NFL players in harm's way

"Take a left right here," Merril Hoge told his driver, who was navigating the streets of downtown Pittsburgh during morning rush hour.

And then Hoge slipped, seamlessly, back into his monologue on so-called mild traumatic brain injury.

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"Some of the permanent aspects are dealing with bright light, sunlight and the overall fatigue of it," he said, talking on his cellular phone. "I still get headaches all the time."

Hoge paused briefly.

"Take a right at the light," he instructed the driver.

"The headaches don't seem to digress," Hoge continued, "but they haven't increased in severity, either. I feel sharp -- I've worked at it. But in a sense, I feel like I'm not quite where I was."

Still, the fact that Hoge was effectively multi-tasking, carrying on two completely different conversations almost simultaneously, is a major cognitive victory for the former NFL running back, now a respected ESPN and NFL Films analyst and the chairman of the board of the Western Pennsylvania Caring Foundation.

Nine years ago, Hoge was standing in his Lake Forest, Ill., kitchen, wondering why he couldn't focus long enough to deliver more than a few coherent sentences at a time. He had been hit by a Buffalo Bills cornerback -- just grazed, really -- in the Chicago Bears' fifth game of the 1994 season. But it was his second concussion in a month and, ultimately, it ended his career.

As he attempted to explain what he was feeling that gray October day, Hoge verbally stumbled and winced.

"You see what happens?" he said wearily. "I get lost. I have no idea what you just asked me. It's like I've got Alzheimer's."

The road to recovery was frightening and frustrating. He used to carry his phone number in his wallet because sometimes, even when he was just going to the mailbox, he couldn't always find his way back home. It took him three years to learn to read all over again.

Hoge is not bitter about the game that, quite literally, knocked some sense of himself out of his head. He believes it is a game well worth playing, despite the risks.

"I believe when you formulate the correct technique and administer it at the youth level, the less likelihood there will be of injury," Hoge said. "The advancements in helmets and equipment is seriously important, but brain trauma is going to occur -- it can't be stopped. Not unless they invent a helmet to put on the brain."

Study: Hitting a brick wall
TV ratings, along with other measures, indicate football is the most popular game in America. It is also the most routinely violent. According to a recent study, there were 497 brain injury-related fatalities in American football between 1945-1999.

The vast majority (75 percent) of those deaths were to high school athletes. None, however, occurred on an NFL field, where the athletes are bigger, faster and stronger.

And yet, a recent Virginia Tech University study that featured helmets with acceleration sensors reported one hit on a linebacker that registered at 124 times the force of gravity. A typical fullback, researchers learned, will suffer 27 hits per game with impacts of 10 G to 111 G.

"Yes," said Mike Goforth, Virginia Tech's head athletic trainer, "we were surprised. That's like running your head into a brick wall.

"I'm as big a football guy as there is but, yes, it does concern me. They're getting bigger, faster and stronger, and they're wearing lighter and lighter equipment. When do we start building them too big and too fast? What happens when you don't have anyone left to play the games?"

The average NFL player, based on the initial 2003 rosters, weighs 245 pounds. The Seattle Seahawks averaged a league-high 249.8 pounds, and the Oakland Raiders had 10 offensive lineman tip the scales over 300 pounds, averaging 322 pounds per man. Before he was drafted from Syracuse in 2002, Indianapolis Colts defensive end Dwight Freeney ran the 40-yard dash in 4.38 seconds, an unprecedented time for a defensive lineman.

Dennis Smith, who played safety for the Denver Broncos from 1981-94, was voted to play in six Pro Bowls because he was such a ferocious hitter.

"Hitting another human at full speed is not a normal thing," he once said. "But it's my job and I have to do it."

Defensive players, judging by their behavior after administering big hits, seem to relish them. When Buddy Ryan was the coach of the Philadelphia Eagles from 1986-90 there were alleged bounties on opposing quarterbacks.

Early this season, on Oct. 5, Dallas safety Roy Williams drilled Arizona running back Emmitt Smith, his teammate in 2002. Smith's scapula was fractured.

"I like to hit," Williams said, who also broke Kurt Warner's hand while he was blitzing in 2002.

