Chronic traumatic encephalopathy (CTE) is a type of brain damage that has been found in 345 of 376 deceased former National Football League (NFL) players, according to a 2023 report by the Boston University CTE Center, which has led the effort to diagnose CTE cases. In comparison, a 2018 BU study of the general population found one CTE case in 164 autopsies, and that one person with CTE had played college football. [1] The NFL acknowledged a link between playing American football and being diagnosed with CTE in 2016, after denying such a link for over a decade and arguing that players' symptoms had other causes. [2]
While much attention in the NFL has focused on limiting or treating concussions, the latest medical research indicates that the brain damage in CTE is caused by the cumulative impact of all collisions involving a player's head, [3] [4] which confirms what was generally known nearly a century ago but was then largely forgotten. [5] The NFL has implemented rule changes to reduce collisions to the head [6] and has sought to improve helmet design. [7] Critics respond that significant head trauma is inevitable for bigger, faster players in tackle football [8] and that helmets are of limited use in preventing a player's brain from crashing into their skull, which is the cause of the brain damage that leads to CTE. [9]
As more parents (including some NFL players) decide not to let their children play football, [10] [11] it remains to be seen whether football will eventually face a significant decline in popularity [12] like boxing, which fell from prominence as the brain damage suffered by ex-boxers drew more public attention. [13] Football is currently the most-watched sport in the U.S. by a substantial margin while basketball is the most-played sport. [14]
Although the symptoms of CTE can vary, it doesn't directly cause death but instead changes personality and behavior, making a person not feel like themselves anymore. [15] Players with CTE can become isolated from their friends. [16] Sometimes they become unable to tell a story, [17] carry on a conversation, [18] or recognize their loved ones. [19] One former player later found to have CTE described having headaches that felt like ice picks hitting his brain. [20]
Some former players with CTE suffer from memory loss and depression. [21] Some players and those around them deal with their violent mood swings, rage, [22] and paranoia. [23] [24] In some cases, damage to players' brains contributes to severe alcoholism leading to death. [25] [26] Two former NFL Man of the Year winners suffering from CTE symptoms shot themselves in the chest so their brains could be studied for the damage inflicted by football. [27] [28]
Heisman Trophy winner and former NFL All-Pro Bo Jackson said in a 2017 interview with USA Today that if he had known about the risks associated with CTE, he would never have played football, and he discourages his children from doing so. [29] In late 2017, former running back Larry Johnson, who holds the NFL record for most rushing attempts in a season, reported having symptoms akin to Aaron Hernandez, including memory blanks, suicidal thoughts and thoughts of committing violent acts. Although there is no way to positively diagnose CTE before death, Johnson believes he is living with the disease. [30]
The CEO of the Concussion Legacy Foundation states that "[l]ater stage CTE (stage 3 and 4) is associated with dementia, but early-stage CTE (stage 1 and 2) is more associated with what is called neurobehavioral dysregulation, which includes violent, impulsive, or explosive behavior, inappropriate behavior, aggression, rage, 'short fuse,' and lack of behavioral control." [31]
Each year of playing tackle football increases a player's risk of developing CTE by 30 percent. [32] Family members and friends frequently struggle to try and provide care for former players with CTE, [33] [34] while the NFL has been criticized for not following through on its limited promises [35] and not using basic tests to identify dementia in former players for its legal settlement. [36]
A common definitive test currently can be made only by examining the brain tissue of a deceased victim. 345 of 376 NFL players whose brains have been autopsied had CTE. [1]
As the vast majority of deceased former players never have specialized autopsies done on their brains, the first such autopsy wasn't performed until 2002, [37] and the families of most deceased players keep their autopsy results private, the following list shows a small fraction of NFL players who have had CTE. The age listed to the right of many players' names is when their CTE symptoms began, as indicated in the referenced sources, although in some cases symptoms could have begun earlier.
