Researchers at Boston University made a landmark discovery of Stage 2 chronic traumatic encephalopathy, a degenerative brain disease, in a posthumous examination of former soccer player Patrick Grange.
According to a Wednesday report by The New York Times' John Branch, Grange is the first named case of CTE found in soccer—a sport that doesn't often include violent collisions and significant risks of head injuries. There are four stages of CTE severity, and the more advanced stage, the more severe.
Boston University provides an explanation of the disease on its official CTE Center website:
(CTE) is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head. CTE has been known to affect boxers since the 1920s. However, recent reports have been published of neuropathologically confirmed CTE in retired professional football players and other athletes who have a history of repetitive brain trauma. This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau. These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement. The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.
Grange passed away at age 29 in April 2012 after battling Lou Gehrig's disease (h/t Yahoo! Sports) and was a former member of the Chicago Fire's Premier Development League club.
In Branch's report, Grange's parents noted how since the age of three Grange practiced heading the ball in soccer. Whether or not that is the cause remains to be seen, but it stands to reason, the years of repeating that action and whatever other head traumas—however minor—could have played a part.
The other type of football, which takes place on the gridiron with pads and involves incessant collisions, has been linked most with the disease. CTE has been discovered posthumously in more than 50 former NFL players, and signs of it have been detected in retired living players, according to a November 2013 report by ESPN.com's William Weinbaum and Steve Delsohn.
A PBS Frontline documentary titled "League of Denial" was released in October 2013 and outlined the issue of concussions and head injuries in the NFL, implying that the league had a crisis on its hands.
Dr. Ann McKee, whose research at Boston University was prominent in the aforementioned documentary, performed the examination of Grange's brain. She wasn't in a hurry to speculate or draw correlations regarding how Grange developed the disease, per Branch:
He had very extensive frontal lobe damage. We have seen other athletes in their 20s with this level of pathology, but they've usually been football players. ... We can't say for certain that heading the ball caused his condition in this case. But it is noteworthy that he was a frequent header of the ball, and he did develop this disease. I'm not sure we can take it any further than that.
Also mentioned in The New York Times report is that Grange suffered "a few memorable concussions." Since he had at least three that his parents can recall, the findings don't seem as striking. Dr. Erin Bigler, director of Brigham Young University's MRI research facility, expressed he wasn't surprised at Grange's posthumous diagnosis, despite soccer being a more finessed game:
The brain is a very delicate organ, and it probably can withstand some injury, but the whole issue of repeated injury is a very different circumstance. When it's moving, it's moving with its 200 billion brain cells. And those cells are being, in some way, mechanically deformed, some more than others, which gives you an appreciation of what's going on with these collisions.
NBC News' Rebecca Ruiz was distraught upon learning of the news, noting its significance:
Oh my. Researchers find CTE post-mortem in a former soccer player. Means a lot to me personally & for the sport too. http://t.co/VrdPEzaZNL— Rebecca Ruiz (@rebecca_ruiz) February 26, 2014
This finding of CTE in Grange is another ominous sign of how little clarity there is about concussions based on current research. Yeshiva University's Albert Einstein College of Medicine neuroradiologist and neuroscientist Michael L. Lipton intimated that sentiment in his remarks to Branch about the potential danger of heading soccer balls.
"The cold, hard reality is that the data don't exist to address that question," said Lipton. "We're really in very much uncharted territory. So what should I do with my kid? That basically becomes the kind of risk-benefit assessment we have to make all the time in life."
But it's diagnoses like Grange's at Boston University that can set the stage for significant progress in the future. It's vital to find answers, even though the circumstances surrounding Grange's situation are tragic given how early he passed away.
Another big discovery unearthed was the diagnosis of CTE in a rugby player, which McKee found in 77-year-old Australian Barry Taylor. That's far more of a high-contact sport, but Taylor had the most severe case possible in Stage 4.
Since players can shake off symptoms with adrenaline or persuasion based on the varying degree of concussions, it's harder to diagnose in the immediate aftermath. There is a fine line between safety and danger of further damage.
This should lead to more testing among soccer and rugby players, and the fact that researchers have been able to diagnose at least signs of CTE in living ex-NFL players, perhaps similar methods can be utilized to determine just how much of an impact the disease is having on soccer.
The brain is important but is ever fragile, and the more that's known about it, the more precautions can be taken to ensure that all athletic competitions—even nonviolent ones—are as safe as possible. In light of this new information regarding Grange, soccer's perceived safety seems less reassuring.