A brief history of CTE in American Football, and its implications for its future



Sunday Football, the Superbowl, CTE? 


Three terms that now seem to be equally synonymous with American Football. But what has led to the increasing fear of concussions within the sport, and what impact will it have on its future?


CTE (Chronic Traumatic Encephalopathy) - a progressive brain condition caused by repeated blows to the head, and episodic concussions - has been gaining significant recognition within American Football circles, including the NFL, since Dr. Bennet Omalu first published his revolutionary findings in a 2005 edition of the scientific journal Neurosurgery.


The paper, titled ‘Chronic Traumatic Encephalopathy in a National Football League Player’, was the culmination of over three years of detailed research conducted by Omalu, and his colleagues in the Department of Pathology at the University of Pittsburgh, on the brain of seventeen-year NFL vet Mike Webster.


In this paper, Omalu and his team presented detailed findings of how they had discovered large build-ups of tau protein in Webster’s brain, which in turn affected his mood, emotions, and cognitive functions in a similar way to how beta-amyloid protein groupings contribute to Alzheimer’s disease. And, as a result, Webster’s brain represented the first confirmed recording of CTE within an NFL player.


“I had to make sure the slides were Mike Webster’s slides”, Omalu later stated via Frontline. “I saw changes that shouldn’t be in a fifty-year-old man’s brain, and also changes that shouldn’t be in a brain that looked normal.”


This paper, published with the intention of raising awareness for a serious medical condition that is ravaging football players - both current and former - was instead met with unexpected levels of hostility.


In May 2006, almost a year after it’s publication, Omalu’s paper caught the attention of the NFL’s MTBI (Mild Traumatic Brain Injury) Committee, who issued a letter requesting an official retraction of the paper. The committee’s letter even went as far as to claim Omalu’s research on CTE was “completely wrong” and “a failure.”


However, this cannot be said to have been a completely unexpected outcome, for the MTBI Committee had long been controversial with its treatment of head injuries within the sport.


In fact, the Committee had been publishing papers attempting to counter the rising narrative of the dangers of concussions in Neurosurgery since 2003 - totalling 16 papers between 2003-06.


But arguably the most egregiously physical action committed by the Committee was in Week 9 of the 2003-04 season.


It was during this game between the New York Jets and the New York Giants that Jets’ WR Wayne Chrebet was knocked out cold after a blow to the back of his head by an opponent's knee.


Dr. Elliot Pellman, the Jets’ team doctor - and head of the MTBI Committee - was the one to examine Chrebet, and ultimately clear him to play.


Controversy arose after the game, when reports came out how Pellman had emphasised how “very important for your career” this game was to Chrebet, suggesting how even the head of the MTBI believed players should put their team’s success above their long-term health. 


Pellman further stood his ground in a January 2004 edition of Neurosurgery, when the MTBI Committee stated that: “A total of 92% of concussed players returned to practice in less than seven days.” 


The paper went on to claim that: “More than one-half of the players returned to play within one day, and symptoms resolved in a short time in the vast majority of cases.”


However, Omalu’s theory linking repetitive concussions and head injuries to longer-term brain issues was further strengthened with the publication of his second paper on the topic, ‘Chronic Traumatic Encephalopathy in a National Football League player: part II.’


This paper was focused around the study of another former NFL player, 8-year pro Terry Long, who had committed suicide in 2005 following years of battling depression. 


Within the paper, Omalu detailed how he found tau protein deposits similar to “a 90-year-old brain with advanced Alzheimer’s”, a worry considering Long died at 45.


It was after this second paper that the general reception to Omalu and his theories became more positive, with the NFL even admitting their wrongdoing in certain aspects, including disbanding the controversial MTBI Committee in 2007 - although Pellman didn't retire until 2016.


So now, with the base knowledge of the issue of concussions and CTE within the top league of American Football internationally, the NFL, we turn our attention to three players who have played in some of the top tiers of British American Football - Matt Panton,  Liam ‘Chip’ Jordan, and David ‘Woody’ Leitch.


Through these players, we can gain an understanding of the current understanding of concussions amongst players, thoughts on concussion protocol and their treatment, as well as how the sport should continue to adapt to support the development of players, particularly those at youth levels.


Matt Panton, a Defensive Lineman for the Kent Falcons, a University team, explained how: “After doing the first few training sessions at Uni with the Football team, we had a meeting and our Head Coach showed us a video detailing what is a concussion, how you get them, and some tell tell signs of what symptoms are and how you can spot them for yourself and others.”


Liam ‘Chip’ Jordan, a former Offensive Lineman at the University level, and current player for the Kent Exiles, a team in the top British league, the BAFA Premiership, explained how: “We would talk about [concussion protocol] at any point it seemed someone had a head injury, and the beginning of every season it was mentioned, and everyone was constantly reminded to speak to coaches if you had any form of head injury symptoms, or if you thought you’d had a head injury you went straight to the coaches so that they could make sure you were being looked after properly.”


David ‘Woody’ Leitch, a current Defensive Lineman at both the University and senior level, explained how, despite football having an abnormally high concussion risk, his choice of sports had prepared him for such possibilities, stating: “It’s always something that's mentioned, always something we know that exists. I used to do amateur boxing so it's something I’ve grown up with in sports. It's a known kind of thing.”


Unfortunately, this depth of discussion and knowledge on concussion and head injuries is only because it is an all too real possibility for those who play - at any level. 