Included in the list are players diagnosed with amyotrophic lateral sclerosis (ALS) who were never tested post-mortem for CTE but whose history appears consistent with CTE. A typical diagnosis of ALS has primarily been based on the symptoms and signs the physician observes in the patient and a series of tests to rule out other diseases [141] and therefore, prior to the discovery of CTE as a phenomenon in ex-American football players, many CTE cases were diagnosed as ALS. After CTE was first diagnosed in 2002 in the brain tissue of Mike Webster, [142] brain donation for specialized autopsies to check for CTE have become more available. [143]
A cohort mortality study run by the National Institute for Occupational Safety and Health (NIOSH) examined 3,349 NFL players who played at least five full seasons from 1959 to 1988. [144] [145] Findings showed that while NFL players lived longer than the average American male — although that could be due to the correlation between income and life expectancy in the U.S. [146] — the risk of death associated with neurodegenerative disorders was about three times higher among the NFL cohort. [144] [145] The risk for death from Alzheimer's disease and ALS were about four times higher among the NFL cohort. [144]
These players have publicly acknowledged either having been diagnosed with likely CTE or having experienced symptoms, such as dementia or unusual memory loss, consistent with CTE but that could have other causes or CTE could be one of a combination of causes. For example, ex-players that have presented with symptoms late in life may have other forms of age-related dementia. In some cases, the player has received a diagnosis of ALS, but their symptoms are consistent with CTE.
Around 4,500 players brought multiple lawsuits against the NFL alleging that it had covered up a growing body of medical evidence about the preponderance of head-trauma related CTE in ex-NFL players, and some testimonials have come in that context.
At present, there is no definitive CTE test available for living persons. The age listed to the right of many players' names is when their symptoms that possibly indicate CTE began, as provided in the referenced sources, although in some cases symptoms could have begun earlier.
After multiple lawsuits [213] and many years of litigation, the NFL and lawyers for around 4,500 former players (or their estates) announced a financial settlement of $765 million in 2013. [238] The list below currently contains fewer than half of those players.
The NFL was heavily criticized when it became known that race norming, which assumed that black players started with lower cognitive levels than white players, was being used in determining whether players qualified for help in the initial years of the settlement. The parties to the settlement discontinued the use of race norming in June 2021. [239] [240] [241]
More recently, many players and their families have complained of being unfairly denied benefits under the settlement. [242] Although the settlement's terms require that the latest medical tests be used to diagnose mental impairment, basic imaging tests are not paid for, saving "the NFL tens of millions in medical costs alone". As one neuroradiologist said, “If you’re trying to find dementia in the last 10 or 15 years and you’re not using imaging, you’re not really trying that hard.” [243]
Christopher John Nowinski is an American neuroscientist, author and retired professional wrestler. After extensively researching concussions in American football, Nowinski co-founded the Concussion Legacy Foundation, where he is currently CEO and co-founded Boston University's CTE Center. As a professional wrestler, he is best known for his tenure with World Wrestling Entertainment (WWE) under the ring name Chris Harvard and later under his real name.
Michael Lewis Webster was an American professional football center in the National Football League (NFL) from 1974 to 1990 with the Pittsburgh Steelers and Kansas City Chiefs. He is a member of the Pro Football Hall of Fame, class of 1997. Nicknamed "Iron Mike", Webster anchored the Steelers' offensive line during much of their run of four Super Bowl victories from 1974 to 1979 and is considered by many the greatest center in NFL history.
Ollie Genoa Matson II was an American Olympic medal winning sprinter and professional football player. He played as a halfback and return specialist in the National Football League (NFL) from 1952 to 1966 for the Chicago Cardinals and the Los Angeles Rams. He played college football for the San Francisco Dons and was selected by the Cardinals in the first round of the 1952 NFL draft.
Richard Cameron Arrington was an American professional football player who was a quarterback for the Philadelphia Eagles of the National Football League (NFL). He played three seasons for the Eagles from 1970 to 1973. He played college football at Georgia and Tulsa.
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated trauma to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. The disease often gets worse over time and can result in dementia.
Larry Cleo Morris was an American professional football player who was a linebacker in the National Football League (NFL), primarily with the Chicago Bears. The 1950 graduate of Decatur High School became an All-American playing college football for the Georgia Tech Yellow Jackets before his NFL career. "The Brahma Bull" was named one of the linebackers on the NFL 1960s All-Decade Team. He was sentenced to probation for his role in the Savings and loan crisis.
