Thanks to the high-profile National Football League (NFL) concussion litigation of several years ago, it seems that most athletes, parents, and coaches in most sports have at least some familiarity with chronic traumatic encephalopathy (CTE). However, while general awareness of CTE has grown, in our experience, few people truly have a clear understanding of the link between CTE and sports-related concussions.
This link is critically important – not just for NFL players and other professional athletes in high-impact sports, but for youth athletes who participate in many different types of sports and other physical activities as well. Recent scientific research has proven the potentially-severe impacts of multiple sports-related concussions and the ensuing effects of CTE, and the financial and non-financial costs of coping with CTE can be substantial.
What Is Chronic Traumatic Encephalopathy (CTE)?
Chronic traumatic encephalopathy is a degenerative brain disease that results from repeated impacts to the head. Trauma refers to the physical force of impact, and encephalopathy is simply the medical term for a brain disease or brain damage. As a chronic condition, CTE is defined as a condition having long-term effects. And recent studies suggest that athletes who suffer multiple concussions are at risk for experiencing the effects of CTE for the rest of their lives. There is also evidence to suggest that CTE can reduce athletes’ life spans, often significantly.
Why Are Athletes at Risk for Developing CTE?
The risk of suffering sports-related concussions also puts athletes at risk for CTE. The reason for this is simple: CTE results from repeated trauma to the brain, and this is precisely what occurs when an athlete suffers a concussion. A concussion is a brain injury that occurs when the brain bounces off of the inside of the skull (e.g., in the event of a collision with another player or an unexpected fall). And when an athlete suffers repetitive brain trauma over time, this can cause the degeneration that is characteristic of CTE.
What Athletes Are at Risk for Developing CTE?
While the national discussion of CTE in sports largely began with professional football players suing the NFL, athletes in many different sports face the risk of suffering concussions that can ultimately lead to the development of CTE. The specific nature of the sport is not as important as the risk of players or athletes hitting their heads – whether in collisions with other athletes, collisions with stationary objects, impacts from hitting the ground, or traumatic events. For example, the following is a non-exclusive list of sports in which players and athletes may be at risk for developing CTE:
- Action sports (e.g., BMX riding, skateboarding, and snowboarding)
- Baseball and softball
- Gymnastics and cheerleading
- Ice hockey
- Boxing, mixed martial arts (MMA), wrestling, and other combat sports
Although it is important to be aware of the risks that athletes in these and other sports face, it is also important not to exaggerate the issue. Some athletes in these sports will develop CTE, and others will not. Even in the NFL, not all players end their careers with permanent brain damage. The reasons for this vary, from the specific positions athletes play, to their genetics and the number and severity of the head injuries they suffer. Ultimately, athletes, parents, coaches, trainers, and team doctors need to be aware of the risks, and they all need to make informed decisions within the scope of their respective roles in protecting athletes’ safety.
What Are the Early Symptoms of CTE?
As a degenerative brain disease, chronic traumatic encephalopathy is a condition for which the symptoms typically worsen over time. As explained by the Concussion Legacy Foundation, a non-profit research organization founded by concussion experts:
“Early symptoms of CTE usually appear in a patient’s late 20s or 30s, and affect a patient’s mood and behavior. Some common changes seen include impulse control problems, aggression, depression, and paranoia.
As the disease progresses, some patients may experience problems with thinking and memory, including memory loss, confusion, impaired judgment, and eventually progressive dementia. Cognitive symptoms tend to appear later than mood and behavioral symptoms, and generally first appear in a patient’s 40s or 50s. . . . In some cases, symptoms worsen with time. . . . In other cases, symptoms may be stable for years before worsening.”
The understanding that symptoms can begin to appear as early as an athlete’s late 20s is a relatively new development in CTE research, and it is critical to managing the risks athletes face during their lifetimes. If an athlete begins to exhibit symptoms in his or her late 20s or early 30s, it will be important for him or her to receive a diagnosis and to perhaps consider an early retirement. That said, any decisions regarding health care and/or an athlete’s professional career should be made with the advice and guidance of experienced medical professionals. It is also important to understand that the early signs of CTE can be symptomatic of other brain disorders as well, and an athlete should not assume any particular condition or outcome in the absence of an expert medical diagnosis.
