National Football League

The hard-hitting truth of concussions and the NFL

Published Apr. 9, 2015 11:40 a.m. ET

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"Early in my career, I remember hearing that the NFL used a rheumatologist as its concussion expert," recalled former quarterback Sage Rosenfels. "He actually stated that it was fine to go back into a game after being knocked out or suffering a concussion. His 'expertise' contradicts everything that a neurologist would say then and today."

Rosenfels played 12 years in the NFL, including two seasons with the Minnesota Vikings. During that time, he witnessed several teammates suffer concussions -- both diagnosed and undiagnosed. Since retiring in 2013, Rosenfels has become increasingly disturbed by news and data released regarding concussions, their long-term effects, and the lack of information made available by the NFL.

For Rosenfels and many others, it's impossible to ignore the facts after staring them in the face.

Concussions at any level can cause brain bleeding, head trauma and risk of serious side effects or death, and many concussions go undetected and undiagnosed. According to a study cited in the Youth Sports Safety Alliance, 50 percent of "second impact syndrome incidents" -- brain injury caused from a premature return to activity after suffering initial injury -- result in death.

Several tragedies have already occurred at the high school and college level as a direct result of football-related head injuries. In 2010, 17-year-old senior Nathan Stiles collapsed at halftime during a game. Stiles had suffered a concussion in a game the previous year; although he had been cleared to play, his brain had not fully healed and he died of a brain hemorrhage. Frostburg State's Derek Sheely died in 2011, six days after heavy-contact practice and complaining of severe headaches.

"A death on the field, which I believe is bound to happen, may be the only thing that could end the NFL's massive growth," Rosenfels said.

Not all former players share this perspective, however. The issue prompts a wide spectrum of reactions; while some side with Rosenfels and identify the league as the story's villain, others feel quite differently. Matt Birk falls into the latter category.

A former center, Birk played in the NFL from 1998-2012, 10 of those seasons with the Vikings. He now works as the NFL Director of Football Development in New York City. Birk sees firsthand -- and on a daily basis -- a lot of the controversies and concerns that cross the NFL's desk. Some of these issues, such as the concussion conversation, are things he first encountered on the field himself.

When asked to weigh in on concussions and the concern of prolonged effects, Birk acknowledged the risk. He also offered reassurance about the league's response to the issue.

Extensive funding, research and resources have been poured into the protection surrounding head injuries in the NFL, and Birk feels confident that the league is safer now that it ever has been.

"The game has never been safer than it is today," Birk expressed. "I think it will continue to be a focal point -- from now until forever. Football is a physical sport, so the safety issue will always be at the forefront."

The former center also offered insight on those who continue to play, seemingly "ignoring" the dangers of suffering additional injury on top of previous concussions. While it may appear that the issue is one of fame, fortune or even ignorance, Birk debated that theory. Players that make it to the NFL make it that far for a reason -- they have football in their blood. There is nothing else they want to do. To many of us on the "outside," it may seem an obvious choice for a cornerback to simply hang up his cleats after suffering a third or fourth concussion. To the player, however, it's just not that simple.

According to Birk, playing through concussions and prolonging retirement is not the inability to walk away from a paycheck; it is the inability to walk away from a passion.

"At a certain point, money doesn't matter," Birk said. "If you're playing in the NFL only for money, I don't know how long you're going to last . . . You have to have passion for it. You have to feel purpose doing it. Otherwise, it doesn't matter what they pay you -- it's not enough. If you think a guy plays too long, it's because this is what we were made to do. This is where we feel fulfilled professionally."

Former Vikings safety Jack Brewer founded the Coalition for Concussion Treatment after playing for three teams from 2002-06. Brewer now emphasizes that many "have already sacrificed their health and wellness just to get to the NFL" and sums it up this way: "When you love what you do, it becomes very difficult to walk away."

But if players suffering multiple concussions don't walk away, they are risking so much more than long-term injury or an altered livelihood. They are risking death.

The truth about concussions in the NFL is finally demanding exposure, but the initial breakthrough occurred over a decade ago when Pittsburgh Steelers Hall of Famer Mike Webster died of a heart attack at just 50 years old.

When Dr. Bennet Omalu performed an autopsy on the former NFL star, what he discovered was Chronic Traumatic Encephalopathy, or CTE.

"I had to make sure the slides were Webster's slides," Omalus said in the Frontline documentary "League of Denial". "I looked again. I saw changes that shouldn't be in a 50-year-old man's brain."

Before 2002, this disease had never been identified in football players. This was the first instance, the first proof, to suggest that playing football could cause permanent brain damage resulting in memory loss, depression, and even suicide.

In 2011, former Chicago Bears safety David Duerson died of a self-inflicted gunshot wound to the chest. He left a simple note behind: "Please, see that my brain is given to the NFL's brain bank."

One year later, retired NFL star Junior Seau died of a similar cause. To his family members, neighbors, and hundreds of people who loved Seau, his death at just 43 years old proved devastating. The New York Times' Greg Bishop wrote the following shortly after Seau committed suicide:

"In retirement, Seau set out to develop his restaurant business and his foundation and to spend time with his family. He had an office at the restaurant and regularly stopped in to take photos with fans. On Thanksgiving, Seau's restaurant hosted a meal for locals in need that drew hundreds."

Recent San Francisco 49ers standout linebacker Chris Borland retired from football this offseason after just one year in the NFL, due to fear of the possible long-term effects of head trauma brought about by the game. 

Seau connected with anyone and everyone. Three days before he died, he actually spoke at a memorial service for his mailman. The theme of the speech? To celebrate life.

