The Pittsburgh Steelers edged their AFC North rivals the Cincinnati Bengals 23-20 on Monday night but the game was overshadowed by ugly moments of violence that did little to lessen the NFL’s reputation for brutality.

The most worrying moment came when Steelers linebacker Ryan Shazier was taken to a hospital for an MRI and a CT scan after he injured his back and was carted off the field early in the game. Shazier tackled receiver Josh Malone, fell to the ground and grabbed his back. The 25-year-old was strapped to a backboard and taken off. He was moving his arms on the field but his legs appeared immobile.

Steelers general manager Kevin Colbert said Shazier would not require surgery at this time in a statement released by the team, adding that he would stay in the hospital overnight and continue evaluations with “hopes of returning to Pittsburgh on Tuesday”.

Both teams were subdued for the rest of the half after Shazier’s injury but passions were reignited when Steelers receiver JuJu Smith-Schuster leveled Vontaze Burfict with an illegal hit. Smith-Schuster then stood over the prone Burfict taunting him. It was an unseemly episode on a night when Smith-Schuster’s team-mate Shazier appeared to have suffered a serious injury. Burfict was carted off the field with a head injury after being treated on the field for a few minutes but reports later indicated he had not been seriously hurt, Smith-Schuster was suspended for one game on Tuesday for his actions.

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Bengals running back Joe Mixon also received treatment on the field while the Steelers receiver Antonio Brown received a heavy blow to the head while catching the touchdown that tied the game at 20-20.

The former Dallas Cowboys quarterback Troy Aikman tweeted: “This game is hard to watch for a number of reasons. Terrible for the NFL and the game of football overall.”

The Steelers-Bengals rivalry is one of the most hotly contested in the NFL, and has contained a particular edge in recent years. In an infamous playoff game in the 2015 season, Burfict concussed Brown after a brutal hit. Burfict was suspended three games for his actions.

The Bengals had led Monday’s game 17-0 at one point but allowed the Steelers back into the game, partly due to gifting Pittsburgh a team record 173 penalty yards.

Earlier on Monday, one of the NFL’s biggest stars, Rob Gronkowski, was suspended one game for a late and illegal hit on an opponent who was lying on the ground.