Dr. David Chao
The Training Room


We all hear about the pending magnetic resonance imaging. Sometimes the test is needed and helpful. Often, especially on the big injuries, the team doctor already knows the diagnosis and has passed it on to the club.

Done correctly, physical exam is extremely accurate for major ligament and tendon tears like ACL, PCL, MCL, Achilles, shoulder labrum and distal biceps. MRI are not needed but often players and their agents still rely on them. Other times, it is away for the medical staff to be absolutely sure of the diagnosis or provide the team with a little extra time to ponder roster moves.

Let’s take two examples from Sunday’s injuries: Ravens safety Matt Elam and Bengals defensive end Michael Johnson. Both were announced to be waiting for MRI before any official word.

Elam injured his biceps near the elbow and the team was worried about a distal biceps tendon rupture which would mean surgery. Reports surfaced of either a complete or partial tear and the team was waiting for an MRI. Complete distal biceps tears are an easy clinical diagnosis. In fact, I indicated such a rupture for Prince Amukamara based on broadcast video during a Giants game last year.

Expect the formality to be announced soon of a full distal biceps tear and surgery. Recovery is minimum three to four months. Although Elam will likely go on injured reserve, there is a chance the team could elect to designate him for return.

Johnson went down with what looked like a severe knee injury, casting a pall on Bengals practice. Two team doctors were present to exam him on the field prior to being carted off. Based on that evaluation, the team was confident that it was not a season ending ACL tear.

Bengals head coach Marvin Lewis acknowledged his confidence in the medical evaluation being the better than MRI, stating the doctors have “always been 100 percent with me from wherever it stands on those battlefield exams. They’re pretty accurate and I feel pretty good about it.” Expect the MRI to make it official that the injury is to his MCL and not his ACL which will allow an early season return.

When it comes to major injuries, as a former head team physician, we typically knew on the field what the severity was. An MRI is certainly helpful in diagnosing nuances of injuries. For example, my hands can immediately tell me the ACL is torn, but an MRI is helpful to determine associate meniscus tear or bone bruise.

I used to say to players “I hope I am wrong, so let’s wait for the MRI”. All the while, I was essentially sure of the bad news. This served to let the player come to grips with the diagnosis before it became official.

Over a decade ago, we were ahead of the curve in getting all post-game MRIs done and information to team executives by my scheduled 11am Monday morning meeting. Nowadays, some teams are even getting MRIs immediately after the game, although the announcement of results comes later.

Essentially the MRI is a confirmatory second opinion. When it comes to major injuries, the team already knows the outcome.

MMMD 1: Failed physical and failed conditioning tests

Last week, we covered active and reserve PUP and NFI. What does it mean to fail a physical or conditioning test?

Ladarius Webb and LeGarrette Blount failed initial conditioning tests and were placed on the NFI list. Not being in shape to pass a coach’s test can be considered grounds for not passing a physical.

Brodrick Bunkley failed his physical based on last year’s quad injury and no conditioning test was needed. The Saints have clearly moved on but in some ways the team was protecting itself and in others it was protecting the player. You can’t cut an injured player in the season he was injured, but you can cut last year’s injury. By not passing Bunkley on the physical the team limits its loses. He doesn’t get any 2015 money, even if there is residual injury. The move makes the player eligible for injury protection monies. Being released is never good but the team may have been looking out for themselves and the player here.

MMMD 2: Inevitable injury parade starts despite non-contact practices

Justin Jackson of the Cowboys and Stephen Hill of the Panthers both tore their ACL while Kyle Williams of the Broncos tore his Achilles. All three are season ending injuries and will require surgery.

The new CBA limits practice and contact, yet there is no drop in ACL or Achilles tears. Both ACL and Achilles ruptures are predominately non-contact injuries that occur at full speed. In fact, I feel like Achilles is so common that it has become the new ACL.

MMMD 3: Last week was PUP watch

The significance of Physically Unable to Perform designation was explained last week. As expected, Jadeveon Clowney and Earl Thomas were placed on active/PUP. Both are expected to come off soon. Marques Colston and Carlos Hyde were on the PUP list but were removed quickly, preserving the team’s ability to use reserve/PUP if needed for the regular season.

