Weighing in on concussions

Todd Heap remembers catching a pass in the end zone ... and then darkness.

It was four years ago against Denver that Heap thought he had scored a touchdown before Broncos linebacker Al Wilson forced an incompletion by planting his shoulder underneath the Ravens tight end's chin.Heap's helmet flew off. His body fell backward to the turf. And he blacked out.

But like so many players in a sport that glorifies personal sacrifice for victory, Heap returned in a matter of plays, making more catches and absorbing more hits.

"I was like, `They're not going to stop me from getting on the field,' " said Heap, who was checked out on the sideline and cleared to play. "So the awareness has to be there to protect us from ourselves."

Tomorrow's preseason opener against the Philadelphia Eagles is the first time the Ravens will play in a game since recent studies claimed multiple traumatic concussions contributed to early dementia, severe depression and the deaths of four former players.

Ravens center Mike Flynn, who is in his 10th season, said he doesn't need statistical data to warn him about the dangers of concussions.

"I got to believe your body is not made to be hit like that, so there's going to be some long-term effects," Flynn said. "And if they tell me there isn't, I'll say, `Well, let's take your head and smash it for 11 years.' "

So, why does Flynn continue to play?

"We live in the moment and we think we're invincible," said Flynn, who thinks he gets concussions more frequently at this stage of his career. "But believe me, it's a constant debate with older players: `I love playing and I feel good now, but what is this really doing to me?' "

According to the NFL's mild traumatic brain injury (MTBI) committee, there is no evidence multiple concussions have a cumulative effect.

But the Center for the Study of Retired Athletes at the University of North Carolina contends that players who have suffered at least three concussions have triple the risk for neurological disorders later in life.

The MTBI committee criticized these findings because they are based on surveys and not scientific data.

The league is conducting its own study on retired players, but the results of this research could take two to three years.

"We don't know for sure the long-term effects of concussions as it relates to football," said Dr. Andrew Tucker, the Ravens' physician and a member of the MTBI committee. "Some of the data out there is interesting and it's concerning. But we have to build on that."

After a league-wide symposium in June, the NFL has taken steps to address the severity of concussions, starting in training camp this year.

The league has implemented a whistle-blower system, which allows injured players to anonymously notify the NFL if they are feeling forced to play when they are not ready to do so.

The NFL also will require all players to undergo baseline neuropsychological testing starting this season, which helps teams compare the mental functioning of an athlete before and after a concussion.

Other measures include enforcing rules that require players to properly buckle their chin strap (which reduces the chance of a player losing his helmet and injuring his head more seriously) and distributing a brochure to help educate players and their families about concussions.

"The most extreme form of prevention would be not to play the game because it is certainly a game that has risks," Tucker said. "And those risks will never be made zero."

Differing opinions

Could one of the risks be death?

Dr. Bennet Omalu, a Pittsburgh neuropathologist, studied the brains of four deceased NFL players in recent years -- former Philadelphia Eagles safety Andre Waters and former Pittsburgh Steelers offensive linemen Mike Webster, Terry Long and Justin Strzelczyk -- and found damage in each one that would have produced depression and advanced dementia.

Waters committed suicide at the age of 44. Long killed himself at 45. Webster died at 50 of heart failure after experiencing many personal problems. And Strzelczyk was killed at 36 when his pickup truck crashed while he was being chased by police.

Omalu's findings have been disputed by the NFL, but Ravens running back Willis McGahee made a blunt personal assessment of the ramifications of collision after collision.

"Every time you're hit, you're losing a brain cell," he said.

The NFL's repeated rejection of other studies has spurred criticism from some experts in brain trauma. Because the NFL committee's research doesn't match other results, there is a perception that the league skews its numbers so they're more favorable to the NFL.

"I don't want to sound mercenary, but from a pure business standpoint, it doesn't make sense to have an asset that is at risk," Ravens coach Brian Billick said. "The last thing you want to do is lose a player careerwise to a concussion because that's a lost resource.

"They can doubt the moral and ethical character of us if they want to, but you can't doubt the fact that we're pretty good businessmen. And it only makes good business sense to make sure the players are in the healthiest environment."

`A smart player'

Derrick Mason's advice borders on blasphemy in the football world.

After sustaining two concussions over a decade as an NFL receiver, Mason tries to avoid head trauma these days by picking his battles.

If he's going over the middle with a head-hunting safety coming right at him, isn't it better to go down to the ground rather than be knocked down?

"It's better to be a smart player than a tough player," said Mason, who is in his third season with the Ravens. "Because if I got down and later made a big play, then I'm a smart player as opposed to taking that crucial hit that might take me out."

This season, instead of knocking heads, some players are using them to contemplate the consequences of getting featured on ESPN's "Jacked Up."

According to the Ravens, they average one concussion every two to three games.

There have been seasons where they have dealt with as few as five and others where there have been as many as 20.

While Mason said athletes need to make better decisions, others suggest the entire player fraternity needs to take better care of its own.

In the macho arena of football, players are often congratulated for knocking someone out of the game, especially if it's a quarterback.

Ravens special teams ace Gary Stills said he is not looking for that "kill shot" and doesn't believe he has ever given anyone a concussion.

"I'm not going to say I'm going to take it easy on you, but I'm not going to try to hurt you," Stills said. "This game is about us, not me."

The increased awareness of concussions hasn't been limited to players.

NFL coaches understand the consequences of pushing players back onto the field after they have incurred brain trauma.

New awareness

In previous generations, a player would be given ammonia capsules on the sideline and rushed back into the game once his head cleared.

Billick compared the attitude toward concussions to the way heat was dealt with at training camps. Coaches once thought they could toughen their players by not giving them water in sweltering conditions.

"Think about it. How stupid was that? But it was from ignorance, not maliciousness," Billick said. "The limit of your medical knowledge back then [for concussions] was, `Just shake it off.' "

Billick said his protocol in handling players with concussions is simple: He doesn't have a say.

When a player suffers a head injury, he said the player's status will be determined by the team doctor and trainer.

"When they tell me a player shouldn't go, it's done and the end of discussion," Billick said.

Pressuring players back onto the field has become a focal point for the NFL after former New England linebacker Ted Johnson said he wasn't given enough time to recover from his head injuries.

Johnson said he suffers from deep depression and an addiction to amphetamines because coach Bill Belichick pushed him onto the field in 2002 against the advice of the trainer.

Belichick responded to the allegation by saying, "If Ted felt so strongly that he didn't feel he was ready to practice with us, he should have told me."

Billick said he doesn't believe that happens these days, adding that a coach "would be criminally liable" if he did.

Said Billick: "I can't imagine the individual that would say, `No, I know more than a doctor or trainer.' "

Risk vs. reward

The trainers and doctors can tell a player he can't return to the game. The coaches can agree with them.

But players sometimes put themselves at risk by sneaking back onto the field.

At every level of football, Tucker has told a player to sit during a game only to have the player return without his knowledge. The trick now is to take the injured player's helmet away.

"You've got someone who is injured and irrational, and that's a bad combination," Tucker said.

In the player's mind, he could lose respect -- or, more important, his job -- by remaining on the sideline.

Now, every player who suffers a concussion has to ask himself if the long-term risk is greater than the immediate reward.

"As a player, you don't ever want to come off the field," Heap said. "There is a reason most guys are out here -- it's because they're pretty stubborn. Since we were kids, we learned how to hit, how to be tough and how to play through things.

"It just changes now when it's the rest of your life that you're dealing with."
Sun reporter Ken Murray contributed to this article.