Of the three players interviewed, all have taken multiple hits to the head - often by an opponent's helmet or knee - and two of them have suffered multiple concussions during their careers.


Woody stated that he hasn’t he hasn’t suffered any concussions “that I’m aware of.” But he went on to explain how: “A few players lead with their heads so you get a sore forehead afterwards but I’ve not had shaky legs or migraines or anything like that.”


However, Chip and Panton weren’t as lucky, with them both suffering two during their time at University. 


Chip gave a brief run down of the concussion protocol and rehab, stating: “”First thing first you have to make sure you’re drinking plenty of water, I found that coconut water really helps. But, primarily making sure not to do any strenuous exercise til the symptoms have subsided, lots of rest, and try to avoid bright lights because it makes the symptoms worse. As soon as the symptoms are gone then slowly build back up the intensity of your exercise and not doing any contact for at least a week after symptoms subside.”


However, it’s not always as straightforward as it would seem to diagnose a concussion. Panton explained how, for his two experiences: “So my first one I didn’t [notice] it straight away, it was the next day.


“My second one was more instantaneous, during a game so I just went over to my Head Coach and was like ‘Coach my head's ringing and I can’t think straight, I think I’ve got a concussion’, and then just sat out the rest of the game.” 


But still the rehab and recovery procedures remained the same, with Panton explaining how: “I took it easy, didn't do any gym or workouts, had plenty of water.”


Then, as the concussion protocol dictates, he was able to return to non-contact training after five consecutive days without displaying symptoms - as he put it: “I went to a couple of training sessions and took it easy, got back into it bit by bit.”


But, as shown with the Chrebet incident in 2003, players can sometimes feel pressure to rush back before they may be fully ready. 


Is this just an issue in the pros - where money is involved - or does it also seep into the semi-pro and collegiate levels?


Chip explained the struggle that all team athletes feel, of trying to balance their health and recovery alongside supporting their team on the field, stating: “I’ve never had pressure from coaches or other players but myself, obviously enjoying playing the game, I want to get back as quickly as possible. Fortunately the coaches, as soon as they know you have a concussion, they’re not going to let you back until they know that you’re safe, not when you think you’re safe because you want to play, because I think I can speak for everyone for who plays, we wouldn’t [want to] sit out a game no matter how badly we felt.”


Similar sentiment was expressed by Panton, when he stated: “For my second [concussion], we had a game the next week and we were quite low on D-Linemen, so maybe a little bit of pressure there, like if I don’t make it then we’d have very few people at my position and they’d struggle all game so yeah, maybe a little bit of pressure. But that was just me, it wasn’t anyone being like ‘oh you’ve got to come back’, it was just me wanting to be there for my team.”


Although never suffering a concussion, Woody has suffered other serious injuries while playing, and so was able to offer an explanation for why he think the attitudes are a little different between semi-pro and pro sports, stating: “‘No I wouldn’t say [I’ve ever felt any pressure to rush the recovery process], the level we play at, there’s not money involved, there’s a bit of promotion/demotion but there’s not the same kind of pressures you get, you know, no ones mortgage is dependent on someone playing a game and playing well.


“I think all professional sports suffer from the fact that you know if you’re at the elite, you’re at the top, there’s a lot of people under you. If you’re not at your best there’s someone who could be better than you who’s willing to do something you’re not willing to do [rush back/play injured]. So I could see a situation where people are rushed back before they feel ready.”


As shown, one positive impact of the NFL’s acceptance of the issue of concussions is the increased studying of lower levels of football, and beginning to increase safety measures as a result. 


Of all US high school sports, football has the highest concussion rate, with about 10.4 per 10,000 ‘athletic exposures’. Furthermore, since 1997, there have been about 50 reported deaths among football players high school age or younger due to serious head injuries


A recent paper in ScienceDaily by Wake Forest Baptist Medical Center, ‘Head Impacts linked to imaging changes in youth football players’, highlights the severity of the issue, and brings further credence to notions around the country to attempt to reduce the contact level of youth football - in particular u12s - as well as the promotion of non-contact 7-on-7 scrimmages to replace some offseason contact training.


Panton expressed his support of reducing the contact level for youth players, stating: “You can put on pads [and] do bag work, light contact, technique [drills]. I feel that’s how I learnt most stuff from my first few training sessions, it wasn’t contact at all, it was just technique.”


Chip echoed this sentiment, stating: “I’d say that that's a pretty sensible approach at those younger ages. Realistically, the contact level should at the very least be reduced because they haven’t had time to develop that technique, and their bodies obviously haven’t fully developed. So, giving them time to learn the basics outside the contact part of the game, then when they do get to the contact part of the game they’re gonna be a lot safer. I think it's a really good idea.”


However, Woody expressed a counter argument that is arguably equally present within the football community, when he stated that: “A benefit of doing [contact and tackling] from a younger age is you learn to do it safely, when people aren’t 20-stone machines going at 20 mph. It's an easier age to take a bump than later in life.”


So, whilst efforts are being made to make the sport safer - starting from youth all the way to the pro’s - how much of an impact will this really have. In the cut-throat world of professional football, can players really afford to always put their health first when they don’t have fully guaranteed contracts? And if that is the case, what example does this set for those attempting to make it there themselves oneday?



(Publication date: July 28th 2021)

A brief history of CTE in American Football, and its implications for its future