CTE and its dangers: an investigation of sports injuries

Photo courtesy of Blake Israel

On Feb. 25, 2023, former Jacket and National Football League (NFL) wide receiver Demaryius Thomas was inducted into the Georgia Sports Hall of Fame in Macon, Ga. Born in Georgia, Thomas found great success in his 10-year-long professional football career, primarily spent with the Denver Broncos. Thomas unfortunately passed away in December 2021 at the age of 33, with posthumous medical examinations diagnosing him as having chronic traumatic encephalopathy (CTE). CTE is a concerning neurodegenerative condition frequently diagnosed in professional athletes, specifically football players.

Since it can only be diagnosed in posthumous medical examinations, public perception on how to anticipate and avoid cases of CTE in collegiate or professional athletes is unclear. One of the main risk factors currently associated with CTE is repeated sub-concussive head impacts.

Michelle LaPlaca is a BMED professor at Tech who studies “neurotrauma, injury biomechanics, and neuroengineering as they relate to traumatic brain injury.” While she has investigated methods for diagnosing concussions, she has not directly studied CTE.

“We know that repeated head impacts are a risk factor [for CTE], but it’s very difficult to draw a straight line from players having concussions [to] them developing CTE,” LaPlaca said. “There’s clearly something else that also helps to predispose somebody to developing that kind of brain pathology. I do think that football and collision sports can just increase the risk for developing CTE, but the general consensus in the medical community is that it’s not a direct cause.”

Matthew Ventresca is a sports sociologist and cultural studies scholar with the School of History and Sociology. According to Ventresca, one issue with the public awareness of CTE is that people often settle on one extreme.

He said that some people believe that “CTE is inevitable for anyone who’s played at a high level of football or any other collision sport.” There is another understanding that CTE is incredibly rare and not something to be concerned about. 

“The unfortunate thing is that it’s currently very hard to determine where exactly the level of absolute risk falls between those two extremes,” Ventresca said, adding that conservative estimates say between 10% and 15% of NFL players will develop CTE in their lifetimes.

He said that in the domain of public health those rates go beyond what would be considered a major concern, and “if 10% of a new type of car was causing accidents, and people were getting hurt in these accidents, that would almost automatically justify a recall of that car.”

Ventresca described how sports sit in a cultural space at odds with an unbiased assessment of risk. The love, enjoyment and benefits that people get from a game like football “skews their interpretation of the science and the perceptions of risk associated with participation in a violent sport.”

Football players cite many benefits beyond professional achievement to participating in their sport. According to Josh Idowu, fourth-year IE, playing varsity football in high school put him in the best physical shape of his life.He emphasized the strong mental health benefits of being so physically active, and how its effects even seeped into his academics. 

“Football was probably the best thing that ever happened to me, because you just learn a lot of things about life and discipline and how to grow from tough situations that a lot of things didn’t give me,” he said. Idowu expressed an awareness of CTE and recounted teammates who have had to quit the sport due to injury and concern for their personal health.

Ventresca described how the response to CTE is further complicated by the governing organizations’ histories with the issue.

“There is very well documented and very widespread mistrust of organizations like the NFL and the NCAA around this issue, and I believe very strongly that they have earned that mistrust,” he said, adding “I believe they’ve made some modest but still important improvements to their approach on brain injury.” These improvements can also be seen in other divisions, and they usually focus around concussions.

For concussions, recourses like player awareness, baseline cognitive testing and injury response plans have become observable at every organized level. With subconcussive impacts, the person will not experience any symptoms following the event, making them less detectable than concussions.

Idowu recounted taking pre-concussion baseline exams in order to participate in high school football. Before any football is played, the players are given an exam designed to target tasks affected by concussions. If at any point the players are suspected of having a concussion, they repeat the test to check for a decline in performance. 

According to Ventresca, while current responses deal with concussions and concussion rates, they stop short of addressing cumulative head impacts, a metric that would also address the long-term neurological problems they have been associated with.

Ventresca described another roadblock as professional organizations reliably prefer the latest technological or physical solution over behavioral solutions. While saying that there are opportunities for individual sports teams and institutions to set a different example on these issues, Ventresca speculated they may be pressured to not provide extra support or protection beyond what is standard, so that all teams look equally responsive. Ventresca also emphasized the need to facilitate player self-advocacy. 

“One thing we can do so that athletes feel like they can advocate more for their brain health is provide better [guarantees] for athletes. So at the pro level, I’m talking about mandating guaranteed contracts … and then at the college level, same goes for guaranteed scholarships,” he said.

While strides have been made regarding the ability for players at private schools to unionize, there is a less clear path for student athletes at public schools to do so.

Along with player advocacy groups, Ventresca also described issues with player education. Contrary to an attitude where athletes “know what they signed up for,” he said, “a lot of research has shown that athletes aren’t actually fully informed or fully aware about the risks that they face when playing a contact sport.”

Referencing recent research on player education, Ventresca said, “many college football players, they actually showed limited knowledge or underestimated the risk of long term cognitive psychological ailments that are associated with playing football.”

Commenting on the fan aspect, “as a sports-loving culture, we have to be willing to live with the consequences of that, … which might be fewer people signing up to play football.”

The Technique reached out to Tech Football for comments regarding the mitigation of subconcussive head impacts, player education and player resources. Tech football forwarded a copy of Tech athletics’ NCAA-compliant concussion program policy and also gave the following statement:

“The concussion program policy is included in the sports medicine manual that is provided to student-athletes every year. In addition to what is outlined within this policy, Georgia Tech athletics is constantly evaluating ways that the risks of head injuries can potentially be mitigated. Additionally, Tech’s sports medicine staff promotes an environment of trust and an open forum for student-athletes and/or coaches to communicate any concerns relative to injury or illness, including any head-related injuries.”

The NCAA requires athletics programs to provide a written concussion safety protocol. However, according to ncaa.org, “Division I submission of institutional concussion management protocols for review by the Concussion Safety Protocol Committee is not required at this time.”

While the NCAA does not currently require a plan for mitigating sub-concussive head impacts among players, it provides a checklist for the concussion safety protocols of its member schools, which includes a section on “reducing head impact exposure.” Tech athletics’ concussion program policy makes no reference to subconcussive head impacts and provides no protocols for addressing overall head impact exposure, only focusing on concussions.

However, the policy does say that “prevention of concussion will also be discussed including appropriate equipment, strength training and utilization of safer techniques in their sport.” Safer techniques in playing can be important for reducing overall head impact rates if implemented.

Tech athletics’ concussion program policy also states that “pre-season education will consist of an educational presentation and/or handout for later referral for the athlete and coach.” The Technique requested any educational materials provided by Tech Football addressing the risks of either CTE or repeated subconcussive head impacts but did not receive any material in response.

“There’s still a lot we don’t know about the mechanisms of the disease and risk factors, and susceptibility and prevalence … but we do know that getting hit in the head over and over and over again is bad for you. And I feel like that is a message that sometimes gets lost when we’re too focused on the finer details of the science,” Ventresca said. “We’re focusing on the trees, and we lose sight of the forest in that we have more and more athletes at younger ages reporting these issues.”

A copy of the Tech athletics’ concussion program policy can be found with the online version of this article at nique.net.