Andre Maurice Waters was an American professional football player who was a safety for the Philadelphia Eagles and Arizona Cardinals of the National Football League (NFL) from 1984 to 1995. Waters was regarded as one of the NFL's most aggressive players, serving as an integral part of one of the league's top defenses. On November 20, 2006, Waters died by suicide and was subsequently diagnosed with chronic traumatic encephalopathy (CTE). He is one of at least 345 NFL players to be diagnosed after death with CTE, which is caused by repeated hits to the head.
Henry Childs was an American professional football player who was a tight end in the National Football League (NFL) for the Atlanta Falcons, New Orleans Saints, Los Angeles Rams, and the Green Bay Packers. He was a Pro Bowl player in 1979.
Max Culp Runager was a professional American football punter in the National Football League (NFL) for eleven seasons for the Philadelphia Eagles, the San Francisco 49ers, and the Cleveland Browns. A graduate of Orangeburg-Wilkinson High School, Runager played college football at the University of South Carolina. He punted for two Super Bowl teams, the Philadelphia Eagles in 1980 and the San Francisco 49ers in 1984.
Ron Johnson was an American professional football player who was a cornerback for seven seasons with the Pittsburgh Steelers of the National Football League (NFL).
Michael Johnson Pyle was an American professional football player who was a center for nine seasons between 1961 and 1969 in the National Football League (NFL) for the Chicago Bears. In 2019 he was selected as one of the 100 greatest Bears of All-Time.
Paul Kevin Turner was an American professional football player who was a fullback for eight seasons in the National Football League (NFL) for the New England Patriots and Philadelphia Eagles. He played college football for the Alabama Crimson Tide. Turner died after a multi-year battle with amyotrophic lateral sclerosis (ALS), which had been triggered by chronic traumatic encephalopathy (CTE).
Grant Earl Feasel was an American football center in the National Football League (NFL) for the Baltimore/Indianapolis Colts, Minnesota Vikings, and Seattle Seahawks.
Charles Ray Easterling was an American football safety in the National Football League (NFL). He graduated from the University of Richmond in 1972 and was drafted by the Atlanta Falcons in the ninth round of the 1972 NFL draft.
Adrian Lynn Robinson Jr. was an American football linebacker. He was signed by the Pittsburgh Steelers as an undrafted free agent in 2012. He played college football at Temple University.
Dr. Bennet Ifeakandu Omalu is a Nigerian-American physician, forensic pathologist, and neuropathologist who was the first to discover and publish findings on chronic traumatic encephalopathy (CTE) in American football players while working at the Allegheny County coroner's office in Pittsburgh. He later became the chief medical examiner for San Joaquin County, California, and is a professor at the University of California, Davis, department of medical pathology and laboratory medicine. He is currently the president and medical director of Bennet Omalu Pathology.
Concussions and play-related head blows in American football have been shown to be the cause of chronic traumatic encephalopathy (CTE), which has led to player deaths and other debilitating symptoms after retirement, including memory loss, depression, anxiety, headaches, stress, and sleep disturbances.
Concussion is a 2015 American biographical sports drama film written and directed by Peter Landesman, based on the exposé "Game Brain" by Jeanne Marie Laskas, published in 2009 by GQ magazine. Set during the 2000s, the film stars Will Smith as Bennet Omalu, a forensic pathologist who fights against the National Football League trying to suppress his research on chronic traumatic encephalopathy (CTE) brain degeneration suffered by professional football players.
The Boston University CTE Center is an independently run medical research lab located at the Boston University School of Medicine. The Center focuses on research related to the long-term effects of brain trauma and degenerative brain diseases, specializing in the diagnosis and analysis of chronic traumatic encephalopathy (CTE). According to researchers at Boston University, CTE is a brain disease involving progressive neurological deterioration common in athletes, military personnel, and others who have a history of brain trauma. The disease is primarily caused by repeated blows to the head, some of which result in concussions or sub-concussive symptoms.
Most documented cases of chronic traumatic encephalopathy have occurred in many athletes involved in contact sports such as boxing, American football, wrestling, ice hockey, mixed martial arts, rugby and soccer. Other risk factors include being in the military, prior domestic violence, and repeated banging of the head. The exact amount of trauma required for the condition to occur is unknown. Below is a list of notable cases of CTE in sports.
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