Everything hurt. Rugby does that. A disc in Aly Muldowney’s neck jutted into his spinal cord. His ankles never let him forget a teenage basketball habit. His knee had anger issues. And that was just the physical stuff.
There are days you can call depression an absence of pain, an absence of anything, and others when it hurts like a stab wound, like someone is garrotting your soul. Depression was his mind’s response to just how much life hurt, dulling everything to dull the pain.
He sat in team meetings at Connacht and Exeter Chiefs where everyone talked across each other, every sound gradually crushing his head from the outside. Even a team talk over-running by a few minutes broke him piece by piece. It all hurt more because he couldn’t say anything, because even he didn’t know where it came from, because no one would have listened or understood if he did.
Then, midway through a two-year stint at Grenoble, club doctors prescribed 200mg of opioid painkiller tramadol before and after matches for persistent neck problems.
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Tramadol worked spectacularly well. Too well. Soon he took it constantly, first facilitated by doctors, then by less legitimate means. Until it was banned by WADA in 2022, there was a thriving underground tramadol trade around Europe’s rugby clubs.
“I started taking painkillers so I’d be happy and cheery, but then I’d have to take more and more to keep happy, and it just got too much. It was a problem,” Muldowney says.
“You want to take them because they make you feel good, but you need to take them because otherwise people are going to be on your back telling you what a shit person you are because you don’t fit into the norm. Because you’re neurodivergent.”
A lock who looks the part, 6ft 5in and bearded with tattoos daubed up both bulbous arms, Muldowney was diagnosed with attention deficit hyperactivity disorder (ADHD) in 2021, having started the diagnostic process while at Bristol Bears. ADHD is one of a range of conditions covered by the umbrella term of neurodivergence, a difference in brain function from the wider population, estimated to affect around 15 per cent of people. Other neurodivergent conditions include autism, OCD, dyslexia and Tourette’s.
Muldowney is also pursuing a formal autism spectrum condition diagnosis on doctors’ advice, but NHS waiting lists are delaying that process – more than 212,000 people are currently awaiting assessment in the UK. The story of his diagnosis is increasingly common, the product of self-reflection after his son Arlen was diagnosed as autistic while the family were based in Grenoble.
A late starter, Muldowney didn’t play professional rugby until he was 27, joining Glasgow Warriors after winning the now-defunct National Trophy with Birmingham-based Moseley. Two years at Exeter followed, before the most successful period of his career under Pat Lam at Connacht, helping the club to their first ever Pro12 win in 2016 having been named their “Team Man of the Year” in 2015.
Muldowney played for Exeter Chiefs and Bristol Bears in the Premiership (Photo: Getty)He talks of Lam as the best coach of his professional career, “a lot better” at checking on his welfare than others. When Muldowney’s Grenoble stint fell apart, signed off on sick leave, addicted to tramadol by day and needing Zopiclone – a prescription insomnia medication – just to sleep through his anxiety at night, Lam signed him in Bristol. His neck injury worsened almost immediately upon arrival and he admits now he should have retired then, but he felt he owed his old coach.
As grim as withdrawal was, Muldowney stopped taking tramadol immediately after his career ended in 2020. It transpired the trigger was rugby, underpinned by a hyper-masculine, hyper-competitive environment which all too often considered, and considers, difference to be weakness.
Now 41, he talks of elite rugby as a brutal hellscape, simply reflecting how it made him feel, drowning in failures of basic safeguarding and care which largely persist. Across the men’s game, neurodiversity provision and education are almost non-existent. When he announced his diagnosis in November 2023, the only people within rugby to contact him were a few former teammates, whose messages were variations on the theme of: “I knew there was always something wrong with you.”
“Essentially, all coaches won’t care. If I’m burnt out, or struggling in the meeting, and I need time on my own or any time away, they’re not going to care.
“Every day you do monitoring. You put your body weight in, you put how you’re feeling. I’d be honest in a lot of them, but no one cares. You’re a piece of meat. What can you do on Saturday? That’s all it comes down to.
“They’re going to drop you if you miss a training session or miss a video analysis session, it doesn’t matter why.
“They’re not going to understand or really care how much pain could happen sometimes, sitting in a room full of people, loads of different noises, watching a video for one, two hours sitting still.
