Gallery: Chattanooga area athletic and health officials say brain injury football study is wake-up call
POLL: Are high school football players adequately protected from CTE?
There are 18 days until the Chattanooga area's first high school football game.
But while kickoff countdowns dwindled and fans began dusting off team colors, researchers presented a sobering reminder of football's potential danger.
A study, published on July 25 in the Journal of the American Medical Association, examined donated brains from deceased, former football players ranging from youth to pros and found that nearly 88 percent of the individuals had chronic traumatic encephalopathy, or CTE, a degenerative brain disease thought to be caused by repeated head trauma.
The most alarming result was that 110 out of 111 National Football League players, which made up the bulk of the sample, showed signs of CTE. Forty-eight out of 53 college players and three out of the 14 high school players in the study were diagnosed with the disease.
The latest research is the largest CTE study ever conducted, and while the results are significant, the research's major limitation is that the brains were not randomly selected — they were donated. Despite this weakness, the study suggests that football players may be at greater risk of developing neurological disease.
"People didn't know at some point over 50 years ago that smoking caused lung cancer — the same thing applies here — we didn't know that chronic head trauma could cause this condition," said Dr. Bill Moore Smith, medical director of Erlanger sports medicine and head team physician for the University of Tennessee at Chattanooga. "We're starting to get more information through this study."
But aspects of CTE remain foggy.
Genetics, number of years played, amount and force of hits sustained, player age and position, and other factors could affect the disease's progression.
No known machine or test can detect the protein deposits and tissue degeneration that characterize the condition, so it cannot be accurately diagnosed in living people.
Symptoms, which include memory loss, depression and dementia, usually occur years or decades after injuries are sustained.
Concussion, a type of traumatic brain injury where brain cells are damaged by abrupt movement within the skull, and mild blows to the head are potential causes.
And it's not exclusive to football. Other sports, military service and domestic violence can increase exposure to head injuries.
BY THE NUMBERS
High school football participants: 2008-09
High school football participants: 2015-16
High school football participants: 2015-16
A SWEEPING RESPONSE
On the state and local level, doctors, coaches and players have responded to the growing body of knowledge surrounding brain injuries in athletes.
In 2009, Washington state passed the first law requiring that a youth player with a possible concussion be removed from the athletic event and cleared by a medical professional before returning to play. Since then, every state has adopted a form of "return to play" law.
"There were the days of getting your bell rung — those days are over," said Mark Mariakis, a 33-year veteran football coach and varsity coach at Chattanooga Christian School.
As the evidence supporting the link between football and CTE develops, several notable NFL players have hung up their helmets in retirement. But at the high school level, football participation is strong.
It is the most popular sport with 1,083,308 participants in the country, according to the latest National Federation of State High School Associations Athletics Participation Summary. Boys soccer, the sport with the second most participants, has 591,133 players.
Although national participation numbers for football declined slightly — from 1,113,062 to 1,083,308 — since the first "return to play" law was passed, the number of high school football players increased in Tennessee, Georgia and Alabama.
East Hamilton Varsity Coach Ted Gatewood, who played high school football at Red Bank High and college football at Memphis State, now the University of Memphis, said he's seen major changes in the sport since 2009. That same year, one of his players experienced a severe concussion.
"That was a really big wake-up call for us at our school," he said.
A NEW GAME
Football today is vastly different from the football Gatewood grew up playing.
"The biggest difference is we've backed off the physical contact tremendously," he said, adding that practice speed is slower, and a large portion of time is dedicated to education, performing no-contact drills and learning proper tackling technique: "heads up to see the target, placing the head to the side of the target, and really putting an emphasis on 'do not use your head gear.'"
He said players and coaches are more aware of concussions and their symptoms — headache, confusion, dizziness, nausea, balance problems and loss of consciousness — and are trained in concussion protocol.
New rules aim to prevent second-impact syndrome, a serious and often fatal condition that occurs when multiple concussions occur back-to-back, by stopping a player's participation in athletic events until a concussion heals completely.
"Based on the classification of what concussions are, I would say I probably had a concussion, maybe a couple, but it was one of those situations where we didn't know exactly what it was at the time," Gatewood said.
Better equipment, particularly helmets, are also improving safety.
GUARDING AGAINST INJURY
Mariakis said that he was disturbed and surprised by the number of injured players in the study, but he feels positive about the steps that his school is taking to reduce brain injuries, including using a "guardian cap" for added protection.
The Guardian Cap is a soft, shock-absorbing helmet cover that snaps to the helmet's facemask. The cover can absorb up to 33 percent of impact and is worn by more than 60,000 players, according to the company's website. They come in five different colors and cost $59.95 for an individual cap.
Chattanooga Christian players are required to wear the caps in practice, and they can choose to wear them during games, unless the player has a history of concussion. In that case, coach requires the cap at all times.
"You can't guarantee that a kid is not going to get an injury in football, but you take every precautionary step to do what you can to prevent it," he said.
Mariakis' team also has a full-time athletic trainer on site during practice, something that Smith said he believes is vital for players' safety.
"We really need a certified athletic trainer on the ground at every school who can quickly recognize a concussion," Smith said.
A study published in January in the Journal of Athletic Training estimates that 70 percent of public secondary schools and 58 percent of private schools in the United States employ an athletic trainer.
But as the football community works to make its beloved sport safer for future generations, new discoveries emerge, CTE continues to appear in headlines and players' careers, or lives, sometimes end for the sake of a game.
"I think football is a great sport, and there are a lot of life lessons that young men can learn from it," Smith said. "But we have to admit and recognize that this is a real health issue, and if we want football to survive this, we have to do everything we can."
Contact staff writer Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.