NFL Faces Clash on Concussions
Be tough. Play hurt.
That mentality is woven into the fabric of the NFL. But amid an aggressive movement within the league to better prevent and manage the treatment of concussions - including stricter return-to-play guidelines announced Wednesday - it's apparent a shift in football's macho mind-set is also needed.
Pittsburgh Steelers wide receiver Hines Ward has fueled much debate since questioning Ben Roethlisberger's toughness and in timating that the locker room was split "50-50" on whether the injured quarterback should play during an interview Sunday night with NBC before a key game at the Baltimore Ravens.
Roethlisberger, to whom Ward has since apologized, was scratched from the game by doctors because of headaches that lingered from a concussion suffered the previous week.
Ward, a 12th-year veteran, also told NBC's Bob Costas that on more than one occasion he has lied to doctors about symptoms he experienced after suffering head injuries in order to be cleared to play - underscoring the notion that it is common practice for NFL players to risk further damage.
"Anybody fortunate to have a career in this league like Hines Ward has lied about the symptoms," says Arizona Cardinals wide receiver Sean Morey, a former teammate of Ward's and co-chairman of the NFL Players Association's concussion and brain injury committee formed Oct. 2. "The culture is that you play injured. But with head injuries, there's a lot of gray area in determining whether you are hurt or injured."
Such an issue also has hit home this week in Morey's locker room.
Roethlisberger's counterpart from Super Bowl XLIII, Cardinals star Kurt Warner, told The Arizona Republic that he considered lying to doctors about his post-concussion symptoms before he was ruled out of Sunday's game at the Tennessee Titans. Like Roethlisberger, Warner was hurt the previous Sunday. He worried that teammates would second-guess his desire to play but ultimately told doctors of lingering neck pain.
"That's the whole key with this issue, is a player being honest," Warner said. "I can tell you I wrestled with it when I was going down to that room to talk to them (before the game), saying, 'Uh, do I want to stretch the truth a little bit? Do I want to tell them everything so I can play? Because I know I could dictate that.
"But I had to go, 'What are you thinking? This is bigger than that.' The easy thing to do is play. The hard thing is to make the decision where you feel like you could be hurting your team but you don't know whether you're putting yourself at risk or not."
NFL and union on the case
The prevention and management of concussions has become a front-burner issue in the NFL. Commissioner Roger Goodell has moved to implement revised policies that include requiring the presence of independent medical experts during games to evaluate and treat players who have suffered head injuries.
The process of securing independent experts hasn't been completed, but the NFL announced Wednesday that, effective immediately, teams are advised that players showing symptoms of concussions should not return to games or practices that day and until they are cleared by the team physician and an independent neurological consultant. Previously, loss of consciousness was the measuring stick.
The players union also has been proactive, forming its own committee and pushing the league to revamp its concussion committee - which resulted in the resignation last week of co-chairmen Ira Casson and David Viano. An Oct. 28 hearing before the House Judiciary Committee probing long-term effects of head injuries in the NFL also raised awareness.
Add the concussions suffered in recent weeks by high-profile players, including running backs Brian Westbrook of the Philadelphia Eagles and Clinton Portis of the Washington Redskins, and attention on the issue might be unprecedented.
According to the NFL, about 175 concussions occur league wide each season - which equates to roughly one for every other game, including preseason and postseason. Yet, given that these injuries can be hidden, some suspect the actual number could be higher.
"If you've had five documented concussions, you probably can double or triple it," says former Cincinnati Bengals tight end Ben Utecht, who is contemplating retirement after suffering a fifth concussion during a training camp blocking drill in August. "That means you've probably had 15 in your career."
It's possible that some players don't know if they've had a concussion. Minnesota Vikings defensive end Jared Allen was asked if he ever had a concussion.
"Not me," Allen said Sunday. "Concussion-free. But I'm sure I play with one every year."
Former Dallas Cowboys quarterback Troy Aikman, who retired after the 2000 season following a series of concussions during a 12-year career, says that while he commends league efforts, he worries that players will be more hesitant to reveal symptoms.
"My concern is: How many head injuries now will go unreported?" Aikman said of the more stringent policies. "No player is going to want to come out now and say, 'I had a concussion.' Once you say that, you're out at least a week. So now guys will be reluctant to report it. Teams will be reluctant to report it."
Aikman's suspicion might have been validated by a poll of 160 NFL players conducted Nov. 2-15 by the Associated Press. While about half of the players maintained they had suffered at least one concussion, 30 indicated they have hidden or played down the effects of a concussion.
"We need to continue to impress upon them the importance of recognizing their injuries," said DeMaurice Smith, the NFLPA's executive director. "But we must also try to understand what motivates that fear."
Better education sought
Smith thinks that in addition to an NFL culture that is wrapped in the expectation to play through many types of injuries, players might be concerned about losing their jobs and/or don't understand the significance of head injuries.
In step with new policies, Morey is in a chorus declaring the need for better education about the effects and ramifications.
"Here's the No. 1 thing players need to understand: It's not your call," Morey says. "I think players can play through a lot of things, but this is one area where they need to rely on the experts."
Mark Lovell, director of the University of Pittsburgh's sports concussion program and independent consultant to the NFL, is among the doctors who say that failing to treat head injuries properly could lead to clinical depression, cognitive deficiencies and early stages of dementia, in addition to other issues. Still, new findings constantly are revealed. Says Lovell, "Eighty to ninety percent of what we know now, we learned in the last five or 10 years."
Lovell collaborated with Steelers neurosurgeon Joseph Maroon to develop a baseline test that measures cognitive functions and reaction. The test, which provides a comparative tool when players are retested after suffering head injuries, has been used by the Steelers since the late 1990s, but it didn't become a requirement for all NFL players until 2007.
Morey thinks debate within the medical community about the long-term effects of concussions is a major reason the NFL hasn't moved faster to implement some of the policies. Shortly after Smith was named to his post in March, Morey urged him to form the union's committee.
"There's been a resistance on behalf of the NFL to embrace a number of medical studies over the last few years," Smith said. "It is the primary reason we formed our own traumatic brain injury committee. We don't have to rely on the people who employ our players to do everything."
During the hearing on Capitol Hill that addressed concerns of retired players, Goodell outlined aspects of league efforts in dealing with head injuries, including the investment of more than $5 million in research over the last 15 years.
He testified that the research has resulted in the development of new helmets, while underscoring emphasis on rules and treatment as priorities.
Goodell also recently assigned his new special assistant, former coach John Madden, to seek recommendations for reducing head injuries from a coaches committee that he chairs. The panel is considering reducing offseason contact work.
Aikman, for one, wonders how rules changes might affect the game. "It's a slippery slope," Aikman said. "I don't know how you eliminate some of the helmet-to-helmet contact and still maintain the integrity of the game."
Utecht, who experienced post-concussion symptoms for three months, appreciates the emphasis on concussions.
"The idea that you could be one hit away from ending up like Muhammad Ali is scary," Utecht said.
He also wants to play again. In that regard, he knows he is hardly alone. "Even as concussions become viewed as a more serious issue, players are gladiators," Utecht said. "And they still want job security and the chance to make a paycheck."