They remember the hard hits - most of them, at least. The brain-rattlers that left them blank-eyed and disoriented, they have no recollection of at all. But the ones that snapped ligaments, rendered bones the consistency of crushed ice or bent joints in ways they ought not to bend are still felt every morning years later.
A career in the National Football League creates echoes good and bad. Some reverberate in medical records, others in luxuries from rich contracts. But the most vivid ones for many former players come when they get out of bed each day and put their feet on the floor. If the NFL confers wealth - a rookie's base pay next season will be $405,000 - it exacts a heavy price: lifelong hurt.
A Washington Post survey of retired NFL players found that nearly nine in 10 report suffering from aches and pains on a daily basis, and they overwhelmingly - 91 percent - connect nearly all their pains to football.
"I hurt like hell every morning when I wake up," says former linebacker Darryl Talley, 52.
"I can't run anymore," says former offensive lineman Pete Kendall, 39. "I can't play basketball with my kids, can't walk for any extended distance."
"I'm 40 years old going on 65," says Roman Oben, another ex-lineman. "God knows what I'll feel like when I'm actually 65 years old."
The Post's online survey of more than 500 retired players paints a rare portrait of the toll a career in the NFL has on the long-term health of those who competed in the bruising game. The results also present a striking paradox: Nine in 10 said they're happy they played the sport. But fewer than half would recommend children play it today.
Among the survey's other findings:
• Nine in 10 former NFL players reported suffering concussions while playing, and nearly six in 10 reported three or more. Two in three who had concussions said they experience continuing symptoms from them.
• More than nine in 10 players reported suffering at least one major injury while in the NFL. More than half reported three or more; one in five reported five or more.
• Forty-four percent of former players said they have either had a joint replacement or have been advised they'll need one.
• A third rated the medical care offered by team doctors as either "not so good" or "poor," though a majority rated it as "good or "excellent." Those who retired more recently reported more satisfaction than those who retired earlier.
• About the survey • Complete survey results • Highlights
In addition to those surveyed, The Post conducted extensive interviews with more than three dozen retired NFL players, and most said they accepted a certain amount of pain as the fair exchange for football's compensations.
"If you have brains when you start, you are aware that banging your head into people is not the best thing for your body," said tight end Chris Cooley, a two-time Pro Bowler with the Washington Redskins.
The physical, gladiatorial nature of the game attracted them in the first place, many said. Among its rewards were electrifying Sundays, deep relationships with teammates, personal pride and social mobility - it paid for their college educations and afforded them a lifestyle they would never have enjoyed otherwise.
"The game was going to better your family, better your life, better your children's lives," said former defensive tackle Warren Sapp, recently elected to the Pro Football Hall of Fame.
But player responses also raised the question of whether at least some of the lasting damage they incurred was avoidable, and if the NFL is doing enough to mitigate it.
Continuous crippling pain
Seventeen years removed from his NFL career, ex-quarterback Don Majkowski says he can no longer hold down a job. He can't stand for long periods, and sitting is also tough. He has undergone nearly 20 surgeries related to football, including 11 on his ankle, three on his shoulder and two on his back. He has a 12-inch scar on his stomach, and he can't walk very far because his left foot is fused with his ankle by a pair of metal plates and 13 screws. "It's like walking on a pirate peg leg," he said.
No one warned Majkowski that all those blindside hits might result in lumbar spinal fusion and degenerative disk disease, and certainly no one mentioned the crippling pain that preceded it. What few warnings he did receive, he didn't particularly listen to. "You hear stories of what you will have to face when you get older," he said. "You don't put much merit in that when you're younger."
Injuries forced the former University of Virginia standout to retire at the end of the 1996 season, but his medical saga was just beginning. He had bone spurs, torn ligaments, degenerative arthritis and not much cartilage in his knees. He got a staph infection from one of his ankle surgeries. The bone spurs frayed his Achilles' tendon so badly that one day it ruptured when he was simply walking up the steps to his house. Then came the disk problems. Today he has two steel plates in his back, and he needs another in his neck.
For all of that, Majkowski, 49, counts himself one of the luckier ones, because he is financially secure. At the height of his career he commanded a salary of more than $1 million a year; he estimates he was able to save about $6 million. Anytime he is tempted to play violins for himself, he goes to a Green Bay Packers reunion and realizes how many older players are far worse off, both physically and financially.
