A major BMJ study found that at least one in four former NFL players who died between 2016 and 2021 had chronic traumatic encephalopathy. The finding does not mean every living player has CTE, but it does make one thing harder to avoid: football’s danger is not only about concussions seen on Sunday. It is about the lifetime accumulation of hits that begin long before the NFL.
NEW YORK | Filed at 1:59 p.m. Eastern time
Football has always asked America to accept a bargain.
The sport gives fans spectacle, community, ritual, identity, fantasy, money, school pride, city loyalty and the kind of physical drama that few games can match. In return, everyone knows there is a cost. Players limp. Knees tear. Shoulders separate. Fingers break. Careers end early. Pain becomes part of the culture. A new study forces a harder question: what happens when the cost is not only orthopedic, but neurological?
Researchers from Mass General Brigham, Boston University and the Concussion and CTE Foundation reported this week that at least one in four former NFL players who died between 2016 and 2021 had chronic traumatic encephalopathy, the degenerative brain disease known as CTE. The disease is linked to repeated head impacts and can only be confirmed after death through examination of brain tissue. The number is both conservative and alarming.
The researchers identified 878 former NFL players who died between 2016 and 2021. Of those, 235 donated their brains for study. Among the donated brains, 215 showed evidence of CTE. That means 91.4% of the donated brains had the disease. But because not every former player donated a brain, researchers reported the minimum confirmed prevalence across all 878 deceased former players as 24.5%. That is the one in four figure.
It should not be misunderstood. The study does not prove that one in four current NFL players have CTE. It does not diagnose living players. It does not reveal the exact risk for every position, every era or every athlete. It also cannot eliminate selection bias, because families who suspect neurological problems may be more likely to donate a loved one’s brain for research. But the study also does not allow football to hide behind uncertainty.
Even the most conservative estimate found confirmed CTE in nearly a quarter of all former NFL players who died during the six year period studied. The true percentage could be higher. Researchers estimated the possible range for those who died from 2016 to 2021 from 24.5% to 97.7%, while acknowledging that the extreme high end is unlikely. The scientific point is not that the exact number is settled. It is that the burden is large enough to demand a response. For the NFL, this is the latest and perhaps most direct challenge to the league’s long running safety argument.
The league can point to real changes. It has limited contact practices, improved concussion protocols, redesigned kickoff rules, pushed better helmets, expanded independent medical evaluations, promoted Guardian Caps in practice, funded research and publicly acknowledged that head trauma must be reduced. League data have shown reductions in diagnosed concussions in recent seasons. Those steps matter. They should not be dismissed as meaningless. But the new study exposes the limit of focusing too narrowly on diagnosed concussions.
CTE is not believed to arise only from spectacular hits that leave a player motionless on the field. Researchers have increasingly focused on repetitive head impacts, the many smaller collisions that happen in practices, games, drills, blocking, tackling and years of football development. A lineman may not suffer a headline concussion every week, but his head may absorb repeated contact hundreds or thousands of times over a career. A linebacker, running back, tight end or special teams player may build exposure long before reaching professional football.
That is why lead author Dr. Daniel Daneshvar emphasized that many of the head impacts former NFL players experienced came before the NFL, at the college, high school and youth levels. That detail shifts the debate from the NFL alone to football’s entire pipeline.
The NFL is the visible center of the sport, but it is not where football begins. It begins in youth leagues, middle school fields, high school stadiums, private camps and college programs where children and teenagers learn the sport. By the time a player reaches the NFL, years of head contact may already be part of his history. That makes CTE not only a professional sports issue. It is a youth sports issue.
Parents who allow children to play tackle football are often told that equipment is better, coaches are more informed and concussion awareness has improved. Those claims may be partly true. But better concussion management does not erase the cumulative nature of head impacts. If risk builds through repeated exposure, then delaying tackle football, reducing contact practices and changing the structure of youth football may matter as much as what happens in NFL stadiums. This is the uncomfortable public health message. Football may be safer than it was. It may still be unsafe in ways that matter deeply.
