Perhaps the most painful of Jim Otto's 23 surgeries occurred five years ago. That's when doctors operated on his back for 11 1/2 hours to remove scar tissue and insert rods, screws and ties so he could walk again.

"Twenty-three, 22, you lose count after a while," said Otto, the former Oakland Raiders center. "I remember that one because I was almost paralyzed, and doctors had to pull my intestines aside to get to my back."

It has been 20 years since Otto retired after a Hall of Fame career. His dedication and durability symbolized the team's "Commitment to Excellence" motto.

In 15 seasons, Otto played 210 consecutive games and made the AFL All-Star or Pro Bowl team 12 times.

He was once the league's iron man, but Otto's body is now a

combination of plastic joints, flesh and screws. He has had two major back surgeries, 16 knee operations and five artificial knees. He has arthritis in his shoulders and neck.

"Jim can't walk through an airport without the metal detectors going off," said Miki Yaras-Davis, director of benefits for the NFL Players Association. "Almost no one leaves this game unscarred either physically or mentally."

Few occupations can provide the riches and fame, yet simultaneously the danger, of pro football. One contract can provide financial security for a lifetime. One great performance, such as Joe Namath's for the New York Jets in Super Bowl III, can bring endless endorsements.

But pro football is a brutal game, a sport that long has glorified pain and punishment. It is filled with sights and sounds of collisions that are sometimes startling and other times frightening.

That crackling thud can mean a broken bone or a torn cartilage -- and a redefined life.

According to the latest NFLPA survey, conducted in 1990, more than one-third of 645 players whose careers began as early as 1940 and ended no later than 1986 retired because of disabling )) injuries. Nearly two out of three retirees live with a permanent injury.

Two years ago, Detroit Lions guard Mike Utley took a hit and suffered severe spinal damage, leaving him nearly a quadriplegic. Utley's injury received a lot of media attention because it happened during a game.

But many former players are experiencing health problems after the spotlight dims, the celebrity fades and they cease to be larger than life.

Former Los Angeles Raiders offensive lineman Curt Marsh, who retired in 1987, had his right foot and lower leg amputated Sept. 21. Namath's famously fragile knees are so painful that he can't carry his children down steps. Former Chicago Bears tight end ** and head coach Mike Ditka waddles like a wooden toy soldier because of an artificial hip.

And Colts Hall of Fame quarterback John Unitas' once-golden right arm has a restructured right hand. Unitas also has an artificial knee and will have a hip replacement soon.

"You ever go to a retired players association convention?" said Yaras-Davis. "It's an orthopedics surgeon's dream. They all have the crab-like walk, and it's hard to believe they were once these feared gladiators. Forty-year-old players are having the same problems as 80-year-old men."

"Wherever there is repeated trauma to certain areas, wherever joints and ligaments have been injured, arthritis and other degenerative diseases, well, it's going to happen," said Dr. Stan Lavine, team physician of the Washington Redskins from 1975 through 1985. "That's one of the major reasons why so many of these guys walk with limps."

Some are barely walking.

According to Yaras-Davis, a knee injury forced former Chicago Bears defensive lineman Roger Stillwell to get special devices to pull himself out of bed. He also had a ramp to enter the bathtub.

Stillwell, who played only three seasons with the Bears, walks with a cane.

Otto used to collapse in the early years of his retirement, even though he walks without difficulty now.

"It would become so embarrassing that I stopped going out in public," said Otto, who had his knees drained and injected with painkillers four times a week during his last three playing years. "There have been times when I've said, 'Why'd I do this?'

"But I wasn't going to lay there and whine. Football is a contact sport, and injuries are a part of the game. And if you can't take the injuries, get the hell out. Yes, I'd do it all again. It's not for whiners."

Former San Francisco 49ers defensive lineman Charlie Krueger was a tough guy. But a knee injury that was treated with repeated shots of cortisone and steroids forced him to end a 15-year playing career after 1973. Krueger now can't kneel and has problems walking on uneven surfaces. He hasn't jogged since January 1989.

Ten years of lawsuits against the 49ers left him with a $1 million settlement in 1989 and plenty of bitterness.

"Hell no, I wouldn't do it all over again," said Krueger. "I've heard guys like Jim Otto and Dan Hampton say they would do it again. Damn fools. They're still in that state of denial. They don't want to believe that someone put them in a position to make them look like idiots."

