On any given Sunday, 90 men will mummy themselves in tape, pads and plastic armor. They'll don helmets, patiently wait out the national anthem, and then proceed to gouge eyes, flail skin, splinter fingers, jerk muscle from bone and ram those very same helmets into each other's skulls, all in an effort to stick a 15-ounce leather oval into the end zone of a National Football League game.
"You want to know how hard you're hit• If you're a running back, and you're hit full-speed, he can literally knock the feces out of your bowels. You lose all feeling in your limbs. That's how hard they hit in the NFL," said Merrill Hoge, a former Steelers and Bears running back forced out of the game in 1995 because of a devastating series of concussions.
To understand how football affects the bodies and minds of those who play it, the Pittsburgh Tribune-Review analyzed four years of NFL injury data; interviewed more than 200 current and former players, coaches and managers; and delved into thousands of pages of the latest medical research, finding:
"We're modern-day gladiators, right now," said David Terrell, a safety for the Oakland Raiders. "This is our arena, Sundays at 1 o'clock."
To help chart the myriad ways players hurt each other, the Trib analyzed the only public injury information doled out by NFL clubs -- the weekly injury report. The league refuses to release more detailed data.
The injury lists have roots in two mandates: State workers' compensation laws and federal reporting requirements force teams to record injuries. Because a paper trail is needed to substantiate a potential on-the-job disability or safety issue, broken bones, joint tears, ruptured muscles, head wounds and other ailments are written down.
NFL bylaws also require teams disclose to their opponents their players' pre-game injury status so coaches can prepare strategies. An NFL memo written by Commissioner Paul Tagliabue and distributed at the start of the season summed up the league's mandate:
"The weekly personnel/injury reports have been a cornerstone of the public's confidence in the NFL for decades. Clubs are expected to issue information that is credible, accurate and specific within the guidelines of our policies."
While some coaches used to fudge specific injury information -- the NFL's 1999 data was so suspect, the Trib didn't use it -- club executives try to grade injuries as accurately as possible, listing players as "probable" for a game, "questionable," "doubtful" or "out."
Team doctors and sports physicians who specialize in treating pro athletes told the Trib that even a player marked "probable" for Sunday's game has a "serious" injury, much as a bad fall or a degenerative bone condition would be considered serious on a workers' compensation filing.
"As a fan, maybe you don't think it's serious because the player is playing, but it can still be serious," said Dr. Derek Jones, one of the nation's foremost orthopedic surgeons at the Ochnser Clinic in New Orleans.
The 2003 NFL injury rate was nearly eight times higher than that of any other commercial sports league, according to the U.S. Department of Labor -- and that includes the National Hockey League, the National Basketball Association and professional auto racing.
Unlike the other pro sports, however, the NFL makes its information public. In fact, Tagliabue recommends to clubs that they open their practices to reporters so that they can see whether players are injured.
Although training camps and preseason games take their toll on players -- 168 athletes started the 2003 season on the injury rolls -- the Trib concentrated solely on how and why players were hurt during a 17-week schedule and the playoffs.
During this span, practices are notable for their absence of hard blocks and tackles, a reality created by spartan 53-man rosters and the need to suit up highly skilled but very expensive athletes on game day. Every player, doctor and team executive interviewed by the Trib said virtually all NFL injuries stem from brutal, high-speed contact encountered during games or from muscle tears suffered by players trying to get out of the way.
Players enter the field realizing they might be seriously, perhaps permanently, injured. Much of the high-speed, high-impact contact is deliberately brutal, especially early in the game, when teams seek to create a level of dominance over opponents.
"You'll see guys every time you go out there who get slower and slower. They're more worried about you hitting them than they are covering the ball. You can take advantage of them and take them out of the game right away with a big hit," said Steelers special teams captain Clint Kriewaldt, a six-year linebacker.
