The pocket collapses, the ball comes loose and Arizona Cardinals linebacker Eric Hill recovers.

On an attempted scoop and score, Hill is drilled in the side of the head by an offensive lineman.

Lights out.

The former LSU linebacker missed the rest of the game, but he didn’t undergo concussion protocol. He played the following week.

That was just football in the ‘90s.

Recently, another gruesome concussion to NFL quarterback Tua Tagovailoa and Brett Favre’s Parkinson’s diagnosis have created a renewed relevance for concussions and CTE in football. While the zeitgeist has evolved with time, so too has the science and technology. Now, public knowledge is beginning to fall behind.

CTE, or chronic traumatic encephalopathy, often shows signs later in life once players are retired. Currently, it can only be diagnosed postmortem.

“It’s my era of people that are moving forward, and we’re starting to see those symptoms show themselves,” Hill told the Reveille. “I do have guys that I played with or played against that I know are showing signs of struggle neurologically.”

Ronald McKinnon, a former NFL teammate of Hill’s and current Division II linebackers coach, now experiences symptoms like headaches and trouble with balance.

“Sometimes you wake up and your train of thought is everywhere,” McKinnon said. “Sometimes you don’t know where you’re at. It’s really tough.”

The degenerative process of CTE can have a wide range of symptomatic outcomes. These include Parkinsonism, cognitive deficits, memory loss and all kinds of behavioral and emotional symptoms, said Dan Molloy, special projects manager for Concussion Legacy Foundation.

“For me, to think that what I’ve put myself through, that I came out unscathed – no, I don’t believe that,” Hill said. “I think there is some real damage there. I just think it has not progressed as rapid as some other guys.”

Molloy believes there’s still a reluctance to recognize the long-term harm that can take place from a life in football.

Following the hit that left him unconscious for 30 seconds, Hill returned to practice that same week.

“I’m convincing myself that I’m okay, and I just wasn’t okay,” he said.

Hill believes he had more concussions at practice than in game.

“There were times you take a shot to the head, and it was very customary for us to keep little ammonia packs in our sock,” he said. “We’d pull it out, pop it and wake ourselves up, so to speak.”

Fortunately, football programs including LSU have taken dramatic strides in the right direction since then.

Efforts to limit contact in practice as well as eliminating two-a-days are both steps that LSU has taken. Technology like sensory mouthguards to detect big hits, guardian caps and position-specific helmets have also been implemented.

“In the last 10 years there have been more change in helmets than there were the previous 50,” said Gregory Stewart, Tulane Center for Sport co-founder and co-director. “The league was able to shame the helmet manufacturers into making progress.”

Even newer are custom helmets made based on scans of a player’s head.

Now, in nearly every locker room, you can find a poster outlining and explaining the range of helmets available, from cutting edge to newly prohibited.

LSU is currently participating in multiple studies, including one using sensor-embedded mouthguards in collaboration with Football Research Inc.

The study’s Manual of Procedures says that “describing the number, magnitude, direction and time history of impacts experienced by collegiate football players and comparing across relevant player, event and season parameters can help the research team understand injury mechanics, protective factors and risk factors associated with sport participation and sport-related concussion.”

In coaching, there’s an effort to take the head out of tackling. Players are coached to attack same shoulder, same foot and wrap up.

“The way I coach football, I teach my guys to use their hands,” said Karl Dunbar, Pittsburgh Steelers defensive line coach and former LSU defensive lineman. “I tell our guys all the time, your arms are longer than your neck.”

At the NCAA level, autonomy with medical staff is often considered better than at the professional level.

“The rules are very clear that the medical folks have the right,” Stewart said of medical intervention. “Athletic trainers can’t get fired over something like that.”

Today, all 50 states have legislation on the proper protocol for how concussions should be managed.

“Our physicians and athletic trainers have the utmost authority when it comes to medical decisions,” LSU Director of Sports Medicine Micki Collins said. “Our coaches don’t question what we do and when we do it.”

