Football: An American tragedy

No aspect of players’ football lives is more debilitating, controversial, or paradoxical than injuries and their consequences. The media strike a frightening chorus: “The NFL is killing its players and the league doesn’t care.” “Most pro football players face a future of disability and pain.” “Retired NFL players experience living hell.” At the same time, other sources proclaim—as Sports Illustrated put it—“NFL players, in general, live longer” than their American male peers, and there’s evidence that they’re in better health than their non-player counterparts in many respects. Even more strikingly, we read that “former NFL players . . . are overwhelmingly happy they played in the league, including more than 85 percent of players who suffered at least five major NFL injuries.” Player after player culminates his story of NFL mayhem with the same surprising refrain: “I’d do it all over again in a heartbeat!”

In recent years, the NFL has undertaken massive rule changes to curb violent hits and combat disabling injury, yet players overwhelmingly say the league is going too far. “I understand that they want the sport to be safer,” laments All-Pro safety Troy Polamalu. “But eventually you’re going to start to take away from the essence of this game and it’s not really going to be the football that we all love.” In spite of all they know about the prospects of disabling injury, players say they don’t want to be protected. It’s a tough man’s game, and they want it that way.

No doubt, football is violent and dangerous; that’s part of its appeal. But it’s also part of the enduring mark it leaves on players. NFL Sundays—but also practices and workouts—clearly jeopardize players’ health. There were more than 30,000 injuries in the NFL from 2002 through 2011, including nearly 4,500 in 2011 alone.  That’s more than two per active player. While some of these are fleeting, and recovery is complete, there’s hardly a player who leaves the game without painful reminders of his violent past. Ninety-three percent of former players missed at least one game due to a major injury, and over half report suffering three or more major injuries during their NFL careers. Eighty-six percent report that they underwent orthopedic surgery as a result of a football injury.  A substantial majority of ex-players said that injury played some role in ending their careers.

If the surgical scars aren’t reminder enough, nine out of ten former players wake up each day to nagging aches and pains that they attribute to football. About eight in ten report that the pain lasts most of the day. Among younger retirees aged 30 to 49, one third say their work lives are limited in some way by the aftereffects of injury. Retired players are much less likely than their age peers in the general population to rate their health as excellent or good, and nearly 30 percent of NFL retirees rate their health as only “fair” or “poor.”  Even though mortality rates among former players are lower than the general population, in many other respects, it’s a grim picture. Many former NFL players are damaged goods.

The Concussion Crisis

In August 2013, the NFL reached an out-of-court settlement with over 4,500 former NFL players who sought damages stemming from disabilities brought on by head injuries suffered while playing in the league. The players alleged that the NFL had willfully concealed information, circulated significant misinformation, and obstructed research indicating that players put themselves at severe risk of chronic brain disease by playing pro football. The NFL agreed to pay up to $765 million to fund medical exams, concussion-related disability compensation, and a program of medical research into brain injuries. Payouts would extend over 20 years, with 50 percent coming in the first three. The agreement explicitly states that the settlement in no way represents an admission by the NFL of liability or a concession that the plaintiffs’ injuries were caused by football.

The settlement actually extends beyond those players who filed suit, and covers all 18,000 of the league’s retired players, quadrupling the number eligible to receive compensation. Players can opt out of the settlement, thus declining compensation but retaining their right to pursue further legal action. All retired players or their families are eligible for compensation if they can show severe cognitive injury or impairment related to NFL football, but players who died before 2006 (and their families) will be excluded from benefits. The settlement caps payments at $3 million per individual for dementia, $4 million for chronic traumatic encephalopathy (CTE), and $5 million for Lou Gehrig’s disease (ALS), Parkinson’s disease, Alzheimer’s disease, or another severe cognitive impairment. At the time of the provisional settlement, there appeared to be at least 300 cases of former players who would qualify in the highest compensation categories.

While the NFL admitted no legal liability, the settlement is a tacit admission that the NFL has actively prevented players from knowing the full extent to which they were inviting chronic brain disease by playing in the NFL—information vital to making informed decisions about their long-term physical and mental health.  The NFL’s shameful complicity in suppressing information about the consequences of concussions and its attempts to thwart scientific research into concussions and their aftermath were further unmasked by media exposés such as the 2013 book League of Denial and an accompanying PBS Frontline documentary of the same title. There’s little question that brain injury is a much more serious problem than the NFL has wanted to admit.

