Football’s CTE problem is real—divulging the NFL’s dismissal of the disease and downplaying of concussion issues

As evidence piles on, football’s burgeoning concussion and subsequent CTE problems will only grow if the NFL continues its lackluster course of action. [Bill Chan, AP]

In the midst of a trade request, helmet-gate, and social media exposé, NFL wide receiver Antonio Brown has lived quite the spectacle. In a matter of months, his reputation veered into an infamous example of career decimation.

Speculation surrounding his antics have raised serious questions about his mental health. Inevitably, some have suggested Brown’s erratic behavior a result of the NFL’s longstanding taboo: chronic traumatic encephalopathy, or CTE. While it’s unwise to diagnose players from speculation, it does again bring CTE to the forefront of football discussion. As the CTE revelation continues to amplify, the NFL still remains coy towards a responsible course of action.

CTE is a degenerative brain disease linked to professions with repetitive head trauma—athletes, veterans, and fighters [1]. Tau proteins, abundant in central nervous system neurons, undergo excessive clumping throughout the brain that kills functioning cells [1].

Normal brain tissue (left) alongside brain tissue exhibiting severe CTE (right). Brown shades indicate extensive areas of defective tau protein.

Symptons of CTE are lethal—the extensive list is daunting: paranoia, memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, suicidality, parkinsonism, and dementia [2].

There are no current diagnosis methods for the disease. Even worse, there is no cure. Select symptoms can be treated through cognitive therapies, but most are inoperable [1]. Clinical research targets the development, progression, and diagnosis of the disease, but the current treatment landscape is grim [2].

Football’s connection to traumatic brain injury is widely known—the consequences lived by former NFL players depicts the frightening truth. Packers legend Brett Favre questions playing for so long. At 20 seasons, he details hundreds, if not thousands, of undiagnosed concussive hits that resulted in early memory loss [3]. In 2013, the NFL reached a $765 million agreement with 4,500 former players over head trauma lawsuits [4]. In 2016, the league settled concussion lawsuits with 20,000 former players through a $1 billion payment [5].

In 2017, Dr. Ann McKee performed autopsies on 111 former NFL players. An astonishing 110 revealed CTE—over 99% [6]. A majority also suffered from behavioral, mood, and cognitive symptons as well as dementia. She believes that NFL veterans sustain tens of thousands of sub-concussive hits. Boston University scientists found that CTE risk doubled at only 2.6 playing years—the average NFL career is 3.3 years [7]. From 266 autopsies, they estimate that each year of play increases CTE odds by 30%.

It was previously believed that CTE onset began in older age, many years removed from playing. However, McKee suggests that CTE risk is a matter of football exposure. Her study included former NFL players as young as 23. Tyler Sash, a former NFL safety, died at 27. His CTE findings are a result of 16 years of youth, collegiate, and professional football [6]. Former NFL tight end Aaron Hernandez suffered from a severe case of Stage 3 CTE until his death at 27 [8]. Hall of Fame linebacker Junior Seau’s CTE onset likely occurred earlier than his suicide at 43 [9]. McKee concludes, “it is no longer debatable whether or not there is a problem in football — there is a problem” [6].

In 2002, Dr. Bennet Omalu exposed the NFL’s best kept secret. The autopsy of Steelers legend Mike Webster revealed the first recorded CTE presence in an NFL player [10]. In 2005, Omalu’s publication depicted the long-term neurodegenerative outcomes from an NFL career [11]. Rather than investigate these findings, the NFL blatantly questioned his work [10]. The NFL-operated Mild Traumatic Brain Injury Committee (MTBI) proclaimed false research and asserted “no known history of brain trauma inside professional football” [10]. They doubled down by claiming that a return to play after sustaining a concussion “does not involve significant risk of a second injury either in the same game or during the season” [12]. Omalu’s subsequent research was deemed “speculative,” and he was excluded from further involvement [10]. McKee’s evident findings of neuropathological tracers were later met with resistance from the NFL’s doctors [10].

The NFL reveals its blind eye through mediocre player safety standards. Until 2012, the league failed to openly share data on player concussions [13]. Concussion protocol is mediocre at best. In 2017, Jacoby Brissett suffered a brutal helmet-to-helmet hit against the Steelers that left him limp — yet, an immediate sideline check cleared him for the Colts’ very next offensive possession. Chris Nowinski, co-founder of the Concussion Legacy Foundation (CLF), called the protocol a “fraud” and one of the “clearest concussion signs of the season.” As recent as 2017, only 41% of helmets were designated as “best performing” [14]. Nearly one in five players used suboptimal models that are now banned.

The obvious failure surrounding Jacoby Brissett’s concussion protocol is only one example of the NFL’s inept player safety standards. [twitter.com/ChrisNowinski1/]

This dismissive attitude is no surprise. CTE and concussion awareness is a direct threat to the NFL’s popularity, and more importantly — the bottom line. Most popular among the major professional US sports leagues, the NFL hauled in $15 billion in revenue in 2018 [15]. With growing broadcast packages, merchandise sales, and legalized sports betting, commissioner Roger Goodell targets a $25 billion annual revenue by 2027 [15]. To keep this consistent growth, the NFL’s incentive lies in maintaining the status quo.

