High School Football Can Lead to Long-Term Brain Damage

By Bryan Toporek 

A sweeping new study has found evidence that long-term brain damage can occur after playing football for just a few years... in high school.

Released Monday by the Boston University Center for the Study of Traumatic Encephalopathy, the study found such injuries to six young men who played football in high school, but stopped before college, and did not play professionally.

Researchers from the BU Center examined the brains of 85 deceased former athletes and military veterans to check for traces of chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease that can be triggered by repetitive mild traumatic brain injuries. Another 18 subjects without a history of mild traumatic brain injury were used as the control group.

Of the 85 brains examined outside of the control group (84 male, 1 female, ranging from 14-98 years old), 68 were found to have CTE, including 34 former professional football players and one semi-professional football player. Fifteen of the 68 brains with CTE were in people who had played only high school football (six) or college football (nine).

Based on their findings, the researchers developed a first-ever pathological classification for CTE that divides the disease into four stages based on severity, ranging from Stage I (reporting headaches, loss of attention) to Stage IV (severe memory loss, dementia).

Let's dive into a little bit more detail about the high school football players, specifically. Of the 103 brains examined (the 85 in the study and the 18 in the control group), 13 had high school football listed as at least one of their exposures to mild traumatic brain injuries. The subjects in the study aren't referred to by name, only by case number, so that's how they're presented here, too.

Results for Former High School Football Players

Of the 13 former high school football players in the study, seven had no signs of CTE. Cases 20, 21, 22, and 24 were all former high school football players who died before the age of 20, none of whom had traces of CTE in their brains. (Two died of overdoses, one from cardiac arrest, and one from suicide.) Cases 26 and 28 were former high school football players who died between the ages of 20-29, and neither had CTE when they died. (Case 26 died from a gunshot wound; case 28 committed suicide.)

Case 32, another former high school player, committed suicide between the ages of 40-49 with no traces of CTE in his brain. However, he was diagnosed with multiple system atrophy, a neurodegenerative disease that causes symptoms similar to Parkinson's disease, according to the U.S. National Library of Medicine.

Now, for the six former high school players who were found to have traces of CTE:

• Case 36 played high school football and basketball, died before turning 20 due to sudden-impact syndrome (a brain sustaining a second concussion before fully healing from the first), and had Stage 1 CTE;

• Case 37 played both high school football and rugby, died before turning 20 due to a cerebral oedema (brain swelling due to an excess of water), and had Stage 1 CTE;

• Case 38 played high school football and served in the military (where he was exposed to explosives), died between the ages of 20-29 from an intracerebral hemorrhage, and was found to have Stage 1 CTE;

• Case 40 also played high school football and served in the military, committed suicide between the ages of 20-29, and had Stage 1 CTE;

• Case 47 played high school football, was a prison guard, and also served in the military (where he was exposed to explosives), died between the ages of 30-39 due to an overdose, and had Stage II CTE;

• Case 52 played high school football, committed suicide between the ages of 40-49, and had Stage II CTE.

The researchers found a "significant" correlation between the pathological stage of CTE and the number of years spent playing football, the number of years since retirement, and the age of death of each player. However, the number of concussions reported by each family and the position each played on their football teams did not have a significant link to pathological CTE stages.

CTE was also found in four NHL players, one amateur hockey player, seven professional boxers, one amateur boxer, and one professional wrestler.

Four of the 68 cases of CTE occurred in brains of people who had no history of contact sports, including three military veterans and one individual who "displayed self-injurious head banging behavior."

Lessons Learned

What's to be taken from all of this? A couple of thoughts.

First, if it wasn't clear enough already: Even at the high school and college levels, football is an extremely dangerous sport with potential long-lasting ramifications. Before this study, the BU Center had previously found CTE in the brains of a 17-year-old high school football player who died of second-impact syndrome, an 18-year-old multi-sport athlete who suffered multiple concussions playing high school football, and a 21-year-old junior on the University of Pennsylvania football team.

The type of brain degeneration being found in these young former high school football players shouldn't be occurring until decades later, Dr. Ann McKee, co-director of the BU Center and lead author of the study, told CNN for a documentary earlier this year.

That's not to say that all former high school football players are doomed to a life with CTE at some point, however. Many of the world's leading concussion experts are urging caution at drawing a causal link between football and CTE, saying much more research is needed before definitively tying the two together.

"The vast majority of the neuroscience community does not believe that research has yet identified a causal relationship linking repetitive head trauma in football and CTE; I include myself in that,"said Kevin Guskiewicz, co-director of the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Institute at the University of North Carolina, to ESPN.com.

Like everything else, football is a calculated risk. On the plus side, the game instills qualities such as hard work, leadership and teamwork in youths, as a parent recently pointed out in a commentary for ESPN.com.

On the other hand, as Cases 36, 37, 38, 40, 47, and 52 can attest, there's at least a chance that the head trauma sustained while playing high school football could contribute to long-term brain degeneration down the road.

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