Momentarily setting aside the controversy over concussion research at the heart of the lawsuit, what’s most remarkable in this scenario is the sheer number of former players claiming significant brain damage from playing in the NFL. More than 4,500 living players maintain that they have symptoms of football-related brain damage. That’s nearly a quarter of all living NFL alumni. A 2013 Washington Post survey found that around 90 percent of former players indicate that they suffered at least one concussion while they were playing. Of those who did, two thirds say they still experience symptoms. The NFL Player Care study—commissioned by the NFL itself—asked alumni respondents if they had ever been “diagnosed with dementia, Alzheimer’s disease, or other memory-related disease.” While relatively few reported such diagnoses, comparisons with age peers in the general male population are shocking. Older retirees (50 and older) are five times more likely to report such diagnoses (6.1% to 1.2%), while younger alums (30–49) are 19 times more likely (1.9% to 0.1%). Moreover, neurodegenerative mortality among a 1959 through 1988 cohort of NFL players was three times higher than that of the general population, and the mortality rate for this cohort due to Alzheimer’s disease or ALS was four times higher. While these data don’t say that football wreaks havoc on all players, they clearly suggest that former NFL players are dramatically more likely than the average man on the street to suffer from long-term brain damage.

Every NFL player has his “bell rung.” These shots to the head are likely to cause concussions. They leave players momentarily stunned, disoriented, “seeing stars,” feeling woozy. The most pronounced symptoms may pass in a few minutes, but headaches, impaired vision, memory loss, or cognitive “fuzziness” may persist. Nevertheless, most players simply “play through” the symptoms, getting back into action as soon as they can.

The medical definition of a concussion is a bit more ominous. It’s a brain injury caused by a force transmitted to the head that results in a collision between the brain and the skull that surrounds it. When someone takes a jolt to the head, the brain bangs around inside the skull case. The collision sets off organic, neurological, and chemical reactions that alter the brain and disrupt its functions. There’s a wide range of possible symptoms: loss of consciousness, memory loss, slowed reaction times, cognitive impairment, drowsiness, headaches, irritability, and emotional fluctuations. Some people even go temporarily blind. Most of these symptoms, however, resolve spontaneously.

No two concussions are alike. Some are more serious than others, and some may persist for days, if not weeks. NFL players have “shook off ” the effects of concussions since the game began. There are countless stories of players having their bells rung, but playing on, not knowing what they were doing, and remembering nothing afterwards. In one memorable instance, Cowboys quarterback Troy Aikman was “dinged”—kneed in the head—during the January 24, 1994, NFC championship game. Aikman had played well and the Cowboys beat the 49ers, but Aikman ended up in the hospital with a concussion. He couldn’t remember anything about the game. Steve Young, a contemporary of Aikman’s and a fellow Hall of Famer, was once asked about how many concussions he suffered. His reply: “You mean official ones? . . . An official one is when you’re knocked out and carted off the field. But I get dinged all the time and just continue to play. We might dumb down the playbook a little bit, but I couldn’t count those.” Jim Otto, Hall of Fame center from the AFL and NFL, probably took as many hits to the head as anyone.

I’ve had over 20 concussions myself. . . . There were so many times that I would walk off the field and my eyes would be crossed. Did you ever have that happen to you? Get hit in the head so hard your eyes were crossed? You sit there. It’s strange; it’s really strange. Or what about if you had amnesia for two days? When you looked at your wife and you didn’t know who she was, like, who’s this chick? And you couldn’t remember. You got hit in the head, and you had amnesia.

Eventually, Aikman, Young, Otto, and hundreds of others whose bells have been rung snap out of it—more or less. For generations, that meant that they were good to go. But part of the recent concussion controversy has centered on exactly what happens over the long run when the brain is jarred enough to produce concussion symptoms.

