Any debate as to whether chronic traumatic encephalopathy (CTE) is a legitimate neurological malady that affects football players is slowly being put to bed. Repetitive hits to the head resulting in sub-concussive trauma and that concussions are the culprit here. Clinical findings associated with CTE include memory loss, depression, anxiety, violent behavior, mood disorders and heightened suicidality, among other impairments. It tends to progress with time and can lead to dementia according to a 2014 article by Stein et al. in Alzheimer’s Research and Therapy.
A retrospective 2017 study by Mez et al. published in the Journal of the American Medical Association studied 202 post-mortem brains of former football players and suggested a relationship between repetitive head trauma in football players and CTE. In fact, a neuropathological diagnosis was made in 177 out of 202 (87 percent) former football players. Mild CTE was diagnosed in 21 percent of those who only played high school football, however, 48 of 53 college (91 percent) and 110 of 111 National Football League (99 percent) players were found to have severe CTE.
If repeated head trauma in football is a known cause of CTE, why are we not limiting a player’s exposure to it by stopping full-contact practices?
Traditionally, football players spend much of their time during a practice week in full contact drills. And if the working theory is that repetitive subconcussive hits to the head and concussions result in CTE, full-contact practices should end. The old adage that “practice makes perfect” has some truth, but contact practices in football add very little to the inherent skills of a player or the team’s ability to execute. Full-contact practices only serve to make the brain more susceptible to CTE.
If you consider that games are usually played one day per week, and full-contact practices are conducted at least three days per week, it’s inevitable that the increased number of practice hits to the head will increase the likelihood of brain trauma.
Now if I begin to digress and can’t remember where I was going with this, it’s because I played nose guard for nine years. It’s safe to say that the number of sub-concussive hits I sustained at practices alone is substantial. There’s no history of neurodegenerative disorders in my family, but I am now noticing the occasional memory lapse in my mid-50s. It could be normal, but I wonder?
As a former defensive lineman, my recollection of practices bring to mind one indisputable thing — violent hitting. It was commonplace to undergo multiple gladiatorial contests with teammates in order to obtain or maintain the coveted starting position. Hit after hit after hit, we would line up in the trenches and hit. Over the years, I heard countless players utter the phrase “I got my bell rung.” That’s code for “I sustained head trauma with possible concussion.” Given the competition factor involved in football, repetitive head trauma is a regular occurrence at practice. Just watch the movie “Rudy,” and you get the idea.
And the games … forget about it. I can remember plotting with my closest defensive colleagues before a game and saying things like, “Let’s go beat some heads in.” This wasn’t a symbolic call to arms. We meant it, and we carried it out. And of course, that often involved crashing one’s head against some other player’s head at top speed. As an interior lineman, this was the norm on nearly every play. It is true that recent rule changes putting a stop to head hunting has been a step in the right direction, but practice still remains a battlefield for unnecessary head trauma.
The burning question for me is why are full-contact practices still the norm? Teams can always condition, run non-contact drills and teach strategy, right? Full-contact practices at all levels of competition are unnecessary. Finely tuned athletes who know the game do not need to hit their heads all week long in preparation for the games.
If the argument for contact practice is to find out who is the toughest and most physical, then limit this to the beginning of the season only — in the preseason. After that, use game performance as the metric for the following week’s line-up or consider some combination of performance/strength/speed, etc. Anything but daily practice head beatings will be an improvement.
With all of the talk about injury prevention in sports, abolishing contact during football practices just makes sense. And certainly, one could make the case that contact football in any form is hazardous to the brain, but I suppose small improvements in safety are better than none at all. Just as cutting back on smoking from a pack a day to five cigarettes is a move in the right direction, so is changing how we view the game of football. It’s time for managers and coaches to pull back the reins and limit practices to non-contact drills only. Let’s not go the way of the tobacco companies and continue selling a flawed and harmful product just because there’s money to be made. Brain tissue is at risk here.
Chris Nyte is an otolaryngologist.
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