Foto:
Duncan Elliott / DER SPIEGEL
01.09.2025, 14.09 Uhr
Alix Popham can hardly remember anything anymore. Not the two rugby world championships he won with Wales, not the victory in the illustrious Six Nations Championship in 2008. And also not the moment that means so much to him that he has framed it in silver and black.
The photo is hanging in his workout shed behind his house in the southwestern Welsh town of Newport, among the jerseys, medals and rugby caps. It shows Popham in his early 20s wearing the Welsh national team jersey, pride writ across his face, as he shakes hands with South African hero Nelson Mandela.
Popham’s Welsh national team jersey hanging on the wall. Foto: Duncan Elliott / DER SPIEGEL
“I wish that encounter was still in here,” says Popham, 45, tapping his forehead.
But the only thing the former rugby professional can remember is the day in summer 2004 when he regained consciousness in the hospital with nurses kneeling at his bed and kissing the hand he had used to greet Mandela. And that everything was blurry and his head was pounding.
He was told about the friendly against South Africa in front of an audience of around 44,000 fans. About how he had smashed headfirst into the hip of an opponent, lost consciousness and swallowed his tongue. How a teammate had pulled his tongue out of his throat. And how another teammate had said after the game: “Luckily it was just a concussion.”
Traumatic brain injury, in which the brain slams against the inside of the skull, is one of the most common injuries in professional rugby. And it is becoming more common, in part because the players have grown larger, heavier and faster in recent decades. The collisions, as a result, have become more violent.
But even more dangerous, say neurologists, are the many smaller blows to the head, so-called sub-concussive traumas – tiny jolts that are not enough to trigger acute symptoms but can cause significant damage to the brain on the long term.DER SPIEGEL 35/2025
The article you are reading originally appeared in German in issue 35/2025 (August 22nd, 2025) of DER SPIEGEL.
His neurologists estimate that in his 14 years as a professional player, in both practice and matches, he suffered more than 100,000 such mini jolts, says Popham. The effect is similar to a water spigot dripping on dry ground – initially, it doesn’t have much effect. But over a number of years, it can have a negative impact on thinking, feeling, even breathing.
On a warm morning in early July, Popham is wearing shorts and a pink T-shirt, a fitness watch on his wrist. Soon, he will jump onto a treadmill, part of his training regimen in preparation for a triathlon in Sweden. “I need goals to get me through the day,” he says.
Alix Popham training on his treadmill. Foto:
Duncan Elliott / DER SPIEGEL
Five years ago, when he was 40, doctors at King’s College in London diagnosed Popham with “early onset dementia, likely stemming from chronic traumatic encephalopathy syndrome (CTE).” CTE is a rare degenerative brain malady that occurs with striking frequency among boxers, rugby players and American football players.
More and more former professional athletes have begun speaking openly about the later consequences of brain trauma, writing books describing depression, suicidal thoughts and violent outbursts. Jason Kelce, a former NFL star with the Philadelphia Eagles, announced in May that he was likely suffering from CTE. “All the research would suggest that I have some degree of it,” he wrote on X.
“Sometimes, I feel like an imposter, as if my career never actually happened.”
Alix Popham, former professional rugby player
After years of mounting pressure, the National Football League in the United States established a multi-billion-dollar fund in 2015 to provide financial assistance to former players who are suffering from CTE or other neuro-degenerative illnesses.
Now, World Rugby, the international rugby federation, is facing increased pressure to follow suit, as are the national federations of England and Wales, with former professionals suing them because they failed to protect their athletes from the long-term effects of concussions and repeated blows to the head.
Popham experiences the symptoms of CTE every day – when he becomes furious for no reason, when he is gripped by panic in large groups of people and only wants to run away. He says he can hardly remember three items on a shopping list, which is why he types everything into his smartphone before thoughts vanish from his memory. He tries to respond to messages immediately, afraid that he will otherwise forget.
Medical professionals say his brain works a bit like a camera without film. It can no longer save experiences or impressions.
“Sometimes, I feel like an imposter,” says Popham, looking at the photo with Mandela. “As if my career never actually happened.”
From the outside, Alix Popham looks to be in excellent shape, with his fresh-looking freckled face and wakeful eyes. When he was still playing professionally, his upper body was bulky and muscular. Today, he is quite a bit slimmer, with only his misshapen ears still bearing witness to his rugby past.