By his own count, Mike Webster, Hall of Fame center for the Pittsburgh Steelers and Kansas City Chiefs from 1974 to 1990, played in 300 games, going back to high school, without missing a single game. He reckoned he’d shown up for 890 of a possible 900 practices in the NFL. He’d knocked heads literally tens of thousands of times in the “pit” of the offensive line. Within a few short years of his retirement, Webster’s everyday aches and pains became severe. He battled hand and foot afflictions. His teeth began to fall out. In addition to physical deterioration, many friends and associates noted that there was something wrong inside his head. He couldn’t sleep. He became paranoid and behaved erratically. His speech was scattered and disjointed. His memory failed repeatedly. He lost his balance. He took on a vacant look—no emotion, no affect. His cognitive functioning slipped. He was “beat up” and “discombobulated,” according to his doctor. Ultimately, Webster became socially dysfunctional. He couldn’t hold a job or live normally in the company of others. His family couldn’t cope with his erratic behavior and his wife divorced him. He simply wasn’t the man they had loved and grown up with. He came to rely upon Ritalin to maintain momentary focus, but eventually abused the drug and began forging dozens of prescriptions. His life became the horror story of an unbalanced, erratic transient.

Finally, Webster, with the assistance of a team of friends, doctors, and attorneys, filed for NFL disability benefits, presenting testimony from four physicians to establish that Webster had disabling brain damage due to his play in the league. The NFL, however, dragged its feet. The Retirement Plan Disability Board insisted on a fifth handpicked “independent” neurologist. When he agreed with Webster’s doctors, the NFL finally granted Webster “total and permanent” disability benefits. The league’s explanation for the decision included an extraordinary admission: “[Webster’s] disability is the result of head injuries suffered as a football player with the Pittsburgh Steelers and the Kansas City Chiefs.” This concession would become even more significant when subsequent concussion litigation arose.

Webster’s story, however, doesn’t end with the disability board. Three years later, his maladies caught up with him, and he died, ultimately from heart problems, at age 52. During a routine autopsy, however, the forensic pathologist, Bennet Omalu, noted that the death certificate indicated that Webster had suffered from “depression secondary to postconcussion syndrome.” Not a football fan himself, Omalu recalled media stories of football great Mike Webster’s erratic behavior and tragic demise, and realized that this was the very same Webster on his examination table. The body was ravaged beyond belief, but when Omalu examined Webster’s brain, it looked completely normal, a startling anomaly. Curious, Omalu got permission to study Webster’s brain. His findings set off a torrent of questions, followed by a flood of research that eventually morphed into a major controversy.

Beneath the surface, Mike Webster’s brain was anything but normal. He had a serious pathology that’s come to be known as CTE. The condition is a progressive degenerative disease found in athletes (and others) with a history of repetitive brain trauma. This might include symptomatic concussions as well as asymptomatic subconcussive blows to the head. The head trauma triggers progressive degeneration of the brain tissue—the scientific literature often refers to this as a pathologic “cascade.” The pathology includes the build-up of an abnormal substance called “tau,” a protein that enables the brain to function, but that can also strangle it if the tau congeals into clumps called “neurofibrillary tangles.” These tangles can choke neurons inside the brain, causing a wide variety of problems. The changes in brain chemistry associated with CTE may begin months, years, or even decades after the last brain trauma.

CTE is insidious. It may lead to memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, cognitive impairment, and, eventually, progressive dementia. As the disease progresses, symptoms become more severe and broader in scope. Memories fail. Victims can’t concentrate or focus their attention. The brain’s executive functioning declines; victims’ organizing capacity fails, they can’t plan things out, they exhibit poor judgment, and multitasking suffers. Sometimes speaking becomes disjointed or difficult. Victims become uncharacteristically irritable, impulsive, or aggressive. Some become completely apathetic at times, in complete contrast to other outbursts of aggressive behavior. Others suffer from depression, paranoia, even suicidal tendencies. Instrumental activities are compromised so that routines of everyday life become impossible. Ultimately, full-blown dementia may set in. While CTE may have symptoms similar to Alzheimer’s disease and other neurodegenerative conditions, its organic presentation is different. Equally important, whereas Alzheimer’s disease and other dementias appear later in life, CTE shows up in relatively young people.

Mike Webster was only 52, and the interior of his brain was laced with tangles of tau.

Given the statistical evidence of widespread aftereffects of head injuries, how likely is it that former NFL players are actually suffering the ravages of CTE? Clearly, all of them aren’t symptomatic. But most have had concussions and thousands claimed some sort of brain damage in the 2013 law suit. For years, the NFL steadfastly denied that concussions were common, or that they had any lasting health consequences. Moreover, the league completely rejected the notion that head injuries sustained playing in the NFL caused lasting brain damage or disease. These denials were at the heart of the former players’ lawsuit. The NFL, they argued, had been deceptive by denying the harmful effects of head injuries and suppressing information about the dangers of playing in the league. Without all available information, the suit argued, players could not make intelligent, informed decisions about the risks they were taking.

