Dr. Kevin Most: CTE
Football season is upon us, is it time to embrace it or perhaps time to look at other sports that are not as damaging such as lacrosse or soccer.
Traumatic Brain Injuries can be mild or devastating to the individual and the families of the individual. On the other end of the brain injury spectrum we see close to 4 million sports related concussions injuries in the US each year, this is a low estimate as many go undiagnosed where the patient is not seen by a physician. Yet these concussions we are now noting are leading to major health issues that may be impacting many who played one of the most popular sports known, football.
Over the past few years we have heard about CTE (Chronic Traumatic Encephalopathy ) and professional football players. In fact the first documented case was in 2005.Much of the coverage had been anecdotal stories of a football player that had passed and an autopsy showed signs of CTE. This often explained the behavior of the player prior to their death. Families concerned as to why a loved one acted a certain way prompted review of brain tissue. This week the anecdotal portion of the story is all changing as JAMA has results of a study that should have all football players and parents of football players concerned.
CTE is a chronic progressive brain illness that is linked to repetitive or major head trauma, such as concussions. Symptoms include depression, behavioral changes, confusion and early dementia as the damaged brain tissue reacts to the multiple blows or concussions it is exposed to. It appears to have two presentations, one at a younger age that showed behavioral changes and mood disturbances and the other at an older age where more cognitive changes were noted. The bad thing is there is no treatment for this, no medication will reverse the damage that the trauma has done.
In the past we have discussed the technology behind new football helmets, mouth guards that measure impact, other equipment that monitors how strong a blow was to a player and if they should be removed from the game. We have discussed the need to rest the brain following a concussion as we know that two concussions in close succession can cause major damage. The goal in equipment manufacturers has been to make safer equipment and equipment that has sensors and can monitor activity and force.
Remember the skull is there to protect our brain from normal daily exposure of bumps and smacks that we do routinely. Hitting our head occurs routinely and our skull is there to protect our brain. The bad thing about the design of our skull is that it is a contained space and the brain essentially floats in that space. When we get a large force blow to one side of the head (think football tackle) the brain is pushed forcibly against the skull and a contusion or damage occurs leading to a concussion. Concussions are essentially a stunned area of the brain that in simple terms is bruised and needs to rest in order to go back to normal.
The focus has been on the deaths of these celebrity football players but as we enter the football season the timing of the results of this study could not be more concerning to even the parents of pee wee football players. It is football season and we all love to watch the game.
JAMA last week came out with its conclusions on the connection between football and CTE. The JAMA study looked at just over 200 football players, 111 of whom had played in the NFL. These individuals were chosen as family members, or the players themselves requested that their brain be studied. Now when we look at research studies we like to look at random controlled studies but that is not the case here. These are handpicked data points that they looked at. This is termed a convenience sample, as they are self identified versus a more general view of a population. With that being said we do have to understand that the statistics and data cannot be extrapolated to all football players or even all NFL players, however the results will get your attention and make us think about the impact beyond college and NFL players.
The study looked at the brains of just over 200 players, 111 of them had played in the NFL. Of the 200 players brains reviewed, signs of CTE were found in 87 %, more concerning was that of the 111 NFL players 110 showed signs of CTE. Now remember this is not a random study and the families had concerns to a point where they requested the brains to be studied, so this is a select group of players. None the less the concern is still there as CTE is overall a very rare illness.
Now if you are all there thinking, “so it is the NFL, of course we would see that”, it goes beyond that. The study looked at some individuals who stopped playing after High School, and others who stopped playing after college. These results are probably more concerning. Think of football players as a pyramid, with the base of the pyramid being youth football, moving up to high school football, college football and at the tip the NFL. So with that picture think of the number of players in each group. For example, my High School class had a great football team, I can think of 7 that went on to play college football including Big 10, but the other 40 players ended their football in high school. We know that not many of the college players make it to the NFL, my alma mater Kansas has only placed a few players in the past 5 years, yet they have a full team every season. So I think we get the picture of the scope.
Now back to the study, of the 200 players studied 14 of them stopped playing in high school and 20% of them were noted to have CTE on autopsy, for the 53 who went on and played thru college 91% had CTE noted. Now I have to remind you that these individuals were studied because their families had concerns and requested the brains to be studied. Again the NFL players studied showed 99% of those studied had CTE. This trend would obviously suggest that the longer an individual stayed in the game the higher the chance of CTE, but again remember these are selected individuals.
This study is the largest study performed on a select population that were exposed to essentially the same head trauma while playing the same sport. This did not include hockey players or other sports. Now although this study does have limited scientific standing it is probably more important from a public awareness of the link between this progressive brain illness and repetitive brain injury.
As we look at this study one large concern is the fact that players are getting stronger and faster and that the equipment has not been able to keep up. This study had individual who played football 5 decades ago when the game was a lot different. Football players are working more on training and strength than they did 20 years ago. The concern is how many players do we have out there right now who have the early portion of this illness and how many do we have that will suffer from the later portion over the next few decades.
So what do we do? This is a sport that is followed by millions, has a huge financial impact on individuals, colleges and NFL towns but at what expense. Time to start looking at Lacrosse for our new Saturday and Sunday sport. Parents need to consider what impact does this have on the future of our youth. Parents, think about the future of your child, we need more doctors than we need football players.