It started as just an ordinary preseason game. But one play made it anything but ordinary. The Oakland Raiders were playing the New England Patriots on August 12, 1978. Patriots wide receiver Darryl Stingley ran a slant pattern across the middle that left him an easy mark as he reached for an overthrown pass. Waiting for him was defensive back Jack Tatum, who considered himself the hardest hitter in football, meaner than the Chicago Bears' Dick Butkus, and the greatest outlaw to wear Oakland's villainous silver and black. Tatum considered two alternatives. "I could have attempted to intercept," he recalled in his book They Call Me Assassin, "but because of what the owners expect of me when they give me my paycheck, I automatically reacted to the situation by going for an intimidating hit." He once said, "My best hits border on felonious assault." Tatum's shoulders met his prey full bore, breaking the third and fourth vertebrae in Stingley's neck.
"I wasn't expected to live," Stingley says today. A trainer with good intentions but poor technique yanked his helmet off while he lay on the field. His head was not immobilized as he was wheeled off the bumpy Oakland Coliseum field "like a bouncy figure on a string." After two weeks in the hospital he had developed "all the respiratory complications that are so common with these injuries. It wasn't until November, three months later, that I was out of the woods." The incident left him a quadriplegic. Stingley, then 26, was a first-round draft pick out of Purdue five years before. What would become of him?
Stingley's injury was devastating, haunting, final. But it was also the exception. Few of the 17,000 men who have played in the National Football League since 1920 have been crippled for life. But football -- and other professional sports -- are rife with serious injuries that end careers and affect the quality of players' lives.
Since March 1999, serious injuries have leveled prominent athletes in the four major American team sports: basketball, football, baseball and hockey. Jayson Williams, the New Jersey Nets' power forward in the second year of a six-year contract worth $85 million, broke his foot in practice last spring while attempting to come back from a broken leg the year before. His money was guaranteed, but not his career: he retired last June. That same month, San Francisco 49ers quarterback Steve Young announced his retirement after enduring the effects of a fourth concussion suffered the previous October. Last March, Atlanta Braves right-hander John Smoltz succumbed to a torn medial collateral ligament in his right elbow after being disabled twice in 1998 and twice again in 1999. The 33-year-old missed the entire 2000 season. During hockey's Eastern Conference Finals last May, as Eric Lindros, the Philadelphia Flyers' two-time all-star, crossed the New Jersey Devils' blue line, Scott Stevens clocked him with a shoulder-to-head check. Lindros fell, his head bounced on the ice, and he suffered his sixth concussion. The fate of his career is still uncertain.
The Stingley injury had such lasting significance in the NFL that the compensation for active players who suffer a "total and permanent" disability is now commonly known as "the Stingley benefit." But what happens to other injured NFL players, and injured players in other sports? Ultimately it depends upon the kind of contract they signed, their length of service, and the sport they play.
NFL contracts are never guaranteed. A player who, say, signs a five-year deal for $30 million, with a $9 million signing bonus (bonuses are typically about a third of the value of the contract), and has a career-ending injury in his first preseason game after signing, will get to keep his signing bonus, which is guaranteed. But he will not get the dollar value of the full contract, although he has the option of filing an injury grievance to get a settlement on top of his bonus.
Ex-New York Jets wide receiver Al Toon, who had signed a three-year, $4.2 million contract nine months before, retired in 1992 after one too many concussions. The Jets paid him the remainder of his $1.375 million salary for the 1992 season. Players like Toon, who left the game because of injuries but were not disabled to the degree that they couldn't pursue other vocations after their careers, receive what is called a line-of-duty disability. (Players injured more severely, who are unable to pursue other work after their injuries, receive the higher, career- ending disability payout -- the "Stingley benefit.") Toon's temporary disability payout was a microscopic $600 a month in 1993, the first year after his injury. It then went up to $1,000 a month in 1994, and to $1,680 a month from mid-1994 through 1997, and then it stopped. (In the NFL, line-of-duty disability payouts expire after four years.) Fortunately, Toon, 37, now living outside Madison, Wisconsin, is not only able to work but is flourishing. He has a real estate license and a degree in economics, and he invests in real estate, hotels and fast food franchises. "The retirement plan doesn't kick in until 55, [but] you can take it early at 45," he says. "I'm not relying on that."
