In the 2012-2013 school year, 1,086,627 male high school students played American football, making it the most participated in sport in the United States (Jeffery, 2014). In 2017, a study of over 200 brains from deceased American football players found that 87% had Chronic Traumatic Encephalopathy (CTE). Within that sample, 111 brains were from National Football League (NFL) players, and 110 (99%) were found to have CTE (Mez et al., 2017). Before this study, the dangers of football, specifically the risk of CTE development, was not at the forefront of the conversation surrounding football. The National Football League itself tried to cover up the full effects of repetitive head traumas for years, only recently acknowledging the link between football and CTE (Belson & Schwarz, 2016).
CTE is a progressive neurodegenerative condition that is associated with repeated head trauma (such as in military service or participating in tackle football); it is only diagnosed by a post-mortem examination of brain tissue (Omalu, Bailes, Hammers, & Fitzsimmons, 2010). Behavioral and mood symptoms are common among those with CTE, such as violent outbursts and behavior, depression, substance abuse, hopelessness, suicidal thoughts and behaviors, impulsivity, and anxiety (Mez et al., 2017). Cognitive symptoms include memory, attention, language, and visuospatial difficulties. In severe cases, dementia and motor symptoms, such as gait instability, are common (Mez et al., 2017).
Pathology
CTE is considered a tauopathy, which is a pathological accumulation of tau proteins in the neurofibrillary or gliofibrillary tangles in the brain (Goedert & Spillantini, 2017). Tau proteins stabilize microtubules and are abundant in neurons of the central nervous system. In tauopathies, these proteins are hyperphosphorylated, which causes them to dissociate from the microtubules and form insoluble aggregates (Goedert & Spillantini, 2017). The role of aggregates in neurodegenerative diseases is not entirely understood. Researchers have also observed other structural and cellular changes in CTE, including extensive brain atrophy, astrogliosis, myelinated axonopathy, microvascular injury, and perivascular neuroinflammation (VanItallie, 2019).
Ethical Considerations
Participation in American football at any level of play is considered enough exposure for CTE development (Mez et al., 2017). A few companies have looked at improving helmets to perform better during impact. While this is a feasible idea at higher levels of play, these helmets are costly, priced between $500-$1500 USD, and are unlikely to be utilized at youth and high school levels (Kubota, 2016). Some doctors have also suggested a more practical solution: that full-contact practices at all levels should no longer be the norm (Nyte, 2018). Instead, teams can use that time to condition, run non-contact drills, and work on strategy and technique. This implementation would limit the potential for subconcussive hits and concussions to once a week during games (Nyte, 2018). While this is a free and relatively simple solution, getting teams and communities onboard with tackle-free football is incredibly complicated. Football is interwoven with tradition and culture in many communities across America. One small town in Texas recently reinstated tackle football for seventh graders, even though it was banned barely five years ago (Belson, 2019). This dilemma begs the question: Should we let children play football? Is it ethical to allow them to participate in something that may have life long detrimental effects before they can genuinely understand and consent to those risks?
References
Belson, K. (2019, November 16). A Small Town Gave Up Tackle Football. It Came Storming Back. The New York Times. Retrieved from https://www.nytimes.com/2019/11/16/sports/youth-tackle-football-marshall-texas.html
Belson, K., & Schwarz, A. (2016, March 15). N.F.L. Shifts on Concussions, and Game May Never Be the Same. The New York Times. Retrieved from https://www.nytimes.com/2016/03/16/sports/nfl-concussions-cte-football-jeff-miller.html?searchResultPosition=3
Goedert, M., & Spillantini, M. G. (2017). Propagation of Tau aggregates. Molecular Brain, 10(1). https://doi.org/10.1186/s13041-017-0298-7
Jeffery, T. P. (2014, February 2). Football Is Top Sport in U.S.: 1,088,158 High School Players. Retrieved November 30, 2019, from https://www.cnsnews.com/news/article/terence-p-jeffrey/football-top-sport-us-1088158-high-school-players
Kubota, T. (2016, March 30). 5 Ways Science Could Make Football Safer. Retrieved November 30, 2019, from https://www.livescience.com/54239-how-to-make-football-safer.html
Mez, J., Daneshvar, D. H., Kiernan, P. T., Abdolmohammadi, B., Alvarez, V. E., Huber, B. R., … McKee, A. C. (2017). Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football. JAMA, 318(4), 360. https://doi.org/10.1001/jama.2017.8334
Omalu, B. I., Bailes, J., Hammers, J. L., & Fitzsimmons, R. P. (2010). Chronic Traumatic Encephalopathy, Suicides and Parasuicides in Professional American Athletes. The American Journal of Forensic Medicine and Pathology, 31(2), 130–132. https://doi.org/10.1097/paf.0b013e3181ca7f35
VanItallie, T. B. (2019). Traumatic brain injury (TBI) in collision sports: Possible mechanisms of transformation into chronic traumatic encephalopathy (CTE). Metabolism, 100, 153943. https://doi.org/10.1016/j.metabol.2019.07.007
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