattered. This last incident left his eye hanging down out of its socket and he was forced to drink meals through a straw. An enthusiastic trombonist, he stopped playing; his confidence, she noticed, was clearly affected. “It was terrible,” says Pollock now. “Terrible for us all to see.”

After her son’s second injury, Pollock – a physician and public-health professor – decided to investigate some of the dangers of rugby. She learned from the Scottish Rugby Union that it had never seriously collected any injury data, not even a basic audit. So in 2006 she decided to conduct a small study of her own. She called 76 parents and pupils, all in their final year at her son’s school, and asked what injuries the boys had experienced during their short rugby careers and exactly how they had occurred.

The results, she notes in her new book Tackling Rugby: What Every Parent Should Know, were “surprising and alarming”. For boys in the 1st and 2nd XVs – the most committed players – 70% had sustained a serious injury, perhaps a concussion, ligament tear or fracture during their five years at the school. Among all children – including some who had given up the sport at the earliest opportunity – more than a third had been injured playing rugby.

Pollock is the first to note the limitations of her study and the sample size it analysed. She is also aware that research into rugby injuries remains “an extraordinarily neglected area”. But since she began to look into the sport she has noticed some disturbing trends. Pollock did a larger survey, published in 2009, which found that a typical schoolboy playing 15 matches a season had a one-in-six chance of being injured – that is, suffering a complaint that prevented him playing for at least a week. The most dangerous aspects of the game were the scrum and the tackle.

There is reason to believe, too, that the risks of playing rugby are increasing. In 1995 the sport became professional at the senior level and now it is clearly a more physical, punishing endeavour. International players today weigh, on average, 10% more than they did in 2000 and have improved their time for the 10m sprint by 5%. The effects have trickled down to schoolboy level. A study by Professor Michael Garraway from the University of Edinburgh found in 2000 that injuries had near-doubled in the professional era and increased among school-age boys as well.

There is particular concern now about concussion. Across multiple sports, the long-term effect of repeated blows to the skull is being surveyed, and there is substantial evidence in retired players linking it to brain damage, specifically a progressive neurological condition called chronic traumatic encephalopathy. Again, rugby has not been studied as extensively as other sports. In American football, however, more than 4,500 former NFL players sued their league for downplaying the dangers of concussion, and last year there was an out-of-court settlement for around £500m. Malcolm Gladwell compared American football to dog fighting.

Rugby authorities would certainly point to rule changes they have introduced to make the sport less dangerous. For example, junior players in the UK no longer clash shoulders like rutting deer when they engage in a scrum. Competitive lineouts are now introduced gradually. At some ages, in particular forms of rugby – specifically seven-a-side – there is a weight limit for players. Most of the unions have introduced campaigns to more accurately identify concussion and improve its treatment. England’s Rugby Football Union was unavailable for comment for this article.

What changes would Pollock like to see introduced? “Oh my God, I’m not an expert,” she replies. “All I can tell you is where the risks are and where the injuries are taking place, so parents will make their own informed decisions. But given we know that the tackle and the scrum are where injuries are occurring – up to two-thirds of injuries can happen in the tackle – then you might want to reconsider the sport your child plays. Parents might vote by withdrawing their children. Or a school might say: ‘We’ve looked at the injuries and it’s not safe enough. From now on, we are going to play touch rugby.’”

At present, an extreme development seems unlikely. However, Glenalmond College – an elite boarding school in Scotland whose alumni includes the rugby talisman David Sole – withdrew its 1st XV from two fixtures in 2013 because of concerns over “mismatches in physique”. The previous year, its team had sustained a number of injuries in matches against Loretto School in Edinburgh and Strathallan in Perth. “We had to ask: ‘Was it safe?’” says Mike Davies, Glenalmond’s director of sport. “And we had a massive amount of support from parents for our decision.”

Pollock stops short of calling for rugby to be banned, but she does believe that every parent whose child plays rugby should be in no doubt of the risks they face. “This needn’t be seen as an attack on the sport,” she says. “It’s about making the game safe and pleasurable for children. The reason I’m so passionate about it is that children are very, very vulnerable: we have a special duty of care both as parents and collectively as a society.”

On a recent Sunday morning – almost exactly a year to the day James Gray was injured – the Casterton Sedbergh 1st XV take on Witham Hall, an independent school on tour from Lincolnshire. From early on, it is obvious that Sedbergh has the edge – they are bigger, fitter and more skilled to a boy – but sensible refereeing makes it a more even contest. Safer, too – early on, the referee insists that the two packs of forwards should not push against each other because of the disparity in respective weights.

