Chronic traumatic encephalopathy (“CTE”) is a degenerative disease that is theoretically linked to repeat mild traumatic brain injuries (“TBI”). Since its discovery in 2002, CTE has been studied extensively, especially in regard to its prevalence in participants of certain sports. In recent years, football has been front and center of the discussion, as many former players were diagnosed with CTE posthumously. In light of recent findings, state lawmakers have begun proposing bans on youth tackle football, citing the recent CTE research that asserts the longer a player engages in tackle football, the more likely they are to develop the degenerative brain disease. This series is a deep dive into the issue, providing a foundation about traumatic brain injury and CTE, its effects on adults and children, notable cases and research findings regarding football players diagnosed with CTE, and the positions on the ban of youth tackle football.
The series concludes with a novel conclusion: blame the treatment, not the tackle. As the saying goes, “there isn’t smoke without fire.” Recently, with the prevalence of CTE in the news, popular culture, and the like, many began thinking “there isn’t CTE without the tackle.” This couldn’t be more off base. We really should be thinking of it as “there isn’t CTE without improper treatment.” Simply, the risk of brain degeneration due to improper treatment is far greater than the risk of injury from the hit itself.
Part 1 of the series focuses on defining and discussing traumatic brain injury and CTE, but in adults and children;
Part 2 of the series focuses on notable cases of CTE, as well as recent research into the disease;
Part 3 of the series discusses the proposals to ban youth tackle football; and
Part 4 of the series considers the truth about the research behind CTE and its limited scope in light of the spotlight it has received in pop culture and social media. The significant importance of proper protocol and treatment following head injuries is discussed, suggesting the possibility that CTE is not precipitated by the tackle itself, but rather poor treatment of the hit. Furthermore, it is not only the treatment, but the management of the treatment that needs serious attention. This is particularly true where treatment management can be addressed here and now and the possibility of CTE, although a valid concern, will never be definite until postmortem diagnosis, when it is too late to take direct action.
Confirmed Cases of CTE in Former NFL Athletes
Mike Webster, who most knew as “Iron Mike”, was a center for the Pittsburgh Steelers. Iron Mike was a legend voted onto the All-Pro team six straight years and won four Super Bowls. He also was an inductee in the Pro Football Hall of Fame. However, his life post-NFL was turned upside down when his behavior took a turn for the worst and morphed from bizarre into terrifying. In a few short years, Webster lost all of his money, got divorced, forgot how to eat, and began sleeping in his car. An avid reader, Webster could fly through books on Winston Churchill and World War II, but his memory was so fragmented he would not be able to remember the simplest of things, such as how to get home in a city that had been home for so many years.
Webster began scribbling notes on legal pads to document his mental decline. One note about his symptoms reads in part, “deep, confusing, twisting fishing line tangled up mess of confusing things go on all the time.” His sons recalled their father shaking so much from his condition that he would zap himself with a Taser gun and said he did it to calm his nerves. Webster also would take Ritalin to control his mood swings, but at one point was arrested for forging Ritalin prescriptions. Finally, after much searching for a diagnosis, psychologist Fred Jay Krieg agreed to examine Webster. Krieg determined that Webster had dementia due to head trauma.
When Webster died of a heart attack at the age of fifty, Dr. Bennet Omalu had an opportunity to examine Webster’s body during an autopsy. It was very clear that Webster died of a heart attack, but Webster’s concerning behavior before his death made Omalu question whether Webster suffered some type of brain damage or illness.
At first look, Webster’s brain did not show typical signs of Alzheimer’s or dementia, but Omalu continued to study the brain for answers. What Omalu ended up discovering was shocking: small brown and red splotches all over Webster’s brain. The BU studies assert that these spots are known as tau proteins and are accumulations of tangles, which slowly spread and kill brain cells. However, Dr. Willer notes that there has not been enough research to definitively state that the tau itself actually is the cause of the damage, or just a marker for another substance which we have yet to identify.
Omalu published these unique findings in a study, naming the condition chronic traumatic encephalopathy, or as we know it, “CTE.” The movie Concussion follows Omalu’s discovery of CTE, as Webster was the first NFL player he autopsied and found evidence of the degenerative brain disease.
Aaron Hernandez was a notable tight end for the Patriots, playing on the team for three years and leading many to believe he had a great career ahead of him. However, in 2013, he was arrested and charged for the murder of Odin Lloyd. In 2015, Hernandez was found guilty of first-degree murder and sentenced to serve life in prison without the possibility of parole. While on trial for Odin Lloyd’s murder, Hernandez was also indicted for the 2012 double homicide of Daniel de Abreu and Safiro Furtado. After a trial in 2017, Hernandez was acquitted of the double homicide charge.
