Dominic Ryan: The terrifying concussions which have forced my retirement

A year ago playing for Leicester Tigers in the Aviva Premiership, Dominic Ryan thundered into Wales and Lions winger George North, unaware that the tackle would be the beginning of the end of him playing professional rugby. Today in The Irish Times he publicly announces his retirement.

Ryan, 28, offers unflinching honesty in describing how concussion destroyed his hopes of revitalising a career that had become a little stagnant at Leinster; how a once outstanding, teak-tough flanker who thrived on big hits was consumed by anxiety and self-doubt.

He recounts the terrifying symptoms, the sleepless nights, the two-week migraines, the flashing white lights, the pounding pressure building in his head, the dizziness and nausea, before he eventually realised they were not normal for a healthy body.

It’s a salutary tale vacillating from blind courage to self-delusion, one that points a spotlight on brain trauma within sport and the disturbing manner in which some sportspeople are conditioned or hardwired to think differently, even when the signs are fateful and obvious, and how they refuse to believe the plain truth that is right in front of them.

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The Beginning Of The End

September, 2017, Northampton Saints v Leicester Tigers, Franklin’s Gardens:

I started on the bench and came on two minutes into the second half as a replacement for Brendon O’Connor, who had gone off with a hamstring issue. I was playing really, really well.

I was happy, tackling aggressively and carrying hard. The ball went wide to [Northampton Saints wing] George North and I tracked across from a midfield ruck. I was thinking, ‘I am going to make an important tackle here that will be remembered’. I ran as fast as I could, whacked him with everything I had and put him into touch.

I woke up, exhaling deeply. I was badly winded. The physios were over me saying, ‘are you alright, are you alright’. I said, ‘yeah, yeah, just give me a second, I am winded’. I was winded.

If you get knocked out like that it is a split-second, flick of the lights, on and off. People think to be knocked out you have to be out for 30 seconds. The reality is that it is a flick of the lights, a reset of the brain. I wasn’t aware at the time if I was knocked out, so I played on, injuring my shoulder later on in the second half.

I had my head on the wrong side [in the tackle] but to me as a player you are primitive, you’re an animal, and the sole focus is to take that person down. I don’t care how I do it. You rely on instinct. I’m not thinking for the George North incident, ‘left shoulder tackle and my body on the right side so my head is out of harm’s way’. I’m thinking, ‘he’s about to bloody score so do what you can to put him into touch’.

One of my attributes was physicality and a lack of respect for my body. It sounds stupid but if you were to take that away from me, it’d be like taking away Johnny’s [Sexton] decision making or Jack McGrath’s scrum work.

No HIA

On the basis that he was ‘winded’ Ryan didn’t undergo a Head Injury Assessment (HIA) during or after the match and the following week managed eight minutes off the bench against Gloucester, his third match for the club having made his debut against Bath, on the weekend prior to the Saints game. He was picked to start against Harlequins at the Stoop the following weekend.

Officially Knocked Out

Going down to the Stoop I remember being on the bus and feeling that nervous excitement I had going to the Aviva as a 21-year-old. It was exactly what I was looking for moving over to England, that hunger to play rugby which I feel I lost towards the end of my career in Leinster. I had the butterflies in my stomach that I hadn’t had in years.

Seven minutes into that game we had a lineout about five or six metres out. I came from the back to hit in on the ball and our hooker Tom Youngs, who was joining the lineout, latched on beside me. He accidentally clipped the side of my head, really lightly, a gentle tap. The next thing I am on the ground, the ball is under my stomach and I'm lying flat on it.

I hear, ‘Dippy, Dippy get the ball back, get the ball back’. I squeezed the ball through my legs. Getting up from the maul I was a bit shook. When you get knocked out briefly, you start to think, ‘was that a big bang, was I stunned or knocked out?’ I thought to myself, ‘I’ll shake it off’ so I played on. Two or three minutes later I was aware of feeling dazed, disorientated and had started seeing big patches of white lights.

This was everything I wanted as a 27-year-old, to start a big Premiership game and my body had let me down

Having been to a neurologist before the first sign of a migraine is usually a visual symptom; for me it was big white patches. Some people get blurred vision, some get tunnel vision but I got big patches of white, blind spots essentially in my range of vision. I said to myself: ‘you are not being a hero by staying on. Your brain is telling you that there is something wrong. You need to come off’.

