The injuries still linger in Brian Westbrook's mind. The high-ankle sprain about 10 years ago, when Westbrook missed maybe a week before rushing back and playing a step slow. The concussion in Washington in 2009, when Westbrook was knocked out in the first quarter of a Monday night game and wanted to resume playing two days later.
Now he has to wonder: At 36, when he forgets names, is it because he wasn't paying attention when he heard it? Or is it because of hits like those that he sustained during a nine-year NFL career?
Westbrook, a two-time Pro Bowler with the Philadelphia Eagles, says now that if he could do it over again, he would still play football, just a bit more cautiously than he did. As a guest speaker at the National Athletic Trainers' Association conference at the Baltimore Convention Center on Thursday, he used his own experience as a cautionary tale.
"Protect your athletes from themselves," he urged the trainers in attendance.
Westbrook was a guest speaker on a panel with seven athletic training experts from various fields, including education, the workplace and the military.
Westbrook spoke highly of his experience with athletic trainers such as Rick Burkholder, his athletic trainer for all eight years he played for the Eagles. Burkholder urged Westbrook to take time to recover from his 2009 concussion. Westbrook ended up missing three weeks.
"Manage the expectations," said Westbrook, a Fort Washington native and DeMatha alumnus. "So many coaches, if you have an ankle injury, it's two days, [then] back out on the field. The truth is, sometimes it's not a two-day injury. Sometimes it's a two-week injury. So you have to manage those expectations."
Sometimes, Westbrook acknowledged, athletic trainers can push players to return to the field, but often they have to hold players back. That's a tall order for some athletes who, like Westbrook, want to be on the field relentlessly.
Westbrook played the same way — if you're able to run and catch, you're healthy enough to play. Though he says he's doing well for the most part, as a retired player who already feels some of the consequences of a grueling career, he wants to teach those athletes the dangers of that mindset.
"All you can do is tell them the stories," he said after the panel. "All you can do is try to educate them. All you can do is give them all the information that you possibly can, and allow them to make the decision and help them make the decision. That's all you can do."
Westbrook is one of a number of former NFL players who have spoken out about their past as the league's problem with traumatic brain injuries takes up more of the conversation. But Thursday's discussion wasn't limited to concussions.
According to Dr. Douglas Casa, chief executive officer of the Korey Stringer Institute at the University of Connecticut, the four leading causes of death in sport are, in descending order of frequency: cardiac issues, head injuries, heatstroke and exertional sickling (decreased blood flow upon exertion for athletes with the sickle-cell trait). He said together, those four ailments make up more than 90 percent of deaths.
The Korey Stringer Institute, created and named in honor of the former Pro Bowl offensive lineman who died of heatstroke on the practice field in 2001, works with sporting entities to preserve player safety. The institute promotes measures such as slowly phasing in activity in hot weather and testing athletes for the sickle-cell trait before practice. Both reduce the incidence of sudden death on the field, and both are free to implement.
Casa also cited a study that athletes have a 90 percent survival rate from cardiac issues with an automated external defibrillator accessible within two minutes.
Meanwhile, Dr. Tamara McLeod of A.T. Still University labeled concussions as a public health concern. The Center for Disease Control estimates the annual incidence of concussions is between 1.6 and 3.8 million, with many going unreported. According to McLeod, sport-related brain injuries generate annual hospital costs of more than $6 million.
Those numbers can go down if athletes report concussions and take the proper steps to recover, a decision they must continue to make to be safe.
"At the end of the day, especially for professionals, they're going to have to make that decision for themselves," Westbrook said. "For the kids, it's a little bit easier, because you can say, 'OK, you're not playing. Two weeks.' But when you're talking about in the big leagues, it's a different world."