Like aches and pains, the financial consequences of NFL injuries may be slow to emerge, but they can be devastating. “Vested” players are currently covered by NFL insurance for five years after retirement (see Appendix 2 for a summary of retirement benefits), but that short window doesn’t accommodate the sorts of problems and expenses that emerge several years after retirement. Non-vested players get no NFL health care coverage (and there are probably more former players who were never vested than those who are currently covered).68 On top of that, many players can’t purchase adequate insurance because of “preexisting conditions.” In general, vested former players are a bit better off than men in the general population. Ninety-two percent of vested ex-players aged 50 to 64 have health insurance, compared to 85 percent of all men in that age range. Ninety-one percent of younger ex-players (30–49) are insured, verses 78 percent of their age peers in the general population. The difference, according to the NFL Player Care study, is likely to be due to former players purchasing their own privately administered insurance.69
The long-term financial ramifications of football injuries aren’t the only lifestyle changers. While a notable percentage of them end up at least partially disabled, for some players, the disability really is “total.” About four percent of ex-players report needing help from others to deal with personal care needs such as eating, bathing, or dressing themselves (about twice the rate of the comparable general population). Around seven percent need help with everyday household chores, conducting business, shopping, and getting around town (again about twice the rate of non-NFL peers). Perhaps most chillingly, former players are over five times more likely than other men their age to suffer from dementia.70 For some, encroaching dependency is mainly the result of more or less typical aging. But for others, deteriorating bodies and brains wreak havoc on lives of much younger men, as well as the lives of their families and loved ones. Some of the stories are heartrending.
In 2012, Sports Illustrated published a cover story titled “The Other Half of the Story.”71 It presented a moving saga of wives and loved ones who endure the burden of caring for players who’ve suffered severe injuries—primarily head trauma—and the pain of watching the men they love slip away. It’s a painful account of once fit, powerful, and mentally vibrant men in the ostensible primes of their lives losing control of their bodies, memories, and mental faculties. It’s a chilling portrait of descent into dependency: grown men needing to be treated like children. But it’s also the depressing story of what NFL families lose to the ravages of injury. Not only do they lose their men, but they give up their own lives and freedom. Wives and girlfriends must monitor their men at every turn; watch them so they don’t wander off and get lost; call the police to search the neighborhoods when they do; keep their loved ones out of the bathroom where they might mistake a razor for a toothbrush; help them with the most basic of hygiene and toilet needs. As former players’ conditions render them more and more childlike, wives become progressively like mothers of infants, setting aside their jobs, social circles, and personal time to tend to their men. The toll on their lives is almost as great as the price paid by their injured players.
Drug abuse is another collateral consequence of injury. Sometimes players turn to drugs for respite from the pain. Given their injuries, it’s not surprising that former NFL players have long histories of heavy over-the-counter and prescription drug use. It’s hard to find a player who hasn’t relied on painkillers of one sort or another. Players pop over-the-counter analgesics such as acetaminophen and ibuprofen like candy. Under the supervision of medical personnel, they frequently use more potent painkillers—opioids which include morphine, codeine, hydro-codone (Vicodin), and oxycodone (Percocet). Some players and former players report excessively self-medicating, sometimes with legitimate prescriptions, sometimes without. Often such drug use begins as treatment for pain due to injury, but escalates into escapist, if not recreational, drug use, and even addiction.72 It’s almost inevitable, according to former linebacker Keith McCants: “They are going to shoot you up with morphine after the game, give you cortisone during the game, whatever it takes to get you back out there on the field. And that is with each and every NFL team. So when an athlete ends up on drugs, they don’t ask him why or how did they do it. They know damn well how it happened.”73
Mark Schlereth, former offensive lineman and veteran of over two dozen major surgeries, is well known for his willingness to tolerate pain and persevere through injury. His approach to pain management was simple, yet comprehensive. “I’ve done it all,” he says. “I would strap a dog turd to it if I thought that would make me feel better. I’d do whatever I have to do. Have I had Toradol shots? Yes. Have I abused anti-inflammatories? Yes. Have I used painkillers? Yes. Have I got shot up with painkillers and Xylocaine and different things to numb areas so I can play? Yes.”74 Reliance upon—indeed, the abuse of—painkillers has at least two significant ramifications for life after football. First, it increases the likelihood of players damaging their already compromised bodies by masking signals that more harm is being done. Toradol is just the latest in a long line of painkillers used to “shoot them up and get them back on the field.” It is a non-steroidal, non-narcotic anti-inflammatory drug often used to manage postoperative pain. While it isn’t addictive, the drug is considered dangerous enough that it’s banned in some European countries. Kidney damage and gastrointestinal bleeding are possible side effects, while as an anticoagulant, it may also exacerbate the effects of concussions. But its primary danger for NFL players lies in its ability to deaden feeling, inhibiting a player’s ability to sense pain and injury. A player can hurt himself and not even notice.
