Like most Americans, I have been subjected to everything NFL since the beginning of September. I would like to say football only takes place on Sunday, but no. Almost every day of the week, I hear someone talking about football, yelling at the game, or discussing how Taylor Swift got drafted into the NFL. But, when I think of football, I think of how those men are just playing bumper cars with their bodies. That’s why this week I am talking about the terrifying brain disorder often found in the brains of athletes called CTE.
Football pretty much covers all my favorite things: costumes aka uniforms, drinking in the afternoon, eating appetizers instead of full meals, and performances by cheerleaders, dance teams, marching bands, and players when they do something good. But like I said before this episode isn’t about the great things about football, instead we’re gonna down this debby and talk about the traumatic injuries often gone unseen and untreated by sports players.
What is CTE?
CTE stands for Chronic Traumatic Encephalopathy which is a brain disorder likely caused by repeated head injuries. This is a rare disorder that we don’t have a lot of information on since diagnosis is unable to be done until after death while doing an autopsy of the brain. In brains with CTE that have been studied, researchers have found that there is a buildup of tau protein around the blood vessels.
In the simplest terms, the buildup of tau protein in the brain can cause the brain to waste away. This will impact the nerve cells and the communication between cells. That being said, people with CTE may show signs of neurological diseases, such as Alzheimer's disease, dementia, ALS, or Parkinson's disease.
According to an article released by the Mayo Clinic, experts are trying to understand how repeated head injuries and other factors might contribute to the changes in the brain that result in CTE. The disease has been found in the brains of people who played U.S. football and other contact sports, including boxing. It can also be present in military members who were exposed to explosive blasts. The development of the disorder is often associated with Second Impact Syndrome which occurs after a second head injury happens before previous head injury symptoms have fully healed. It is also often confused with “post-concussion syndrome (PCS)” which is similar, but different.
PCS is a condition people can develop after having a concussion. It can last weeks or months but goes away as the brain recovers from the injury. Chronic post-concussive syndrome is a long-term form of this condition, but it doesn’t involve the unusual buildup of tau protein in the brain that forms during CTE.
While some long-term diseases and disorders can develop from CTE, there are no specific symptoms that have been linked to the disease. Some of the possible symptoms can occur in many other conditions, making it difficult to link them directly to CTE and diagnose the disorder before death. There were cases where loved ones reported symptoms including cognitive, behavioral, mood, and motor changes in people who were later confirmed to have CTE after death.
These reports from loved ones have led experts to believe that CTE symptoms appear in two forms. In early life, between the late 20s and early 30s, the first form of CTE may cause mental health and behavioral issues. Symptoms of this form include depression, anxiety, impulsive behavior, and aggression. The second form of CTE is thought to cause symptoms later in life, around age 60. These symptoms include memory and thinking problems that are likely to progress to dementia.
A study conducted in 2017 at the Boston University CTE Center and VA Boston Healthcare System examined the brains of 292 deceased former football players to determine features of CTE within the brains. Among the players, the median age at death was 66, and 87% of brains were diagnosed with CTE. These players had an average of 15 years of football participation and 110 of the 111 NFL players’ brains studied had CTE. Literally, 99% of the brains of retired NFL players were diagnosed with CTE.
Among the 27 brains diagnosed with mild CTE, 96% had behavioral and/or mood symptoms, 85% had cognitive symptoms, and 33% had signs of dementia. Among the 84 brains diagnosed with severe CTE, 95% had cognitive symptoms, 89% had behavioral/mood symptoms, and 85% had signs of dementia.
Researchers noted that several related factors may make players more vulnerable to CTE which include when a player begins the sport, the duration of playing during games, the player’s position, and cumulative hits. Just because someone plays a contact sport doesn’t guarantee they will have CTE or feel the symptoms of CTE, but it does significantly increase the risk of CTE.
Cases of CTE
One of the most horrific aspects of this disorder is its ability to turn professional sports players into completely different people. Brain trauma can make it difficult to regulate emotions or make decisions. This disorder is the common denominator in many cases of professional players having erratic behavior or taking their own lives or the lives of others.
I first heard about CTE through Aaron Hernandez’s criminal case and the Netflix docu-series based on his life.
Aaron Hernandez was a former New England Patriots tight end who was convicted of murdering Odin Lloyd, his friend and the boyfriend of his fiancè's sister. Hernandez then took his own life in prison. After his death, researchers studied his brain and it was revealed that he suffered from the worst case of CTE doctors had found in a person his age. Doctors said the damage would have certainly affected his impulse control and judgment and impacted many of the irrational, dangerous decisions he made starting from when he began playing football at the University of Florida at the age of 17. This could also explain the extreme paranoia Aaron faced, not just over the crimes he committed, but general unnecessary paranoia that caused him to lash out at others.
