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.
The Super Bowl is today! I must admit, today is one of my favorite days of the year. This year’s favorite (by a small margin), the Kansas City Chiefs, have had concussion protocol issues in its past (remember when nine former players sued the team for brain injury resulting from improper protocol and treatment and only a year later, the tragic incident with Jovan Belcher, where his mother later sued the team?), which reminds me of what is really important today: that players remain safe and healthy so we can enjoy the Super Bowl for decades to come.
With CTE at the front and center of almost every lawsuit involving players of contact sports, especially the NFL, society has begun to conclude that the tragic, inevitable diagnosis of CTE is not only going to occur, but is going to increase exponentially. Our popular culture has created Netflix documentaries and late night specials about the good ole boys who were transformed into crazed, erratic individuals that their families did not even recognize. Each of these stories ends with a “this is just what happens” mentality and leaves its audience with an achy feeling of despair – isn’t that what good television is, anyway? Especially for the millions who love to sit and watch crime t.v. and take a moment to play doctor and dive into the psyche of a stranger they know nothing about.
No wonder CTE is such a prevalent term; those three letters are thrown around by just about everyone nowadays. However, we are getting the wrong message from these tragic cases. The real message is: sure, CTE is going to happen. Sure, CTE is probably linked to repetitive brain injury. Sure, the symptoms of CTE are scary and absolutely tragic. But, CTE is not the last word. We need to be using CTE as a launching pad to discover more about what we do not know about the disease and how we can limit occurrences of its development. Furthermore, at the end of the day, it’s not CTE that we need to be worried about – its ALL TBIs. We need to worry more about repetitive traumatic brain injuries and less about the disease that maybe, just maybe, might develop but we will not be able to diagnose until death – which is far too late.
It’s not the tackle and it’s not even the TBI that we should blame. It is the subsequent treatment of the TBI that we need to focus on. Most importantly, it’s about proper protocol and proper treatment management. With so much more to be discovered about traumatic brain injuries (and CTE especially – including how it is caused, how it progresses, and the like) I offer a bold thesis: we should see instances of CTE and related diseases linked with brain injury decline as proper protocols are implemented and followed not only in professional leagues, but also college athletics, high school athletics, and even elementary teams.
Barry S. Willer, PhD, Professor of Psychiatry at the University at Buffalo School of Medicine and Biomedical Sciences and Director of Research for the internationally renowned UB Concussion Clinic, together with his colleague John J. Leddy, MD, Clinical Professor of Orthopaedics at the University at Buffalo School of Medicine and Biomedical Sciences and Director of the UB Concussion Management Clinic, have revealed shocking findings about the treatment of concussions and have developed an effective treatment plan for those who suffer a concussion.
For anyone who has ever suffered a hit to the head, you know the drill: close yourself in a dark room, draw the blinds, and rest as much as possible. Some doctors even suggest that you avoid reading, using a computer or phone, and even watching t.v. Dr. Willer and Dr. Leddy have proven this archaic approach to treating concussions is not only outdated and ineffective, but actually hinders an individual’s ability to quickly and effectively recover from the hit. Dr. Willer and Dr. Leddy are experts when it comes to treating sports-related concussion, traumatic brain injuries, and various concussion symptoms. This internationally recognized program is founded on scientific research, care, baseline testing, and treatment. The results are a safe return-to-activity program that fits the individual. This scientifically validated concussion treatment approach safely and effectively reduces symptoms and returns individuals to their usual activities.
In summation, Dr. Willer and Dr. Leddy’s exercise-based concussion protocol is carefully constructed specifically to each patient and results in returning individuals to their usual activities safely. Hopefully at this point, your face is squished in a confused expression and you are thinking “no, no, no. I’ve always been told that you need to rest in a dark room.” This highlights my entire point about what we know about brain injuries, CTE, and the like: DO NOT ACCEPT ANYTHING AS A FOREGONE CONCLUSION. When we do this, we end up practicing poor protocol and keeping new developments in the dark. In order to advance science, we need to challenge everything from the “correct” method of treating a concussion to the supposed causes of CTE.
In BU’s studies, CTE has been found in the brains of nearly all professional football and hockey players, many of whom had clearly exhibited dementia, and whose brains were donated for study by their families. Therefore, rightly so, investigators commenting on these postmortem studies have cited selection bias and the lack of a control group (that is, donated brains from people who didn’t play contact sports) as important limitations.
In a study of “a relatively small sample of former athletes,” Dr. Willer and Dr. Leddy did not find evidence of early-onset dementia in the retired players, which would be expected with CTE. The comprehensive, case-control study is believed to be the first age-matched athlete comparison designed to identify in retired living athletes cognitive symptoms or imaging findings that would indicate the presence of early-onset dementia.
Dr. Willer notes, “We don’t deny that CTE exists in some former athletes. It has been linked to contact sports and concussions that happen while playing those sports, but it’s not a sure thing. The larger question is, how prevalent is the problem?”
I add to Dr. Willer’s larger question, can we reduce instances of the problem via proper protocol and treatment management? Is it possible that we would see a decrease in the negative symptoms reported by athletes who suffer multiple concussions or even CTE in autopsied brains when the protocol and treatment of those players are tracked over time? Would following proper protocol and adherence to a treatment management plan such as that of Dr. Willer and Dr. Leddy allow the brain to recover fully and therefore reduce instances of these symptoms such as memory loss, erratic behavior, mood changes, and even early-onset dementia and CTE? What we still don’t know about the Tau proteins discovered in individuals diagnosed with CTE is how they get there exactly – would we see less if individuals were fully recovered before experiencing another hit? These are vital questions that could change the landscape of current research and are worth looking into.
The bottom line here is that the real issue isn’t CTE, despite high profile lawsuits and TMZ and late night documentaries. The real issue is a little less glamorous because it’s been right under our noses. The real issue is implementing and following proper protocol (hint: not the “protocol” the University of Tennessee used with Brian Maurer) and adhering to an appropriate treatment plan. The greatest danger is caused by failure to implement and comply with concussion management protocol. The study I would like to see is of those players diagnosed with CTE, which were under a well-implemented, well-controlled concussion management protocol. (Unfortunately, that is not possible until we have a means of diagnosing CTE before death.)
CTE may happen down the road and its severity in those who suffer with the disease should not be discounted. However, in the broader world, traumatic brain injuries (concussions) happen every single day. TBIs are the bigger problem here and if we can combat this issue, we will likely combat hundreds of other issues in the process. Focusing on the potential for developing CTE, while not to be ignored, is less a priority than making sure proper protocols are established and followed and treatment is carefully controlled because we ARE SURE that if someone is not treated appropriately following a concussion, there WILL be significant adverse effects.
Let’s change the conversation. It’s not “should we ban tackle football for children under 12?” It’s “we must establish and implement proper concussion protocol for players of all ages playing contact sports and have a system that properly tracks adherence to and control of an appropriate treatment plan.”