In October, a helmet-to-helmet hit spun University of Southern California wide receiver Robert Woods around 180 degrees while he was blocking on a kick return against the University of Utah.
Woods pushed himself up, lurched toward the wrong sideline, then teetered and wobbled nine strides before plunging face-first into the midfield turf.
He pushed teammates away with weak shoves. Two trainers grasped his arms and led him off the field.
Woods missed one play before returning to the game.
The video loop is seared into Ramogi Huma's mind and, truth be told, left the former UCLA linebacker who is president of the National College Players Association — an advocacy group for college athletes — feeling as if someone slugged him in the stomach.
"It almost felt like when you read stories about dogfighting," Mr. Huma said. "It didn't feel right. It cast a huge shadow over college for me. Over football, period."
The incident redoubled Mr. Huma's belief in the need for urgent change to how the NCAA deals with head injuries. In August, his organization distributed a five-point proposal to the NCAA and the six major conferences. The 108 words included freezing the number of regular-season football games and limiting contact in practice.
The Pac-12 agreed to a meeting. The Big Ten wrote a letter. The others? Nothing.
Head injuries have left the NFL under unflinching scrutiny over the past year. Ray Easterling and Junior Seau, among others, shot themselves and were later among the dozens of former players in which chronic traumatic encephalopathy (CTE) was diagnosed. More than 4,000 former players are suing the league over the long-term consequences of concussions. A study from the National Institutes of Health determined that former NFL players run three times the risk of developing neurodegenerative diseases as the regular population. Every hit, every player who stumbled to the sideline, every press box announcement about a player being "shaken up" took on new meaning.
At the NCAA level, however, the issue has escaped similar furor. But a little-known concussion lawsuit against the NCAA in U.S. District Court for the Eastern District of Illinois is ahead of the NFL litigation, crawling through discovery that has turned over at least 130,000 pages of NCAA records to the plaintiffs. Depositions are scheduled for next month. The lawsuit could dwarf the NFL action — seeking to include every athlete who played a sport for the 1,281 NCAA-affiliated institutions. The case is part of a deluge of litigation against the NCAA, challenging a variety of actions including use of athletes' likenesses and the penalties imposed on Penn State University as a result of the Jerry Sandusky sexual abuse scandal.
The NCAA strenuously denied the lawsuit's allegations, including that the organization doesn't properly protect athletes from concussions.
"I think the gap is widening between what the NFL is doing and what the NCAA is doing," said Chris Nowinski, a former Harvard football player who is executive director of the Sports Legacy Institute that studies brain trauma in athletes. "There is money being made and the players have no voice in protecting themselves."
President Obama, in an interview last week with the New Republic, expressed worry about the NCAA's approach to concussions, particularly because college athletes don't have a union and aren't paid like their NFL counterparts.
In an appearance at Old Dominion University three weeks after Woods absorbed the dizzying hit, NCAA President Mark Emmert asserted that his organization is taking the lead on concussion issues. The NCAA, after all, grew out of a 1905 White House meeting called by President Theodore Roosevelt with athletics leaders from Harvard, Princeton and Yale after 18 players died during the football season.
"The NCAA was at the front of this," Mr. Emmert said in the videotaped session. "We set up protocols now when there's a suspicion that someone had a concussion, that coaches and trainers now have specific protocols to go through to pull a kid out of a game and you don't play until we verify what their status is. Very few people know we're doing that."
The concussion test Woods passed to return to the game? Multiple reports outlined three questions:
What is today's date?
Who is the president?
What's 100 minus 7, minus 7, minus 7?
Lost in minutiae
Concussions are mentioned three times in the NCAA's labyrinthine 430-page Division I manual for 2012-13. Recruit? Four-hundred ninety-five mentions. Meals? Seventy-nine mentions. Movies? Eight mentions. Bagels? Two mentions.
The bagels are part of the infamous rule that permits universities to provide bagels, fruits and nuts to athletes. A spread, such as cream cheese or peanut butter, would be a violation. (The NCAA eliminated the rule, effective in August, as part of last month's significant downsizing of the manual.)
But the same level of minutiae that ensnared athletes for offenses such as selling championship rings and receiving free tattoos doesn't apply to concussions. The manual's lone reference to head injuries is the 15 lines of Rule 220.127.116.11, adopted in 2010, that instructs each university to keep a concussion management plan on file. The NCAA's most recent sports medicine handbook devotes six pages to brain injuries, including a 70-word warning about CTE.
The plan is the crux of the NCAA's approach. Requirements include education and athletes' agreements to report any signs of concussion to medical staffers. One doctor's clearance is required to return to play after a concussion diagnosis. The NFL requires two doctors' clearances, among other prerequisites.
"It allows coaches, officials, medical providers to all be on the same page," said David Klossner, the NCAA's director of health and safety. "It provides a minimum standard."
Virginia Tech's plan, for instance, covers four pages. The University of Oregon's is a page and a half, shorter than the NFL's sideline concussion assessment checklist.
