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Brain Injury in the NFL

Posted on by Everett Lehman, MS

It’s that time of year again—football season.  While pro, college and pee wee football players and fans across the country prepare for the annual rituals of the game, questions of safety linger on the sidelines.  A new study from the National Institute for Occupational Safety and Health (NIOSH) finds that National Football League (NFL) players may be at a higher risk of death associated with Alzheimer’s and other impairments of the brain and nervous system than the general U.S. population. These results are consistent with recent studies by other research institutions that suggest an increased risk of neurodegenerative disease among professional football players.

The paper, “Neurodegenerative causes of death among retired National Football League players,” published in the journal Neurology looked at a cohort of 3,439 NFL players with at least five playing seasons between 1959-1988. While NFL players on average live longer than the average American male, the new research found that the overall risk of death associated with neurodegenerative disorders was three times higher among the study group than the general U.S. population.  The risk for two major subcategories, Alzheimer disease and ALS (also known as Lou Gehrig’s disease), was four times higher for the NFL players.

In addition to the overall comparison with the general population, the study also compared the deaths of players associated with neurodegenerative disorders based on playing positions.  More neurodegenerative deaths were observed among players in “speed” positions (quarterback, running back, halfback, fullback, wide receiver, tight end, defensive back, safety, and linebacker) compared with players in “non-speed” positions (all defensive and offensive linemen).  Other research studies have shown that speed players may be at higher risk of concussion since they can build considerable momentum prior to the point of being tackled or tackling another player. Offensive and defensive linemen usually engage other players soon after the football is snapped, mitigating the potential to build up momentum to a tackle or a block.

Study limitations

While our study is consistent with  other recent studies that have found increased risk of neurodegeneration among NFL football players, our research has several limitations.  Some of the limitations are listed below.

  • It is not possible to determine from our study the cause of the increased risk of death from neurodegenerative disorders.  Research suggests that football players who have experienced one or more concussive blows to the head are at increased risk of neurologic disorders but our study does not establish a cause-effect relationship between football-related concussions and death from neurodegenerative disorders.
  • Since our cohort was limited to longer-term professional players, our findings may not be applicable to those who play for a shorter term or high school and college football players.  The magnitude of risk may depend on the intensity and frequency of brain injuries incurred over a number of years.
  • The study relied on death certificate information for causes of death; at the time of analysis only 10 percent of the participants had died. Of the 334 players who had died, Alzheimer’s, ALS, and Parkinson’s Disease were listed for 17 of them. The small number of deaths used in the study only allowed us to place players into two broad position categories.  We were not able to identify potentially important differences in neurodegenerative mortality risk across the various positions included within the speed position group.
  • Other studies have suggested that Chronic Traumatic Encephalopathy (CTE), which can exhibit symptoms similar to Alzheimer’s disease and ALS, may occur years after sustaining football-related concussions. Since CTE is a newly confirmed diagnosis, it is possible that some deaths attributed to Alzheimer’s or ALS on death certificates may actually have been related to CTE. A brain autopsy is necessary to diagnose CTE and distinguish it from Alzheimer’s or ALS; no death certificate would have listed CTE as a cause.
  • We did not have information on environmental, genetic or other risk factors for neurologic disorders.

Additional studies to quantify the cumulative effects of brain injuries, in particular the relative effects of concussive-level injuries, will be of particular importance in understanding the underlying disease mechanisms not only in football but other sports where head injuries are common such as soccer, boxing, horse racing and hockey.

Everett Lehman, MS

Mr. Lehman is an occupational epidemiologist and deputy division director  in NIOSH’s Division of Surveillance, Hazard Evaluations & Field Studies.

See also NFL Players Tackling Heart Disease

Posted on by Everett Lehman, MS

23 comments on “Brain Injury in the NFL”

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    That is a drop in the bucket to the NFL and a slap in the face to the men who have lost their lives, either by death or brain damage and injuries, and in our case, in his early And the NFL didn’t “give it” they were forced to, and will the billions they make, that is nothing but a charitable tax write off that does nothing but further benefit the league who has destroyed so many lives in the name of entertainment and money.

