CTE and football: Is it right to worry about concussions, or are people jumping the gun?

(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.

Figure 1, NFL players’ brain shows four main signs of CTE (Ann C. McKee, M.D., V.A. Boston Healthcare/Boston University School of Medicine)

Notable Research

CTE Investigation

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).

Figure 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).

Figure 3, Former Pittsburgh Steelers LB Mike Webster, (Michael Chikiris/The Pittsburgh Press)

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)

Groundbreaking research

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.  

Conclusion

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.


References

[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.

2017 National Championship Preview: Tarheels to avenge last year’s heart-wrenching loss

Photo via ASSOCIATED PRESS/DAVID J. PHILLIP

NCAA Tournament – National Championship

Monday, 9:20 (ET) on CBS

University of Phoenix Stadium, Glendale, Arizona

No. 1 North Carolina Tarheels vs. No. 1 Gonzaga Bulldogs

After an unpredictable tournament sprinkled with cinderella stories, two number one seeds are playing for the National Championship.

The Gonzaga Bulldogs beat the South Carolina Gamecocks last night 77-73. Gonzaga held a solid lead for most of the game, but allowed South Carolina to go on a late 16-0 run. The Bulldogs then regained control and played solid basketball down the stretch to win.

The North Carolina Tar Heels barely hung on last night against the Oregon Ducks in a 77-76 win. UNC got down early, but came back before halftime and controlled the game for the majority of the second half. They let the Ducks creep back into it late, though. With possession and just over five seconds on the clock, UNC missed four consecutive free throws. Luckily, the best rebounding team in the country corralled two offensive boards on those misses to seal the win.

After two hard fought wins, Gonzaga and UNC will compete Monday night for the National Championship.

What to watch for

Zach Collins vs. USC.jpg
Zach Collins celebrates after his huge night against South Carolina (Mark Humphrey/AP Photo)

Big men (Karnowski vs. Meeks)

Both teams are dominant inside.

When forwards Isaiah Hicks and Tony Bradley were limited by the Ducks last night, Kennedy Meeks exploded for 25 points and 14 rebounds. North Carolina has arguably the most dominant inside presence; they have the best rebounding margin in the country.

Gonzaga is a great rebounding team, too, ranked 11th in the country. Against South Carolina, Gonzaga’s big men took over. Center Przemek Karnowski scored 13 points and had five rebounds, while forward Zach Collins, had 14 points and 13 rebounds off the bench.

Karnowski has the ability to exploit small teams because of his height. He’s not as dominant on the boards as he should be, though, averaging just under six rebounds per game. It wouldn’t surprise me if he struggles against North Carolina’s elite big men.

It’s hard to bet against either teams big men, but I think as long as North Carolina’s can avoid foul trouble, they’ve got the upper-hand.

Slight Advantage: North Carolina

Joel Berry hobbles off against Kentucky (Getty).jpg
Joel Berry II walks off after suffering another ankle injury against Kentucky in the Elite Eight (Getty Images)

Guards

When everyone is healthy, North Carolina has the advantage at the guard spot. Joel Berry II’s playing ability has been hindered, though, due to his recent ankle injuries. He shot 2-14 against Oregon, and after playing 35 minutes on Saturday, his ankle’s not going to be any better.

Gonzaga has a group of solid guards led by Nigel Williams-Goss, who scored 23 points against the Gamecocks, many of which game at crucial points in the game. Their guards are tough and play with sound fundamentals.

Williams-Goss is arguably better than Berry and is playing without any injury concerns. He has also shown the ability to do everything: score, assist without turning the ball over, exude toughness, and perform in clutch moments.

Advantage: Gonzaga

Jackson and Nigel Williams Goss 2017
UNC’s Justin Jackon (left) and Gonzaga’s Nigel Williams-Goss (Getty Images)

Star Power

Stars win games late and win championships.

Williams-Goss has shown himself to be a star, but I expect Berry to play solid defense against him, limiting his scoring.

I don’t see anyone being able to control forward Justin Jackson. He’s been the best player for the Tar Heels this season and down the stretch. His clutch shooting will keep UNC in the game early and help them pull away late.

Prediction

UNC has more star power and size than Gonzaga. Not to mention, UNC has the experience of playing in a National Championship game. Even though they lost on one of the most memorable shots in March Madness history, the experience will help them on Monday.

Championship games are won with experience, so last years game might be the difference for the Heels; their guys have been here before.

North Carolina will win a nail-biter late thanks to a few timely rebounds from Meeks and a few clutch shots from Jackson.

Final Four Preview: UNC’s size and depth too much for Oregon

Photo via Getty Images

No. 1 North Carolina Tarheels vs. No. 3 Oregon Ducks

NCAA Tournament – Final Four

April 1, 8:49 pm (ET) on CBS

University of Phoenix Stadium, Glendale, Arizona

Last week’s UNC-Kentucky game was the unofficial National Championship. I decided that whichever team came out on top in that nail-biter, I’d pick to win it all.