"I'm friends with them and they are all just hurting big time," he said. "Hip replacements, knee replacements, you name it, and they had to pay for it themselves and it devastated them, a lot of the guys."
Few professions leave their work force with such lasting bruises and scars. The NFL and the league's Player Care Foundation, an independent charitable organization, sponsored a study at the University of Michigan in 2009 that surveyed 1,063 former players. About eight in 10 reported suffering from pain that lasts most of the day. Among younger retirees, aged 30 to 49, one in three said he was unable to work or limited in work. And almost 30 percent of them rated their health as only "fair" or "poor."
Ten percent of those under 65 in the Michigan survey needed surgery they could not afford, 16 percent needed dental care they couldn't pay for and 8 percent could not afford prescription medicine.
Jerry Kramer, an All-Pro offensive lineman with the Packers from 1958 to 1968 who won two Super Bowls under Coach Vince Lombardi, says he's currently putting off a hip replacement.
"Injuries? Let me give you a list," Kramer, 77, said. "Broken bones, leg, the leg below the knee, separated bone and ankle, had to have bolt put in, thumb, arm, broke rib, detached retina, concussion - all from football.
"I have learned fairly well to handle the pain," he added. "I find no comfort in dwelling on it or allowing it to impact my life."
Packers reunions usually include dinner and a golf outing. But a lot of the players, Majkowski included, aren't capable of playing anymore. "We just go and ride around in the golf carts," he said.
Misgivings about treatment
There were more than 30,000 injuries in the NFL in the 10-year period of 2002-11, including nearly 4,500 in 2011 alone, according to the league's data. In any given season, there are roughly 2,000 players who suit up in an NFL uniform. In The Post survey, former players noted misgivings with the way NFL teams treated them when they got hurt.
Almost half of those surveyed (47 percent) said team doctors prioritized interests of the team over their health. Just 13 percent said they felt their health came first, while 36 percent said their health and team interests were prioritized equally. Nearly four in 10 players (38 percent) sought medical advice outside of team doctors and trainers during their careers, while nearly three in 10 (29 percent) said their teams discouraged them from seeking out those second opinions.
The NFL has undertaken wide-reaching measures to address player safety in recent years. It has formed half a dozen committees to examine rule and policy changes and invested in medical research on the impact of concussions, such as a $30 million grant to the National Institutes of Health. The league has changed rules to make kickoffs safer, protect defenseless receivers from jarring hits, bar the ballcarrier from leading with his helmet and require concussed players to be cleared by an independent neurologist before returning to action.
The league is also conducting an ongoing campaign to reform what executives say is a "culture" of playing through pain.
"That culture has existed and it needs to change," said NFL Executive Vice President Jeff Pash. "That is a big part of what Commissioner Goodell is trying to do. We're trying to move toward a player safety culture. It's going to take time, but I think we're making progress, seeing them being more honest about their injuries."
NFL executives and player advocates say there is a major stumbling block to trying to educate players in their prime to better protect themselves: The rewards of the NFL are much more tangible than any hypothetical injuries that, to them, loom far down the road.
"It's like being awfully drunk at night and throwing up and swearing you will never let it happen again," said Ralph Cindrich, a former NFL player who now serves as a player agent. "And the next morning you're having a bloody mary at 9."
There are financial incentives for playing through pain. Much of the money in a player's contract is not guaranteed, so he doesn't get paid if he suffers a season-ending blow. This can encourage players to ignore or hide injuries.
"It's a very competitive business. There's always somebody ready to step in if you can't go," said defensive end Tyoka Jackson, a District native who played from 1994 to 2006. "It really comes down to one question: Can you go? You try to make sure the answer is yes as much as possible."
Nine in ten players surveyed by The Post reported playing while hurt during their careers, and 56 percent said they did so "frequently." Nearly seven in 10 (68 percent) said they felt they had no choice in doing so.
"If you didn't hurt while you were playing, then you weren't playing," Talley said.
Forty-nine percent of the former players surveyed said they wish they'd played while hurt less often.
Many said they were aware a football career entailed sacrifices that would impact their long-term health. In the 2006 offseason, the bone in Roman Oben's left foot essentially split in half. He'd already won a Super Bowl and pocketed around $10 million over the course of his career. His wife and mother urged him to retire. Instead, Oben underwent two reconstructive procedures, as doctors fused the bone with a metal plate before wrapping it with a ligament from a cadaver.
