Part III: Is CTE another wrinkle on the inside?

Part III: Is CTE another wrinkle on the inside?

“As we age we develop wrinkles on our face and consider this a normal part of the aging process. We do not label this condition “degenerative face disease.” -Greg Streblow

Recent research has shown that conditions such as arthritis, degenerative disc disease, and disc herniation are a normal occurrence of aging and have been labeled “wrinkles on the inside.” In fact, a review written by Brinjikji et. al. 2015 reporting disk degeneration in 3110 asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age.

Diagnoses listed above may lead to fear of movement and an increase in health care expenditure. The current media buzz surrounding CTE has struck fear in younger athletes causing them to avoid sports in which head contacts may occur. Rosemarie Scolaro Moser, Ph.D, Director of the Concussion Center of New Jersey states, “this worry has become irrational to the point that they are afraid to engage in normal activities for fear of further brain damage, even when it is clear to us that they have recovered. It’s as if they have equated the diagnosis of concussion with doom and a sentence of irrevocable brain damage.” She proposes that our society has now created “Concussion syndrome anxiety” disorder.

In part I and II of our CTE blog post it was stated, “A cause and effect relationship has not yet been demonstrated between CTE and sport-related concussions or exposure to contact sports. As such, the notion that repeated concussion or subconcussive impacts cause CTE remains unknown.” We need to direct our athletes away from reports of CTE in professional athletes as they are often misleading. For example, when NHL player Todd Ewen passed it was reported in the media his depression and suicide were most likely the result of a career in the NHL, repetitive head trauma, and the inevitable onset of CTE. However, autopsy of his brain showed no CTE was present. As an attempt to decrease “concussion syndrome anxiety”, I propose we redirect our society and provide hope when recovering from a head contact injury instead of being fearful that this “condition” may develop. Furthermore, I propose we look at the entire body of literature with unbiased populations.

Research done by Iverson et al, 2019 explored mild CTE in people who had no known participation in contact sports or history of repetitive neurotrauma. Findings indicated that 5/6 cases with NO known history of neurotrauma meet consensus criteria for CTE. In other words, 83 percent showed CTE even though they had not participated in contact sports.

As more research comes out on this topic, will we end up finding out that it perhaps is another wrinkle on the inside?

Questions/comments post below!

Dr. Dillon Caswell, PT, DPT


References:

1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-6.
2. Iverson GL, Luoto TM, Karhunen PJ, Castellani RJ. Mild Chronic Traumatic Encephalopathy Neuropathology in People With No Known Participation in Contact Sports or History of Repetitive Neurotrauma. J Neuropathol Exp Neurol. 2019;78(7):615-625.
3. Brooke de Lench. CTE: Is The Media Scaring Young Athletes To Death?08/08/2017.