Understanding CTE: The Origins and Ongoing Troubles Plaguing Contact Sports

NFL takes a hard look at concussions and protocol after years of public outcry

Hedija Spahalic

When Tua Tagovailoa, the quarterback for the Miami Dolphins, suffered a major hit during a game against the Buffalo Bills in Week 3 of this year’s NFL season, many were concerned after he was cleared to return to play so soon.

Despite being visibly unsteady on his feet at the time, four days later he was hit again during a game against the Cincinnati Bengals. The hit resulted in him being knocked unconscious and Tagovailoa was immediately placed in concussion protocol and briefly hospitalized.

Concussions, which are the most frequent head injuries among athletes in contact and non-contact sports, were first distinguished from other similar head traumas by Abu Bakr Muhammad ibn Zakariya Al-Razi in the 9th century. Al-Razi is widely considered to be the world’s greatest Muslim physician.

Scientists, researchers and athletes alike have fought for the severity and prevalence of head injuries to be taken more seriously by the National Institute of Health (NIH), specifically chronic traumatic encephalopathy (CTE).

CTE is described as a “repetitive close-headed injury that occurs due to years of playing a variety of contact sports such as boxing, football, rugby, hockey, or lacrosse.” A diagnosis for CTE can only be made posthumously.

Recently, their pleas were heard.

The NIH is the largest biomedical research agency in the world. In July, a panel of scientists and researchers found a causal link between traumatic brain injuries in contact sports and CTE.

This conference supported the US Centers for Disease Control’s (CDC) 2019 statement, which affirmed, “The research to date suggests that CTE is caused in part by repeated traumatic brain injuries, including concussions, and repeated hits to the head, called subconcussive head impacts. However, understanding among researchers about the causes of CTE is currently limited.”

However, despite two leading independent medical research facilities being in agreement, the Concussion in Sport Group (CISG) downplays the seriousness of the connection. This organization is backed by major sports organizations such as FIFA, the IOC and World Rugby.

CISG has published concussion consensus statements by lead author and Australian neurologist, Paul McCrory, who has called concussions “transitory” and CTE coverage in the media “hoo-hah”.

The group’s most recent consensus was published in 2017 and was led by McCrory. It states that “a cause and effect relationship between CTE and concussions or exposure to contact sports has not been established.”

Yet, in a study conducted by Boston University in 2017, they found that 99% of deceased NFL players from their research (110 out of 111) had CTE. The study outlined the relationship between the number of years contact sports are played to the severity of their CTE diagnosis.

“There are many symptoms that are frequently seen in individuals with CTE, such as aggression, impulsivity, and other mood/behavioral and cognitive problems,” Bobak Abdolmohammadi, Research Data Analyst and a contributor to the Boston University study said.

After the Tua Tagovailoa incident, the NFL and the NFL Player’s Association (NFLPA) responded to league-wide calls for change in concussion protocols. The new changes removed a loophole and changed the “gross motor instability” requirement to “ataxia”.

In short, the change removes the orthopedic loophole that allows players to get examined and back into the game so quickly.

“Our union will continue to follow the data when it comes to this serious issue, especially when we know that in many cases, the true impact on players may not be realized for years down the road,” the NFLPA said in a statement.

Issues when it comes to recognizing head injuries during NFL games are still frequent.

This week, DeVante Parker, a wide receiver for the New England Patriots, was seen getting up shaky and unsteady by fellow teammate Nelson Agholor.

Once Agholor noticed, he began frantically trying to get the officials’ attention and took a knee before the next play began. Critics have spoken out about how spotters could have missed Parker showing concussion symptoms.

After the game, Parker posted on his Instagram story calling out the NFL and thanking Agholor for signaling to stop the game. The NFL and NFLPA said they would be reviewing the circumstances surrounding Parker’s concussion and how the officials could have overlooked it.

Several former players and sports organizations have called for more research to be done to help come up with ways to identify CTE in patients who are alive.

Jake Plummer and Jeb Putzier, former NFL teammates, both said they would be joining other players in donating their brains to science for further CTE research after their deaths.

“Studies are underway which are aiming to better understand the clinical picture of CTE, especially considering the overlap in symptoms between CTE cases and other neurodegenerative diseases,” says Boston University’s Abdolmohammadi.