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The NFL and CTE The NFL and CTE
If staggering after a hit to the head isn't part of the current guidelines, it sure should be. Also, players themselves may not... The NFL and CTE

by Kimberly Allen, RN

As the nation readies itself to watch the Super Bowl by buying beer, chips and chicken wings, doctors and health advocates are preparing for the Big Game in a different way – by releasing more information about concussion’s and their relationship to CTE. What is CTE?  Chronic traumatic encephalopathy is a degenerative disease that is diagnosed after death.  CTE has also been called dementia pugilistica or “punch drunk” and in the past was associated more with boxers. Today, CTE is more common in athletes that participate in such sports as hockey, and football.

Head trauma and CTE in particular has gotten a lot of press lately, and some reaction to it by the NFL. The case of San Diego Chargers linebacker Junior Seau, who committed suicide for inexplicable reasons, made doctors look at possible brain damage as a reason for his tragedy. The results of Seau’s autopsy are in and, as believed, the scientists that analyzed his brain tissue concluded that he suffered from CTE. Shortly after the announcement regarding the findings in Seau’s brain tissue autopsy, researchers announced that they had done a study on CTE and pro football players.  There were 85 brains from veterans and athletes with history of repeated head trauma donated by their families for the study.  Of the 85, 68 had CTE.  Of the 68 there were 34 NFL players, 9 college players and 6 that had played only high school football.

footballCTE is caused by repeated episodes of head trauma.  Concussions are the number one type of head trauma in athletes.  Though concussions are frequently considered mild traumatic brain injuries they are still brain injuries.  And the long term consequences are coming further into the light.  a concussion occurs when you suffer an impact to your head that causes your brain to slosh around and hit the inside of your skull.  Usually the severity of the impact determines the severity of the concussion.

There are different degrees of concussion, depending on your symptoms.  The symptoms of a concussion usually involve a temporary impairment in brain function with a wide range of cognitive, emotional and physical symptoms.  Concussions can occur with or without a loss of consciousness.  Should you suffer repeated concussions, even those when there’s no loss of consciousness, you are increasing your risk of developing CTE.

Frequently the symptoms of CTE do not manifest until years after the trauma and has symptoms similar to other neurological conditions like Alzheimer’s and Parkinson’s disease.  CTE is a progressive disease that usually has 3 stages.  The first stage is onset on psychotic symptoms and disturbances.  The second stage is characterized by memory loss, erratic behavior and early symptoms of Parkinson’s disease and the third stage is characterized by dementia and symptoms consistent with Parkinson’s disease like difficulty with speech, swallowing and walking.

Until recently, the only way to confirm CTE was in a pot mortem exam. But now,  researchers at the University of California, Los Angeles have developed a new tool for brain scanning that can identify CTE in living people.  The UCLA team performed the scan of five ex NFL players that are still living and were known to have suffered at least one concussion.  The scans showed the build up of an abnormal protein called tau which strangles the brain cells in all five players.  The researchers found that the tau was concentrated in the areas of the brain that control memory and emotion as well as other functions.  These patterns of tau build up were consistent with those found in the CTE brains that were studied after autopsy.  Though only five players were examined, if future studies produce the same results it could be a huge breakthrough in treating CTE.

concussionAs an avid football fan, I love watching the game. However, I cringe every time I see any player down and surrounded by doctors, trainers and team mates – no matter what team he plays for.  I’ve watched the rules change over the years in an attempt to limit injuries.  Helmets have also been improving over the years to help protect the players heads.  Recently, former NFL players started suing the NFL, claiming that the NFL knew the potential complications of concussions and didn’t tell the players.  Since the law suits were filed, the NFL has moved the kickoff line up and increased the penalty for hits to the head.  The NFL has also donated $30 million to the study of concussions and CTE and have set guidelines to assist in diagnosing concussions on the sidelines.

But these guidelines might not be enough. I would like to know how it is that many of  us that were watching the Bear’s game against Houston and saw Jay Cutler stagger off the field after a hit to the head by one of the Texans only to return and continue to play.  If staggering after a hit to the head isn’t part of the current guidelines, it sure should be.  Also, players themselves may not be willing to report their injuries. I can understand why. Especially after Alex Smith of the 49ers left the game with a concussion only to be permanently replaced by Colin Kaepernick.  I realize it’s the coaches prerogative to play whoever he wants, but it’s these types of moves that keeps the players from letting anyone know they’ve been injured.

No one wants to tell the players that they need to start taking responsibility for their health.  Many players have a “play no matter what” attitude.  Unfortunately, this attitude develops long before they get to the NFL.  Most of it starts in high school.  I watched high school games when I was in school and then when my son played and the culture of football has always had the same attitude. It doesn’t matter how hard you get hit, if you can walk and talk you can play.  These young players want to impress their coaches and they watch their football idols on TV playing injured and disregard any potential health risks.  After watching my brother and my son play with “mild” concussions, I can certainly understand the attitude of parent questioning whether to let their children play football, as President Obama did recently when he conjectured whether if he’s had a son whether or not he’d let him play the sport.

In many areas of the country football is a religion and in those areas if you’re a boy frequently you’re not given a choice, you play or else.  There are local rivalries that drives the parents to push their high school players to play no matter what.  For many schools, the motto is “win at all costs.”

CTE is the only  form of dementia that is preventable.  It is caused solely by environmental factors.  The only way to prevent CTE is to prevent concussions, especially repeated concussions.  Fortunately, the NFL and NCAA have been working to improve safety and prevent concussions. However, you can change the rules, put in place guidelines for detecting concussions and invest in research, but if you don’t change the attitude of the players, it’s not going to be effective.  Players need to understand that by hiding their injuries, especially head injuries, continuing to play can seriously jeopardize their health in both the long and short term.  And parents and coaches need to start teaching children and teens the importance of staying healthy so they can have long healthy careers as well as lives.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at