Only days after the acquittal, a correction officer found Hernandez hanging from a bedsheet in his prison cell. Many wondered what caused the twenty-seven-year-old to take his life, but wondered even more so how his behavior became erratic and violent in what felt like the blink of an eye. After his death, Hernandez’s family donated his brain to be studied more extensively.
Dr. Ann McKee, the lead researcher of the CTE Center at Boston University performed a brain scan, which revealed evidence of damage to the frontal lobe and large portions of black spots created by tau protein. The level of damage and degeneration evidenced in Hernandez’s brain has never been seen in a person of his age and has only been discovered in brains more than twenty years older. Although direct, conclusive lines cannot be drawn between Hernandez’s behavior and the significant level of damage discovered in his brain, it is a fact that the frontal lobe is responsible for impulse control, problem solving, and judgment. Hernandez’s brain showed severe damage to the frontal lobe. Furthermore, the amygdala, which is involved in emotional regulation, was discovered to be severely impaired.
Dr. McKee diagnosed Hernandez with CTE (which, at this time, can only be diagnosed postmortem) and shortly thereafter, Hernandez’s family filed a $20 million lawsuit in 2017 against the Patriots and the NFL. The family accused the team and the league of being fully aware of the severe level of brain damage that could result from repetitive impact injuries and that the team and the league failed to disclose, treat, and protect Hernandez from such damage. The family has since dropped the lawsuit, but left open the possibility of filing in another court. The silver lining that follows Hernandez’s tragic death is that studies of his brain have contributed significantly to the understanding of CTE, especially in very young individuals.
In 1974, Stabler was named the NFL’s most valuable player and three years later, he was the quarterback who led the Raiders to victory in the Super Bowl. Stabler threw for 27,938 yards during his fifteen years in the NFL and is well known for the contributions he made in the football industry.
After suffering many injuries throughout his career, Stabler retired in 1984. Following retirement, Stabler would often discuss his severe headaches, disorientation, and forgetfulness with his long-time partner. He often told her that he was “certain that he was suffering from the consequences of playing football.” When Stabler passed away from colon cancer, he requested that his brain be donated to the Boston University CTE Center for research.
Dr. McKee, the same doctor who examined Aaron Hernandez’s brain, studied Stabler’s brain and confirmed a diagnosis of CTE. She noted that the disease was spread throughout his brain and showed severe damage to areas responsible for learning, memory, and emotion. Dr. McKee noted that these findings resulted in a broadened understanding of the reach for positions at the risk of CTE. Quarterbacks are typically considered less likely to be tackled than other positions (this understanding may be a result of rules such as the “Brady Rule” that restricts players from hitting a quarterback below the knee without getting a penalty). Note that players such as Stabler played in the “old” NFL before the Brady Rule and other rules that restrict certain hits and therefore these results may not broaden the understanding for the reach for positions at the risk of CTE.
Chris Nowinski, the founder of the Concussion Legacy Foundation, noted how unique it was that Stabler anticipated his diagnosis years in advance. Although more common in recent years, football players in the 1970s and 1980s were far less likely to distance themselves from the NFL as they began to experience the physical and mental impacts the game had on their bodies. However, Stabler was honest and brave in his decision to actively distance himself from the game and after retirement, made comments that he hoped his grandsons would choose not to play football.
In his twelve years playing with the Eagles and the Cardinals, Andre Waters (nicknamed “Dirty Waters”) was known for his aggressive tackling, racking up hundreds of tackles throughout his career. Although Waters was a fierce competitor on the field (notably, often leading with his head), he was known as a generous friend to his teammates and exhibited strong ties to his family, especially his mother.
Despite Waters’s kind and lovable character, his family members reported that he began displaying signs of moderate to severe depression. In November 2006, Waters took his own life. According to a story published by The Times, Chris Nowinski, a former Harvard football player and professional wrestler who has suffered a number of concussions, called the Waters family to request permission to use remaining parts of Webster’s brain for testing. The family agreed and four pieces of Waters’s brain were sent to be tested by Dr. Omalu and examined by Dr. Omalu (the same doctor who examined Mike Webster’s brain).
Omalu reported that the brain tissue resembled that of an eighty-five-year-old in the early stages of Alzheimer’s. Omalu concluded that if Waters lived another ten or fifteen years, he would have been fully incapacitated. He stated, “no matter how you look at it, distort it, bend it. It’s the significant forensic factor given the global scenario,” indicating that the brain damage Waters suffered was caused or drastically expedited by the successive concussions he suffered while playing football.
