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Opinion CTE and violent sports: It's time to rethink our approach

A football player's brain is a frightening thing.

You don't have to be a neuropathologist to know that repeated blows to the head are going to take a toll.

But a new study, led by Dr. Ann McKee, chief of neuropathology at the VA Boston Healthcare System, provides some damning evidence of the link between football and the devastating neurological condition, chronic traumatic encephalopathy (CTE).

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Read more: Damage found in 110 of 111 former NFL players' brains

The researchers, who examined the brains of former football players, found that 99 per cent of the players they studied had CTE. Just as concerning is that some of those studied were as young as 23 and had only played at a high-school level.

Of course, this doesn't mean all football players are doomed to suffer horrific brain damage. The study subjects were not chosen at random; rather, the players (or their families) donated their brains because of suspicious symptoms.

But what Dr. McKee's research does provide is incontrovertible evidence of a link between football and CTE – something that, until fairly recently, the leadership of the National Football League and the Canadian Football League had denied, in much the same manner Big Tobacco long denied that smoking caused lung cancer.

The study also provides some important clues about who is most at risk of CTE. Researchers found, for example, that in their sample, linemen were most likely to suffer from CTE and experience the most severe damage to the brain. (Forty-four of the 110 NFL players with CTE were linemen.) And, the longer a career, the greater the brain damage, with few exceptions.

CTE is a condition caused by repeated blows to the head. The jolts trigger degeneration of brain tissue and buildup of a protein called tau which, in turn, can lead to symptoms such as memory loss, aggression, depression, dementia and suicidal behaviour. (Tangles of tau are also a tell-tale sign of Alzheimer's, but the patterns of tau that characterize CTE are distinct.)

There has been a lot of attention in recent years focused on concussions in football (and other sports, such as hockey, and other high-risk activities, such as being a combat soldier). But CTE is believed to result not only from concussions, but from repeated, head-jarring hits that are so commonplace in football.

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Over a 10-year period, a lineman will deliver and absorb an estimated 15,000 hits. Pro linemen are big, powerful men who are not doling out love taps but, rather, blows equivalent to driving a car into a brick wall at 50 kilometres an hour and, in lieu of an air bag, having a piece of plastic and foam on your head.

The question now is: What do we do with this information? What can be done to reduce the risk of traumatic brain injury, particularly in violent contact sports such as football?

We have to recognize, too, that the science is in its infancy. We still have no idea how many football players over all suffer from CTE – though it is probably a small minority.

We don't know either the role of genetics and lifestyle factors. Why do some players suffer traumatic brain injury and others do not, even if their activities are similar?

What we do know, however, is that the dose makes the poison – the more blows to the head a player suffers, the greater the damage.

We know too that technology is not the solution. No helmet, no matter how strong, can prevent the brain from sloshing around during collisions.

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Professional players, presumably, know (or at least are beginning to understand) the risks, and they balance those against the potential rewards, including multimillion-dollar contracts.

In pro football, there have been rule changes to reduce blows to the head. But violence sells, and the NFL, which hauled in $13-billion (U.S.) in revenue last year, is going to cling to its macho traditions, even if it costs young men their brain health and their lives.

But what this research should push us to do, more than anything else, is protect children and youth by minimizing their exposure to brain-jarring hits.

That doesn't mean wrapping them in a protective bubble, but it should lead us to question whether participation in violent sports, such as tackle football, is necessary or desirable, especially below the college level.

The legacy of those who donated their brains to science should be a sober reminder that a brain is a precious thing.

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