Handling concussions is complex for Texans players

Clark on 'Concussion': The movie makes the issues real and tangible to audience (2:43)

Ryan Clark joins First Take to describe what kind of impact the movie "Concussion" will have on the NFL moving forward. (2:43)

HOUSTON -- Three days after his quarterback suffered the second of two concussions in less than a month, Texans receiver DeAndre Hopkins was perfectly candid on the subject.

Does he read about concussion research or seek information about the injury’s impact?

“I really don’t want to because it’s probably bad,” Hopkins said. “But it pays the bills to take [the hits]. I mean, s---. It’s bittersweet.”

Hopkins, a 23-year-old who was just named to his first Pro Bowl, said he’s had two diagnosed concussions and expects he’s had many more that went undiagnosed. He isn’t alone in not wanting to think much about brain injuries.

Today’s players have access to more information than ever about what can happen to them due to repeated head trauma, but football is also part of their identities. Some become millionaires because of it. Some have played since kindergarten. There are players who seek out the research and want to know, and there are those who would rather just play the game while they can. That this field of study is relatively new and still developing colors the subject.

As Texans quarterback Brian Hoyer recovers from two recent concussions, he’s delving into a world of risks and unanswered questions. He’s expected to return to practice today while taking the next step in the NFL’s concussion protocol.

Hoyer wants as much information as possible. He suffered his first concussion of the 2015 season on Nov. 16, and he told his coaches he was having trouble remembering plays. That triggered the league's concussion protocol. After he recovered, he said that was the fourth concussion he’d suffered playing football -- one in high school, one in college and one as a rookie in the NFL.

“If I was younger, I’d be a little more brazen and stupid about it,” Hoyer said last month. “You hear horror stories about people. I went into it and even my wife was like, 'I’m actually proud of you for dealing with it the way you did.' I was dead serious about it. I gave them fully accurate answers. If we’re going to talk about that process, players, that’s our responsibility, too.”

He felt completely healed when he returned to play on Nov. 29. Then he suffered another concussion on Dec. 13, after being driven to the ground at least six times during that game.

“Generally the time between concussions decreases as the number of concussions increase, suggesting that the brain is at higher risk for more brain damage,” said Dennis Molfese, a professor of neuropsychology at the University of Nebraska-Lincoln and founding director emeritus for the Center for Brain, Biology and Behavior. “A concussion is a brain injury. My bias is that it is a permanent brain injury.”

The trouble with symptoms

The NFL identifies brain injuries by concussion symptoms -- there is really no other way. But just because someone doesn't have symptoms -- headaches, dizziness, confusion -- doesn't mean they don't have an injury.

“The public and a lot of lay media have this idea that a concussion occurs the moment you get hit and that will be discovered,” said Dr. Jeffrey Kutcher, a neurologist and the executive director of The Sports Neurology Clinic. “When the reality is you need to be very cognizant of the fact that the injury can produce symptoms later on.”

Hoyer has tried acupuncture, among other treatments, to aid in his recovery. Kutcher notes that a treatment that helps the symptoms might not be helping the actual injury to the brain. Some use mental exercises to help their recovery, and Kutcher said it’s possible that could help.

Research in other types of brain injuries has shown exercises, or rehab, helps more if it isn’t started too early or too late.

“The same thing should apply to concussion, but there is no data that shows what kind of exercises and how much exactly,” Kutcher said.

Even considering the lack of information, concussion research has progressed dramatically in the past 10 years.

Discoveries of chronic traumatic encephalopathy (CTE) in brains of deceased football players have led to awareness, concern and lawsuits.

They have also led to changes in the way the NFL handles concussions. Coaches, some of whom still aren’t convinced of the dangers of concussions, are forced to take brain injuries seriously. Players can't return to play until they’ve fully healed. Independent neurologists consult.

Answers lead to more questions

In former Patriots linebacker Ted Johnson’s NFL career, there was no independent neurologist assigned to take concussed players out of games, as there is now. There were no limits on the hits at practices. There was no NFL concussion protocol that prevented coaches from re-inserting players before their brains healed.

When he retired in 2005 because of concussions, he struggled to find a doctor who could explain to him what was happening to his brain. Toward the end of his career, he began experiencing depression, social anxiety, trouble sleeping and bouts of anger and impulsiveness.

Johnson became addicted to Adderall, which he used to help a brain that wasn’t functioning properly. When he couldn’t muster the prescriptions needed for legal amphetamines, he turned to cocaine, too. He’s been more outspoken lately in sharing his story in hopes that it will help others.

One survey conducted in 2007 of more than 2500 retired professional football players found 11.1 percent to have a current or prior diagnosis of clinical depression. Retired players who had three or more concussions were three times as likely as players with no history of concussions to suffer from depression.

“I went to a hospital with a well-respected, decorated psychiatrist examining me,” Johnson said. “He got to a point where he said, ‘I don’t know what to do with you, Ted. Why don’t you try ECT?’ I said 'ECT, what’s that?' Electroshock therapy. I was like, ‘Like "One Flew Over the Cuckoo’s Nest?"’”

Today, Johnson can discuss the functions of the frontal lobe of the brain as fluidly as he can explain a blocking scheme. He sought doctors and scientists who could help him understand things like post-concussion syndrome and CTE.

He understands, too, the desire not to know too much.

“The old 'ignorance is bliss,'” Johnson said. “If I [knew] every time I got my 'bell rung' or got 'dinged' it was actually a concussion and could lead to long-term brain disorders, maybe I wouldn’t have continued to play.

“… I think guys know more about it than they ever want to admit. I don’t think guys want to go on the record while they’re playing for a team and voice their concerns about brain trauma.”

Current players' views differ

Linebacker Brian Cushing, the Texans' representative to the NFL Players Association, wants his teammates to know as much as possible about head injuries.

“Obviously we’ve been taught a little bit, but you have to go out and figure things out on your own, do your own research and talk to people,” Cushing said. “You’re just hoping some guys do that. As a player rep, that’s something I’ll push.”

Cushing has two young sons.

“I want to be around for them, be as mentally sharp as I possibly can for the rest of my life for them,” he said.

Texans running back Chris Polk, 26, said he’s been cautioned to protect his head ever since his first football practice, when he was six years old.

“Your brain will take you further than your feet ever will,” Polk said. “I’m pretty sure we’re all professionals here; we all know when something’s not right. Just like when someone rolls their ankle, they’re not going to get attention right away and ask. I feel like it’s the same with concussions.”

It isn’t that way with every player. Safety Quintin Demps, one of the Texans’ alternate NFLPA reps, said the only way to be diagnosed for a concussion is for the player to indicate there is a problem. Has he ever had a concussion?

“I’ve never stayed on the ground long enough for me to be checked,” he said.

As the Texans, their doctors and Hoyer grapple with his status for this week, the impact of his repeated concussions will be a factor.

Kutcher believes neurological testing after the concussion has healed is critical in determining whether brain trauma has caused brain damage. Degenerative brain diseases are far from a certainty, even for people who suffer concussions, though the chances increase significantly. Kutcher recommends annual, comprehensive neurological exams, similar to annual physicals, to determine if brain trauma is affecting a person.

“People take a very simplistic approach of, ‘Oh, you’ve had three and you should stop for the season or you’ve had five and you should retire forever,’ don’t really understand the complexities,” Kutcher said. “… And they’re not doing the patient a service at all. ... There’s a tremendous lack of respect for what it means to retire from a sport.”

Decisions about head injuries are complex and rely on science that still has only incomplete answers.