Late in 2013, award-winning journalists Mark Fainaru-Wada and Steve Fainaru pulled back the curtain on the NFL’s deception in a relentless account of how, for decades, league officials manipulated information about the incidence, prevalence, and consequences of concussions in the NFL. League of Denial vividly details how the NFL misrepresented data, conducted questionable research, and attempted to suppress and discredit research others were doing on concussions and their aftermath. Along the way, the NFL compromised the professional peer review process to get its own research published in scientific journals, exerted illegitimate influence to suppress other scientists’ research findings, and attacked the work and character of legitimate researchers who produced findings contrary to the NFL party line.

While there’s a notable sampling bias in the collection of the cases studied—brains tend to be donated for study by families of deceased players who were suspected of having brain disease—the consistency of these findings is compelling. Moreover, not a single case of CTE has been found that wasn’t preceded by some sort of brain trauma.  Does this mean that all NFL players have or will get CTE? No. Does it mean that every player who suffers a concussion will develop CTE? Again, the answer is probably no. It’s nearly impossible to establish a certain causal link between suffering a concussion and developing CTE. Given the evidence currently available, it’s also difficult to establish the likelihood that a former player, or a player who suffered a concussion, will develop CTE. The incidence and prevalence of the disease are still unknown. But some scientists—such as Ann McKee, who has probably examined more postmortem cases of CTE than anyone—are willing to speculate:

The incidence and prevalence [of CTE], we won’t know those until we have a way to detect it in living people. Then we can look at thousands of people who play these sports, and really come up with an incidence and a prevalence. . . . We have over 70 [deceased] football players with this disease, from all levels, and we’ve done that in five years. I just don’t think we could do that with a rare disorder. I just don’t think it’s possible. Even if we were selecting for families that thought that the individual had the disease, we have an enormously high hit rate. . . . So I think the incidence and prevalence have to be a lot higher than people realize. And I also think that given the worst of circumstances, if you take a single year, and you look at all the NFL deaths in a single year, and that’s your denominator, and on the numerator you put all the cases that we’ve had with CTE of NFL players, assuming that we got the only cases of CTE of NFL players ever, anywhere, it’s about 10 percent. Ten percent of NFL players get CTE. Well, that’s a huge percentage, if you ask me. And that’s the lowest it can be.

The conservative estimate that ten percent of former NFL players might have CTE, accompanied with the dramatic autopsy evidence, casts the NFL cover-up in an even more unflattering light. It squarely implicates the league in the documented tragedies of players with CTE who’ve violently taken their own lives. It raises the possibility that other violent incidents—for example, the case of former Kansas City Chiefs tackle Jim Tyrer, who murdered his wife, then killed himself—may have resulted from football-related brain disease. Equally important, the research suggests that the NFL may be liable for damages to thousands of former players who develop CTE and who may someday suffer the debilitating aftershocks of the hits they took in the NFL. This corroborates the league’s tacit admission in the lawsuit settlement and its on-the-record acknowledgment that Mike Webster’s disability was “the result of head injuries suffered as a football player” in the NFL. A telling pronouncement came late in 2009, in the wake of congressional hearings on the NFL’s concussion crisis, when Greg Aiello, the league’s communications director, quietly confessed, “It’s quite obvious from the medical research that’s been done that concussions can lead to long-term problems.” This is the only time anyone from the NFL has publicly acknowledged a connection between football and brain disease.

In the shadow of this mountain of damning evidence, the concussion lawsuit settlement between players and the NFL has generated considerable conjecture. On one hand, $765 million dollars is a hefty sum. On the other hand, spread across a possible 4,500 claimants, it amounts to a relatively small average individual payout ($17,000). An expanded number of claimants further dilutes the settlement pool. Why, then, did the two sides settle so quickly?

From the NFL’s point of view, the $765 million payout pales in comparison to possible damages that might be awarded should the league lose the case in court. That amount could rise into the billions. While $765 million is nothing to scoff at, the NFL is a multibillion-dollar industry that can absorb the financial hit. Perhaps more importantly, by settling the case out of court and signing an agreement that doesn’t admit liability for players’ head injuries, the NFL dodges the prospect of establishing legal precedent that could be cited in future litigation, which might cost the league even more.

