What actually is CTE? The most common answer I get is, “it’s a brain disease that football players get that make them go crazy.” The scientific definition is, “A syndrome that is theorized by some to develop after repetitive concussive and subconcussive impacts to the head and is manifested by a complex set of progressive neurodegenerative and/or psychiatric disorders.” Not too far off, except it is not limited to football. This “disease” was first described in boxers and instead of typing out the history, I’ll let this picture do the work for me:
The debate of CTE and repetitive head shots being problematic is not new and has been around since the first half of 1900’s. Fast forward to 2018, more research has been done but the same debate continues. Is CTE a disease? Is it static of progressive? How many hits are needed to cause it? Let’s look at both sides of the debate.
Supporters of CTE will say there is a specific pattern of a certain tau protein that is found in brain structures and that the individual suffers from behavioral disturbances, increased suicidality, and neurodegeneration. A study by McKee et al. in 2017 supporting CTE made headlines as they found 177 out of 206 subjects from all levels of football were diagnosed with CTE. This study also reported that out of 111 brains from deceased NFL players, 110 met criteria to be diagnosed with CTE. 41 percent of the subjects were linemen, whereas 1 percent where kickers/punters. Moral of the story, maybe special teams isn’t too bad (#kickersarefootballplayerstoo). The worldwide headlines read “99 percent of NFL players have CTE.” Very alarming statistics that caused many young players to retire early from the league.
Let’s look at the other side of the debate before forming conclusions. I think it’s Dr. Phil that says, “no matter how thin the pancake there is still two sides.” An article by Randolph 2018 states, “The evidence to date, however, does not rise to the level of a verifiable disease, and remains at the level of case report.” In the media they failed to publish some very important facts. First, in that same McKee study out of 202 subjects, 25 players displayed no pathological abnormalities. The next limitation that we must be aware of is the population. In order to be diagnosed with CTE the player must be deceased, which means their families have to donate the brain to be studied. This is important because most brains donated are by families who want an answer to rationalize the players’ abnormal behavior prior to death. There has yet to be a CTE study done with a control group; athletes that played in the NFL and did not have behavioral changes. Also, the results from CTE studies cannot be expanded to lower levels of football, as almost every brain studied as been from higher collegiate and professional levels.
Lastly, research has shown that traumatic brain injury does not lead to neurodegeneration and that, as a whole, retired NFL players are much healthier physically and mentally compared to age-matched general populations. This was shown by Lehman et al. who concluded suicide among this cohort of professional football players was significantly less than would be expected in comparison with the United States population. There were no significant differences in suicide mortality between speed and non-speed position players.
Would you let your child play football? Is CTE a real disease? It for sure needs to be talked about.
Leave comments, let’s get talking about this people!
Dr. Dillon Caswell, PT, DPT
References
Lindsley CW. Chronic Traumatic Encephalopathy (CTE): A Brief Historical Overview and Recent Focus on NFL Players. ACS Chem Neurosci. 2017;8(8):1629-1631.
Randolph C. Chronic traumatic encephalopathy is not a real disease. Arch Clin Neuropsychol. 2018;33(5):644-648.(shout out to soon to be Dr. Bea Davis for the reference)
Lehman EJ, Hein MJ, Gersic CM. Suicide Mortality Among Retired National Football League Players Who Played 5 or More Seasons. Am J Sports Med. 2016;44(10):2486-2491.
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