For his loved ones, the most painful part of losing Seau was that he suffered in silence. No one realized the post-concussion symptoms he dealt with, the depression that he wrestled with daily as a result of repeated head trauma.

Seven months after Seau's death, Kansas City Chiefs linebacker Jovan Belcher shot and killed his girlfriend, the mother of their three-month-old daughter, before driving to the Chiefs' practice facility and shooting himself in front of team officials. He was only 25 years old.

"Imagine how many times linemen, linebackers, and running backs get hit in the head over the course of their career," Rosenfels said. "Using a car as a metaphor, you don't have to get into a huge accident to ruin a car. You could also take a small hammer and pound away at it for years to cause even more damage."

We're talking more than a risk, here. We're talking reality.

So, the question looming over this entire issue remains this: how much did the NFL know, and when did the NFL know?

Certainly, there was a lot of information unavailable prior to the 2000s. But why, when Dr. Omalu studied Webster's diseased brain, was the league less-than-receptive to the discovery?

"I don't think players knew the true risks of concussions until recently," Rosenfels said. "But the more research that comes out, the darker the consequences seem to be. They are better documented now -- the word has gotten out. It's obvious the NFL and its teams spent decades hiding information from the players about concussions."

Up until just a few years ago, there was very little medical focus on long-term consequences of head injuries on the sidelines. In most cases, the head trainer would perform a simple assessment to determine if a player had a concussion.

"It was basically up to (the trainer) and the team doctor," Rosenfels explained. "Being that both were hired by the team, it was an obvious conflict of interest. Some trainers had the trust of the players, and some did not."

The former quarterback acknowledged the elephant in the room: football is a "macho" sport. The players don't want to sit out. No one is forcing an injured player back onto the field.

But the problem is just that -- the decision to re-enter a game should never be left in a player's hands. First, that individual is not thinking clearly anyway, as a result of a head trauma. Second, players in the NFL feel so much pressure to compete and perform that common sense often takes a back seat.

This concept is nothing new; even with proper precautions in play, many athletes will continue to push themselves past what is safe. Numerous players will attest to this, including Brewer.

"I can understand -- from the sports and athlete perspective -- what it feels like to get a mild concussion and have the pressures both internally and externally to return to the field prematurely," Brewer said. "Guys are going back to the field because the culture of professional sports, of sports in general, makes it hard to admit they are hurting."

Gary Plummer, former NFL linebacker and teammate of Seau's, described the stigma on the field in an interview with the Los Angeles Times.

"Any linebacker who doesn't see stars at least five times per game simply isn't doing his job," Plummer said. "(Head injuries are) something players typically don't discuss for fear they will be replaced."

It's quite possible that players are not the only ones experiencing fear of replacement, however -- the league itself faces astronomical repercussions to this issue. While unrealistic to expect that the NFL will ever face a complete demise, it certainly faces the threat of decreased popularity.

A decrease in popularity equals a decrease in revenue.

"Everyone (in the NFL and its media partners) has a financial incentive for the game to grow," Rosenfels said.

This was illustrated all too clearly when ESPN, which originally helped to produce the Frontline documentary, removed its name and all affiliations from the project.

Over the past few seasons, the NFL has increased safety rules and protocol specifically around the risk of head injuries. Does this fix the problem? Do the new rules reflect honesty and ownership, or is the NFL simply acting as a business, protecting itself from additional lawsuits?

"At the end of the day it is football, which is a contact sport," Brewer said. "To totally protect players would require taking out contact and changing the entire sport of football. With that said, I do believe the league has finally faced the health concerns . . . doing everything in its power to protect players with the procedures following concussions and the protocols in place to prevent players from going back into the game too early."

There will always be players who find their way onto the field following a concussion; anyone watching this year's Super Bowl knows that to be true.

However, the changes on the field are, for the most part, doing their job. The facts have bubbled to the surface, and -- regardless of motivations -- the NFL is finding ways to better protect its players from further injury.

But that won't offer much comfort to the families of Webster, Duerson, Seau and Belcher. Reactive implementation of rules will not restore the memory of former Minnesota Gophers and NFL tight end Ben Utecht, who is experiencing degenerative brain disease at the age of 33.

And it won't change the game at its core. No matter how many new techniques are introduced, how much protective equipment is designed, or how many rules against head-to-head contact are implemented, there will be players who break the rules. There will be knee-to-helmet concussions and brain-jolting hits that leave players battered, bruised and scarred.

On March 16, San Francisco 49ers linebacker Chris Borland announced his retirement from the NFL after just one -- very successful -- season. Borland cited head trauma concerns, identifying football as "inherently dangerous." The 24-year-old is walking away from most of a four-year, nearly $3 million contract.

He is giving up something he once called his dream. But to Borland, who has only two officially diagnosed concussions, it's just not worth it.

"I mean, if it could potentially kill you -- I know that's a drastic way to put it, but it is a possibility -- that really puts it in perspective to me," Borland said in an ESPN interview. "Who knows how many hits is too many?"

Reality of long-term danger became impossible for the league to ignore; it's increasingly more difficult for players to ignore; and public awareness intensifies every day. The issue is growing large enough to prompt those heavy, ethical questions. For many in the stadium seats, it may boil down to a choice as frank as valuing entertainment over another person's health. Or vice versa.

"When -- not if -- someone dies on the field in either the NFL or major college football," Rosenfels said, "those who profit from the game will be extremely concerned about its long-term viability."

That's just the hard-hitting truth.

Follow Lindsey Young on Twitter

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