Then why didn’t the players press their advantage? Certainty is the key factor. Coupled with the immediate needs of many currently disabled players, a guaranteed payout is appealing. No court case is a sure thing, and even in victory, the amount of an eventual award is uncertain. It could be enormous, but it might also fall short of expectations. Should the players lose, they might not get a cent, and hundreds of players could find themselves in dire straits, with no help whatsoever. The NFL has the resources to effectively oppose the litigation and drag out the process for years, if not decades. For players with pressing medical and financial problems, a huge payoff ten years down the road isn’t very promising. They and their families might not last that long.

Most crucially, despite the mounting scientific evidence and swelling public support, establishing the NFL’s liability in court is a difficult proposition. The case would shape up much like class action suits against the tobacco industry, where, for years, epidemiological evidence wasn’t sufficient to establish legal liability. In order to win a judgment, the players would need to prove that the NFL knowingly placed players in harm’s way—that the league knew that playing NFL football caused chronic, debilitating brain damage and that the players were kept ignorant of the imminent danger.

The initial challenge would be to establish that players didn’t know that football could cause brain damage. This is a major hurdle, because everyone knows that football is a violent game, fraught with danger. The second key issue would be establishing a direct causal link between injuries incurred on an NFL playing field and brain damage. It’s virtually certain that playing football leads to widespread concussions. There is also convincing scientific evidence that multiple instances of brain trauma—especially repeated concussions, but also repeated subconcussive events—are associated with chronic brain disease. But this evidence is probabilistic, not experimental. That is, it can be established that NFL players as a group are likely to suffer concussions. And players suffering concussions are likely, as a group, to develop brain disease. But court decisions don’t hinge on probabilities. Cases are adjudicated based on clear, if not certain, causal connections between individual circumstances and individual outcomes. Here’s where the players’ case becomes difficult.

In defending their case, the NFL would argue that a player needed to establish the direct link between an injury incurred in the NFL and the subsequent development of brain disease. They would require players to provide documentation of brain injuries while playing in the NFL, and while such documentation is increasingly available, prior to 2000, almost none existed. Data currently at hand is unsystematic and often anecdotal. Team and player medical records are often inconclusive about the number, timing, and extent of player injuries. Players themselves are complicit in this shadowy documentation because they are notorious for not letting team officials know they’re hurt. They get their “bells rung,” shake it off, and get back on the field, even if they can’t see clearly or remember where they are or what they’re doing. Retrospective accounts of unreported concussions are not compelling legal evidence.

Even if a history of NFL-related concussions could be established, the defense would demand that claimants prove those injuries directly resulted in debilitating brain disease. Again, the evidence is largely probabilistic. It doesn’t establish the certainty of causality, an argument that would surely be front and center in any litigation. For example, all neuropathologically confirmed cases of CTE have a history of brain trauma, but not all individuals with exposure to brain trauma develop CTE. Players may be likely to suffer brain disease, but to win a court case, a player must establish that specific injuries directly caused his own specific debilitating outcomes.

Players would also be required to rule out other possible causes of brain disease. This, too, is difficult. The NFL would argue that everyone— concussions or not—has some probability of eventually developing brain disease. The onus would be on the player to prove that other factors that might reasonably cause brain diseases—for example, heredity, routine lifestyle choices, normal aging, and myriad other alternate explanations for players’ current conditions—were not involved. Even more daunting, from the players’ perspective, is the prospect of ruling out other non-NFL head injuries as the cause of current medical problems. This is virtually impossible. Nearly every NFL player has participated in four to ten years of organized football before reaching the NFL, including hundreds of games and thousands of practices. The NFL would argue that this participation almost certainly contributed to current medical conditions, thus absolving the league from liability for the present state of affairs. What’s more, since recent scientific evidence suggests that initial concussions render players more susceptible to subsequent brain trauma, the league could argue that concussions experienced in high school and/or college were the precipitating cause of brain disease—that players already had “pre-existing conditions” before they reached the NFL. Players would be required to demonstrate that this was not plausibly the case. Proving that an elite high school and college player never had his bell rung is a tall order.

Given the challenges faced by both parties to the litigation, the settlement represents a compromise based on the perceived risks and rewards for both sides. The NFL limits damage and heads off catastrophic precedents. The players take home a guaranteed payoff without having to prove a problematic case that might involve years of litigation. Those gravely in need will get help almost immediately. The compromise cost the NFL $765 million. The players forfeit the possibility of a multibillion-dollar payday. Both sides can claim public relations victories. The NFL hasn’t admitted responsibility for player injuries. The league can say it is simply doing what’s right by taking care of its players and former players. For their part, the players can point to the tacit admission of guilt by the NFL and the quick and substantial payout to players who really need the help.

