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Frequency of Chronic Traumatic Encephalopathy (CTE) in Football Players

Recently an article was published in JAMA by Mez, Daneshvar, and Kiernan et al that investigated the frequency of Chronic Traumatic Encephalopathy (CTE) in football players. It has become a topic of controversy because CTE has become a red flag for the public eye. It is now known to be correlated with repetitive trauma from popular impact sports such as hockey, football, and even soccer. While many hope to avoid or prevent the progression of this disease, there is currently no definitive causation and therefore no cure-all. CTE is a post mortem diagnosis that requires evidence of an accumulation of certain proteins along with other neurological criteria.

Mez, Daneshvar, and Kiernan et al used current classification systems to evaluate and assess 207 donated brains of football players. An overwhelming majority of them (87%) met the criteria for neuropathological diagnosis of CTE and the article detailed severity of symptoms (pre-mortem) associated with severity of CTE as well as mean age of death. While the article suggested a relationship between higher level of football participation (NFL) and worse disease presentation, the authors were definitely not stating a cause and effect relationship. The conveniance sample was for investigating possible relationships between activity levels and disease burden. This was an observational study with no constant or variables to compare.

Studies have shown that while living, a person with CTE may present with similar behaviors and cognitive impairments to that of a person with mood disorders, dementia, or Alzheimer’s disease. Mez, Daneshvar, and Kiernan et al outlined common characteristics and behaviors of the people that were diagnosed with CTE and therefore provided a foundation for future studies to help eventually determine causation, a sensitive and specific means of evaluation, and prevention. Until then, athletes of all levels must try their best to avoid repetitive and unecessary microtaumas. Playing smart and competitively, not aggresively, can help minimize repeated impact and trauma in every game.

Elizabeth Lamontagne PT, DPT, SCS, CKTP

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