Jay Ruderman:

Welcome to All About Change. Today, my guest is Chris Nowinski. Chris is a former football player at Harvard University and a professional wrestler with WWE, World Wrestling Entertainment, where the matches are scripted, but the injuries are very real.

After enduring a career-ending head injury, Chris has dedicated his professional life to serving patients and families affected by brain trauma, particularly chronic traumatic encephalopathy or CTE, a progressive neurodegenerative disease that develops after repeated head injuries. Chris advises youth and professional sports leagues on concussion protocols and makes his voice heard on social media when those leagues don’t meet safety standards.

Chris, welcome to All About Change. Thank you so much. It’s an honor to have this discussion with you.

Chris Nowinski:

It’s my pleasure. Thanks for having me.

Jay Ruderman:

So Chris, so much has changed in public sentiment regarding concussion since you left the WWE. ESPN doesn’t have jacked-up segments anymore.

Announcer:

A little in-move, come back outside and Shawn Taylor from the U is going to finish him off, we’ll take another look at him and then I want you to give a listen to this hit.

Terry Glenn jumps up and says, “Shawn, I didn’t get jacked up!”

Shawn says, “Yes, you did!”

Alex Smith to Terry Jones. Oh! Cheryl sends the ball with the hit. You got to pick that ball up a little bit.

Jay Ruderman:

NFL players can wear padded helmets and much more. What do you think the most important changes are either technical or cultural that have increased concussion safety over the past two decades?

 

Chris Nowinski:

I think the most important thing is that we’ve changed how we talk about it in the culture. So, when I got hurt in ’03, there was no education about it and no one took it seriously and we treated athletes as heroes when they were knocked unconscious and went back into the sport.

Drawing attention to the dangers of concussions and calling out the professional sports leagues, we changed the culture around it, which then allowed for changes to be made throughout most of sports, not all of sports, but most of sports, especially at the high school level, to ensure that athletes were cleared by doctors before they returned and not being asked to be put in games anymore.

Jay Ruderman:

The NFL is now allowing padded helmets, which I saw for the first time when I attended a game this year. Do they really work and are they an improvement?

Chris Nowinski:

The jury is out on those, so there’s no evidence to date that they work outside of the lab. The way they test these things is you put a helmet and a pad on a head form and you jam a missile into it and you see if the padding reduces the acceleration felt by the brain, and of course, it does because you put a pad on anything, it’s going to work.

But when they’ve put accelerometers in people’s mouths and mouth guards, put the pad on their helmet and had the pad on some people and not on other people, the head experience doesn’t change. And so that tells us that they’re probably not as good as we thought or we would like it to be or if it works at all. Then the other thing that’s sort of come up is that the NFL has been bragging now for probably a year and a half, almost two years, that they had this massive reduction in concussions when they have used these in preseason, but they announced it and said a paper was forthcoming and having published over 50 papers myself, when it takes a year and a half, there’s something potentially questionable in their methods that is preventing this, preventing the most powerful league in the world from getting a relatively modest paper published.

So, every day that paper’s not published, I get more skeptical of the NFL’s claims.

Jay Ruderman:

So, what you’re saying that everything trickles down from the NFL and the NFL is one of the biggest sports enterprises in our country or in the world, and we talk about the concussions that they’re documenting, but then there’s all these concussions that they may not be documenting.

Do you think that in the NFL that they’re under reporting the number of concussions that happen during games?

Chris Nowinski:

There’s no question that concussion under reporting is happening, obviously driven by the players. The evidence is that you’ll see tons of players when they retire within a year or two, talk about the fact that they actually had symptoms every week. If you’re not a great player, you will get a reputation as being not tough and probably lose your job.

Basically, when you talk about concussion numbers in the NFL, you’re talking about the concussions that players weren’t able to hide or that players were secure enough in their job, they could report them. But there’s so many dynamics going on here, so we’re not missing the knockouts anymore. We used to. We’re not missing the egregious acute symptoms, but acute symptoms don’t always correlate to the severity of the injury. It can also be certain that 99% of those who wake up the next day feeling like they have, like, “Oh, I must’ve been concussed last night,” are not coming into the building and saying, “I was,” because we only hear about a handful of those a year.

But most concussions have delayed symptoms. They do now have informed consent, they know the risks of playing through them and most of them will still play through them at that age for that amount of money. And so it’s complex in terms of the messaging it sends to the rest of the public.