Before his NFL career, Duerson was an all-American defensive back for Notre Dame. He then spent most of his eleven years in the NFL playing for the Bears, playing safety on the famous 46 defense that fueled the team’s Super Bowl championship in 1985. Duerson also won the Super Bowl in 1991 while playing for the Giants. He retired after the 1993 season.
After retiring from the NFL, Duerson began a successful career in the food service industry, but unfortunately, this success did not last long. Duerson’s business collapsed, he faced bankruptcy, and he began exhibiting symptoms of brain trauma, such as memory loss, poor impulse control, and abusive behavior. Duerson was aware of his mental decline and even served on the six-member panel that considered claims for disability benefits filed by former NFL players. In 2007, Duerson told a Senate subcommittee that he questioned whether players’ cognitive and emotional struggles were related to football.
In 2011, Duerson committed suicide by shooting himself in the chest. It is presumed that he strategically shot himself in the chest and not the head so that his brain could be examined for damage. This presumption is founded on the final note Duerson left to his family requesting, “Please, see that my brain is given to the NFL’s brain bank.” After his death, Boston University’s Center for the Study of Traumatic Encephalopathy studied Duerson’s brain and diagnosed him with CTE.
Duerson’s son Tregg made a brief statement at the news conference where the CTE diagnosis was revealed. Tregg stated, “It is our hope that through this research questions that go beyond our interest may be answered – questions that lead to a safer game of football from professionals to Pop Warner. It is my greatest hope that his death will not be in vain and that through this research, his legacy will live on and others won’t have to suffer in the same manner.” Duerson’s other son, Brock, said that the diagnosis provided an explanation for his father’s decline. He stated, “I don’t want people to think just because he was in debt and broke he wanted to end it. CTE took his life. He changed dramatically, but it was eating at his brain. He didn’t know how to fight it.”
Known as a dedicated and fierce linebacker, Seau had a wildly successful twenty-year career in the NFL. Seau played for the Chargers, the Dolphins, and the Patriots and was a ten-time All-Pro select, a twelve-time Pro Bowl select, a 1990 All-Decade Team select, and a 2015 Pro Football Hall of Fame inductee.
In 2012, Seau’s girlfriend found him unconscious with a gunshot wound to the chest. His suicide came on the heels of the suicide of Duerson, who also shot himself in the chest. A postmortem brain scan determined Duerson suffered from CTE. After Seau’s suicide, his family donated his brain to the National Institutes of Health and insisted on scans to determine if Seau suffered from CTE.
The autopsy report of Seau’s brain was published in World Neurosurgery and stated that Seau’s brain revealed abnormalities consistent with CTE, resulting from exposure to repetitive head injuries. This report resulted in the NFL responding to the findings, stating that the report “underscore[d] the recognized need for additional research to accelerate a fuller understanding of CTE.” This statement accompanied a $30 million research grant from the NFL for fuller exploration and research of CTE in order to promote the long-term safety of athletes.
During the 1950s and 1960s, Frank Gifford contributed both offensively and defensively to the Giants, who won five NFL championships during that time. Gifford took many hits throughout his career, but one devastating hit stands out among the rest. In November 1960, Eagles linebacker Chuck Bednarik tackled Gifford, knocking Gifford unconscious instantly. Following the hit, Gifford was hospitalized for ten days and was unable to play for two years from what is still known as one of the most notorious concussions in NFL history. Symptoms such as tingling fingers, confusion, and short-term memory loss followed Gifford for the rest of his life.
After his NFL career, Gifford became a television sports commentator and used his famous persona to help the NFL impose rules on helmet-to-helmet hits. In an article published by the New York Times Gifford stated, “You have to start in high school and get them to play the right way. And it’s hard on officials, whether on the field or in the league office, who have to be the judge and the jury.”
In 2015, Gifford passed away from natural causes. Later that year, Gifford’s family released a statement that confirmed a postmortem diagnosis of CTE. The family stated, “We . . . find comfort in knowing that by disclosing his condition we might contribute positively to the ongoing conversation that needs to be had; that he might be an inspiration for others suffering with this disease that needs to be addressed in the present; and that we might be a small part of the solution to an urgent problem concerning anyone involved with football, at any level.”
Speculating What CTE May Look Like in Current NFL Players
CTE can only be diagnosed by an autopsy and therefore there is no definitive way to tell if a current player who has sustained successive head traumas and is exhibiting concerning mental deterioration and erratic behavior is suffering from CTE. In an article published on this blog in September 2019, I analyzed Antonio Brown’s erratic behavior beginning at the end of the 2017 season and continuing through the 2019-2020 season.
