A Reluctance to Look the Future in the Face

Introduction

On the 6th of October 2025, the world of rugby was confronted with yet another sobering reminder of the personal cost that can be associated with a career in the sport. Lewis Moody, the former England captain and a linchpin of the triumphant 2003 World Cup team, announced that he had been diagnosed with motor neurone disease ^{3, 16, 18}. At the age of 47, an age when many of his contemporaries are enjoying the fruits of their sporting careers, Moody finds himself facing an entirely different and formidable challenge ³. His public disclosure, made just two weeks after receiving the diagnosis, was characterised by a poignant honesty, admitting to a profound reluctance to "look the future in the face" ^{30, 43}. This sentiment, understandable in the face of such a life-altering condition, resonates deeply within a sporting community that has become all too familiar with the devastating impact of motor neurone disease. The news of Moody's diagnosis follows the high-profile battles with the same illness fought by fellow rugby luminaries Doddie Weir and Rob Burrow, both of whom have since passed away ^{17, 35, 37}. Their courageous and very public struggles with the disease have done much to raise awareness and funds for research, a mantle that Moody now appears poised to take up. His situation, however, also serves to intensify the ongoing and often contentious debate surrounding the long-term neurological consequences of playing elite-level rugby. The correlation between repetitive head injuries, a seemingly unavoidable aspect of the game, and the increased risk of neurodegenerative conditions is a subject of growing scientific scrutiny and public concern.

The Man Known as 'Mad Dog': A Career Forged in Ferocity and Commitment

To fully appreciate the gravity of Lewis Moody's current situation, it is essential to understand the man and the career that propelled him to the zenith of international rugby. Born Lewis Walton Moody on the 12th of June 1978, in Ascot, Berkshire, his journey in the sport began at the tender age of five at Bracknell Rugby Club ²⁰. His education at Oakham School in Rutland saw him transition from the centre to full-back, before finding his true calling as a flanker in the Leicester Tigers youth setup ²⁰. It was at Leicester that Moody's professional career was forged, making his league debut at the remarkably young age of 18 years and 94 days, a club record at the time ²⁰.

His playing style was characterised by an almost reckless bravery and an unyielding commitment to the contest, attributes that earned him the affectionate and fitting moniker of 'Mad Dog' from both his teammates and the adoring supporters ²⁰. Standing at 1.91 metres and weighing 102 kilograms, he was a formidable presence on the field, renowned for his ferocious tackling, his tireless work rate, and his exceptional ability to compete for the ball at the breakdown and in the air ²⁰. His career with Leicester Tigers spanned from 1996 to 2010, during which he made 223 appearances and was an integral part of a dominant era for the club, securing numerous domestic and European titles ²⁰. In 2010, he moved to Bath Rugby, where he continued to play with the same intensity until his retirement from the professional game in 2012 ^{3, 20}.

It was on the international stage, however, that Moody cemented his legacy. He earned his first cap for England in 2001 and went on to represent his country 71 times ²⁰. The crowning achievement of his career, and indeed for that generation of English rugby players, was the victory in the 2003 Rugby World Cup in Australia. Moody's contribution to that historic triumph was immense, his defensive prowess and relentless energy being key components of England's success. He was also selected for the British and Irish Lions tour in 2005, a testament to his standing as one of the premier flankers in the northern hemisphere ²⁰. His services to rugby were recognised with an MBE, a fitting tribute to a player who gave his all for club and country ³. Beyond the accolades and the statistics, however, it was the manner in which he played the game that endeared him to so many. He was the embodiment of courage and commitment, a player who never took a backward step and who inspired those around him through his actions. It is this same fighting spirit that he will now need to draw upon in his battle with motor neurone disease.

A Deeper Understanding of Motor Neurone Disease

Motor neurone disease, or MND, is a term used to describe a group of rare neurodegenerative disorders that selectively affect the motor neurones ^{1, 2}. These are the nerve cells that transmit messages from the brain and spinal cord to the muscles, controlling voluntary movements such as walking, speaking, swallowing, and breathing ^{5, 6}. When these motor neurones progressively lose their function and die, the muscles they control weaken and waste away ⁵. The National Health Service in the United Kingdom describes MND as a condition that causes muscle weakness that deteriorates over a period of months or years ⁴. It is a life-shortening illness for which there is currently no cure, although treatments are available to help manage the symptoms and improve quality of life ⁴.

There are several different types of MND, with the most common being amyotrophic lateral sclerosis, or ALS, which accounts for the majority of cases ¹. ALS affects both the upper motor neurones in the brain and the lower motor neurones in the spinal cord ¹. Other forms of the disease include progressive bulbar palsy, which primarily affects the muscles of the face, throat, and tongue, leading to difficulties with speech and swallowing; progressive muscular atrophy, which affects the lower motor neurones in the spinal cord; and primary lateral sclerosis, which affects the upper motor neurones in the brain ^{1, 4}. The specific type of MND a person has will influence the initial symptoms and the pattern of disease progression ⁴.