I signalled to the physio while ’Quins were taking a penalty and said to him, ‘look I’m seeing flashing lights here’. He took me off the pitch, reviewed the footage and [saw] that I was visibly out. I underwent a HIA and failed. I went to the changing room and got changed. I was really annoyed that it happened again. I know it sounds stupid. My career to date had been a bit injury-ravaged.

Matt [O’Connor, the Leicester Tigers coach]) wanted me and I wanted to go somewhere where I was wanted. He knew I came from a good background in terms of the culture at Leinster and a winning pedigree and he wanted to bring that into Leicester. I relished the new challenge, new league, new living arrangements, new coaches; having to make 50/60 friends in terms of the whole squad. I loved it over there.

I had temporarily lost my excitement for rugby maybe through rejection, not being wanted; being on the outside looking in when everyone had been fit and available at Leinster. Don’t get me wrong I loved my time at Leinster and they will always be my team but I knew that I had to move if I wanted to be a first -choice player.

This was everything I wanted as a 27-year-old, to start a big Premiership game and my body had let me down. That was quite hard to take. I ripped off my tape, throwing it on the ground, really pissed off.

Tom Youngs said to me subsequently, ‘ah what happened to you Dippy boy, you fell under me. I went to latch you and you just collapsed to the ground’. That was confirmation for me that I was definitely knocked out. He said that I literally fell to the ground like a stone.

Neurologist

Ryan had concussions in February and April of 2017, during his final few months at Leinster. After the latest concussion at Harlequins he was sent to see Dr Richard Sylvester, one of the leading neurologists in London.

He ruled me out for 12 weeks. He said, ‘look you have had time off since your last concussion in April’. I was worried about my health, not about who’s right or wrong. I wanted to tell the doctor honestly that I believed I was knocked out two weeks prior to that [in the Saints match], and not just winded.

He said: ‘you had 12 weeks off during the end of last season/summer. That’s probably long enough for your brain to heal but I don’t know. It’s very hard to say that they are related but evidently you have not had enough time between the Northampton game and this incident. And you have had four in seven months so I am going to rule you out for 12 weeks’.

That sidelined me until the second weekend of the Heineken Cup matches in December. It is not an injury you can say that after 10 weeks I am going to rush to get back. At that point I was concerned about my head.

In A Dark Place

The months following the Harlequins match were dark for me, mentally and physically, because I spent a great deal of time in my bedroom with the curtains closed. I had sensitivity to light and I was getting migraines.

I took about two weeks off, feet up, completely relaxed, because I was going to be off for 12 weeks. About the 13th of October I did a weights’ session. It was only an introductory weights’ session because you did everything at a graduated pace.

About 20 minutes after completing it I went out to watch the lads train and I started to get tunnel vision. My peripheral vision blurred and I got white patches that flashed. It resembled looking at fireworks through binoculars. I could only see what was in front of me. I said to myself, 'Jesus Christ this is bad'. It brought on the worst migraine. I had had migraines before around concussions but only directly related to trauma.

This was the worst. I couldn’t talk on the phone. I found people talking in my ear irritating. I remember going out for coffee with the lads, it wasn’t even a sunny day and I had my sunglasses on. It sounds stupid but that little bit of extra darkness the sunglasses afforded me helped.

That migraine lasted two weeks. It was intense for about five or six days. Going over ramps in a car I had to ask whoever was driving to slow down, crawl over them, because my brain was properly humming, absolutely pounding. The club sent me home for a week to recuperate. People had begun to ask why I wasn’t playing.

When I returned to Leicester I resumed weights, got through the first session and then gradually started lifting heavier loads. I started to feel dizzy and a pressure in my head building when doing heavy squats and heavy resistance work.

Return To Play

I took no contact, rugby wise, in those 12 weeks. I was very diligent. The first day back I did light bag hits. On the second day I stepped it up a little and then didn’t do anything for the next 24 hours. The fourth was December 22nd, the day before I was going home on a five day break.

I wanted to step up the rehab so I could go home with a positive mindset. A physio accidentally caught me with his elbow while I was hitting bags. It was the biggest bang I had received to my head in 12 weeks. I felt quite dizzy. A particular thought process overrode the warning signs. I hadn’t had a bang in months and it might be my body getting used to things again.

I went in to the changing room, feeling really weak. I had a shower, grabbed some food and started to feel nauseous. I got into my car to go to the airport and just before leaving rolled down my window to say goodbye to one of my mates on the team, Kyle Traynor.

He looked at me and said ‘are you alright? You are very pale’.

I said: ‘no, I don’t feel well.’