Though sidelined in October 1999 with his fourth concussion in three years, Steve Young received all of his $7.5 million salary for that year. Young underwent a series of medical tests but was never placed on injured reserve. Upon announcing his retirement the following June, he also drew a $1 million roster bonus from San Francisco. Because of the years Young played, from 1985 to 1999, he can apply for a line-of-duty benefit of $4,070 a month. He has four years to apply but has yet to do so. In addition, he receives $160,000 annually in severance pay.
While contracts are not guaranteed, the increase in benefits by the NFL Player's Association shows an understanding of the dangers inherent in the sport. By 1993, NFL players who had totally disabling, degenerative conditions were covered by the pension plan. Former Oakland center Jim Otto, who is on permanent degenerative benefits for various injuries, receives $110,000 a year for the rest of his life. This standard benefit is paid to players 12 years out of the league, or younger than 45, whichever is the latter. Before 1993, inactive players with disabilities were receiving just $1,000 a month. Since 1993, players who were active at the time of their injuries, like Stingley, get $234,000 a year for life.
"In years prior to 1993, they [the NFL] would simply not recognize the football causation [of injuries]," says Miki Yaras-Davis, the Player's Association director of benefits. "Darryl Stingley was the reason we always looked at total and permanent active [benefits]. He was the first one that had such a dramatic, televised incident."
"Whenever we've negotiated a contract for the active players, we've always gone back and helped the retired players, too," says Gene Upshaw, executive director of the Player's Association. "That's why the Stingley benefit has continued to grow and will continue to grow as we go forward. We've also gone back since 1993 and improved our pension plan for retired players over 50 percent." Tommy "Touchdown" Wilson, now 68, made $9,500 in 1956, the running back's first year in the league. His last contract, for 1963, paid him $38,000. He now receives $4,500 a month, or $54,000 a year in benefits (pensions are based on years of play). The NFL minimum salary is now $193,000, a minimum that increases to $440,000 for a player with five or more years' service.
If Tommy Wilson is a football everyman, Mel Davis is basketball's version. While still at St. John's University in New York, where he played from 1969 to 1973, Davis was injured and underwent reconstruction of his right knee. Nevertheless, the New York Knicks selected Davis 12th overall in the first round of the 1974 National Basketball Association draft. After three years as a part-time power forward, he was waived by the Knicks in 1977 and spent his last NBA season in New Jersey before playing in Europe. His four NBA seasons equal the duration of the average NBA player's career.
In good health, Davis is now the executive director of the National Basketball Retired Players Association. "Collective bargaining agreements have improved our pension package," says Davis. "But our pension needs to be improved in parity with the other leagues. I don't want to get into it too heavy. I'm a very good friend with [NBA commissioner] David Stern and [executive director of the National Basketball Players Association] Billy Hunter. But right now our pension is no way near what football or baseball or hockey is. That's why it needs to be revisited, put on the table and addressed. The guys making the big, big money may not need the money, but there are guys who played six years and didn't make the big money and [could] use that pension money." Pension depends on length of service: $306.34 per year of service is paid to the player each month. "It's a modest pension," says Davis. "Hopefully, the powers that be will change it at the next collective bargaining in four years so that players who made this league what it is today can support their lifestyles like those who played baseball and football do."
The NBA takes far better care of the players who least need it -- its active players. "The vast, vast majority of players in the league, when they sign contracts -- short-term or long, especially long-term guarantees -- have injury guarantees so they get their money, regardless of their ability to play or perform. Somewhere in the range of 90 percent of our players have guaranteed contracts," says Dan Wasserman, director of communications for the NBA. The 10 percent of contracts not guaranteed are those of rookies drafted in the second round, undrafted rookies, and join-on players. "Every first-round pick gets a three-year guaranteed deal," Wasserman continues. "If Kenyon Martin [the New Jersey Nets' first pick in the 2000 draft who broke his leg in college last spring] broke his leg while working out, right now, every penny of that $12 million contract is guaranteed."
So is Jayson Williams's contract. During Williams's retirement announcement last spring, Nets officials surely had in mind what part of Williams's $85 million salary would be paid by their insurance carrier. The team will have to wait until April 1, 2002, to learn if its petition to have Williams declared a permanent medical disability -- and thereby have his pay totally removed from the team's salary cap -- is accepted by the league office. If the league approves the petition, the Nets will have about $3.8 million more salary cap room.