The process to ensure follow-through on the policies is hazy.
"That enforcement is just like any other bylaws," Mr. Klossner said.
Has any institution been investigated or penalized for violating the rule?
"I'm not aware of that," Mr. Klossner said. "It's really about having a plan in place."
What happens if an institution's plan isn't followed?
"It's like any other rule," NCAA spokesman Christopher Radford said. "You know how thick the manual is. We don't send our enforcement division out randomly cross-checking rules. But if there is a situation where it comes up where it is relevant that could potentially go into the enforcement process like any other rule. Potentially."
To Mr. Klossner, progress looks like moving kickoffs up 5 yards to the 35-yard line before last season. He points to previous rule changes to eliminate spearing and protect defenseless players. A voluntary reporting system to track injuries shows concussions have leveled off since 2005. There's also last year's $400,000 donation to the National Sport Concussion Outcomes Study Consortium, which will study 1,000 college athletes. And Mr. Emmert hired Dr. Brian Hainline, a neurologist who worked for the United States Tennis Association, as the NCAA's first chief medical officer.
Dr. Hainline, who didn't return a request for comment, started last month. He will head the NCAA's newly created Sports Science Institute.
"There are no shortcuts or definitive answers yet. For us, that's the real challenge," Mr. Radford said. "We're trying our best to keep up."
The lawsuit, filed in 2011, disagrees. A former football player at Eastern Illinois University named Adrian Arrington "who suffered numerous and repeated concussions" is the lead plaintiff. He is joined by former University of Central Arkansas football player Derek Owens and Angela Palacios, who played soccer at Ouachita Baptist University.
The 19-page lawsuit details five concussions Mr. Arrington suffered at the university that led to memory loss, seizures, depression and migraines. He quit the football team and dropped classes. In addition to damages, the lawsuit seeks establishment of a trust fund to pay for medical monitoring of all past, present and future NCAA football players and stricter organizationwide return-to-play guidelines.
The Chicago-based lead attorney, Joe Siprut, wonders why the case hasn't garnered the same attention as the NFL litigation that has been consolidated in federal court in Pennsylvania.
"It took [Mr. Arrington] years and years just to try and be able to finish school. He needs help," Mr. Siprut said. "He's the poster boy for this whole problem. He gave everything on the field. But they chewed him up and spit him out."
One legal analyst familiar with the case sees a greater possibility for it to move forward compared with the NFL litigation.
"I believe in time all of this is going to change," said Marc Edelman, a sports law specialist and professor at Barry University School of Law. "The case against the NCAA, given the organization's unique position created to protect student athletes from head injuries, is going to make the case against the NCAA far stronger than the case against the NFL."
Paul Anderson, a lawyer who tracks concussion issues at NFLConcussionLitigation.com, termed the NCAA a "concussion plantation" where players risk lifelong health problems in exchange for education and the slim chance of an NFL career. But he said he doesn't think going to court is the most effective way to address the issue at the collegiate level.
"It seems like the biggest claim they have is that the NCAA, at best, drug its feet," Mr. Anderson said. "The NCAA can say, 'We weren't the only ones.'"
Football is a violent game. Mr. Huma understands that. He sustained one diagnosed concussion at UCLA, but hits dizzied him plenty more times.
College athletes are going to try to play through concussions, he said: They're not going to stop until their body — or a doctor — forbids it. They want to win. They want a shot at the NFL.
"We're not asking for miracles," Mr. Huma said. "Why not minimize those risks and put in a little something to support those players who take the risk and make a big sacrifice?
"They have uniform national laws over whether a player can sign an autograph or receive payment or get a free burger in the drive-thru at McDonald's. But when it comes to something like brain trauma, they're hands-off."
Mr. Huma points to the Ivy League's initiative — which cut full-contact football practices to two per week and limited spring practices starting in 2011 to reduce concussions and subconcussive blows — along with the relative dearth of studies examining the long-term impacts of head injuries on college athletes.
The NCAA is tracking the Ivy League's plan, but it's too early to draw conclusions, Mr. Klossner said.
In December, Mr. Huma's proposal added a call to place independent concussion specialists on the sidelines to determine whether a player can return to a game and remove the decision from team doctors. There isn't an NCAA-wide requirement for how to evaluate and diagnose concussions, other than mandating that such a process be in place. Next season, the NFL expects to have independent neurologists on the sidelines.
No one responded to the change.
Frustration lingers in Mr. Huma's voice. Same with Mr. Nowinski.
The Woods pileup is a touchstone for an issue in which the core idea of amateurism and still-advancing science collide with aggressive litigation and reform agendas.
"Even an idiot could tell those players were concussed," Mr. Nowinski said, referring to Woods and Arizona quarterback Matt Scott, who vomited on the sideline after he was kicked in the head during an October game.
"The fact there was no punishment for the program or even a statement alerting people that, 'Hey, we should do better next time,' is just incredibly disappointing."
So, Woods answered the three questions correctly after barely being able to take a solid step and returned. The game, as always, went on.
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