The big hits add up to 27 categories of reported injuries that players have suffered over the past four years, from abdominal tears to broken wrists, according to the weekly NFL injury reports. Tops of the pops: knee injuries, which range from broken knee bones to severe rips in the ligaments.
Over the past four years, 1,205 players -- including Kriewaldt -- have suffered knee injuries. Knee trauma accounts for nearly one out of six injuries in the NFL, affecting every position nearly equally.
Other scourges of the NFL include ankle breaks and sprains, 928 over the past four years alone; 683 pulled and shredded hamstring and groin muscles; and a mix of head, spine and neck trauma affecting 652 players, according to the NFL's injury reports.
The joint and bone trauma adds up over the years, often crippling players later in life. A 2001 survey of 2,552 NFL vets by the Center for the Study of Retired Athletes at the University of North Carolina found that nearly two out of five former players suffer from arthritis after leaving the game. Sixteen percent of former NFL players reported arthritis so severe that it "often limits their activities."
"Falling. Kneeling. Going the wrong way. Throw 245 pounds on your body and cut every which way and see how long your joints last," said Raiders linebacker Travian Smith.
Smith has missed every Raiders game since Halloween because of a torn knee ligament. He lost most of the 2003 season after playing on a strained meniscus ligament, considered one of the most painful injuries in the NFL. After the meniscus goes, an athlete can spend years "wiggling" his knee into place when it locks up during a game, but pros generally try to play through the excruciating pain.
"They find a way to play. I mean, with this game, there is so much pressure on you to play. Unless you have an injury you just have to sit out for, you play through it," said Cleveland Browns linebacker Barry Gardner, a six-year veteran who plays despite a damaged MCL.
While knee and joint injuries have always occurred in professional football, they have been dropping over the last 30 years, according to the NFL. In their place, however, have arisen other injuries, ranging from very serious brain and nervous-system injuries to broken arms, hands and fingers.
Past and present players, coaches, historians and doctors told the Trib that these injuries have been triggered by changes in the game itself.
In the mid-1970s, shortly after the merger of the NFL with the American Football League, team owners began to enact a series of rules reforms designed to rev up the pace of the game. The changes morphed pro football from the slow rough-and-tumble scrum of running plays into a faster, more TV-friendly contest of deep passes downfield that are a hallmark of today's NFL.
The focus has shifted from power runners like Larry Csonka and Franco Harris rumbling for a few yards and a cloud of dust behind a screen of burly blockers.
"It was a game of collisions, of course, but it was also more a game of pushing," said Joe Horrigan, historian at the Pro Football Hall of Fame in Canton, Ohio. "You didn't have a lot of the long-distance impacts that came with a revolution in speed and passing. The focus was on power, especially powerful running backs."
As old-timers say, the sluggish running game "killed you slowly" by causing long-term degenerative bone and joint problems -- conditions exacerbated by playing on concrete-hard AstroTurf. Today's aerial play gets an athlete "quickly," with high-speed impacts on nearly every passing play.
A Ball State University study has found that 55 percent of all players from the 1960s, before the rules changed, suffered career-ending injuries or required multiple surgeries to correct the trauma of the game. For the players in the 1970s and 1980s, however, that trend rose 25 percent, and the length of players' careers started to drop.
In 1970, the average NFL player lasted nearly five years in the league. By 1986, he had a three-year stay, a downward trend that continued as the league adopted more pass-happy formations, such as the West Coast offense, according to the NFL Players Association.
The changes in the rules that allowed wider offenses had unintended consequences. Allowing offensive linemen to extend their arms to impede defenders during pass protection gave quarterbacks more time to throw. Reducing penalties for offensive holding, illegal use of the hands and tripping from 15 yards to 10 gave centers, guards and tackles more incentive to reach out and touch someone.
Those changes in the rules led defenders to "windmill" their arms to sweep past offensive linemen, whose unprotected arms and hands remain exposed to helmet blows, tangling face masks and hard body armor. Today, an offensive guard is 50 percent more likely than other players to suffer an elbow, finger, hand or thumb injury, according to NFL injury data.