Jay Ruderman:

And it’s amazing because in preparation for this interview, I looked at Wikipedia and CTE, it’s obviously an epidemic in the National Football League, yet it’s still the most popular sport. How do you put that together?

Chris Nowinski:

The way I look at it is somebody who played, I played eight years, I played through my senior year at Harvard. I had success. I was nearly an NFL prospect. You don’t understand the risks when you sign up. And the problem that football has ethically is that everybody who plays signs up as a child, every single one, and so they don’t understand the risk. And then by the time they’re old enough to become aware of the risk, their identity is wrapped up in the game, the rewards are too high and the culture is one that you quit, you’re ostracized forever. So you can choose to walk away from your life, your friends and your job or continue to take those risks knowing that frankly the risks are incremental at that point because you’ve already… By the time you’re an NFL player, you’ve already put in 10, 15 years.

I sometimes feel like they’re sort of victims in that sense that once you have that chance to make money playing football and now that chance to make money has moved up a few years with NIL. But once you have that chance to make money, it’s so hard to walk away. I get these calls from one or two NFL players a year who are in their early twenties who wake up to the idea of like, “Hey, do I probably have CTE already?” And we have that conversation and even at that point almost nobody walks away.

Jay Ruderman:

How do you feel about that? I mean, the layman can see it on the field that the guy is going through something awful, but yet he’s back in the game.

 

Chris Nowinski:

It’s a good question that sort of digs into the confusion. We’ve been learning all this stuff in real-time and in the early days when we started diagnosing CTE, we realized that one in five people we were diagnosing with CTE did not have a diagnosed concussion in their career. And we also started seeing that in our other brain banks of regular people, even those who had had car accident, traumatic brain injuries, other concussions, they didn’t have CTE.

And so we started trying to push this narrative that it’s not the concussions that are causing CTE, it’s the repetitive hits. The problem is the concussions are the only thing you can see with signs and symptoms like Tua Tagovailoa’s hand, becoming conscious of his hand cramping up because he’s having a severe brain injury. I still find today in 2025 when I talk to some NFL players, especially younger ones, they think that concussions is was what causes CTE and they will tell me, “I’ve only had one concussion,” and therefore they’re not worried about it.

And so that is a problem that we are still are not educating the football community around what is causing concussions. And then it’s a dose response relationship. The more years you play, the greater your risk. NFL players, most of them don’t understand this and don’t believe they’re at risk. And then the other ones who do, most of them think they’ve been involved so long that we might as well make their money and leave more money for their family because they probably already have it, which is sort of a sad state of affairs. And then with Tua specifically-

Announcer:

Penalty flag comes in and Tua Tagovailoa was roughed at the end of the release. The pass rusher came on top of him there and Tagovailoa suffered some type of an injury on this play. We have Teddy Bridgewater in the game right now. Tagovailoa, oh boy, getting up. Oh my goodness, that’s an awful, awful sight to see. They will take him to the sideline immediately.

Chris Nowinski:

… I would argue that if he didn’t want to have CTE, he should retire. But CTE is the reason you retire, not necessarily concussions that you have recovered from symptomatically.

Jay Ruderman:

But you can’t tell if you’re going to get CTE.

Chris Nowinski:

You can’t tell if you’re going to get CTE right now. So that’s the big problem. So, one of the reasons I created the Concussion Legacy Foundation and partnered with Boston University is because I realized that the only way we’re going to figure this disease out is by looking at brains postmortem because the entire world had basically ignored this disease ever since, in 1928, a medical examiner named Harrison Martland wrote this sort of famous index article called Punch Drunk in the Journal of the American Medical Association. I think the world culturally just had no sympathy for boxers. Boxers didn’t have advocates.

 

And so once we proved boxers get punch drunk, we forgot about the disease. And so when we started the CTE Center at Boston University in 2008 and our brain bank, there were no active research programs worldwide on this issue. So then it became, all right, we’ve got to figure out what this is. And so that led to me calling families and reading… I’ve been reading obituaries for 20 years when calling families to try to build this brain bank and we’re now at 1,650 brains in the brain bank. And so we’ve learned dramatic amounts, but what we haven’t yet figured out is how to diagnose in living people.

And that is really what the goal is because once we can diagnose in living people, it gives us a chance to actually run clinical trials and figure out how to treat this disease and stop it as well as figure out how many people have it which will inspire more changes. And so it’s slower than you want it to be and we have to do the work, but we are making great progress.

