Chronic Traumatic Encephalopathy or, CTE, is a disease that has recently attracted a lot of media attention in the sports world. Lately no one sport more than football. The media has called CTE the beginning of the end of football as it is currently played. Prolific figures both in the sport and not, have said that they would never let their sons play. Legends have said that they would have never played in the first place if they knew the risks. With all this attention came very little clear understanding for CTE. What really is CTE and will it really have the impact on football that the media has said it will have.

CTE most simply is a degenerative disease of the brain, believed to be caused by concussions and sub-concussive blows to the head. Essentially the brain is being bruised by each head injury and only gets worse with each recursive injury. The bruising of the brain eventually leads to certain areas of the brain to be damaged. As a result of the damage, the individual may show symptoms of memory loss, confusion, impaired judgement and eventual progressive dementia. Further down the road some patients show symptoms of motor inability. Behavioral and emotional issues are also shown to arise in some patients (Concussion Legacy Foundation). 

Studies first started to arise about mental health in sports in the early 1900’s. Doctors became aware of the risks that boxing played in an individual’s mental health when boxers were stumbling around days after fights. This daze the athletes would find themselves in was coined “punch drunk” based on the way they acted and their inability to control themselves. Studies began to sprout up shortly thereafter where doctors mainly studied the long-term effects of retired boxers. Technology and medical practices were nowhere near the level to find very much out about the disease, but the doctors of the time were successful in naming the disease they were studying as Chronic Traumatic Encephalopathy, the same term that is still used today. The recent major find that has really set this whole issue in motion was the release of a study done by neuropathologist, Dr. Ann McKee and her team. Dr. McKee spent years collecting brains of deceased former professional football players who were suspected of showing signs of CTE. She positively diagnosed 110 brains to have CTE out of a total of 111. Players in the study came from most all positions on the football field. Linemen represented the highest position of brains but is also the position with most players. The figure of 110 out of 111 is what really swept the nation and began to bring the attention to the safety of the game. People saw this as meaning that if 99% were positively diagnosed then one would only assume that most current football players have it as well. At this point, the future of football seemed bleak as there was this evidence showing how common CTE must be. 

ESPN and other sports news sites reacted drastically to the breaking study calling for all sort of change to the game and change to the way the players are treated, both directly after a concussion and years down the line when they are retired. One of the most talked about change brought about by the NCAA regarding the new findings was the targeting rule. The targeting rule says that there is an automatic 15-yard penalty for any player who leads with the crown of their helmet during a tackle. This is also true for players who aim their tackle above the shoulders of some other player. To really drive home the point in avoiding unneeded contact the rule also says that if after the play is reviewed and the penalty is confirmed that player will be disqualified for the rest of the game (NCAA). This change is all in an effort to make extremely intense hits to the head and neck region as least common as possible. Another largely followed change to the way the game is played is also in attempt to lessen the commonality of intense and vicious hits to all players. This rule changes the yard line kickoffs occur at. Kickoffs were moved up 10 yards hoping to cause more touchbacks; touchbacks also now result in possession at the 25 instead of the 20 to make them more beneficial to the receiving team (NCAA). With more touchbacks, the fewer number of kickoff returns which drastically cut down on the number of vicious hits during returns. Returns are believed to be where some of the hardest hits because all the players are running full speed at each other. The worst hits being those to players that are unsuspecting of the approaching man who then does not even have time to protect themselves. Both of these rule changes I understand and support. They modify the game enough to make certain hits or opportunities for hits to be decreased without taking away too much rough and tough contact that makes football what it is. this in my mind is a win-win for all parties. The fans do not lose all contact while the game is safer for the players. Some ideas, that have not been enacted, call for too much softening of the game, changing aspects too much. These such ideas I am not able to support while I like the idea of looking out for the players but seem as though taking too much away.