In my analysis, I argue that Brown may quite possibly be living proof of CTE and its effects. Although we cannot definitively diagnose Brown with CTE, it is worth considering what type of concerning behavior is just “Brown being Brown” and what might be evidence of a serious degenerative brain disease. However, scientists outside of the original research team have not confirmed results where CTE has been diagnosed postmortem (there are less than a handful of people who orchestrate this research) and there is little information regarding what other diseases may have caused these results and each individual’s predisposition to these diseases. Therefore, nothing more than speculation can exist at this time.
Since being dropped by the Patriots (the last team to give the wild card that is AB a shot), Brown has not stopped making headlines with his odd and even terrifying behavior. In Latest disturbing Antonio Brown video is signal that shouldn’t be ignored and treated as AB being AB, Dan Wetzel covers the most recent AB controversy. On January 13, footage emerged from Brown’s personal Instagram page of him berating his children’s mother, with police and the kids looking on. Wetzel urges, “to stop caring about him because he’s not on a roster seems cruel.” Brown has hit a new low where not only was he screaming obscenities in front of his children and police, but he did so while voluntarily broadcasting it live to his social media audience. There is no longer any reason to shrug this off as “Brown being Brown.” AB needs professional help.
Wetzel concludes his observations by noting, “There is more to health than physical though, and if non-professionals who witnessed this outburst can see obvious problems, can see the sadness, someone has to get him to a real doctor. Whether he realizes it or not, Antonio Brown is calling out for help. With every regrettable incident, the question increasingly becomes, can anyone get it to him?”
Changing How They Look at the Game: CTE and its Effect on Young NFL Players
We all may be able to speculate about Antonio Brown and what damage his brain may have sustained through repetitive hits throughout his NFL career, but at the moment, it does not seem to be clear to Antonio Brown himself. However, other (even younger) players have kept track of the cutting-edge research that surrounds CTE, degenerative brain disease, and what may happen if they continue to play and suffer traumatic brain injury.
In January 2020, Luke Kuechly announced that he was retiring from the NFL after eight seasons. At only twenty-eight years old, the Panthers’ linebacker was arguably the best middle linebacker in the NFL. What would cause such a young and successful player in his prime to retire from the NFL and walk away from millions? After reviewing those who have suffered with symptoms of CTE the answer is easy: long-term health over short-term success.
Kuechly has suffered many hits and concussions, but that historically never caused players to retire at such a young age. So what is different now? In the NFL, where retiring before thirty years old was shocking, why now is it becoming commonplace for players with something left in the tank to walk away?
In his article published with Sports Illustrated, Albert Breer notes four items that explain the new phenomenon of young, successful NFL players with much left in the tank walking away from the game. (1) Players have far more information than ever before on what football is doing to them physically. (2) Players are being paid more and doing a better job managing their money. (3) Players are preparing for their post-football lives earlier, so walking away is not quite as daunting. (4) The guilt with such a decision that may have existed even six or seven years ago is not what it was. Football is a family: there is a huge responsibility these people feel to one another.
Calvin Johnson retired at thirty-years-old, Patrick Willis retired at twenty-nine-years-old, Rob Gronkowski retired at twenty-nine-years-old, and Andrew Luck retired at twenty-nine-years-old. After reading the cautionary tales of Webster, Hernandez, Stabler, Waters, Duerson, Seau, and Gifford, these early retirements should not be a surprise. After watching Brown spiral out of control in front of our eyes, these early retirements should not be a surprise. Yet, there still remains a knee-jerk reaction to feel shocked when we see such young players walk away from something that is no longer good for them. We can no longer do this. We must be better, we must trust those who know their bodies and their minds, we must root for our favorite players to have successful lives long-term rather than explosive careers short-term. Players’ priorities are changing. Players are beginning to recognize that the game they love is damaging their quality of life in the long-term. Early retirements of some of the best to play the game should be celebrated. We should honor the mature choices these players are making and continue to shift the culture from the “league warrior” mindset to one of mature and responsible decision makers who recognize how to care for themselves in the long run.
Having said this, should we begin to consider giving more credence to the idea of banning children under the age of twelve from playing tackle football? Many have dismissed the idea, but if we have young, successful players who love the game walking away in the name of their health, should we maybe reconsider allowing young children to suffer successive helmet-to-helmet hits? The question remains: is it really the hits we should be worried about or something much more manageable?