Writers of Pro Football Prospectus 2008

29 Jun 2010

Chris Henry And CTE

The great Iowa Hawkeyes blog, Black Heart Gold Pants, took a couple of looks at CTE (and why it is so unbelievably frightening) today. (Here is the second one.) It really is fascinating, and not in a good way, to think about what it could mean if a wide receiver, who only played college/pro football for about seven years, had CTE at 26. You can't help but ask who else has been affected at this point, and to what lengths organized football must go to attempt to prevent this. And if it's worth it for them to do so.

Posted by: Bill Connelly on 29 Jun 2010

39 comments, Last at 16 Jun 2011, 9:03pm by Max Doreno


by Rich Conley (not verified) :: Wed, 06/30/2010 - 10:16am

"It really is fascinating, and not in a good way, to think about what it could mean if a wide receiver, who only played college/pro football for about seven years, had CTE at 26."

I'll concede that, if there's any indication that it was caused by football, which, at this point, there isn't.

by Aloysius Mephis... :: Wed, 06/30/2010 - 11:18am

Not sure what your basis is for saying there's "no indication." As I see it there are two possibilities. One, repeated blows to the head caused his CTE. Two, a rare, degenerative neurological condition unrelated to football caused his CTE. We may have different views on which is more probable, but I don't agree that the second alternative ought to be presumed true until disproven.

by Jimmy :: Wed, 06/30/2010 - 1:45pm

I think the point he is trying to make is that there could have been other traumas in his life other than football that we don't know about. Maybe he went over the handlebars of his bike when he was five or fell out of a tree. There doesn't seem to be much eveidence of Henry suffering concussions in football (at least no recorded incidences, although there is every chance that people weren't looking hard enough). I think the problem is that there are a lot of variables to investigate, not just football.

by Aloysius Mephis... :: Wed, 06/30/2010 - 11:54am

Fair enough; I agree it makes sense to look at all the variables and possible causes. Still, my understanding of CTE is that the damage takes place at a cellular level, and it's not the type of thing that is caused by one impact, or two, or ten, or twenty. It's caused by hundreds or thousands of repetitive traumas over a period of years. In my opinion there's quite a bit more than an indication this is football related; there's a high probability. Of course that doesn't mean it's also probable there were no other causes or contributing factors.

by roguerouge :: Wed, 06/30/2010 - 12:12pm

It seems to require repeated concussions, so while it's certainly possible he was abused as a child or an exceptionally poor bicyclist, to argue that correlation does not mean causation ... well, that's conveniently over-cautious. I like football too, but I find sticking my head in the sand over the mounting evidence of brain injury in this sport to be problematic. Certainly, I'm going to do some soul-searching over whether it's moral to continue to follow this sport.

by Aloysius Mephis... :: Wed, 06/30/2010 - 2:04pm

Not to single you out for nitpicking, but because this is an error that I'm hearing repeated frequently, the issue does not seem to be repeated *concussions* per se. Rather the problem is repeated sub-concussive trauma, of the type that, say, a lineman might sustain on the majority of plays from scrimmage. Coming up from your stance and driving your facemask through the other guy's grill won't concuss you, but over time the hits still add up.

by Revenge of the NURBS (not verified) :: Wed, 06/30/2010 - 10:26am

Just asking a dumb question -- is there any way to test for this on people who aren't dead? Is it something that can be seen on a scan, or only on the actual physical brain tissue?

by Shattenjager :: Wed, 06/30/2010 - 10:52am

I don't think that's at all a dumb question.

As I understand it, you need the actual tissue to see it for certain. However, they are really looking for the same things as with Alzheimer's (neurofibrillary tangles and tau proteins). While sure Alzheimer's diagnosis also requires the brain itself, you can make essentially an educated guess by using the cluster of symptoms and the fact that you can see some known differences in functionality (though those differences in functionality can have other causes, which is why it's imperfect before being able to examine the brain). So, there may be a way, given some time (Remember, this is a pretty recently discovered phenomenon.), in which they can at least make an educated guess about it during life. The Center for the Study of Traumatic Encephalopathy (which has an excellent website, btw, at http://www.bu.edu/cste/) says that developing a reliable test for use on living people is one of its goals.

