‘Recipe for CTE’: Contact sports on collision course with concussion crisis

The Sydney Morning Herald (Sydney, Australia)

September 18, 2022

Chris Nowinski is a neuroscientist specialising in concussion, and the world’s leading advocate on the dangers of repetitive hits to the head in sports. The 44-year-old has just returned to Florida from Sydney where he launched his Stop Hitting Children in the Head campaign, which seeks to exclude children under 14 from playing contact sport.

Fitz: Chris, tell us about your own elite sporting beginnings.

CN: I played [American] football at Harvard and was an All-Ivy League defensive tackle before I took up professional wrestling for the WWE as “Chris Harvard”. I played a snobby Ivy League “better than thou” type of character.

Fitz: “Played”? You’re not saying that pro-wrestling is staged???

CN: Ha! Don’t tell anyone, but pro-wrestling is performance. But it can be more dangerous than you think.

Fitz: Either way, it gave you a close-up look at concussion…

CN: One night I got kicked in the chin and by the time I hit the ground I’d blacked out. I still wrestled the next night, even though just walking up some stairs in the arena I nearly passed out. Then I developed what’s called “REM behaviour disorder”, which is where you act out your dreams. And so my girlfriend woke to me standing on the bed trying to climb the wall and couldn’t wake me up, even when I jumped headfirst into the wall through a nightstand. About a minute later I woke up with her crying. I had no recollection of what happened. That scared me, and I showed up to the arena the next day and said, “This happened to me last night”, and they said “Okay you’re done, until we figure this out”.

Fitz: And you’ve been figuring it out ever since, using your combination of a Harvard education, and heavy experience in concussive sport…

CN: Yes, I met Dr. Robert Cantu, who I went and co-founded the Concussion Legacy Foundation with, and last week we launched our 4th chapter in Australia. He taught me everything that I should have known about concussion, including that the dings I regularly dismissed were actually concussions, that I should have rested to recover, and about the potential long-term damage done by those sub-concussive hits. I said I should write a book about this, to protect other athletes. So in 2006, I wrote Head Games – Football’s Concussion Crisis, which focused on concussions but had one chapter about CTE, the degenerative brain disease that’s caused by repeated head impacts and is very prevalent in football. It starts as small lesions in the brain you get while you’re playing, that spread for the rest of your life and can cause problems with how you think; how you sleep; it can remove your inhibitions, cause impulsivity, aggression, and mood swings … and it deteriorates from there. Mental health problems show up in mid-life and then the severe cognitive problems set in later. I figured out that if we can change this whole culture, we can save a lot of people.

Fitz: And what about setting up the Boston Brain Bank, to carefully collect the brains of deceased footballers, so that CTE could be studied and you could learn more. How did that start?

CN: In November 2006 a famous NFL player, Andre Waters, killed himself at the age of 44. I put together that he likely had CTE, that that was why he was struggling. I was able to convince a medical examiner to let me have part of his brain to study, and I sent it to the neuropathologist featured in the movie Concussion, Dr Bennet Omalu. And Andre Waters proved to be the third NFL player diagnosed with CTE. From there, Dr. Cantu and I started a brain bank at Boston University led by the brilliant Ann McKee. Of the first 111 brains of NFL players examined, 110 had CTE.

Fitz: And soon enough, CTE was also affecting those close to you?

CN: Yes. A lot of my teammates and old wrestling opponents are not faring great. In 2015, the captain of my Harvard football team in 1999 started deteriorating with depression and anxiety, while self-medicating with alcohol – and it spiralled into a nightmare. He died in December. We’ll have the results of his brain study this month, but I think there’s zero chance he doesn’t have it.

Fitz: Knowing what you know now, having come to Australia often and seen particularly NRL cases up close, do you care to speculate on the likely prevalence of CTE in our footballers?

CN: As only a handful of NRL players have been studied it would be pretty inappropriate to speculate on a firm figure. But 12 of the 21 athlete brains studied so far by the Australian Sports Brain Bank, have it, including rugby league players Steve Folkes and Peter Moscatt, while from the AFL we’ve had Danny Frawley, Shane Tuck and Polly Farmer. And knowing that a lot of kids here start to tackle at six: I think in the professional ranks, it’ll be relatively common. We already have so many players who’ve stepped forward struggling with early onset dementia and such symptoms, so that tells me that it’s going to be way, way more common than anyone would like it to be. As to rugby union, we’ve already seen CTE cases in America and the UK.

