The NFL Players Association has created a ‘health playbook’ aimed at educating players on the risks associated with the high-contact sport.
The first-ever football medical guide distributed to NFLPA members this week notably includes information about chronic traumatic encephalopathy (CTE), a severe brain injury believed to be caused by repeated blows to the head.
A study published last summer looked at the brains of 111 deceased football players and found that all but one had the degenerative disease that causes symptoms such as memory loss, depression and dementia.
The disease got considerable attention when it was revealed that former New England Patriots tight-end Aaron Hernandez, who committed suicide in prison in April 2017 aged 27, had one of the worst cases of CTE researchers had ever seen.
The image above compares a normal brain with one from a former football player found to have CTE. Symptoms are a result of physical changes in the brain as an abnormal protein called tau builds up in excess
The July study by Boston University researcher Dr Ann McKee examined a total of 202 former football players from the whole range of field positions, about half of whom had played in the NFL.
Overall, 87 percent of the players had CTE.
Cases were mild in high school players and more severe cases in those who played in college or professionally.
There is only a small body of research on CTE in part because it is difficult to measure its prevalence in the population because it can only be diagnosed after death.
CTE has four stages of progression beginning with no symptoms, followed by rage, impulsivity and depression.
The third stage is characterized by confusion and memory loss, and the fourth stage is advanced dementia.
Symptoms can arise years after the players are out of the game, and are a result of physical changes in the brain as an abnormal protein called tau builds up in excess.
The new health playbook advises that players are cautious but rational about head injuries, according to ESPN.
‘The most important advice is not to assume you have a chronic, irreversible disease simply because you have symptoms,’ the playbook says.
‘Consult an expert in this field who can do the comprehensive neurologic evaluation and studies necessary to determine your status and the best treatment for it.’
In recent years the NFL has repeatedly been cagey about the connection between the high-contact sport and head trauma.
Dr Mitch Berger, the neurosurgeon at the head of the NFL’s subcommittee on long-term brain injury, denied that there was any proven link between the two in 2016.
A month later in a congressional meeting the league’s senior vice president of healthy and safety Jeff Miller admitted that there was an undeniable risk for degenerative brain diseases such as CTE in NFL players with a caveat: ‘But there’s also a number of questions that come with that.’
‘From my standpoint, I played football for nine years through high school and I wouldn’t give up a single day of that,’ NFL commissioner Roger Goodell said in a press conference before Super Bowl 50.
‘If I had a son, I’d love to have him play the game of football because of the values you get. There’s risk in life. There’s risk in sitting on the couch.’
However, the conversation is changing as more research emerges.
In 2016 the NFL pledged $100 million to fund brain research and engineering advancements for things like helmets that could help prevent injury.
In a statement to Sports Illustrated, the league said: ‘The NFL is committed to supporting scientific research into CTE and advancing progress in the prevention and treatment of head injuries.’
At a head, neck and spine committee meeting during the NFL combine Tuesday the league’s chief medical officer Dr Allen Sills revealed that there was a 16 percent rise in diagnosed concussions from 2016 to 2017.
Sills said the data should serve as a ‘call to action’ for the NFL to increase prevention efforts.
Aside from CTE, the 107-page playbook contains information on topics such as concussion detection and treatment, joint injuries, and high blood pressure and cholesterol.
It also covers performance-related topics such as sleep, nutrition, and mental health.