Reaction to the settlement has been decidedly mixed. The feedback is complicated by players’ defiant attitude toward injury itself. For many of them, injury is just a “part of the game” that has to be accepted. Jim Otto obviously deserves considerable help from the NFL for the injuries he’s suffered. He’s more than willing to talk about the steep price he paid for his career. But he’s adamant about accepting responsibility for his fate. He doesn’t want the NFL’s help or its money.

Nobody is giving me any special help. And over here these guys [the players filing suit] are wanting the world. They’re suing everybody for a lot of money, which I don’t like because that’s going to hurt football in high school, Little League and in [the] pros. . . . They’re going to cost so much money that the owners and high schools won’t be able to afford the insurance for the game and stuff like that. I’m against all that. Let’s play football.

Asked about the evidence that former players are suffering the debilitating effects of concussions and CTE, Otto responds:

Well, I’m  trying in my mind not to relate that to my situation, you know. . . . I don’t want to believe that that’s what’s happened. . . . Those are the battle scars of a gladiator. The gladiator goes until he can’t go anymore. And that’s what I’m doing. . . . I don’t want to make excuses . . . I knew about concussions.

Otto isn’t alone in stoically accepting his fate, but others are equally adamant that the players settled for far too little. “$765 million?” asks former Minnesota Viking Brent Boyd, one of the original plaintiffs in the lawsuit. “The breakdown is $1.2 million over 20 years per team. What is that, a third of the average salary? There is no penalty there. It’s pocket change.” Boyd has a point. In the broader scheme of things, the NFL stands to make somewhere between $200 billion and $500 billion over the 20 years during which the league will dispense the $765 million settlement award. Viewed in this context, it is, indeed, pocket change.

In January 2014, Judge Anita Brody raised precisely this issue when she denied preliminary legal approval of the settlement. Brody’s central concern was that not all retired NFL players who ultimately receive a qualifying diagnosis (or their families) will be adequately paid under the current plan. She also objected to a lack of data in support of the settlement’s economic assumptions. In July 2014, the NFL agreed to remove a $675 million cap on compensatory claims for players with neurological symptoms, and Brody granted preliminary approval.

But it’s not only about the money. Like many other players, former NFLPA president and Pro Bowl center Kevin Mawae is disappointed that the NFL hasn’t admitted culpability. “[Fans] see $765 million and they think it’s a windfall for the players. It’s great for . . . the guys that would fall in the category of needing immediate help,” he says. “But it’s $700 million worth of hush money that they will never have to be accountable for.” Anticipating future litigation, Mawae argues that the NFL hasn’t had to disclose damaging information it has withheld for years. He calls the settlement a “pittance,” a relative “drop in the bucket.” “The league won,” he laments. Former Packer Dorsey Levins, another plaintiff, also wanted an admission of liability, but acknowledges the need for immediate help: “When a guy [with symptoms of CTE] calls me and says, ‘I’ve called the NFL five times. I can’t get a response. My head hurts all the time. And if I can’t get help, I’m going to take care of it [end his life].’ I couldn’t sleep. What do you say to a guy like that?”

In the larger health picture, where do former players stand in the wake of all this? Many are suffering the aftereffects of hits to the head. Some are enduring the ravages of CTE. There’s some financial relief on the way, but it’s not as much as it appears at first glance. Some players may receive several million dollars, but the average payout is going to be far less. Perhaps the most chilling insight to come out of the concussion crisis is the realization for players that many of them may be looking down a very bleak road to a future of mental decline and disability. They wonder if it’s already happening. Upon hearing of Junior Seau’s suicide and the speculation that it was CTE induced, Steve Young pleaded with his friend and former teammate Gary Plummer. “Please, bro, tell me there’s more to it than just the concussions, tell me that please.” Every former player who’s had his bell rung is probably asking the same thing.

Excerpted from “Is There Life After Football?: Surviving the NFL” by James A. Holstein, Richard S. Jones, and George E. Koonce, Jr. Copyright © 2014 by New York University. Reprinted by arrangement with NYU Press. All rights reserved.