Playing quarterback is tough enough without having a sports hernia that causes your body to jackknife with every nose tickle.
Derek Carr suffered quietly, but his 2012 season was nothing to sneeze at. He led Fresno State to its first share of a conference football title since 1999, throwing for 4,104 yards and 37 touchdowns. He was the Mountain West Conference player of the year and was also named to the all pain-tolerance team.
"A lot of my teammates didn't know," Carr said of the injury. "We tried to hide it the best we could, but I had to roll out, to keep teams honest. It was a fun year; at the same time it was a hard year."
Carr said not playing was never an option. "My teammates meant too much to me," he said.
Even those closest to Carr, at first, weren't aware of the injury.
"I remember sneezing one time and I was on the ground," Carr said. "My wife walked in and thought there was something really wrong. She asked me what happened. I told her I sneezed and she laughed at me."
The pain was no joke.
Carr had surgery to repair the hernia in January and his successful recovery is bad news for Mountain West defenses.
"I can run!" Carr said. "I can get out of the way of pressure."
The only knock on Carr last year was that he stood too long in the pocket.
He was sacked 27 times, seven times alone during a lopsided Hawaii Bowl loss to Southern Methodist.
Second-year Coach Tim DeRuyter's goal this year is to up the tempo on offense to get the ball out of Carr's hand quicker.
"He's got to learn to have that clock in his head," DeRuyter said.
Carr's decision to stay for his senior season and not opt for the NFL draft made Fresno State a top-25 caliber team and one of the favorites in the Mountain West.
The Bulldogs need to replace leading rusher Robbie Rouse, but star receiver Davante Adams, the Mountain West freshman of the year, returns after catching 102 passes last season for 1,312 yards and 14 touchdowns.
The defense made a huge turnaround last year after switching from the 4-3 to the 3-4. The Bulldogs forced 35 turnovers, fifth-best in the nation, after finishing last the year before with only nine.
The Mountain West has 12 teams now, with two divisions. Boise State has been picked to win the Mountain Division, and Fresno State is the favorite in the West Division.
The two favorites match up in Fresno on Sept. 20 in what could be a prelude to the first Mountain West title game. Similar to the Pac-12 Conference, the team with the best record will play host to the championship game.
Fresno State had long been a "BCS buster" under coach Pat Hill, taking on the best teams in the nation. Hill's Bulldogs nearly shocked USC in an epic 2005 game at the Coliseum, but the dragon-slayer business took a physical and mental toll.
Fresno State, surprisingly, did not win even a share of a conference title in the decade of the 2000s.
That's what made it remarkable that DeRuyter won a Mountain West title share in his first year at the school.
With Carr back and healthy, Fresno State has a chance this season to make it a full share.