A recent Washington Post study found that 50 percent of players who retired in the 1990s or later reported using Toradol during their playing days. About 70 percent of players who got out of the game after 2000 said they used the drug. The Post reports that in 2000, 28 of 30 teams used Toradol injections on game days, averaging 15 pregame injections per team. The drug works fast; an intramuscular injection can quell pain within ten minutes. And it lasts for a full game, with a half life of over six hours. As former defensive end Tyoka Jackson puts it, “Once you get your first one, you realize, wow, you can play pretty pain-free for the entire game. . . . Whatever’s ailing you, you don’t feel.”75 Nearly 80 percent of former players using Toradol said they took the drug as a masking agent, intended to dull the pain they expected to feel during games. They used the drug to manage anticipated pain, not necessarily to deal with something that already hurt.76 Either way, those using Toradol could injure, or reinjure, themselves and not realize it until well after the fact. Perhaps this is how so many players survived their 20,000-car-crash careers. But it may also be part of the reason they were in those crashes in the first place.
Whether or not drug abuse is inevitable, reliance upon pain medication can become habitual if not addictive. NFL players use painkillers at a much higher rate than the general population, according to research conducted at the Washington University School of Medicine in St. Louis. The study found that seven percent of the former players were currently using painkilling opioid drugs. That’s more than four times the rate of opioid use in the general population. More than half of players used opioids during their NFL careers, and 71 percent reported “misusing” the drugs. That is, they used the medication for a different reason or in a different way than it was prescribed, or they may have painkillers that were prescribed for someone else. Fifteen percent of those who misused opioids during their careers continued to misuse after they retired, according to the study. One retired player reported taking up to 1,000 Vicodin tablets per month. Another said he might take 100 pills per day and spend more than $1,000 per week on painkillers.77 While there is no systematic evidence that former NFL players are more frequently involved in illicit drug use than members of the general population, strong medication—often with perception altering properties—is a way of life of many players long after
their playing days are done.
Players may also try to mask pain through alcohol use. While there’s no certain causal linkage, former players are 10–15 percentage points more likely to have ever been drinkers or to currently drink than are their non-playing counterparts. Rates of heavy and binge drinking, however, are only slightly higher among former players than among the general population. Only about ten percent of former players include themselves in these categories, although self-reports of heavy drinking show rates among former players to be twice those of non-players.78
Taken together, the collateral consequences of injury add up to a depressing picture—literally. About one in four former players has either been diagnosed with depression or experienced major depressive symptoms. On a battery of lifetime depression screening measures, former players consistently report symptoms at higher levels than their age peers in the general population. While they are no more likely to report symptoms “at the current time,” former players are more likely than age peers to have experienced a wide variety of problems, across the board, with the greatest discrepancies coming among men aged 30–49.79 Players who have at least three concussions are three times more likely to become clinically depressed later in life than are players without concussions. And players with at least three concussions are five times more likely to be diagnosed with early signs of dementia.80 Given the prevalence of head injuries, that adds up to a lot of depressed ex-players.81
Pain and the Sports Ethic
Most former players live with chronic pain, yet they stoically embrace their fate. They feel it, acknowledge it, accept it. They wear their surgical scars as badges of honor, seldom regretting the sacrifices they’ve made and the pain they bear. A mere glimpse into a recent Green Bay Packers Alumni Weekend is telling. Health concerns dominate nearly every conversation among veterans from as far back as the 1950s to those who recently retired.82 We heard numerous variations on the following exchange:
“How you doin’, man? Haven’t seen you in a while.”
“I’m OK, doin’ well, doin’ fine. The knee’s holding up. I may not get it replaced for another year or two.”
“That’s great man, because if you can make it to 40, you might not have to get it done again when you’re 60.”
“How’s the shoulder?”
“It’s fine—long as I don’t have to get nothin’ off the top shelf.” [He laughs.]
“I hear Michael got his hip done. About time. Last time I saw him, he couldn’t walk. Had to cancel on that golf thing this summer.”
“Well, great to see you. It’s been too long. We gotta talk.”
“Right, man. I got your cell. I really miss it, miss the game. Wish we could all do it again.”
These players are more typical than Mike Webster or Jim Otto, living with the nagging reminder of chronic pain that dwell side by side with their fond memories of the game that hurt them. This peculiar ambivalence is not a brand of mixed feelings, uncertainty, confusion, or demoralization. Rather, it’s the steadfast, open-eyed affirmation of players’ powerful, deep-seated positive and negative feelings toward the game’s violence. They are genuinely pulled in opposite directions. Players aren’t lying, boasting, or dissembling when they claim at the same time that football has ruptured their lives but they would do it all over again without qualm.
The paradox isn’t simply the upshot of psychological denial. By the time any player reaches college-level competition, he’s probably been injured severely enough to warrant medical attention. An occasional player may entertain the hope that he will escape serious injury, even as others go down all around him. But this, too, is rare. Every NFL player expects to be both hurt and injured as part of the normal course of events. If there’s any denial, it’s in relation to the probability of bouncing back from injury. Knowing that injury is inevitable, most players believe that when they are injured, they will be able to overcome the pain and damage to get back on the field, even if they’ve seen hundreds of other careers end on IR. The bottom line: players know that life after football is certainly going to include chronic pain.