Carson: 'That's your brain'
Harry Carson was a warrior who similarly inspired fear in opponents. He played inside linebacker for the New York Giants from 1976-88 and is a finalist for this year's Pro Football Hall of Fame vote. He paid a terrible price for that potential honor.

The entire thrust of Bill Parcells' brutal defense in the run to Super Bowl XXI was funneling the ball carrier to the middle of the field so Carson could make the tackle.

After his career, Carson pursued a career in television. He was on the sideline a few years ago doing an interview with Syracuse's Paul Pasqualoni when the head coach's name flew out of his head.

"Right in the middle of the interview, I forgot his name," Carson said from his Bergen County, N.J., home. "I would lose my train of thought. I would get anxious when they'd throw it down to me live. You're thinking, 'What am I going to screw up?'

"Toward the end of my career, I had to pick and choose my words very carefully. Words that I'd normally come up with, I'd see them in my head, but I couldn't pronounce them. I'd be searching for the word and go, 'Um, um, um.' It was somewhat embarrassing. I would listen to vocabulary tapes on the way to practice to retrain my brain."

Today, Carson still suffers from the effects of post-concussion syndrome. He still has his foggy moments, occasional headaches and lethargy, but said, for the most part, he feels good and continues to learn how to deal with the symptoms.

Regardless of evolving equipment safety, concussions, he said, will never decrease.

"No," Carson said. "It's the nature of the game. You have objects in motion and then, suddenly, they stop. Look at the egg. There's a collision and the yoke crashes against the shell.

"That's your brain."

Pellman: Searching for answers
Elliot Pellman was the New York Jets' associate team physician when wide receiver Al Toon was forced to retire in 1992. Toon was suffering from severe headaches and depression, but little was known about what had caused his condition.

Pellman sensed that it probably was related to the concussions Toon had sustained over his eight-year NFL career, but he didn't know much more than that. Post-concussion syndrome had not yet been identified. During Pellman's years of medical school, internal medicine training and fellowship from 1975-86, he had never received a single lecture on concussions.

He vowed to learn more.

In March of 1995, spurred by the highly publicized cases of Al Toon, Merril Hoge and others, the NFL implemented a number of safety-related rules changes that dealt with the use of the helmet against defenseless players. The retirements of Steve Young and Troy Aikman shed further light on the cumulative effect of multiple concussions.

Since then, the league has attempted to discourage illegal hits with big fines. While playing for San Diego in 2002, New England safety Rodney Harrison, who has accumulated nearly $300,000 in fines during his NFL career, was suspended for one game -- losing a $111,764 paycheck -- for a helmet-to-helmet hit on Oakland's Jerry Rice. In addition, a fine of $50,000 was imposed on Philadelphia safety Brian Dawkins, and Darren Woodson of the Dallas Cowboys was tagged for $75,000.

While it had long been believed that NFL players had a shorter life span than non-players, a 1994 study by the National Institute for Occupational Safety found that football players died at a rate 46 percent less than that of the general population. Certainly, the overall fitness of the league's athletes works in their long-term favor despite the obvious health risks of their profession.
-- G.G.

"At the end of day as a physician, you have to ask yourself, 'Did I do everything I could?' In my original work with Al Toon, I was confused and frustrated that I didn't know as much as I should," Pellman said from his Long Island office. "My quiet pledge to Al, and myself, was to start getting some answers."

Today, Pellman is the chairman of the NFL's Mild Traumatic Brain Injury Committee. A $2 million project by the NFL that studied brain injuries from 1996-2001 and recently was made public is beginning to provide some of those answers.

The results, published in an ongoing series of articles in "Neurosurgery," a medical journal, are staggering. In those six seasons, there were 787 reported cases of mild traumatic brain injury. This works out to a rate of 0.41 concussions per game. Most came as a result of collisions between 17 and 25 miles per hour and the average impact was 98 G.

There was no trend of increased concussions through the six seasons; the number, according to Pellman, has remained fairly constant over the years.

Defensive backs suffered the most injuries (18.2 percent), followed by members of the kicking unit (16.6 percent) and wide receivers (11.9 percent). Quarterbacks, the subject of recent protective legislation in the league, suffered only 7.9 percent of those concussions.