“Even nowadays, they won’t care. They’ll say they will. They’ll be in the papers, they’ll be tweeting, they’ll be saying all these things, trying to get brownie points. But when it comes down to the brass tacks of selection, they’re not going to care. At all.”
This story could be complicated by Muldowney not being diagnosed while he was still an active player, but this is about any difference as much as it is neurodivergence. Diagnosis should not be a prerequisite for sufficient care and understanding, for respecting every player’s needs.
Muldowney’s view of rugby reflects James Haskell’s comments to The i Paper in April 2023 as he explored his own ADHD diagnosis, saying: “In rugby, the mental side is massively neglected, it’s not on most people’s radars.
“They don’t understand how it works. Most teams have psychologists, but coaches don’t believe in its importance, so they’re always on the periphery. It’s very backwards.”
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There are fundamental questions here about how Muldowney was not diagnosed earlier, why he didn’t believe he could speak to anyone about how he felt and why he is one of a handful of Premiership players to publicly reveal their neurodivergence. How he was forced to the point of a painkiller addiction, and why he says he would have retired earlier had he been diagnosed earlier.
“There were some horrendously low moments [in my career], times you just don’t want to be here in life, times you don’t want to be on the planet. I don’t want to be around anyone. I don’t want to see anyone. Don’t want to do anything, don’t want to live, I don’t want to be absolutely anything.
“But then you kind of get through because I’ve got three children, a wife. You analyse it – what effect will that have on them? You might think it’s easier for you, but then you’re putting a burden on them for rest of their life, not just financially but emotionally.”
Haskell and Muldowney are two of three current or former Premiership players who have revealed ADHD or autism diagnoses, alongside ex-England wing Jonny May. Other elite neurodivergent players include Henry Slade, who has OCD, while Scott Quinnell, Lee Byrne, Tom Harrison and Chris Robshaw have all also disclosed their dyslexia diagnoses.
Jonny May (left) and James Haskell (right) are both neurodivergent (Photo: Getty)Yet this cohort being so small is indicative of the wider culture of silence and ignorance around neurodiversity in men’s rugby, embedded in the prevailing fallacy of a “one size fits all” team spirit, the idea that equality comes from treating all players the same, rather than offering equal levels of individualised care and support.
This is a crisis so deeply ingrained into the men’s game that the vast majority will not even recognise it as a problem. While The i Paper understands that the RFU’s diversity team have begun the early stages of neurodiversity training, there is no mention of neurodivergent conditions across any of their current diversity and inclusion policies.
What Muldowney found most difficult was the expectation to do everything as a group, to always subsume into a whole off the pitch.
He speaks a lot about the psychological impact of masking – altering your behaviour to fit societal norms and expectations – a common trait among neurodivergent people. He requested his own hotel room on away trips, a place to unwind and just be himself, alone. This was considered “unsociable” and repeatedly turned down.
“It’s just the fatigue, and I’m not talking about physically – we’re all physically tired,” he explains. “I don’t think people understand how masking affects you. You spend your life trying to fit in, not trying to be yourself, to be too much. It’s so tiring.
“And obviously when you’re tired, you’re down, you’re quiet, and then you end up getting depressed because of all the fatigue that comes off the top of that – being a professional athlete and then masking all day, every day, on top of that.
“I played a character that you’d be happy with and accept, then went home and was absolutely exhausted and stressed, really bad anxiety and depression.
“It’s heartbreaking to be told you are not good enough and have a negative effect on the team for being your true self. That’s the main reason I would take the tramadol – to help me mask when I didn’t have the energy myself.”
Muldowney recently started a role as neurodiversity coach for juniors at his local club Stoke-on-Trent RUFC as he continues to navigate life post-diagnosis. He doesn’t want to coach formally, this is more about mentoring and offering an understanding sounding board.
Day-to-day, he keeps his distance from elite rugby, working as a procurement manager at Wolverhampton University while studying for a masters degree in leadership and management at Northumbria. It’s a different life, but one he makes work for him.
“Recently I’ve been contemplating more how I am around other people, realising how I’ve had to play different characters all the time around people. You try and mirror personalities to fit in.
“I was taking tramadol and loads of other things to try and stay in character. It’s more about accepting myself and being myself. F**k people, basically. I’ve got no time for it anymore, it’s no good for me. It makes me poorly. I’m sick of being in pain.”
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