A former hockey enforcer searches for answers on CTE before it’s too late
By David Waldstein
Page 68 of Boston University’s Hope Study questionnaire asks, “Have you ever injured your head or neck in a fight or been hit by someone?”
For Chris Nilan, a simple yes could never convey the whole story.
The answer stretches out over 300 bare-knuckle fights as a professional hockey player and countless other brawls on the street corners of Boston beginning in his childhood. Most times, Nilan was the one dispensing the punishment. But hockey fights almost always involve mutual, bone-crushing blows, sometimes fracturing bones and rattling brains.
The Hope Study, run by BU’s Chronic Traumatic Encephalopathy Center, has been measuring the brain health of living subjects with Alzheimer’s disease and related dementias since 1996. Nilan, curious about the condition of his brain after years of on-ice battles and eager to help with the research, turned to BU, where participants return each year to repeat extensive testing, and eventually donate their brains. CTE can only be diagnosed posthumously, but the Hope Study’s testing can provide valuable clues while patients are alive.
Over his 13 years in the league, Nilan, who was labeled Knuckles before he even turned pro, fought an astonishing 316 times, the third most in NHL history, according to the NHL Fight Card database. All of it was followed, coincidentally or not, by years of drug addiction, alcohol abuse and anger issues before Nilan settled into a quiet life in a Montreal suburb. An engaging, humorous sort with a Boston accent, Nilan now hosts the “Raw Knuckles” podcast, fishes, cooks, reads, runs addiction recovery groups and spends quiet time with his fiancee, Jaime Holtz.
But if there was ever a high-risk candidate for CTE, the degenerative neurological disease associated with repeated impacts to the head, or body blows harsh enough to rattle the skull, Nilan would fit the category.
Researchers have long suggested that the more hits to the head someone receives, including subconcussive ones, the more likely they are to develop cognitive and neurological problems later in life. A study earlier this year of football players’ brains suggested the cumulative impact of multiple hits can also play a role.
Some 30 years after retiring from a violent and successful career, Nilan signed up for the Hope Study.
“I don’t worry about having CTE,” Nilan said. “But sometimes, you wonder.”
Ten years ago, there might have been more concern. Nilan’s past substance abuse and outbursts of rage mirror some of the behavior exhibited by other hockey enforcers following retirement — players like Bob Probert, Derek Boogaard, Wade Belak, Todd Ewen and Steve Montador. All of them were diagnosed with CTE, which can only be detected after death.
Nilan is 65 and sober now, still with a sharp wit and a vivid memory of a tumultuous life.
On April 17, Nilan entered the Hope Study. He and Holtz answered background questions from their home over a video conference call with researchers, who asked about Nilan’s family and behavioral history, his moods, his memory, his mother’s dementia and his career on the ice.
A few weeks later, he went to Boston for the cognitive and medical testing, and a month after that, he received results that can give participants a snapshot of their brain health at that moment.
Nilan went into the study feeling healthy and robust, perhaps even a bit lucky. He empathizes with players who suffered from the same dangerous work that he did but points no fingers. Nilan does not believe the sport caused his past substance abuse issues, and he does not regularly suffer from depression.
But because of his nearly unmatched history of fighting in hockey, Nilan has emerged as an important subject for researchers studying the effects of repetitive brain impacts and ways to detect it before death.
Even if he does not have CTE or show signs of cognitive impairment, researchers will want to know why not, and what can be learned from it.
“That’s huge,” said Dr. Michael Alosco, the co-director of clinical research at BU’s CTE Center. “Why do some people get it, and some don’t? What is different about them? It could be very informative for treatment and prevention.”
Over a day and a half in Boston, Nilan underwent a battery of medical, cognitive and neurological exams designed to help researchers learn the causes and effects of repetitive head impacts that can lead to CTE, and perhaps one day design a test that will detect it in living patients.