Some 282 injuries were incurred on passing plays (39.1 percent), while running plays registered 31.3 percent and kickoffs 18.5 percent.

Interestingly, the majority of the injury-inducing hits occurred to the side of the helmet, not the front. And almost always, it was the offensive player -- not the striking defensive player -- who suffered the injury.

Researchers at the Ottawa-based firm Biokinetics & Associates studied videotape of 182 concussions and were able to recreate 31 of them in the laboratory with crash-test dummies.

"We answered a number of questions with the first two publications -- which areas of the head are most vulnerable and which positions are most susceptible," Pellman said. "This type of science gives us information that is clinically useful.

"From my vantage point, this study was unique for any sports league. The players will be the ones who benefit most and, hopefully, it will sprinkle down to the colleges and high schools."

While the experts were deconstructing film and recreating collisions in the lab, researchers at Virginia Tech were dialed in to the actual crashes on the football field. Led by team physician P. Gunnar Brolinson and project leader Stefan Duma, a mechanical engineer, the project covered the entire 2003 football season.

Eight helmets were equipped with sensors of the kind that trigger air bags in cars and they were rotated by position for two practices per week and for every game -- a total of 48 sessions that included 38 different players at eight different positions. During that time, more than 3,300 impacts were recorded.

"Fortunately, none of the subjects suffered a concussion," said Goforth, the head athletic trainer. "And, unfortunately none of them suffered a concussion -- if you know what I'm saying. Still, we were able to measure real-time impact."

While the G forces involved are eye-opening, Goforth said it was difficult to measure the cumulative effects of blows to the head.

"Which is worse, one blow at 124 G or 10 hits at 70 Gs each?" he asked. "It's hard to know. How much can the human body take, what's the threshold? We just don't know. That's why we need to study more. We're looking for further funding.

"Our hats are off to the Pellman people. Between their study and what we're doing, you're going to see some ground-breaking data in the future."

Recovering from the hangover
Harry Carson wasn't in the lineup for the Giants this season, but his old team handed out some punishing hits.

In the opener against St. Louis on Sept. 7, they knocked around Kurt Warner and he suffered a concussion -- he never returned to the starting lineup as Marc Bulger took the team to the playoffs.

On the same field on Nov. 2, the Jets' Wayne Chrebet suffered a similar injury -- and fate. He was placed on injured reserve 10 days later and never played again.

Warner, who backed up Bulger the rest of the season, has reportedly suffered three concussions during his career, but was cleared to play the following week against San Francisco. That Chrebet was prevented from playing for the rest of the season underlines the growing awareness of the dangers of head injuries. It was at least his fifth concussion, going back to his college career at Hofstra.

Chrebet hopes to play next year, but he's not sure.

"I'm not the final say," Chrebet told New York writers back in December. "You look at the risk involved there. I want to play, obviously."

Chrebet described the days after the concussion this way: "It's like you fell into a black hole -- you wait for the sun to come out again. It's a crazy thing. Every morning you wake up feeling hung over, like you had the worst night of your life."

Carson was in the stands when Chrebet went down.

"The guy goes across his head and I went, 'Oops ... concussion.' I called it," Carson said. "When Warner got hurt, I saw him fumbling and thought, 'He's not himself.'

"It's like rolling the dice -- it could happen to anyone. You can't look at one thing to stop concussions. You catch an uppercut with a forearm, a helmet-to-helmet and your head is going to go back. Your brain is going to sort of rattle around."

That's what happened to Hoge at Chicago's Soldier Field in his final NFL game. When he went down, the trainers ran out onto the field.

"Where are you?" they asked him.

Hoge didn't hesitate.

"Tampa Bay," he answered.

The trainers exchanged glances.

"Why?" they asked him.

"Because," Hoge answered confidently, "I can hear the ocean."

Today, Hoge's success after football is a tribute to hard work. After a few difficult years he was able to retrain his brain to perform normal tasks. Then, in 2003, he overcame Hodgkin's lymphoma.

The dark days, the struggle to make himself understood, the fight to discover who he was -- it's all in the past.

"To be honest with you," Hoge said earnestly, "I don't remember any of it."

Greg Garber is a senior writer for ESPN.com