By Les Carpenter
Washington Post Staff Writer
Sunday, April 22, 2007; E08

LOS ANGELES -- The night of the Dallas Cowboys' second consecutive NFC championship in January 1994, Troy Aikman was in a hospital unable to remember what, if anything, he and his teammates had accomplished hours earlier.

A third-quarter hit had knocked the quarterback's brain against the sides of his skull. At a concussion seminar this past Friday morning, Aikman's agent Leigh Steinberg recalled visiting him in the hospital that night and being met with blank stares.

Steinberg remembered Aikman asking, "Did I play a football game today?"

When Steinberg said yes, Aikman then asked if he played well. Steinberg again said yes. Aikman then wondered if the Cowboys had won. When told yes again, Aikman asked what the win meant. Steinberg told him he was going to the Super Bowl.

"His face really brightened then," Steinberg recalled.

Five minutes later, Aikman turned to Steinberg and said, "Did I play a football game today?"

Steinberg told this story at the seminar he put on along with the Los Angeles-based Sports Concussion Institute to illustrate a fact that now seems startling. After a week of fogginess and feeling sick to his stomach, Aikman played in the Super Bowl, exposing himself to a potential blow that could have caused further head trauma and put him at risk for future debilitating problems.

Several years ago, Steinberg organized a seminar to study concussions, but the subject quickly died. Now interest has regenerated after recent suggestions that the deaths of former NFL players Mike Webster, Andre Waters and Terry Long might have been related to concussions. Friday's seminar drew several doctors who are considered leaders in the field and who presented new findings that appear to show just how blows to a brain not healed from a previous concussion can cause exponentially more damage.

Mark Lovell, the director of the Sports Medicine Concussion Program at the University of Pittsburgh Medical Center, said estimates from the Centers for Disease Control show there are 1.6 million to 3.8 million sports concussions a year. Other studies of high school athletes suggest 70 percent of football players reported concussion symptoms but only 20 percent knew they had a concussion. It takes two weeks for 60 percent of high school athletes to recovery fully from a concussion, he said.

Several of the doctors worried that too many of those kids are returning to action sooner than that, which leaves the brain vulnerable to another hit that could give the athlete headaches, dizziness and temporary amnesia for weeks and put him or her at a heightened risk for conditions such as Alzheimer's and Parkinson's diseases.

The problem is no one knows just how extensive those risks are.

"This is the last frontier in medical research," Steinberg said. "We know everything about the knees and joints. But the brain is truly the last frontier."

Complicating such study, many of the doctors said, is the current sports culture that demands players get onto the field as soon as possible. Several gave anecdotal evidence of high school athletes who tried to get back into soccer games or football games or play again within days of what appeared to be severe concussions.

The doctors urged all high schools and sports teams to adopt baseline testing, which requires athletes to look at a television monitor and respond to a series of prompts. This gives a record of normal brain activity, so when a head injury occurs, the athlete can be tested again to determine how much function has been lost.

While many professional sports leagues do baseline testing, only a fraction of high schools do.

To illustrate how tricky this research can be, several doctors said injured players can fake their way through basic tests for concussions by saying they feel fine, even as their heads are pounding. Only when more extensive tests are given, forcing the patient to remember simple facts and identify objects, can the true extent of the injury be determined.

Bennet Omalu, a forensic pathologist who first made the link between brain injuries and the deaths of Waters, Long and Webster, showed pictures of each player's brain to demonstrate how normal all three of the brains appeared. Only after further examination could the telltale signs of head trauma be identified.

The brain of Webster, who had several post-football health issues, showed dementia "often seen in an 80-year-old," Omalu said.

Technology is helping in studying brain issues. Some scientists have wired the helmets of college football teams to study the force of impact on the brain.

There was a lot of discussion about designing new helmets, but many cited the problem of having something that is comfortable enough for a player to want to wear.

"People are appalled when I tell them to put a used swimsuit on their kids, but they put on their kids' heads anything that comes out of the equipment closet," said J. Nadine Gelberg, the president of Get Charged, a company that examines sports technology. "They don't know what's happened to that helmet."