"I knew then at 33, 34 years old, I was going to have trouble walking when I'm older," he said. "I just knew it. . . . I made the decision. I said, 'I don't care. I deserve to work as hard as I can to improve the quality of life for my family. It's my risk. I'm doing what I'm supposed to do.' "
Oben appeared in only six games in the two next seasons before retiring. He says today he has no regrets about his decision and the sacrifice he made.
The Post's survey also revealed that the longer someone plays the game, the more likely he will be coping with its impact years later. Players who spent 10 or more years in the league were about twice as likely to have suffered five or more concussions, and more than twice as likely to have had five or more orthopedic surgeries. Although the vast majority of former players said they were "happy" to have played the game, those who played at least 10 years were about three times more likely to say they were "not happy."
"You play until 35 or 36, you're gonna pay for it," said Oben, who spent 12 years in the league. "You're not going to give up your house, the experiences you had, the financial security you were able to achieve - you're not going to give that up. But all of it comes with a cost."
Prevalence of concussions
The most severe consequence of an NFL career is head trauma that can lead to brain disorders as well as a host of mental health issues. More than one in three former NFL players said they experienced five or more concussions in The Post survey, and three in four players who've had at least three reported experiencing continuing symptoms today.
Fred Smoot, 34, lost count of the concussions he experienced during his nine-year career, before sideline protocols were in place to prevent players from staying on the field with head injuries. Or rather, he didn't bother counting them, since he experienced them so frequently as a defensive back who plowed into receivers and running backs at a dead run. "There were many times I'm on the field and praying the quarterback don't throw my way because I don't know what's going on," he said. "It was a glaze or a fog over the eyes."
Former quarterback Kurt Warner suffered at least five concussions during his 12-year NFL career and says the dangers surrounding head trauma played a role in his retirement in 2009.
"It's ultimately going to come down to players realizing we're not invincible. I don't mean we're not invincible this week or this year - we're not invincible when we're 45 or 50," he said. "We have to understand the big picture of what going back out there does, what it does to the ligaments in our knee, what it does to our head if we're taking continual blows. I think that's the big picture we have to continue to strive towards, to educate players that we're not invincible."
While concussions have received the majority of the headlines in recent years, the vast majority of reported injuries in the NFL still occur below the head. From 2007 to '11, according to the league's injury data, concussions on average accounted for about 7 percent of the injuries suffered in the NFL. In that same period, orthopedic injuries - knees, ankles, hips and shoulders - accounted for nearly 50 percent.
In The Post survey, 83 percent of NFL retirees said they have undergone orthopedic surgery, most of them multiple times. Three in 10 reported five or more surgeries.
"The cumulative effect of what you did for a living is really not shown until age 40 to 45," said Bruce Laird, 62, who played safety in the NFL from 1972 to '83 and today is in need of a new shoulder. "For the most part, guys try to stay active, play golf, tennis, work out. But all of sudden, you're around 45, you start waking up going, 'Man, my shoulder, my hip, my knee.' Then seriously by 50 to 55, it's constant pain everywhere. 'I can't stand very long. I can't walk very far. My neck is compressed. Arthritis is killing your shoulders. Everything.'"
In The Post survey, fewer than half of former players (46 percent) said they'd recommend children play youth or high school football today; 30 percent said they'd neither recommend nor discourage it.
"My son - I have a baseball bat in his hand, so that should tell you a little something," Jackson said.
The willingness of a player to recommend the sport to children was closely related to the number of injuries he suffered. Sixty percent of retired players with two or fewer concussions said they'd recommend the sport for children, compared with only 42 percent of those who'd suffered three or more concussions. Players from that latter group were three times more likely to discourage their children or grandchildren from playing.
"I'd rather encourage my son to own a football team than play for one," said Eddie Mason, 41, who played six seasons in the NFL between 1995 and 2002, four with the Redskins.
sally.jenkins@washpost.com;Â rick.maese@washpost.com;Â scott.clement@washpost.com
Clement is a polling analyst with Capital Insight, the independent polling group of Washington Post Media. Capital Insight Director Jon Cohen and pollster Peyton M. Craighill contributed to this report.
Do no harm? NFL's medical dilemma.
PART ONE | Medical care in the NFL is medicine turned on its head, often with troubling results.
Pain and drugs in the NFL
PART TWO | Coping with injuries and pain in pro football has fostered a culture of painkiller use and abuse.
Stuck with the bills
PART THREE | The NFL's health insurance ends years before many physical consequences of a player's career appear. So who should pay?
