NFL’s Probe Has an Impact

Merril Hoge endures the searing studio lights while taping ESPN’s “NFL Matchup� show, hides his pain and talks knowledgeably about a sport he’s loved since childhood.

Later at his home in Pittsburgh, he dims the lamps and waits in the soothing semidarkness for an end to the pounding, numbing headaches.

Some days his head throbs morning to night, his vision filtered as if through a veil, the world separated from him by a gauzy haze.

There were worse times shortly after he suffered four concussions in five weeks in 1994 and played his last game at 29 after less than a season as running back for the Chicago Bears and seven for the Pittsburgh Steelers.

There were the three days when he didn’t recognize his wife or daughter. Days when he couldn’t remember his phone number or address. Days when he felt so paranoid or apathetic or tired he didn’t care if he lived or died.

He still can’t remember the day he announced his retirement.

“The scary part is worrying about maybe becoming senile at a young age,� Hoge says, his voice choking at the thought of being a burden to his wife and two children. “The doctors told me I very well may have sped up something that normally might happen at 75 or 80, and it could happen now at 45 or 50. It makes me mad that I wasn’t treated with a little more concern. I deserved that.�

Hoge, Steve Young, Stan Humphries, Troy Aikman and other players who have suffered head injuries are part of separate studies by the NFL and the NFL Players Association to examine the epidemic of concussions in the league.

The NFL study is looking at the players with concussions reported on injury lists--20 so far this season, including five quarterbacks--and dozens more who had concussions but didn’t make the list because they didn’t lose playing time. Not counted will be the untold number of loopy players who either didn’t reveal they had a concussion or didn’t realize they had one.

The union’s study is focusing on about 1,200 retired players to examine the long-term effects of cumulative concussions, from the punch-drunk syndrome observed in some retired boxers to milder but significant reactions like those experienced by Hoge, former New York Jets receiver Al Toon and former St. Louis Rams quarterback Chris Miller.

Dr. Elliot Pellman, the Jets’ physician and chairman of the NFL’s subcommittee on mild traumatic brain injury, estimates there are about 200 concussions in the league each season. Most of them are mild “dings,� causing brief bouts of confusion and/or amnesia but no loss of playing time.

In San Diego last weekend, Chargers quarterback Stan Humphries stayed at home with his family rather than make the trip with his teammates to San Francisco. His head still rumbles and his nights are still torn by bouts of insomnia. Next week, a month after his second concussion of the year and fourth in two years, he goes to the doctor for a new battery of neuropsychological tests, his career uncertain at 32.

Humphries wants to keep playing but knows he’s not in the same situation as the 49ers’ Young, rocked for his third concussion in 10 months in the opening game this season, but back two weeks later.

“My symptoms were very straightforward,� said Young, who was scared for Humphries when he saw a tape of one hit he took, his eyes rolling wildly. “That’s why I had a real sense of peace about my own decision. I had a headache for a number of days. I lost a little sleep and memory for a while. But then it constantly got better. I didn’t have any of the real serious symptoms like Stan’s having.�

Pellman doubts the studies will show football players with the kind of brain damage seen in boxers like Muhammad Ali and Jerry Quarry. Mike Tyson, for example, “must have gotten nine (concussions) in one round� in his first fight against Evander Holyfield, Pellman said.

“Fighters have one mild traumatic brain injury after another without completely recovering,� he said. “They could never go on like that in the NFL. Besides the ability to recall things, get new information, hear audibles being called, you just can’t function. That type of pugilistica dementia we don’t see in the NFL, I believe.�

In high school and college football, studies have estimated 5% to 20% of the 1.2 million players suffer concussions each year--an especially frightening number since many schools do not have qualified physicians at each game.

Though many NFL players believe there are more concussions in recent years because players are bigger, faster and stronger than ever, Pellman suspects the rate of concussions has stayed about the same in football at all levels as long as the game has been played.