The onset of MND can be subtle, with early symptoms that are often mistaken for other, less serious conditions ^{4, 5}. These can include a weakened grip, making it difficult to hold objects; weakness in the legs or feet, which may cause stumbling or tripping; slurred speech; and muscle cramps or twitches ^{4, 8, 14}. As the disease progresses, the symptoms become more severe and widespread. Individuals may experience increasing difficulty with mobility, eventually requiring the use of a wheelchair ⁵. Swallowing and speaking can become progressively more challenging, and in the later stages, the muscles that control breathing are affected, leading to respiratory failure, which is the most common cause of death in people with MND ^{6, 8}. It is important to note that MND does not typically affect the senses of sight, hearing, smell, taste, and touch, nor does it usually impair cognitive function, although a small percentage of individuals with MND may develop a form of dementia ⁸.

The causes of motor neurone disease are not yet fully understood. In the vast majority of cases, the disease appears to occur sporadically, with no clear reason for its development ⁶. It is believed that a combination of genetic and environmental factors may play a role ⁴. In approximately 10% of cases, there is a family history of the condition, indicating a genetic predisposition ⁴. The diagnosis of MND can be challenging, particularly in the early stages, as there is no single definitive test for the condition ⁴. A neurologist will typically conduct a thorough clinical examination and may order a series of tests, including blood tests, nerve conduction studies, and magnetic resonance imaging (MRI) scans, to rule out other conditions with similar symptoms ⁴.

The Personal Impact of a Devastating Diagnosis

The news of a motor neurone disease diagnosis is a life-altering event, not only for the individual but also for their family and loved ones. Lewis Moody's public statements have provided a candid and moving insight into the emotional turmoil that accompanies such a revelation. His admission of a reluctance to confront the future speaks to the profound psychological impact of being diagnosed with a progressive and incurable condition ^{30, 43}. This sentiment is compounded by the cruel irony that, in the initial stages of the disease, the physical symptoms may be relatively minor, creating a disconnect between the gravity of the diagnosis and the individual's current state of health. As Moody himself expressed, "it's so strange because I feel like nothing's wrong. I don't feel ill. I don't feel unwell" ^{30, 43}. He described his current symptoms as "very minor," consisting of some muscle wasting in his hand and shoulder, and affirmed that he is "still capable of doing anything and everything" ^{30, 43}. This initial phase, where the full force of the disease has yet to manifest, can be a particularly challenging time, filled with a mixture of disbelief, fear, and a desperate desire to hold on to a sense of normality.

For Moody, a man whose life and career have been defined by physical prowess and an indomitable will to win, the prospect of a future characterised by increasing physical dependence is undoubtedly a daunting one. The transition from being an elite athlete, in peak physical condition, to someone living with a degenerative disease that will progressively rob him of his muscular function is a journey that will require immense courage and resilience. His primary concern, as is so often the case in these situations, is for his family. Moody is married to Annie, an interior designer, and the couple have two children ²⁰. The diagnosis has been described as a "huge shock" for the entire family, and Moody has understandably requested space for them to navigate this difficult time together ^{3, 18}. The emotional and practical challenges that lie ahead for the Moody family will be significant. As the disease progresses, the need for care and support will increase, placing a considerable strain on all involved. The role of the carer is a demanding one, both physically and emotionally, and it is a reality that many families affected by MND have to confront.

In his public statement, Moody expressed his gratitude for the support he has received from his family, friends, and medical professionals ³. He also acknowledged the debt owed to those who have gone before him in the fight against MND, whose efforts have contributed to the progress that has been made in research and support for those living with the disease ³. This sense of community and shared experience is a vital source of strength for many people affected by MND. The support networks and resources provided by organisations such as the Motor Neurone Disease Association are invaluable in helping individuals and families to cope with the multifaceted challenges of the condition ^{9, 23, 32, 41}. These organisations offer a range of services, including information and advice, emotional support, financial assistance, and access to specialised equipment ^{9, 23, 32, 41}. For Lewis Moody and his family, as for so many others, these support systems will be a crucial lifeline in the months and years to come.

A Shadow Over the Scrums: Rugby's Troubling Relationship with MND

Lewis Moody's diagnosis is not an isolated incident within the world of rugby. It is the latest in a series of high-profile cases that have brought the issue of motor neurone disease to the forefront of the sport's consciousness. The most prominent of these are the cases of Scottish international Doddie Weir and English rugby league star Rob Burrow. Weir, a beloved figure in the game, was diagnosed with MND in 2016 and dedicated the remaining years of his life to raising awareness and funds for research through his My Name'5 Doddie Foundation ^{35, 37}. His tireless campaigning and infectious positivity in the face of adversity inspired millions and led to a significant increase in public understanding of the disease ³⁷. Weir sadly passed away in November 2022, but his legacy continues to have a profound impact ^{37, 42}.

