The hit came fast and hard to the head of one of the AFC's best wide receivers. He stayed on the ground a moment, then got up slowly. One step, two, and on the third he stumbled, obviously wobbly from the hit.
He regained his balance, made his way to the sideline and was standing next to one of his offensive coaches -- waiting to go back into the game -- when the team's trainer approached. The player raised his hand in a stopping motion, and the trainer stayed away.
In a different game, a different Sunday, another top AFC wide receiver on another team took a hard hit to the head. Again, he clearly stumbled and wobbled. Once more, a team physician approached. But the player made a similar stop gesture, and the medical staff backed away.
I witnessed both incidents first-hand. We're not naming the players, because teams could offer many reasons why medical staff never followed through with a concussion evaluation. But the scenes have been repeated each week: A player gets hit in the head and slowly leaves the field. It looks like he might have a head injury, but it's nothing obvious. The team medical staff approaches, but the player waves them off.
A four-month look at how the NFL handles concussions in a more tightly controlled environment shows that following the new rules remains extremely arbitrary. Many times, players ignore them. Sometimes, teams do. In other instances, there is a pact between the two to skirt them.
While NFL teams have enacted smart and thorough mechanisms to help players deal with the dangers of concussions, some have found a way around them by simply waving off doctors on the hits that aren't clearly visible or where the player doesn't lose consciousness. Some are hiding concussion symptoms from doctors, players said in dozens of interviews.
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"In some cases, if you avoid the doctors, you can avoid the concussion exams," one AFC North player said, "and the doctors know you're avoiding them, but let you."
Said one player, who is also a player representative: "The concussion rules are the best they can be. The league and the union have done a good job protecting players, but the truth remains, players are still hiding concussions, because they want to protect their careers. In some cases, teams know a player is concussed and let it go. Yes, that still happens."
The NFL and players union might soon respond to holes in the policy by placing independent doctors on the sidelines during games, taking the decision out of the hands of the interested parties: the teams and players. But until then, some players will continue to put themselves at risk by doing whatever they can to stay on the field.
Washington Redskins linebacker London Fletcher, who has never missed a game in 13 seasons, said some organizations follow the new rules stringently. But he said other teams still allow players to diagnose themselves.
"The NFL is taking concussions seriously for the first time in my career," Fletcher said, "but there are still too many gaps in the new rules. Players being players are taking advantage of those gaps."
A consistent theme is that the system works when players want it to. Privately, players have high praise for the new rules but say dozens of players are still bypassing them out of fear of losing their job to injury, losing money in free agency or called soft by their teammates.
"You know, that's the fear I think that any player faces," said Pittsburgh safety Troy Polamalu, who in many ways has become the poster child in the concussion battle. "And that's the fear that any individual faces, overcoming any certain fears of being a coward, you know, and letting your teammates down or turning down a hit. That's the beautiful thing about sports is these fears are right in your face and it's pretty obvious if you turn them down or not."
Asked if he worries the next hit will cause an even worse concussion, Polamalu says, "Oh, I have the fear, no question about it. But I'm willing to fight it, for sure. In the situations I had this year, I don't think I would do anything differently. Third-and-1 with [Jacksonville's] Maurice Jones-Drew, either let him get the first down or not? That's the type of internal battle we fight as athletes."
Polamalu has had a reported seven concussions going back to high school. San Diego linebacker Takeo Spikes, who started his NFL career in 1998, remembers being knocked unconscious when playing in a game at Auburn. A short time later, he returned to the game.
"To this day, I don't remember what happened," he said. "I woke up on the sideline, shook it off, and went back in.
"We've come a long way from those days. The NFL and union have done a great job making things better. But we have a long ways to go. Players still have that grinder mentality. 'Concussion? I can get through that.' We still need to change that mindset."
Several team trainers and doctors contacted by CBSSports.com would not comment on the record but stated the league's protocols, while not perfect, do a better job of protecting players.
NFL spokesman Greg Aiello told CBSSports.com: "Part of the ongoing culture change in our game is making sure players buy into the health and safety priorities that we have established. Those priorities are an important part of the new CBA and the players deserve credit for that. But it is an ongoing challenge when you are dealing with competitive, tough-minded athletes and we have to keep working at it with the players."
Based on current science, the stakes with concussions have never been higher or more potentially frightening for players. Brain researchers are finding that a disease called chronic traumatic encephalopathy, or CTE -- a close cousin of Alzheimer's -- is caused by blows to the head and can lead to addiction, impulsive behavior and memory loss. Scientists currently can only diagnose CTE posthumously. CTE has been found in almost two dozen deceased NFL players.
Just this month, a lawsuit filed by 11 former players -- including former New Orleans player Joe Horn -- in federal court in Newark alleges that in the not too distant past, players were given Toradol, a powerful anti-inflammatory drug, to mask concussion symptoms. The suit alleges players who might have suffered concussions were given the drug and then returned to the field.
The new rules were designed to help protect players from some of these dangers and alleged abuses. Players say the rules are generally working but that the league is running into an old problem: Changing the mentality of the people the rules are designed to protect. Players' desire to play through concussions despite the dangers remains an almost unbeatable force.