Emma Gray looks on from the side of the pitch, wrestling with a pair of Labradors and a whippet. “I’m not quite as close to the touchline as I used to be,” she says. “I stand back a little bit. But from my point of view, my boys have benefitted hugely from playing rugby. And I just think boys are boys. They need to be physical. They are like Labradors: they need love, feeding, exercise, rough and tumble, and they are happy.”

James, meanwhile, stands behind the posts furiously scribbling on a pad. The rugby coach has asked him to make notes on what the team is doing well and the areas where it could improve. At the end of the 57-7 victory, I suggest there can’t have been much in the latter column. “Actually we weren’t very good at receiving their kick-offs,” he replies. He’s right – something I’d totally overlooked.

Best of all, there are no significant injuries. This is something that no one can take for granted any more and, to its credit, Sedbergh clearly takes the prevention and treatment of injuries very seriously. On any game day it has a nurse with pitch-side training, a doctor and a paramedic, all of whom can reach any incident within three minutes. Some schools and clubs will offer a similar provision, although it remains at their discretion.

Sedbergh also allows any of its pupils to opt out of playing rugby for any reason. “I would be amazed if there were many schools in the land now where rugby was compulsory,” says Scott Carnochan, headmaster of Casterton Sedbergh and a former schoolboy international for Scotland himself. “If a parent came to me and said: ‘My boy just doesn’t enjoy it, doesn’t want to play’ – that’s fine. I don’t think schools can force a child to play a sport that they genuinely don’t like. I don’t think that’s what education is about any more.”

According to Pollock, however, it does still happen that children are required to play rugby at school. As we speak, she pulls up an email she received at 3.30am that morning from a father whose son was concussed playing rugby at boarding school. She reads: “The look in his eyes was as much as we could take…” Pollock sighs: “Oh, that’s really desperate.” There was also the case of 10-year-old Curtis Elton, a talented pianist whose hands have been insured. Last year, his mother asked that he be withdrawn from rugby at Haberdashers’ Aske’s Boys’ School in Hertfordshire, but she was told her son couldn’t “pick and choose” his lessons and he left the school.

At junior level, safety is certain to become a greater preoccupation for parents. Few doubt that schoolboy rugby will continue to follow the beefed-up, heavy-hitting example of the senior game: players are already bolstered by everything from strength training in the weights room to protein shakes and, disconcertingly in some cases, supplements such as creatine.

“Have the boys got bigger?” asks Stuart Oliver, Sedbergh’s director of sport. “At the prep-school age, no. At the age of under-16 to 18, possibly yes. We do not promote the use of any supplements at all at Sedbergh, but I know there’s a lot of young athletes out there who take them as a way of getting muscle hypertrophy. Getting bigger for rugby. We are fighting against the tide all the time.”

The sport can also expect to receive significant interest – and an influx of new players – when the 2015 Rugby World Cup is played in England and Wales next autumn. Pollock is unconvinced that the authorities will do the necessary research on injuries. “They see it as a battle rather than a rational discussion,” she says. “Anything that is seen to damage the reputation of the game has to be squashed. And injuries are the most damaging thing, because if parents think their children are at risk, they will either take steps to have them not play or they’ll make sure the game is changed to make it safer.”

Of course many parents and their children will continue to decide that the dangers of playing rugby are outweighed by the benefits of fitness, self-confidence and camaraderie that many find in the sport. Or they will rationalise that it is no more precarious than skiing, mountain biking, even football. Now, more than ever, rugby is “a stern nurse of men”.

“James has learned a life lesson that will stand him in good stead,” says Emma Gray. “We all fall, but he’s picked himself up and dusted himself down. It’s made him a more determined person and it’s made him think about the fact that life doesn’t always work in your favour. But you don’t give up, and that’s what he always said: ‘Whatever happens, I’m not going to give up.’”

Tackling Rugby: What Every Parent Should Know by Allyson M Pollock, is published by Vero at £9.99. To order a copy for £7.49, go to bookshop.theguardian.com

IMAGES:

Open play: Will Carling attacks the Irish line in 1989. He started his rugby career at Sedbergh. Photograph: Bob Thomas/Getty

Every step of the way: 12-year-old James Gray (in white) with his family. Despite his injury, James intends to play rugby again.

For more on this story go to: http://www.theguardian.com/sport/2014/sep/28/is-rugby-now-too-dangerous-for-children-to-play