Former Colts quarterback Bert Jones, 45, said: "Everybody goes into the game realizing that two things are going to happen: Either one day you're going to be cut because you're no longer good enough, or an injury is going to cut short your career. If anybody tells you anything different, then they are dumber than I think they are."

Krueger replied: "Oh yeah, wait till some of these guys turn 65, and they have a bad heart, crummy knees or a screwed-up

personality. Players are bigger now. There have been problems with steroids. The artificial surfaces are much harder than grass. We haven't seen the worst yet."

Silent conspiracy

Former Raiders internist Dr. Rob Huizenga, in his book "You're Okay, It's Just a Bruise," suggests that some team doctors were involved in a silent conspiracy with management to put players back on the field at any cost.

Marsh played with the Raiders seven years, during which he was hospitalized 18 times and had 13 surgeries. During his fifth training camp, he suffered the injury that ultimately led to amputation. Longtime Raiders team doctor Robert Rosenfield, who died last January of cancer, diagnosed it as strained ligaments.

Marsh took more than 100 painkilling injections from the Raiders and continued to play, which only made his condition worse. Marsh says his current doctors have concluded that the bone in his ankle may have been broken in the training-camp incident.

Players were not allowed to get medical second opinions until 1982, according to the NFLPA.

"They told me if I took the shots and played, it would get better," said Marsh. "Well, as you know, it didn't get better. I'm not out for revenge or anything, but I do think they took advantage of my loyalty."

Hall of Fame linebacker Dick Butkus had a similar situation with ++ the Bears. Team doctors injected his knees with cortisone and other high-powered drugs in 1972 and 1973, causing permanent damage, he said. Butkus, once the the most feared player in football, sometimes walks as if one leg is inches longer than the other.

Krueger endured as many as 50 procedures in which bloody fluid was removed from his swollen knee and replaced with steroid compounds.

During one game in 1970, a piece of Krueger's knee was broken off, but he was given codeine and put back in to play. He played five more games before the loose bone mass was removed.

"They never told me part of my knee was missing," said Krueger. "Back then, owners would do anything to maximize their payrolls to win the war games. Coaches had a way of making you feel less manly if you didn't play. They'd shoot you up, and you could get painkillers anywhere. They would worry about the consequences later."

Huizenga said: "I would say most of the doctors are first-rate professionals, but they can fall into a trap from the huge pressures of owners and the millions of dollars involved, especially in big games. Doctors can pressure players who don't think they will ever get hurt or the ones who think they have only a few years left to make money."

Lavine, now the University of Maryland's team doctor, agrees with Huizenga, but adds the pressure does not come solely from owners, but also from coaches, parents and especially players.

"Most of these players are young, and they feel invincible," said Stuart Fishelman, a Baltimore doctor who provides sports psychology services. "Some play with injuries because they fear they might lose their job or position and their self-concept and identity. There is also a tremendous fear perpetuated by management that younger guys are a threat if you can't perform."

Most current players feel they have more leverage since Butkus filed a $1.6 million suit against the Bears in 1974 and came away with a $600,000 settlement. Soon, attorneys were winning workers compensation cases throughout the league, which caused doctors to be more cautious with their diagnoses.

Also, once the NFL became a billion-dollar business about 1980, teams became less likely to risk injuries with million-dollar players, and urged them to participate in year-round conditioning, which includes weight training and aerobic exercise.

"In the 1960s, if you hurt your knee and had surgery, you would be out for the year," said former Bears defensive lineman Hampton who retired in 1990 after 10 knee surgeries in 12 seasons. "Now, you can get scoped and return in nine days, because the medical procedures are more sophisticated. Fifteen years ago, players had control of very little. Now, a player has two agents, two houses and a couple of cars. Then he says when or whether he will practice or take a painkilling shot to play."

Difficult transition

When players retire, they cite feelings of abandonment, loneliness, paranoia, helplessness, despair and loss of self-esteem. They blame these problems for failed relationships, unemployment and drug or alcohol addictions.

The NFLPA report found that of the players leaving the game because of injury, 70.6 percent had emotional problems some time during the sixth-month transition period after football. Of those who did not leave because of injury, 56.2 percent reported similar emotional problems.

"Once you leave the game, people forget about you quite quickly," said Drew Pearson, the former Dallas Cowboys wide receiver. "No matter how many passes you've caught or touchdowns you've thrown, that's nice, but it doesn't mean anything in the real world."

"The transition period isn't always smooth," said Yaras-Davis, noting that the average career of a player is less than four years. "You wouldn't believe the number of divorces when the big money stops coming in. We don't keep records, but we're seeing greater numbers of psychological problems when they're finished playing."

