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From USA Today:

Super Bowls have turned on a John Riggins run, a Joe Montana pass and a Santonio Holmes catch. In this era of heightened NFL efforts to protect the brain on game day and for life, what if a Super Bowl hinged on a penalty for roughing the passer or hitting a "defenseless" receiver?

For Super Bowl XLVI, New England Patriots linebackerBrandon Spikes said it was his job to play "within the rules" against the New York Giants— whether he like those rules or not.

"I just do business as business," Spikes said. "I don't like it as a defensive player. … It's a violent sport. … It's like gladiators out here. … Now, it's changing. But like I say, I do business as business."

Atlanta Falcons CEO Rich McKay, chairman of the NFL Competition Committee, says rules are rules. "To the extent that a penalty decides a game, that's not the way anybody wants a game decided, but it does happen in our league," McKay says.

NFL Commissioner Roger Goodell says safety is safety. "We're going to continue to push to make this game safe," he says. "It's good for the players. It's good for the game."

Safety in the NFL remains a work in progess:

•Since 2007, the league and the players union have pushed stepped up efforts to diagnose and treat concussions. The 2011 season began with the NFL's first league-wide policy for sideline assessments, and it was adjusted after a glitch in Cleveland. Has it gone far enough?

•In 2010, the NFL increased discipline for illegal hits to the head and neck. It's levied hefty fines against players. This season, linebacker Pittsburgh Steelers James Harrison was suspended for a game — the first such suspension since the 2010 crackdown. The kickoff was changed this season in a safety move, and protection for "defenseless" receivers was enhanced. Has the league gone too far in regulating hard knocks?

•Goodell says that since 1994, when the NFL set up its first concussion committee, it has been "leading the way" in research. It currently is testing whether helmet sensors can be used to measure hits. It plans a long-term project to monitor the brain health of current and retired players. But the NFL also is a defendant in more than 20 lawsuits filed in federal courts in six states by about 300 former players. They allege that in decades past the league knowingly failed to protect players from concussions, which the suits claim led to long-term brain damage and deaths.

The new sideline assessment policy includes an evaluation process that takes about seven to 10 minutes when a player shows signs of a possible concussion. What if it's the final quarter of the Super Bowl and the quarterback doesn't pass the evaluation? Would he be pulled from the game as the league requires?

"I think that if a guy gets concussed, and he fails the sideline test, he's not going to be put back in," said Richard Ellenbogen, co-chair of the NFL Head, Neck and Spine Committee and a University of Washington neurosurgeon. "In the last two years, the commissioner has gotten out his mantra of safety first. No one trumps the doctor.'

Coping and researching

The NFL's current policy: If a player is diagnosed with a concussion during a game, he is out for at least that game. The NFL says he can't practice or play until he passes neurological tests and gets the OK from team doctors and an independent neurological consultant.

The NFL Mild Traumatic Brain Injury Committee published a study in 2004 that said that a player diagnosed with a concussion could return to that game without a "significant risk of a second injury" as long as he became symptom-free. In 2004, the committee found in a study that "there was no evidence of worsening injury or chronic cumulate effects of multiple (concussions) in NFL players."

Dave Duerson played safety in the NFL from 1983 to 1993 with the Chicago Bears, Giants and Phoenix Cardinals. He committed suicide in February 2011 at 50.

At Duerson's request, his brain was studied after his death at Boston University's Center for the Study of Traumatic Encephalopathy. Chronic Traumatic Encephalopathy (CTE) is a brain disease once thought to only affect boxers. The center has studied the brains of 19 deceased NFL players, and 18 have been diagnosed with CTE, according to Chris Nowinski, a member of the center's board of directors.

Did blows to the head sustained in football cause the CTE found in Duerson and others? "We're a couple of steps away from the true cause and effect," Nowinski says. "We're confident that trauma is a key to starting it, but not everyone who has trauma is going to get it."

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