The iconic celebrity relationship between pop star Taylor Swift and football player Travis Kelce drew people from all over the world to watch the 2024 Super Bowl LVIII between the San Francisco 49ers and the Kansas City Chiefs. Many “Swiftie” fans watched this historic game just for a glimpse of the Reputation singer. According to the National Football League, more than 200 million viewers watched all or part of the Super Bowl, making it not only the most-streamed Super Bowl, but the most-watched program in history [1]. As the demand for sports entertainment increases each year, organizations such as the NFL must try and minimize the risk of injury to its players while also maintaining the entertainment value of these highly competitive sports. The physical nature of the sport can lead to serious injuries such as broken bones, concussions, and even degenerative neurological diseases that can be debilitating for a player for months or even years. One such disease is called Chronic Traumatic Encephalopathy (CTE). This progressive degenerative disease is found in people that have sustained many head injuries, such as football players, hockey players, military personnel, and even individuals that have been subjected to long periods of abuse [2].
CTE was first described in 1928 when Dr. Harrison Martland noticed several emotional, memory, and personality changes in boxers who had sustained repeated blows to the head, which he coined “punch drunk” syndrome [3]. These symptoms, along with depression, anxiety, aggression, and impulsive behavior, are common for people that have developed Chronic Traumatic Encephalopathy [2]. While it is widely recognized that head injuries can result in traumatic brain tissue damage and even death, relatively few individuals are aware of the molecular processes underlying such injuries. At the molecular level, the proteins and enzymes within the damaged neurons are what set the basis for the development of CTE. Specifically, a structural protein called tau (which supports microtubules in neurons) can misfold if the microtubules are damaged, say, by a head impact [4]. The real kicker (no pun intended) about the misfolding of tau proteins is that it is a cascade effect; when one protein folds, it can make adjacent proteins fold in a sort of chain reaction that slowly spreads and kills brain cells [4]. This neurodegenerative disease is incurable and is very hard to detect in living patients. Individuals at any age can suffer from CTE, but the symptoms of this disease may not be noticeable for years or even decades after a traumatic brain injury has occurred [4].
As common as head collisions are in sports, why is there not more media coverage on this progressive disease? One problem with CTE is that it can only be confirmed in a patient postmortem [2]. Many families of ex-professional athletes only receive answers after an autopsy has been performed to diagnose that the individual had this disease. However, many health-care providers can still make assumptions of whether or not an individual has CTE based on their history and present symptoms. Along with his colleagues, Kevin Guskiewicz, a prominent researcher in sports-related concussions, conducted a study that showed 61 percent of NFL players will have at least one concussion during their football careers [5].
Is it ethical to introduce children to football at young ages, even if it exposes them to the risks of brain injuries during a crucial time in their development? What preventions can be put in place to decrease the severity of head collisions and thus potentially lower the likelihood that someone will develop this disease later in their life? Many fans resist the idea of making sports safer in fear that the game will become boring or lose the “magic” that brings together so many people. The NFL has a clear dilemma that it must balance: should it make its games safer and potentially lose viewers, or continue to allow dangerous plays that may hurt its athletes? The answer is both. The NFL should not change the game so much that it is unrecognizable to its viewers, but the league has put many precautions in place that will help protect its athletes. For example, rule changes have been enforced over the last several years that prohibit many plays that use excessive force of one’s head to make contact with another player, such as the blindside block [6]. Medical protocol has also gotten stricter to prevent brain injury as well. For example, if a player is experiencing concussion symptoms or neurological impairment at any point during a football game, the medical staff will not allow the athlete to reenter the game under any circumstances [6]. Nevertheless, the same precautions implemented at the professional level may not transfer into youth football leagues. The lack of media attention and funding allocated to youth football games may lead to fewer precautions and a more lax approach to game regulation in regards to safety. A new study from Boston University’s CTE center revealed that 63 out of 152 contact sports athletes younger than 30 years of age at the time of their death had chronic traumatic encephalopathy [7]. A neurodegenerative disease once believed to only affect older individuals has now proven to also impact young athletes in high-contact sports. While sports offer numerous physical and social benefits, the potential neurological consequences raise serious concerns for young athletes. As awareness grows concerning the risks associated with contact sports, parents and coaches face much responsibility to ensure the safety and well-being of children while promoting their participation in such activities.
Every tackle, every collision, warrants our attention to player safety and well-being on and off the field. As new, preventative measures are created to allow a more safe and effective way to lower risks due to collision-related injuries on the football field, it is very important to continue to look for new ways to prevent brain injuries in players. CTE is a stark reminder of a future that many professional football players may unfortunately have to go through. However, as many NFL officials, researchers, and healthcare providers continue to look for a solution to this disease and many others, strides towards a future where the diagnosis and treatment of CTE is available for athletes in high-impact sports is not an impossible feat.
1. Super Bowl LVIII is most-watched telecast in history: NFL Football Operations. Super Bowl LVIII is Most-Watched Telecast in History | NFL Football Operations. (2024, February 12). https://operations.nfl.com/updates/the-game/super-bowl-lviii-is-most-watched-telecast-in-history/
2.Mayo Foundation for Medical Education and Research. (2023, November 18). Chronic traumatic encephalopathy. Mayo Clinic.https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921#:~:text=Repeated%20head%20trauma%20is%20likely,lead%20to%20repeated%20head%20injuries.
3. Smith, D. H., Johnson, V. E., Trojanowski, J. Q., & Stewart, W. (2019, January 21). Chronic traumatic encephalopathy - confusion and controversies. Nature News. https://www.nature.com/articles/s41582-018-0114-8
4. The science of CTE. The Science of CTE | Concussion Legacy Foundation. (n.d.). https://concussionfoundation.org/CTE-resources/science-of-CTE
5. Guskiewicz KM, Marshall SW, Bailes J, Mccrea M, Cantu RC, Randolph C, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery (2005) 57:719–726. doi: 10.1227/01.neu.0000175725.75780.dd
6. NFL Health & Safety. NFL Football Operations. (n.d.). https://operations.nfl.com/inside-football-ops/players-legends/player-health-safety/
7. Ann C. McKee, M. (2023, October 1). Neuropathologic and clinical findings in young athletes with repetitive head impacts. JAMA Neurology. https://jamanetwork.com/journals/jamaneurology/fullarticle/2808952?resultClick=1