Chronic Traumatic Encephalopathy (hereinafter CTE) is a degenerative brain condition associated with repeat head injuries, particularly in contact sports, and characterized by the accumulation of abnormal proteins in the brain leading to cognitive, behavioral, and motor impairments.[1] CTE gained widespread attention in media through high-profile cases involving former athletes, leading to increased awareness of the long-term neurological consequences of traumatic head injuries.[2] With the National Institute of Health (hereinafter NIH) formally acknowledging the connection between CTE and repetitive traumatic brain injuries in 2022, questions arose around the future of contact sports, such as football, hockey, rugby, and soccer.[3] As more research emerges and initiatives are implemented to ensure athlete safety pertaining to head trauma, there is a growing need to reconcile the enjoyment derived from these sports with the need for safeguarding participants’ well-being.[4]
Athletics in America is deeply ingrained in the nation’s culture, with over 45 million children in the United States participating in organized sports annually.[5] Competitive sports give children the opportunity to socialize with others, teaching them life skills, including teamwork, responsibility, and self-discipline, they would not necessarily learn in other settings.[6] However, with the benefits that come from participation in sports, so do injuries, with approximately twenty-one percent of all traumatic brain injuries among children in America occurring from contact sport participation.[7] More specifically, between 1.7 and 3 million sports-related concussions occur each year, with roughly 300,000 concussions resulting from football.[8] Overall, two in ten high school athletes who participate in contact sports — including soccer, lacrosse, hockey, and basketball — will experience a concussion this year, with fifty percent of those going unreported or undiagnosed.[9]
Pathologist Harrison Stanford Martland, who recognized the distinct neuropsychiatric disorder, “punch-drunk syndrome,” first studied CTE.[10] In 1928, it was thought that the condition was exclusive to boxers.[11] However, more recent studies recognize that athletes of any sport with repeated brain injuries can suffer from the condition.[12] Symptoms of CTE are similar to Alzheimer’s disease and dementia, including decreased memory capacity and concentration and extreme shifts in behavior and personality.[13] Even with increased awareness and research on the disease, CTE is not formally diagnosed until an autopsy is completed.[14] Nonetheless, research suggests a causal link between the amount of CTE pathology, meaning the accumulation of p-tau protein in the brain, and the severity of cognitive and functional symptoms of CTE.[15] Additionally, the National Institute of Neurological Disorders and Strokes — an office within the NIH — has published standards for diagnosing living patients with CTE, but it can only be utilized in research settings- not in practice.[16]
Several studies conducted brought to light the prevalence of CTE in deceased former athletes.[17] The latest report, released by the Boston University CTE Center in 2023, announced that 345 out of 376 former National Football League (hereinafter NFL) players studied were diagnosed with CTE, calculating a nearly ninety-two percent detection rate.[18] Another study, conducted by the Boston University CTE Center, found a greater than forty percent of athletes who played sports at the amateur level presented with CTE.[19]
Because CTE is largely the result of repeated head trauma, specifically concussions, protocols in sports are in place to lower the overall incidence of concussions in athletics.[20] Many professional sports leagues, including English Premiership Rugby, Major League Baseball, the National Collegiate Athletic Association, the National Hockey League, the National Basketball League, and the NFL, all require players to undergo tests, such as the Immediate Post-Concussion Assessment and Cognitive Testing Test, and the Automated Neuropsychological Assessment Metrics Test, which allow athletes to establish baseline cognitive functions prior to injury.[21] These tests constitute a safety protocol checklist which inform potential post-injury evaluations as to whether an athlete is suffering from a concussion and the precautions that are needed for recovery.[22] Professional leagues including the NFL have additionally increased funding and research to increase helmet innovation, in turn decreasing the amount of concussions suffered on the field during active gameplay.[23]
Even with increased research, awareness, and initiatives, it is important to be proactive, and not reactive when addressing CTE.[24] To decrease the number of head traumas occurring, leaders of professional and amateur sports leagues can implement stricter rules regarding player safety and enhanced equipment standards.[25] These standards could include adherence to concussion protocols, such as delaying a return to gameplay after suffering a concussion is suffered, as well as requiring use of equipment, such as helmets, that has been researched and designed with the goal of decreasing concussions in mind.[26] Regulatory bodies including state athletic associations could follow initiatives made in collegiate and professional sports in establishing stricter rules, so as to ensure amateur athletes are provided with the same amount of care and action as collegiate and professional athletes when it comes to preventing concussions.[27] These regulations could range from proper tackling techniques and the reduction of full-contact drills during practice, to regular equipment inspections ensuring helmet safety.[28]
Overall, CTE is a preventable disease. As awareness of CTE continues to grow, it is imperative to adopt proactive measures to protect the health and well-being of athletes. While advancements in research and increased safety initiatives are crucial, there remains a critical need for stricter regulations and enhanced safety protocols within both professional and amateur sports leagues. It is through these concerted efforts to balance the enjoyment of participating in sports with the prevention of long-term neurological consequences associated with repetitive head trauma, that decreasing the prevalence of CTE can be achieved.
