Concussion Legacy Foundation & Boston University CTE Center introduce the first CTE Prevention Protocol

Breakthrough study inspires a playbook with specific actions to prevent CTE

(Boston) Prevention of Chronic Traumatic Encephalopathy (CTE) is now possible, experts say, but it will require sports to move beyond current concussion protocols. To help sports teams prevent CTE in current players, the Concussion Legacy Foundation (CLF) and the Boston University (BU) CTE Center have published the first CTE Prevention Protocol, which provides a simple playbook to prevent the degenerative brain disease diagnosed in nearly 1,000 athletes across more than a dozen contact sports.

The CTE Prevention Protocol was inspired by 15 years of BU CTE Center research investigating why some individuals exposed to head impacts develop CTE while others do not. A study published Tuesday in Nature Communications by researchers at Mass General Brigham, Harvard Medical School, and the Boston University Chobanian & Avedisian School of Medicine showed that in football players, CTE risk is closely correlated to the cumulative force of impacts to the head. Simple changes to how sports are played and practiced — to reduce both the number of hits to the head, as well as the strength of impacts — could prevent most future CTE cases.

“Over the last decade, every sport has created a concussion protocol to protect athletes,” said Chris Nowinski, PhD, CEO of the Concussion Legacy Foundation. “Concussion protocols do not prevent CTE. Every sport and team need a CTE Prevention Protocol based on the principles of fewer hits to the head and fewer hard hits to the head. CTE prevention is that simple.”

In the study of 631 deceased football players, the largest CTE study to date, scientists found the number of diagnosed concussions alone was not associated with CTE risk. Instead, football players’ odds of developing CTE were related to both how many head impacts they received and how hard those head impacts were.

“CTE is a preventable disease, and this new study suggests that we could lower the odds that athletes develop CTE if we reduce both the number of head impacts and the force of the impacts,” said Dr. Ann McKee, chief of neuropathology for the VA Boston Healthcare System and director of the Boston University CTE Center and UNITE Brain Bank. “Based on what I have learned from patients and their families, we should do everything in our power to prevent CTE.”

As an example, the CTE Prevention Protocol shows that for offensive linemen, reducing head impacts in practice by half during high school and college would be expected to reduce the odds of developing CTE by 50%. If the hardest 10% of impacts were prevented through safer drills and rule changes, CTE risk would decrease by another 50%.

“Although this study was limited to football players, it also provides insight into the impact characteristics most responsible for CTE pathology outside of football, because your brain doesn’t care what hits it,” said study lead author Dan Daneshvar, MD, PhD, Chief of Brain Injury Medicine for Spaulding Rehabilitation at Mass General Brigham, Assistant Professor at Harvard Medical School and advisor to CLF. “The finding that estimated lifetime force was related to CTE in football players likely holds true for other contact sports, military exposure, or domestic violence.”

You can read and download the CTE Prevention Protocol here.