Rob Burrow, a diminutive but incredibly courageous player for Leeds Rhinos, was diagnosed with MND in 2019 ^{26, 35}. Like Weir, he chose to share his journey with the public, allowing documentary cameras to capture the devastating progression of the disease and its impact on his family ⁴². His story, and the incredible fundraising efforts of his former teammate Kevin Sinfield, have further galvanised the MND community and raised millions of pounds for research and support ^{17, 42}. Burrow's death in June 2024 was met with an outpouring of grief and tributes from across the sporting world and beyond ⁴². The shared experiences of Weir and Burrow, two men from different codes of rugby but united in their fight against the same cruel disease, have created a powerful and enduring narrative that has resonated deeply with the public.

The increasing number of former rugby players being diagnosed with MND has inevitably led to questions about a potential link between the sport and the disease. While the causes of MND are still not fully understood, there is a growing body of scientific evidence to suggest that repetitive head trauma, a common occurrence in contact sports like rugby, may be a significant risk factor. A study conducted at the University of Glasgow and published in 2022 found that former international rugby players were at a significantly higher risk of developing neurodegenerative diseases compared to the general population ^{13, 24, 28}. The study revealed that these former players had an approximately two and a half times higher risk of dementia and, most strikingly, a more than fifteen times greater risk of motor neurone disease ^{24, 28}. These findings, described as "concerning" by researchers, have added a new sense of urgency to the debate about player safety in rugby ²⁴.

It is important to note that correlation does not necessarily equal causation, and more research is needed to establish a definitive causal link between playing rugby and developing MND ^{13, 22}. However, the statistical evidence is compelling and cannot be ignored. The nature of rugby, with its high-impact collisions, tackles, and scrums, means that players are exposed to a significant number of concussive and sub-concussive head impacts throughout their careers ^{11, 25, 39, 40}. These impacts can cause damage to the brain, and it is hypothesised that this cumulative trauma may trigger the neurodegenerative processes that lead to conditions like MND and chronic traumatic encephalopathy (CTE) ^{11, 21, 27, 31, 34, 36}. The issue is not confined to rugby; similar concerns have been raised in other contact sports, most notably American football, where the link between head injuries and CTE is now well-established ²⁷. The growing awareness of these risks is forcing rugby's governing bodies to confront some difficult questions about the future of the game and the measures that need to be taken to protect the long-term health of its players.

The Unseen Injury: Head Trauma and the Quest for Answers

The potential link between a career in professional rugby and the subsequent development of neurodegenerative diseases such as motor neurone disease is a matter of intense scientific investigation and growing public concern. At the heart of this issue lies the cumulative effect of repetitive head impacts, an inherent risk in a sport defined by its physicality ^{25, 38, 39}. While the immediate and visible consequences of a concussion are well-documented, it is the long-term, and often unseen, damage to the brain that is now the focus of so much research ¹¹.

Chronic traumatic encephalopathy, or CTE, is a progressive degenerative disease of the brain found in individuals with a history of repetitive brain trauma ²¹. Initially identified in boxers, CTE has since been diagnosed in a significant number of former athletes from a range of contact sports, including American football, ice hockey, and, increasingly, rugby ^{21, 27, 34}. The pathology of CTE is characterised by the abnormal accumulation of a protein called tau in the brain, which leads to the death of nerve cells and a range of clinical symptoms, including memory loss, confusion, impaired judgment, aggression, depression, and, eventually, progressive dementia ²¹. The diagnosis of CTE can currently only be confirmed through a post-mortem examination of the brain, which presents a significant challenge for researchers trying to understand the prevalence of the condition in living athletes ^{21, 34}.

The relationship between CTE and MND is complex and not yet fully understood. However, there is a growing body of evidence to suggest that the two conditions may share some common underlying mechanisms, particularly in cases where there is a history of head trauma. Some studies have found that individuals with a history of traumatic brain injury have an increased risk of developing MND, and the pathological features of CTE have been observed in the brains of some individuals who have died from the disease ^{22, 24}. This has led to the hypothesis that, in some cases, repetitive head impacts may trigger a neurodegenerative cascade that can manifest as either CTE, MND, or a combination of both.

Recent research has begun to shed more light on the biological changes that occur in the brains of rugby players who have experienced multiple concussions. A study led by researchers at Durham University, as part of the UK Rugby Health Project, found that retired rugby players with a history of concussion had abnormal levels of certain proteins in their blood that are associated with neural damage and are known to play a role in the development of Alzheimer's disease and MND ³³. This research suggests that it may be possible to develop blood-based biomarkers that could be used to monitor the brain health of athletes and potentially provide an early diagnosis for neurodegenerative diseases ³³. Such a development would be a significant breakthrough, allowing for earlier interventions and a better understanding of the risks associated with contact sports.