The consistency of concussions year to year does not bode well for recent safety implementations. Since the 2012 season, there have been on average 244 diagnosed concussions each season. The 2017 season recorded the highest number of concussions, 281, since the NFL first publicly released concussion data [12].

As evidence piled and pressure mounted, concussion science forced the NFL’s hand. In 2012, the league donated $30 million to the National Institutes of Health (NIH) for brain research [10]. Four years later, over half of the donation was renounced because of the league’s attempt to influence research [10]. In 2016, new concussion rules were implemented to mixed results. The NFL announced a $100 million “Play Smart, Play Safe” initiative towards better helmets and technology, as well as medical research into head trauma [10]. Still, ongoing research is trivial for current NFL players — from 2018 to 2019, there was a 44% increase in preseason concussions [16]. Since the 2012 NFL season, the number of diagnosed concussions has staggered year to year but overall remained consistent [12]. The looming concussion issue remains a persistent problem of the league’s past, present, and future.

Atop the football world, the NFL endangers more than its own athletes. Everyday, thousands of collegiate and millions of youth amateurs participate in tackle football. The NFL’s minimal accountability continues to set a dangerous example for those who idolize the league. While concussion awareness has grown, effective safety practices and implementation are still far behind the science at every competition level [17].

The NFL’s current course of action could not be more amiss. A commitment to scientific research decades ago would have likely progressed player safety tremendously. Instead, negligible improvement has been made since Omalu’s initial prognosis nearly 20 years ago. Recent implementations are half-hearted attempts to play catch up and still downplay the severity of the sport’s concussion and CTE problems.

Solutions to football’s dangers are far from straightforward, but they must be addressed in face of a looming existential threat. Indeed, the most emphatic critics have predicted the NFL’s inevitable demise.

New helmet technology, improved player education, and rule changes have taken a step in the right direction. This season, a pilot program with select NFL teams involves sensor-laden mouth guards that record impact magnitudes, allowing researchers to collect data surrounding sub-concussive hits [14].

Players can also retire early — a compelling shift that brings life after football into focus. Andrew Luck, 29, abruptly announced his retirement in August. He joins Rob Gronkowski, Calvin Johnson, and Patrick Willis as notable players to retire at 30 years or younger since 2015. These decisions are an admirable stand for player health and self interests. More importantly, they oppose a cultural stigma in which players find it difficult to walk away able-bodied.

On Oct. 10, 2019, the Concussion Legacy Foundation released a controversial commercial depicting the dangers of youth tackle football. The relevance of football education and its associated health risks will only continue to grow alongside CTE awareness. [www.youtube.com/user/sportslegacydotorg]

Awareness has also prompted action at lower competition levels. Earlier this month, the CLF released a commercial likening youth tackle football to children smoking cigarettes — a drastic analogy compelling parents to educate themselves about the risks of an early tackle football career [18]. Instead, the CLF advocates for flag football until age 14. In New York, lawmakers are considering a bill that bans tackle football for children under the age of 12 [19].

Above all else, the most effective solution lies in the NFL’s willingness to own the concussion and CTE dilemma. Posturing attempts for ongoing research and further data collection—which is entirely hypocritical to the extensive studies presented — utterly contradict the NFL’s highest priority of “player safety” [20]. Upgraded helmets, early retirements, or delayed tackle football cannot be permanent solutions in a multi-billion dollar business placing countless lives at risk. These marginal improvements will not suffice as more revelations of CTE and its consequences pile on.

The NFL has failed to sacrifice for these issues. But as principal of the football world — and the only influence with enough resources — it must govern football’s renaissance. Eventually, the way football is played will have to change. Whether that involves rewriting the rule book, reinventing tackle mechanics, or radical ideas like the removal of helmets, now is a prime opportunity for the NFL to decide that narrative. Whatever difficult decisions must be made, it’s up to the league to do right by players and move all in.

With pressure from all around and time winding down, it’s currently 3rd & Goal. The NFL must act decisively to determine the fate of this game.

