Why more NFL players are self-reporting concussion symptoms

The San Francisco 49ers had just completed a 22-yard pass, but the play came at a considerable cost for Frank Gore.

The running back sustained a concussion while executing a block against Seattle Seahawks linebacker Bobby Wagner.

Gore laid on his back after the play, initially unable to get up. Several teammates raced to his side before Gore left the field without assistance.

It would not take long for the gravity of the situation to register for the veteran, who at the time in 2014 was in his 10th season. With two games left in the season, his first concern was not his health, but rather the impact his absence might have on his upcoming free agency.

"I knew I had to show people that I could still play," Gore told ESPN. "I was 31 years old. And I just knew when you get older how teams judge you."

So in the days following his diagnosis, Gore made a decision he's not proud of: He lied about his lingering symptoms. He even managed to pass an evaluation later in the week that enabled him to play in the following game and the season finale a week later.

"You know, I've actually never told anyone about this," Gore said. "What happened is that whole year, I was splitting snaps with [Carlos Hyde]. But he was hurt. So, I said, 'Man, this might be my last chance to really play.'

"I knew they were going to draft somebody, and it was my last year with San Francisco. So, I just said, 'I gotta find a way to play.'"

As he recounted the story, Gore drew a distinction between attitudes toward concussions at the time versus the views of today.

"We didn't even talk about them," said Gore, now an adviser in the 49ers' scouting department. "It wasn't something we thought about."

Today, NFL executives are welcoming a trend: More players are alerting medical staffs to their concussion symptoms. During the 2023 season, 43% of concussions "had an element of self-reporting," according to the league. As recently as 2016, that number was 19%.

Yet, while self-reporting increased, the number of diagnosed concussions decreased from 244 in 2016 to 219 last season. The league credits improvements in equipment and rules changes for the reduction. Another change was implemented this week at the annual league meetings in Orlando, Florida, as owners voted to revamp the kickoff format in order to -- among other things -- reduce concussions caused by high-speed collisions.

The uptick in self-diagnoses, experts and players say, is the result of players becoming more knowledgeable about concussions. Not only are they more informed, they say, they're also more willing to act on that information. There are exceptions, however.

"We will never be able to spot every single injury," NFL chief medical officer Dr. Allen Sills said. "There are absolutely going to be injuries that can only be captured by a player speaking up.

"That's why self-reporting is so important."

If anyone understands the potential impact of a concussion diagnosis, it's Indianapolis Colts center Ryan Kelly, who has suffered three diagnosed concussions.

In 2017, his second season in the NFL, Kelly suffered a concussion in Week 12 that produced symptoms that lingered so long he missed the final five games and ended up on injured reserve. Kelly suffered two more concussions last season, including one in Week 2, when he alerted team trainers, who promptly removed him from the game.

"I can get a knee replacement," Kelly said. "I can't get a brain replacement."

But Kelly acknowledged the conflicts players face in confronting concussions. The kinds of things that flashed through Gore's mind years ago are still in play today.

"It's tough," said Kelly, a member of the NFL Players Association executive committee. "I can't show it to you on an MRI, can't show it on an X-ray machine, but you lay there at night knowing that you're looking out for your future and your family. I've got kids. I've got a family I want to look after.

"But [teams] preach availability all the time."

Still, Kelly played it safe. And he wasn't the only Colts player who suffered a concussion in that Week 2 game against the Houston Texans. Rookie quarterback Anthony Richardson, who is 21, grew up in an era of concussion awareness and wasn't taking any chances.

"I noticed I wasn't feeling the way I should," Richardson said. "I asked them to take me to the [injury] tent to check and see. I didn't want to hurt the team."

Richardson missed the remainder of the game, and the following week as well.

Today's concussion protocol -- which was developed in partnership with the players union -- requires signoff from an independent expert before a player returns to action. Unaffiliated neurotrauma consultants (UNCs) are stationed on each sideline, and spotters are in a skybox at every game to monitor players who might be displaying the effects of a concussion. UNCs are empowered to remove those players from games.

During a late-season game in 2022, ex-Pittsburgh Steelers quarterback Kenny Pickett, who has since been traded to the Philadelphia Eagles, returned to action after being cleared by the medical staff following a concussion evaluation. But he soon developed symptoms, including changes in his vision. Pickett self-reported, was removed from the game and missed the following week.

New York Jets cornerback D.J. Reed made a very different calculation during an Oct. 1, 2023, game when he hid his concussion symptoms. Reed admitted the opportunity to play in the nationally televised "Sunday Night Football" game against the Kansas City Chiefs influenced his decision. After the game, Reed's symptoms worsened, and he missed the next two games.

"It didn't feel right, but just the selfish part of me just wanted to play," Reed said. "Going back and looking at it, any time you get a concussion, you've got to pull yourself out.

"Talking to the doctors, that could have been bad. Something terrible could have possibly happened, so definitely a lesson learned."

The lessons the NFL have learned about concussions have prompted new rules, but that's just part of the equation. Self-reporting also plays an important role.

"People saw a lot of those [former players] struggling later in life," Kelly said. "I do think that players now think, 'If this is what it takes, and then at 60, that's what I look like, then no.' I want to be able to remember my kids' names. I want to be able to play with my grandkids.

"And that's more important than playing with a concussion."

Brooke Pryor and Rich Cimini contributed to this report.