Jay Ruderman:

You’ve always been an athlete, you were recruited to play football at Harvard, you went into the WWE as a wrestler. At one point, you received such a severe concussion that you tell a story about sleepwalking and getting up at the night and diving into a wall and breaking a cabinet and a lamp, and your girlfriend at the time was freaked out. And I think at that time you said, “That’s it, I’m out.”

From that situation, what propelled you to found your center, to get your PhD, to take this on as your life cause?

Chris Nowinski:

So, it was a slow process to get here. So, at the beginning it was, I’ve got a headache every day, I can’t get back to work. And so I started traveling around the country to find a doctor that would fix me. So three months in, I go see Dr. Robert Cantu in Concord, Mass. He’s the guy who changed my life by just starting to educate me along with the evaluation and helping me appreciate that I’d had a lot of concussions I wasn’t calling concussions throughout my life and had I rested any of them instead of continued to play, I probably wouldn’t be in this situation because my brain would’ve recovered. That was just a moment in that first meeting with him where I was like, “God, I can’t believe that after 19 years of bashing my head that I never knew what a concussion was, what it meant for me, and that I could have just rested and I’d still be fine.”

And so it was that sort of idea that I feel like athletes should know this and I couldn’t go back to work and I had time. So I said, “All right, maybe I’ll try to tell them.” And he encouraged me to do that because he said, “As doctors, we don’t have the platform to create this sort of change in the sports world and maybe you do.” So I wrote a book that nobody read called Head Games: Football’s Concussion Crisis in ’06, where not only did I outline the science that was there that we should be handling this different, but I also got very motivated by the fact that the NFL was playing the role of big tobacco and covering it up.

I remember in the early days of doing the research, people would say: “Oh, the NFL’s on top of this. They’re publishing this great research.” I could even tell with virtually no training that the NFL’s research was garbage, that they were designing studies that could not find problems long-term because, for example, if an NFL player fell out of the study because they had to quit football due to brain injury, they could not be followed up on. The life-changing concussion would disappear from the study because they couldn’t be at the facility to be tested again. And it was stuff like that that just blew my mind. And so I realized that there was a cover-up going on.

And so in 2006 when Andre Waters took his life, who was a player I grew up watching, great safety for the Eagles. I had learned that CTE was just been found in two NFL players and I ended up coordinating his brain donation because I realized that again, concussions are invisible and that’s why it’s able to be covered up. But CTE is something you can see and that will change people’s mind about this. And so started getting brains basically, and I realized that nobody was as passionate about it as I was, that it would’ve died if I stopped doing it because all the doctors had doctor jobs and they had their own lives to worry about. And it was a very risky proposition going up against the NFL and not the NHL and now FIFA and World Rugby.

But at that point I had nothing to lose. I figured if you’re going to be 6’5″, 260, and a big tough football player and wrestler, you should be willing to use that strength to take some hits. We got the New York Times to write about it in the front page. We started changing the conversation back in ’07. Then it was if we have brains, we need a nonprofit. So I learned how to incorporate a nonprofit, again, assuming I would never lead it. And then it was, okay, now we need a medical school because the NFL can fight with us all day long, but they can’t… A university’s not going to take this. They have credibility. So that was BU and even then it wasn’t like this is going to be my life’s work. I just kept getting them brains and thought I’d hand it off.

And then they suggested as long as… They gave me an office in the building and said, “As long as you’re here, go get a PhD.” And so I did that and I was like: “All right, you know what? For this to keep going, I’ve got to keep doing it.” We have almost 90% of the world’s CTE cases. It’s cool, but it’s also disappointing because we need a lot of people working on this to figure this out.

Jay Ruderman:

So much of what you’ve done is personal. You were an athlete with brain injuries yourself in your past. You played football, you wrestled. Your early campaigns were really connected to people that you knew professionally.

How do you now take this deeply personal connection and work with other activists who might share your point of view but don’t have the immediate connection like you do?

Chris Nowinski:

Concussions matter to those of us who have not recovered. And so there’s easily 4 million more concussions each year in sports, but the number of people that have long-term symptoms is relatively small and no one’s ever counted it. And so there’s not a huge community with chronic symptoms. And once they do get better, they forget about this. If you have a bad experience with concussions, once you’re over it, you never want to think about it again.