As some new ideas were beginning to take place, both for the safety of the players both from NFL careers down to peewee football leagues and for the sake of the game, there were some who were not as supportive as it seemed everyone else was. Daniel Engber, a columnist for Slate, is one of those not completely sold on the pumped-up headlines. One article that he writes he picks apart why Dr. McKee’s work does not necessarily mean as much as one may first think. One of his major points in this is that CTE can only be diagnosed post mortem. Meaning that in current day the only way to diagnosis this disease is after the individual has already passed away. Because of this, there is no real way to asses if the changes we make in the game are working or if the new safety precautions are making a difference because there is no way to see before and after such precautions have gone into effect. Concussions are one way that could be argued for as a way to see if such precautions are working but, it is believed by the Concussion Legacy Foundation, that only 1 in 6 concussions are diagnosed currently. This is because it is a common occurrence for a football player to admit that somewhere throughout their career that they hid a concussion or tried to hide the symptoms they were showing to the trainers. Another piece of evidence that somewhat discredits the use of concussions to show progress, is that sub-concussive hits are believed to be what damages the brain more that concussions in athletes (Montenigro, Corp.). Sub-concussive hits are hits that are more minor in intensity such that the athlete shows no signs of a concussion but still make the brain move around in the skull damaging areas of the brain. Sub-concussive blows to the head happen on the football field most commonly in linemen when they jump as the ball is snapped into their blocker, or when other positions block players as well. Most players may have only a few concussions over the course of a football career, whereas it is estimated linemen could have 10s of thousands of sub-concussive blows to the head over football career spanning into their mid-to-late 20’s (Montenigro, Corp.).

Another issue that Enber argues in his article is that the brains used in Dr. McKee’s research were all donated to her cause because the individual showed signs of brain damage when he was living. Because of this it is hard to gauge how these brains represent all retired players. It is next to impossible to check every single player because they can only be diagnosed post mortem but only checking the ones that already showed signs does not necessarily get to represent the whole for all men that play football. Enber brings up a study done at the University of Michigan in 2008 to try and find a way to gauge what these 111 brains represent of the total, if this is only the worst of the worse cases of if these 111 really are a good medium. The study in 2008 was a survey that polled almost one thousand retired professional football players of their health issues. The health issues that were importantly asked about were those that Dr. Mckee and others agree to be common symptoms of CTE. What was found through this survey was that all of the medical issues except for one had only a fraction of a percentage point difference between the answers of the players and the answers of common American men in the same age group. The only answer that was not a fraction of a percentage point was that of dementia, but still only a small digit percentage point increase for football players. 

In Enber’s mind, the technology in diagnosing CTE is still way too young and far behind what the media believes to adequately call for radical change on the gridiron. Technology and medical practice need to advance to a state in which it is possible to diagnosis CTE in individuals still living so that the changes can be monitored with tests to find what is making a difference and what is not. All understanding of what is happening to the brain when these types of hits occur will greatly increase once such medical practice and technology allow for it. Ways in which to lessen the risk will then be realistic. This is also true for the administration of football leagues in that they will be able to discuss how the game needs to be molded to make positive advances in the health of football players. Although in Daniel Enber’s mind there is little to no new knowledge coming from McKee’s research, I believe that it is a valuable step. Now there is a base line to compare other brains to. McKee had to have had some sort of basis for deciding why the lone brain was no diagnosed with CTE. This basis could change in the future but at least currently there is some sort of range to use to judge the brain’s damage to.

CTE is a real effect of playing football for years and years; Dr. McKee’s evidence clearly shows the connections between the game and mental health; how much is still yet to be discovered.  There is certainly change that is being brought about to help with this but there is still a lot unknown. I see no problem in changing a few rules here and there to lessen hits. On top of that even less wrong with ever trying to advance helmets and other personal body protection. Helmets will continue to evolve as sports science evolves, but CTE should not be the end to football. There is still way too much unknown with no real good way of testing new advances or the affects that change has truly made. Once there is a reliable way of monitoring the health of a brain after hits and after games then the future will be more clear. Until then, I believe there is no need for America to through in the towel. 
