21 Jun CTE Risk and Diagnostic Challenges in Contact Sports

MedicalResearch.com Interview with:

Jenny T. Makhoul

Jenny T. Makhoul, MBS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA 18509

MedicalResearch.com: What is the background for this study?

Response: Chronic Traumatic Encephalopathy (CTE) is a progressive neurodegenerative disorder caused by repeated head trauma, particularly in contact sports such as American football, boxing, and soccer. It was first described in 1928 as “punch drunk syndrome” and later formally named as CTE by Dr. Bennet Omalu in 2002. It is characterized by cognitive decline, mood disturbances, and motor dysfunction.

Recent findings show that even teenage athletes can develop CTE, this is a growing public health issue. Despite increasing awareness, CTE remains diagnosable only post-mortem, and no effective treatments exist. Our focused review explores the sport-specific clinical presentations, neurobiological mechanisms, diagnostic challenges, and the use of rodent models to deepen our understanding and support future prevention development.

MedicalResearch.com: What are the main findings?

Response:  Our report found that the severity of CTE symptoms varies by sport and position. American football players, particularly running backs and wide receivers, showed the most severe forms due to high-frequency, high-force collisions. Boxers often displayed symptoms during their careers due to rotational impacts. Soccer players experienced milder cases, though risk increases with frequent heading or inadequate ball pressure regulation. Across all sports, the buildup of hyperphosphorylated tau and chronic neuroinflammation are key drivers of CTE pathology. While advanced brain scans and tests of spinal fluid show promise, they are not yet validated for clinical diagnosis. Rodent models have replicated key CTE features, but variations in methodology challenge standardization and translation to humans.

MedicalResearch.com: Were there any limitations?

Response:  One major limitation is that CTE can only be definitively diagnosed post-mortem, making early detection in living individuals extremely impossible. There is also a lack of research on female athletes, with only two documented female cases, neither of which involved athletes, raising concerns about sex-based diagnostic bias. Rodent models are valuable but vary in design, and many fail to replicate the rotational and linear forces seen in human injuries. Additionally, confounding variables like substance use in retired athletes can complicate human studies and outcomes.

MedicalResearch.com: What should readers take away from your report?

Response: Chronic Traumatic Encephalopathy is a serious and irreversible condition that goes beyond professional athletes to include military personnel and victims of domestic violence. Our review emphasizes the urgent need for reliable, non-invasive diagnostic tools and more inclusive research that addresses the underrepresentation of women. Combining human and rodent studies provides a more comprehensive understanding of disease progression. Prevention, especially in youth sports, should be a priority through improved safety regulations across all levels of contact sports, better equipment, rule changes, and informed public health initiatives. 

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: Future research should focus on developing and validating reliable biomarkers for early diagnosis in living individuals, including female athletes and diverse populations to uncover potential sex-specific disease patterns, standardizing rodent models and imaging protocols to improve reproducibility, conducting longitudinal studies to track the long-term impact of repeated head trauma, and exploring targeted treatments that slow or prevent tau buildup and neuroinflammation.

Citation: Makhoul JT, et al. Neurobiology and Impact of Chronic Traumatic Encephalopathy in Athletes: A Focused Review. Cureus 2025- in press. https://www.cureus.com/articles/349972-neurobiology-and-impact-of-chronic-traumatic-encepha lopathy-in-athletes-a-focused-review#!/

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Last Updated on June 21, 2025 by Marie Benz MD FAAD