New information regarding CTE

The Journal of the American Medical Association (JAMA) published a study that found a high propensity of neuropathological evidence of chronic traumatic encephalopathy (CTE) when analyzing the brain tissue of deceased NFL players. Through various news media outlets, the results of this study have been widely distributed and concerns have been voiced over the association of American football and CTE.

CTE has made the news for some time now and was recently highlighted in the 2015 film “Concussion.” As a progressive degenerative disease, CTE is commonly found in people with a history of trauma to the brain. Common side effects associated with CTE can include motor impairment, irritability, aggression, speech and language difficulty and dementia.

The above-mentioned study found CTE in 87% of the brains studied with 99% of those involving former NFL players.

So with this new information, where do we go from here?

First and probably foremost, we need to acknowledge that this warrants our attention, but we should take caution and not overlook the limitations of this study;

  1. “…caution must be used in interpreting the high frequency of CTE in this sample, and estimates of prevalence cannot be concluded or implied from this sample.”
  2. “…the VA-BU-CLF brain bank is not representative of the overall population of former players of American football; most players of American football have played only on youth or high school teams, but the majority of the brain bank donors in this study played at the college or professional level.”
  3. “…this study lacked a comparison group that is representative of all individuals exposed to American football at the college or professional level, precluding estimation of the risk of participation in football and neuropathological outcomes.”

The key take-home point from this study is that the published findings are very concerning for a correlation between higher levels (collegiate/professional) of participation in American football and CTE, but additional research is necessary to further understand this association.

On the local level, a recently published study conducted by Dr. John Tokish and Ellen Shanley examined the impact of the USA Football Heads Up safety program on concussion rates within the Greenville County School District. During the 2015 football season, 2,500 high school athletes playing on teams that had participated in the USA Football Heads Up safety program demonstrated concussion rates 33 percent lower than the athletes of teams that had not participated.

Additionally, the Heads Up players demonstrated a faster resolution of their concussions, returning to full participation 27 percent faster than athletes in the non–Heads Up group. The average time to recovery was 18 days for the Heads Up group versus approximately 25 days for the non-Heads Up group.

With the upcoming football season fast approaching we should be mindful of the established laws and protocols for addressing concussion in sport, focusing on injury prevention and early recognition. A multidisciplinary approach to management includes a team effort between the athlete and his/her parent or guardian, coach, athletic trainer, teachers and physician(s) with the goal of achieving neurocognitive recovery prior to an unrestricted return to sport.

Additional information can be found on the AAOS website. For more information about Prisma Health’ss Athletic Trainer Network, which helps local schools implement the Heads Up curriculum, click here.

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