I will point out that while I took some courses in neurology and brain biology in undergrad, I am by no means a professional, and so even though I think I know what I'm talking about, it would not be a tremendous shock to find out I'm wrong about any/all of the above.

by dmb :: Wed, 06/30/2010 - 1:23pm

Only a dumb question if you've read articles about it all the way through -- I have absolutely no medical background, but many of the Chris Henry news articles have addressed this. :)

The answer is that right now there's not. In fact, the technique used to identify CDE isn't even conducted in regular autopsies; as Shattenjager suggested, brain tissue itself is used (stained) to make the diagnosis. This probably opens up issues of selection bias -- are the families of anyone who didn't play contact sports having postmortem analysis look for this? -- but certainly not enough to dismiss it as an issue for people who have participated significantly in contact sports.

by Shattenjager :: Wed, 06/30/2010 - 4:29pm

This is a very minor addition (not even a nitpick): It's actually more than stained, because the brain is basically impossible to cut at first (I've been told it's about the texture of slightly less solid Jello). It has to be prepared first, though I do not remember exactly how.

I had not heard that this technique was not part of a standard autopsy, which is interesting.

I've asked a neurologist who writes a blog I read and hosts my favorite podcast to discuss this football/CTE issue in a future show/post, so I'm hoping that happens.

by dmb :: Wed, 06/30/2010 - 4:45pm

Cool. Like I said, I have NO expertise on this whatsoever (I haven't taken a biology class since I was a sophomore in high school); I was just repeating what I've read in multiple CTE-related articles.

If the neurologist ends up honoring your request, please ask to have it put up as an XP!

by Shattenjager :: Wed, 06/30/2010 - 6:35pm

Will do.

by Theo :: Wed, 06/30/2010 - 3:49pm

Yes and no. There are many types of scans available routinely done on people who come out of car crashes, have head aches or sustain a head injury otherwise.
Scans are actually better when you're alive for the obvious reason that your body goes bad after you die.

by dmb :: Wed, 06/30/2010 - 4:46pm

Right, but the question was whether CTE can be detected using any of those scans, and the answer is "no."

by MJK :: Thu, 07/01/2010 - 1:39pm

I don't know much about CTE specifically, but I do study general traumatic brain injury (TBI), especially in military patients, as part of my job. So this may be related...

In generally, what is called "mild" TBI (mild in this case meaning that no skull fracture occurs, not that it's not a problem), is very hard to see in living patients, and is usually diagnosed by symptoms rather than by looking at any kind of brain scan or fluids test. One of the most common underlying damages is called "diffuse axonal injury" or DAI, and is only occasionally visible on very specific types of scans (because it is diffuse). DAI can develop without outward signs of a concussion, and there may be other types of underlying brain injury that also do not show up on most brain scans, and that can develop from sub-concussive impacts (especially repeated ones).

It also should be noted that an impact is not even strictly necessary (although it is the most common cause of civilian brain injury). Any mechanical force that causes a sudden acceleration or rotation of the head can cause injury.

All that being said, there are some brand new, bleeding edge, technologies that have the potential to spot otherwise invisible mild TBI in living patients--the most promising one that I am familiar with is called diffusion-tensor imaging or something like that. The basic idea is that there are certain types of scans that can measure the degree of anisotropy of brain tissue (anisotropy means that the mechanical response of the tissue is directional, like a bundle of fibers, instead of the same in every direction, like a piece of jello). Injury to brain tissue has been linked to a decrease in anisotropy, even if the injury cannot be seen on other brain scans. The catch is that anisotropy varies widely from one individual to the next (and within the brain itself)--healthy tissue in one person could be less anisotropic than injured tissue in another--so you need before and after imaging to be done on a patient to use this technique to see if they are injured. And it's not cheap. And it's still highly experimental and doesn't always work.

But I wonder if this technique could be used to track the development of CTE in football players, given that the NFL and the players themselves have lots of money, know they are at risk, and know the times they are at risk (so they could get scanned before and after every season, for example).

by Jimmy :: Wed, 06/30/2010 - 11:22am

What does stick out to me is how much research is needed into these areas. The amount of variables that need to be examined is massive. Does age at which the brain starts to receive significant impacts matter? I know there are all kinds of pre-birth conditions that can damage the development of the brain in later life, are these being screened out? Could there be underlying congenital conditions that lead to some people suffering worse neurological injury than others from the same traumas? Two different people suffering the same knock on their skin will suffer different bruising reactions could there be similar variation in brain bruising? At least there seems to be a movement towards trying to figure some of this stuff out.