"I mean, you use your hands on every play," said Raiders guard Ron Stone, holding up two fists of swollen, bloody flesh after a game in Pittsburgh. "You may bang a helmet to your hand. You may get 'em caught funny. You have 'em hurt in any number of ways. You just got to deal with it. I mean, it hurts. It hurts bad, too."
But it wasn't the fingers that gave out for Stone this year. The All-Pro missed the last three months because of a bum knee.
Funneling the pain
No one has received more help from the rulebook than the quarterback. Since 1979, referees must blow a play dead every time a defender has a quarterback firmly in his grasp. New rules enacted in 1994 that further protect the QB, including stiffer roughing-the-passer penalties, have made QBs and centers the safest positions on the field..
NFL injury reports indicate that two of five quarterbacks are injured every year. The injury rate for the linebackers trying to sack them is 25 percent higher.
While QBs touch the ball on every play, linebackers repeatedly throw their bodies into large, strong men in a halo around the passer. That's why they get so many bashed chests and severe neck injuries, not to mention the larger numbers of broken legs, ribs, hips, shoulders and wrists recorded in the NFL injury reports.
Their injury rates now are nearly equal to those intended QB targets, the wideouts and tight ends -- more than half of whom are injured every year.
Cincinnati Bengals QB Jon Kitna likens the NFL's pass schemes to "funneling" receivers toward deepening layers of punishment. A toss to the sidelines means defensive backs slam the wideout into the dirt. A pass across the middle foretells a tight end laid out by a linebacker. A bomb downfield sets up a hurtling wideout for a head-on collision with a blazing cornerback.
"You're talking about the best of the best, you know• There are no soft guys in this league, so when you get hit, you get hit by the best," he said.
The men who catch balls suffer some of the NFL's highest rates of chest bruises, broken ribs, separated shoulders and concussions -- a testament to what it's like to dare a reception against men who hit like baseball bats.
"Your body is just out there, so a lot of wideouts don't like going across the middle," said Steelers All-Pro receiver Hines Ward.
"If you do, you've got to expect to get hit. The safeties are trying to hit on wideouts, so you're leaving yourself real vulnerable to getting a nice concussion or a nice hit from a defensive back."
Ward has racked up nearly 6,000 yards and 42 touchdowns despite playing through crushed ribs, a bad back, pulled hamstrings, sprained ankles and excruciating toe injuries. And he knows the cornerbacks and safeties trying to stop him have it worse. Nearly seven out of 10 face serious injuries annually, partly because of the sheer force they must generate to bring down big, fast running backs and receivers.
"It's give-and-take. You're going to give out a lot of hits. But every time you hit someone that hard, you're hitting them with your bones and flesh, too," said Matt Bowen, a star safety for the Washington Redskins.
Since arriving in the NFL in 2000, Bowen has been dogged by a broken foot, a nasty concussion and several groin and shoulder injuries. In the fifth week of this season, he went down with a major knee injury and was lost for the year.
Players, coaches, NFL executives and physicians agree that the NFL wants to tackle the high body count. Were it not for innovations in medical science, nutrition, weight training and some equipment, the injury ranks would be even larger, they said. These improvements have helped repair joints and muscles, with arthroscopic surgery and other procedures returning players to the field faster than ever before.
"The league has always been very proactive in terms of protecting the players from injuries," said Dr. Elliot Pellman, team physician for the New York Jets. "There's a reason, I think, why the injury levels have remained constant, even though the rules of the game changed. Part of that is because of the outstanding medical care players receive. There have been improvements in the equipment they use and the training they receive. All of that has led to controlling injuries."
Since the 2000 season, the total number of weeks pros have spent on the injury rolls has edged up from 3,618 to 3,845, according to NFL injury reports.
