Concussions in Football: Understanding CTE Risk and Evolving Treatment with Dr Tina Shetty | Science Friday

Podcast at a glance

In this Science Friday episode Flora Lichtman talks with Dr Tina Shetty, a neurologist and concussion expert who has worked with the Giants, Mets and Liberty. They examine concussion science, the unknowns around chronic traumatic encephalopathy (CTE), and how treatment and return-to-play decisions have evolved for athletes and the general public.

• CTE risk in football and living-concussion decision making
• The limits of current tests and the role of genetics like APOE-e4
• A shift from cocooning to active, lifestyle–based recovery

Overview

The podcast features Flora Lichtman interviewing Dr Tina Shetty, a former Giants neurologist and concussion expert now running a NYC concussion clinic and teaching at Weill Cornell. The discussion centers on how concussions affect the brain, what scientists know about long-term risks like chronic traumatic encephalopathy (CTE), and how treatment and return-to-play practices have evolved, especially in professional sports compared with the general population.

Concussion fundamentals: how the brain is altered

Shetty emphasizes that concussion is a functional injury rather than a structural one. The brain’s networks and their chemical signaling are disrupted, leading to subtle symptoms such as headaches, dizziness, light and noise sensitivity, and screen fatigue. Because diagnostic scans like MRI and CT are often normal in mild traumatic brain injury, clinicians rely on history, symptom patterns, and an understanding of disrupted brain connectivity. She notes that energy metabolism in the brain and neurotransmitter systems such as serotonin and dopamine may be involved in the post-injury phase, creating an “energy crisis” at the neuronal level that underpins symptoms.

CTE risk, living players, and the APOE-e4 question

The conversation tackles the new study reporting that about one in four NFL players may develop CTE over a lifetime. Shetty stresses the key caveat: CTE is a postmortem diagnosis, and linking it to living athletes who have concussions is inherently challenging. While there is no definitive living-test for CTE, researchers consider genetic markers like APOE-e4 when discussing risk and future trajectories. This can lead to more nuanced conversations about continuing contact sports, especially for players with certain genetic predispositions, while avoiding unwarranted alarm about CTE for every concussion.

Treatment evolution: from cocooning to active management

A major theme is the shift away from “cocooning” in a dark room toward an active, prescriptive approach. Recovery strategies include diet optimization with protein support, sleep as a key medicine, and mindful management of screen time and environmental stimuli. Shetty explains that nutrition, sleep, and proper sleep-wake scheduling can influence headaches and overall recovery. Pharmacologic options are discussed carefully; older antidepressants that influence dopamine and other pathways may have roles in low doses for sleep and headache, though they are not standard acute-concussion therapies. The emphasis remains on individualized care that addresses both the physical injury and the patient’s mental well-being.

Clinical practice, training, and the lived experience

The panel covers how professional teams rapidly triage head injuries, with athletes moving quickly into the care of doctors, trainers, and specialized neurologists. In contrast, most concussion patients navigate self-advocacy within the broader, often fragmented healthcare system. Shetty points out that med school historically did not treat concussion as a formal unit, but sports medicine training is increasingly emphasizing return-to-play protocols and clinical management of mild traumatic brain injury.

Takeaways for listeners

The discussion underscores that concussions are highly individual, with outcomes influenced by biology, environment, and timely care. While living athletes cannot be guaranteed protection from long-term effects, an active, evidence-based approach to treatment can lead to better short-term recovery and potentially better long-term brain health. The podcast highlights the need for balanced risk communication, better testing where possible, and a compassionate, patient-centered approach to care that respects both scientific uncertainty and the person behind the injury.

Implementation notes

Listeners are encouraged to consult with medical professionals about concussion management, consider genetics in risk discussions when appropriate, and view sleep, diet, and activity as central to rehabilitation. The episode closes with a reminder of the mind-brain intersection in brain injury and the importance of maintaining person-centered, holistic care.