Article published Oct 1, 2006
It's an old National Football League standard: If you're hurt, you
play. If you're injured, you don't.
But the difference between being sore and needing surgery is subtle in today's NFL, where the line between a serious ailment and pedestrian pain is blurred by doctors working for the teams and athletes who want
to play, even at risk of their own health.
Last week brought a pair of dangerous incidents -- Tampa Bay Buccaneers quarterback Chris Simms playing with a ruptured spleen, and Dallas Cowboys receiver Terrell Owens returning to practice one day after
overdosing on pills -- that sounded an alarm in the medical community about the conflict between the teams, their physicians and the players in pro sports.
The cases were a reminder, some say, of the long-standing struggle to balance ethics, money and player safety in the NFL.
Critics say the league is tiptoeing through a minefield, where the drive to get star players back in the game can cloud medical decisions
with serious, sometimes fatal, consequences.
"There is a huge problem in the National Football League," said Dr. Robert Huizenga, a former team physician for the Oakland Raiders. "And it doesn't seem like anyone wants to address it."
The debate is as old as the game itself and as complex as the West Coast offense. On one side are the players, and on the other are coaches and front-office personnel.
In the middle are team physicians, doctors and trainers whose
allegiance to the health of players can be tested by the owners who pay their salaries.
"The real question is: 'Who does the doctor work for?' Does he work on
behalf of the athlete or is he working for the team?" asked Dr. Stephen Rice of the Jersey Shore (N.J.) Medical Center, who is a College of Sports Medicine fellow and former physician at the University of Washington.
Critics say team physicians sometimes fall prey to their bosses' demands, scrambling for "miracle cures" that mask serious injuries and
put players back on the field when they shouldn't be.
"I don't think there's any question that, when you get a strong coach in your face saying, 'This guy needs to be ready,' you do what it takes to get them back on the field," said Ralph Cindrich, a former player and now one of the league's premier agents.
"There are a lot of instances where they push a guy back before he's ready."
In the business of football, roster spots and million-dollar contracts are won by the players who grit through twisted joints and shredded tendons -- even if they're risking a serious injury that could lead to devastating consequences in the long term.
In a landmark study at the University of North Carolina, researchers found that nearly 60 percent of retired NFL players had suffered at least one concussion during their careers. The survey also concluded
that retired NFL players have a 37 percent higher risk of Alzheimer's disease than other men of the same age.
Former team physicians and longtime sports medicine professionals say he doctors are put in a tenuous position each week, where snap decisions carry serious ramifications in the billion-dollar world of the NFL.
Each team employs a staff of trainers to deal with pedestrian ailments such as sore muscles and sprained joints. They also have a squad of doctors to diagnose and treat injuries.
NFL teams generally will not allow media access to trainers and physicians, and Bucs doctor Joe Diaco could not comment for this story.
"It's a business, a two-sided business that is driven by the fact that, if you can't perform, you can't play," said Dr. Jon Schriner, who operates six sports medicine centers in Michigan and has worked with collegiate and Olympic athletes.
The sidelines and the training rooms where athletes rehab can be lonely places, where the sense of invulnerability that drove an athlete to the NFL can lead to isolation from coaches and teammates.
In a world of machismo, toughness can be a player's defining attribute.
Take Brett Favre, the Green Bay Packers quarterback whose legacy was determined more by his ironman streak of 224 straight starts than his
Super Bowl win or 402 touchdown passes.
There is no label feared more than "injury-prone" or, worse yet, "soft." So while there is pressure from coaches to send players back prematurely, the players often put the same pressure on themselves.
Said Bucs receiver Michael Clayton: "A lot of guys play this game with
a passion (that) we'll play until we die, until we can't anymore."
Careers can be made, or lost, on a reputation of playing with pain. The first three weeks of this season have seen players suffer through organ damage (Simms), concussions (Arizona quarterback Kurt Warner) and possible broken bones (Seattle running back Shaun Alexander).
In each instance the players refused to leave the field.
"The athlete thinks he is invulnerable, that nothing bad can happen," Rice said. "They almost need to believe that, in order to face the risks that they do."