Under a new agreement that came into effect for the 1999-2000 season, the league also posted a new minimum annual salary based on years of service. The minimum is now $1 million for 10-year veterans, as opposed to the old collective bargaining agreement in which there was just one minimum, regardless of length of service, set at $272,000. Thus Herb Williams, the league's senior member at 41 when he played a total of 34 minutes (or about 45 seconds per game played) for New York in 1998-'99, was entitled to $1 million because he was an 18-year veteran.
"Not only do you have guys playing longer because they can make a million bucks, but you have guys coming out of retirement," says Wasserman. Last season, Los Angeles Lakers coach Phil Jackson, perhaps possessed by the compelling belief that he needed John Salley to shore up his title run, brought the center back from retirement. Under the terms of the agreement, Salley, 36, who had last played four years before on the Chicago Bulls 1996 title team, made an estimated $1 million for averaging roughly seven minutes, two points and a rebound a night. Career benchwarmer David Wingate did the same with the Knicks, playing just 32 minutes and scoring two points the entire year.
A first-year NBA player this season must be paid at least $316,969. But when that same player has one year of service, his salary will be raised more than $106,000, to $423,500. Each year after, up to 10 years, his minimum pay increase will average about $65,000 per year. Also, under the new collective bargaining agreement, the 401(k) plan now pays out 140 percent. In other words, if the player decides on putting aside $10,000 of his salary pre-tax, the clubs and league will kick in $14,000 on top of that. "You hear a lot about employer match," says Wasserman. "But I haven't heard one which is 140 percent. In the first year of the program, about 90 percent of the players participated without the match. Now with the match we'll probably have even higher."
Unlike the NFL, Major League Baseball contracts are guaranteed. While neither the MLB Player's Association nor the Baseball Alumni Association granted any interviews despite repeated requests, we know that if Mike Piazza were unable to play for the New York Mets next season due to injury, or Juan Gonzalez continues to flail at curve balls in Detroit, both would receive the full cash terms of their deals. Cases far more interesting than those hypotheticals have already arisen.
Few pitchers in the early 1990s had a sunnier future than Brien Taylor. After he struck out an ungodly 476 batters in 239 innings in high school at Beaufort, North Carolina, and went 29-6 with a 1.25 ERA, the New York Yankees made Taylor their first pick overall in the 1991 draft for a then-record bonus of $1.55 million. Shortly after, Taylor got into a bar fight involving Ron Wilson, a former friend who was on parole, and Taylor's brother, Brenden. Brien Taylor wound up with a damaged shoulder and was charged with misdemeanor counts of assault and communicating threats, counts that were dismissed 11 months later by a Carteret (North Carolina) County district court judge. However, Taylor did pay a price for the altercation.
He needed reconstructive surgery on his pitching shoulder and hasn't since come close to his vaunted 99-mile-per-hour fastball. The Yankees released Taylor after he appeared in 13 games for Class A Greensboro in 1998. In January 1999, the Seattle Mariners signed him to a minor-league deal before releasing him from extended spring training that June without his having pitched in a regular-season game. He pitched in five games for the Cleveland Indians' Class A Columbus team in 2000, allowing eight runs in 2 2/3 innings. Taylor's progress in extended spring training was not adequate and he never returned to active duty. He has since announced his retirement. "He was struggling getting out hitters at the extended level, which are young guys just out of high school or the Latin countries," says Mariners assistant player development director Greg Hunter.
While it is conceivable that the Yankees could have gone after the signing bonus they gave to Taylor, it was not clear whether he was at fault in the barroom brawl. Besides, "the signing bonus is almost impossible to retrieve," says Gary Gillette, an essayist for the encyclopedic Total Baseball and the co-author, with Stuart Shea, of the Baseball Insider. But retrieving a signing bonus is not without precedent. Arbitrator Sam Kagel was called in to mediate a dispute between the Detroit Lions and running back Barry Sanders, who had signed a six-year, $36 million deal in 1997, with an $11 million signing bonus, but abruptly retired prior to the 1999 season. Sanders tried to retain the entire bonus, but Kagel ordered him to repay $5,583,000 of it.
