"Get up. Walk it off."
That's the frequent mentality of athletes facing injuries across the wide spectrum of contact sports. But former football players and safety advocates told Congress that dismissing a concussion as "getting your bell rung" or "clock cleaned" creates a public health risk and necessitates review by the National Football League and Congress.
Amid growing concerns that the NFL has created a culture of hard hits and machismo where players do not report injuries to team doctors, NFL Commissioner Roger Goodell faced tough questioning before the House Judiciary Committee today over the NFL's efforts to protect players from head injuries.
Today's hearing was scheduled after the NFL announced in September the results of an internal study performed by the University of Michigan. The study revealed that players who suffered from head injuries are susceptible to much higher rates of dementia and cognitive disabilities.
Since taking over as commissioner in 2006, Goodell said that no other single issue has demanded more of his energy and attention than player safety, but refused to draw a connection between hard hits on the gridiron and brain diseases suffered by players later in life.
"We know that concussions are a serious matter, and that they will require special attention and treatment," Goodell said. "Medical considerations must always come first. Decisions regarding treatment of player with concussions, and when they can resume play must be made by doctors and doctors alone."
But Gay Culverhouse, the daughter of former Tampa Bay Buccaneers owner Hugh Culverhouse, told the committee that team physicians are not looking out for the best interests of the players.
"The team doctor dresses as a coach on the sidelines," Culverhouse said. "He is not an independent advocate for the player. The players get to a point where they refuse to tell the team doctor that they have suffered a concussion. They do not self report because they know there's a backup player sitting on the bench, ready to take their position."
Dr. Robert Cantu, co-director of Boston University's Center for the Study of Traumatic Encephalopathy, said repetitive concussive hits to the head lead to a brain disease known as chronic traumatic encephalopathy (CTE).
"There's no doubt that these injuries lead to an incurable neurodegenerative disease called CTE, which causes serious progressive impairments in cognition, emotion and behavior control -- even full-blown dementia," Cantu testified.
Rep. Bill Pascrell Jr., D-N.J., who is co-chairman of the Congressional Brain Injury Task Force, compared football players suffering from CTE with soldiers returning from Iraq and Afghanistan with traumatic brain Injury.
"The same way that we have gained greater understanding in research from the brain injuries of our soldiers, we should also take this opportunity to learn from the injuries of professional athletes," Pascrell said.
Pascrell cited statistics from the Center for Disease Control and Prevention that estimate 3.8 million concussions related to sports occur each year and added that those athletes who suffer a concussion are four to six times more likely to sustain a second concussion.
Cantu agreed, testifying that the risk extends beyond the NFL and affects football players at all levels and athletes in a variety of sports.
"The brain does not know what caused it to be violently shaken inside the skull," Cantu said, "a football helmet-to-helmet hit, a left hook to the jaw, a check against the boards or even a blast injury in military combat."
Goodell, the son of the late Sen. Charles Goodell, R-N.Y., helped implement what is known as "the 88 plan," which provides up to $88,000 from the NFL and the NFL Players Association to aid with the care of players afflicted with dementia, Alzheimer's disease and other brain diseases. Moreover, former players participating in the program do not have to prove that their brain injury is related to football.
Merrill Hoge, an ESPN analyst covering the NFL, played seven seasons in professional football but was forced out after suffering multiple concussions. Hoge suggested that Congress help establish a new national standard to evaluate brain injuries in athletes by requiring that a neurological doctor be part of all evaluations of head trauma and that an athlete is not cleared to play until they are asymptomatic for seven consecutive days.
"If we established those standards with all football, we would have less tragic stories than we have to this point," Hoge said.
Rep. Maxine Waters, D-Calif., whose husband Sidney Williams played in the NFL, asked the commissioner what the league was doing now to improve the welfare of retired players during ongoing collective bargaining negotiations with the player's union.
"We've heard from the NFL time and time again: You're always studying, you're always trying, you're hopeful," Waters said.
As Goodell tried to explain that the negotiations are in early stages, Waters pressed her point.
"I know that you do everything that you possibly can to hold onto those profits, but I think the responsibility of this Congress is to take a look at that antitrust exemption that you have and, in my estimation, to take it away," Waters said.
A 1961 law grants professional sports leagues antitrust exemptions for broadcasting. That exemption has enabled the NFL to sign television contracts totaling billions of dollars and has transformed the league into the successful moneymaker it is today.
Goodell was joined at the witness table by his counterpart in the collective bargaining negotiations, NFL Players Association Executive Director DeMaurice Smith.
"My number one priority is to protect those who play and have played this game," Smith said. "There is no interest greater than their health and safety."
Rep. John Conyers, D-Mich., the chairman of the House Judiciary Committee, asked Goodell and Smith to open up their medical records to a congressional investigation.
Both agreed to provide the committee with the data.
Conyers said he wants to collect the information to help him understand the dangers and risks associated with football at all levels of competition.
"We need an expeditious and independent review of all the data," Conyers said. "I say this not simply because of the impact of these injuries on the 2,000 current players and more than 10,000 retirees associated with the NFL and their families. I say it because of the effect on the millions of players at the college, high school and youth levels."
Still, some members of the committee questioned whether Congress should get involved in the business of the NFL, suggesting the NFL doesn't need a referee in Washington, D.C.
"Football, like soccer, rugby and even basketball and baseball, involves contact that can produce injuries," said Rep. Lamar Smith, R-Texas. "We cannot legislate the elimination of injuries from the games without eliminating the games themselves."
Other members argued that without independent research, the public could be misled into underestimating the serious impact of football head injuries and the dangers of walking off the pain.
"Young children, often encouraged by parents and coaches, attempt to imitate what they view as the noble behavior of their football heroes, gladiators," said Rep. Hank Johnson, D-Ga. "This behavior is clearly dangerous, and a refusal to recognize and respond to this danger is reckless and irresponsible."