Chronic Traumatic Encephalopathy (CTE): The Brain Condition That Plagues the NFL
By Cheyanne Ryder
Aaron Hernandez
After a lifetime of playing football, Aaron Hernandez seemingly took his success into the end zone. Number 81, a superstar athlete, that millions of football fans looked up to and adored. Hernandez was a tight end for the New England Patriots after being drafted in the 2010 NFL draft where he signed a five-year $40 million contract. He had the world at his fingertips after 3 successful seasons.
However, things took a turn for the worst in June of 2013 when he was arrested in his home for the murder of his close friend, Odin Lloyd. Following his arrest, the Patriots released Hernandez from their roster, though he didn’t immediately lose the support of his entire fanbase. The world began crushing around him, the career he had worked his whole life to build was slipping from his grasp. In the midst of courtroom hearings, Hernandez was indicted on two additional murder charges for a double homicide that occurred in 2012. He was found guilty of the murder of Odin Lloyd in April of 2015 when he was sentenced to life in prison without parole (Bertram, 2020). Two years later, in February of 2017, he went to trial for the double homicide but was later acquitted (Bertram, 2020). On April 19, 2017, Hernandez was found to have committed suicide in his prison cell and was pronounced dead a few hours later.
Aaron Hernandez was 27 years old at the time of his death. His brain was studied, and he was diagnosed with one of the most severe cases of Chronic Traumatic Encephalopathy (CTE). CTE is a degenerative brain condition that results from frequent and repeated head trauma. This condition likely developed because of Hernandez’s lifetime of playing football. He is one of the hundreds of NFL athletes that have been diagnosed postmortem.
What is CTE?
Dr. Bennet Omalu defines CTE as “a progressive neurodegenerative syndrome caused by single, episodic, or repetitive blunt force trauma to the head and transfer of acceleration-deceleration forces to the brain” (Resnick, 2020). Dr. Omalu was one of the leading CTE researchers when it was first discovered. His first discovery of CTE was in the brain of Mike Webster in 2002. Webster was a former NFL athlete who played for the Pittsburgh Steelers and a Pro Football Hall of Famer.
Dr. Omalu studied Webster’s brain during an autopsy and found evidence of tangled proteins, commonly found in brains with dementia (Laliberte, 2018). He was quoted saying, “these abnormalities were not something I thought I should be seeing in a 50-year-old man” (Laliberte, 2018). For his age, Webster’s brain damage was uncommon and severe.
Dr. Omalu was able to make the connection between repeated head trauma and neurodegeneration by calling upon an existing condition known as dementia pugilistica. Dementia pugilistica was commonly found in boxers due to the severe head trauma they experienced throughout their career (Laliberte, 2018). There had previously been no significant ties between contact sports and degenerative brain conditions through research, other than that of dementia pugilistica. Dr. Omalu named his diagnosis chronic traumatic encephalopathy (CTE) and was about to turn the world of football, and other contact sports, upside down by revealing one of their darkest secrets.
There is a wide variety of mood and behavior symptoms that are commonly associated with CTE. Mood symptoms include, but are not limited to paranoia, memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, suicidality, parkinsonism, and dementia (Dong, 2019). Behavioral symptoms include, but are not limited to deterioration in cognitive functioning, deterioration in socioeconomic class, bankruptcy, breakdown of intimate and family relationships, spousal separation and divorce, and alcohol and drug abuse (Antonius, et al., 2014). The severity of these symptoms depends entirely on the severity of the disease, but not everyone with CTE will experience the same symptoms. CTE is divided into 4 different stages, with Stage I being the mildest and Stage IV being the most severe (Mez, et al., 2017). The more severe the disease, the more intense the symptoms are experienced.
Though there is a clinical presentation of symptoms, CTE is undiagnosable during the lifetime of an athlete. Symptoms can also take decades to present in an individual. Not only is CTE undiagnosable, but once the damage has been done, there is no way to reverse it. Although therapy can be used as a method to cope with the symptoms, the condition itself is uncurable.
Upon studying his brain, Aaron Hernandez was found to have had Stage III CTE. It is possible that his drastic actions were due to the degeneration in his brain. CTE is known to make individuals act out in violent ways due to the damage to the parts of the brain responsible for decision-making. It is possible that CTE could explain his actions however, this is not at all a conclusive answer for his actions.
NFL vs CTE
CTE is not confined to the world of football. “The condition has been found in athletes who played, soccer, ice hockey, rugby, mixed martial arts, and even BMX riding” (Laliberte, 2018). However, one of the most severely affected groups is that of NFL athletes. In a 2017 study, Dr. Ann McKee performed autopsies and studied the brains of former NFL athletes and found that 110 of 111 showed signs of CTE (Dong, 2019). That is a percentage of over 99 percent.