It's different in hockey. If a National Hockey League player has a career-ending injury, he's guaranteed the money under the entire contract. Regarding pensions, the payout depends upon length of service. If a player skates in fewer than 400 games, he collects an annual payout of $8,000 for life, starting at age 45. For someone who plays more than 400 games, he receives an annual stipend of $12,500 for life from the age of 45, as well as a one-time lump sum of $250,000 when he hits 55. If a player plays fewer than 160 games -- the equivalent of two NHL regular seasons -- he receives nothing.
But after the 1995 NHL lockout, in which the main issues were free agency and arbitration, the players ended up with higher salaries and more long-term deals than ever before. "Both sides got something they liked, since they've extended it twice since," says Tim Wharnsby, manager of media relations for the NHL Player's Association. The league minimum salary is now $150,000 and the league average has catapulted to $1,365,000.
While hockey salaries began skyrocketing in the 1990s, all contracts were guaranteed decades ago. "I'd have been paid even if I'd broken my leg in the first year of the contract," says Rene Robert, a right winger who skated in two all-star games and played 744 games over 15 years in the NHL, from 1968 through 1982. Until his last few seasons, Robert, who is now the executive director of the NHL Alumni Association, suffered few major injuries. "I had three multiyear contracts. My first two were three-year contracts and my last one was a six-year contract. In addition, I would have been paid for disability insurance over and above my contract if I was disabled."
Sports injuries are far from new, but concern about them has reached an all-time high. Ruptured ligaments and jumper's knee, stingers and burners, slipped disks and shoulder separations, Achilles tendonitis and degenerative arthritis, groin pulls and rotator cuff injuries -- this is but a short list of the common maladies that beset active and retired professional athletes every day. But when it comes to injuries, with the obvious exception of boxing, pro football draws the most attention.
"The thing over the years that astounds me is the effect that injury plays in a [football] player's life," says Beverley Pitts of Ball State University, who, along with her colleague Mark Popovich, conducted a study of retired pro football players that reveals the long-term consequences of the sport. "By that I mean because [football] injuries happen so abruptly. This is the factor that makes football a different kind of sport. Players don't get to choose those life-changing moments. It is chosen for them, and that's usually because of an injury." The end is not only uncertain for pro football players, but usually imminent: the average NFL career is just 3.5 years, shortest among the major pro sports.
The researchers sent surveys to 2,216 members of the NFL Player's Association, with 55 percent responding. Only 36 percent of the pre-1970 players (those who retired prior to that year) reported having sustained an injury that caused them to miss eight or more games. With post-1970 players, that figure leaps to 65 percent.
The increase is reflected by the sharp rise in knee surgery, both arthroscopic and invasive. The study also showed that instances of invasive surgery actually increased along with arthroscopic knee surgery. Although the data cannot prove it, the post-1970 jump to 65 percent is often attributed (by players and others) to players being pushed to return to the field too fast. That is, in the past, when invasive surgery was the only option, a player had no choice but to miss several weeks after surgery. With the advent of arthroscopy, players feel better faster and go back to playing far earlier. Often, they are back long before their knees are strong enough to take it, so they get hurt again.
Arthritis was the most commonly reported health problem among the retired players, with 47 percent reporting the condition. The study also revealed that more players today are retiring earlier due to injury. Of those who played before 1970, 42 percent said they retired by choice, while 30 percent said that injury caused their retirement. For those playing since 1970, 22 percent elected to retire while 46 percent said that injuries compelled them to do so.
Although their career may be brief, their retirement years needn't be, despite an old locker room myth. A National Institute for Occupational Safety and Health mortality study completed in 1994 disproved the myth that the average professional football player dies at the age of 52. The study examined the death certificates of former players and found that, as a group, they had longer-than-average life spans. But old myths die hard.
"In 1994, on the day of Super Bowl XXVIII, a doctor spoke [at a press conference] and said, 'What we've come up with is that players don't die at 52, they live an average of 72 to 79, slightly longer than the average American male,'" recalls Frank Woschitz, director of the NFLPA Retired Players Association. "About 600 people were at that press conference and at least 400 got up and walked out, because they had already written their stories that football caused early death."
Even if NFL players' average life span is no longer in question, the quality of that life still is. "My point has always been to [the players], 'No, you're not going to die early, but your old age may be very uncomfortable,'" says Yaras-Davis.