While Pellman and other medical professionals work to rehabilitate the wounded, NFL executives ponder how to tinker with penalties to make the game safer. During the waning era of the running game, for example, the league outlawed head-butting, slapping and intentionally ramming helmets into defenseless runners or receivers. Had they not made those reforms, longtime NFL insiders say, the body count would be far worse today.
"In the '50s or '60s -- and you can see this in the films -- spearing was legal. Crackbacks were legal. A player could fall down, get up and start running again," said Steve Sabol, president of the award-winning NFL Films. "You couldn't play professional football today with those rules. Half the players in the Hall of Fame would have been fined more than they ever earned if they played the same way now they did then."
The NFL's powerful Competition Committee screens these reforms before they are enacted by the league's clubs. The committee is composed of coaches and front-office executives from eight teams. Two union representatives monitor the group.
If a change in the rules is accepted by the committee, it's forwarded to the clubs for passage. To change a rule, at least 24 of the 32 franchises must approve.
"We do everything we can on the committee to keep the game safe. That's our No. 1 priority. We make new policies every year, and we have always enacted everything the players brought to us," said Bill Polian, general manager of the Indianapolis Colts.
Players disagree, saying that making the game more exciting often takes precedence over safety. They point to the committee's decision last year to overturn a long-standing rule allowing defensive backs to "bump" wide receivers five yards from the line of scrimmage to impede their progress downfield.
The decision was sparked by a controversial playoff game in which the eventual Super Bowl champs, the New England Patriots, frustrate the NFL's most potent passing team, Polian's Colts, by mauling wideouts near the line of scrimmage.
NFL referees' stricter enforcement of these illegal contact penalties doubled the number of yellow flags at the feet of defensive backs, according to the league.
Polian defended the new policy as a much-needed safety measure.
"The point of emphasis will lead to fewer injuries," he said. "There will be fewer collisions going down the field. You won't have all that grabbing on the receivers by defensive backs and all the injuries that come from receivers trying to pull away. They get a lot of shoulder injuries doing that.
"What was going on before wasn't acceptable, all that grabbing and poking. If it's not acceptable to do that in a schoolyard, why is it OK to do it in the NFL?"
Under the new rules, Colts QB Peyton Manning passed for 4,557 yards and a record-setting 49 touchdowns. At the end of the regular season, passing yards finished up nearly 9 percent throughout the league. There were 14 percent more TDs than the previous year and interceptions fell 8 percent.
New England leads the NFL's injury list with six hurt defensive backs. To augment their depleted ranks, the Patriots dragooned former Pro-Bowl receiver Troy Brown as a slot cornerback.
During training camp and early games, defensive backs throughout the NFL told the Trib that strict enforcement of the new rule would lead to more serious injuries for cornerbacks and safeties, who increasingly would have to challenge passes in midair. They say that's an inherently more dangerous practice because collisions with bigger players often come at greater velocity.
"If you've got a cover corner who is 5'10" and 185 pounds, you've got receivers who are 6'4" and 230 pounds that are running 4.3s, 4.4s (seconds in a 40-yard dash). That's going to put us at risk because we're a little overmatched," said Steelers safety Mike Logan.
Over the past several years, Logan has suffered hamstring, groin, foot, quadriceps, back and neck injuries. Fellow Steelers defensive backs Deshea Townsend, Chad Scott and Chidi Iwuoma have missed games this year because of similar injuries.
On Oct. 25, Denver Broncos offensive tackle George Foster plowed into the leg of Bengals defensive lineman Tony Williams, breaking his ankle and ending his season. In the NFL, an offensive lineman can legally "cut"-block or "leg-whip" a defensive player below the knees, as long as no one helps him do it.
Defensive tackles like Williams are 20 percent more likely to get hurt than their counterparts across the line. While they suffer similar rates of broken elbows, hands and fingers, it's the large number of calf, leg and quadriceps injuries that set them apart from their foes in the trenches.