The study also found that dementia was common among brain donors and that advanced stage CTE was associated with symptoms typical of dementia before death, including memory loss and impaired cognition. That finding matters because the debate over CTE is often pushed into abstraction. Terms like “tau protein,” “postmortem diagnosis” and “selection bias” can make the disease sound distant. Dementia makes it personal. Families do not experience CTE as a scientific category. They experience decline.
They may see a former player forget conversations, repeat himself, become confused, struggle with judgment, lose emotional control or change personality. They may watch someone who once lived through discipline and bodily control become dependent, frightened or unrecognizable. They may spend years trying to understand whether symptoms are aging, Alzheimer’s disease, depression, addiction, trauma, CTE or some combination. The inability to diagnose CTE definitively in living people deepens that pain.
Doctors can evaluate symptoms. Researchers can study biomarkers. Patients can undergo cognitive testing, brain imaging and neurological exams. But a definitive CTE diagnosis still requires postmortem brain examination. That means living former players often exist in uncertainty, and families may not receive confirmation until after death.
Researchers are trying to change that. Current efforts are focused on identifying biomarkers and imaging patterns that could distinguish CTE from Alzheimer’s disease and other neurodegenerative conditions. Former players such as Matt Hasselbeck have joined research studies aimed at finding ways to diagnose CTE in the living. That work is essential because prevention is not enough for the men already living with symptoms.
The league’s response to the new study was careful. The NFL said it continuously strives to make football safer, including by implementing strategies to reduce concussions and head impacts. The league also said it remains committed to ensuring that former players have access to resources for physical and mental well being, and encouraged former players concerned about their health to seek available help. That is the correct institutional tone. It is also not enough.
Resources matter only if former players know how to access them, trust them, qualify for them and receive care early enough to matter. The NFL’s concussion settlement and related benefit systems have been legally and emotionally complicated for many retired players and families. A public commitment to health must be measured not only by programs listed on a website, but by the lived experience of people trying to navigate care. The NFL’s central challenge is credibility.
For years, the league fought and minimized concerns about the long term consequences of head trauma. The culture has changed since then, but trust lost in one era does not automatically return in another. When a new study says at least one in four deceased former players in a recent window had CTE, the league cannot answer only with safety statistics. It must answer with transparency, research access, benefit clarity and structural willingness to reduce exposure even when reduction may alter the game. That last point is the hardest.
Football’s violence is not accidental. It is part of the sport’s design. Blocking and tackling are central. Speed, force and collision create the drama fans love. Every safety change must navigate a difficult line: reduce brain trauma without turning football into a different sport. The NFL has made changes before, including protections for defenseless players, kickoff reforms and practice limits. Yet the cumulative head impact problem suggests that the deepest risks may not be solved only by flagging the most obvious hits. Practices matter. Youth football matters. Linemen matter. Special teams matter. The number of years played matters. The age at first exposure may matter. The total head impact burden matters.
That broad view changes what reform should look like. Football leaders should focus not only on diagnosing concussions, but on reducing total head contact. That could mean fewer contact practices at every level, stricter limits for youth tackle football, more noncontact training, better coaching on avoiding head first contact, independent medical oversight, improved helmet standards, position specific exposure tracking and wider use of sensors or video analysis to identify high risk drills and behaviors. The most immediate gains may come outside the NFL.
The professional league has money, medical staff, equipment research and collective bargaining structures. High schools and youth leagues often do not. If the biggest share of lifetime exposure begins before the NFL, then reforming only the professional game leaves young athletes carrying risk without professional resources. That is why the study should prompt state athletic associations, school districts, youth leagues and colleges to act.
Schools should ask how many full contact practices are necessary. Youth programs should consider delaying tackle football until later ages. Parents should receive plain language risk disclosures. Coaches should be trained to reduce head contact in drills. Athletic trainers should be present more often. Children should not be asked to absorb adult level risks before they can understand the consequences. The cultural resistance will be fierce.