The documentary on Aaron Hernandez also discusses Mike Webster, the first football player to be diagnosed with CTE after death in 2009. I looked into Mike Webster’s diagnoses and doctors estimated Webster had been in the equivalent of 25,000 motor vehicle crashes in over 25 years of playing football at the high school, college, and professional levels, and the impact of those crashes showed on his brain.
As I mentioned before, researchers at Boston University’s CTE Center studied the brains of hundreds of high school, semi-professional, and professional sports players. This included the brain of 32-year-old retired NFL player Phillip Adams. Adams was a defensive back and was drafted by the 49ers in 2010. He bounced around the league playing for the Patriots, the Seattle Seahawks, the Oakland (now Los Vegas) Raiders, the Jets, and the Atlanta Falcons before his career ended in 2015.
In April 2021, Adams shot and killed six people and then took his own life. During the study conducted on his brain, he showed an “unusually severe” form of CTE. Adams’s brain showed significantly dense lesions in both frontal lobes which is an abnormally severe diagnosis for a person in his 30s. Researchers noted that this resembled the brain of Aaron Hernandez. This seemed to be a random act of violence.
Adams’s family told investigators that he experienced difficulty sleeping through the excruciating pain sustained from injuries during his playing career. A serious ankle injury ended his rookie season and he sustained two documented concussions while playing for the Raiders.
Adams also complained to his family of frequent memory lapses, according to the York County coroner. Researchers at Boston University said the following about Adams: “There were inklings that he was developing clear behavioral and cognitive issues. I don’t think he snapped. It appeared to be a cumulative progressive impairment. He was getting increasingly paranoid. He was having increasing difficulties with his memories and he was very likely having more and more impulsive behaviors.”
His family has released a statement saying: “We cannot say that we are surprised by these results, however, it is shocking to hear how severe his condition was. After going through medical records from his football career, we do know that he was desperately seeking help from the NFL, but was denied all claims due to his inability to remember things and to handle seemingly simple tasks such as traveling hours away to see doctors and going through extensive evaluations.”
During this study at Boston University, it was revealed that other NFL players, including Junior Seau, and Dave Duerson who took their own lives, and Jovan Belcher who killed his girlfriend before killing himself all had signs of CTE in their brains.
The study conducted at Boston University didn’t just study the brains of football players but various sports including hockey and the brain of NHL player Bob Probert. Probert was known for his fists and was involved in 246 fights during his professional hockey career. He tragically died of heart failure at age 45 in 2010.
Kind of like football, hockey employs and rewards players who are known as reckless enforcers to intimidate opponents. Hockey players will keep fighting until their opponent is unable to play and they have to spend the rest of the game in the locker room. It’s a very violent sport that wants its players to be violent.
In his autobiography Tough Guy, Probert talks about how he had 3,300 penalty minutes during his career. This ranked him fifth-most penalty minutes in NHL history. He recounts brawls with other enforcers and there are so many to talk about that it takes up 11 pages in the book. A 2007 Hockey News poll rated him the greatest enforcer in hockey history, once again praising and rewarding him for violent, dangerous behavior.
His widow, Dani, told The New York Times that the research group revealed that her husband’s CTE was less developed than that found in most football players of similar age; however, she noted that in his final years, he exhibited uncharacteristic behavior, especially memory loss and a tendency to lose his temper while driving. She said that her husband was aware of growing concern about CTE among athletes in contact sports and that they had discussed it soon before he died after a “60 Minutes” feature on the subject.
She told the publication: “I remember joking with him, ‘Wouldn’t your brain make a nice specimen?’ He started questioning whether he would have it himself. He told me that he wanted to donate his brain to research when he died. Who would have thought that six months later it would be happening?”
Probert isn’t the first hockey player to be diagnosed with CTE. Long-retired player Reggie Fleming was also diagnosed with CTE. Fleming was an enforcer who played before the full adoption of helmets.
Boxing is the founding father of brain injury-causing sports. An article by The Guardian titled “Boxing is a mess: the darkness and damage of brain trauma in the ring” discusses Tris Dixon’s book on CTE in the boxing world. Dixon explained that neurologists struggled to explain the slurred speech, memory loss, shakes, violent mood swings, depression, and other symptoms that plagued boxers. They frequently called this “Punch Drunk Syndrome.”
