In the old newsreel, the year is 1949. The Cleveland Browns are playing the newly minted San Francisco 49ers. The players wear leather helmets and no face masks. A 49er running back, John “Strike” Strzykalski, takes the ball off tackle and darts through the line. Several Browns converge to knock him down, but Strike struggles up from the turf, plunges another 10 or 12 yards, takes another hit, and staggers, fighting for inches until he goes down inside the 49er five yard line. It is one of those moments people celebrate in sports—a moment when a player sacrificed his body for the sake of the team.

No one can say for sure that football injuries have caused Strzykalski’s cognitive problems. His symptoms may be a natural consequence of aging. But his wife, Betty, recalls that even when John was younger, he was forgetful.

Many, many times, he would say, ‘If you’d gotten hit in the head as much as I did playing football, you’d forget things, too,’” she says. “When he played, they didn’t have the equipment and the medical attention the players get today. He would get dizzy a lot and confused, but they never thought about taking him out of the game. The trainer would say, ‘Take an aspirin, you’ll be okay.’”

Kevin Guskiewicz knows better. Guskiewicz, director of Carolina’s Sports Medicine Research Laboratory, is also research director of the new Center for the Study of Retired Athletes. He studies head injuries, investigating the possibility that repeated concussions are associated with the early onset of diseases such as Parkinson’s and Alzheimer’s, and other neurological disorders.

If you take a blow to the head, you’re going to have a group of axons, probably thousands of them, that are injured,” he says. “For example, the front part of the brain is associated with learning and memory and higher-order thought processes, so a blow to the front of the head might lead to temporary memory loss or confusion. Usually, that disruption is very short. But if we send that person right back into the game, those axons may not have time to recover and heal before the next blow. We can’t see this kind of injury the way we can see the black-and-blue swelling from an ankle sprain, for instance. We rely on very subjective information such as the athlete saying, ‘I just don’t feel right. I feel dizzy. I have this ringing in the ears, I have blurred vision.’ But these guys want to get back into the game. So, many times, the decision comes down to guesswork.”

One goal of the new center, Guskiewicz says, is to eliminate the guesswork. He envisions research that would, over time, lead to better equipment, better rules, and better guidelines for return-to-play decisions. So today, he is speaking to a group of former pro players and their wives who have gathered at Carolina to try to make life better for the players who follow them. After they’ve heard from Guskiewicz and Carolina’s new head football coach, John Bunting, the players will evaluate a survey that Guskiewicz plans to send to 3,600 retired professional players nationwide. The survey will gather information the center needs to identify the most pressing health problems of retired players and to help set priorities for research.

As they watch the video of Strzykalski, many of these former players wonder if they will someday face the same kind of memory problems or worse. Most are still young, in their 30s or 40s. But some limp, and they grimace in pain as they stand. For them, the game is over, but they are still making the sacrifice. And they’ve only begun.

Reuben Davis, 36, is among them. A former standout at Carolina, Davis retired from football after an 11-year career as a defensive tackle with Tampa Bay, Phoenix, and San Diego. His weight has edged about 15 pounds higher than his playing weight of 320—not bad for a man of his size. He limps because he tore both Achilles tendons playing in the National Football League (NFL). He also has pain from several knee operations, a dislocated elbow, and a vertebra he fractured in college.

Davis, once known for his quickness and agility, says he has “a clumsy nature” now. “I have to kind of drag my foot along. And every morning, when I wake up, I deal with the pain.”

He doesn’t worry so much about the consequences of head injuries—he had “only one or two” concussions during his playing days, he says. But he and his wife, Latanya, do worry about his ability to remain active enough to keep his weight down, and they worry about the cost of health insurance because insurance companies regard former players as high risk, they say.

Davis’s list of health problems is typical of retired players, Guskiewicz says, and that’s why the center will include more than the neurological studies that have become his specialty. Guskiewicz and the center’s medical director, Julian Bailes of West Virginia University, will coordinate a research program with several branches. One branch will involve orthopaedics and arthritis. Another will focus on nutrition and cardiology, since a large number of retired players become obese soon after retirement, putting them at risk for heart disease. Guskiewicz also envisions research into the long-term consequences of using performance-enhancing steroids, which are banned by the NFL but nevertheless are abused by some players, potentially leading to tissue damage in the heart, muscles, and joints.

Carolina, which landed funding from the NFL Players Association, is an ideal place to conduct this sort of wide-ranging, collaborative research, Guskiewicz says. “Carolina is often recognized for sports,” he says, “but we’re just as good if not better in research and academics. This new center really combines all of these strengths. We have outstanding orthopaedic surgeons and a very strong arthritis group, as well as exercise physiologists, nutrition faculty, and cardiologists.”

Frank Woschitz, director of the Retired Players Association of the NFL Players Association, says that retired football players need special help dealing with the effects of their injuries. “One hundred percent of the players who played football got hurt,” Woschitz says. “After they retire, some of these players make it day to day, but others get despondent because of their health problems, and some give up. We want to help these players get back into the mainstream. So we’re very enthusiastic about this program at UNC. And we’ll do everything we can to help make it successful.”

For Betty Strzykalski, the center offers the possibility that today’s players might avoid some of the hazards her husband faced. She came with John to the center last fall for a series of tests that confirmed his memory problems but gave them optimistic news about his balance and motor skills. It reassures her to know that other players and their families will someday be better informed and better protected.

We see the players today getting hurt, especially with concussions, and we say, ‘Oh my, what’s going to happen to them, later on?’” she says.

Two years ago, she and John flew to San Francisco for the 50th anniversary of the 49ers and a reunion of the original team. “There were at least a dozen players from that original team,” she says, “and they were all so banged-up looking. John was in about the best shape of any of them. They all loved playing the game, but every one of them is paying a price.” But like John, she says, they told her “it was worth it.”

She has an award-winning newspaper photograph of John being upended, his head plunging toward the ground.

He shows this picture to everyone who comes to the house,” she says. “And he says, ‘This is how I was dropped on my head, and this is why I’m in the shape I’m in.’”

He laughs about it, but Betty is glad she wasn’t near the field when that photo was taken. From one point of view, it is a portrait of valor—another one of those moments when a player sacrificed his body for his team and a love of the game. But, as Betty says, “It scares his wife to death.”

Neil Caudle was the editor of Endeavors for fifteen years.

Initial funding for the Center for the Study of Retired Athletes was provided by the NFL Players Association, the UNC-CH Office of the Vice Provost for Graduate Studies and Research, the UNC-CH College of Arts and Sciences, the UNC-CH Department of Exercise and Sport Science, the UNC-CH Department of Orthopaedics, and the West Virginia University School of Medicine.