It’s not a big activist community in the post-concussion space because it is a painful personal experience. Those who really struggled with it can often destroy… The teenagers end up on a different academic trajectory and people lose jobs and lose families. So that’s one part of it. The other part of it is with CTE still only being post-mortem, there’s only a thousand families worldwide who’ve ever been told you loved one had CTE. And almost everyone who’s living doesn’t want to think about it because who wants to have this dark cloud hanging over them? And so one of the ways that every spring that we try to make this real to people and connect them to the issue is we have something called the Race to End CTE.

When someone gets CTE, just their family knows and maybe there’s a memorial or maybe they’ll share it on social media, but that’s the end of it. And so we try to speak everybody’s name that we’ve lost and we also try to lean in on existing networks to get people to remember who these people were and what it cost them. And one of the most effective ways has been getting college football alumni teams together. And so we start to group these names together so that people realize, if I cared about that college, I now know of five to 20 people who played there who I watched, who now have it. You have to cluster these things and you have to say it every year because the other sad part is that no one’s going to say it for us, right? Notre Dame has lost more than 20 people to CTE. They will never tell anybody that. We have to try to find ways to do it ourselves.

Jay Ruderman:

You recently published research about shake, a new sign that can be used to identify concussion in real-time, and I want to know how you present this new research and modify it, your approach when you talk to different levels of the sport or different sports.

Chris Nowinski:

Thanks for noticing that. Just this blind spot we’ve all had, it was actually the 2022 first Tua Tagovailoa concussion that inspired me to do this research and write this paper, which was the idea that there was a Sunday game and then a Thursday game and the Thursday game, everyone saw him get knocked out and it was all very sad. But the Sunday game, he, in my and a lot of people’s opinion, he definitely had a concussion, but he was put back in the game and they tried to claim the reason he stumbled and fell is he had a back injury.

Jay Ruderman:

Right.

Chris Nowinski:

And so if he was diagnosed with a concussion, he never would’ve played in that Thursday game. The reason I felt that the back injury story was obviously not true is because he got up and twice he went like this…

And that’s a familiar visual for anybody who’s watched movies or cartoons or experienced a lot of concussions that when you take a hit and something’s off, you’ll often voluntarily make that motion to try to either fix your double vision or get rid of the ringing in your ears or jumpstart your brain because you can’t hold a thought in your head. I used to complain about this on social media that he did the head shake, but they didn’t hold him out. And then I realized that the head shake wasn’t in anyone’s concussion signs list. So basically when 2007, 2009 when concussion protocols were being slowly created, they asked experts to come up with a list of signs of why you should be held out. Being unconscious is one, getting up and falling over is another one, these obvious signs, but this one just never made a list.

 

Then I looked in the literature and realized it’s not on the list because no one’s ever studied it, no one’s named it, no one’s studied it. There’s no data on whether or not it actually correlates with concussion. But I think we all sort of knew intuitively. And when we rolled it out, we put together a bunch of videos from Roger Rabbit and National Lampoon’s Christmas Vacation, they’re doing it, all these old movies. So it was in the culture, but not in the medical literature. So we ended up doing a survey for athletes who had retired within the last 10 years. We showed them videos of athletes doing it. We said, “Did you ever do this after a hit to the head?” And they said… It was about ninety-some percent said yes. And we said, “Okay, well, what were you feeling?” And we gave them lists that were both concussion-related and non-concussion related.

Like, did you have head pain or did you really have an emotional reaction to what had just happened to you? And it turned out that almost three out of four times that they did this after they were hit in the head, it was because they were experiencing what we would consider to be a symptom of a concussion. Part of the reason we did it as a survey is we wanted to get out there as quickly as possible. And we also knew that most concussion research is done using video. Like the NFL has video of concussions that happen in the field, and then they try to mark what happened afterwards. But those of us who’ve done this know you don’t always shake your head right away. You might go to the sideline, you might do it there, you might do it in the locker room. So survey was the right way to do it, and we were successful.

And so I worked with collaborators like Dr. Dan Daneshvar at Harvard University and a great team, and we published it and now we’re fighting to get it out there. And we’re realizing that partially because of all the fights we’ve had over CTE, people aren’t necessarily wanting to do us a favor of adding it, but that’s only going to hurt kids. And so we’re trying to remind them that next time you have a player do that, you leave them in and something bad happens, you’re now going to be legally liable because you should have had this in your protocol because you have things in your protocol that have less research than our one study.

