Every fall, more than a million young Americans don helmets and padded shoulder pads to play high school football. But this year, questions are intensifying over the risk youth athletes face from repeated head injuries after a gunman who played football in Southern California claimed he suffered from a degenerative brain disease.
After killing four and taking his own life, Shane Tamura — a former varsity player at two Los Angeles-area high schools — left behind a three-page suicide note, authorities say, alleging he suffered from chronic traumatic encephalopathy.
“Football gave me CTE,” Tamura reportedly wrote. “Study my brain please.”
It remains unclear whether the 27-year-old actually suffered from CTE, because the disease can only be diagnosed definitively through brain dissection. However, the claim comes at a time of growing concern over the health risks of contact sports in high school — football in particular.
Caused by repeated head injuries, including concussions and non-concussive impacts, CTE tends to be mostly diagnosed in those who have played football for a decade or longer. However, four years of high school football could expose a player to CTE, said Chris Nowinski, co-founder of the Concussion Legacy Foundation, a nonprofit group that supports athletes and others affected by CTE and concussions.
“The odds of having CTE are best correlated to the number of seasons played,” Nowinski said. “The best window we have is we have studied 45 former high school players who died before 30, and 31% had CTE.”
The issue of chronic brain injury and youth football has been a heated one in Southern California.
Facing political pressure last year, Gov. Gavin Newsom vowed to veto any legislation that sought to ban youth tackle football in the state. Citing parental freedom to decide on which sports their children can participate in, Newsom said he would work with legislators to strengthen safety in the sport.
Currently, California maintains protocols for student athletes who experience concussions or a head injury during a game. Those measures include removing the student from play and evaluation from a licensed health care professional.
The California Youth Football Act also limits full-contact practices for youth football teams to no more than 30 minutes a day for no more than two days per week. It also bans full-contact practices for youth football teams during the off season.
While such laws attempt to limit the risk of injury, experts say the threat cannot be removed entirely.
“What ends up mattering more than anything else, really, is just how long you’re playing, how many hits to the head you’ve gotten over that time, and the intensity of those hits to the head that you experience: Those are what play the biggest role in someone’s risk,” said Dr. Daniel Daneshvar, chief of brain injury rehabilitation at Harvard Medical School.
“So can a high school player get it? Yes,” Daneshvar said.
Tamura appeared to blame the NFL for his condition, according to officials, although he never played football beyond high school.
Experts say players such as Tamura, who is listed in online player profiles as performing offensive and defensive roles, are particularly at risk for CTE.
“On his online Huddle profile, it says he was also a defensive back, and he was clearly a very good running back, which would have twice the exposure,” Nowinski said.
It could take from two to six months for scientists to determine whether the gunman actually suffered from CTE, experts say. Such an examination however would require the family’s permission.
High school athletes who are playing football warrant greater study and treatment, Daneshvar said.
“Of the 3.97 million football players in this country, those that are playing at the college and the professional level are less than 4%, so we’re talking about over 96% of people are playing at some youth or high school level,” Daneshvar said.
“Although they’re likely to be at lower risk, based on the fact that they likely have played fewer years than someone who plays at the collegiate pro level, their numbers are greater.”
One of the most well-known cases of a young football player who developed severe CTE is Aaron Hernandez, a tight end in the National Football League who played three seasons with the New England Patriots until his 2013 arrest in the murder of fellow football player Odin Lloyd.
Hernandez was convicted in 2015, and when he died at the age of 27, researchers at Boston University studied his brain and diagnosed him with CTE Stage 3, caused by repeated head trauma.
“When you see someone with Stage 1 and a couple of microscopic lesions, it’s tough to make an interpretation as to how that might affect their behavior,” Nowinski said. But with a person with Stage 3, such as Hernandez, he said, “you can be confident he was not the same person at 27 as he was at 15. Everybody in Stage 3 has some level of symptoms and impairment. “
The disease starts with small lesions developing in the prefrontal cortex, along the brain stem, which sets off a chain reaction that slowly kills brain cells. It’s a reaction that can continue to spread long after repeated impacts stop, Nowinski said.
If scientists determine that Tamura had CTE, Nowinski stressed that did not mean the brain disease caused him or others to commit crimes.
“It’s very clear that most people who have developed CTE have not become murderers, and most people have not had extraordinary psychiatric symptoms that involve them to have involuntary psychiatric holds,” Nowinski said.
However, other forms of brain damage could have affected his behavior.
“CTE is not the entire story,” Nowinski said, noting that experts have identified at least 15 other types of changes to the brain that are associated with traumatic brain injury and repetitive traumatic brain injury. “Even in the absence of CTE, it doesn’t mean that brain damage can’t be driving this. And in many cases, we think that the non-CTE changes are more profound than the early stage CTE changes in people who are young, who have changed”
Diagnosing CTE is a complex process and involves the study of more than 20 regions of the brain, Nowinski said.
First, the brain is preserved in formalin for two weeks. When it is pulled out, it is examined for patterns of atrophy or old contusions. Then, the brain is sliced up and very thin sections are put on glass slides and stained with antibodies that help make abnormal proteins visible.
There is currently no treatment for CTE, but Daneshvar said it should not be viewed fatalistically.
“We have many patients who are experiencing symptoms that may be associated with CTE pathology, and we’re able to identify their symptoms and treat them, and they get better,” he said. “If somebody has a severe depression, there are medications and interventions we can do to help manage their depression.”
As another high school football season approaches, California legislators are proposing Assembly Bill 708, which would allow youth players to wear padded helmet add-ons that are sometimes worn by NFL players. Such equipment is currently prohibited.