LSU uses C3 Logix, a concussion assessment system, to aid medical staff’s decisions when transitioning recently concussed players back into play and back into the classroom.

It’s also the responsibility of the institution to keep their athletes informed so they can make good choices, because playing through injury is ultimately a two-way decision.

“Every student-athlete here at LSU, every year, gets concussion education,” Collins said.

At yearly physical appointments, student athletes meet and discuss one-on-one with their doctor.

LSU also holds hour-long presentations by physicians covering catastrophic injuries like concussions. This education is sport specific and includes newer insights like subclinical traumatic brain injury research.

Collins said she has seen a great increase in student-athletes looking out for each other. That’s significant because of the fundamental role of player honesty in diagnosing with accuracy.

“Sometimes you have to protect these guys from themselves,” Dunbar said. “Because it’s a gladiator sport, they want to be on the field because that’s how you make your living. You don’t want to make your living and not be able to have a living after football is over with.”

At the professional level, financial incentive plays a significant role, as players may hide injuries to avoid a reputation of being injury-prone. Hill said he knew players who’d privately get medical help outside the team facility in order to get themselves back on the field.

“It follows you, and as that file gets bigger and bigger, they start to look at you as a risk,” Hill said of the injury-prone label. “There’s a lot on the line economically, maybe not at that moment but the following year.”

Tagovailoa earned a four-year extension prior to this NFL season. If his most recent concussion had come before this contract, things could look different.

As important as these efforts to address CTE are, it’s important to note they can only do so much. The very nature of concussions means total prevention is impossible when protection is outside the skull.

“Football is a violent sport,” Stewart said. “You’re never going to completely take concussions away.”

Even the prevention of head-to-head hits with penalties like targeting is not an all-encompassing solution.

“They’re big guys coming full force, hitting and stopping,” Stewart said. “Even if they’re not hitting their head. That’s one of the other ways we see concussions, kind of a whiplash type of thing.”

Another roadblock to the process of assessment is the possibility of delayed symptoms.

“You’re not going to catch every concussion on the field because symptoms can develop later on,” Molloy said.

Putting players back into the game if they have no immediate symptoms has risks. Second impact syndrome occurs when a player gets a second concussion before the first one has healed.

“It is a massive brain swell that can be fatal in up to 50% of cases,” Molloy said. “Almost everyone who survives has some kind of lifelong morbidity or disability.”

Fortunately, this condition is rare and attentive medical personnel can limit its possibility.

More recent conclusions have indicated that long-term damage is not only more common than originally thought, it can be asymptomatic. These hits are called subclinical traumatic brain injuries.

“It may not cause symptoms, but it might be causing tiny, microscopic tears in your neurons that put you at risk for degenerative disease later on,” Molloy said.

Molloy likens the association of football and neurodegenerative disease to the gradual harm of cigarettes and lung cancer.

“What we’ve seen, it’s not so much the big hits, it’s the repetitive,” Collins said.

Still, there are parts of the research that seem to confound logic.

“There are individuals that have very high G-force hits and have no symptoms,” Stewart said. “Other individuals have low G-force hits and a lot of symptoms.”

This highlights one of the most important caveats: all this research is new.

“We’re not in the infancy stage anymore,” Stewart said. “But we’re still in the toddler stage of understanding what’s going on with concussions.”

There are confounding variables to all this research, like difficulty transitioning away from football or preexisting head trauma or mental health issues.

A lack of effective biomarkers and poor methods of imaging also continue to limit progress.

“Every time you make a change, it’s 10 or 15 years before we know if the change worked or not,” Stewart said.

Stewart believes there will one day be a biomarker that can better indicate a player’s predisposition to long-term neurodegenerative disease. Other ongoing efforts include working to diagnose CTE prior to death, which could shorten the timeline dramatically.

Until then, prevention and education take priority.

“Degenerative brain disease from contact sports has the potential to ruin your life,” Molloy said. “It’s not your destiny, but mitigate your risks wherever you can.”