Post-concussion syndrome, the new buzz words around the NFL this season, have come down hard on quarterbacks Chris Miller of the Rams, Vinny Testaverde of Cleveland and Dallas' Troy Aikman.
Twelve days after suffering a concussion, Miller still complains of headaches, blurred vision and memory loss. Testaverde is still groggy, and Aikman, floored one week by Arizona's Wilber Marshall, was in uniform the next week.
The syndrome forced Chicago running back Merril Hoge and New York Jet wide receiver Al Toon to retire recently. Doctors once dismissed the syndrome as paranoia, but recent studies have proved otherwise.
"You used to send people home after a trivial car wreck, and they looked fine," said Dr. Alex Valadka, assistant professor of neurosurgery at Baylor College of Medicine. "Then they kept coming back, complaining of headaches. In the past, you sent them home again, thinking they were crazy. But not anymore."
NFL players need only a matter of weeks for broken bones or muscle tears to heal, but it can take several months for effects of a concussion to subside, doctors said.
"The Rams have to ask themselves what they want to do with Miller right now," Valadka said. "I've treated some high school kids after they get their bell rung on Friday nights, and it's a tough question to face.
"Usually, it's the best player on the team and he's trying to get a college scholarship. So do you send him back and let him risk ending his career altogether, or keep him out?"
A sports injury handbook published by Barrons instructs football players who suffered concussions to "lay off 28 days and seek medical advice before returning to the game."
Aikman played in the Super Bowl last January after a serious concussion hospitalized him after the NFC Championship Game against San Francisco. Although Aikman played, that doesn't necessarily mean Miller should, Valadka said.
"There's not much that can be done at this time for him," he said. "You can try some kinds of cognitive rehabilitation, but that takes time. The bad news is that this takes a long time, but the good news is that everyone comes around."
Dr. Sean Grady, an associate professor of neurological surgery at the University of Washington, said the recovery time depends on the person and the degree of the injury.
"Some people with his problem take up to three months to fully recover," he said, "where others are fine within a couple days."
Grady compared the brain's role in a concussion to that of a bowl of Jell-O being shoved into a wall.
"The brain has the consistency of Jell-O and floats in water," he said. "It shifts and moves with injuries. When the bowl stops (hitting the wall), the Jell-O continues, then goes backward, vibrating back and forth."
The concussion jars the brain, stalling the electrical signals from moving through the nervous system, he said.
Miller suffered his concussion when he was hit by New Orleans' Ernest Dixon in the first quarter of the Rams' 37-34 loss to the Saints on Oct. 23. He hit the back of his helmet on the Astroturf but remained conscious. He stayed in the game for the rest of the first half and threw a 19-yard touchdown pass to Isaac Bruce.
But Miller began feeling dizzy at halftime, and the Rams pulled him out for the second half. An MRI test and CAT scan showed no brain damage, but Miller complained of pressure in his temples as if he had a bad head cold.
He still has trouble formulating plays and "pre-snap stuff," and struggles to focus during game-plan meetings. His blurry vision prevents him from reading a newspaper and seeing playing cards during locker room games with his teammates.
"Those are very typical effects from a concussion," Grady said. "About 30 to 35% of all people have those effects, and their MRI and CAT scans are completely normal."