(NFL football player after head collides with ground, AP Photo)
In 2018, it is hard to talk about football without bringing up concussions. After a study was released correlating football with Chronic Traumatic Encephalopathy as 110 out of 111 NFL players’ brains were diagnosed with CTE, football has been heavily linked with long-term brain damage and concussions (Daneshvar, Kiernan, Abdolmohammadi, et al 2017).
So what’s the issue?
Football is America’s most popular sport. So if the aforementioned data accurately reflects the damage someone’s brain takes during football, the future of those who play football would be in jeopardy.
In 2016, close to two million kids, ages 6-12, played tackle or flag football regularly in America, per the Aspen Institute.
According to the National Federation of State High School Associations, football has the highest participation among high school boys with over 1 million participants, more than 400,000 more than track and field and basketball, respectively.
The NFL had $13 billion in revenue in 2016. $3.5 billion more than the MLB (plays more than 10 times as many games) and $8 billion more than the NBA of which plays more than 5 times as many games as the NFL, via Market Watch. Despite the concussion and CTE risk and the lower number of games, the NFL reigns supreme in popularity among Americans.
In what was briefly mentioned in the introduction, a study was released in the summer of 2017 suggesting CTE is related to prior football participation (Daneshvar, Kiernan, Abdolmohammadi, et al 2017).
202 deceased brains, all of which played football at some level, were donated to the research. Each brain was then tested for CTE (see fig. 1 above), something that currently can only be done once someone is deceased. After the testing, they found that 177 out of the 202 players were diagnosed with CTE. And the different groups of results are below in fig. 2 (Daneshvar, Kiernan, Abdolmohammadi, et al 2017).
Note the exact numbers are as follows: 0 out of 2 preschoolers, 3 out of 14 high school players, 48 of 53 college football players, 7 of 8 Canadian Football League Players, and 110 out of 111 NFL football players.
The majority of players who had college experience or higher suffered from severe pathology while the majority of those who did not make to the college level with CTE suffered from mild pathology (Daneshvar, Kiernan, Abdolmohammadi, et al 2017).
It should be noted that each one of these brains was donated to the research, meaning the brains were not selected at random.
UNC’s Zachary Kerr
The University of North Carolina’s Zachary Kerr found a correlation between prior concussions, depression and increased aggression.
In Kerr’s study, 797 questionnaires were answered by former college athletes. Based upon those questionnaires, a player who reported three or more concussions was 2.6 times more likely to exhibit symptoms of depression compared to a player who did not report a concussion (Kerr 2014).
The Journal of Neurology’s Alan Carson
The aforementioned studies do not provide a promising outlook for those who are fans of football as the research has some strong evidence supporting the connection between poor brain health (CTE, depression, aggression) in the future and football.
With that being said, Alan Carson, from the Journal of Neurology, isn’t ready to jump the gun.
Carson is preaching less conversation and more science as he believes the debate has been taking place among the mainstream media instead of scientific journals.
“If football were viewed as a drug, it saved 296 lives but at the cost of 17 deaths.”
– Alan Carson
The movie ‘Concussion’ was based on former NFL player Mike Webster (see fig. 3 above) who died at 50 years old due to a heart attack and was diagnosed with cognitive dysfunction.
However, it wasn’t touched on that Webster had addiction problems with opiates, amphetamine, drugs, and alcohol. He also was treated for lymphoma, would electrocute himself to aid his sleep and was rumored to use performance-enhancing drugs during his playing days. This information creates multiple confounding factors that would cloud the suggestion that football led to his demise (Carson 2017).
In addition, Carson discusses another study that looked at 334 deceased NFL players. Among those 334, 17 died with neurodegenerative disorders. The all-cause mortality rate for these NFL players was half of the national average (Carson 2017). As such, “if football were viewed as a drug, it saved 296 lives but at the cost of 17 deaths,” said Carson.