The response from the rugby authorities to this growing body of evidence has been a subject of considerable debate. While there has been an increased focus on concussion management and player welfare in recent years, with the introduction of head injury assessment protocols and return-to-play guidelines, many critics argue that these measures do not go far enough. There are growing calls for more fundamental changes to the way the game is played and coached, particularly at the youth level, to reduce the overall exposure of players to head impacts ^{28, 34}. Suggestions have included limiting the amount of contact training, reducing the number of matches in a season, and even modifying the rules of the game to reduce the frequency and severity of collisions ^{28, 39}. The challenge for the sport is to find a way to mitigate these risks while preserving the essential character of the game that is so beloved by players and fans alike.

A New Battleground: Channelling Adversity into Advocacy

In the face of his life-altering diagnosis, Lewis Moody has already signalled his intention to confront his illness with the same determination and fortitude that defined his rugby career. While his immediate priority is, quite rightly, his family, he has also expressed a desire to use his platform to support others affected by motor neurone disease and to contribute to the ongoing search for effective treatments and a cure ³. This transition from athlete to advocate is a path that has been trodden with immense courage and impact by both Doddie Weir and Rob Burrow, and it is clear that Moody has been inspired by their example.

Moody is no stranger to the world of charitable work. In 2014, he and his wife Annie established The Lewis Moody Foundation, a charity dedicated to supporting families affected by brain tumours ^{7, 10, 12, 15, 20}. The foundation was inspired by a young rugby fan, Joss Rowley-Stark, and its work focuses on raising funds for vital research, promoting awareness to reduce diagnosis times, and providing respite for families living with the daily challenges of a critical illness ^{10, 12, 20}. The experience and infrastructure that Moody has built up through his foundation will undoubtedly be invaluable as he now turns his attention to the cause of motor neurone disease. In his public statement, he announced his intention to "create an opportunity to support a charity closer to my current situation" and expressed his hope that he would be able to share more details of his plans in the near future ³.

The response to Moody's announcement from the rugby community and the wider public has been one of overwhelming support and solidarity. Tributes have poured in from former teammates, opponents, and fans, all expressing their admiration for the man and their sadness at his diagnosis. This collective outpouring of support is a testament to the high regard in which Moody is held, both as a player and as a person. It also reflects the growing awareness and understanding of motor neurone disease within the rugby family, a direct result of the tireless campaigning of Weir and Burrow. The foundations they have laid have created a powerful sense of community and a shared determination to tackle this devastating disease.

The challenges that lie ahead for Lewis Moody are immense, but his resolve to face them head-on is already apparent. His journey will be a difficult one, but in choosing to share his story and to lend his voice to the fight against MND, he has the opportunity to make a profound and lasting impact. The world of rugby has witnessed his strength and resilience on the field of play for many years. Now, it will witness those same qualities being brought to bear on a far more important and personal battle.

Conclusion

The diagnosis of motor neurone disease in a figure as prominent and respected as Lewis Moody serves as a stark and poignant reminder of the human cost of this devastating condition. His personal struggle, now thrust into the public eye, will undoubtedly resonate far beyond the confines of the rugby world, adding a powerful new voice to the growing chorus of those demanding greater action in the fight against MND. The courage and candour with which he has spoken about his diagnosis, and his expressed desire to channel his energies into advocacy and support, are in keeping with the character of a man who has always led from the front.

Moody's situation, however, cannot be viewed in isolation. It is part of a deeply troubling pattern of neurodegenerative disease affecting former elite rugby players, a pattern that can no longer be dismissed as mere coincidence. The scientific evidence, while still evolving, points with increasing certainty towards a causal link between the repetitive head trauma inherent in the sport and the elevated risk of conditions such as MND and CTE. This presents an existential challenge for the game of rugby, a challenge that requires a response that is both urgent and comprehensive. The welfare of the players, at all levels of the game, must be the absolute priority. This will necessitate a fundamental re-evaluation of the way the sport is played, coached, and governed, with a view to minimising the exposure of players to the risks of long-term brain injury.

The stories of Lewis Moody, Doddie Weir, and Rob Burrow are not just stories about rugby players. They are stories about husbands, fathers, and sons, whose lives have been irrevocably altered by a cruel and unforgiving disease. Their bravery in the face of adversity has inspired a generation and has galvanised a community into action. It is now incumbent upon the world of science, medicine, and sport to honour their legacy by redoubling the efforts to understand, treat, and ultimately cure motor neurone disease, and to ensure that future generations of athletes are not forced to pay such a heavy price for the game they love.