When Tunch Ilkin entered the National Football League in the 1980s, players were expected to compete while hurting.
"It was considered a badge of honor," Mr. Ilkin, a former Steelers offensive lineman who does radio commentary for their games, said. "We celebrated that."
Mr. Ilkin, 52, started his career in the wake of Steelers greats like Jack Lambert, Joe Green and Mike Webster -- players noted in football lore for being invincible ironmen.
"They were tough guys," Mr. Ilkin said. "They played hurt, they played sick, they played through all types of injuries. That was the standard. When I came into the league and looked at them, I said, 'That's the way to do it.' "
But players like Mr. Ilkin and former Steelers safety Mike Wagner hope that is changing, and quarterback Ben Roethlisberger's decision to sit out the Steelers' game Sunday against Baltimore might be proof.
But when players are cautious in dealing with injuries such as a concussion -- which has short-term effects but long-term consequences -- some fans, as well as teammates, have questioned their toughness. Where in the past players took it upon themselves to play through the pain, today's athletes are much more informed, and much more careful, about injuries.
Still, many fans expect football players to be invincible.
Before the game against the Ravens, receiver Hines Ward said his teammates were "50-50" on whether Mr. Roethlisberger, who sustained a concussion Nov. 22 against Kansas City, should play. Mr. Ward added: "I could see some players or teammates questioning, like 'It's just a concussion. I've played with a concussion before.' "
But Merril Hoge, an ESPN analyst whose career as a Steelers running back was derailed by multiple concussions, said Mr. Roethlisberger, Arizona quarterback Kurt Warner -- who also sat out Sunday after sustaining a concussion the week before -- and the coaches should be praised.
"It was historic," Mr. Hoge, 40, said.
The high-profile injuries occurred as NFL Commissioner Roger Goodell re-evaluates the league's concussion policy.
Mr. Goodell and Mr. Hoge testified before Congress in October on the NFL's handling of player concussions. Several former players have had severe cases of depression and dementia that some researchers have tied to repeated head trauma.
But Mr. Ward's comments reminded several former players about the pressure most NFL players have to live up to their tough-guy images.
The problem, Mr. Hoge said, is when players take it too far.
"Football is a tough game for tough people. It's macho," he said. "All those things are true. But it's not stupid."
Mr. Ilkin remembers a game where he had a concussion, sat out a few plays and re-entered the game. Eventually, a Steelers doctor had to tell coach Chuck Noll not to let Mr. Ilkin play.
"There's not a whole lot of wisdom in that," Mr. Ilkin said, "but that was just the culture."
Mr. Wagner, 60, recalled a similar incident. After heading to the sidelines with an injury, he went back into the defensive huddle. Team trainers then took him to the locker room, removed his jersey and took his helmet away to keep him from going back on the field.
X-rays taken the next day revealed that Mr. Wagner had three fractured vertebrae.
Warren Sapp, an NFL Network analyst and former NFL player in Tampa Bay and Oakland, said he wishes his peers had the information and medical treatment players receive today.
"If it ain't broke, wrap it up and go -- that used to be the mentality," he said.
But, Mr. Sapp, 36, said he always took control of decisions that affected his health.
"When I deemed I wasn't healthy enough to play, I didn't play," he said. "I didn't give a damn what the doctors said."
For Mr. Ilkin, Mr. Wagner and Mr. Hoge, the pressure to play was enormous. But all say, for the most part, it was self-induced.
"Nobody made us do this," Mr. Ilkin said. "Nobody said, 'Oh you're OK. Just go play.' It was our choice."
During his rookie season with the Cincinnati Bengals, linebacker Reggie Williams, a Dartmouth alumnus, wanted to prove to his players that he could be an Ivy League graduate and a tough guy. After dislocating his thumb on a play, Mr. Williams popped it back into place inside the huddle, not missing a down.
"Then," he said, "I proved I was one of the guys."
He played for more than a decade in the NFL in a career that took him to two Super Bowls.
But many of those years were marred by injuries, and Mr. Williams, 55, is now fighting to save his right leg from amputation. He has had about 20 knee operations, and, depending on how intense the pain is, he said he would do it all over again.
Roland A. Carlstedt, chairman of the American Board of Sport Psychology and a licensed clinical and board-certified sport psychologist, said two groups of athletes are prone to play with an injury:
• The first group subconsciously adopts "repressive coping." These athletes have high pain thresholds, high self-esteem and perform well in high-pressure situations.
• The second has a personality trait called neuroticism, where the person is full of self- doubt.
An athlete from the first group plays injured because he thinks he is invincible. An athlete from the second group plays injured to convince himself that he is invincible, Dr. Carlstedt said. He said the decision to sit Mr. Roethlisberger is a testament to the attention concussions have received.
John Heil, a clinical psychologist at Psychological Health Roanoke in Virginia, said fans can still consider NFL players as tough, even if they are more cautious with their bodies.
"Everything has its limits," Dr. Heil said. "If you're sitting in a chair and your slobbering on yourself, you're not a tough guy anymore."
Michael Sanserino can be reached at firstname.lastname@example.org or 412-263-1722.