Some exercise advice for former football players (worried about CTE)

Posted on March 16, 2016


Bennet Omalu is the subject of Will Smith’s latest movie, Concussion. He wrote an op-ed for the New York Times in December, 2015, which garnered a good deal of death threats on social media attention and discussion.

The thesis of his article makes a lot of sense. Maybe we should view football like smoking or alcohol, where there is an age minimum for participation, due to the potential for negative health consequences. Fair enough.

However, he claims to have been the first person to diagnose chronic traumatic encephalopathy, in 2002. He was not. Doing a google scholar search between 1900 and 2001, we get:

CTE before 2002 1 CTE before 2002 2

He may have been the first person to extend an already existing diagnosis to NFL players, but finding a new population for an already existing diagnosis is not the same thing as first diagnosing a disease.

Next, if you’re someone who used to play football, like every other thing written about this topic, after reading this you’re left with the feeling of, “Wonderful. How soon until I’m streaking up through the quad to the gymnasium?”

Omalu, or whoever his editor was, makes a point in mentioning we cannot make new brain cells.

Omalu brain cellsA way to make a part of an article stand out is rather than make it part of a paragraph, make it its own paragraph. Even if it’s only two sentences. Hence, the above.

It’s always troubling when people in a health profession speak in a

fuck it meme breaking bad meth

kind of manner.

In this day and age, there is always something which can be done. Is there some new clinical trial for someone who isn’t responding to standard treatment? (Basically always, yes, there is.) Or sometimes that thing is merely making a terminally ill cancer patient more comfortable. Making their last days more enjoyable. (Which can end up helping them live longer!) But you don’t tell that patient to piss off.

With football players, it’s as if we’re saying to people in their 20s, “hide yo kids; hide yo wife.” We’ll see your gunshot-through-chest-suicide-laden body in a decade or two. It’s similar to how patients feel about knowing their genetics. “Why are you going to tell me something I can’t do anything about?” “Cause, cause, it’s science! It’s cool, right?” Any one of my former football teammates I’ve talked to about this, it’s a shoulder shrug and we’re off to arguing who is buying the next beer. I’m sure if they felt they could do something to mitigate the risks of their past playing, there would be more to talk about.

So what is most concerning about Omalu’s op-ed is how much evidence there is we DO make new brain cells. 

It seems his only rationale for the brain not making new cells is his experience looking at them under a microscope. My initial reaction was this is a guy who spent his career as a forensic pathologist, and we don’t exactly pull brain cells out of people’s bodies, unless they’re dead…Hasn’t he only looked at dead brains anyways? Can you really extend that finding to a living body? But hey, I don’t know all the nitty gritty of this world.

What I do know more about is exercise, which is why I know neurogenesis -making new brain cells- exists. Another google scholar search comes back with only twenty five thousand plus results:

neurogensis scholar search 1 new brain cells scholar search 2

Some lighter reading can be found here, bolding mine:

“The area, a subregion of the hippocampus called dentate gyrus, is one of only two brain regions for which the evidence for lifelong neurogenesis is incontrovertible…”

Along with this detailing how we can look at neurogenesis in the living.

One of the more popular science books and authors of the 2000s is Norman Doidge, for a book called The Brain That Changes Itself. His follow up being The Brain’s Way of Healing. That totals like 800 pages of new brain cells, malleability of the brain, etc.

– > These are recommended books. One of my favorite parts of the Healing book is a passage about the new findings on how to manipulate the brain involve active interventions, not passive. The patient has to exercise in some shape or form. Whether that’s listening exercises, physical movement, they need to actively do something. Whereas a passive interventions would be take a pill. Much like positively changing your muscles takes work, so does changing your brain. You want to negatively change things? Do nothing.

Even Omalu’s statement preceding this was funky.

“The risk of permanent impairment is heightened by the fact that the brain, unlike most other organs, does not have the capacity to cure itself following all types of injuries.”

But what non-Wolverine organ has the capacity to cure itself following ALL types of injuries?

Again, the thesis of the article makes a lot of sense. But considering this is a leading voice on this topic, that it seems I can’t hear about this guy, including when he speaks, without hearing how many degrees he has (first sentences of the Concussion movie!), it’s troubling the way he presents his argument, as well as the illegitimacy of much of it.