Predictions in the month of March are erratic, anyone can figure that out by looking at their bracket. Take my prediction with a grain of salt. Here are the keys to victory for both teams.

Oregon’s keys to victory

NCAA Basketball: NCAA Tournament-Midwest Regional-Kansas vs Oregon
No. 5 Tyler Dorsey shushes the crowd (Photo via Denny Medley – USA Today Sports)

Ride the experience of Dorsey and Brooks

Guard Tyler Dorsey and forward Dillon Brooks are averaging more than 14 points per game this season. Dorsey, the point guard and leader, is a gritty player who embraces big moments. He’s been Oregon’s best weapon in the tournament, averaging 24.5 points per game.

Brooks, the 6 foot 7 forward, is clear-cut NBA talent. He hasn’t had a 20 point game in the tournament yet, but has been a solid force for the Ducks, scoring in the mid-teens and rebounding well.

Brooks will have to pick up the slack on offense for the Ducks to win this game.

Take advantage of the ankle

North Carolina’s Joel Berry II won’t be 100 percent on Saturday after rolling his ankle several times over the past few weeks; Dorsey should look to take advantage of his immobility.

For Oregon to have a chance tomorrow, Dorsey will need to score close to 30 points.

Rebound

The emergence of forward Jordan Bell gives Oregon a dynamic new weapon.

The one advantage that UNC has over everyone in the country is size. Bell will have to continue his dominance on the glass if Oregon wants to keep the game close. Bell has averaged almost four more rebounds per game in the tournament (12.5) than his season average (8.6).

Cause foul trouble

With Isaiah Hicks, Kennedy Meeks and Tony Bradley in the UNC front-court, Bell is going to have a tough day. In an effort to mitigate North Carolina’s size, Bell will need to go after Hicks to induce foul trouble.

If Oregon can reduce Hick’s minutes, Meeks and Bradley might struggle to stay in front of Brooks and Bell.

Small ball

To combat UNC’s size, Oregon will have to play small-ball. Oregon only has one quality big man, Bell, while the Tarheels have three. The Ducks need to quicken the pace of play, forcing UNC’s bigs to struggle going up and down the court. Dorsey and Brooks will flourish in an open-court environment.

UNC’s keys to victory

Justin Jackson intros.jpg
No. 44 Justin Jackson is introduced at Chapel Hill (Photo via Inside Carolina)

Justin Jackson

Justin Jackson needs to continue his clutch play. UNC goes through stretches where they struggle to score because they lack shooters. Jackson’s their only star shooter, so he’ll need to hit threes and clutch shots to prevent the Tar Heels from just relying on short range baskets.

Size

UNC has the means to dominate the glass. Oregon only plays one person above six-nine, Bell, while the Tarheels play three. It’s a glaring mismatch, and the number one rebounding team in the country, UNC, needs to take advantage.

Despite UNC’s love for running and gunning, it makes sense for them to slow it down sometimes and throw it into the post. Oregon won’t be able to stop Meeks, Bradley and Hicks down low. Any foul trouble on Bell created by action down low would kill Oregon’s chances, too.

Depth

This is the main reason why I don’t see Oregon winning this game. If Oregon slows the game down, UNC’s size will take over. If Oregon speeds the game up to combat the Tarheel’s size, UNC’s depth will take over.

UNC consistently goes ten guys deep in a game, and those five bench players aren’t inept.

Campus legend, Luke Maye, has been rebounding and hitting shots left and right, including the game-winner against Kentucky.

https://twitter.com/DylansFreshTake/status/846143469307473920

Tony Bradley provides an inside presence that will be hard to stop, and senior guard Nate Britt can provide rest for Berry.

North Carolina’s bench also features guard Stillman White, who played well for Berry in his absence, and guard Seventh Woods, a star in the making.

In their 74-60 win over Kansas, Oregon used just three players off the bench. Two of those three, Keith Smith and Kavell Bigby-Williams, combined for only nine minutes, one point, one assist and one rebound. The other sub, Casey Benson, played 21 minutes, scoring only four points and grabbing two rebounds.

Prediction

 

Kennedy Meeks Oregon.jpg
No. 3 Kennedy Meeks will present a lot of trouble for Oregon’s (Chuck Liddy/ Raleigh News and Observer)

 

Oregon’s starting five might be great, but they lack size and depth. They’ve gotten away with it up to this point, but UNC boasts the best big men and the deepest team in the country.

Berry also said that his ankle is expected to be close to 100 percent. I doubt it is, but it shouldn’t have a huge impact on his play.

North Carolina may be the best team in the country and they match up well against Oregon. The Ducks could make it close, but the Tar Heels’ depth will ultimately overwhelm the Ducks.

 

2017 NCAA March Madness: Predictions, Sleepers and Headlines

John Peterson/Icon Sportswire via Getty Images