The main things that have changed, he said, are a broader definition to include concussions that don’t involve a loss of consciousness; improvements in tests that reveal subtle symptoms or structural damage to the brain; and the publicity surrounding high-profile players who have been hurt.

One thing that hasn’t changed in about 25 years are helmets. They were designed to prevent major brain injuries, such as skull fractures or bleeding in the brain, but “no one ever designed them for (concussions) because it wasn’t a concern up until about four years ago,� Pellman said.

One of the most famous photographs in football history is a grisly portrait by The Associated Press of New York Giants quarterback Y.A. Tittle dazed and on his knees in 1964, his helmet off and blood gushing from a cut over his eye.

He speaks casually, and with a sense of pride, about the way he and other players of his era stayed in games despite concussions. In one game for LSU against Vanderbilt in the 1940s he was knocked out, woke up on the sideline and returned in the second half to throw the winning touchdown pass.

“I was knocked unconscious at least five times in my career,� said Tittle, a Hall of Famer who played from 1948 to 1964 for the Baltimore Colts, San Francisco 49ers and Giants.

“A lot of times,� he said with a laugh, “coaches put up their hand and asked, ‘How many fingers do I have up?’ That was the test. Even if I was groggy and couldn’t remember anything for a few plays, I would do things sort of automatically that I was trained to do. Yet I could get over to the sideline and not remember who we were playing. I wondered, ‘What am I doing? What is the score?’ And I’d have to look at the scoreboard. I didn’t tell anybody a lot of times because I didn’t want to get substituted for.�

Despite all those concussions, Tittle said he never had prolonged effects from them. Nor was he aware of other players who had concussions who suffered symptoms for very long.

“I heard all that talk about Steve Young and how he should’ve retired,� said Tittle, whose insurance agency in Palo Alto, Calif., is near Young’s house. “But look how he’s come back, and he’s just as good as ever as far as his playing performance is concerned.�

Young doesn’t quite see it that way, though.

“Because of the scrutiny,� Young said, “the players almost have the right, given by the football fathers, to say, ‘You know what, I’ve got some concussion problems and it’s OK not to play,’ or ‘It’s OK to retire because of it.’

“You talk to Chris Miller, Merril Hoge and other guys and they’ll tell you they can’t remember how to get home, or they can’t taste the difference between hot and cold. For every guy who says there isn’t anyone that has been affected, there’s been a guy who’s been affected for a long time.�

More important than the number of concussions, Pellman said, is defining who is at risk for post-concussion syndrome--a long-term condition characterized by numerous, often debilitating problems from brain injury--and stopping injured players from returning too soon.

“I don’t want our study to be a witch hunt,� he said. “The numbers we’re seeing convince me that post-concussion syndrome is a very, very uncommon event.�

In Pellman’s 11 years with the Jets, he has seen post-concussion syndrome with three of his players, Toon, Boomer Esiason and Marcus Turner.

“And of those, Boomer and Marcus did fine, and it was really only Al Toon who had long-term problems, and he’s 95% better now,� Pellman said.

Certainly there are now more diagnoses of “mild concussion,� a term that came into vogue a few years ago as doctors became sensitive to the varying degrees of the injury.

Concussion used to refer only to people who were knocked unconscious or who suffered amnesia and confusion. Under new guidelines, a mild or Grade 1 concussion describes a condition of confusion but no amnesia or loss of consciousness; a moderate or Grade 2 concussion involves confusion with amnesia, and no loss of consciousness; and a severe or Grade 3 concussion involves loss of consciousness.

For each of those categories, doctors have developed a general course of treatment.

But diagnoses and treatments are not always simple. Doctors found that players who received more than one concussion in a short period or a high number in their careers risk long-term, perhaps permanent, damage. Worse, second-impact syndrome, a rare condition characterized by swelling on the brain from a jolt too soon after the first concussion, can be fatal, as it has been for about 15 high school and college players.

Pittsburgh quarterback Kordell Stewart suffered a mild concussion in the second half of a game this season, came out, and returned to play the next week.