by Aloysius Mephis... :: Wed, 06/30/2010 - 11:39am

Not that I needed any further convincing on this subject, but to me this highlights how crazy it is that profitable college football programs (and I know there are very few of them) don't pay their players. The "scholar-athlete" notion has always been a joke, at least at the top football programs, but what if we now learn that the players' minds are actually being damaged? What if some of them are losing cognitive function every time they step on the field? And it's OK for the top coaches to get millions of dollars while their players get nothing? Insane.

by Illmatic74 :: Wed, 06/30/2010 - 3:01pm

But, universities really don't have the ability to pay the players if they wanted too. Yes football makes money and so does basketball but every other athletic program is actually losing money at most division 1 schools. But, I do think players should be able to pursue professional opportunities sooner.

by Aloysius Mephis... :: Wed, 06/30/2010 - 3:42pm

I don't follow your reasoning as to why college football players can't be paid, at least at schools with football programs that make a lot of money. I understand most athletic programs lose money, but I don't understand why that means you can't pay football players. Most schools might not be able to afford it, but, again, coaches at elite programs can make millions. If the program is profitable enough that it makes sense to pay the coach that kind of money, why shouldn't the players get paid as well?

I'm willing to be persuaded that I'm wrong, just looking for clarification more than anything.

by Revenge of the NURBS (not verified) :: Wed, 06/30/2010 - 4:53pm

I've heard this argument before, and I don't get it. Essentially, what you're saying is that a football or basketball player needs to suck it up allow the money he generates to support field hockey, lacrosse, track, and every other "friends and relatives" sport. It still doesn't address the basic inequality that players are generating money for the school and receiving a 0% cut of it. Whether the school decides to spend that money on funding other sports, expanding the library, or stuffing sacks of money into the university president's pocket is not the point.

Universities DO have the ability to pay the players (neglecting NCAA rules, but that's not the point I'm arguing). They choose instead to spend that money on fielding non-profitable teams in other sports. Now, I'm not advocating dropping non-revenue sports, because I think that would be a sad day. I'm just saying that I don't buy the notion that it's somehow the football team's responsibility to prop up the entire athletic department.

by tuluse :: Wed, 06/30/2010 - 7:14pm

Since when is room, board, an education, and often a stipend, 0%?

by Revenge of the NURBS (not verified) :: Thu, 07/01/2010 - 8:18am

That's the same thing the athletes that generate no money get, so it's 0% of the money they generate.

by tuluse :: Thu, 07/01/2010 - 8:51am

Not all the other athletes get a full scholarship.

Also, they world class facilities and get to play on TV and get noticed by NFL scouts.

by Revenge of the NURBS (not verified) :: Thu, 07/01/2010 - 10:24am

"Getting to play on TV" is precisely at the heart of the matter. The players get to be on TV, and the university gets to have a multi-million dollar payout for being on TV. World class facilities are just an arms race between the schools to use in recruiting players. I can think of a much more effective use of that money, if you wanted to recruit players with it...

Getting noticed by scouts is also at the heart of the matter. That playing college football allows you access to the next level is only so because the system has been set up that way by the NCAA and NFL, who make a lot of money off it.

by jack :: Wed, 06/30/2010 - 5:28pm

Not saying that I disagree with paying players. However, if the argument is that football players should be payed because of the risks they're taking, I would disagree with only "profitable" programs paying players. Not only that, but being that we're in the beginning stages of finding out what type of violent head trauma causes this disease, you could make a similar argument for hockey, soccer, lacrosse, etc; which leads to the other reply that it would not be feasible for universities to pay their players. Truth be told, they are being paid with a (basically) free education. Oh irony, that the reason they get said free education could 10-20 years down the road stop them from using it.

by bingo762 :: Wed, 06/30/2010 - 12:24pm

"and to what lengths organized football must go to attempt to prevent this."

Not to be cruel but is it football's duty to prevent it? It's kinda like boxing, you know the risks going into it

by Revenge of the NURBS (not verified) :: Wed, 06/30/2010 - 12:50pm

Not sure I'd choose boxing as the model to emulate for sport leagues. It's usually a good idea for a sport to at least partially look out for the welfare of its participants, even if it may not be a legal "duty" per se. If it turns into a bloodsport, that pretty much limits you to the truly rabid fan and the mentally unbalanced participant.