Football is deeply woven into American life. In many towns, it is not only a sport. It is a social institution. It creates friendships, discipline, scholarships, identity and opportunity. For some players, football is a path to education or economic mobility. Any conversation about brain disease can feel like an attack on communities that love the game. It should not be framed that way.
Loving football and demanding safer football are not opposites. The sport’s future depends on facing the science honestly. Parents will not trust a culture that hides risk. Players will not trust a league that treats old injuries as public relations problems. Fans will not be less responsible because they enjoy the game, but they will be more responsible if they understand what they are watching. The new study also raises a moral issue for media and business.
The NFL is the most powerful sports league in the United States. Networks, advertisers, gambling companies, fantasy platforms, apparel brands, stadium sponsors and streaming services all profit from football’s popularity. Player health cannot be treated as the league’s problem alone while the broader economy enjoys the spectacle. If the business of football is national, then the responsibility is national too.
That responsibility should include funding independent research, not research that depends on league control. It should include long term medical support for former players. It should include public reporting on head impact reduction. It should include youth level education funded by those who profit most from the sport’s highest levels. The study does not end the debate about football. It clarifies it.
The question is no longer whether repeated head impacts can be dangerous. The question is how much danger society is willing to accept, how much can be reduced, and who bears the cost when the cheering stops.
Some will argue that adults should be allowed to accept the risk. That is true for professional players who understand the danger and are compensated. But even adult consent becomes complicated when the full risk is not knowable during a career, when benefits systems are difficult, and when the exposure often began in childhood. Children cannot give informed consent to a disease that may not appear for decades.
That is why the youth football question will become more urgent. If CTE risk is tied to cumulative exposure, then every year of tackle football matters. Flag football, later tackle start ages, limited contact practices and better coaching may offer ways to preserve participation while reducing risk. None of these ideas will satisfy everyone. But doing nothing is no longer defensible. Football has changed before. It can change again.
The forward pass changed the game. Helmets changed the game. Facemask rules changed the game. Concussion protocols changed the game. Kickoff rules changed the game. The idea that safety reforms destroy football has been repeated for generations. The sport has survived each change because its appeal is larger than any single drill or collision style. The question is whether it can survive the truth.
The BMJ study gives football no easy exit. It does not provide a neat percentage for every living player. It does not prove that every former player with memory problems has CTE. It does not prove that current safety measures are useless. But it does show that confirmed CTE among deceased former NFL players is not rare. Even the lowest estimate is high enough to alter the conversation. At least one in four is not a statistical footnote.
It is a warning. For the NFL, the warning is that safety progress must be measured across a lifetime, not a season. For colleges and high schools, the warning is that the professional league cannot absorb blame for hits that begin on their fields. For parents, the warning is that better helmets are not the same as eliminating risk. For fans, the warning is that the beauty and brutality of football cannot be separated as cleanly as the broadcast would like.
Football will continue this fall. Stadiums will fill. Fantasy drafts will happen. Children will wear jerseys. Former players will watch with pride, grief, nostalgia or concern. The game will remain powerful because it gives people something real to gather around. But after this study, the bargain feels different.
America can still love football. It can no longer pretend it does not know what football may do to the brain.
Reporting and sourcing transparency note: This article is based on current public reporting and research materials from Reuters, The BMJ, BMJ Group, Mass General Brigham, Boston University, the Concussion and CTE Foundation, the Associated Press, NFL player health materials and related reporting on concussion reduction efforts.
Health information note: This article is for news and public information only. It is not medical advice. Current or former athletes experiencing memory problems, mood changes, cognitive symptoms, depression, suicidal thoughts or other concerning symptoms should seek evaluation from qualified medical professionals. Anyone in immediate crisis in the United States can call or text 988 for the Suicide and Crisis Lifeline.