“At least I’m still alive,” says Erich Grau. “When I go to the cemetery, I think: Now they’re lying down there. Six to eight former football players, died early, less than 60 years old, completely out of character in the last five years of their lives. That’s hard to bear.” Gray is 68 years old. He was one of the pioneers of American football in Germany: He was a founding member of the Bavarian club Ansbach Grizzlies, played in the first season of the then Bundesliga in 1979 and was the first starting quarterback of a German national team in 1981.
Today he is the only former professional athlete in Germany to speak publicly about his suspected illness: chronic traumatic encephalopathy (CTE) – the illness from which the German boxing star René Weller, who died in August, also suffered.
Grau will probably never find out whether he really has CTE during his lifetime. To date, the disease can only be clearly diagnosed after death through an autopsy of the brain. But Gray has been experiencing the symptoms that scientists associate with CTE for more than 20 years. His memory is becoming weaker and weaker. He postpones conversations with strangers until the morning because he can hardly concentrate in the second half of the day. “I’m also feeling dizzy more and more often,” Grau told DW. “On the MRI [Magnetresonanztomographie – Anm. d. Red.] I can see that my brain is atrophying in all areas [schrumpft].” Since last summer, he has also had increasing difficulty coordinating his movements, said the former footballer: “I know that it won’t get any better. But I’m trying to hold on to what I have left.”
Higher risk of suicide
At the age of 45, the then high school teacher consciously noticed for the first time that he could hardly concentrate anymore. Uncharacteristically for him, he suddenly became short-tempered and aggressive. Studies have shown that personality can change dramatically in the early stages of the disease: the risk of suicide increases and violent outbursts are also possible. Australian football player Heather Anderson took her own life in November 2022 at the age of 28. Philipp Adams, a former National Football League (NFL) professional, shot six people and then himself in April 2021. CTE was diagnosed during autopsies on the brains of Anderson and Adams.
There are now around 350 definitely confirmed cases of CTE in former NFL players. The disease has also been detected in deceased athletes in other contact sports such as rugby, ice hockey, football, boxing and martial arts. Their brains were significantly reduced in size. In addition, whole clumps of so-called tau proteins were found in the outermost layer of the cerebrum. These tiny protein building blocks actually stabilize the nerve cells. Jerky movements of the brain run the risk of the proteins folding incorrectly. This can damage the nerve cell so badly that it dies. A chain reaction can occur. Like all so-called neurodegenerative diseases, including Alzheimer’s and Parkinson’s, CTE is not yet curable. Only individual symptoms can be treated.
No “Sports Brain Bank” in Germany
In the USA, Australia and New Zealand – countries where football and rugby are particularly popular – there are now so-called “sports brain banks”. Donor brains from deceased activists are specifically collected and examined there. “It would be a dream for me if we had a ‘Sports Brain Bank’ in Germany specializing in CTE, to which my brain could be taken after my death without much effort,” says Grau.
The German Center for Neurodegenerative Diseases (DZNE) is currently setting up a “brain bank” with locations in several German cities. Main reason: Brain researchers generally lack tissue material. In international comparison, Germans are considered to be rather reserved when it comes to organ donations. Due to a lack of mass, specializing a “brain bank” in sports and CTE would at best be the next step.
Many small blows to the head are also dangerous
The clinical picture of CTE was known as dementia pugilistica (boxer’s dementia) or punch-drunk symptoms as early as the 1920s. Even back then, it was assumed that severe blows to the head could cause lasting damage to the brain. Today we know that even small, regular blows or impacts to the head – below the threshold of a concussion – can have serious consequences.
“If you accumulate these head concussions over many years, they lead to similar neurodegenerative processes as head trauma,” says Inga Körte. Professor of neurobiology at the Ludwig Maximilians University (LMU) in Munich and the Harvard Medical School in Boston. “Research has found this in different sports, age groups and countries over the past ten years. These are robust results.” Apparently hardly anyone in Germany is interested in them.
Better to be a “hero from back then”.
Körte, who has been researching CTE since 2009, also goes to sports clubs to inform parents about the possible long-term consequences of head concussions. “At a large football club whose name I don’t want to mention, only one father was interested,” Körte told DW. “It’s obviously not yet an issue that parents in high-performance sports in this country are concerned with.”
The scientist says it’s not just about the rather rare disease CTE. Other dementias such as Alzheimer’s or depression are no less serious. “It’s about brain health as a whole. Can the brain tolerate being constantly shaken? The answer is probably no. Or maybe some brains can tolerate it, but not all.” This needs to be researched, not only, as before, primarily in the professional sector, but also in popular sports. Not just for athletes, but also for female athletes.
Erich Grau estimates that “certainly a quarter” of his former football colleagues are currently “extremely deteriorating” mentally. At alumni meetings, the topic of CTE is still given a wide berth, says Grau: “They would rather be the heroes from back then than take these symptoms of the disease seriously.”
From header bans to high-tech face masks
Some contact sports have responded to the alarming research findings. The NFL tightened its rules on tackling. In the new sport of flag football, there is no attempt to bring down the opponent at all. Since 2015, a header ban has been in effect in US football for children up to the age of ten. In England and Scotland heading ball training is prohibited before the age of twelve. In Germany, from mid-2024 onwards, the youngest footballers will only play in small teams on small pitches with small goals, which makes headers relatively pointless. A high-tech mouthguard will be tested in rugby next year: It transmits data via Bluetooth that shows the forces the head is exposed to.
Former football player Erich Grau is skeptical that CTE can be brought under control with such rule changes: “If lung cancer had been abolished with the introduction of the cigarette filter, I would have higher hopes.”