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Real Men and Traumatized Seahorses: The Legacy of War and Contact Sports

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He can't remember his daughter playing soccer. Sometimes he has trouble finishing his sentences.

He is Brett Favre, one of the greatest football quarterbacks of all time. His name graces football's record books over and over again. He is first not only in passing touchdowns, but also in passing yardage, pass completions, pass attempts, pass interceptions, games started and games won. In one of the most remarkable feats in sports, Favre played for 18 1/2 years straight without missing a game. He started 297 consecutive games, leading the Football Hall of Fame to dub him the "Iron Man."

The "Iron Man" moniker seems a bit of an understatement. During the streak of consecutive starts, Favre suffered injuries including: a shoulder separation, a deep thigh bruise, a severely bruised left hip, a severely sprained left ankle, a sprained right thumb, right elbow tendinitis, a left mid-foot sprain, a sprained lateral collateral ligament of the left knee, a broken left thumb, a softball-sized bruise of the left hamstring, a mild concussion, a sprained right hand, an injured ulnar nerve, bone spurs on the left ankle, a torn right biceps, a pulled groin muscle, a left ankle fracture, a left heel fracture, and a sprained sternoclavicular joint. He was hit so hard that he had the wind knocked out of him and he coughed up blood. Still he managed to come back week after week for over 18 years and to start each and every game.

Favre also holds the record for number of sacks. During his professional career, Favre was sacked 525 times. For the uninitiated, being "sacked" means to be tackled behind the line of scrimmage. Often these are quite violent plays, as there is an incentive for the defense to tackle with enough force to cause a fumble. From my high school physics class, I remember that f= ma; force equals mass times acceleration. A 250-pound linebacker running into a quarterback at top speed can generate a lot of force.

The damage that makes Favre unable to remember his daughter's soccer games started early in his life, as it does in the lives of football players in general. A study recently published in the Journal of the American Medical Association compared three groups of young men: college football players who had suffered a concussion, college football players who had never suffered a concussion, and young men of the same age who had never played football.

The results were frightening. The hippocampus, the part of the brain that is essential to normal memory functioning, was smaller in the football players compared to the controls. The football players who had suffered concussions were the most severely affected. The number of years of organized football experience was associated with the degree of brain volume loss. Interestingly, the young football players in the study had played organized tackle football for at least seven years. Some had played for as long as 18 years.

The hippocampus gets its name from the Latin for "seahorse," because Julius Caesar Aranzi, a Venetian anatomist from the late 16th century, thought it looked like one. The hippocampus belongs to the limbic system. It plays important roles in short and long-term memory and in spatial navigation. Severe damage to the hippocampus results in profound difficulties in forming new memories. It often also affects memories formed before the damage occurred.

Junior Seau suffered from insomnia and depression. He began having wild behavioral swings and episodes of forgetfulness. Then he started making irrational business decisions and gambling away large sums of money. On May 2, 2012, he went into the guest bedroom of his home, held a rifle to his chest and ended his life. He was 43 years old. He had been one of the greatest football linebackers of all time.

Junior Seau's family donated his brain tissue to the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health. His brain showed Chronic Traumatic Encephalopathy (CTE), a type of brain disease seen in athletes and others who suffer repetitive head injuries. CTE can only be diagnosed at autopsy. CTE has been found in professional athletes who participated in football, hockey, rugby, boxing and wrestling. The youngest known person to suffer from CTE is 17-year-old Nathan Stiles, who died hours after playing in a high school football game. During his short football career, Stiles had suffered a series of sub-concussive and concussive blows to the head.

Researchers at Boston University performed postmortem examinations on the brains of 85 people with a history of repetitive mild traumatic brain injury. CTE was confirmed in 68 of them. Family members gave detailed histories concerning any mental or behavioral abnormalities in the subjects. Symptoms varied from none at all in the mildest cases to severe dementia and included: headaches, loss of attention and concentration, memory loss, aggressive tendencies, depression, executive dysfunction, explosivity, mood swings, impulsivity, language difficulties, and disturbances of gait and speech.

In addition to athletes with repetitive head injuries, CTE has also been seen in combat veterans who have suffered blast exposure injury. The mechanism of injury is quite different, but in each case the initial insult triggers a pathophysiologic cascade that results in death of brain cells in particularly sensitive areas like the hippocampus. Both the athletes and the combat veterans who suffered with CTE had similar brain pathology and symptoms, which included: headaches, irritability, depression, loss of concentration and attention, insomnia, memory loss, violent outbursts, executive function impairment and word-finding difficulties. Suicide was common in both the athletes and the combat veterans with CTE.

The methods that we, as men, sometimes choose to resolve our differences and to test our athletic prowess are leading to significant numbers of serious brain injuries. We are literally knocking ourselves senseless. There are safer and better ways to resolve our differences and to test our prowess. Take a moment to reflect on your own store of cherished memories. Imagine not being able to retrieve them, or not being able to lay down new ones. In addition to memory loss we are causing violent outbursts, depression, aggressive tendencies, and even death. Is this the legacy we want to impart to our boys and young men?

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