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHBL or Suffolk University Law School.
Anya is a second-year law student at Suffolk University Law School with an interest in intellectual property law combined with the life sciences. She received her Bachelors of Science degree from the University of Maryland, College Park in Bioengineering in 2022.
[1] See What is Chronic Traumatic Encephalopathy, Ind. Univ. Sch. Med., https://medicine.iu.edu/expertise/traumatic-brain-injury/what-is-chronic-traumatic-encephalopathy#:~:text=Chronic%20Traumatic%20Encephalopathy%2C%20or%20CTE,concussions%20and%20repetitive%20head%20impacts [https://perma.cc/ETG8-K6KC].
[2] See NIH Chronic Traumatic Encephalopathy Diagnosis Conference, Nat. Inst. of Neurological Disorders & Stroke, https://www.ninds.nih.gov/current-research/focus-disorders/traumatic-brain-injury-research/nih-chronic-traumatic-encephalopathy-diagnosis-conference [https://perma.cc/5C77-SNP8].
[3] See United States National Institutes of Health (NIH) concludes CTE is caused by repetitive traumatic brain injuries, Concussion Legacy Found. (Oct. 24, 2022), https://concussionfoundation.org/news/press-release/NIH-CTE-repetitive-traumatic-brain-injuries [https://perma.cc/9MNQ-R76V]; see also Will Recent Brain Trauma Findings Affect the Future of Football?, Colum. Coll. Today, https://www.college.columbia.edu/cct/latest/think-tank/will-recent-brain-trauma-findings-affect-future-football [https://perma.cc/RVR2-GE2J]. See generally Focus on Traumatic Brain Injury Research, Nat. Inst. of Neurological Disorders and Stroke, https://www.ninds.nih.gov/current-research/focus-disorders/focus-traumatic-brain-injury-research [https://perma.cc/7SQF-TNRY] (explaining traumatic brain injury research); Scott Ritsema, Landmark Ruling: Contact Sports Cause CTE and Brain Damage, Bisnar Chase LLP, https://www.bestattorney.com/blog/landmark-ruling-contact-sports-cause-cte-and-brain-damage/ [https://perma.cc/SH2K-LL8C] (acknowledging causal link between repeated head traumas and CTE).
[4] See Anne Tjønndal & Stian Røsten, Safeguarding Athletes Against Head Injuries Through Advances in Technology: A Scoping Review of the Uses of Machine Learning in the Management of Sports-Related Concussion, Frontiers (2022). See generally Daniel Garnett et al., Physical Conditioning Strategies for the Prevention of Concussion in Sport: a Scoping Review, Sports Med (2021).
[5] See Jannik Lindner, Youth Sports Industry Statistics [Fresh Research], Gitnux (Dec. 20, 2023), https://gitnux.org/youth-sports-industry-statistics/ [https://perma.cc/H4PK-97BP].
[6] See What Life Skills Can We Learn From Sports?, Univ. Kans. Sch. Educ. & Hum. Sci., https://onlinesportmanagement.ku.edu/community/life-lessons-from-sports [https://perma.cc/7PVV-FTZK].
[7] See Sports Injury Statistics, Stan. Med. Child. Health, https://www.stanfordchildrens.org/en/topic/default?id=sports-injury-statistics-90-P02787 [https://perma.cc/XP6T-JZHM]
[8] See Concussions Facts and Statistics, UPMC, https://www.upmc.com/services/sports-medicine/services/concussion/about/facts-statistics [https://perma.cc/KJ92-D5JY].
[9] See id.
[10] See NIH Chronic Traumatic Encephalopathy Diagnosis Conference, supra note 2.
[11] See id.
[12] See id.