For comparison, a study conducted by researchers at the University of Toronto analyzed the brains of NHL and colligate hockey athletes. They found that 17 out of 35 brains of deceased hockey players showed signs of CTE (Schwab, et al., 2021). That is less than half, with a percentage of 48.6 percent. Though this is still a significant percentage, it is nowhere near the affected percentage of the NFL athletes in Dr. McKee’s study.
Following Dr. Omalu’s diagnosis of CTE in Mike Webster, he and his colleagues published a paper on the study of Mike Webster’s brain titled, “Chronic Traumatic Encephalopathy in a National Football League Player.” After it was published, they immediately received backlash from the NFL. They received a letter from the NFL’s Committee on Minor Head Injury demanding that their findings be withdrawn (Laliberte, 2018).
Though Dr. Omalu and his colleagues published the paper in 2005, the NFL did not formally acknowledge the presence of CTE in their athletes until 2009 (Resnick, 2020).
They also did not openly share information regarding their concussion data until 2012 (Dong, 2019). With new research coming out, people started to wonder, what did the NFL have to hide? After facing scrutiny and being under a monstrous amount of pressure, the NFL donated $30 million to the National Institute of Health (NIH) toward brain research in 2012. However, in 2016 they withdrew more than half of the donation because they unsuccessfully attempted to use their bias to influence the research being conducted (Dong, 2019).
However, in 2016 the NFL poured $100 million into their own concussion research. At first, it seemed as though they finally took a step in the right direction, until it was discovered where the money went. This $100 million went into a single study, that researched head trauma in horse jockeys. This may seem like a lot of money for a single study, and that’s because it is. Not only was this study not about football, but it was also being conducted by researchers “who appear to have already made up their minds about concussions and chronic traumatic encephalopathy” (Bien, 2017). Although the NFL could not use their bias to influence the research conducted by the NIH, they found a way to do it themselves.
Impact on the Sport of Football
Time after time, the NFL has let down their athletes by failing to take the necessary accountability for head trauma and CTE sustained by playing professional football across the nation. Not only are they putting the lives of their athletes at risk, but also those who idolize those athletes that play football throughout their childhood, high school, and college. Scientists at Boston University estimate that each year of participation in football increases an individual’s odds of CTE by approximately 30% (Dong, 2019). When the NFL fails to make necessary changes for the safety of their athletes, they are providing a poor example for smaller leagues.
As more information has been coming out exposing the significant dangers posed by playing in football, there have been effects in overall participation of football. Former NFL quarterback Brett Favre was quoted saying that he would “prefer that his grandsons play golf over football” and even former President Barack Obama has said that he wouldn’t let his sons play football (Resnick, 2020). High school students and their families have also taken note of the potential dangers of playing. Though football is still the most popular sport for males in high school, in 2020 the number of high school students playing football reached its lowest number since the 1999–2000 school year (Resnick, 2020).
Regulations, such as ImPACT testing, have been put into place in most schools in hopes of making student-athletes safer. ImPACT stands for Immediate Post-Concussion Assessment and Cognitive Testing and is meant to be used as a tool to determine when an athlete can safely return to their sport following a concussion or head injury (ImPACT). With ImPACT, students take a baseline test that measures their cognitive capabilities and memory prior to participating in contact sports. Following a concussion, the student would repeat the test and their scores will be compared to their baseline to determine whether they are eligible to return to their sport or not. Though ImPACT is a tool that improves the safety of returning to a sport, it does not improve the overall safety of participating in contact sports.
The NFL has taken small steps to improve safety, but they are not as momentous as they should be. They have developed new helmet technology with improved engineering, improved player education, and made a few changes in the rulebook, but according to Michael Dong, these “cannot be permanent solutions in a multi-billion-dollar business placing countless lives at risk.” Dong also states, “These marginal improvements will not suffice as more revelations of CTE and its consequences pile on.” The NFL has the resources to take the necessary measures to improve the safety of their players and set a precedent for smaller leagues, yet they often choose not to.
Moving Forward
It is undeniable that the NFL is refusing to properly acknowledge CTE and take the necessary accountability toward the improvement of safety measures and has done so for decades. CTE is their kryptonite. It threatens their bottom line and puts their popularity at risk. But how many athletes will have to suffer the miserable symptoms of CTE during their lifetime and be diagnosed during an autopsy for the NFL to be concerned? Changes need to be made, the NFL has possession, and hopefully, they don’t drop the ball.