Symptoms of CTE include memory loss, dementia, impulse control issues, depression / suicidal thoughts. Omalu references the brain damage is irreversible. Another statement he can’t back up, as it’s not like he, nor anyone, ever diagnosed a living person, then followed them and their treatment, along with a control group, in a randomized trial, to see what happened. It’d be like looking at tumors only in the dead, before the advent of chemotherapy, and saying all tumors cause irreversible pathology causing death. (And not all tumors are malignant!)

Plus, we know we can do things to help all the above. We can improve memory, we can improve dementia symptoms, we can improve depressive symptoms. One way we can do this is, again, from a thing called exercise. (We recently found those most susceptible to Alzheimer’s are those who need exercise the most!)

One would assume people experiencing these types of symptoms are pretty stressed. My experience was when stopping playing, you’re essentially told you have to stop. For many, this turns their life upside down. You don’t know what to do next, you don’t what you can do next. You’ve spent your life getting good at one thing, which now you can’t do anymore. “How am I going to fit in with the world now? How am I going to make a living? How do I compete with Terry Tate Office Linebacker?”


A dramatic drop in self worth can occur. And that’s stressful.

Robert Sapolsky is one of the world’s leading expert on stress. He has a phenomenal book Why Zebras Don’t Get UlcersOne of the big recommendations for handling stress? Oh hey, exercise, there you are again.


More specifics on exercise, and takeaways

Yes, football players already exercise a ton. What we want to look at here is

1) Former football players

2) Type of exercise.

For many former players, exercise, or training, was not fun. It wasn’t something you wanted to do. In my college experience, each senior got up to give a speech the last practice of the year. It was a very emotional moment for most, as they knew they were done. The best senior also happened to be the most accomplished off the field.

“You know, it blows my mind how much we do. The amount of working out, the running, the vomiting, the watching film. Twelve months a year we do this. We play ten games a year. We do all this work so we can hopefully enjoy 10 days a year. Where else can you say that?”

Long story short, many former players don’t exercise. It conjures up bad memories, it was never enjoyable to begin with, it was just a way to get to game day.

For those who do exercise after playing…

In all the pathologies mentioned above, aerobic exercise is what most often is looked at, and is what most often stands out as the benefit. From Sapolsky’s book,

“-Exercise enhances mood and blunts the stress-response only for a few hours to a day after the exercise session.

Exercise is stress reducing so long as it is something you actually want to do. Let rats voluntarily run in a running wheel and their health improves in all sorts of ways. Force them to, even while playing great dance music, and their health worsens.

The studies are quite clear that aerobic exercise is better than anaerobic exercise for health (aerobic exercise is the sustained type that, while you’re doing it, doesn’t leave you so out of breath that you can’t talk).

– Exercise needs to occur on a regular basis and for a sustained period. While whole careers are consumed figuring out exactly what schedule of aerobic exercise works best (how often, for how long), it’s pretty clear that you need to exercise a minimum of twenty or thirty minutes at a time, a few times a week, to really get the health benefits.

– Don’t overdo it.”

(In case someone is wondering about rat / animal studies, the link above about incontrovertible evidence has more on why rats are so often used, as well as human evidence.)

Then there is this, covered in the New York Times…the same magazine Omalu ran his op-ed:

“They found very different levels of neurogenesis, depending on how each animal had exercised.

Those rats that had jogged on wheels showed robust levels of neurogenesis. Their hippocampal tissue teemed with new neurons, far more than in the brains of the sedentary animals. The greater the distance that a runner had covered during the experiment, the more new cells its brain now contained.

There were far fewer new neurons in the brains of the animals that had completed high-intensity interval training. They showed somewhat higher amounts than in the sedentary animals but far less than in the distance runners.

And the weight-training rats, although they were much stronger at the end of the experiment than they had been at the start, showed no discernible augmentation of neurogenesis. Their hippocampal tissue looked just like that of the animals that had not exercised at all.”

Anaerobic is more stop and go activity. Run really fast, walk, run really fast again, walk again. That’s anaerobic. Go for a few mile run? That’s (primarily) aerobic.

