Former NFL Players, CTE, and the Questions We Should Be Asking

Written by James Demetrious, DC, DABCO
Board Certified Chiropractic Orthopedist

A Recent Study

A new study in The BMJ by Daneshvar and colleagues identified 1,712 former NFL players who died between 2008 and 2021. Of the 338 who underwent neuropathological examination, 315 (93.2%) had chronic traumatic encephalopathy (CTE). That number almost certainly understates the prevalence among all players. Brain donation is not universal, and families are more likely to donate the brain of a former athlete who had cognitive, behavioral, or neurological problems. Due to this lack of data, we truly don’t know the true prevalence of CTE.

The Number That Deserves Our Attention

Consider the 2016 to 2021 period. The observed prevalence of confirmed CTE was 24.5%. Approximately one in four documented former NFL players who died during this period had neuropathologically confirmed CTE.

Why This Matters in Our Offices

Chiropractors regularly evaluate patients who have sustained head and neck trauma. Many of these patients present with headaches, neck pain, dizziness, balance problems, cognitive complaints, sleep disturbances, and persistent symptoms that may  be causally related. Once again, there’s a deficit of understanding the true prevalence of brain injury in this cohort of patients.

I previously wrote a PostGradDC Clinical Pearl, “Imaging Traumatic Brain Injury,” on diffusion tensor imaging (DTI) and tractography (DTT). Associated research showed that concussion and mild traumatic brain injury may involve microscopic white matter and axonal abnormalities that conventional imaging does not reveal. Unfortunately, many chiropractors, do not submit their patients for advanced imaging.

We Need to Ask Better Questions

For years we asked, “How many concussions have you had?” That question is no longer enough. Consider asking:

  • What sports did you play?
  • For how many years?
  • What position?
  • Have you had diagnosed concussions or other traumatic brain injuries?
  • What about the repetitive head impacts that were never diagnosed as concussions?
  • Have you undergone advanced imaging or have you been tested for traumatic brain injury biomarkers?

What We Can Do, and What We Can’t

Our job is not to diagnose CTE. It remains a neuropathological diagnosis that can currently be confirmed only after death. However, it is of vital importance to conduct careful histories and examinations of our patients. We must understand and consider advanced neurological assessments, imaging and associated biomarkers that may provide insight into patient assessment and care.

Our Job is to Recognize, Evaluate, Differentiate, Treat and Refer When Appropriate

  • Don’t dismiss. When a patient with a head injury history presents with progressive cognitive changes, balance problems, behavioral changes, persistent headaches, dizziness, sleep disturbances, or neurological abnormalities, don’t simply attribute the findings to aging, cervical dysfunction, or an old concussion.
  • Examine carefully. Assess cognition, gait, balance, coordination, cranial nerves, sensory function, and motor function.
  • Build a real differential. Consider neurodegenerative disease, cerebrovascular disease, vestibular disorders, metabolic abnormalities, medications, structural pathology, and other causes.
  • Escalate when appropriate. Obtain advanced imaging or refer to neurology, neuropsychology, neuroradiology, vestibular specialists, or other qualified providers.
  • Keep helping. We can still manage the musculoskeletal, cervicogenic, headache, and functional complaints, while staying alert to findings that need further investigation.

Final thoughts

Chiropractic physicians are often sought out by patients for associated traumatic brain injury, symptoms and signs. We are uniquely qualified to manage the neuromusculoskeletal associations that are within our scope of practice. It is important that we continue our education to recognize the new evidence, approaches and available treatment to improve patient outcomes.

Reference: Daneshvar et al. Prevalence of chronic traumatic encephalopathy at death in National Football League players: retrospective population based cohort study, 2008-21. BMJ. 2026;394.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a distinguished board-certified chiropractic orthopedist, educator, author, and editor. 

© 2026 – James Demetrious, DC, DABCO. Open Access. Unrestricted use, distribution, and reproduction are allowed in any medium, provided you give appropriate credit by citing the original author and source: Demetrious J. Concussion, Traumatic Brain Injury, and Chiropractic Practice. PostGradDC.com; 2026.