Nilan had his blood and spinal fluids drawn and was scheduled for magnetic resonance imaging of his brain. He tackled cognitive and memory tests involving word games, number sequences, short stories and mazes.
There are more than 400 participants in the program now, and about one-third have been exposed to repetitive head impacts.
In some ways, Nilan’s contribution to the study was an opportunity to do in retirement what he loved most as a player: defending teammates. Nilan accumulated 3,584 penalty minutes over the regular season and playoffs, the fifth-most in league history, and he played almost 300 fewer games than the top four offenders. He twice set the Canadiens record for most penalty minutes in a season: 338 in the 1983-84 regular season and 358 the following year.
“If what I do now can help them figure out ways to detect CTE earlier,” Nilan said, “maybe guys in the future can be forewarned and saved from further damage.”
Chris Nilan is a quintessential Bostonian of a certain time and demographic, the kind they make movies about: A tough, working-class hockey player of Irish descent, hundreds, if not thousands, of local kids yearned to be just like him. He was born Feb. 9, 1958, at the Faulkner Hospital in West Roxbury, Massachusetts, the son of Henry and Leslie Nilan, a hardworking, blue-collar couple who raised their four children in a strict household. Chris Nilan still found his way into scraps as a kid and soon discovered he was a capable and fearless fighter. Often, he said, it was in defense of others.
Fighting is far less common in today’s NHL than it was in the 1980s and ‘90s, as the league has ushered in rules modifications and a faster style of play, even though Gary Bettman, the league commissioner, still denies a link between fighting and CTE. Nilan opposes a ban on fighting but acknowledges being sickened when a player is knocked unconscious in a fight.
In the years after his career ended, his hands, knees and back throbbed from 13 years of pounding and too many surgeries. Nilan began ingesting Percocet, a prescription pain killer, and then became addicted to oxycodone and alcohol.
He eventually found heroin and took it intravenously. In 2015, his mother had a stroke, and Nilan went to visit her at Faulkner, the hospital where he was born. He asked a drug dealer to meet him there, and he shot up in a maintenance closet. The next thing he knew, he was on a gurney with a nurse calling his name, yet another overdose victim.
Nilan met Holtz in rehab, and she has been his stanchion, guiding him out of relapses and back to recovery. The researchers asked Holtz about Nilan’s memory and moods and if he displayed moments of rage. She explained that several years ago, she told Nilan that if he did not get his anger under control, she would leave him.
“He would lose his temper for the smallest things,” she said. “Chris acknowledged those issues in his life and is completely different now. All of that has changed. He faced some hard truths and emotions and dealt with them. Growing up, that is how he was raised.”
Nilan adored his father, who died in 2021, and is immensely proud of him. Henry Nilan was a Green Beret in the Army reserves and a draftsman at Draper Labs in Cambridge, Massachusetts, and he worked hard to provide for his family. He also hit Chris Nilan as punishment until Chris was about 16 and threatened to run away. Growing up in that environment, he said, led to much of his anger and propensity to violence, not his career as an enforcer.
On June 8, Nilan and Holtz sat in Nilan’s podcast studio in their home and listened to Alosco and Hannah Bruce, a fellow researcher, present the findings. The results cannot rule out CTE, but they were very good for Nilan. His cognitive, memory and motor tests showed he was well within the normal range for his age, gender and education. In most, he was above average. Had there been any reason for concern, Alosco would have recommended clinical care for diagnosis and treatment, which he did not consider necessary at the time.
Alosco said Nilan is in a very high-risk group and urged him to remain vigilant with his sobriety and a healthy lifestyle. He also asked him to return for the yearly research follow-ups, and Nilan said he would.
At the end of the meeting, Alosco stressed that researchers want to know the factors that have made Nilan appear resistant so far to degenerative neurological disease, whether genetics, medical history, the types of head impacts, his lifestyle or other factors.
“That’s why your data might be so valuable to answer who is resilient to these long-term effects of repetitive head impacts,” Alosco told Nilan.