"They can do a better job with the leg-whipping and stuff like that for the D-linemen. For me, that's the main thing," said Kevin Mitchell, a linebacker and defensive end for 11 years on several NFL teams.
Mitchell played through a decade of sprains, a bad shoulder and a torn knee. One toe stayed broken for six years. He was cut by the Redskins in camp.
With an eye on the body count of players like Williams and Mitchell, union executive director and Hall of Famer Gene Upshaw has told the league it's time to tweak the rules. He's received support from fellow legend Art Shell, the NFL's senior vice president for football operations and development.
But critics contend the NFL makes too many reforms reactively, after a savage televised injury like the Foster "cut" block or an avoidable tragedy such as Korey Stringer's death in 2002.
Despite years of warnings about the risk of heat stroke at summer training camps, the NFL didn't institute leaguewide dehydration guidelines until after the Minnesota Vikings All-Pro tackle died from thirst.
Rather than make reforms after a tragedy, players want the clubs to take a more comprehensive look at injury stats, basing future rules changes on the latest science. They say they're counting on the NFL and its owners to "do the right thing."
"Football is a team sport. Players often assume the team will do the right thing for them. That's something they learned at the college level. You're part of the team, and the college and the coaches and everyone else will be there for you. And then you get to the professional level and they have to learn about the way things are really done there," said Trace Armstrong, an All-Pro defensive end for the Bears, Raiders and Dolphins who went on to lead the players union before retiring last year.
He's slowly recovering from 15 years of ruptured tendons, bashed ribs, torn knees and a bad shoulder. But he realizes the scars of the game will travel with him for the rest of his life, and he can count them, sort of, on his fingers. His hands are so mangled "only one of my fingers works the way God intended them to."
Maybe, he said, a new way
of editing the rulebook could change that, along with reforms to the sort of equipment teams buy for players and the training regimen they ask them to follow.
"We have done so much to make this game safer over the years, but the time has come to really look at it all -- not for us who already played, but for the guys who are coming next," Armstrong said.
About the research
The Pittsburgh Tribune-Review began this project on professional football injuries by analyzing the last four years of weekly injury reports compiled by the NFL.
Today's report is the culmination of that effort — trips to training camps and locker rooms, more than 200 interviews with active and former players, coaches, historians, union officials, NFL front office executives, agents, physicians, trainers, mechanical engineers and equipment managers and manufacturers.
Rather than a simple story on wins and losses, the Trib decided to follow the insiders' advice on the forces that truly influence the league's high injury rates: NFL rules changes, finances, equipment designs and the rapidly increasing size, strength and speed of the modern athlete.
Data came from numerous sources, including the weekly injury reports generated by the franchises themselves and decimated nationwide.
Other key pieces of information came from archives at the Professional Football Hall of Fame in Canton, Ohio, which safeguards rare game reports, rosters, training camp weigh-ins and workplace investigations conducted by private and governmental agencies. The oldest data sets used by the Trib were Ivy League medical charts dating back to the 1920s.
From all that came series of databases focusing on 27 of the most common non-disease ailments suffered by professional athletes every season. The Trib then correlated those numbers with NFL rosters to determine which positions were likely to absorb certain kinds of injuries, and which weren't.
Players and medical experts filled in the blanks on why various sorts of players got "nicked," "dinged" or "thunged," and others didn't. From there, statistical analyses of the databases, controlling for factors ranging from the season to whether a team played a particular game on artificial turf helped supplement the reporting. Additional Information:
About the reporterCarl Prine arrived at the Pittsburgh Tribune-Review in 2000. He has written award-winning investigations into the state of America's chemical plant security, Title IX gender discrimination against high school athletes, the heroin trade in Western Pennsylvania and the 2002 Quecreek mine disaster.
He collaborated with Trib business writer Michael Yeomans on a 2003 probe into the financial stability of the National Hockey League. It published while Prine covered the invasion of Iraq as a reporter embedded with the U.S. Marine Corps.