Foto:
Duncan Elliott / DER SPIEGEL
Popham is still an athlete, though. He has participated three times in the Race Across America as part of a cycling team, a coast-to-coast ride of 4,800 kilometers. He started racing in triathlons and swam across the English Channel with other former professional rugby players, even though he hates swimming. Sport, he says, is his rehabilitation program. “Nothing else makes me feel better.”
“If you were still standing at the weekend, you’d play. If you were seeing stars, you’d be given smelling salts.”
Former rugby player Alix Popham
On the treadmill, Popham talks about how he started playing rugby as a four-year-old in Newport, a bleak port city near the Bristol Canal. How he was playing for his school, his club and the national team all at the same time, with up to three or four matches per week in addition to training. “If you were still standing at the weekend, you’d play,” he recalls. “If you were seeing stars, you’d be given smelling salts.”
Popham went on to play for elite clubs like Newport and Leeds in addition to the Welsh national team. He was fast, tough, uncompromising: 1.91 meters (6 feet 3 inches) tall and weighing 115 kilograms (255 pounds), he was a workhorse between the attack and the defense. His job as a flanker was to steal the ball, bring down opponents and disrupt counterattacks. He was considered one of the toughest players of his generation. Videos show him plowing headfirst through opponents as if they were bystanders. Fans loved him for his fearlessness.
Rugby is a religion in the United Kingdom – and is far more than just a sport, even today. It represents community, fairness, courage and team spirit. Just that the athletes themselves pay a high price.
Alix Popham playing for the Welsh national team in a 2007 World Cup group match against Canada. Foto:
Laurence Griffiths / Getty Images
Popham (r.) tackling an opponent in November 2007. Foto: David Rogers / Getty Images
Even as a youth player, the trainer would tell him to charge into opponents at full speed because otherwise he would risk injury, says Popham. And if you were injured, you played anyway out of fear of losing your spot on the team. There was also little in the way of medical care – “just a single physical therapist for 50 players.”
He says he dislocated his shoulder at least eight times, tore his triceps muscle, broke his arm. His day began with coffee and pain pills, and there was also often a bowl full of ibuprofen in the middle of the locker room, he says. “We ate the things like candy.”
Running into a Wall at 30 Kilometers per Hour
In rugby, heads and bodies are constantly colliding – and not just during games, but in training as well. Week after week, for 11 months a year. In the NFL, the season lasts around five or six months, with players participating in around 30 games and training sessions per year that include blows to the head. In rugby, the total is many times that.
When rugby players slam into each other, the force is similar to a bicycle running into a wall at a speed of 30 kilometers per hour. On average, professional players suffer a concussion every 20 to 25 matches.
“The risk of lasting brain damage increases by 14 percent for every year of a player’s career,” says William Stewart of the University of Glasgow, a leading neurologist. The players, he says, have almost no breaks during which their brains might be able to recover. Stewart says he knows of former professionals who would look forward to the weekends because they would at least get a couple of breaks during matches. “During the week, they would be torn apart in training.”
In 2023, Stewart found evidence of CTE in two-thirds of the brains of deceased former rugby players he studied – damage to the white matter of the brain, fine tears in blood vessels and changes to the axons, the “wiring,” of nerve cells. All are possible causes of memory loss, motor disorders and anxiety.
A brain scan revealing CTE in an American football player. Foto: Charlotte Observer / Tribune News Service / Getty Images
The illness can only be conclusively diagnosed after death. It is similar to an avocado: You can only tell just how rotten it is once you’ve cut it open.
Popham first began noticing that something was wrong in 2019, eight years after his career had come to an end, when he suddenly started forgetting names and dates. He says he was unable to concentrate and found it unbearable when several people would speak at the same time in a crowded room. “I couldn’t understand a single word,” he says. “I had to get out.”
His wife can help with the details, he says. He refers to her as “master brain,” because she can remember things that he has long since forgotten. They have known each other since they were both in school. They got engaged, moved in together and got married all on the same date, June 3. “It’s the only date that I have to remember,” Popham says.
Melanie Popham, 46, a tall, resolute woman with shoulder-length hair, works as a personal consultant. She walks through the combined kitchen and living area and points to the two-dozen framed photos hanging on the wall. “So he doesn’t forget the things we have experienced together,” she says. Their honeymoon in South Africa. Vacations in Thailand, Croatia, Greece. And moments with their three children.
Alix Popham’s wife Melanie. He calls her “master brain” because she remembers things that he has long since forgotten. Foto: Duncan Elliott / DER SPIEGEL
In early 2019, she says, she began noticing for the first time that the man she had known for 30 years was changing. He forgot conversations they had just had. He would ask her to write emails for him because, as she later realized, he could hardly think clearly. At first, she thought stress at work might be the reason.
