Is Playing Football Hazardous to Your Brain?

Malcolm Gladwell in a recent appearance on ESPN’s Pardon The Interruption had some sobering comments on how an accumulation of seemingly minor head collisions over an NFL football career can inflict damage to players that resembles that from Alzheimer’s disease. To listen to the interview, check out this podcast starting at the 9:15 mark where Gladwell stated that some percentage of football players would wind up in dementia wards by the time they reached their 50s.

Gladwell was there to promote his article in The New Yorker that asks the question How different are dogfighting and football? The introductory video to the article, This Is Your Brain on Football is quite compelling and thought provoking.

He starts by saying that both football and dogfighting both inflict enduring injury on its participants. Then he details how autopsies of many retired NFL football players have brain injuries that result in dementia but are not caused by disease like Alzheimer’s but are from a condition called C.T.E.

Chronic traumatic encephalopathy (C.T.E.), which is a progressive neurological disorder found in people who have suffered some kind of brain trauma. C.T.E. has many of the same manifestations as Alzheimer’s: it begins with behavioral and personality changes, followed by disinhibition and irritability, before moving on to dementia. And C.T.E. appears later in life as well, because it takes a long time for the initial trauma to give rise to nerve-cell breakdown and death. But C.T.E. isn’t the result of an endogenous disease. It’s the result of injury.

Neuropathologist Bennet Omalu diagnosed the first known case of C.T.E. in an ex-N.F.L. player back in September of 2002, when he autopsied the former Pittsburgh Steelers center Mike Webster. He also found C.T.E. in the former Philadelphia Eagles defensive back Andre Waters, and in the former Steelers linemen Terry Long and Justin Strzelczyk, the latter of whom was killed when he drove the wrong way down a freeway and crashed his car, at ninety miles per hour, into a tank truck. Omalu has only once failed to find C.T.E. in a professional football player, and that was a twenty-four-year-old running back who had played in the N.F.L. for only two years.

When we think of head injuries in football, we think of the major hits that cause concussions. The effects of these major hits are pretty closely monitored to try and make sure that permanent injury doesn’t occur.

But a football player’s real issue isn’t simply with repetitive concussive trauma. It is, as the concussion specialist Robert Cantu argues, with repetitive subconcussive trauma. It’s not just the handful of big hits that matter. It’s lots of little hits, too.

That’s why, Cantu says, so many of the ex-players who have been given a diagnosis of C.T.E. were linemen: line play lends itself to lots of little hits. The HITS data suggest that, in an average football season, a lineman could get struck in the head a thousand times, which means that a ten-year N.F.L. veteran, when you bring in his college and high-school playing days, could well have been hit in the head eighteen thousand times: that’s thousands of jarring blows that shake the brain from front to back and side to side, stretching and weakening and tearing the connections among nerve cells, and making the brain increasingly vulnerable to long-term damage. People with C.T.E., Cantu says, “aren’t necessarily people with a high, recognized concussion history. But they are individuals who collided heads on every play—repetitively doing this, year after year, under levels that were tolerable for them to continue to play.”

This raises a major question as to whether brain damage may indeed be an inherent danger of the sport, especially for these linemen who endure head collisions on just about every play. As Gladwell points out, hitting is an integral part of the sport and it is unclear how helmets can be improved much to provide any further protection. Maybe the larger question is whether we can do anything without dramatically changing the game and perhaps taking much of the appeal from it. Football has long overtaken baseball as America’s national pastime and for many of us, we couldn’t imagine our autumn weekends without it whether it is high school, college or the NFL. But having said all of that, if you are a parent who has seen the evidence of permanent brain damage in these retired football players, would you really want your sons to become football players?

Post-Script: October 21, 2009

Concussion Trauma Risk Seen in Amateur Athlete

Brain damage commonly associated with boxers and recently found in deceased NFL players has been identified in a former college athlete who never played professionally, representing new evidence about the possible safety risks of college and perhaps high school football.