“In Kordell’s case, he was definitely confused, but this cleared within a reasonable period of time. All the data we had indicated it was safe for him to play again,� said Steelers physician Dr. Joseph Maroon, who with former partner Dr. Julian Bailes first used neuropsychological tests on players several years ago.

Those tests--to see how a player processes information, whether his short-term or long-term memory is impaired, and whether he can perform rapid alternating skills the way he could before injury--have become the standard by which NFL team doctors evaluate the effects of concussions.

A few days after Green Bay Packers wide receiver Don Beebe was knocked out for 10 minutes on Sept. 28 when he was sandwiched on a slant in Detroit, he spoke of how fragile his head felt and why he would have to sit out the next game.

“It’s kind of like you put an egg in a pan when you just open it from the shell,� he said. “If you touch it right away, the yolk will burst. But if you let it cook for a while, and let it set and harden, then it’ll take a bigger poke. That’s the way my head is right now. They have to wait until the swelling goes down in my head.�

Beebe missed one game, practiced the following week and played every game after that, ignoring pleas from his wife, Diana, to retire after six concussions in nine years.

Hoge wanted to keep playing, too. He’s angry he wasn’t sidelined longer by the Bears’ doctors after his first concussion in the last preseason game of 1994, and that he wasn’t told of the risks he faced or the symptoms he might notice when he returned to practice a week later.

“The first one was like an earthquake,� said Hoge, jolted in the head by tacklers from three directions. “I remember fighting like mad, mentally, to get up. But I went back to the huddle, played two more plays, and walked to the sideline. I told them I got hit in the head, and I guess they sat me down and asked me a bunch of questions I couldn’t answer right.�

Hoge was taken to a hospital, where he was evaluated with a Grade II concussion because he hadn’t lost consciousness. But the severity and persistence of his symptoms, Hoge was told later, might just as well have put him in the Grade III category, which would have kept him out of uniform longer.

“If you look at my symptoms, a neurological doctor would say, ‘Listen, you need four to five weeks,�’ Hoge said. “It’s like we know 555-1212. We can rip it off like that. Well, after my concussion, five or six days later, I could get to the number, but it was more like 5-5-5, uh, 1-2-1-2. Just that little subtle delay is telling you the wiring up there in the brain is not functioning at a normal level.�

When Hoge returned against Tampa Bay, he felt overwhelmed in the huddle trying to follow the plays. Still, he kept playing, unaware that his lapses were related to the first concussion or that they could presage more serious brain damage. The Bears’ doctors, he said, never examined him after the first concussion and didn’t tell him about possible symptoms.

Pellman understands Hoge’s anger but says that, just as with Toon the year before, post-concussion syndrome among football players wasn’t a recognized problem at the time and expertise was scant.

“It was eerie to watch films of the plays,� Hoge said. “When I ran a play in the flat, I fell and stumbled all over myself. It just looked like I was a dummy or a smashed drunk.�

Hoge had two more concussions, one against Tampa Bay and one in Philadelphia, that weren’t diagnosed or reported on the injury list. In fact, he realized they were concussions only after the season when he described them and the effects they had on him during an examination by Maroon, a brain expert and his former doctor at Pittsburgh.

But that diagnosis came too late to prevent post-concussion syndrome and save Hoge’s career. His last concussion came against Buffalo when he collided with a cornerback on a sweep.

“Granted, I wanted to play, but what burns me to this day is they risked not just my career but my life because of the second-impact syndrome that could be involved,� said Hoge, who has considered a lawsuit but hasn’t taken any action against the Bears.

Even in the aftermath of Hoge’s and Toon’s retirements, and the concussions of Aikman, Young and Humphries, most NFL players still are largely oblivious to the signs and dangers of concussions, Hoge said.

“Every football play there’s a potential for one of those concussions,� Hoge said. “Rules can’t change it. And if you say they can, and if you say a better helmet can, then you’re ignorant of the injury. Players need to understand that, educate themselves, get properly evaluated, and rest for as long as it takes. I don’t want somebody to die on the field before players realize how serious this is.