Examining The Correlation Between Football-Related Head Injuries (in the NFL), and Chronic Traumatic Encephalopathy
The sport of Football is an American pastime. The NFL has become so popular that, the average viewership of the NFL Regular Season from 2010 to 2020 is just about 16.72 million viewers per game (via statista.com). People spend their early lives training for their shot to play in the NFL, and make their professional football dreams come true. But, should they? Football has a reputation for being a very high-contact and physical sport, in which a violent tackle occurs nearly every play. We've seen a plethora of gruesome injuries occur, ranging from ACL tears to spinal concussions. But one of the most impactful and dangerous injuries in American Football are head injuries. Head injuries, such as concussions, are very common in the NFL, despite the technological advancements made to the helmet in order to prevent such injuries. Throughout former NFL players, injuries to the head area have been proven to be quite traumatic. Today, I'll be examining cases of Chronic Traumatic Encephalopathy (or CTE for short, as it will be referenced throughout this article), in ex-NFL players, as well as the correlation between NFL-related head trauma and CTE.
Identifying the What (Pt. 1)
(📸 courtesy of lawyers-2016)
NFL players come across frequent head trauma. They are forced to make tackles as part of the game, and head-on collisions can and do happen. Injuries such as these have had a severe correlation with future behavioral changes/disorders and potential fatalities. One thing is for sure, these injuries aren't to be taken lightly. CTE is one of the most coming neurodegenerative diseases that are caused by football-related head trauma, which is why we'll be focusing on CTE in this article.
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Identifying the What (Pt. 2)
(📸 courtesy of qbi.uq.edu.au)
According to the US National Library of Medicine, "recent reports on the frequency and magnitude of head impacts encountered by contact-sport athletes have led to concern that repetitive, high-impact blows might be injurious to their brains." Injuries such as concussive blows can cause a degenerative impact on a person's brain, one of the most common degenerative conditions being CTE. The full details of CTE are unknown by researchers as of now, but they do know that it is caused by repeated head traumas. While there are no directly linked symptoms, the usual symptoms are listed below:
Difficulty thinking (cognitive impairment)
Impulsive behavior
Depression or apathy
Short-term memory loss
Difficulty planning and carrying out tasks (executive function)
Emotional instability
Substance misuse
Suicidal thoughts or behavior
All of these symptoms can be seen within ex-NFL players diagnosed with CTE, such as Aaron Hernandez (the topic of players with CTE will be discussed in a later section). CTE can lead to diseases like Alzheimer's, Amyotrophic Lateral Sclerosis (also known as ALS/Lou Gherig's disease), Parkinson's disease, or Frontotemporal Lobar Degeneration.
CTE deteriorates your brain, and commonly causes changes in the physical qualities of a person's brain, as seen below.
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Identifying the How
(📸 courtesy of the Mayo Clinic)
Repetitive head trauma/concussions cause damage to the brain by causing the brain to bounce off of the skull, and cause rotation in your brain. The CTE then develops due to changes from those repetitive traumas.
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CTE In The Pros - Aaron Hernandez
(📸 courtesy of heavy.com)
Disclaimer: All of the following information is courtesy of the Boston University Brain Bank study done on Aaron Hernandez's brain after his death, led by Dr. Ann McKee.
One of the most notorious NFL players of all time, former Patriots Tight End Aaron Hernandez, was diagnosed with high levels of CTE post-mortem. Hernandez was convicted for the murder of Odin Lloyd after a trial started when the body was found on June 17th, 2013. Hernandez then committed suicide in his jail cell on April 19th, 2017, after 2 years of his sentencing. After his death, a group of Boston University researchers conducted studies on his brain. After the study, it was revealed that Hernandez had stage III CTE, and according to the VA-BU-CLF Brain Bank as well as the Concussion Legacy Foundation the symptoms included, "cognitive loss, memory loss, behavioral changes, and impaired judgment." Hernandez's brain also had clear "brain atrophy, which is the degeneration of brain cells." Another symptom found in Hernandez's brain was "large perforations in the septum pellucidum, a central membrane."
(one scan of Hernandez's brain done by Dr. McKee)
One heavy.com article on CTE states that "CTE has been known to affect boxers since the 1920s (when it was initially termed punch drunk syndrome or dementia pugilistica)…The repeated brain trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau.” The article continues by stating a quote from Dr. McKee saying, “Especially in the frontal lobes, which are very important for decision-making, judgment, and cognition, we could see damage to the inner chambers of the brain.” “This would be the first case we’ve ever seen of that kind of damage in such a young individual.” A build-up of Tau in a brain with CTE looks like this:
(📸 courtesy of heavy.com)
The atrophy of the fornix (nerves associated with memory) seen in a scan of Hernandez's brain earlier in this article, shows "classic CTE", as Dr. McKee put it.
Hernandez's Conclusion
(📸 courtesy of The Boston Globe)
Hernandez's case of CTE has no direct link to his actions, but an assumption can be made. According to McKee, "In any individual, we can’t take the pathology and explain the behavior. But we can say collectively, in our collective experience, individuals with CTE and CTE of this severity have difficulty with impulse control, decision-making, inhibition of impulses or aggression, often emotional volatility and rage behaviors." I doubt that Hernandez would've committed the murder, or committed suicide if his cognitive judgment wasn't impaired. Hernandez had a documented concussion/head trauma during his NFL career, and potentially more undocumented concussions in college and high school, worsening his case of CTE. Hernandez's case shows a high correlation between football activities and his stage III CTE. Though no direct link to his act of homicide has been proven, we can safely infer that Hernandez just wasn't thinking straight.