He advised me not to drive for the moment. We went back into the team room and I fell asleep for 40 minutes. I was wiped. I drove to Birmingham Airport and started to feel sick on the plane, vertigo type symptoms. For several days I didn’t feel well.

Castres, A Rugby Swansong

Ryan returned to Leicester on December 27th and told the medical staff about the incident. They instructed him to report any further issues. He was non-playing 24th man for the New Year’s game and trained that week, suffering dizziness after a couple of impacts. The club, essentially out of Europe having won one of their four matches to date wanted him to prove his fitness in the away tie against Castres in January, to demonstrate that he would be a viable contender for selection in some important upcoming Aviva Premiership matches.

We were under the pump in the league. It was absolutely fair of him [Matt O'Connor, Tigers' coach] to ask me to play in that match. It was four weeks after the original return date, so I hadn't been rushed back. The week before I returned to play I held a tackle bag for [secondrow] Mike Fitzgerald and my head snapped forward twice. The dizziness returned.

The backs did a few but they don’t hit hard. Mike returned and rocked me twice more and suddenly the whole stadium began to sway. I knew I wasn’t right. I said it to the doctor on the Monday and he said, ’that doesn’t sound right’. He asked me what I want to do about it. I said, ’I don’t know, I’m four weeks over my return to play date, am I over-thinking things?’

I said, 'No, my head's at me.' He asked: 'Why the hell didn't you tell us?'

I was asking lads ‘do you feel dizzy after a knock?’ The answers were largely, sometimes yes, sometimes no. Others were like no, never. It was a stupid question to ask people. I decided to go really hard in training the following day and if I had any issues subsequently I wouldn’t play at the weekend.

Training went really well, I thought, ‘I’m back’. Then we did contact and I didn’t quite feel 100 per cent but it’s rare that a player is. In training you’d go hard for 30 or 40 seconds where you’d make one or two big collisions and then you’d break up for a couple of minutes. I had a chance to compose myself between sets. The internal monologue went something like, ‘how are you feeling Dippy? Good. You will play then’.

About 11 minutes into the [Castres] game I was involved in a big collision; tackled, I hit the ground hard and my head bounced. I wasn’t right, dizzy again. It happened three times in the first half. The dizziness lasted for a couple of seconds before clearing.

At half-time the forwards and backs split up and I stared at the wall, thinking about how I was going to get through another 40 minutes? This, after all, was my 80-minute window to be employed for the next year. The forwards were talking about the lineout and I was staring at this white wall, trying to fight a rising sense of dread.

Emotional Breakdown

It happened again at the start of the second half, another dizzy spell. Five minutes later I am standing outside 10, a secondrow outside me and another player standing inside me. I was in the perfect position to carry as a forward. Joe Ford shouted over to me, 'Dippy, Dippy carry this ball'. I thought, 'I'm not carrying this' because I felt I was now waiting to be knocked out. I grabbed the secondrow threw him inside and said, 'you carry and I'll latch you through. Normally I'd be knocking lads out of the way to carry.

I was taken off after 55 minutes, predetermined because it was my first game back. The physio went to each player taken off, ‘you alright, you alright? Dippy, you alright? Well done, well played’.

I said, 'No, my head's at me.' He asked: 'why the hell didn't you tell us?' I sat in a chair at the side of the pitch beside one of my good friends and team-mates Gareth Owen. That phrase kept ringing through my head, 'why didn't you tell us, why didn't you tell us?'

I started crying uncontrollably, bawling. Gareth said, ‘get inside, don’t let people see you like this’. It dawned on me the reason I didn’t tell was because I knew it was very serious. I was trying to convince myself I was alright. I relished contact all my life. But now I was scared of it. It was making me feel dizzy. That’s why that question, ‘why didn’t you tell us,’ kept running through my mind like a tickertape over and over again. I surmised that deep down the reason I didn’t tell them because I suspected I was finished there and then.

Back To The Neurologist

I went back to the neurologist, Richard Sylvester and the news wasn't great. He explained that despite time off, having only six to eight weeks contact in the last 12 months, there were obviously still issues and that some of my symptoms sounded vestibular in nature. He sent me for tests to Professor Luxton. They proved inconclusive, highlighting a problem with my ear canals but Professor Luxton, she said that if she scanned a lot of rugby players most of them have similar abnormalities because of the nature of the game.

She put me on a course of vestibular rehabilitation, which took me up to mid April. I returned home in May to the family house. One day while bouncing on the trampoline with my little sister and the dog, I felt pressure in my head; with each bounce it was getting sorer. I got off and sat down. I tried a couple of weeks later with a similar outcome.

The neurologist had told me the previous January: ‘if you still have symptoms in the summer the decision is easy for me, it’s clear-cut; you are not playing again. If you are symptom-free and you feel great, I still want you to come to me. Anyone who plays rugby is susceptible to being knocked out. Before you might ever consider playing again you come see me because I want to talk to you about the dangers of resuming your career’.

That trampoline incident did scare me but I went on holidays in June, came back feeling great, and resumed weights and fitness training.

The Point Of No Return

In July Ryan enlisted one of his former physios and ditto a former coach to run through the return to contact process. He wanted closure, something he readily accepts appears ludicrous to most people, given his experiences in the preceding months.

The pressure in my head built, the dizziness returned as the session unfolded. I stopped at that point. I went back to the neurologist in London and we had a long chat. He told me that there were players that presented with worse symptoms than I had who haven’t retired but he’s had people not as bad as me who have said, ‘I have had enough’. My case was in between the two extremes, but definitely towards the bad end of the spectrum. He advised that I should call it a day and that if I retired he would support my decision.

As a player rugby is your passion, your joy, your life. Richard Sylvester understood the demands of my job pointing out that I was okay to be a regular Joe but not okay to be a rugby player. For me it was getting to the point that another knock or two could affect me being a regular Joe. For me coming to terms with it was very difficult, despite everything.

Throughout all this, I had family and friends saying they were worried about me, particular after I was stood down for the remainder of the season in January. That was the first time that they opened up to me. They asked me, ‘what did the neurologist say?’ I told them he said I might have to retire if my symptoms don’t go away. My friends and family were grateful because they didn’t want to be the first ones to bring it up.

I’m relieved; it’s a weight off my shoulders. Pardon the pun but with a bit of distance I can see it was a no-brainer to retire. I can see now I was literally putting myself in harm’s way.

The last year hasn't soured my relationship with the sport, I still love rugby

I am not an anxious person but from that time getting knocked out in September I wasn’t sleeping until two or three in the morning, not just worrying about my head but worrying about being in Leicester and not being able to play, letting people down. I moved to England to play rugby and now I couldn’t. When was my head going to be better? I had many sleepless nights over it.

When I came home, before and around Christmas time, my mum asked me a few times if I was alright. I didn’t disclose too much detail. I had told Richard [Sylvester, neurologist] about the anxiety and said, ‘look I’m not sure it’s to do with my head issues’.

He replied that ‘whether it’s a direct or indirect result, you are still experiencing it as a symptom of being concussed. It doesn’t matter if your brain is releasing chemicals that make you anxious as a result of the blows or it is a subsequent component of being knocked out, it’s not a good thing’.

I am not an anxious person but I was anxious as hell over there.

I told some of this story to people not involved in professional sport and they have said, ‘you didn’t need to go to a doctor, I’d have told you to stop, that you shouldn’t play anymore’.

I know people will look from the outside and think I should have been saved from myself. I get that and with some distance from my rugby career I will probably appreciate it even more but when you are at the epicentre, when it means everything, you’ll go way beyond what others think is reasonable.

If I had played for Ireland 15 or 20 times I think I would be very content with my career. I just wish I had played for Ireland more. I suppose the bottom line is that no one cares who you are after you retire. Rugby gave me character traits that I will carry for life, lifelong friendships and it gives you a financial head start. That is rugby for me in a nutshell.

The last year hasn’t soured my relationship with the sport, I still love rugby and it has given me amazing opportunities and experiences that are unique and a lifetime of memories that I otherwise would have missed out on. It’s most important for me to acknowledge the unstinting support I have received from mum, Jackie, dad, Neville, my three sisters, Alison, Rachael and the most vocal of the lot, Clodagh.

A special mention to my girlfriend Kate, who has been with me from day one, through the highs and lows. Their selflessness in supporting me is something for which I am deeply grateful and forever thankful.

Epilogue

Dominic Ryan won one cap for Ireland against Georgia in 2014, played 20 times for the Ireland Under-20s and also represented the Wolfhounds and Emerging Ireland. A product of Gonzaga College, UCD, Lansdowne and the Leinster Academy, he made 113 appearances for Leinster scoring 18 tries in eight years with the province. In the summer of 2017 he joined the Leicester Tigers on a one-year contract, making five appearances. He is migraine-free since his last collision with a tackle bag.