But it wasn’t long before Alix began having outbursts of anger “out of nowhere.” At home, he tore the stair railing out of the wall, punched a hole in the wallboard, and hit himself in the face until his eyes were blue, screaming: “What is going on in my head!?”
Melanie Popham called these outbursts “Hulk moments,” after the green cartoon figure with his otherworldly strength. Just the step of giving the incidents a name helped her understand that it wasn’t her husband having the outbursts, it was something else. The signs of his fits of anger can still be seen: the hole in the wall hidden behind a mirror; the broken railing nailed back together; a half destroyed doorknob on the ground floor.
Studies have found that CTE patients frequently struggle with aggression and violence – even committing assaults or losing all control. In late July, a 27-year-old former high school football player shot four people to death in a New York office high rise. In his farewell note, he blamed the NFL for the brain damage he had suffered – and CTE for his actions.
“I stayed because I know that he is sick. And that the man I love is still in there somewhere.”
Melanie Popham
When her husband’s violent outbursts first started, says Melanie, she would scream at him. “But that didn’t help.” Later, she would try to speak to him in a soothing voice to calm him down. But sometimes, all she could do was take the children, shut themselves in and wait for him to get ahold of himself. “He never hit us,” she says.
Still, Popham was becoming a danger to his own family. Once, he forgot that he had turned on the grill in the kitchen and flames came shooting out of the oven – right next to the highchair where their youngest daughter Darcey was sitting. Another time, he forgot to turn off the water in the bathtub, flooding the bathroom. “What the hell is wrong with you?” she screamed at him.
Then there was the incident when Popham took a bike ride through an area he knew well. But he didn’t return. He called Melanie, confusion in his voice, and said he didn’t know where he was. She had to guide him home, says Melanie. When he returned, he burst out in tears. That, says Melanie, was the turning point, and she forced her husband to go to the doctor. She thought he might have a brain tumor. They had never before heard of CTE.
After several months of tests, they received a diagnosis over the phone on April 16, 2020, a day Melanie says she will never forget. The neurologist spoke of premature dementia, likely caused by CTE. She remembers asking what could be done. “Nothing,” the doctor said. There is no treatment. Alix, he said, might be completely helpless in 10 years.
When she heard that, says Melanie, she was overcome by nausea. “We had actually been planning to have another baby,” she says, her voice breaking and eyes filling with tears. “But that would have been irresponsible in this situation.” She still wonders today if they made the right decision.
For an entire year, she said, she told nobody of the diagnosis, except their children – in part because Alix could still control himself for a few hours at a time, enough for a few phone calls or a meeting. Later, she learned that people with brain maladies frequently hide their symptoms out of fear of having to confront their problems.
“I’m Just a Burden. I’m Ruining Your Lives”
Melanie says she lived in constant fear of the next outburst. Sometimes, when she didn’t know what to else to do, she would drive into the forest and listen to the Beatles or Queen as she gazed up at the treetops – crying, thinking and hoping. There were moments, she says, when she considered leaving her husband.
Then, one day, following yet another angry outburst, Alix got onto the car yelling: “I can’t take it anymore. I am just a burden. I’m ruining your lives! I’m going to end it!” And drove off with the tires squealing.
Melanie kept calling him and sending him messages. “I love you. Your children love you. Please come home.”
But Alix didn’t respond.
When he did finally return several hours later, she says, “his eyes were full of fear.” He slumped into the sofa, she says, and asked her with an empty gaze why she was staying together with him.
Today, Melanie says: “I stayed because I know that he is sick. And that the man I love is still in there somewhere.”
Melanie made a call to the British health agency NHS. “If you don’t send someone,” she said, “then I will soon have three children without a father.” A week later, a neuropsychologist and an ergo-therapist were sitting on the couch in their home.
She searched for possible therapies, read studies and learned about how the brain works. “I became a goddamned neuroscientist.” Together, they agreed on a code word to deal with Alix’s eruptions of anger. For a time, she would yell “rugby” as a sign that he should go outside to cool down. It was her way of living with the disease.
After finishing his run on the treadmill, Popham walks out into the yard wearing just a bathing suit and a stocking cap and steps into an ice bath, built out of a modified freezer. He settles in, closes his eyes and presses his hands together as if in prayer. The coldness pushes the sickness out of his head, he says. And for a brief moment, he hasn’t a worry in the world. “I concentrate on my breathing,” he says.