This term dates back to 1928 when the American doctor Harrison Martland wrote a paper called Punch Drunk. It was a groundbreaking study, but Martland argued wrongly that punch-drunk syndrome only affected mediocre boxers. We now know that legendary professional boxers such as Joe Louis, Sugar Ray Robinson, Muhammad Ali, and Aaron Pryor may have all suffered from CTE.
The Guardian interviewed the wife of Aaron Pryor, Frankie Pryor. She told the publication: “I didn’t understand the damage was caused solely by boxing until he started showing anger. Aaron was so easygoing until then. I started taking him to a neurologist around 1994. At that point, we didn’t know [it was CTE]. Initially, it was just front temporal lobe damage, but he never stopped going to a neurologist until he died.”
I also want to highlight how relevant CTE is in professional wrestling, specifically in the WWE. You may be familiar with professional wrestler Chris Benoit who rose to fame in the 90s and 2000s.
Tragically, Chris took the lives of his wife and son followed by his own in 2007. His wrestling style was notoriously physical, and he was known for taking significant blows to the head. He frequently performed diving head butts, a move that involved him launching himself headfirst off the top rope to strike his opponent. This move was his signature which he performed regularly throughout his career. Friends and colleagues have described him as becoming increasingly withdrawn and erratic in the years before his death. He had trouble sleeping, was easily agitated, and would often forget things or repeat himself in conversations. In the years following his death, Chris was diagnosed with CTE.
Since then, more than 60 former wrestlers, most of whom were famous in the 1980s and 1990s, sued the WWE, saying they suffered repeated head injuries including concussions that led to long-term brain damage. They accused the WWE of knowing the risks of head injuries, but not warning its wrestlers.
I don’t want to ruin the illusion, but professional wrestling is a choreographed dance routine. I’m sure there was a point where professional wrestling was “real”, but it’s always been an entertainment sport. Basically, there’s no need for any moves that would cause concussions or any harm for that matter. Professional wrestlers have been very outspoken about how unnecessarily dangerous the WWE is.
Those accusing the WWE include the families of Jimmy “Superfly” Snuka and Harry Masayoshi Fujiwara who died in 2017 and 2016 respectively and were both diagnosed with CTE. Other wrestlers have reported signs of dementia and other neurological disorders. Several lawsuits were dismissed in 2018 by U.S. District Judge Vanessa Bryant in Hartford, Connecticut. Bryant ruled there was no evidence that the WWE knew while the plaintiffs were wrestling that concussions or head blows during matches caused CTE or other long-term injuries.
A full list of over 60 plaintiffs/former wrestlers as well as the status of their case is available on the WWE Concussion Lawsuit News website, but I wanted to share a few here as well:
The first case was brought by Billy Jack Haynes as a Class Action seeking to get neurological testing and neurological medical care for all former WWE wrestlers.
The second case was filed by Vito Lograsso and Evan Singleton who supported Billy Jack Haynes.
Jon Rechner (Balls Mahoney) was diagnosed with CTE and his tag team partner (Brian Knighton (Axl Rotten) had early suggestions of CTE. Both wrestlers died in 2016 at age 44.
Efforts to Decrease Risk
Now that we have gone over what it is and I’ve given you just a few examples of the players who were diagnosed with CTE after death, you’re probably thinking, “So what the hell are we going to do now?” Obviously, American football, and other professional violent sports, aren’t going anywhere.
So, doctors and experts on the sidelines are responsible for removing players who may have received brain injuries during games or practice to prevent even more damage from occurring and sometimes, they don’t do that.
The Aaron Hernandez documentary also shines a light on the use of Toradol, which is a painkiller given to football players as young as the college level to get them to continue to play while injured. The documentary replays all of the brutal hits Aaron took throughout his career and I couldn’t help but audibly gasp after watching each one.
Meanwhile, on a recorded phone call with his fiancè, Aaron is heard saying “You know what’s crazy? They banned that shit from the league saying you only could take it if you have a serious injury or something. Guess who they gave that shit to every fucking game? Me.” The NFL also got Aaron a secret apartment, which is typical for players. In the wise words of Aaron’s longtime family friend: “Did you think he was going to be painting Bob Ross pictures over there?”