Note -- I'm not saying that's what happened to boxing. But boxing is definitely way down from where it used to be, and appears unlikely to ever return to prominence.

by bingo762 :: Wed, 06/30/2010 - 1:00pm

Look at how football was when it started and today and look at how far it's come in regards to player safety. The equipment, rules, doctor access, etc. It's not perfect nor can it be but I think they go above and beyond "at least partially look out for the welfare of its participants". I don't think the onus should be on organized football to do anymore. Studies are done and results are published and it's up to the participants and viewers to decide if they want to play or watch.

by Revenge of the NURBS (not verified) :: Wed, 06/30/2010 - 2:15pm

Agreed in principle, but the reality is that there are several things the NFL could and should be doing. Concussion-reducing helmets are not mandatory, for no good reason that I can see, and the rules pertaining to playing with concussions are a joke. That may be an issue of individual responsibility, but I'd also think it's in the teams' interest to keep their players healthy. So I'd have to disagree with the idea that the NFL can't be expected to do any more than what they do in this area. Just because things are better than they were doesn't mean they're all that they could be.

by Illmatic74 :: Wed, 06/30/2010 - 3:04pm

But I really doubt the players are the ones reading this studies. Plus to play the game you need a sort of level of invincibility so they would most likely shrug off stuff like this.

by dmb :: Wed, 06/30/2010 - 1:30pm

Well, part of the issue is that for years, the NFL hasn't been interested in making sure that players knew the risks going into it. It seems like the league is starting to turn the corner in that regard these days, but I think it would be good for public sentiment to push the league to actively explore the risks and proactively inform players of those risks.

But beyond that, I would say that yes, the league has a responsibility to help minimize those risks. Factory workers probably know that their job will be dangerous when they're hired, but those businesses are still expected to use safety procedures, equipment with easy emergency shutdowns and other safety features, etc. (I know that it doesn't always end up working that way -- there was a fabulous PBS Frontline about one particularly eggregious offender several years ago -- but I think it's a good society-wide expectation that employers take whatever measures they can to minimize the job-related health problems of their workers.)

by Raiderjoe :: Wed, 06/30/2010 - 12:48pm

Fball vety tough sport on mind and body

by dmb :: Wed, 06/30/2010 - 1:33pm

"There's an old phrase about Bernese Mountain Dogs: '3 years a young dog, 3 years a good dog, 3 years an old dog; the rest is a gift from God.' This news about Chris Henry might mean career football players are something close to the same: '20 years a young man, 20 years an athletic man, 20 years an old man; the rest is a gift from God.' As an avowed and diehard football fan, I hope so much that, in the face of the evidence unfolding in front of us every day, it's not true."

That more or less sums up my feelings on the subject. I do think more evidence is needed before we truly start leaping to wide conclusions, but this news is awfully serious.

by panthersnbraves :: Wed, 06/30/2010 - 2:47pm

Does anyone know what position Henry played in HS?

Also, in my son's rec league, everyone runs Oklahoma drills. You stand in line, wearing left-over pads and helmets, and start smacking each other. Between drills and practice, players are likely to run what? 100+ plays? 5 days a week. for several months.

Since some scientists are now saying that brain development continues on even up to age 20, it may not have been just the College and NFL years, or just full-blown concussions.

by Illmatic74 :: Wed, 06/30/2010 - 3:13pm

In the Malcolm Gladwell article of last year they pointed out that the most damaging part was not the kill shots that we see it was rather the daily little hits a player gets in practice and in games.

by panthersnbraves :: Wed, 06/30/2010 - 2:54pm

sorry for double posting, but I saw another title, and thought of something - has anyone thought about looking at Hockey players? I would think getting slammed into the glass over and over might be similar.

by Aloysius Mephis... :: Wed, 06/30/2010 - 4:34pm

You're right. New York Times did an article back in '09. The player it focuses on played back in the helmetless era, but it also has some anecdotal evidence from more recent players that have experienced memory problems. Honestly I'd be surprised if CTE isn't fairly prevalent in hockey players.


by Ella James (not verified) :: Fri, 07/02/2010 - 7:19am

I don't thing CTE can be detected using any of those scans.

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by Max Doreno (not verified) :: Thu, 06/16/2011 - 9:03pm

me too i dont think it can be detected.
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