    This is the reason I play soccer (football to the rest of the world) instead of American Football; no brain injuries for me thanks.

    It is true that concussion is several times more likely to occur during (American-style) football play than during soccer, but concussions are not rare in soccer. In one study of high school sports during the 2005-2006 sports season, approximately 21,000 boys and 29,000 girls received concussions while playing soccer.1 About 1,000 of the soccer-related concussions required treatment in an emergency room.2 So soccer players are at risk of concussion and steps should be taken to minimize that risk whenever possible; if concussions do occur, they should be treated properly. An excellent source of information on the identification, management and treatment of concussion in youth sports can be found at the following Centers for Disease Control and Prevention website:

    1. Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions Among United States High School and Collegiate Athletes. J Athl Train. 2007; 42(4): 495–503.
    2. Gilchrist J, Thomas KE, Xu L, McGuire LC, Coronado VG. Nonfatal sports and recreation related traumatic brain injuries among children and adolescents treated in emergency departments in the United States, 2001-2009. MMWR 2011: 60(39);1337-1342.

    I am a brain injury lawyer in St. Louis and have dealt with a number of TBI cases. No question repetitive and even a single incidence of head trauma causes TBI. But I was always curious beyond this, what is the effect of TBI on the family? Recently, there was an interesting study done by Eleonore Bayen, MD (part of the PariS-TBI study) investigating the predictors of informal care burden 1 year after a TBI. The study concludes informal caregivers suffer significant health problems and subjective sense of burden caring for loved ones with brain injury. So, the effects of brain injury are not limited to the victim alone- they transcend to the caregiver, which is a huge issue.

    If you want to see the real effects of TBI, possible CTE and bvFTD, my 2 year old daughter are true examples of the real destruction and trauma it causes the family. Been watching the man I love and father of my beautiful innocent daughter deteriorate before my eyes over the years. The worst part is no one has any ounce of sympathy for these NFL players who have basically lost all quality of life in their 30s and the innocent children have lost their fathers before they can even talk or can even form memories. As horribly disturbing as it might sound, a sudden death or act of desperation would have been a million times easier to handle and explain to my daughter than to sit and watch him slip away and not even have a reasonable explanation to even hold onto. We struggle daily, we mourn daily, and I, as the person in the middle of it all, get attacked for every decision I make no matter what it is. The fact my daughter has to cuddle with the small plastic action figure of her dad bc she misses him so much is beyond heart shattering. And worst part is no one can have an ounce of sympathy or understanding.

    As family, of an amazing man who i have seen deteriorate throughout the years before my very eyes, my daughter and I have suffered and are still suffering at the hands of the lack of sympathy and understanding of damage NFL players sustain throughout their short careers. My daughter’s father played for over 10 years, he was cut during his 11th year because of the need for knee replacement on both knees at the age of 34. Since then he has been told he has the knees and back of a 90 year old man. On top of that he has been diagnosed with early onset dementia, TBI, and frontal lobe damage. He continuously makes crazy, outlandish, and far from coherent or rational decisions along with stories that make 0 sense. Additionally, I have to have the same conversation with him daily, reminding him what happened to his things, and that I cannot be with him bc I can’t trust his irrational decisions especially now that we have a daughter. I am suffering from PTSD, major depressive disorder, anxiety and panic attacks, insomnia and several other major traumas. On top of it all we are also experiencing< what I believe to be beyond discrimination and racism from local authorities, who believe that felony stalking charges (aka calling me too much during the night, in which the compulsive behavior as well as times: i.e.. late night and compulsive calls is more of a crime than the theft of $60k worth of jewelry and high end small bags and accessories ( of which I have both witnesses and proof() as well as sexual assault and battery (again of which I have proof and witnesses) . The officials felt it was more appropriate to spend tax payer money to send the Wisconsin PD (we live in California!) to his mother and sister"s house to find him for these "stalking" charges but yet has decided to not even do so much as ask or even question the sociopathic predator that has terrorized my life after my daughter"s who at the time was 9 -10month old. I didn't even get so much as a "victims right" pamphlet for the assault and theft, as i did with the "felony stalking" charges Not even one question to that predator. And yet the police want to cause more trauma to the victims, my daughter and I, against our wishes and requests. all because they have a vendetta against my daughter's father and, I. And I wholehearted believe its prejudice again his privileges during his NFL days, but mostly because he is black and I am white! Durning a police investigation the officer flat out called us OJ Simpson and Nicole Brown! I want to start a civil case against the NFL, a class action suit, against them, and not because Im looking to cash in but because people need to see the damage it causes to the families involved. We have been through more than people could even comprehend in just one year. yet we get 0 sympathy or even as much as empathy from one soul, even our own family!This injustice and pain we have suffered at the hands of the NFL is beyond any pain I have ever felt.

