Bob Ford: Brian Westbrook's return stirs debate over the risks of playing after a concussion.

Brian Westbrook suffered a concussion when he ran headfirst into Redskins linebacker London Fletcher's knee during the first quarter of a game nearly three weeks ago. (Steven M. Falk/Staff Photographer)

When the trainers got to Brian Westbrook as he lay supine and unconscious on the grass at FedEx Field with his teammates and opposing players standing hushed around him, Westbrook's arms were extended rigidly at his sides, locked in the grip of the event that had just leveled him.

The presence of such a reaction indicated a severe medical emergency, one that can be caused by a stroke, brain hemorrhage, a tumor, or some other traumatic brain injury. In the case of Westbrook - who is expected to play today for the first time since that moment - it was caused by his choice of profession, which led to a violent collision between his helmet and the right knee of Washington Redskins linebacker London Fletcher during a Monday Night Football game nearly three weeks ago.

As soon as Westbrook was awakened on the field by head trainer Rick Burkholder, nearly the only question asked aloud about the Eagles' running back concerned when he would be able to again play football.

That is normal in his business. Players "get dinged" or "get their bell rung," and it is considered part of the job. Westbrook suffered what is commonly called a concussion, in this instance a blow severe enough to put him to sleep. It might be normal for pro football, but it is decidedly not normal.

"When your lights go out after taking a hit, something really bad happened in your head," said Douglas H. Smith, the director of the Penn Center for Brain Injury and Repair. "It has to be something bad to make you go off-line like that."

Smith, a doctor and a professor of neurosurgery at the University of Pennsylvania School of Medicine, is a leading researcher in the correlation between traumatic brain injuries, which include concussions, and their long-term effects on the victims.

"What happens in some cases looks like Alzheimer's disease in people who have had repeated concussions," Smith said. "This is what our group studies, and it appears that when you damage the nerve fibers in the brain, the ongoing changes last for years and can ultimately manifest themselves that way."

The House Judiciary Committee brought representatives of the NFL into hearings last month to ask about this kind of thing and to inquire what the league intended to do about it. There were horror stories of the cumulative brain injuries that have plagued former players, of once vital men who couldn't hold jobs, who drifted into homelessness, who, as in the case of former Eagles safety Andre Waters, took their own lives.

The timing of the hearings, as they related to Westbrook, presented an interesting look at the league's conflicting priorities. NFL officials were testifying that they consider concussions very serious business at the same time Eagles officials were speculating that the recently unconscious Westbrook might not have to miss even one game.

It turned out that Westbrook did miss a game, after suffering a recurrence of headaches, and then missed another because of another headache, while coach Andy Reid held out hope for his availability until the last moment each time.

Today, for better or worse, the wait is over. Westbrook is expected to play against the San Diego Chargers this afternoon. He will take the ball, lower his head, charge into the line, and try not to consider what might happen next.

Burkholder, the Eagles' trainer, is considered both very good and very conscientious at his profession. He is one of two NFL trainers who serve on the league committee that formulates policy on concussions. Notwithstanding that expertise, Burkholder is an employee of the team and as such serves the twin masters of protecting the players' health and getting them back into productive roles as soon as possible.

Asked if Westbrook now has a higher risk of concussion, if he is possibly on the road to the kind of repetitive injuries that have ruined the later lives of other players, Burkholder said it depended on the care he receives.

"If he's handled poorly," Burkholder said. "But is [the risk] greater because he's had this one? We don't think so, as long as we manage it correctly."

It is the opinion of someone who has been as involved as his job allows in learning all he can about concussions, while also staying up to date on every other ailment an NFL player can suffer. It is an opinion that speaks more of recovery from the last concussion rather than prevention of the next one. It is also an opinion contradicted by the latest and best research.

"Manage it correctly?" Smith said. "By what? Putting a force field around him? We know that a major risk for getting a brain injury is having had a brain injury. We call it second impact syndrome and have good evidence that if you take one hit, the threshold for the next injury seems to be lowered the next time."

There is no bubble wrap in which to swaddle Westbrook, regardless of how carefully his return has been handled. Football is violent, and the head is at risk on every play. The players are rewarded well for the chances they take. In exchange for the money, for the fame, they have to make these deals with themselves. It can happen, they know that, but they must believe it won't happen to them.

"I'm concerned about it, because I'm concerned about the long-term effects of it," Westbrook said in his lone news conference since the injury. "But when you go out there and play football, you have to go out there and play worry-free football. You have to go out there and try to play with reckless abandon."

Westbrook, who is 30 years old, played four years of high school and four years of college football before his eight seasons in the NFL. That's thousands of hits over the years. No one knows - not Westbrook, not the coaches, not the trainers, not any doctors who might be consulted - whether he has already suffered damage that will become apparent later in life or sooner. No one knows what happens with the next hit.

"If you have a concussion, should you ever play again? I would say no," Smith said. "Each person has to decide for himself or herself, but personally I can't imagine losing part of myself for any money. It doesn't seem to be worth the risk."

Westbrook has had a great career, but it is likely his greatest days in the NFL are past. He is hobbled and hampered by chronic knee and ankle injuries now and is pushed from behind by a younger player eager for his own time to begin. Three weeks ago, he was unconscious on the field, his arms clenched, his eyes staring empty.

If you have liked the game of football as played by Brian Westbrook, think of him today when he goes back out there. He has been cleared to return, but no one knows better than Westbrook, once the crashing and the collisions begin, just how little that might mean.


Contact columnist Bob Ford

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