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Brain injury

Repetitive head impacts directly linked to CTE, study reveals

Calls renewed for urgent action in implementing CTE prevention and mitigation efforts, particularly involving children

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Repetitive head impacts can be directly linked to causing degenerative brain disease chronic traumatic encephalopathy (CTE), new analysis by world-leading experts has revealed. 

Calls have now been renewed to sports organisations, governments, parents and coaches, and the military, for urgent action in implementing CTE prevention and mitigation efforts, particularly involving children. 

“This innovative analysis gives us the highest scientific confidence that repeated head impacts cause CTE,” said study lead author Dr Chris Nowinski, Concussion Legacy Foundation CEO.

“Sport governing bodies should acknowledge that head impacts cause CTE and they should not mislead the public on CTE causation while athletes die, and families are destroyed, by this terrible disease.”

The researchers analysed the data through the ‘Bradford Hill criteria’, a trusted set of nine benchmarks developed by one of the pioneers of smoking and lung cancer research, to gauge the confidence science can place in a causal relationship between an environmental exposure and an adverse health outcome.

Among the revelations in the analysis, the authors discovered that the brain banks of the US Department of Defence, Boston University-US Department of Veterans Affairs, and Mayo Clinic have all published independent studies on distinct populations showing that contact sport athletes were at least 68 times more likely to develop CTE than those who did not play contact sports. 

This significant strength of association, combined with robust evidence in all nine categories, is shown collectively to be conclusive evidence linking repeated head impacts and CTE.

The most studied causes of CTE are contact and collision sports like football, rugby, boxing, American football, Canadian football and Australian football. 

The study authors, all international experts in their fields, are concerned that parents and coaches – who have the most control over whether children are exposed to repetitive head impacts – are not getting the facts from global sports organisations, and their children are being exposed to preventable cases of CTE.

Last week, the Football Association (FA) announced a trial ban on heading in under-12s football, in an attempt to reduce repetitive head impacts in the youth population. 

However, recent research has revealed that nearly three-quarters of boys are compelled to participate in contact rugby in secondary state school physical education.

While both the United States Centers for Disease Control and Prevention and the National Football League (NFL) acknowledge a causal relationship between repetitive head impacts and CTE, global sporting organisations – including Fédération Internationale de Football Association (FIFA), World Rugby, International Olympic Committee (IOC), National Hockey League, Canadian Football League, National Collegiate Athletic Association, Australian Football League, National Rugby League and New Zealand Rugby – have not publicly acknowledged a causal relationship.

Experts say it is the duty of these organisations to inform their athletes and their families and take appropriate steps toward CTE prevention and mitigation in light of this recent research.

Dr Adam J White, senior lecturer in sport and coaching sciences at Oxford Brookes University and executive director of the Concussion Legacy Foundation UK, said: “This analysis shows it is time to include repetitive head impacts and CTE among other child safety efforts like smoking, sunburns and alcohol.

“Repetitive head impacts and CTE deserve recognition in the global public health discussion of preventable disorders caused by childhood exposure in contact sports like football, rugby, ice hockey and others.”

“Even we were surprised how strong the causal relationship is between repetitive head impacts and CTE becomes when the data are analysed with the appropriate framework and in an unbiased manner,” said study co-senior author Dr Robert Cantu, medical director of the Concussion Legacy Foundation. 

“All of the co-authors have agreed we will retire the word association and begin using causation in any and all forums in an urgent effort to educate the public.”

While the true extent of CTE is still unknown, experts agree that disease prevention is urgently needed, particularly in light of the new study findings. 

“CTE can only be definitively diagnosed through a post-mortem examination of the brain,” continues Dr White. 

“We don’t yet know how many athletes, military veterans and others exposed to head impacts have CTE, but nearly 1,000 cases have been diagnosed in the last decade. 

“Knowing the exact prevalence of a disease is not required to enact disease prevention efforts, as we have seen in the cases of smoking, seat-belts and sunburn.”

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