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CTE and Youth Athletics: Should Football Take All the Blame?

News headlines about famous former and current NFL players tragically taking their lives are heartbreaking enough on their own; post-mortem diagnoses of chronic traumatic encephalopathy (CTE) only amplifies the tragedy, suggesting suicide was less a choice than an inevitability.

CTE is a major topic of concern across all levels of football, from youth sports to professional leagues, and the NFL is now welcoming research into the disease. But with nearly all headlines about CTE focusing on football, it’s easy to assume CTE is exclusive to the sport. Unfortunately, it’s not.

Part of the reason football has been the so-called poster child of CTE is because most research on the degenerative brain disease has concentrated on concussions. Football is known for its dramatic head-on collisions during game play, especially in the professional leagues, while other sports are presumed to be “safer.”

However, according to a new study published in the journal Brain that examines the root cause of CTE, neuroscientists have found that routine hits to the head, whether or not those hits are strong enough to cause a concussion, are the true culprit.

“On the football field, we’re paying attention to the bright, shiny object—concussion—because it’s obvious,” said Dr. Lee E. Goldstein of Boston University, who led the study, in an interview with the Los Angeles Times. “But it’s hits to the head that cause CTE.”

Soccer HeaderThat means “headers” in soccer, in which the player hits the ball with his or her head, are more dangerous than previously thought. The same goes for hockey, lacrosse, or even baseball, where accidental pitches to the head aren’t as uncommon as people might assume.

According to American Association of Neurological Surgeons (AANS), of the 446,788 sports-related traumatic brain injuries (TBI) treated at U.S. hospitals in 2009, baseball and softball comprised 8.6 percent of the total, compared to the 10.5 percent attributed to football-related injuries. Other unexpected entries on the AANS’s top ten list of TBI-causing sports include basketball, horseback riding, and even golf, which actually ranks higher than hockey.

Because concussion is a subset of TBI, sports that result in head injuries but not necessarily concussion have long been portrayed as “safe” compared to football. But Dr. Goldstein’s study, which found that about 20 percent of known cases of CTE had no record or report of concussion, has effectively shattered that notion.

“Repetitive neurotrauma, independent of concussion, may induce early CTE brain pathologies, even in teenagers and young adults,” Goldstein said in the report’s conclusion.

The implications of the study are grim for youth athletics—if playing nearly any sport runs the risk of head injuries, and thus developing CTE, what are young sports fans supposed to do? Avoiding hits to the head is an obvious answer, and football at least provides some protection with helmets.

Head injury awareness and improved safety policies are now a top priority for youth sports associations. Pop Warner, one of the oldest and largest youth football organizations in the U.S., banned head contact drills during practice in 2012, and other youth leagues, both tackle and flag/non-contact varieties, have followed Pop Warner’s lead in reducing gratuitous head contact.

Youth tackle footballWhen parents consider registering their child for youth football, it’s important to note that safety has less to do with type of sport, and more to do with age. Dr. Julian Bailes, department of neurosurgery chair at NorthShore University Heath System in Chicago, said there are many benefits to playing football before the age of 14 or 15, when players are physically smaller.

Still, in an interview with NPR, Bailes noted that Dr. Goldstein’s study does not indicate a specific age range in which tackle football is safer. It’s also important, he said, to remember that “everything is relative.”

“There are about 10 people who drown every day in the U.S.,” Bailes said, “and we’re not calling to outlaw swimming.”

Ultimately, science might be the solution to safer youth athletics. United Neuroscience, Inc. (UNS), a clinical-stage biotech company based in Dublin, Ireland, announced Jan. 29 plans for the development of a vaccine for the prevention of CTE.

7v7 youthUNS’s vaccine is designed to generate antibodies that target an abnormal protein called tau, which builds up during repetitive brain trauma and leads to the degeneration of brain tissue. Because this protein can take years to aggregate before symptoms of CTE are apparent, a vaccine that inhibits tau build-up and promotes tau removal would be invaluable to youth athletes of all sports, not just football.

“The premise is that we can teach a person’s immune system to recognize the build-up of toxic tau aggregates and prevent or heal these lesions as they form, thereby avoiding progression to CTE,” said Ajay Verma, M.D., Ph.D., chief medical officer of UNS. “Our approach would also have potential as a therapeutic, but the concept of vaccinating a football player or soldier before he or she steps onto the respective ‘battle field’ is what we envision.”

As a U.S. military veteran, Dr. Verma is well aware how common head injuries are among soldiers, and including them as beneficiaries of a potential CTE vaccine hints at the sheer breadth of the disease, which can also affect victims of domestic violence.

Recognizing how far CTE extends beyond the realm of sports is crucial to furthering research and finding solutions to this tragic disease. And until a cure is found, blaming football for CTE to the exclusion of all other youth sports will only give parents and athletes a false sense of security, which could potentially increase cases of repetitive head injuries—and tragically, CTE.


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