Former Pittsburgh Steelers defensive lineman Ernie Holmes once sat on a bridge and shot at passing trucks, and then was arrested for shooting a police officer in the leg before surrendering. Ex-Cowboys wide receiver Bob Hayes and former Miami Dolphins running back Mercury Morris have served time on drug convictions. Former Colts quarterback Art Schlichter, whose gambling addiction led to two NFL suspensions in the early 1980's, was charged with bouncing or stealing more than $400,000 in checks this year. He retired from the Arena Football League in 1992.

"There was recently a Washington Redskins player who got cut and shot his bed full of bullet holes," said Yaras-Davis, who declined to name the player. "These guys constantly live on the edge, and the same behavior they once used to achieve notoriety on the field they exhibit off the field."

Former Colts linebacker Mike Curtis said those cases are few and too highly publicized.

"Too many times we hear about the negatives because we're former athletes, but the media ignores the players who make positive contributions," said Curtis, a D.C. commercial real estate broker. "I think the positive situations would certainly outweigh the negatives."

But a number of former players, including receiver Al Toon of the New York Jets and running back Vic Washington of the 49ers, developed post-traumatic stress disorder. The symptoms are nightmares and cold sweats. They are similar to those experienced by rape victims and soldiers returning from combat.

"Retirement affects athletes in different ways," said Fishelman, the Baltimore doctor. "The highs an athlete gets from the highly selective field makes it hard for them to settle into another pursuit. These are young people who have achieved a lot of emotional and economic success at an early age, but they never think about their careers ending.

"The psychological high and its addiction is parallel to people who become addicted to cocaine or a smoker who has a dependency on cigarettes. Players rarely give much thought to life after football. It becomes quite a shock."

Big players, bigger collisions

Former New York Giants linebacker Lawrence Taylor $ 1/8 revolutionized pro football in the 1980s.

"Lawrence was Dick Butkus, but with speed and range," said John Madden, analyst for Fox television. "When other coaches started seeing what a guy that size could do, they all wanted monster players with speed. Big was in."

The average weight for a lineman on the Colts championship teams in 1958 and 1959 was 240 pounds. Now, the NFL average is about 300, and increasing. As the size increases, so does the force of the collisions.

"The impact and velocity of some collisions, normal Americans can't appreciate because they are not on the field," said John Lopez, head of Towson Sports Medicine and former trainer with the Baltimore Colts. "It's like someone putting your body on I-695 at 6 p.m. and letting it get bounced around by the traffic."

According to several experts, the emphasis on size in the mid-1980s led to a peak use of steroids, which increase strength, muscle definition and aggressiveness.

Ever since the NFL began random drug testing in 1990, the consensus among players, coaches and team medical personnel that steroid use has dropped significantly. In 1990, four players were suspended. Since then, only three players have been suspended for the minimum four weeks for a first offense.

No one ever has been suspended for a second or third time.

"I was proud that the NFL started the random drug testing, and I'm sure use has decreased," said Huizenga, the former Raiders doctor, "but it's still there. The highly educated are hiring counselors to advise them on masking agents and certain other breakdown products. Some players have catheterized themselves and replaced their own urine with clean samples before testing."

Before his death in 1992, Raiders defensive lineman Lyle Alzado said long-term steroid use was the cause of the brain tumor that eventually killed him. Former offensive lineman Steve Courson, who played eight seasons for the Steelers and Tampa Bay Buccaneers, has blamed alcohol and steroids for his dilated cardiomyopathy, a weakened heart muscle.

Steroid use can lead to testicular shrinkage, malignant liver tumors and personality changes and can have an adverse effect on the cardiovascular system.

"A lot of the players who used them are still playing, so we won't know the full effect for maybe another 20 years," Huizenga said. "I think the NFL should monitor them for long-term effect."

The added bulk, with or without steroids, is a concern.

According to a study released last January by the National Institute of Occupational Safety and Health, linemen have a 52 percent greater risk of dying from heart disease than the general population, and are three times more likely to die from heart disease than players at other positions.

An even bigger problem comes when a player's weight balloons after his career has ended.

"I wouldn't want to be the underwriter for Nate Newton and Refrigerator Perry's insurance policies. Those big, fat guys will have to make major adjustments in their lifestyles," said Dr. Bill Howard, head of Union Memorial Sports Medicine Clinic. "It's a medical fact that the extra weight puts pressure on joints, your kidneys and affects your cardiovascular system. Take a look around; you don't see many 72-year-old men that are 6-4, 320 pounds."