In opposition to Kerr’s research, the University of Michigan conducted a study that showed lower rates of irritability and the same rate of depression compared to the average US population (Carson 2017).
Too many unknowns still exist
In the end, Carson points to the multitude of confounding factors that are yet to be unraveled in concussion and neurodegenerative disease research.
For football players specifically, it is tough to point to collisions or concussions when they are constantly given pain medication to just be able to play each Sunday. Who knows what impact those drugs have? Also, it would be naive to think that some athletes haven’t been using performance-enhancing drugs, and again, the long-term side effects from PEDs on brain health are not certain.
It also goes to show that there has been research refuting the idea that concussions are related to neurodegenerative diseases and vice versa. This research involves so many subtleties that are yet to be studied. Not to mention, it might take a full lifetime to better understand considering the fact that no one can test for CTE, at the moment, until someone is dead and that the symptoms go unnoticed for decades.
Yes, there might a correlation, but what is the causation of these neurodegenerative diseases. That is yet to be discovered.
(Figure 4, United Neuroscience via Youtube)
United Neuroscience: CTE Vaccination
In response to the concern, United Neuroscience from Dublin, Ireland, is researching a CTE vaccination in hopes to have it in human clinical testing in 2019 (see fig. 4 above).
A plan to develop a vaccine for CTE was announced by United Neuroscience in January (PR Newswire 2018). It was discovered that the protein tau builds up in the brain after repeated collisions leading to chronic brain disease. United Neuroscience’s hope is to create a vaccine that will inhibit the buildup of tau in an athlete’s brain and therefore negate CTE (PR Newswire 2018).
If the CTE vaccination can successfully be made, physical sports will be revolutionized. Kids who quit due to long-term brain health concerns would return to football. For example, a vaccination in the state of North Carolina would help preserve the futures of more than 30,000 high school football players per year which doesn’t take into account the thousands of youth, college and professional football players.
And the millions of high school football players across the United States.
(figure 5, Columbia Medicine via Youtube )
NoMo Diagnostics: Concussion Diagnosing Helmets
NoMo Diagnostics is creating a new football helmet equipped with sensors. The hope is that it will develop a helmet that can diagnose concussions immediately after contact by monitoring the brain waves of a person. If a concussion occurs, football teams would be able to know immediately as the technology would send a signal to the sideline.
The technology of how the sensors can detect concussions are discussed above (Fig. 5).
While this does not prevent concussions, it would help diagnose them and protect players’ health considering many concussions go unreported.
Overall, concussion research is still in its infancy with so many unknowns surrounding the long-term impacts of concussions. Nonetheless, there seems to be a bright future ahead thanks to United Neuroscience’s research involving the CTE vaccination and NoMo Diagnostics building a helmet to immediately notify football sidelines of a concussion if it takes place.
Football, without a doubt, is a physical and dangerous sport. But the future of the game seems to be in the right hands thanks to the wonderful research being accomplished by those mentioned above.
[Anonymous]. 2018. United neuroscience announces development plans for vaccine to prevent CTE. PR Newswire;
Carson A. 2017. Concussion, dementia and CTE: Are we getting it very wrong? Journal of Neurology, Neurosurgery and Psychiatry. 88(6):462.
Kerr ZY. 2014. The association of concussion history and mental health in former collegiate athletes. Ann Arbor: The University of North Carolina at Chapel Hill.
Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, Alosco ML, Solomon TM, Nowinski CJ, McHale L, Cormier KA, Kubilus CA, Martin BM, Murphy L, Baugh CM, Montenigro PH, Chaisson CE, Tripodis Y, Kowall NW, Weuve J, McClean MD, Cantu RC, Goldstein LE, Katz DI, Stern RA, Stein TD, McKee AC. Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA. 2017;318(4):360–370. doi:10.1001/jama.2017.8334
NCHSAA. 2014. Athletic participation numbers. North Carolina High School Athletic Association.