Jay Ruderman:

NFL players have begun to advocate for their right to decrease hits in practice. Are there other areas, be it youth sports in the military where the athletes or the individuals are advocating for themselves in that way?

Chris Nowinski:

The sad reality is no. I remember very vividly a 2010 meeting with the NFL PA after I helped convince them to bring in their own experts and realize they were being lied to by the NFL. They asked us, what should we do? And we said, the number one thing you can do to reduce CTE risk right now as an NFL player is stop hitting in practice. Because at that point, they were hitting three, four days a week, and that was more than they were hitting in games. And so the doctors hadn’t really thought about it, but the players got it because no one likes to get hit in practice and they understand the math. And so they fought for it. And remarkably, the NFL is so dramatically safer than it used to be, and it’s because the players have been fighting for themselves because they have a union and they have a union that has a committee of experts that I’m on that keeps them up to date.

 

Nobody else has matched that. And so we just worked with Marty Walsh at the NHL Players Association to have them create their first ever CTE committee internally. This summer, we’re having meetings around getting their players up to speed so they can advocate for themselves. The unions outside the US aren’t as strong, so internationally this is not really happening. And then the problem is below the professional level, there are no unions. If college players had a union, college football would be dramatically different.

But right now, college football practices like the NFL used to, and there’s nothing the players can do about it, and the players are even being lied to by the NCAA to tell them that CTE is not a consequence of playing football or hockey or anything else. And so they don’t have a reason to advocate for themselves. And so it’s a shame that the safest place to play is for the adults and the kids have very few protections and no informed consent and no concept of what CTE is. We’re actually working with a state rep to actually mandate CTE education for the first time in the Northeast state because I just can’t believe that people are still hiding from this so many years later.

Jay Ruderman:

Chris, I want to leave you with this. I’m a lifelong Patriots fan and I watched a film called ’85: The Greatest Team In Football History about the Chicago Bears and Chicago Bears creamed the Patriots in ’85. But that team, as they documented it, almost everyone on that team has something that they’re dealing with or is no longer seen in public.

And I remember a quote from the documentary with Mike Ditka who was the coach. They asked him, “Would you let your kids play football?” He said, “No.”

To me, I look at that and been like, “Well, you can be the greatest in history and have this great football team, but is it worth the price?” To me, the answer is no. But it seems like this is still all about money, and it’s money for young people who are making a lot of money that they probably would not have been able to make if they weren’t in football, but also the league itself making tons and tons of money and the advertisers and so forth. I commend you because I think that you’re being listened to, but you’re up against a monster.

Chris Nowinski:

No, you’re right. I appreciate you saying that. And yeah, I mean, I’m from Chicago, so that ’85 Bears team, I’ve gotten very close to a lot of those people. Gary Fencik is one of our biggest advocates, who was the free safety on that team? Dave Duerson, I shook his hand when I got a National Football Foundation award that’s over in the corner there in high school, and then we studied his brain after he took his life. Steve McMichael is now dying of ALS, which is probably caused by CTE, which is very sad to watch. And not everybody’s doing well. I saw Jim Covert at the Super Bowl, he’s still doing great, and God bless him, but it’s hard to watch. Jim McMahon has been a great advocate for us on this, but he’s struggled.

It is hard, so thank you for that comment. It is an unfortunate uphill battle against a big machine, but luckily we have gotten… Those people who have supported us have allowed us to do so much, and we do have a lot to show for it, and we have changed how we do things. We can still do so much better, and we have an entire disease to cure still, and so a lot of work ahead.

Jay Ruderman:

Right. Chris, thank you. It’s been my honor to have as my guest on All About Change, and thank you for all your work and the work that you’re going to continue to do to make our sports safer.

Chris Nowinski:

Thank you very much, Jay. Pleasure to talk to you and thank you.

Jay Ruderman:

Thank you so much for listening to All About Change. Today’s episode was produced by Tani Levitt and Mijan Zulu. To check out more episodes or learn more about the show, you can visit our website AllAboutChangePodcast.com.

If you like our show, spread the word, tell a friend or family member or leave us a review on your favorite podcasting app. We’d really appreciate it. All About Change is produced by the Ruderman Family Foundation. That’s all for now. I’m Jay Ruderman, and we’ll see you soon with another episode of All About Change.