Fitz: You went to the Cronulla/Storm finals match last Saturday night. Everyone else was watching closely to see the narrative unfold. You were watching from the point of view of concussion. What did you see?

CN: I saw endless collisions. That night those big hits didn’t cause enough symptoms to have any of them wobble off the field, but we now know those endless hits can still microscopically damage the brain and put them at risk for CTE.

Fitz: Can the NRL be made safe with different protocols and different rules?

CN: Not in a sport where you’re asking people to run back 10 metres and then sprint forward into a collision! You’re going to cause CTE and that’s it. But if they change how they train, and continue to work on every variable, we can probably cut CTE risk by half or more, though it’s still going to be there. It’s just a simple question of physics. In the NFL, one thing we targeted was getting rid of a kick-off where people would sprint down somewhere between 10 and 40 metres, before their collision, because it was clearly the most dangerous part of the game. But the NRL basically has a kick-off-like collision every 20 seconds, which might be a recipe for CTE.

Fitz: So, 10 years ago, the NFL reached a $1 billion settlement in a class action with former players who claimed the league’s negligence in not making safer conditions to prevent the concussions that had so damaged them. Do you think the NRL, and maybe even the AFL and Rugby Australia, might be facing the same here?

CN: I do know that there are attorneys and players considering class actions in Australia. I suspect they’ll try to move forward, and I think the reason is a lot of these former players are not going to be able to work and are going to have extraordinary medical bills going forward. Dementia is extremely expensive. And so it’s either going to fall on the codes or it’s gonna fall on the government and the taxpayers. But someone’s got to take care of these guys. And I think it’s fair to say that because players are now bigger, stronger and faster and are playing more games and doing more practices, what we’re seeing now is just the tip of the iceberg.

Fitz: Luke Keary, the Roosters five-eighth with a long history of concussions, said last week it is crazy that the NRL doesn’t have limits on full contact training like the NFL does…

CN: I agree completely. Full contact is dangerous. It causes lots of injuries, and we specifically now know it will contribute to CTE risk and it will cause more concussions. And, beyond the moral angle, there is the business perspective. The NFL and the NRL at the pro level are in the entertainment business. To be injuring your players when no one’s watching anyway, and you’re not making any money, doesn’t make a whole lot of sense. The problem we face is that a lot of coaches still don’t believe that they risk causing CTE in their players by training like that. In Australia, the Rugby League Players Association has to step in and fight for them like the NFL Players Association did, to limit full contact training.

Fitz: In my own role as ambassador for the Australian Sports Brain Bank, I was there last week when you launched the initiative for the Concussion Legacy Foundation to stop tackling in sports for those under 14. I am often asked if padded helmets for kids can help protect them, and allow them to play?

CN: Padded helmets will not prevent CTE – see American football. They have an important role in preventing brain injury in single-impact cases (bikes etc.), but generally not in tackling sports or when using your head as a weapon like in soccer. At that point they are mostly just preventing your pain receptors on your scalp from reminding you what a bad idea it is to get hit in the head over and over.

Fitz: I defer to your expertise, but most kids play contact sport for their school years only, and escape with no apparent damage. Surely, the benefits of team sport, even contact sport, outweigh the dangers?

CN: I don’t believe it’s fair to increase the risk of children getting a brain disease when, for youth sports, there are alternatives within those sports that don’t involve head impacts. It’s as much an ethical issue as it is a scientific one. I think the right thing to do is to pause because there’s zero benefit to getting hit in the head hundreds of times. And if we can’t figure out how to teach children whatever lessons we think we’re teaching them without hits to the head and increasing the risk of CTE, then we are not trying hard enough as adults. My day-to-day life now is dealing with desperate former athletes reaching out with terrible symptoms, or talking to the families of people who’ve died too young from this. So, knowing that my own head isn’t right and knowing that I face an uncertain future, there’s zero chance that anyone’s gonna be hitting my children in the head.

Fitz: Your own head isn’t right?

CN: I still take medication for headaches and cognition. I still have the REM behaviour disorder. I still wake up a couple of times a month, thinking that I’m choking to death. And my wife has to convince me that I’m not. My future isn’t certain, but I’m doing everything I can to help the medical community advance diagnostics and treatment while proactively managing my own brain health. Players and their families who are uncertain about their own symptoms should reach out to the Concussion Legacy Foundation HelpLine.

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