Ron Berger —

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As another season of the National Football League (NFL) comes to an end, I have been thinking about the football fans who live with a peculiar form of cognitive dissonance: They certainly must know (but seem able to deny) that the athletic gladiators they enjoy watching, who perform heroic feats on the playing field, are undergoing lasting harm to their physical and mental well-being. One of these harms is a type of traumatic brain injury known as chronic traumatic encephalopathy, or CTE, a neurodegenerative disease associated with repetitive head trauma that worsens over time.

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In 2002, Dr. Bennet Omalu, who was working in the department of pathology at the University of Pittsburgh, conducted an autopsy of Pittsburgh Steelers football player Mike Webster. Webster, who was inducted into the NFL Hall of Fame in 1997, had died suddenly (at age 50) after years struggling with cognitive impairment, mood disorders, depression, drug abuse, and suicide attempts. Omalu, whose story is told in the 2015 film Concussion, starring Will Smith, concluded that Webster had been suffering from CTE.

In subsequent research, Dr. Jesse Mez and his colleagues at Boston University examined the brains of 202 deceased football players who had played for an average of 15.1 years. They found that 87 percent exhibited signs of CTE. Among the 111 NFL players in the sample, 99 percent had CTE. In another study conducted by Dr. Michael Alosco and colleagues, also at Boston University, researchers examined the brains of 246 deceased players, finding that 86 percent showed signs of CTE. Among the players diagnosed with CTE, those who started playing tackle football before age 12 suffered symptoms earlier than those who didn’t start until after age 12, because head trauma has a greater deleterious effect on the developing brain.

CTE is a condition that has been known to affect boxers since the 1920s, when it was initially termed punch drunk syndrome or dementia pugilistica. It has now been confirmed in boxers, football players, and hockey players—and not just in professional athletes but also in individuals who discontinued involvement in sports after high school or college. CTE is associated with the build-up of an abnormal protein called tau, which form clumps that slowly spread throughout the brain. According to the CTE Center at Boston University, the most common symptoms include “memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, suicidality, parkinsonism, and eventually progressive dementia.” The full manifestations of the disease may not occur until years or even decades after the last head trauma.

In 2016, after years of denial, the NFL publicly acknowledged a connection between football and CTE. This admission came in the wake of a class-action lawsuit settlement between the NFL and thousands of former players to provide up to $5 million per retired player who suffers from the condition. The NFL has also introduced more protective headgear and concussion protocols. As of July 2018, nearly 2,000 claims had been filed and more than $500 million approved for disbursement. Still, the players and their families feel that too many claims are being disputed or stonewalled.

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Football is the most popular sport in the United States, and as many as 2.5 million children, mostly between ages 5 to 13, play tackle football each year. Research indicates that children as young as 9 are getting hit in the head more than 500 times a season. Chris Nowinski, co-founder and executive director of the Concussion Legacy Foundation, thinks that parents need to ask themselves hard questions about allowing their children to play tackle football—whether the potential benefits are worth risking the lifelong health of their child’s brain. Emmy Award-winning sportscaster Bob Costas, one of the most astute observers of amateur and professional sports, says that the evidence leads him “to the common sense conclusion that you shouldn’t play tackle football at all until you’re 18-years-old at a minimum. … But then where is the talent pool for college football? The whole thing can collapse like a house of cards if people actually begin to connect the dots.”

Former University of Wisconsin linebacker Chris Borland, who won three Big Ten Championships during his college career, has been outspoken about the injurious effects of football—from the grueling practices to the games themselves. He notes the common use of steroids and administration of painkillers by team doctors to ensure that “guys play with whatever they had going on. … It’s a big industry. And they’re willing to put … young men in situations that will compromise their long-term health.” After being selected in the third round of the 2014 NFL draft and playing one year with the San Francisco 49ers, Borland retired from football because of his concern about head trauma, as he suffered concussion symptoms such as imbalance and ringing in his ears on a regular basis. “I think there’s a certain degree of hubris … with folks high in the NFL,” he says. “They own a day of the week, football’s a religion, and no matter whether or not they’re … claiming concussions are down … the reason football’s the most popular sport is because it’s violent. So they’re … in the violence business. Players joke that Dracula runs the blood bank.”

Sources

Michael Alosco et al., “Age of First Exposure to Tackle Football and Chronic Traumatic Encephalopathy,” Annals of Neurology 83: 886-901 (2018).

Carlos Ballesteros, “NFL Commentator: Football Will Die Because It Destroys Your Brain.” Newsweek, newsweek.com (Nov. 18, 2017).

Colten Bartholomew, “Borland: Winning Trumps Athletes’ Health.” Wisconsin State Journal (Jan. 19, 2020).

Bryan A. Cobb et al. “Head Impact Exposure in Youth Football: Elementary School Ages 9-12 Years and the Effect of Practice Structure.” Annals of Biomedical Engineering 41: 2463-73 (2013).

CTE Center, Boston University, “Frequently Asked Questions about CTE,” bu.edu/cte.

Rick Maese, “Dementia Claims in NFL Concussion Settlement are Going Unpaid, Lawyers Say.” Washington Post, washingtonpost.com (Mar. 20, 2018).

Jesse Mez et al., “Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football.,” Journal of the American Medical Association 318: 360-370 (2017).

Chris Nowinski, “Youth Tackle Football Will Be Considered Unthinkable 50 Years from Now.” Vox, vox.com (Apr. 3, 2019).

Bennet Omalu et al., “Chronic Traumatic Encephalopathy in a National Football League Player,” Neurosurgery 57: 128-34 (2005).