Just ask Norman Scott. The team physician for the New York Knicks since 1978, and now for the Women's National Basketball Association's New York Liberty, as well, Scott is an orthopedic surgeon specializing in knee surgery.
"It's not just professional athletes," he says. "The thing that we worry about in people who do repetitive trauma and high-force types of events is that there is a negative impact on their joints." With joints primed in such fashion, all it takes is one injury. "The literature seems to say now that if you have absolutely normal knees, absolutely normal joints and never have an injury, and there's no evidence to suggest you wore your knees out, once you have an injury, you're probably more likely to have degenerative arthritis. With arthritis, in general, you have night pain, swelling sometimes; the more active you try to be, it tends to bother you more. You have constant discomfort."
Scott is a member of Professional Team Physicians, an organization comprising more than 80 percent of the team physicians of the NHL, NFL, NBA, WNBA and MLB. The group's Web site, www.sportcare.com, provides descriptions of injuries and their prevention.
When it comes to injuries, some people downplay those sustained in basketball because it isn't viewed as a "collision sport" like football. But basketball's brand of collision is the most frequent kind in sports: the repetitive pounding of limbs on hardwood. With the sports lexicon including terms like "anterior cruciate ligaments" with greater regularity, the vulnerability of basketball players has been getting more attention.
In reality, they've had their Achilles' heel exposed for decades.
NBA Hall of Famer Bill Walton has long been hampered by joint injuries. Walton, 48, might be considered one of basketball's 10 most injured. After leading the Portland Trail Blazers to an NBA championship in 1977, Walton broke his foot about two-thirds of the way through the following season, yet still won that year's MVP. But the damage was done. The only time he would enjoy anything like a complete season again was 1985-'86, when he played 80 games backing up center Robert Parrish for the Boston Celtics. Walton played just under 20 minutes a night. He retired shortly into the following season. Since his NBA career began in 1974, he has had at least 30 operations on his feet and knees. Chicago Tribune columnist Sam Smith is a good friend of Walton's. "He has tremendous difficulty walking," says Smith. "We'll walk about 30 to 50 yards and then he'll say, 'Go on ahead; I have to stop and sit down.'" From a career standpoint, Walton was more fortunate than many of his retired NBA counterparts: he now works as a network basketball broadcaster.
Injuries can be just as threatening to a baseball player's career, with pitchers taking the hardest hits. "The carnage among major league pitchers in the last 10 years has been awesome, absolutely awesome," says Gary Gillette. He and statistician Pete Palmer are conducting research on pitching disabilities that shows that pitchers' injuries are increasing.
"In the 1990s, the average major league pitcher had a 26.5 percent chance of being injured seriously enough to be placed on the disabled list in a given season," says Gillette. "That was about the same for non-pitchers. Starting pitchers, however, had a 33.6 percent chance of being disabled each year, much greater than relief pitchers or position players."
The news for pitchers gets even worse. "If placed on the disabled list, a starting pitcher would spend an average of 55 days out of action -- almost one-third of a full season," Gillette says. "None of this, of course, takes into account all the pitchers who had surgery in the off-season or who retired after suffering an injury. Injuries to starting pitchers were up more than 30 percent in the 1990s when compared to 1982-'89. Even worse, there is no sign that the carnage is lessening, as more and more young pitchers are undergoing ligament transplants or rotator cuff surgery at the start of their careers, rather than the middle or end as was the previous pattern."
Gillette and Palmer, along with Stuart Shea, are still gathering data to learn the causes of the increase in pitchers' injuries, although Gillette has two theories: 1) There is increased strain on pitchers' arms because they are going all-out on every pitch. This is different from the way it used to be when pitchers could take it easier for some guys and then go all-out when Ruth or Mantle came to bat. Now, almost any hitter in the lineup can hurt a pitcher; 2) Strength training has benefited hitters more than pitchers. For pitchers, beefing up in the weight room hasn't translated into greater endurance. They are facing stronger hitters, and their elbows and shoulder ligaments are still susceptible to injury.
Hockey players suffer their own peculiar maladies. Last March, Toronto Maple Leafs defenseman Bryan Berard took a stick to the eye when Ottowa Senators Marian Hossa followed through on his shot. The right lens of Berard's eye was destroyed and the retinal wall detached from the back of the eye. To put it gently, Berard's situation is dire. "He can now distinguish light from dark, but it would have to improve quite a bit more to even reach the very low minimum standard for vision required in the second eye to play," says Dan Diamond, hockey historian par excellence and editor of Total Hockey: The Official Encyclopedia of the National Hockey League. According to Toronto ophthalmologist Tom Pashby, who has tracked such accidents, 40 NHL players have been forced into retirement since 1972 because of eye injuries.
