October 23, 2017
Sports fans across the board have followed with varying levels of interest as strides have been made in understanding brain injury in athletes. Several years ago, researchers discovered that repeated brain trauma (like that which occurs in contact sports) lead to a condition called Chronic Traumatic Encephalopathy. Most know it by the shorthand, CTE. Symptoms of the condition begin mildly, and eventually devolve into full-blown cognitive impairment including but not limited to bouts of aggression and suicidal tendencies.
Boxing was the first sport where this condition was obvious. Turns out, two to three hundred blows to the head every few months can break your brain. However, boxing was never trying to hide the impairments it caused. There seems to be an unspoken agreement that what is taking place in the ring will ultimately end badly. The waters became murky when it was discovered that hockey players and football players were also suffering from CTE, at alarming rates.
The repercussions have been enormous. Both the NFL and NHL have settled lawsuits alleging they withheld information about head injuries from players. The two leagues have seen players begin to retire earlier, and as time goes on more questions are raised about the safety concerns of having young people play these sports. That question hits football specifically, as studies are now finding that CTE can affect high school athletes after only a few years of participation.
Football is so dangerous, that practices in the NFL are reduced to walkthroughs and non-contact drills. Youth hockey leagues now ban open-ice body checking until players are 16 or 17 years old, and most house league programs ban it all together. The fear of CTE has gripped the sporting world, but until recently, science was not reasonably close to making definitive diagnoses of CTE in living patients. That appears to be changing.
A group of researchers writing in the PLOS One medical journal have found means of differentiating CTE from other tauopathies such as Alzheimer’s disease. For years, there was no way to test if a patient was suffering from CTE, the only way was to examine their brain after death. Concussions do not cause brain bleeding and lasting visible damage, so the only means of making a definitive diagnosis was to examine the physical brain. Now it seems there may be a road to testing for CTE in live patients.
The researchers have found that a protein, CCL11, exists at increased levels in the central nervous systems of people with CTE. Previously, it was believed that CCL11 was associated strictly with age-related cognitive decline, but these elevated levels are not present amongst Alzheimer’s patients. The study concludes this, about the lack of age-related correlation with CCL11 increases: “An additional explanation for the lack of age-associated correlations is that the years of RHI [repeated head injuries] and the subsequent neuroinflammation mimics the effects of aging resulting in an environment similar to advanced aging. This could result in the neuroinflammatory environment of young and old individuals to appear more similar and obscure potential age-related changes. Neuroinflammation is part of the normal aging process and has been termed “inflammaging”” This means that CTE related increases are demonstrably different from age-related increases, in that CCL11 doesn’t always present with age, but does with repeated head trauma or injury. This study is potentially ground-breaking for doctors trying to develop a test for CTE, as they now have the potential to check for bio-markers indicating CTE. Those markers, along with observation of the symptoms commonly associated with CTE could mean that living athletes can be tested for CTE.
Lead researcher for the study Dr. Ann McKee, who has testified before the United States House Judiciary Committee in 2009 about head injuries in the NFL called this a new development in the study of repeated head injuries. Dr. McKee has worked extensively on CTE, heading the CTE Centre in Boston. She is the scientist responsible for many of the high-profile diagnoses, including hockey players, more than a dozen NFL players, and a boy just 17 years old. Those diagnoses were all made post-mortem, but her research along with that of her colleagues may change the future of the condition.
The benefits of this are potentially life-altering. Players could receive regular tests to determine if they were developing CTE and save themselves from further damage. However, for the leagues, this news could be viewed as troubling. For decades, the NHL and NFL have outwardly expressed concerns about head injuries, while inwardly suppressing information about them. This potential screening for CTE opens the NFL and NHL up to a host of problems. First and foremost, if it can be demonstrated that an even larger number of athletes have the bio-markers indicating CTE related decline in brain function, how long will it be before parents stop signing their children up for contact sports like hockey and football?
The fate of these leagues may end up like that of boxing’s. The only people, with some exception, of course, that box are those who lived exceptionally rough lives. Poverty stricken, systematically beaten down people are those who become boxers. Their stories are so often compelling because they are so heartbreaking. They mortgage their future health to do it, but for many, it becomes a last resort and only option. Hockey and football may face the same problem. Parents are unlikely to enroll their children in sports they know will one day destroy their brains. People who have other options to make it in life will take those options. It is quickly being demonstrated that these sports may not be worth the risk.