    As an injury lawyer based in Miami, I completely agree with Ryan: there is far more damage to any brain injury than meets the eye.

    This article is very helpful, I think it is true that a concussion is more likely to occur several times during play football.

    Having injuries in playing close contact sports is inevitable especially the American football. Even in playing soccer. The players of these two sports almost have the same injuries.

    its being nice to see the safety measures are now taken so seriously at the sports planet futsal thanks you GOV for making sports so safe for us and our children, i am a big fan of soccer

    This is a great blog I wasn’t aware this was such a problem we have lots of head injuries with kids playing football in the UK. I think I will write about this on my site

    I would also prefer that my kids play soccer instead of American football. Soccer is by no means ian injury free sport, as has been pointed out by others comments here, but it is very rare to see any retired professional soccer player or a long time player suffer from any of the aggravated issues that seem to plague football players and boxers, to name two types of athletes who endure frequent head-related blows.

    As someone who loves football, in fact I can’t for 2014 NFL picks. Its a very interesting article, I think athlete or players should take care of their health. It’s a good thing that the government is now paying attention for sports to be safe.

    This is a great blog I wasn’t aware this was such a problem we have lots of head injuries with kids playing football in the UK. I think I will write about this on my site

    Concussion has just recently, started to become taken seriously in the UK. It is a potentially a massive problem waiting to happen in MMA also, with some retired fighters already reporting pugilist dementia. Having had concussion 5 time myself I wrote a short article on the topic []

    This is a great blog I wasn’t aware this was such a problem we have lots of head injuries with kids playing football in the UK. I think I will write about this on my site

    This is an interesting subject. Im wondering for a long time when will sport authorities focus on changing rules or thinking a way to prevent these athletes to suffer like this. Its absurd to know the risks and still allow young man to risk their life by playing a sport game. Not that I dont like NFL but health is a very serious matter in sport. They really should change something about the rules. There cant be kids breaking their heads off just because they want to copy sports stars… In any case, very nice article. It also helped with my site. I hope i see more content like this. Thanks for the article.

    CTE is more of an issue related to repeated head trauma and concussions. That is why the current Legend Study includes pop-Warner, high school, and college athletes in all sports that suffered of are suffering some kind of symptom. Veterans are now included because repeated concussion blasts from artillery, during war can last from hours to days, has shown CTE in soldiers who never played football. We are talking about WWII and Vietnam Veterans. Until the long term Legend Study at Boston University is finished a half a decade from now, we will see that it is not just Football but many people may have died from CTE who never played sports yet still suffered Traumatic Brain Injuries over their lifetime. Cumulative trauma after that first big concussion, be it football, hockey, car accident, cycling accident, playground accident, etc.. is what starts it all and slowly degenerates in the future.

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