Zack Langston was hauled off the field on a stretcher and brought to the team’s medical room. His mother, who was watching the game, followed close behind – terrified.

Langston was a linebacker for Pittsburg State University in Kansas. A remarkably strong kid, he was known as a “wedge-breaker” and a “workhorse”. In high school, he won a “hammer” award for being the team’s hardest hitter. More than 1 million boys play football in high school each year, but less than 2% make it to elite schools like Pittsburg State. Langston was one of them.

He was only dehydrated when he was taken out of the game, but as his mother, Nicki Langston, sat by his side, something else seemed amiss.

“He’s just laying there on the bed, and all of the sudden tears just start rolling down his cheeks, and he’s still staring at the ceiling,” said Nicki Langston. “I said, ‘Zack, what’s wrong? What’s wrong?’ and he said, ‘I don’t know, I don’t know.’”

“I kind of look back now, and I think maybe something was going on then that he wasn’t aware of, we weren’t aware of,” said Nicki. “That was his sophomore year.” He was 20 years old.

Just a few years after playing for the “Pitt State” Gorillas, Zack had bouts of depression, rage and anxiety. He stunned his mother and brother when he tossed a barstool across a hotel room on vacation, and worried everyone when, on three occasions, he bought guns.

Langston told his mother he believed football had “messed up his brain”, but could not explain how. Just a few years after he graduated, at age 26, Zack Langston shot himself, ending his life but preserving his brain, which he had told his girlfriend he wanted examined. He left behind a two-year-old son, three siblings, a mother, father. He also left behind many questions.

“They did the autopsy here at the coroner’s office locally, and said his brain was totally healthy,” said Nicki. “That made things very disturbing, in a way.”

In the last decade, American football’s “concussion epidemic” has become an existential crisis for the sport. Lawsuits against leagues at all levels – from elementary school age to the National Football League (NFL) – have flooded courts. Fewer children are playing. Debates and controversies about brain injuries have enveloped the sport as mounting medical evidence shows the long-term effects of heavy contact and collisions.

In 2005, a Pennsylvania neuropathologist provoked a backlash from the NFL when his paper explicitly linked the degenerative brain disorder chronic traumatic encephalopathy, or CTE, to playing in the NFL. The league tried to discredit the physician, Bennet Omalu, and more recently to influence concussion research with a $16m grant.



The latest research connecting concussions to degenerative brain disease came in July, when researchers from Boston University released a study of the 111 brains of former NFL players that had been donated to their “brain bank”: 110 players, or 99%, had CTE.

It is no longer newsworthy when stars say they won’t let their sons play the sport, or for former players to divulge struggles with homelessness, chronic depression or drug abuse.

But after years of focus on the professional game, attention is now turning to college football, as plaintiffs in a new class action lawsuit seek to bring the same reckoning to college football.

Researchers from Boston University, the leading research institution on the topic, found CTE in the brains of 48 of the 53 college football players, the largest such study to date.

Nicki Langston, whose son’s estate is now party to the lawsuit, first heard of CTE eight months after Zack’s death in February 2014. Her sister “just happened upon” League of Denial later that year, an award-winning documentary on the NFL’s refusal to acknowledge the dangers of repeated head trauma, despite mounting evidence.

CTE’s symptoms are now well documented. “Impulsive, explosive and sometimes violent behavior; depression; and a tendency toward suicidality” is associated with “younger age and an earlier stage of CTE pathology”, the most recent study published in the Journal of the American Medical Association said.

Nicki Langston said: “This was the very first time I’d heard of CTE ... I watched [the film], and I called her back afterwards and said: ‘Oh my God, he had every single symptom.’” Reflecting on Zack’s life now, the Langston family believes he could have had as many as 100 undiagnosed concussions through the 13 years he played school and college football.

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What makes this lawsuit more acute than similar lawsuits in the professional league is the odd economic dynamic between college athletes and institutions they play for. Unlike in other countries, US college sports are a multi-billion dollar industry. Schools make millions from television broadcasting contracts and ticket sales.

The days around this Thanksgiving weekend are packed with some of the most high-profile games.

Elite college football is divided into 11 regions, called conferences. One of those conferences, called the Big Ten, signed a television contract last year worth $2.6bn. By contrast, one of the top academic institutions in the country, Johns Hopkins University in Maryland, spends $2.3bn annually on scientific research and development.

Of the 10 largest sports stadiums in the world, eight belong to American college football teams. Professional American football stadiums don’t even make the list. The largest in the US belongs to the University of Michigan, is nicknamed “the big house” and is one of several to hold more than 100,000 people. The football-crazed University of Alabama pays its football coach Nick Saban $11.1m per year.

But for all the money earned by the programs, athletes see little. The players, who are mostly black, are considered primarily students, and are not paid. They leave school without the sort of long-term health benefits the NFL players’ union has been able to negotiate.

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Nicki Langston, Zack’s mother, said: ‘I was totally expecting them to tell me he had CTE. There was actually a little bit of relief – not relief, but closure.’ Photograph: Marcus Langston

Soon after Nicki Langston learned about CTE, she sent her son’s brain to Boston University, a school at the forefront of the “concussion epidemic”, to be examined. Initially, she did not believe it would even be possible to send her son’s brain – he had died months prior – but the local coroner had saved enough of it for Boston University to perform tests. It took eight months for neuropathologists to conclude what Langston already believed: her son had CTE.

“I was not at all surprised,” said Langston. “I was totally expecting them to tell me he had CTE. There was actually a little bit of relief – not relief, but closure – to know this was what had been causing his issues and his problems.”

Langston is part of a growing group of former college football players and relatives suing the National Collegiate Athletic Association (NCAA), which they say failed to properly protect or warn its players of the danger of repeated concussions.

Decades of scientific data, from the first peer-reviewed paper on “punch drunk” syndrome in boxers in 1928 through to Omalu’s 2005 article on CTE in a professional football player in 2005, should have provided ample evidence of potential harms, attorneys argue.

Some lawyers believe the case could grow larger than the roughly $1bn deal retired NFL players struck with their former employer, intended to care for 20,000 players. Each year, more than 70,000 young men play on teams like Zack Langston’s.

“I am indeed very concerned about professional football players,” said Robert Stern, who co-authored the recent study from Boston University. Stern is part of a four member medical committee advising on a current NCAA lawsuit. “But from a public health standpoint, I’m much, much more concerned about the high school and college football players.”

Though 91% of the 53 brains of college players examined by Boston University had CTE, it is not yet possible to estimate how many players might develop the disease.



CTE can only be diagnosed after death, and the people whose brains were examined by Boston University almost all experienced symptoms during life.

“It wasn’t until the early 70s that children from age six on began to experience these hundreds of subconcussive hits per season,” said Stern. “When you put it together, and you look at folks who only played in high school or who only played in college since 1970 ... there’s around 12 million americans, at a minimum.”

In a separate lawsuit, lawyers have already successfully sued the NCAA to establish a $70m medical monitoring fund for former college players. The current group of lawsuits, to which Langston’s estate is party, is gathering steam to compensate former players and their families. The NCAA did not immediately respond to a request for comment.

Mothers like Nicki Langston are hoping for more lasting change. She and a small group of football mothers who survived their sons, called Faces of CTE, argue no one younger than 14 should play tackle football. “I absolutely do not feel kids should be playing football, absolutely not,” Langston said.



“I’ll drive by football fields – middle schools – and I see these boys out practicing and it just makes me ill … The first time I saw it this season, I wanted to jump out of my car and say, ‘Do you know what you’re doing?’”