Because of the increased attention paid to serious injuries in the NHL, the overall injury tally on ice seems to be lessening. In 1997-'98, NHL teams reported 1,404 game-related injuries for a total of 3,992 regular-season man-games lost, according to the NHL's weekly injury reports, compiled by Diamond. In 1999-2000 the injuries declined: 1,148 total injuries resulted in 2,949 missed contests. (No such statistics are available for earlier seasons.)
Hockey careers last 4.4 years on average, about a year longer than football players and a little less than the NBA's 4.9-year average. The NHL is working at improving that number. "They are trying to make the ice harder and the boards softer," Diamond says. "Right now the ice is soft and the boards are hard." Groin injuries are just one kind of impairment that result from irregular ice conditions, and the immovable boards surrounding the ice frequently account for a number of head injuries.
Perhaps the factor most responsible for the increase in sports injuries is the size of the players themselves. Pro athletes are much larger and stronger than their counterparts of the 1940s and '50s, and even those who played just a few decades ago. For example, according to Total Hockey, the average height and weight of an NHL player in the 1999-2000 season was 6 feet 1 inch and 203 pounds, up from the 1979-1980 season, when the average NHL player was 5 feet 11 inches and 187.5 pounds. In football, Hall of Fame guard Gene Upshaw played 15 years (1967-1981) essentially injury free. He once played 207 consecutive games, a streak only broken in his last season. But Upshaw admits that his playing size, 6 feet 5 inches, 255 pounds, is outdated. Most guards today are well over 300 pounds.
The physics of colliding bodies is growing more ominous. "Force equals mass times acceleration," says Charles Burke, an orthopedic surgeon and team physician for the Pittsburgh Penguins. "The larger the mass and the faster the acceleration, the greater the force. The greater the force, the greater the potential for injury."
So when it comes to injuries, size matters. But it isn't all that matters. A factor contributing to the overall increase in injuries is artificial turf. Studies such as the review of scientific literature undertaken by Dr. Willibald Nagler at Cornell University show that playing football on artificial turf clearly increases the risk of joint injuries. Examining reports published in 25 scientific journals in 1995, Nagler's study showed that foot and knee injuries on synthetic turf occur nearly 50 percent more frequently than on grass. Furthermore, they often are more serious and more difficult to heal than those that occur on grass.
"Regardless of what position the player is, the number of ligamentous injuries is definitely higher when training and playing take place on artificial turf," says Nagler. "The cause is increased friction between the football shoe and the turf." Players have said the same thing -- they describe artificial turf as having "no give," which leads to noncontact injuries. No wonder then that some 87 percent of the 1,034 players who responded to a 1996 survey by the NFL Players' Association preferred to play on natural grass, while only 6 percent preferred artificial turf (7 percent had no preference). Injuries suffered in 1999 by Jets receiver Wayne Chrebet (broken foot while making a cut in practice), Jets quarterback Vinny Testaverde (an Achilles tendon injury while recovering a fumble) and Atlanta Falcons running back Jamal Anderson (torn knee ligament) occurred without contact with another player. In the players survey, a stunning 91 percent believed that artificial turf was more likely to shorten their careers, as opposed to less than 1 percent who believed grass would, and 8.4 percent who said it made no difference. When asked which surface would worsen their quality of life after football, the numbers were just as overwhelming: 84 percent said turf would, less than 1 percent said grass would, and 9.1 percent said it made no difference. Clark Gaines of the Players' Association claims that players have their own terminology for injuries that don't happen on grass: "They are called 'turf injuries.'"
Lake Success, New York, is home to the ProHealth Care Associates medical office, where rheumatologist Elliot Pellman is the director. Pellman is the team physician for the New York Jets and Islanders. The winding corridor to his office is no hall of fame, but a hall of the lame -- a veritable bulletin board of the walking, crawling and limping wounded. Photos abound of injured players such as Testaverde. No heroic shots of pinpoint passes hang here. Testaverde is forlorn, slumped on the field at the New Jersey Meadowlands, with Pellman and a staff of attendants huddled around him, checking his leg following his Achilles tendon tear during the Jets' first game of the 1999 season.