One longtime veteran also stated a possible cold, ugly reality -- some of it financial.
"If you want the truth about this, if the league really removed every player that had a concussion from a game or sat a player for a few games because of a concussion, the league would probably lose anywhere from 20 to 40 percent of its players every week. Stars, middle of the road guys, everybody. Twenty to 40 percent, easy. That's something neither the players or the league really wants."
Said Saints tight end John Gilmore: "Dude, when we strap up, we play for each other. You think, 'Man, if I go down, I won't be out there to block for them. They won't have someone to run that route.' You think about these things ... players are players. We go out there to do a job. I don't care how much emphasis [there] is, that's not going to change things. This is a game for warriors."
• • •
The newer concussion rules were enacted to prevent the type of abuse that players report is still happening. The rules have increased safety. In dozens of interviews, players -- most requesting anonymity out of fear of problems with teammates or the NFL -- say they like the new rules and want them to stick.
The core of the new rules: If a player is suspected to have suffered from a concussion, he is to be immediately removed from the game. He's then given a series of tests by medical personnel on the sideline to examine brain function.
If it's determined a player does not have a concussion, he can return to the game. But if the team doctor determines the player does have one, he is removed from the sideline and cannot return. And he can't practice or play until cleared by an independent neurologist.
"They're just being more cautious this year and taking more precautions with the players, and if you show any type of concussion symptoms during a game, more than likely you're not going to go back in," Pittsburgh wide receiver Hines Ward said. "Despite anything, even if you feel good or whatever. If you've had any type of symptoms, they don't allow guys to go back in anymore. So, that's the biggest difference from this year to previous years. And they want to emphasize safety, so if you have any dizziness or had your bell rung, some form of a concussion, you'll probably end up sitting out the rest of the game after that."
|Did Browns medical personnel fail to identify McCoy's classic concussion symptoms, or willfully ignore them? (AP)|
Yet players and teams are finding ways to skirt the new rules, numerous players said in interviews. Or the rules are simply being ignored.
We don't know exactly what happened to Cleveland quarterback Colt McCoy on Thursday night, but all signs point to McCoy suffering from a concussion and then returning. He was hit helmet-to-helmet by Pittsburgh's James Harrison. McCoy was clearly dazed and stayed down on the field for several minutes. McCoy stayed out of the game for two plays before returning.
After the game, according to the Elyria Chronicle-Telegram, McCoy said he didn't remember the hit, a classic symptom of a concussion. Then, a radio reporter tweeted that Browns public relations officials asked television reporters to turn off the camera lights while McCoy was being interviewed. Light sensitivity is another classic symptom.
One day after the game McCoy's father, Brad, blasted the Browns for their handling of his son.
"He never should've gone back in the game," Brad told the Cleveland Plain Dealer. "He was basically out [cold] after the hit. You could tell by the rigidity of his body as he was laying there. There were a lot of easy symptoms that should've told them he had a concussion. He was nauseated and he didn't know who he was. From what I could see, they didn't test him for a concussion on the sidelines. They looked at his [left] hand."
"After the game, the [public relations staff] made sure Colt's interview was brief and he couldn't face the lights in his press conference. The TV lights and the stadium lights were killing him. Why would you say he was fine? That makes it even worse."
One day later, the team said McCoy would be treated as if he suffered a concussion and defended the handling of the quarterback. In several text conversations with players from around the league after the incident, they pointed to McCoy's situation as one of many that illustrate the weaknesses of the new rules.
McCoy's situation was not so different from what happened to Michael Vick in October. He was hit helmet to helmet by Washington safety LaRon Landry and was visibly stunned. "They're holding him up like a punch drunk boxer," said analyst Brian Billick, who was calling the game. Vick went to the sideline, was examined by medical personnel, and returned just over five minutes later. The Eagles said Vick had dirt in his eye and the wind knocked out of him when there was no evidence either of those things were true.
Fletcher remembers that scene. "No question he was groggy from a hit," said Fletcher. "I called for the doctors immediately. Anyone could see it was a head injury."
Fletcher said that and other instances demonstrate the perils of the player mentality. "It's ingrained in us as players to keep playing even when we know we're doing something extremely dangerous like playing through a concussion," he said.
The key to avoiding an independent neurologist and missing game time, players say, is hide the concussion if possible, or refuse to be examined. For the latter to work, team trainers and doctors have to allow it, and players say some do.
Several players said they spoke to CBSSports.com because they fear the message about the dangers of concussions still has not sunk in among players and teams.
Asked how often players come forward and admit concussions, Gilmore, the Saints tight end, said, "I'm going to be perfectly honest with you. I think a lot of it has to do with where a player is in his career and life. When you start having kids and families, your perspective on things kind of changes a little bit.
"But having said that, as a football player, you do kind of play doctor. 'Am I cool? Is this something I should bring up?' Now, I think we all know how sensitive the concussion issue is right now. I don't know as a player that all of the increased awareness and studies is going to still make you report it sooner than you would say three years ago when there wasn't such an emphasis. I'm going to be perfectly honest. Because now I know what's going to happen if I say it's a concussion. Then I'm out of the game."