What Are the Long-Term Effects of CTE?
Long-term, the effects of CTE can be severe. As noted in the quote from the Concussion Legacy Foundation above, CTE can lead to memory loss, confusion, and impaired judgment, and athletes may also be at risk for dementia. Chronic depression, anxiety, and suicidal thoughts are also possible long-term effects of CTE. The Mayo Clinic also notes that athletes suffering from CTE may become prone to substance abuse.
The long-term effects of CTE are, themselves, serious health conditions for which treatment is necessary. Individuals suffering from confusion and impaired judgment may be at greater risk for injuring themselves (or others) in vehicle collisions and other accidents, and the devastating impacts of dementia are well-known. For athletes who experience multiple long-term effects (the Concussion Legacy Foundation notes that the cognitive and behavioral symptoms of CTE often appear in “clusters,” and an athlete may experience one or both clusters), the day-to-day impacts can invade all aspects of their lives.
Is There a Cure for CTE?
At present, there is no known cure for CTE. Once an athlete suffers from brain trauma due to repeated sports-related concussions, the risk of the athlete developing CTE (and of his or her CTE progressing) does not go away.
Among other things, this makes it particularly important for coaches, trainers, and team doctors to give concussed athletes the rest and recovery time they need when they receive a concussion (as the consequences of suffering multiple concussions in a short timeframe have been shown to be more severe), and to help athletes get the treatment they need when they are at risk for developing CTE. When they fail to do so, they – or the teams or leagues they work for – may be legally liable for the financial and non-financial costs of athletes’ traumatic brain injuries.
What Are the Treatment Options for Athletes Diagnosed with CTE?
Since there is no known cure for CTE, treatment options focus on managing athletes’ short-term and long-term symptoms. As explained by Boston University Research: CTE Center, “[t]he symptoms of CTE, such as depression and anxiety, can be treated individually.” So, rather than focusing on CTE as a discrete medical condition in and of itself, treatment focuses instead on understanding the effects of the condition and what methodologies can be used to manage those effects to the greatest extent possible. The Concussion Legacy Foundation gives the following examples:
- Depression, Anxiety and Other Cognitive Effects – “Working with a cognitive-behavioral therapist can help patients develop strategies that help them manage the particular mood symptoms that are causing the greatest problems.”
- Headaches – “A variety of treatment options exist for headache, including craniosacral therapy, massage, acupuncture, [and] medications.”
- Memory Loss and Difficulty Remembering – “Memory training exercises, including consistent note-taking strategies, can be helpful for continuing a patient’s activities of daily living, despite increasing difficulty with memory.”
For athletes who exhibit signs of dementia, beginning treatment early can be crucial to mitigating the effects and prolonging life as they know it for as long as possible. There are various medications and types of therapy available, and determining the best approach will require a clear understanding of the specific nature of the athlete’s degenerative brain condition.
There are also several resources available that athletes who have been diagnosed with CTE can utilize to minimize the effects of the disorder and improve their daily lives. For example, in its Living with CTE resource, the Concussion Legacy Foundation recommends:
- Write things down if you are struggling with memory loss, and develop a system for keeping track of your notes that works for you.
- Develop a daily routine that you can follow in order to minimize the number of decisions you need to make each day and that can help you achieve a sense of stability.
- Be aware of common impulse behaviors and actively work to avoid them. Seek professional help when necessary.
Work with your health care professionals to develop self-regulation and relaxation techniques that can assist with managing your mood changes, anxiety, and stress.
- Build a support system of friends, family members, coworkers, and community members who understand what you are going through and who are there for you when you need help.
Coping with CTE is different for everyone, and diagnosing, treating, and managing CTE and its effects require a clear understanding of each individual athlete’s personal circumstances. For many, recovering financial compensation is also a crucial component of the coping process. If you have questions and would like to speak with an attorney, we encourage you to contact us for a free initial consultation.
Speak with a Sports Injury Lawyer at Berkowitz Hanna
Berkowitz Hanna is a Connecticut law firm that has represented NFL players and other athletes in concussion and CTE-related lawsuits. To speak with an attorney about your legal rights, call us directly or tell us how to reach you online today.