There was a time when drivers raced injured, when nothing could get them to climb out of their seat.
The rules didn't allow racers to be hurt, sitting out a week would be catastrophic in the point standings, and, ultimately, the payout. Not being able to drive with broken bones, blisters, burns, illness, any ailment at all, could derail a season. Even worse, it could cost a driver his job.
So it's a testament to NASCAR that Dale Earnhardt Jr. felt strong enough last week to take himself out of his car because he couldn't shake symptoms that could be concussion-related. NASCAR's most popular driver benched himself for Sunday's race at New Hampshire and he will await further tests to see if he's able to drive this weekend at Indianapolis Motor Speedway.
Earnhardt said he's battling balance issues and nausea and is uncertain when he will be back in a race car.
"My mind feels real sharp," he said in a podcast recorded Sunday night. "I've struggled with my balance over the last four, five days and I definitely wouldn't be able to drive a race car (last weekend). Making the right decision was out of the question, I made the decision I had to make. It's just going to take a lot of patience."
Tales of drivers racing hurt date back to the beginning of nearly every series. On the same day Earnhardt was watching someone else drive his car in New Hampshire, IndyCar ace Josef Newgarden was powering through on the street course at Toronto with a broken hand. When he wrecked late in the race, his in-car camera caught Newgarden in serious pain and favoring his broken hand.
Don't forget when Ricky Rudd raced with his swollen eyes taped open in the Daytona 500 or Richard Petty driving for weeks with a severe neck injury or the late Dale Earnhardt winning the pole at Watkins Glen with a broken collarbone. More recently, Denny Hamlin twice raced immediately after tearing the ACL in one of his knees and Brad Keselowski won at Pocono a week after breaking his foot.
About 15 years ago, Earnhardt Jr. revealed in an interview that he thought he'd driven with concussion symptoms several times in 2001. His admission led to a tightened medical review policy in which Earnhardt had to be seen by a doctor before he could race after he was briefly knocked unconscious in a 2002 crash at Dover.
As the years went on, Earnhardt became smarter about his health. He missed two races during the 2012 Chase because of a pair of concussions suffered in a six-race stretch, and sitting out those events immediately ended any title shot.
Dashed championship hopes would still be the case for any driver injured during NASCAR's 10-race playoffs, but the sanctioning body has made it easier for drivers to admit they are hurt. By allowing teams to apply for a waiver so the driver will still be eligible to make the playoffs, NASCAR made it possible for Earnhardt to take himself out of the car.
Granted, playoff hopes shouldn't trump health issues — especially concussions, something that could cause long-term damage — but this very small step has given flexibility in a system that previously had none.
Team owner Rick Hendrick made it clear he doesn't want a driver to sacrifice his health to stay in the race car.
"Our guys know that the most important thing is their health, and if they're in an accident and they feel like they've had a concussion, there's a protocol and they need to go through it," Hendrick said before Sunday's race. "It's hard to get out of the car, but we want (Earnhardt) for the long haul. He wants to race for a long time, so we are going to let the doctors make those decisions.
"It's really hard at first, and then the more you think about it, it's the right thing to do for him and it's the right thing to do for the team. We will just take it day-by-day."
It's not clear when Earnhardt was injured — he was in crashes at Michigan on June 12 and Daytona on July 2 — and his symptoms originally led Earnhardt to believe his problem was allergy or sinus related. So he raced at Kentucky two weeks ago not feeling well, and when it didn't improve, he saw a neurological specialist who diagnosed "concussion-like symptoms."
It could be argued that based on Earnhardt's concussion history, NASCAR should have had him tested after one or both of his accidents. But, NASCAR has made it easier than ever for a driver to lessen the stakes of seeking treatment and the participant should take some responsibility for their own health.
That doesn't make any easier for drivers, particularly those who grew up watching a generation that drove hurt.
"It's probably one of the toughest things to do — if I was in that position, it would be very tough for me, I would think," said Ryan Newman.
Carl Edwards noted that Earnhardt's issue "must be serious" if he didn't race and said he respected Earnhardt's decision.
"I can't imagine how tough that decision would be," he said. "Right now with the format, you do have the opportunity to take care of yourself, do what you think is right and still have a shot at the championship."
In the end, Earnhardt did the very best thing he could to help himself. He may also end up being the example for all drivers to put their health above everything else in racing.
Earnhardt, who noted in his podcast that his most recent ImPACT test matched his preseason baseline test, will now follow a treatment laid out by his doctors that includes exercises to retrain his brain.
"I put my health and quality of life as a top priority," he said. "I always do that, so I am going to take this slow and follow the advice of my doctors."