In October 2022, the NFL changed its concussion policy after Miami Dolphins quarterback Tua Tagovailoa sustained two major hits while playing. The first hit took place during a game against the Buffalo Bills. He was pushed to the ground and his head hit the turf. Afterward, he stumbled and needed help steadying himself, leading many viewers to believe he'd been concussed. But he returned to the game after a medical evaluation, and team officials later attributed the wobbliness to a back injury he'd sustained a few plays earlier.
Just four days later, he returned to the field in a game against the Cincinnati Bengals. He was sacked and his head hit the turf again; immediately afterward, his fingers and arms were flexed unnaturally in what appeared to be a "fencing response," a telltale sign of traumatic brain injury.
After these injuries, the NFL had to investigate to confirm what happened to him. The investigation showed that the NFL's concussion protocol had been followed in evaluating him and did not show concussion symptoms during his mid-game medical evaluation after the first injury or in the days that followed before he played in the game where he sustained the second hit. Instead, his unsteadiness was blamed on a back injury he'd sustained on an earlier play.
So, the NFL changed its policy. The revision concerns ataxia, the medical term for the poor muscle control associated with concussions that can appear as unsteadiness or slurred speech. Going forward, any player who is diagnosed with ataxia will not be allowed to return to the game. Previously, players could return if there was another explanation for a moment of instability, like how Tagovailoa's stumble was attributed to the back injury.
When the policy was implemented, it was used almost immediately. An independent certified athletic trainer (also called an "ATC spotter") reported seeing the team's backup quarterback, Teddy Bridgewater, stumble after being hit on the first snap of the game. The report triggered the new clause of the concussion policy, and Bridgewater was pulled from the game.
As I mentioned plenty of times before, there are no specific symptoms doctors could use to diagnose someone with CTE while that person is still alive. However, the invention of better protective gear and legislation surrounding concussions have helped prevent or decrease the risk of CTE. Studies are proving that players of all ages are benefiting from updated policies.
An article released by the University of Washington in 2019, reported that studies have shown that the reporting of concussions has increased and injury recurrence has decreased. The article states the following contributions to those statistics:
Washington state coaches reported completing concussion education and more than 95% demonstrated a basic understanding of concussion causes and symptoms.
After the enactment of the laws, the rate of new concussions increased, attributed to increased identification and reporting. The number of concussions documented in Seattle public high schools more than doubled after the law's enactment.
While more concussions are being reported, the recurrent concussion rate shows a significant decline.
Decreasing recurrent concussions and the number of head impacts overall will decrease the risk of CTE in sports players and average people. There are simple measures that can reduce the chance of having a concussion, where blows to the head can cause notable symptoms including the following:
Wear the appropriate safety gear when playing contact sports like American football or ice hockey. Helmets and other forms of safety gear can reduce the risk of having a concussion. Playing conscientiously and avoiding situations where you could cause a dangerous collision or put yourself at risk for one is also important.
People who enjoy cycling, rollerblading, skateboarding, and similar sports should always wear a helmet. They can make an enormous difference in preventing concussions.
For my average joes out there: Motor vehicle crashes are a common cause of concussions for non-athletes. Wearing your seatbelt can reduce the chances of having a concussion or limit the severity if you still have one.
I’ve mentioned a million times that CTE can’t be diagnosed before death, which is true, but doctors can review the patient’s history of head injuries and conduct various tests to rule out other conditions. These tests include:
Computed tomography (CT) scans which use a series of X-rays and a computer to create detailed images of your bones and soft tissues. A CT scan is painless and noninvasive.
Magnetic resonance imaging (MRI) scans are a test that creates clear images of the structures inside your body using a large magnet, radio waves, and a computer.
Positron emission tomography (PET) scans detect early signs of cancer, heart disease, and brain conditions. It involves an injection of a safe radioactive tracer that helps detect diseased cells.
Testing of cerebrospinal fluid, collected with a spinal tap (lumbar puncture) which can detect meningitis, leukemia, and other illnesses.
Players and experts alike are advocating to reduce the risk of CTE, especially in young players. In 2021, legendary football player and Hall of Famer, Brett Favre released a public service announcement in collaboration with the Concussion Legacy Foundation urging parents to not let kids play tackle football until they’re fourteen. According to Favre, having kids play tackle football before high school is just not worth the risk. Kids can still play flag football, but tackle football shouldn’t be available until they are freshmen in high school.
Brett Favre is very outspoken about the amount of brain injuries he received during his professional career, especially the ones that went undiagnosed. He revealed on the Bubba Army Podcast that he didn’t even know what a concussion was until after his career. He thought concussions were the result of getting knocked down and blacking out for some time. He thought concussions only occurred when you had memory loss or dizziness. He used boxers as an example and said that a concussion is when the boxer gets knocked down, tries to get up, and his legs are rubber.
