What We Know About CTE, The NFL’s Ongoing Crisis
The death of Ken Stabler reminds us that CTE isn't going anywhere
When former Raiders quarterback Ken Stabler died last summer of colon cancer, his fans remembered him for his skill and charisma. Last week, the results of a post-mortem exam revealed the toll 15 years in the NFL had taken on his body—Stabler was diagnosed posthumously with stage 3 Chronic Traumatic Encephalopathy (CTE). He was inducted into the NFL Hall of Fame the following weekend. His story has become all too familiar.
An estimated 1.6 to 3.8 million sports-related concussions occur each year in the United States alone. Put simply, a concussion is caused when your brain and skull accelerate at a different pace and your brain literally bumps into your skull. This contact leaves two bruises on your brain—one at the point of initial impact and another where it bounces back into place. The immediate effects, ranging from momentary confusion to loss of consciousness, depend on the severity of the injury.
Experiencing multiple concussions can lead to Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disease that affects people who suffer repetitive head trauma. CTE, which can only be diagnosed posthumously, has many effects on the brain, including atrophy (loss of mass and function) and the accumulation of tau proteins, linked to dementia in diseases like Alzheimer’s.
CTE shares some of the familiar symptoms of that condition, including memory loss, disorientation, and confusion. Friends and family of deceased individuals diagnosed with CTE often recall behavioral and personality changes, including aggression and depression. Unlike many other neurodegenerative diseases, CTE has a clear environmental cause: repetitive head trauma.
Researchers with the Department of Veterans Affairs and the Boston University Chronic Traumatic Encephalopathy Center maintain the country’s largest post-mortem brain bank. Dedicated to studying the effects of trauma on the human brain and spinal cord, the bank includes the brains of 165 former football players. In total, 79 percent of the men who played football in high school, college, semi-professionally, or professionally were diagnosed with chronic traumatic encephalopathy post-mortem. Of the 91 deceased NFL players included in the study, 96 percent were diagnosed with CTE.
The once-lauded hits that cause a player to go momentarily limp are now a reminder of what players are risking every time they step onto the field. But brain trauma is not only suffered during concussions that cause immediate symptoms. A player may not lose consciousness when he’s knocked to the ground by a 250 lb defensive lineman, but that does not mean no damage was done. CTE can also be caused by cumulative subconcussive injuries suffered over years of playing the sport.
Discussions of CTE revolve almost exclusively around the NFL but this condition is not limited to football. CTE has been identified in athletes who participate in any sport that results in repeated head trauma—among them soccer, hockey, rugby, boxing, and wrestling.
When CTE is mentioned in articles and news reports, an alarming number of people bring up the idea that athletes knew what they were getting themselves into when they signed their contracts. ‘Sure, concussions and dementia are bad, but they chose the money. They knew what was coming.’
This mentality is preposterous. CTE was not even formally identified until the early 2000s. The NFL did not take responsibility until 2014 when a report released as part of a multi-million dollar concussion settlement finally acknowledged what the league had been accused of deliberately hiding for years: “Nearly three in 10 former players will develop debilitating brain conditions, and that they will be stricken earlier and at least twice as often as the general population.”
At present, there are more than 20,000 current or ex-professional football players still living. Countless more played only in high school or college. All of these athletes face an increased risk of degenerative brain conditions connected to their time playing football. The vast majority of athletes are aware of the physical strain on their bodies—the torn ligaments, the sore muscles, the joint strain—but it is only recently that they were informed about the possible neurological effects.
Football players did not know what they were getting themselves into because the NFL used its power to suppress and deny damaging information. By some accounts it still is, preferentially funding research that minimizes the effects of the game.
Some states now require that consent forms for high school athletes explicitly mention and provide information on concussion injuries. A review of several fact sheets provided by high schools across the US revealed information on concussions and identifying the immediate symptoms.
Despite the fact that thousands of high school students will experience a concussion each year, none mentioned the possible long term ramifications of a concussion and the possible increased risk of neurodegenerative disorders. The NCAA concussion fact sheet, developed in conjunction with the CDC, is designed along similar lines: explain what a concussion is, what the symptoms are, urge players to report injuries, and make no references to long term effects.
This does not qualify as informed consent. These “informational resources” encourage players and parents to think of concussions as short-term injuries. It does a disservice to the male and female athletes who, from childhood through adulthood, put themselves at risk for our entertainment.
Every football hero diagnosed with CTE is a stark reminder of the toll the sport places on their health and well being. Every young, promising player who retires at the start of their careers to protect their health is a reminder of how important it is to convey the risks of playing the game.
While there remain many open questions about CTE, we know that there are more Ken Stablers to come.