"The coaches want you big, the owner wants you big, so you try to please them," said former Atlanta Falcons center Jeff Van Note. "Then, all of a sudden, you're out of the routine. You're not making money off your body anymore, so you're not into taking care of it like you were as a player."

Dying young?

Between 1960 and 1989, the average age of 80 vested players who died was 38.7, according to the NFLPA and NFL Management Council.

Previous reports estimate the average age of death for NFL players at 52 or 53, but the study released by NIOSH last January concluded that former players are not dying younger than national life expectancy for males, which is 72.

A lot of former players are convinced football has taken years off their lives. Yaras-Davis said players are opting to take a reduced pension plan at 45 instead of waiting for a full one at 55.

Some have been convinced by the deaths of three Hall of Fame quarterbacks -- Bobby Layne, Norm Van Brocklin and Bob Waterfield -- all of whom died of heart attacks between the ages of 57 and 62. Heart attacks also killed linebacker Larry Gordon (28), defensive end Wilson Faumuina (32), kicker John Leypoldt (40) and defensive tackle Dudley Meredith (52).

"It would be interesting to see how they conducted the study," said Ron Mix, a former offensive tackle with the San Diego Chargers. "The human body isn't meant to take this kind of a beating, and there is always constant pressure. Football has to take its toll."

Concussion danger

Post-concussion syndrome became the latest danger this season, with the retirement of Chicago running back Merril Hoge and injuries to quarterbacks Chris Miller of the Los Angeles Rams, Dave Brown of the Giants, Vinny Testaverde of the Cleveland Browns and Troy Aikman of the Cowboys (who's had four concussions in six years).

There's an average of two to four concussions every game, says former Steelers team doctor Joseph Maroon. It can take several months or a lifetime for the effects of a concussion to subside, and repeated concussions can cause long-term or permanent damage, according to a number of experts.

"The most frustrating thing about the injury is that there is no control. I have no control over getting better," said Hoge. "I'm at the mercy of time."

Concussions result from severe blows to the head. The brain rattles around its protective chamber and bruises, resulting in symptoms such as confusion and memory loss. Quarterbacks are most vulnerable because their upper bodies are exposed while passing.

The mind-scrambling head injuries have shortened the careers of several players and left some perpetually groggy. The list includes Hoge, Al Toon, Lynn Swann, Roger Staubach and Harry Carson.

Former Philadelphia Eagles quarterback Ron Jaworski supposedly leads all players with 34 concussions. Staubach had 20.

"It's a scary injury," said Minnesota Vikings quarterback Warren Moon, who has had three concussions, the last and worst coming in 1992. "The whole feeling is scary, having no control over yourself, just being glassy-eyed. When I did start remembering things, I got really cold, shivering."

The hard surface under artificial turf and the size and hardness of helmets sometimes used for spearing have contributed to the rise in concussions.

"Well, I guess we all know that the artificial turf is here to stay," said Moon. "And some referees are more consistent with the spearing call than others.

"The risk of these concussions is something you really have to think about, because you still have the rest of your life to live. You don't want to live it in a cloud."

A grotesque injury

It has been nearly six weeks since Raiders running back Napoleon McCallum suffered one of the most grotesque injuries in football. In the third quarter of a game against San Francisco, quarterback Jeff Hostetler handed off to McCallum for a routine run up the middle. After gaining a yard, McCallum was stopped by 49ers linebacker Ken Norton.

Replays showed McCallum planting his left leg, then getting pulled down in one direction with his leg pointing in another. The leg stretched as if it were rubber. McCallum suffered a ruptured artery, stretched nerve, damaged calf muscle and hamstring, dislocated kneecap and three torn ligaments and also developed a blood clot.

The injury was so severe that doctors thought about amputation.

McCallum already has had surgery twice, and a third operation is scheduled for next month, at which time an Achilles' tendon from cadaver will be used to finish repairing a ligament.

McCallum has had time to think about the Jim Ottos and Charlie Kruegers. He screams at the television every time he sees a big pileup during games.

And yet, McCallum 31, said he will play football again.

"I've thought about quitting, and I've had some really bad dreams," said the former Navy star, who already has a metal plate in his left ankle.

"I have thought a little what my life will be like when I turn 55 or 60. It could be a nightmare. But I love this game."

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