Pellman is the chairman of a committee funded by the NFL to study mild traumatic brain injuries, or MTBIs. The study began in 1994 and has been funded and overseen by the NFL's Committee on Mild Traumatic Brain Injuries since 1997. The committee's scientists draw conclusions by reviewing videotape of injuries on the field. "Interestingly enough, many of the injuries seem to be occurring from blows to the side of the head," says Pellman excitedly, as if nearing the end of a long chase. "The closer to the ear, the more susceptible the person seems to be." Given the speed and power of today's players, concussions have become the single greatest health concern in the collision sports. All told, NFL players suffer about 100 concussions a season.
A study published in the September/October 2000 issue of the American Journal of Sports Medicine suggests that the brain is more susceptible to injury when it has not properly recovered from a previous injury. In addition, athletes who suffer concussions are three times more likely than other players to suffer another concussion in the same season. Kevin Guskiewicz, professor of exercise and sports science at the University of North Carolina and the study's leader, uses a vivid image to explain what happens during a concussion: "The brain, as I like to describe it, is like an ice cube in a glass of water. Shake that glass of water from front to back and the ice cube resembling the brain is bouncing off the inside of the skull. This is similar to what you're seeing; any acceleration or deceleration of the head is going to cause a jarring and a potential contusion on the side."
The study reveals that an astounding 31 percent of concussed players return to play on the day of injury. "Half of [the 31 percent] returned themselves to the game and never reported their symptoms until after the game or practice or until the next day," says Guskiewicz.
"When you have repetitive concussions, basically you're losing brain cells," says neurologist Jay Rosenberg, co-author of the guidelines on concussions in sports for the American Academy of Neurology. "The issue is, how many brain cells do you have to lose before you decide to quit?" The talk is plain enough.
But smart talk about concussions would have baffled players even two decades ago. Ron Jaworski played 17 seasons as an NFL quarterback between 1973 and 1989. Philadelphia Eagles trainer Otto Davis once told him he suffered 32 concussions, although he lost consciousness only twice. Says Jaworski, "In the old days, you'd get hit and see that twinkle, those stars and they'd say, 'What's your name? What's the score? How many fingers am I holding up?' They made it easy, because the answer was always two. They would say, 'You're ready to go back in, you just got dinged.'"
By the 1990s, the joke was over.
A three-time All-Pro player, ex-Jets receiver Al Toon wasn't impervious to the vicious hits laid on him. After a fifth concussion three weeks before he retired, he was suffering from short-term memory loss, and had trouble with his balance and ordinary activities like walking, taking showers and helping his wife, Jane, with their 8-month-old daughter. He took to staying at home and sitting still. After hearing opinions from Pellman and five other doctors, Toon retired. Just 29, he had expected to play a few more years.
Today, Toon says, "I've been fine for a couple or three years now. It's what I consider normal. The residual effects of the concussions are significantly reduced and I'm doing great. During my post-concussion era the symptoms I had were typical things like concentration problems, loss of memory -- that kind of stuff."
"Al was actually the first player who retired because of post- concussion syndrome," says Pellman. "But the irony was that Al was overshadowed by the Dennis Byrd [paralysis] injury. So Toon's injury really got pushed under the carpet and it wasn't until the following year, when [Pittsburgh Steelers running back] Merrill Hoge had to retire, that post-concussion syndrome really got everyone's attention." Now Dallas Cowboys quarterback Troy Aikman, who has had multiple concussions, must weigh his desire to continue playing against the unknown state of his future health. In years past, frequent headaches from concussions prompted Hall of Famers Lynn Swann and Roger Staubach to retire. And then there's Steve Young.
It was October 1999 when the San Francisco 49ers quarterback was clobbered by blitzing Arizona Cardinals cornerback Aeneas Williams. Young hit the turf hard and suffered his fourth concussion in three years. Eight days before, he had absorbed more than 20 hits in a game against the New Orleans Saints. Tests showed no bruising to his brain, but weeks passed and doctors still had not cleared him to play again. He continued to feel woozy, lethargic and dizzy -- a set of symptoms making up what is called post-concussion syndrome. Incredibly, by season's end, Young -- the highest-rated quarterback in NFL history, a Super Bowl winner, and arguably the greatest athlete ever to play the position -- had faded. He announced his retirement last June.