Why, then, do they gladly accept it? Why do they insist on jeopardizing their own health and safety at a time when the NFL is trying to legislate and officiate some of the danger out of football? The answer implicates achievement, toughness, respect, pride, and the pursuit of the dream—all aspects of the hypermasculine NFL player ethos. Consider how this plays out in a relatively nondescript on-field encounter during a midseason 2013 game between the Ravens and Steelers—two traditionally tough, physical teams. Their games have long been touted as “wars” between organizations committed to beating up and intimidating opponents. There’s more at stake in a Ravens–Steelers game than wins and losses. Of course, these games get a lot of fan and media attention. In this particular instance, the media spotlight focused momentarily on a single play that was touted on the Mike and Mike TV and radio show as the most impressive play of the NFL weekend.
The play? Ravens running back Ray Rice broke off a run down the sidelines into the secondary, where a Steelers defensive back drew a bead on him. The DB had the angle and momentum to deliver a solid hit to knock Rice out of bounds. But this is 2013, and for weeks, if not years, the NFL has warned players about situations just like this. As a result of rule changes and zealous enforcement, tacklers are now having second thoughts about delivering a blow. A defender can’t target the head and neck. Clothesline tackles are strictly forbidden. A tackler can’t lead with his helmet or shoulder in the vicinity of the head. But he can’t go low, either, because knees and ankles are protected. He can’t grab the shoulder pads or helmet and fling his man to the ground. He can’t launch himself at the opposition, leaving his feet to zero in like a guided missile. He can’t touch a player once he’s out of bounds. If he runs through a sideline tackle, he’s going to get flagged. All of these draw penalties, maybe fines or suspensions.
So here comes Rice down the sideline and the DB pulls up, almost imperceptibly. He’s not avoiding the tackle, not shunning contact. He simply raises his center of gravity and prepares to shove Rice out of bounds with his hands and arms. No harm, no foul—literally. But Rice has other intentions. Rather than veer out of bounds, minimizing contact without ceding yardage, Rice lowers his shoulders and drives squarely into the DB’s chest, knocking him head over heels. Rice ends up out of bounds on his feet, the play’s over, and nobody’s hurt. But talk show host Mike Greenberg is enthusiastically proclaiming on America’s most widely heard sports talk show that Ray Rice has just made the most remarkable play of the weekend by “lowering the boom” on the onrushing defender and “dishing out the punishment” instead of absorbing it.83
Why is this scenario significant? Did it change the course of the game? No, the Steelers didn’t “back down” and eventually won. Did Rice pick up extra yardage, stealing a first down through his aggressive play? Maybe a yard or so. The impact of this particular play was minimal. But the description of the play speaks volumes about perceptions of toughness, safety, and commitment in the NFL. Greenberg said it all. Everyone loves the big hit, safety be damned. Ray Rice was the better man because he dished out the punishment instead of taking it. Hearing the reaction to the play, the next time a DB draws a bead on a running back along the sidelines, what are the chances that he risks the penalty in order to deliver the crushing blow—or more importantly, to avoid the appearance that he doesn’t want to “dish out the punishment”? For all the media uproar about player safety, it’s moments like this that broadcast the paramount value of toughness in the NFL. The fans want it, the media tout it, and the players live it. Who wants to be that guy who’s knocked on his ass because he wasn’t willing to risk a 15-yard penalty in order to “lay out” the opponent? In the bigger picture, avoiding injury takes second place to delivering the big hit, even when the big hit is clearly under fire.
In the NFL, nobody can afford to back down. Gary Plummer, a linebacker for 15 years in the 1980s and 1990s, pul
ls no punches:
There is nothing more revered in football than being a tough guy. I encouraged others to be tough guys. I did some horrendously stupid things in my career—like having surgery on Tuesday and playing on Sunday twice. . . . The coaches have euphemisms. They’ll say: “You know, that guy has to learn the difference between pain and injury.” Or: “He has to learn the difference between college and professional football.” What he’s saying is the guy’s a pussy and he needs to get tough or he’s not going to be on the team. It’s very, very clear.84
Football is a tough man’s game, with the accent on masculinity. As legendary linebacker Ray Lewis puts it, players “have to be respected as men before anything else.”85 Mike Greenberg doesn’t put it in these terms, but clearly he loves the tough guy, the better man. By implication, the defensive back that plays within the rules and puts safety first—but is knocked on his butt—is “soft.” He backed down.
While toughness is its own reward, it’s also precious currency in professional football. NFL players are living their life-long dream—a violent, exciting, exaggerated version of the “American Dream” where anything seems possible if one is willing to make the sacrifice. Their bodies are part of that sacrifice. Former players lament the game’s violence and its aftereffects so rarely because they’ve knowingly and willingly paid the price to achieve the dream. And they’re constantly praised by nearly everyone who watches the game. Despite their zeal in displaying the grotesque physical dangers of football, the media are equally fanatical in glorifying the “big hit.”
Is There Life After Football? Page 15