Gilmore then might have hit on the main reason players continue to conceal concussions: "Speaking as a player, this is a game of attrition. It's not a game for everybody. The one thing another man, especially in a locker room, doesn't want is to question their toughness and their pride."
Some of the diagnostic avoidance demonstrates the limitations to the new rules. Players only steer clear of medical personnel when they are not knocked unconscious or the effects of a big hit aren't obvious to fans and media. But those hits still fall under the concussion rules.
When New England tight end Rob Gronkowski was flipped upside down on a tackle against Kansas City this season and landed on the back of his neck, it was a violent and visible play seen by everybody in the stadium. Gronkowski went to the bench and smothered by team medical personnel and administered sideline concussion tests. Players say after those kinds of high-profile hits, dealing with doctors is unavoidable.
But subtle hits noticed by few still lead to concussions, and players say those are less likely to lead to loss of game or practice time. Players say refusing to be examined or hiding concussion symptoms is a spreading counterweight to the new rules.
It's unknown how aware medical staffs are of this tactic or if they play along, but in interviews, players say they believe some team doctors do.
Another important fact: There is still no definition of exactly what a concussion is. "There is still no clear-cut definition, no," said Spikes, who is one of the most educated players on the issue. "It doesn't exist."
This, players said in interviews, allows some team medical personnel to skirt the concussion protocols.
• • •
Saints players are both realistic and nuanced when it comes to concussions. In general, I'm told by players, the Saints are among the best teams when it comes to handling concussions.
While Gilmore thoughtfully but bluntly talked about the reality of concussions and how some play through them, he also told an interesting story of how he and another New Orleans player helped protect a teammate after a concussion.
Saints tight end David Thomas has suffered multiple concussions this season. The first came in Week 3 against Houston. The Saints followed the concussion protocols explicitly, and he wasn't cleared to play again until Week 9. Then Thomas suffered another concussion in Week 10.
Thomas, Gilmore and tight end Jimmy Graham were all sitting together after Thomas suffered that second concussion during a game against Atlanta when Thomas said to both men, "Something's not right."
|Saints tight end John Gilmore acknowledges that players will play through a concussion rather than risk losing playing time. (US Presswire)|
"It's almost as a player that you want to make sure. I'll put it to you in this way. I had one in the past a long time ago, and you know when you have one. When you're not all there, you know. [Thomas] knew he wasn't right. Being that he was just coming back from one, he could have been thinking that maybe he's overthinking it. ... But it's not like a knee. It's not like an ankle. This is something you can't see. It's not something that's going to stop you from running down the field."
Few teams have suffered more high-profile concussions than the Steelers. When asked if he noticed the attention around concussions, Polamalu said, "Absolutely, I'm well aware of the research, I'm well aware of the frenzy that's kind of surrounded this particular injury. I also realize that with the amount that I have that I'm probably under a lot more scrutiny, and we're under a lot more scrutiny than other organizations."
A small group of players on an NFC team spoke to CBSSports.com, and one expressed an opinion that explains the mindset of many around football.
"Guys want to get out there [after concussions] as soon as they can," the player explained. "You get left behind if you miss too much time in this league."
When asked if the new protocols are working, another player from that team said, "They're trying, but changes need to be made."
Spikes identifies one of the central problems with concussions: For all the information scientists have learned about their impact on the brain, they still really don't know that much. That's because -- not to put too fine a point on it -- they need more brains of deceased players to study.
"That's the key," Spikes said, "which is why no question when I die, I'm going to give my brain to research and hopefully that will help the players who come after me."
In the meantime, Spikes said, "As a player you're concerned about concussions, but the truth is you can't worry too much while you're playing. If you do, you'll get hurt even worse, because your mind has to be focused to play this game. If you're not focused, or worrying about something, you'll be out of football and replaced by the next guy."
Fletcher, the Redskins linebacker, said there were several ways to strengthen the new concussion rules. One was put more power in the hands of game officials who witness possibly concussed players (though that idea has many pitfalls). Fletcher also said the union and league can make sideline examinations mandatory so players have no say in the process.
Fletcher said the best thing the NFL can do is have a league-appointed monitor who would patrol the sidelines and make sure teams and players are abiding by the rules. Another player echoed this sentiment, saying it is ridiculous the NFL has officials monitoring what color shoes a player can wear but no independent person watching if the concussion rules are being followed.
The NFL has a new policy this season where a league observer in the press box can alert a team's medical staff on the sideline about a concussion (or other injury) the team may have missed. Some players say that isn't good enough. They want an independent observer with a medical background to look for concussions that were missed or are being hidden by players or ignored by the medical staff.
That change could happen quickly where sources believe an independent neurologist could be on the sideline watching for concussed players and insuring their treatment follows the rules.
"But before any of that, players have to watch their own backs," Fletcher explained. "We put pressure on ourselves to play when we shouldn't be playing because of a concussion. That has got to change."
CBSSports.com correspondents Larry Holder, Chuck Finder and John Kreger contributed to this report.