[13] See Chronic Traumatic Encephalopathy, UCSF Weill Inst. for Neurosciences, https://memory.ucsf.edu/dementia/chronic-traumatic-encephalopathy#:~:text=CTE%20may%20manifest%20in%20different,things%20they%20previously%20cared%20about [https://perma.cc/C7AC-MVYY].
[14] See Mayo Clinic Staff, Chronic traumatic encephalopathy, Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921#:~:text=Chronic%20traumatic%20encephalopathy%20(CTE)%20is,an%20autopsy%20of%20the%20brain [https://perma.cc/8CLU-B89B].
[15] See Gina Digravio & Jessica Colarossi, Researchers Are One Step Closer to Diagnosing CTE during Life, Rather Than after Death, The Brink (Feb. 5, 2024), https://www.bu.edu/articles/2024/researchers-one-step-closer-diagnosing-cte/ [https://perma.cc/RD8E-DSHC]. In autopsy findings,, CTE is diagnosed upon a finding of an accumulation of misfolded tau proteins within the brain, distinguishing it from other neurodegenerative and age-related diseases. Id.
[16] See Douglas I. Katz, MD et al., National Institute of Neurological Disorders and Stroke Consensus Diagnostic Criteria for Traumatic Encephalopathy Syndrome, Neurology (Mar. 15, 2021).
[17] See Doug Most, BU Finds CTE in Nearly 92 Percent of Ex-NFL Players Studied, The Brink (Feb. 7, 2023), https://www.bu.edu/articles/2023/bu-finds-cte-in-nearly-92-percent-of-former-nfl-players-studied/?utm_source=twitter&utm_medium=link&utm_content=research_brain&utm_campaign=social_main [https://perma.cc/F299-H8NZ]. See Brian Doctrow, Ph.D., Chronic traumatic encephalopathy in young athletes, Nat. Inst. Of Health (Sept. 12, 2023), https://www.nih.gov/news-events/nih-research-matters/chronic-traumatic-encephalopathy-young-athletes [https://perma.cc/U63M-STW5] (quantifying CTE prevalence in young athletes).
[18] See Doug Most, supra note 17.
[19] See Brian Doctrow, Ph.D., supra note 17.
[20] See Suggested Guidelines for Management of Concussion in Sports, Nat. Fed’n State High Sch, Ass’n, https://www.nfhs.org/media/1018446/suggested_guidelines__management_concussion_april_2017.pdf [https://perma.cc/YYZ4-4JZB]. See also Head to Head: The National Football League & Brain Injury, NYU Langone Health, https://med.nyu.edu/departments-institutes/population-health/divisions-sections-centers/medical-ethics/education/high-school-bioethics-project/learning-scenarios/the-nfl-brain-injury [https://perma.cc/XC2E-ECCU] (explaining research and solutions to decrease prevalence of CTE).
[21] See An overview of concussion protocols across professional sports leagues, L. in Sport (Nov. 5, 2014), https://www.lawinsport.com/topics/features/item/an-overview-of-concussion-protocols-across-professional-sports-leagues [https://perma.cc/2S84-29KZ]; What is a concussion protocol? Sport by sport, there’s no single solution, ESPN (Sept. 16, 2019), https://www.espn.com/rugby/story/_/id/27628507/what-concussion-protocol-sport-sport-there-no-single-solution [https://perma.cc/A3BG-TZ2Z].
[22] See Concussion Safety Protocol Checklist, Nat. Coll. Athletics Ass’n. (Sept. 2023), https://ncaaorg.s3.amazonaws.com/ssi/concussion/SSI_ConcussionSafetyProtocolChecklist.pdf [https://perma.cc/YSJ2-RQRF].
[23] See Helmet Innovation: Continued Advancements to Keep Players Safe, NFL (Sept. 25, 2023), https://www.nfl.com/playerhealthandsafety/equipment-and-innovation/engineering-technology/helmet-innovation-continued-advancements-to-keep-players-safe [https://perma.cc/5CWG-KFZH].
[24] See Head to Head: The National Football League & Brain Injury, supra note 20.
[25] See generally An overview of concussion protocols across professional sports leagues, supra note 21.
[26] See id. See also Helment Innovation: Continued Advancements to Keep Players Safe, supra note 23.
[27] See generally Concussion Safety Protocol Checklist, supra note 22 (disclosing NCAA concussion protocols). See generally Suggested Guidelines for Management of Concussion in Sports, supra note 20 (outlining concussion protocols in high school athletics).
[28] See generally Will Recent Brain Trauma Findings Affect the Future of Football?, supra note 3.