References

  1. “What Is CTE?” Concussion Legacy Foundation, 7 Oct. 2019, concussionfoundation.org/CTE-resources/what-is-CTE.
  2. “Frequently Asked Questions about CTE.” Frequently Asked Questions about CTE | CTE Center, www.bu.edu/cte/about/frequently-asked-questions/.
  3. Armstrong, Megan. “Packers Legend Brett Favre ‘Absolutely’ Wonders If He Played in the NFL Too Long.” Bleacher Report, Bleacher Report, 7 Oct. 2019, bleacherreport.com/articles/2857005-packers-legend-brett-favre-absolutely-wonders-if-he-played-in-the-nfl-too-long.
  4. Person. “NFL, Ex-Players Agree to $765M Settlement in Concussions Suit.” NFL.com, National Football League, 29 Aug. 2013, www.nfl.com/news/story/0ap1000000235494/article/nfl-explayers-agree-to-765m-settlement-in-concussions-suit.
  5. “Supreme Court Leaves $1B NFL Concussion Settlement in Place.” Chicagotribune.com, Chicago Tribune, 18 Aug. 2019, www.chicagotribune.com/sports/ct-nfl-concussion-settlement-supreme-court-20161212-story.html.
  6. Ward, Joe, et al. “111 N.F.L. Brains. All But One Had C.T.E.” The New York Times, The New York Times, 25 July 2017, www.nytimes.com/interactive/2017/07/25/sports/football/nfl-cte.html.
  7. “CTE Risk Goes up 30% for Each Year of Playing Football.” Futurity, 8 Oct. 2019, www.futurity.org/cte-football-risk-2179082/.
  8. Kilgore, Adam. “Aaron Hernandez Suffered from Most Severe CTE Ever Found in a Person His Age.” The Washington Post, WP Company, 9 Nov. 2017, www.washingtonpost.com/sports/aaron-hernandez-suffered-from-most-severe-cte-ever-found-in-a-person-his-age/2017/11/09/fa7cd204-c57b-11e7-afe9-4f60b5a6c4a0_story.html.
  9. Breslow, Jason M. “Junior Seau Suffered Chronic Brain Damage, NIH Study Finds.” PBS, Public Broadcasting Service, 10 Jan. 2013, www.pbs.org/wgbh/frontline/article/junior-seau-suffered-chronic-brain-damage-nih-study-finds/.
  10. “The NFL Tried to Intimidate Scientists Studying the Link between Pro Football and Traumatic Brain Injury.” Union of Concerned Scientists, 11 Oct. 2017, www.ucsusa.org/resources/nfl-tried-intimidate-scientists-studying-link-between-pro-football-and-traumatic-brain.
  11. Bennet I. Omalu, Steven T. DeKosky, Ryan L. Minster, M Ilyas Kamboh, Ronald L. Hamilton, Cyril H. Wecht, Chronic Traumatic Encephalopathy in a National Football League Player, Neurosurgery, Volume 57, Issue 1, July 2005, Pages 128–134, https://doi.org/10.1227/01.NEU.0000163407.92769.ED
  12. “NFL Concussions Fast Facts.” CNN, Cable News Network, 15 Aug. 2019, www.cnn.com/2013/08/30/us/nfl-concussions-fast-facts/index.html.
  13. Seifert, Kevin. “NFL Concussions Continue to Rise.” ESPN, ESPN Internet Ventures, 26 Jan. 2018, www.espn.com/nfl/story/_/id/22226487/nfl-concussions-rise-highest-level-league-began-sharing-data.
  14. Lemire, Joe. “Inside SportTechie’s PRO DAY: Exploring Helmet Technology and Innovation.” SportTechie, 25 Oct. 2019, www.sporttechie.com/nfl-helmet-technology-innovation-robert-stern-adam-bartsch-jeff-crandall-dave-marver.
  15. Soshnick, Scott, and Eben Novy-Williams. “The NFL Nears $25 Billion Revenue Goal Ahead of Super Bowl.” Chicagotribune.com, Chicago Tribune, 28 Jan. 2019, www.chicagotribune.com/sports/ct-spt-nfl-revenue-super-bowl-20190128-story.html.
  16. Abdeldaiem, Alaa. “Concussions in Preseason Games Up 44% From 2018.” Sports Illustrated, 15 Oct. 2019, www.si.com/nfl/2019/10/15/concussions-preseason-games-increased-44-percent.
  17. Lundberg GD, Metzner D. How to Rescue American Football. Cureus. 2016;8(4):e592. Published 2016 Apr 28. doi:10.7759/cureus.592
  18. Hille, Bob. “Pointed ‘Tackle Can Wait’ TV Ad Hits amid Sobering New CTE Study’s Stats.” Sporting News, (Concussion Legacy Foundation), 14 Oct. 2019, www.sportingnews.com/us/nfl/news/pointed-tackle-can-wait-ad-hits-amid-sobering-new-cte-study-stats/1gickot4k9j7e1wpa7wk17qq3d.
  19. Cbs. “New York Again Considers Banning Tackle Football For Children Under 12.” CBS New York, CBS New York, 29 Oct. 2019, newyork.cbslocal.com/2019/10/29/new-york-again-considers-banning-tackle-football-for-children-under-12/.
  20. sport, Guardian. “Roger Goodell Says NFL Has ‘No Higher Priority’ than Player Safety.” The Guardian, Guardian News and Media, 5 Feb. 2016, www.theguardian.com/sport/2016/feb/05/roger-goodell-nfl-player-safety.

A UCLA graduate with a B.S. in Bioengineering, I have a deep passion for sports medicine, technology, and engineering.

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