My experience with former football players, as well as former athletes, is the type of exercise they did when playing gets brought into the type of exercise they do -if they’re doing any- once they stop playing. Strictly anaerobic.

This is one reason CrossFit is so popular with former athletes. It’s fast, it’s balls to the wall, it’s stop and go, you know there’s a fair chance someone defecates themselves from the intensity. If it’s not this, then many former football players are essentially continuing to powerlift or bodybuild in their post-playing days.

-> Even during the season, it’s unlikely football players hit these aerobic guidelines. Moving at a consistent pace for 30+ minutes just doesn’t happen for this population. Except for that one year many of us former players remember, where we had the alcoholic coach, who decided every 30 seconds he was reminded how much he hated himself someone did something wrong the whole team needed to take a lap (or 10).

Exercise wise, it is a huge shift to transition to only going for a three mile run. “Wait, no weights? No deadlifting? No feeling like I’m going to pass out?” The style of exercise has become a habit.

This doesn’t mean you need to completely take weights out, but it does mean you need to add something different in.

Weights are tricky though. So many former players will have pain. Bum shoulder, knee, something. I’m convinced the chronic pain many former players suffer is part of the suicide process. The depression symptoms. The most recent CTE case study was a 27 year old who couldn’t sleep due to shoulder pain. (He was an accidental pain killer overdose.) That much lack of sleep will eff up anyone’s mind. If I go two nights with subpar sleep it’s as if I can replicate a stumbling Hulk.

One thing which always stuck with me was hearing a former powerlifter say once he stopped competing, he wouldn’t squat, bench and deadlift anymore. (The three lifts powerlifters compete in.) Reason being, he didn’t want to compare his old self to his new self. He knew the only way for it to be a fair comparison was to engage in his old ways, and he couldn’t do that anymore. It was only depressing to see what a shell of himself he’d become.

Adding to this, doing those old lifts -engaging in some of the old habits- makes it more likely to engage in them the way you used to. Benching, squatting, deadlifting are what most former football players have done. Often for at least a decade. It’s tough to go do one of these exercises and not engage in the way you used to do them. Balls out, push through pain, push it to your max. Once done playing, we want to resistance train some, but not like this anymore.

On a brain which has already been put through enough, you don’t want to add pain to that mix. Engaging in things this intensely only adds negative input.

Note the caveats above. A transition needs to be made to include more aerobic work, exercise you want to do -if it’s painful, you don’t want to do it, so you don’t want it to be painful (we’re ignoring the enjoyable pain, like some burning in the thighs, which feels good when you’re done)- all where you don’t overdo it. Not overdoing it is a tough barrier for former athletes. Overdoing it is what they know.

-> One way to prevent overdoing it is, once done with the workout, assess whether you could go do more. If you are leaving your exercise sessions with the notion of “I don’t have anything left” or “I feel like I’m already prepared to know what dying will feel like” you’re probably overdoing it. If you leave the session with, “Yeah, I could probably go do some more of what I was just doing,” that’s often a good place to be.

Running needn’t be the only aerobic outlet either. For some former players, five mile runs might not be great on something like the knees or ankles. Swimming and cycling work. A brisk walk on an incline treadmill for an hour can really get the heart rate going. A long, fast walk itself can be sufficient. Personally, I like doing stair workouts, outside if I can. (Being outside is another way to help depression issues (no, I don’t have any).) I’ll bring some bands with me and do all types of things for my upper body. I still workout in a gym often, but it’s tough for me to be in a gym, only tougher if I do certain exercises, and not get too intense about it.

Finally, a nice complement to all this is engaging in more aerobic exercise and less anaerobic, as well as less intense lifting, may make losing weight more likely. You burn more calories going for an hour run than powerlifting for an hour. When you’re bodybuilding / powerlifting / football training you tend to associate that with big post-workout calories / getting jacked / bragging on Instagram how much dead animal flesh you just consumed. Almost all players will have more weight on their body than needed. Losing weight makes everything easier.

If you’re a former player needing some help getting into exercise again, wanting to do so without pissing your joints off but still feel like you’re doing something, from someone who played for a long time themselves, check out the remote client process and shoot me an email.

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