#25 February Edition: CTE, concussions and brain health

Hi everyone,

CTE has been everywhere lately — and I’m hearing the same questions again and again in clinic:

• “I had a concussion years ago… should I be worried?”

• “Is CTE basically guaranteed if you play contact sport?”

• “Is it concussions… or heading… or just any hit?”

If that sounds like you (or someone you care about), you’re not alone.

This month I want to give you a calm, accurate explanation of CTE — and (importantly) remind you why I still believe concussion is a recoverable injury when it’s managed properly from the start (Patricios et al., 2023). 

First things first: concussion ≠ CTE

A concussion is an acute injury. Most people improve well, especially when the early decisions are sensible — modern international guidance recommends 24–48 hours of relative rest, then a gradual, symptom-limited return to activity(not weeks of complete shutdown) (Patricios et al., 2023). It can be a little more complicated than that but in general gradual stimulation and exercise is the gold standard.

CTE is a different conversation.

CTE is a neurodegenerative disease defined by a specific pattern seen under the microscope (abnormal tau around small blood vessels, often in the depths of brain folds) — and right now, CTE can only be diagnosed after death, not with a scan or blood test in a living person (McKee et al., 2023). 

So if you’ve had a concussion, the most accurate starting point is:

✅ You’re not “destined” for CTE.

✅ Concussion is still something we can treat and guide well.

So what actually raises CTE risk?

The strongest link in the research is repetitive head impacts (RHI) over time — the overall “dose” across years (not just the number of diagnosed concussions) (McKee et al., 2023). In 2023, I was in Vegas for a brain injury conference and a professor from Harvard shared some preliminary data that the risk of CTE equates to a 5 year NFL career according to him. Thats roughly 1500 sub concussive hits, again that is a rough estimate and more research will come out on this.

This is also why some CTE numbers in the media feel alarming: a lot of data comes from brain-bank studies, which are not random samples (families often donate because there were concerns). That can inflate prevalence estimates compared with the general population (McKee et al., 2023). 

On the flip side, community brain-bank work suggests CTE-type pathology is uncommon outside heavily exposed groups (McCann et al., 2022). 

“CTE is caused by more than head trauma” — what does that mean?

A recent piece from Harvard Medical School highlighted a study suggesting CTE may involve additional biology beyond impacts alone. 

In the paper (Dong et al., 2025), researchers examined individual neurons and found that brains with CTE showed distinct DNA damage patterns (somatic mutations). Interestingly, a comparison group with repetitive head impacts without CTE didn’t show the same signal (Dong et al., 2025). 

The calm takeaway is:

That’s not something to fear — it’s often the path toward better prevention and future treatments.

The part I do want you to take seriously

Even though CTE is a hot topic, the most immediate and actionable thing for most people is still:

If a concussion happens - Doing the right things from the start matters.

Not because we can “CTE-proof” someone — but because good early management improves recovery odds and reduces the chance of prolonged symptoms.

Modern guidance supports early, sensible progression and also shows that strict prolonged rest isn’t helpful, while early, controlled activity (and reducing things like excessive screen time early on) can be beneficial (Leddy et al., 2023; Patricios et al., 2023). 

Why I built Concussion Essentials

Most people don’t struggle because concussion is “mysterious.”

They struggle because they’re left guessing:

• “Should I rest more or move more?”

• “Am I doing too much too early?”

• “What symptoms matter?”

• “How do I return to work/training without setbacks?”

That’s exactly why I created Concussion Essentials — a step-by-step guide to help you do the right things at the right time, from day one.

Practical takeaways

• Concussion is usually recoverable — and early decisions influence the recovery trajectory (Patricios et al., 2023). 

• CTE is not the same thing as concussion, and it can’t be diagnosed in life at this time (McKee et al., 2023). 

• CTE risk is most strongly linked to years of repetitive head impacts, but newer research suggests additional mechanisms may be involved (Dong et al., 2025). 

• Best “everyday brain protection” is boring and powerful: regular cardio, strength work, whole-food diet patterns, sleep hygiene, and good cardiovascular health (WHO, 2019; Iso-Markku et al., 2022; Nucci et al., 2024; Lloyd-Jones et al., 2022). 

Until next month — have a physically active month!

Kosta