For Tampa Bay Bucs veteran Dave Moore, a raging rib cage pain in NFL week one wasn't enough to keep him out. The long snapper couldn't breathe, and he spit up blood as he sat in the locker room.
He planned to return to the field as soon as Diaco gave him the go-ahead.
An assistant coach asked Moore if he was OK, and Moore said yes. But he wasn't -- Moore had a broken rib and punctured lung. What he thought
was a bruise was a more serious injury that has kept Moore out since the season opener.
"If I didn't actually spit up blood to realize something inside was going on, I would have gone right back in the game," he said.
But what happens when the injury goes undiagnosed?
In Simms' case, trainers and physicians said a ruptured spleen can be difficult to detect, as the symptoms -- dizziness, abdominal pain and blurry vision -- are similar to cases of dehydration or simple x exhaustion.
The Bucs' trainers and physicians would not comment, but coach Jon Gruden is confident that they made the right decision on Simms, based on the information they had at the time.
But recognizing the difference between pain and injury extends beyond the NFL, Gruden said, to weekend warriors who try to understand the difference between a sore knee and a torn ligament.
"It's every phase of sport," Gruden said. "It's amateur sports, it's professional sports, it's being a human being. Sometimes a man or a woman has to push themselves through it. A normal human being knows what their limitations are."
But a player's needs are sometimes weighed against the team goals, and critics say doctors are caught between competing interests.
Several years ago, many players raised serious questions about the care they were getting. According to an NFL Players Association survey,
players were asked if their physicians were "good" or better. On four teams, 60 percent of the players found their medical staff lacking.
The Cincinnati Bengals' doctors were held in the lowest regard, as only one in five of the players called them "good" or better.
That's where the union stepped in to fight for changes to the
collective bargaining agreement that would offset potential medical conflicts. Players can now pick their own surgeons and receive second opinions from doctors of their choice.
It's all on the team's dime, according to NFLPA official Carl Francis,
and was put in a formal agreement to shield players from making a decision based on a doctor who is paid by the team.
"We made it a priority for the player to be able to protect his rights," Francis said.
But with so much pressure to find "miracle cures," team physicians also are faced with an additional threat: malpractice lawsuits. Just like their civilian counterparts, team doctors are seeing a huge rise in
malpractice insurance and recent litigation by former NFL players that equate to multimillion-dollar settlements.
For example, the family of Korey Stringer, a Minnesota Vikings lineman who died of heatstroke during training camp in 2001, is suing the
team's doctors for $100 million -- enough to cripple a team doctor's long-standing private practice.
"The lawyers are always telling us to get out," said Huizenga, the former Raiders' physician. "They say, 'You've got to be an idiot to do this. It's just not worth it.'"
Now an associate professor of medicine at UCLA, Huizenga spent seven years on the sidelines with the Raiders and became disillusioned by
what he calls a tug-of-war between clubs and doctors. Huizenga's book, "You're Okay, It's Just a Bruise," was an inside account of the way pro football sometimes ignores injuries and turned a blind eye to the 1980s steroid spike.
He believes the ethics that guide civilian doctors get lost in the four-month shuffle of the NFL regular season, where big games come with a big price. The title of his book, he said, was taken from a line used
by a Raiders doctor to diagnose just about every player who came into the trainer's room.
"Your star quarterback has a concussion before the game, but maybe the
team doesn't tell him," Huizenga said. "Or maybe a player has a severely injured knee before the Super Bowl. Give him an injection of cortisone and send him in the game.
"These are serious ethical issues facing team doctors, but it's a system that we've railed against for years and nothing seems to have changed."
Korey Stringer An offensive line- man for the Minnes- ota Vikings, Stringer died of heatstroke in the 2001 training camp. His wife, Kelci, is suing the
team for $100 million.
The former Miami Dolphins receiver is suing team doctors because of a 1999 toe injury that ended his career. The case remains in circuit court.
The Chicago Bears legend won a $600,000 settlement in the 1970s from
the team doctor over repeated cortisone shots to his knees. ______
Herald-Tribune writer Tom Balog contributed to this report.