High school football player Nathan Stiles — who died in 2010 after bleeding occurred in his brain during a football game — was found to have early signs of the brain injury known as chronic traumatic encephalopathy, or CTE, when his brain was autopsied as part of the Boston University study.
The 17-year-old didn't die from encephalopathy, but from the brain bleed, which was probably caused by an earlier concussion that hadn't had time to fully heal before Stiles was tackled in subsequent games.
Ron Stiles, Nathan's father, said he still wonders why his son died when they followed all the rules: Nathan sat out of practices and games for three weeks after his concussion, and he had no lingering symptoms and received his doctor's consent before resuming play. He also had no signs of bleeding on a brain scan after the concussion.
"We sent the scans to Boston after we donated his brain, and the researchers told us absolutely nothing was there," said Stiles, who lives with his wife and daughter in Spring Hill, Kan. "It's definitely a good thing to do the research and try to get better understanding of this."
The new study is sure to prompt renewed calls for restrictions on children playing contact sports, but much is still unknown about the dangers to youth. Coauthor Dr. Robert Cantu, a neurosurgeon and codirector of the BU Center for the Study of Traumatic Encephalopathy, said he is in favor of replacing tackle football with flag football for all children under age 14 since their developing brains may be more vulnerable to impacts. But others — including Peter Warinner, director of sports neurology at Brigham and Women's Hospital — said there aren't any studies to suggest that such a restriction would prevent long-term harm to the brain.
The 2010 Massachusetts concussion law has raised awareness about the dangers of putting high school players with concussions back into practices and games before the brain has time to heal and mandates that doctors sign off before a player can return after a concussion. Cantu, however, would like to see high school teams adopt the new NFL rule that limits contact practices, which involve tackling, to once per week during the regular season.
"There's no talk of setting up formal rules for limiting contact practices," said Paul Wetzel, spokesman for the Massachusetts Interscholastic Athletic Association, a nonprofit organization that represents more than 370 high schools in the state. "But most football coaches will tell you that two or three games into the season, they're limiting contact practices to avoid injuries."
Pop Warner decided to limit contact practices this year, said Jon Butler, the organization's national executive director, and prohibits players with concussions from returning to practices and games without a doctor's consent.
The league for 5- to 14-year-olds also has rules to prevent serious head injuries from occurring during a game, but that doesn't mean coaches always follow them.
The Central Massachusetts game in September that led to multiple concussions was a "clear violation of Pop Warner's rules," said Butler in allowing lopsided teams with more players on one side than the other. "That game should have stopped three to four minutes after it started."