Chin Music

By David E. Thigpen

Like most National Football League players, New York Jets receiver Rob Moore is accustomed to getting hit hard and jumping right back into the fray. But Thanksgiving weekend, as his team faced the Miami Dolphins, the 6-ft. 3-in., 205-lb. Moore caught a pass and got clocked so badly that he couldn't get up -- at least not for three minutes. When coaches and trainers finally hauled him to his feet, he was so dizzy and disoriented that a team doctor forced him to spend the rest of the game on the bench. Hours later Moore was still complaining of nausea and a severe headache. Though he had no sprains or broken bones, the problem was potentially more devastating than a cracked rib or battered knee: he had suffered a concussion -- an invisible, sometimes short-lived but often dangerous injury to the brain.

Unfortunately, the Jets receiver is not alone. On just about any fall weekend, as the 28 N.F.L. teams square off on their 100-yd. battlefields, three or four players will be knocked out of the action by concussions. At least 40 such injuries have occurred this year, and in the past six weeks the casualties have included an unusually large number of highly paid stars. Even in a sport long admired and abhorred for its body-crunching brutality, concern about the carnage is rising. Players, coaches and fans may never forget some of this season's scariest images: the vacant, confused stare of Dallas Cowboys quarterback Troy Aikman after he collided chin-first with a blitzing Phoenix Cardinal; the sight of Buffalo Bills receiver Don Beebe lying, out cold, on the field, with one forearm pointed stiffly into the air; the awful stillness of New York Giants quarterback Dave Brown after his head was slammed to the turf by a Houston Oilers linebacker. The high toll among quarterbacks (the Cleveland Browns' Vinny Testaverde and two Los Angeles Rams passers also went down with concussions) has led some N.F.L. watchers to joke morbidly that the QB is a species more endangered than the spotted owl.

A concussion, as defined by the Professional Football Athletic Trainers Society, is a "jarring injury of the brain resulting in dysfunction." Simply put, it is a shock to the brain -- usually caused by a powerful blow to the head -- that can result in vertigo, disorientation and momentary unconsciousness, or even permanent memory loss, coma and death. Dr. Robert Cantu, a neurosurgeon at Emerson Hospital in Concord, Massachusetts, explains that when the head is hit, "the brain is shaken in the cranium much like Jell-O in a bowl."

Even non-fans know that concussions are a part of any contact sport, and the injury is certainly not new to the N.F.L. According to the league commissioner's office, the rate of player concussions -- one every 3.5 games -- has been unchanged since 1989, the first year statistics were kept. In 1979 Cowboys quarterback Roger ("the Dodger") Staubach retired after four concussions in one season, and Jets receiver Al Toon hung up his cleats in 1992 after 10 career concussions. N.F.L. players even have their own concussion-related argot. Mild blows are known as dingers or bell ringers (because players usually have a ringing in their ears), and a player who has suffered a severe hit is said to have been "sent to dreamland."

| While concussions may be no more common than in the past, there is now a heightened awareness among team doctors, coaches and players (and their agents) that the injuries are often more serious than they seem. Says San Francisco 49ers quarterback Steve Young, who has had his bell rung several times: "People are realizing that nowadays, with players' size and velocity, the physics of some of the hits are taking a toll on people's heads." Medical experts warn that scientific knowledge of the long-term effects of even minor blows to the brain is sparse. Increasingly concerned, N.F.L. commissioner Paul Tagliabue has called a special meeting this week with brain-injury specialists.

School officials are just as worried, for while concussions in the N.F.L. get the most press, the danger of getting knocked out stalks all football players, from the pros to the Pee Wees. Studies have claimed that 20% of high- school and college players suffer concussions in a season (apparently using a much broader definition of the injury than the N.F.L. does). Says Dr. Martin Samuels, a Harvard Medical School neurologist: "The loss of consciousness that occurs in football is so frequent it's frightening."

This season two N.F.L. injuries in particular have helped focus attention on the threat that concussions pose not only to a player's career but also to his long-term health. In October, Chicago Bears running back Merril Hoge retired at age 29 after his second concussion of the season left lingering effects. "I just couldn't come out of it," Hoge recalls. "Ten days after it happened I still had headaches. I was dizzy, lethargic, constantly sleepy, and my memory was shot. I couldn't remember what I was talking about from one minute to the next." Hoge believes the second concussion was so serious because he returned to action less than two weeks after his first one. "A player should be required to take recovery time," says Hoge, "and I mean more than a week or two, regardless of how he says he feels." Eight weeks after his injury, Hoge is still recovering.

Troy Aikman, 28, who guided the Cowboys to victory in the last two Super Bowls, could be forced into early retirement at any time. In an Oct. 23 game against the Cardinals, he took a terrifying blow to the chin from Wilber Marshall, a freight train of a linebacker. It caused the sixth concussion of Aikman's five-year career, and his second in 10 months. Aikman now says he is symptom free and ready to play, an attitude that worries his agent, Leigh * Steinberg. "Players have a better grasp of the contents of a can of diet soda than they do of the effects of their brain rattling against their skull," Steinberg says. "They accept way too much risk."

Neurologists agree. Harvard's Samuels points out that blows to the head may shear the microscopic fibers known as axons, which, like the wires of a switchboard, provide the crucial connections among brain cells. If enough axons are damaged or broken, unconsciousness can occur. And if the impact is severe, it may affect the brain stem, disrupting the electrical signals that regulate heartbeat, breathing and blood pressure. Long-term implications are virtually unknown, but many doctors fear players could suffer lasting declines in memory and other cognitive abilities. "There are no tests done on 60-year- old retired quarterbacks," says Dr. Joseph Maroon, a Pittsburgh neurosurgeon and consultant to the Steelers.

What can be done to limit damage from concussions? Part of the answer lies right inside the standard pro-football helmet. It contains an inflatable sack designed to cushion blows. However, most players prefer not to inflate the sack because they feel it makes the helmet fit too tightly. A newer device is the ProCap, a shock-absorbing polyurethane cushion that attaches to the exterior of a helmet. The ProCap is used by 49ers tackle Steve Wallace and a few others, but most players find it too bulky.

While adjusting their equipment, players need to adjust their attitude and drop the stoicism that has long been part of football's code of conduct. Says Aikman: "It's an unspoken rule that you play through injuries." The N.F.L. could consider adopting strict rules to prevent players from returning to action too soon after a concussion. Even professional boxing is more tightly regulated in many places. In Ohio, for instance, a boxer who is knocked out is forbidden to enter the ring again for 30 days.

Most important of all would be more accurate medical evaluations. Maroon has developed a memory and dexterity test that he periodically administers to the Steelers, and the scores are kept on file. That way an injured player has benchmarks for gauging neurological damage. Until such testing is widely adopted, assessing the harm concussions inflict on players will be mostly guesswork. And they won't know the price of their glory.

With reporting by Julie Grace/Chicago and Alice Park/New York