Brett Favre said that he was never diagnosed with a concussion. That’s extremely hard to believe because, during his career, he was sacked 525 times while playing for the Packers, Falcons, Jets, and Vikings. This includes the game in 2004 when Favre hit his head just before throwing a touchdown pass. Favre told the podcast “That’s what’s so frightening about concussions. You can hit your head, have a concussion, and continue with daily life having no idea that you suffered a brain injury.”
Some hope diagnosing concussions and benching injured players will decrease the risk of CTE and other traumatic head injuries. In December 2023, experts in athletic brain injury and long-term cognitive disorders gathered at a summit at the Cantu Concussion Center. The summit was held to identify gaps in current research into concussions and traumatic brain injuries in professional and youth athletes.
The results from the summit laid out several recommended guidelines, including eliminating unnecessary contact to the head and neck areas during practice and games and penalizing players for such contact.
Dr. Allen Sills is the chief medical officer of the NFL and one of the organizers of the conference. Dr. Sills was quoted saying “Having a collision sport or a contact sport doesn’t mean that that collision or contact has to involve the head. You can play a sport in which there is contact between or among players, but we should try to get the head out of that contact whenever possible.” Sills noted that these guidelines have already been implemented in the NFL and initiatives like the conference will help further research and guidelines that will be created to protect the players even more.
So what now?
Once again you may be asking yourself, “What the hell are we going to do now?” And as I said before, professional sports are not going anywhere. Forbes reported that the NFL alone raked in almost 12 billion in national revenue during the 2022 season. Each of the 32 teams took in $372 million from national media rights, league sponsorships, merchandising, and licensing.
The biggest chunk by far came from the NFL’s national television deals with ESPN/ABC, Fox, CBS, NBC, and Amazon, which totaled $249 million per team. Amazon began its exclusive 11-year, $13.2 billion Thursday Night Football streaming deal with the league last season. This also includes the $372 million from DirecTV’s Sunday Ticket, which averages $1.5 billion a year.
The NFL’s national bounty increased again this year because major networks started their new long-term deals and YouTube took over Sunday Ticket from DirecTV at an average of $2 billion a year which was a 50% increase. National media makes up about 67% of the league’s total football-related revenue. In addition, teams total about $200 million in revenue from non-NFL events, such as concerts, at their stadiums. Long story short, football is entertaining and makes America a lot of money, and not many people care who is hurt in the process, including the players themselves. I’m sure plenty of players would give years off their lives to become a professional, but is it worth it?
In the Aaron Hernandez docu-series, retired 49ers player Chris Borland talks about how he stepped away from football at 24 because he was scared of the impact of head injuries. He said in the documentary, “The reason football is the most popular sport is because it’s violent. They’re not in the health business, they’re in the violence business.”
I also understand players wanting to play as much as possible or having a “big name” on the team to draw in fans and sell merch, but there are so many college players and professional players currently in the NFL and a crazy amount of aspiring players who are good enough to be in the NFL. That being said, it annoys me to think they are making players play through serious injury just because they are a little better than everyone else.
I’m going to give a bizarre analogy that not many people will understand, but just hear me out. While watching a Broadway show, sometimes you can tell when a certain background character or even the main character is playing another side character or a super small part that only has one or two lines in a very short scene. For example, while watching the Broadway musical, Beetlejuice, I noticed that the actor who played the main character, Adam, also plays the delivery man during the song “That Beautiful Sound.” The character rings the doorbell, gets scared, screams like a little girl, and runs out. It's not a big part. It's understandable if they don’t want to cast an actor solely for the scared delivery man role.
I also noticed that the actor who played Delia, Lydia’s stepmom in the show, also plays Miss Argentina, the secretary who greets Adam and Barbara in the afterlife. Miss Argentina sings “What I Know Now” which is one of the best songs in the whole show. Delia is one of the main characters and also gets to sing the great song “No Reason” with Lydia. Also, Miss Argentina is blue. They turn her blue. Then un-blue her so she can finish the show as Delia.
I guess my point is that with all that money in revenue, why can’t we just hire more people? These are careers that people dream of and are draining and damaging to the people who are currently pursuing them. I know we have third g-string backups for that reason, but we continue to put an insane amount of pressure on one singular player as if they aren’t on a team with 50 other people. I’d rather see Jason Kelce retire than risk his life with his beautiful wife and children being cut short. But that’s just me.
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