In the NHL, the number of concussions declined from 94 during the 1997-'98 season to 87 in 1998-'99, rising to 104 in 1999-'00. While the numbers have remained relatively constant, the NHL has made strides with head injuries by being the first pro sports league to require a baseline neuropsychological test for all of its players. The test, which every player must undergo before the season starts, requires the player to exhibit cognitive abilities, like repeating a sequence of words and numbers, and performing tasks requiring spatial orientation, like drawing lines.
Mark Lovell, the director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center, points out that neuropsychologists were previously hampered in their diagnoses because medical tests like CT scans and MRIs couldn't detect mild traumatic brain injuries. "It is sometimes difficult to measure how much different people are after a head injury because we don't have information on how they were before," he says. "Now we can measure whether there has been any change."
Concussions occurred in decades prior, but players didn't report them and teams were lax in diagnosing them. "Back then they'd give you a couple of aspirins and say, 'Go get rid of your headache and you'll be OK tomorrow morning,'" says Rene Robert. "In Washington, about 1973, I got a puck in the back of the head. The last thing I remember was going down and waking up on the bench and spending the night in the hospital. I played a couple of days later." Robert played at 5 feet 10 inches, 184 pounds, about the average height and weight for his time.
But the times have changed. The same height and weight as Robert, former center Pat LaFontaine was considered small for his era, just two decades after Robert's. Playing from 1984 to 1998, he skated in five NHL All-Star Games and two Olympics. His size made him a prime candidate for injuries. His fifth concussion occurred in Buffalo in October 1996 when he collided with 6-foot-6-inch, 235-pound Pittsburgh Penguins defenseman Francois LeRoux.
"We were going full speed and the only part of my body he hit was my neck and head," LaFontaine says. "I lost my helmet and spun around and my forehead hit the ice." A sixth concussion in a 1998 game led him to retire at 33. "If I had taken that concussion six or seven years previous, I would have been back in a week," LaFontaine says, recalling the hit. "This time symptoms lingered on in me for almost six months. Migraine headaches -- there's no way to describe it unless you've visited that scary place."
What can the NHL or NFL do to be more effective against head injuries? Concussion study leader Guskiewicz has some suggestions. "We have a project called the Concussion Prevention Initiative. It's a project funded by the [National] Centers for Disease Control, and we're out in 100 high schools and 40 colleges where we're instituting these baseline tests and bringing them back for injury assessments. It takes the guesswork out of it. You ask a hockey player after they have a concussion if they have headaches, are dizzy, or have blurred vision. Those are very subjective measurements. Their eagerness to get back in the game means they are not really going to give you the truth.
"We can't do a whole lot to prevent the initial injury," he adds. "We can't tell these guys to skate slower or not check. Where we can make an impact is with the second and third and fourth injuries." According to Guskiewicz, the way to do that is to institute mandated preseason screenings for postural stability (balance) testing and neuropsychological testing.
"The mandate could easily come down from the league office," he says. "You basically get a baseline measurement or profile of your player, and if someone has a concussion, you bring him in for these repeated tests. You have what is called a recovery curve. Let's say John Smith scored an 85 at baseline and one day after his injury, he's got a 35. We don't allow him to go back until he's at 95 percent of his baseline."
As a rule of thumb, Guskiewicz suggests using guidelines established in 1986 by Robert Cantu, a neurosurgeon at Emerson Hospital in Concord, Massachusetts, that suggest that players should be held out of action at least seven days after becoming asymptomatic. Cantu's "the first to admit that seven days, based on his clinical impression, is a window of time that would at least eliminate the potential for second impact syndrome, instead of the four days that they are kept out now," Guskiewicz says.
The science will continue to evolve. "We were once in the Dark Ages of understanding head injuries," says team physician Pellman. "Now we're entering the Renaissance."
Knicks orthopedist Scott echoes the sentiments for other sports injuries. "Sports medicine is far from a perfect science today, but it's much more of a science than it was then. We get better and better, realize what we don't know, and try to change the scenario as much as possible."
Kenneth Shouler, a contributor to Cigar Aficionado, was one of the panelists who selected Major League Baseball's All Century Team last year.