Concussion Researchers

‘Debilitating’ brain trauma rampant among NFL players – and league knows it

Q&A with concussion expert Chris Nowinski

By Tolly Taylor

On what would be the last night of Chris Nowinski’s career in the WWE, he stood up on his hotel bed in the middle of the night, still asleep. The movement woke his then-girlfriend, who tried to pull him down but couldn’t. Nowinski then jumped head first into the wall, crashing down on the nightstand as he fell. He stayed asleep for another minute, finally waking to the carnage of broken glass and broken lamps around him.

That’s what it took for Nowinski to realize that he hadn’t recovered from the concussion he suffered five weeks earlier, in June 2003. “That’s what it took for me to realize something might be wrong with my brain, and maybe I should get checked out,” he said.

The episode led to Nowinski creating the Concussion Legacy Foundation, a non-profit organization dedicated to researching concussions and educating people about them. Nowinski is also part of the VA-BU-CLF Brain Bank, which was started in 2008 to study chronic traumatic encephalopathy (CTE), a progressive degenerative brain disease found in football players and other athletes with a history of repetitive brain trauma.

In a Q and A, Nowinski discussed how football needs to change; why NFL players don’t self-report concussions; and what critics of concussion research get wrong.

Q: In a settlement with thousands of former players, the NFL managed to secure an April 2015 cutoff for CTE coverage. As a result, the families of former players who die and are diagnosed with the disease post-mortem won’t be compensated. What do you think of the settlement?

I think the NFL knows that a very high percentage of NFL players are living with pathological CTE, and so if everybody was compensated who had it, it would be a much more expensive [court] case. A lot of players will pass away with CTE before they ever develop symptoms that would be differentiating from other diseases. Or qualify for one of the diseases they do pay for. I know a lot of the families that have lost people since April have been very upset, because CTE is extraordinarily debilitating.

Chris Nowinski
Chris Nowinski travels the country educating students about concussions (courtesy of Chris Nowinski).

Q: Former Minnesota Vikings punter Chris Kluwe tweeted in January that tackle football should be banned until after college. In December, Dr. Bennet Omalu published an op-ed in the New York Times arguing that children should not be allowed to play tackle football until they reach a legal age of consent. What do you think of their proposals?

There certainly shouldn’t be tackle football prior to high school, there’s no question about that. Dr. Omalu’s point that there’s no informed consent prior to age 18 is a valid one, and should be considered. And Chris’ point that college football players are developing CTE and they’re not being compensated for it, while their coaches are making millions, is also a valid point.
I come from the experience of having been a WWE wrestler, which is a very dangerous job, and I think when you’re over the age of 18, you have informed consent. You can do a dangerous job, but I think it’s fair to say that college players are not appropriately compensated or have the ability to negotiate for the compensation that would justify the brain damage that they’re suffering. So, yeah, I think they both have great points.

Q: How do you get NFL players to buy in to concussion research?

It’s very difficult to get players to buy in while they’re active players. Most of the well-known, self-reported concussions come from players whose job safety was secure. Players who don’t have job security are much less likely to report, because they know how much money it’ll cost them if they get labeled a concussion case. So we try to give the players the best information we can, often through the media because it’s hard to get direct access, and hope that they’re making better decisions for themselves. But it still comes down to their decision. What we don’t want is, because there are so many kids are paying attention to the NFL, we don’t want guys bragging about ignoring concussions because that sets a terrible example.

Q: What’s currently the most accurate concussion test?

The one test that has by far the best evidence is the King-Devick test. It was recently published that it has 90 percent sensitivity and specificity across a number of studies performed by some of the best researchers in the country at Mayo [Clinic] and NYU. So that’s the one that we expect everyone to be adopting over the next year. It only takes one minute, so it should be added to the protocol.
We’ve advised the Big Ten and the Ivy League to adopt it. We’ve got Major League Lacrosse using it, the NHL just announced that they’re testing it, so yeah, we expect wide use. Except that, the researchers in the room don’t necessarily make the calls on the clinical protocol.

Q: What’s a major misconception about you that some people have?

I wish that the criticism that we received were actually substantive. I wish people could expand their minds and appreciate that I started the [Concussion Legacy] Foundation after the first two brains that I helped facilitate came up positive. And I thought, gosh, that made the first four brains coming up positive [for CTE], that means something.
We’re now 90 of 94 [brains with CTE], while pursuing every single brain of every single NFL player who dies. It’s completely false that they were all symptomatic. There were plenty of people who donated the brain of their loved one that were asymptomatic and told us they would be the control in the study. There were plenty who had no concussion diagnosed. It’s not us who is creating the bias, and it’s not the players who are creating the bias, because very few of those 93 brains are people who signed up in advance. It’s the families who create the bias, and I think people need to appreciate that the families going 90 of 94 with zero scientific training and no critical criteria for CTE is statistically impossible unless this is incredibly widespread.

Q: What did you think of the “Concussion” movie?

I didn’t see it. We have our own project in the works.

Q: Are you having a movie made about you?

I’m not free to disclose the details, but we have other projects in the works, yes.

Photo at top: Apr 20, 2010 – Dr. Robert Cantu, Dr. Robert A. Stern, Chris Nowinski and Dr. Ann McKee (left to right) study a series of brain scans and discuss a case at the Bedford Veterans Administration Medical Center in Massachusetts, where the pathology of concussive head trauma in ex-athletes is being studied by neurology researcher, Dr. McKee (courtesy of Chris Nowinski).