Alix Popham has almost completely subsumed his life to his illness. Four days a week, he climbs into a low-pressure chamber and breathes pure oxygen. He spends 10 minutes a day in the ice bath and also uses an infrared sauna – fixed routines designed to lessen the pressure on his brain. His biggest fear is to one day become completely dependent on others, to become a patient. He has a good idea of what that would be like: He works for a construction company that also remodels care homes.
Popham taking an ice bath in a converted freezer on his deck. Foto: Duncan Elliott / DER SPIEGEL
He works a maximum of 18 hours a week so that his mind can take a break between all the online meetings. In the afternoon, he picks up his daughter Darcey from school, relying on an alarm to remind him. He writes down everything else. “I want to control what I can control.”
Fourteen areas of his brain now show damage, as a recent scan shows – including regions responsible for language, memory and emotional regulation.
“Therapy Has Changed a Lot”
But he’s also been lucky, says Popham. Not long after his diagnosis, he met an American businessman who told him about a clinic in Monterrey, the city in northern Mexico. The clinic offers radio frequence therapy – for several thousand dollars per stay.
“Professional rugby was developed for television. Fast, physically entertaining – at the sacrifice of player health.”
Sam Peters, author of the book “Concussed”
Popham flew to Monterrey in March 2021 as the clinic’s first ever CTE patient. Every day for almost an entire month, he spent an hour in a tube-shaped scanner that sent impulses to the damaged regions of his brain. The treatment isn’t yet medically approved, but Popham says it has helped him. His bouts of anger have receded, his headaches are no longer as bad as they once were, and Alix’s memory has improved. He’s been to the facility a total of three times and is planning a fourth visit soon. “The therapy has changed a lot,” says his wife.
“Professional rugby was developed for television. Fast, physically entertaining – at the sacrifice of player health,” says Sam Peters, a journalist and the author of the book “Concussed.” But even as the NFL has limited the amount of physical contact during practices, rugby, he says, has continued to adhere to the macho ethos of its amateur days. Be strong. Don’t complain.
Over the years, Peters has collected reports of affected players and their families – stories of memory loss, personality changes, early onset dementia, even deaths. He speaks of a “ticking timebomb,” saying that today’s generation of players will be affected far more often from CTE and other health issues than their predecessors because of the increased amount of physical abuse they are exposed to. “Rugby badly needs to be reformed.”
When contacted by DER SPIEGEL, World Rugby said that they are “constantly working to improve the well-being of its players.” A spokesman spoke of intelligent mouth protectors that send information via Bluetooth about how hard a blow was so that doctors can react more quickly. The association has also launched a global trial involving lower tackling so that head and neck injuries can be avoided. Other questions, the spokesman said, could not be addressed “because of ongoing court proceedings in England and Wales.”
Richard Boardman, a lawyer with the London law firm Rylands Garth, is sitting in front of his computer and scrolling through documents. “There are thousands of them,” he says, including “brain scans, neuropsychological examinations, condition reports and prognoses, case summaries demonstrating serious brain damage – everything systematically analyzed.”
He and his team represent 1,200 players before the High Court in London, including 1,100 amateur and professional rugby players and around 100 football players. One of the files belongs to Alix Popham, including dozens of pages of medical reports and a brain scan.
Boardman accuses the association of systematic failure – too much physical contact during training, insufficient medical care following concussions and the playing down of risks. The sport, he says, is primarily driven by financial interests.
Alix Popham says he knows of cases who wet their beds at night, beat their wives and forget the names of their children. “The association should have provided us with comprehensive information about the risks,” he says.
Would he have quit playing rugby had he received such information? Popham thinks for a bit before saying: “I am proud of what I achieved. But I wish I had known then what I know now.”
In the afternoon, he drives his pickup along a winding road through the forest to a nearby lake. It is a drive he has taken many times before, but he turns on the sat-nav nonetheless. “I simply can’t remember the route,” he says.
After swimming for 45 minutes and 1.8 kilometers in a wetsuit, he climbs out of the water and seems dissatisfied. “Too slow today,” he says. “Too much headwind.”
He could find a swimming coach, he says, but he doesn’t want the pressure. Nobody telling him what to do. His mind can’t take it anymore.
Alix Popham at the lake for a swim. “I wish I had known then what I know now.” Foto:
Duncan Elliott / DER SPIEGEL
Popham looks out at the water, sunlight twinkling on the surface. “I want to enjoy life,” he says, “for as long as I know how.”
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