There is mounting scientific and medical evidence that the collisions in American football are taking a delayed but devastating toll on the players in terms of the concussions and head trauma they cause.
There are big hits in every game at college and professional level between big men. Even a small offensive or defensive lineman can weigh 120kg (almost 19st). The collisions are a clatter of helmet on helmet, like rams butting heads, with the helmets protecting their wearers from immediate external damage.
But two medical studies have shown that athletes, in particular American footballers repeatedly concussed in their playing days, are suffering from a neurological condition, chronic traumatic encephalopathy (CTE), that mimics dementia, Alzheimer's disease and, in some cases, amyotrophic lateral sclerosis (ALS), or motor neurone disease, the usually fatal condition with which Joost van der Westhuisen, the former Springbok scrum-half, has been diagnosed.
Post-mortem brain examinations of 15 former footballers showed signs of CTE in 14. A study sponsored by the National Football League found that its former players reported Alzheimer's and related afflictions at five times the national rate.
Alarmed by this, the image-conscious league introduced new rules for the treatment of concussed players before and during the 2010 season. These included a player being kept off the field until an independent neurologist clears his return, and then, after a concussed player returned to an early-season game, the introduction of a standardised sideline concussion test.
For not-so-old former NFL players who fear the worst about what their brains have become because of the game they played, this outbreak of care is long overdue, and scant consolation for their current plight.
Dave Pear played in the centre of the defensive line for the Tampa Bay Buccaneers, statistically the worst ever team in the National Football League, and the Oakland Raiders from 1976-80. Pear led with his helmet on every play, which was hit "sometimes three, four, five times [per play]. And I played 50-60 plays a game." The Bucs lost 26 games in a row, "so we played a lot of defense". He says he cannot remember the number of times he was concussed during his playing career, which has left him crippled by hip replacements, disc repair and removal, and spinal fusions.
Brent Boyd was of the next generation. Drafted by the Minnesota Vikings in 1980, he also had the option of post-graduate studies in law. He was an offensive lineman. The Vikings played in the Metrodome, on a pitch that was a vast expanse of concrete covered with a thin layer of grass-coloured carpet called SuperTurf. For Boyd, game proceedings would usually finish with him picking himself up after the implosion of bodies that is a typical NFL play. As often as not, one of the first points of contact with the concrete would be his helmet.
"That was the hardest astroturf in the league," Boyd said. "You could get 100 concussions and maybe five involved hitting another person. You're doing your regular duties and you fall backwards and your head hits concrete. That will make you woozy."
In that respect, at 58 and 54 respectively, Pear and Boyd are typical of many former NFL players: they are big, broken relics from the land of the colliding giants, who are now mortal and hurting.
Pear is the founder and an organiser of the Independent Football Veterans group, which advocates for injured players. Boyd has organised hearings in Congress to determine if the NFL is unfairly denying disability payments and other benefits to its former players.
Both are also suffering brain damage, of the type that was once believed to be solely the province of ex-boxers. Medical literature notes that the repetitive brain trauma that causes CTE comes from both concussive and sub-concussive blows.
The American Academy of Neurology says CTE was first identified in 1928. Neuropathologist Dr Bennet Omalu is responsible for the renewal of interest in the condition after extensive, microscopic study of the brain of Mike Webster, 50, who played 15 seasons on the offensive line for the Pittsburgh Steelers before dying of a heart attack; homeless, deranged, and so riddled with pain he used a Taser to put himself to sleep. In 2002, Omalu found the frontal and temporal lobes of Webster's brain infested with a toxic, cell-destroying protein called tau, the result of progressive degeneration of brain tissue.
This brain section controls executive functioning and judgement, emotional response and stability, language use, and the elements of behaviour that make up personality.
Three of the first four ex-players whose brains Omalu examined had died by their own hand. Each showed signs of CTE. Boyd lives with it, his knowledge certain after an experimental procedure at Boston University last December established that he had the condition. Boyd was one of three former footballers to take part in the examination, as well as a wrestler and a boxer.
The study and understanding of the condition is at the early stage where every new development comes with its own set of exclamation marks.
The 21 year-old co-captain of the University of Pennsylvania football team who committed suicide last year was found to have a mild form of CTE. Owen Thomas was a linebacker. He had shown no sign of depression nor any history of mental illness when he took his own life in April 2010.
Kevin Turner played the battering ram position – also known as full-back – for eight NFL seasons with the New England Patriots and the Philadelphia Eagles. He is 41. He was diagnosed with ALS in August last year, the 14th former NFL player since 1960 who is known to have been diagnosed.
The issue is being studied separately by Dr Omalu, and the Centre for the Study of Traumatic Encephalopathy at Boston University. Among the Centre's donors is the NFL, which has contributed $1 million for research.
The centre has established a registry for brain donations from current and former athletes. It says it has received 400 donations. Among the 70 brains it now holds from former athletes and military veterans, 40 out of 50 have been positive for CTE. These include professional wrestler Chris Benoit, who committed suicide after murdering his wife and son in 2007, and two former National Hockey League players.
The most notable recent example was former NFL player Dave Duerson, who shot himself in the chest in February, leaving behind a note asking that his brain be donated to Boston University. Duerson was 50. He suffered at least 10 concussions during his 11 seasons as a safety with the Chicago Bears and New York Giants.
Initially, Duerson was an NFL success story: a trustee of its Players Association benefits board, and owner of a food distribution business. Then, in 2007, he began to complain of memory loss and headaches, problems with vision, attention and impulse control.
Earlier this month, Duerson's suspicions were confirmed, with scientists at Boston University announcing that he had been suffering from a "moderately advanced" form of CTE.
For his part, Dave Pear cannot be certain that he has CTE, although every indication points to it. To describe how he feels now, Pear, who could bench press 500lbs (227kg) "without steroids", who played in the Super Bowl and the Pro Bowl, and who had his own fan club, says: "Personally, I wish I'd never played, because it wasn't worth it," he said. "The bottom line is, it wasn't worth it."
Boyd was 49 when he was diagnosed with Alzheimer's disease. Before the diagnosis, there were the symptoms. An honours graduate in sociology and communications, his football career ended in October 1986, when the supposed shin splints the Vikings had dismissed were revealed to be a broken leg.
The legacy of marriage and divorce soon after was custody of a three year-old son, Anders. Law school was out of the question. Post-football, Boyd believed he no longer had the energy or stamina to sustain intensive study. He was fired from jobs selling insurance, restaurant supplies and a commission job, selling beer.
There was a three-year period where they were homeless. "You're sending a 10 year-old to school out of a tent," Boyd said. "That was rough. Here I was, this guy, high-energy, self-starter, high-achiever, and all of a sudden I couldn't hold a menial job, and the worst part was being called lazy, crazy, those kinds of things."
Boyd was diagnosed with brain damage in 1999. Eight years later he led a delegation of former players to Congress to explain and seek help for their fight with the NFL over increased disability benefits.
One by one, the players were later asked if they would do it all again. Many of them, Boyd remembers, were "Hall of Fame guys – guys who had been taken care of". All said yes, they would go back for more.
Boyd disagreed. "I said 'Hell no'. When you damage your brain, you lose your character and I lost my personality, my drive. It's one thing to limp and have a sore shoulder, but when your brain isn't working, functioning how it's supposed to, it robs your life."Reuse content