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CTE In the Pros - Junior Seau
(📸 courtesy of PBS)
Another big name in NFL history, ex-NFL linebacker Junior Seau committed suicide on May 2nd, 2012. He was only 43 years old. After Seau's passing, his family decided to donate his brain to the NIH (National Institutes of Health) for study. According to a PBS article, "the research team that conducted the analysis said in a statement that Seau’s brain showed multiple signs of CTE, including build-ups of an abnormal protein known as tau." I mentioned tau protein earlier, which stems from an excess of repetitive head traumas. That is one clear sign of CTE that Seau's brain exhibited, as well as "a very small region in the left frontal lobe of the brain with evidence of scarring that is consistent with a small, old, traumatic brain injury," according to the NIH.
There were no images of scans of Seau's brain available publicly, but photos in the Aaron Hernandez section show similar visual symptoms of tau build-up to Seau's described build-up.
Seau's Conclusion
(📸 courtesy of B/R)
Seau's conclusion is similar to Hernandez's. Seau died by a gunshot to the chest in 2012. He was only 43 years old. Since prominent symptoms of CTE such as impaired judgment, emotional instability, depression, impulsive behavior, and suicidal thoughts or actions could all lead to suicide, it's safe to say that CTE played a role in Seau's death. Seau suffered from head injuries during his tenure as an NFL Linebacker, every link of the chain is there. We have the head trauma, the suicide, and the post-mortem diagnosis all coming together to paint a scary picture of Seau's degeneration.
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Full 111 Study Analysis
(📸 courtesy of the NY Times Article on the study)
The previously mentioned, renowned neuropathologist, Dr. Ann McKee, conducted a study on 202 deceased football players (111 NFL players, which are the players we will be focusing on), examining their brains post-mortem. According to The Journal of the American Medical Association, the results of Dr. McKee's total study were as follows:
"Among 202 deceased former football players (median age at death, 66 years [interquartile range, 47-76 years]), CTE was neuropathologically diagnosed in 177 players (87%; median age at death, 67 years [interquartile range, 52-77 years]; mean years of football participation, 15.1 [SD, 5.2]), including 0 of 2 pre–high school, 3 of 14 high school (21%), 48 of 53 college (91%), 9 of 14 semiprofessional (64%), 7 of 8 Canadian Football League (88%), and 110 of 111 National Football League (99%) players. Neuropathological severity of CTE was distributed across the highest level of play, with all 3 former high school players having mild pathology and the majority of former college (27 [56%]), semiprofessional (5 [56%]), and professional (101 [86%]) players having severe pathology. Among 27 participants with mild CTE pathology, 26 (96%) had behavioral or mood symptoms or both, 23 (85%) had cognitive symptoms, and 9 (33%) had signs of dementia. Among 84 participants with severe CTE pathology, 75 (89%) had behavioral or mood symptoms or both, 80 (95%) had cognitive symptoms, and 71 (85%) had signs of dementia.
That's a pretty dense set of results so I'm going to break it down for you. For this article, I'm focusing on only former NFL players, due to the availability of information about CTE in NFL players being greater than that of any other level of play. The results for just the NFL were basically:
110 of 111 ex-NFL players were diagnosed with CTE
101 of 110 ex-NFL players diagnosed with CTE had CTE of a high severity
Among the participants diagnosed with a high severity of CTE, 75 participants had behavioral/mood changes, 80 participants had symptoms regarding their brain's ability to take in, process, and understand information, and 71 participants showed signs of the disease, Dementia (a common neurodegenerative disease).
(📸 courtesy of the NY Times Article on the study)
The former NFL players who had their brains studied were a variety of different positions, categorized above.
When we look at the recording of positions, the extremes of the spectrum paint an interesting picture. We see that Linemen (the most contact-heavy position in the NFL) lead the pack, with 44 ex-NFL Lineman's brains out of 110 total ex-NFL participants were diagnosed with confirmed CTE. And for the fewest ex-NFL participants, we have Place-Kickers (1 participant) and Punters (1 participant). Since those are the two least contact-heavy positions in football, it would make sense that only 2 total ex-NFL Place-Kickers and Punters would be part of this study since the risk of repeated head trauma (and in turn, CTE) is lower among the lower-contact positions. But, the best way to avoid CTE completely is to abstain from extremely contact heavy sports, one of those main sports being American Football.
Conclusion - What We Learned
Researching for this article has been eye-opening. I was shocked at how high the correlation between football and CTE is, and I'm shocked that the NFL has brushed these cases off. The stories of Aaron Hernandez and Junior Seau depict how scaringly dangerous CTE really is. Both Hernandez and Seau died by suicide, and suicidal thoughts/behaviors are symptoms of CTE, so we can observe a correlation there. And regarding the large study we dissected, it is evident that CTE affected the end of the participants' lives in the same manner as in the cases of Hernandez and Seau. The ex-NFL players in the study experienced a wide range of impairments, including emotional and cognitive degeneration. And back to Hernandez and Seau, I think that it's safe to say that the degeneration of their brain caused by CTE had a hand in their suicides.
Overall, the NFL needs to do more in terms of condemning the fact that head trauma from their game is causing the deaths of these ex-NFL players. CTE is not a joke, and it comes in all shapes and sizes. It can cause drastic changes in a person, and it should be taken very seriously.
The sources used in this article can be found in the links to the photos, and if you are interested in learning more about CTE, check out the following links: