I am a doctor and former wide receiver. My brother is in the NFL. Chronic traumatic encephalopathy (CTE) is on my mind.
I settled into my office chair with my coffee, fed for another day at Zoom Medical School, and streamed live to my New York City apartment. The block that we’re on now – neuroscience – is Doozy. Well, honestly, they are all savages.
Today’s lecture topic: Traumatic Brain Injury.
The fourth lecture slide includes a picture Mike WebsterFormer Pittsburgh Stiller, whose story is best known for the 2015 movie concussion—starring Will Smith as the doctor who discovered the explosive link between football and the neurodegenerative disease found in athletes and others with a history of brain trauma called Chronic traumatic encephalopathy—or CTE.
I know what will happen. Often you don’t get a football reference during a medical school lecture. The next few slides illustrate the consequences of repetitive head injuries. Hey she’s coming. CTE.
My colleagues realize that I am a former football player. I got a direct message from one of them: “Knowing what you know now, are you going to play again?”
This is not the first time they have been asked. I asked myself the same question a long time ago.
Football is deeply ingrained in my family. My father and grandfather both played in college. Justin, my younger brother, is the quarterback for the Los Angeles Chargers. My younger brother, Patrick, is a freshman at the University of Oregon.
She played 11 years of football, four of them as a wide receiver at Montana State University. During all that time, I had yet to be diagnosed with a concussion. That doesn’t mean I haven’t had my fair share of violent crashes.
After my career at Michigan State University, I had the opportunity to attend a junior camp for the NFL team—essentially an experience for non-manufactured players. I refused for several reasons. I knew I wasn’t cut out to be a wide receiver in the NFL. I also wanted to start the long journey of becoming a doctor.
My brain health was not a factor in this decision.
Keep track of CTE discovery timeline
The link between football and CTE was first discovered in 2005 by Bennett Omalo, a neurologist who examined the brain of former Stiller and NFL Hall of Fame star Mike Webster while working in the coroner’s office in Pittsburgh.
“Iron Mike”, as he was known, played 220 football games in the NFL. More than any player in Steelers history. He has suffered recurring head trauma during his career.
Webster’s symptoms are now a feature of recurrent head trauma: memory loss, behavioral and mood changes, cognitive impairment, and dementia.
The primary process in brain tissue is the buildup of an abnormal protein called tau, which forms neurofibrillary tangles. Tau is also believed to be responsible for Alzheimer’s disease. Because similar brain regions tend to be affected, most individuals show these distinct symptoms.
As public awareness of the links between repetitive brain injury, soccer, and CTE grew in the early 2000s, things began to change in the NFL. In 2009, the league introduced the concussion protocol.
Also at this time, Mike Leach, Technical Director of Texas Tech University, appeared on the front page of New York times To abuse a player with a concussion by confining him to a small, dark space while the rest of the team is training. Leach has been launched.
The world is finally starting to pay attention – and act.
Fast forward to 2017, when a groundbreaking study from Boston University was published in Journal of the American Medical Association. Of the 111 former NFL footballers who showed symptoms of CTE upon death, 110 were found to have diagnostic criteria for CTE from brain autopsy revealing tau tangles.
The ages of the NFL players, whose brains were donated to science by family members, ranged from 23 to 89 years old. The study included all players’ positions. Most notable are 44 linebackers, 17 full-backs, 10 line-backs and seven midfielders.
I remember reading about this study while preparing for my fourth and final season on the boot in Montana. The discovery was massive – an irrefutable argument that football caused CTE.
Or did you do that?
When it comes to CTE and football, the relationship is not black and white
The problem with the 2017 study, and in fact, much of the CTE research up to this point, comes down to who was included – and who was not.
These brains were donated by families for evaluation especially Because they showed characteristic symptoms of CTE from players with known head trauma.
“It’s biased sampling,” says Steve Kearney, MD, professor and chair of critical care and hospital medicine at New York-Presbyterian Children’s Hospital Morgan Stanley, whose research focuses on self-repair of the brain after injury. “It’s hard to make really strong conclusions other than players who do contact sports and who have repetitive head injuries are definitely at risk,” Kearney adds. “This is also something we’ve known for 100 years.”
A control group would be needed to de-bias the data – such as adding the brains of former NFL players who did not show signs of CTE, as well as the brains of non-athletes to the cohort of participants.
Kernie refers to a condition originally called “drunk hole syndrome,” which was first described by American pathologist Harrison Martland in 1928. Journal of the American Medical Association An article on the strange behavior of boxers – another cruel and beloved sport that has long been associated with head trauma.
Martland wrote: “For some time, warrior fans and promoters have recognized a certain condition that occurs between award-winning fighters who speak of it in the language of ‘drunk punch.’ ‘ or ‘idiot’ or ‘cutting paper dolls’ or ‘nut slugs’. “
A decade later, the term punch-drunk will be replaced by a more appropriate one boxing senility.
It is important to note that the link between RTI and CTE is not exclusively related to football or boxing. Other sports such as football and wrestling have also been implicated.
There are also documented cases of chronic traumatic encephalopathy (CTE) resulting from injuries caused by a military explosion.
“During the Iraq war, service members were coming back with symptoms that weren’t quite PTSD,” Kearney says, explaining the military’s growing integration with CTE in these cases, which were almost never reported by the media. “The NFL gets more attention than the military unfortunately,” Kearney says.
Back to my original question. Do I play football again?
The friendships and life lessons I gained from over a decade of dealing with football have shaped the person I am today.
Furthermore, while I believe the link between repetitive head injuries, soccer, and CTE is real, I think the general public has a skewed perception. The presence of one or two concussions does not guarantee a diagnosis of CTE. Many other factors likely play a role – including adequate recovery after an initial concussion and genetic predispositions to the disease.
My own question of hindsight about playing soccer is now initially being asked by parents who are concerned about enrolling their children in the sport.
The dwindling numbers indicate this. Biwi’s involvement in football is at an all-time low. Meanwhile, waning interest in soccer appears to provide gains for soccer, which, ironically, is not without its neurotic risks.
I asked Dr. Kearney for his advice to parents who are considering whether or not to allow their children to play contact sports – especially soccer.
“As a parent of kids who play sports, I think you can’t live in a bubble,” he says. “Everything we do carries some risk. It’s really about mitigating those risks as much as possible.”
An important way to mitigate these risks, especially in youth football, is to delay the processing component.
My brothers and I started dealing with football in the fifth grade. If you ask us now, we will all put off processing until late middle school or even high school. Not only to reduce repetitive head injuries, but to master the basics of other soccer skills such as body position, blocking technique and hand-eye coordination. All of these skills can be developed through the science of football.
As I see it, the focus of young footballers should be on developing those skills rather than celebrating the traditional physique that inevitably comes later.
Despite the public’s skewed perception of the prevalence of CTE among soccer players, we hope we can all agree on two things: First, minimizing recurrent head injuries. Second, addressing this problem is progressing by delaying youth tournaments and strengthening the fundamentals of the sport’s massive.
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