The PUP news was good for Todd Gurley, Carson Palmer, Sam Bradford, Dont’a Hightower and Brandon Albert. Being left of the PUP list is no guarantee of being ready week one but it does mean the team has no worries about the possibility of missing six weeks.

MMMD 4: JPP pictures are worrisome

It is always said that you “can’t judge a book by its cover”. One can’t judge an injury based on the dressing either. However, the way Jason Pierre-Paul’s hand is wrapped as he approaches one month out from injury is worrisome.

All along I have feared there may be more damage than what has been reported with the index finger ray amputation and thumb fracture. The way his hand is bandaged indicates damage to other fingers too. The question now is to what extent.

Some have speculated his thumb looks shorter, but that may not be the case based on the bulkiness of the entire dressing. Also the use of a sling in a significant hand injury doesn’t necessarily mean shoulder or elbow issues. In any case, we can now assume there is additional damage. I hope he can still make it back quickly.

MMMD 5: Defensive line is harder return from back surgery

The Chiefs’ Dontari Poe had surgery for a herniated disc. Any back surgery is hard to come back from put it may be even tougher playing his position.

Playing any sport coming off back surgery is hard but when you have to leverage against two or more 300 pounders while twisting and using core strength, that makes the task much more difficult. As a 350-pound nose tackle, Poe’s spine is not twice the size of the average 175-pound male, thus the backs of larger players endure more force.

I would anticipate a three-month recovery, making him a PUP candidate. In the short term he should ultimately return to full football form; however, he may have long-term problems after football.

MMMD 6: Eric Berry cancer free and returns to practice

Kudos again to the Chiefs medical staff for discovering a chest mass after a routine post-game complaint of chest discomfort. The early diagnosis was key and eight months later, Berry is cured of his lymphoma (blood cell tumor)

Beating cancer is great news but he was also cleared to return to football practice. He may have a ways to go before he returns to his Pro Bowl form, but the news couldn’t be any better.

MMMD 7: ProFootballDoc scorecard

Previously the self-graded injury prediction/assessment record was at 9-0. The hope is by providing weekly updates, by the end of the 2015 season, there will be meaningful vetted numbers.

This week there was one injury caught on film. In between seeing patients during my regular day, several followers notified me with frame–by-frame injury video on Washington cornerback Bashaud Breeland. He was carted off with a non-contact knee injury and the worry was season-ending ACL. Based on this video alone, my impression was MCL, which later proved correct.

This one was relatively easy as there was great video showing the injury and the 17 years of analyzing NFL injury video paid off. With the current record now at 10-0, I fully expect to be incorrect soon as there is no way to be perfect based on video without examination.

Follow David on Twitter: @profootballdoc

Dr. David Chao is a former NFL head team physician with 17 years of sideline, locker and training room experience. He currently has a successful orthopedic/sports medicine practice in San Diego.

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Jeff Fedotin
Guest Stars


The defending Super Bowl champion Patriots have won the AFC East six consecutive years, but they are poised to be knocked off the division’s top perch.

They have lost their top three cornerbacks from last season, and the NFL upheld a four-game suspension of QB Tom Brady.

Two of their challengers in the division — the Bills and Jets — are similarly constructed teams with the same strengths and problems.

Both the Bills and Jets have very good defensive units, something that shouldn’t come as a surprise considering the main link between the franchises is Rex Ryan, the son of Buddy Ryan, who popularized the 46 defense.

After six years with the Jets, Rex Ryan enters his first year coaching the Bills. Ryan’s replacement in New York, Todd Bowles, actually employs a very similar gameplan involving a blitz-heavy 3-4 D.

Bowles, though, inherits the same problem that plagued Ryan in New York and still negatively affects him in Buffalo — poor QB play.

Although both teams have two of the most uncertain QB situations in the league, their defensive lines are two of the best.

The Jets’ D-line took a hit when defensive end Sheldon Richardson, who was just charged for resisting arrest after driving 143 mph, was suspended four games for violating the league’s substance abuse policy. But even without him, the Jets have Muhammad Wilkerson, a 6-4, 315-pounder with 16 sacks the last two years, and rookie Leonard Williams, who was regarded as the best defensive player in the draft before dropping to No. 6 overall because of rumors of a lingering shoulder injury that he claims were unfounded.

Buffalo’s version of Richardson is Marcell Dareus. The No. 3 overall pick in the 2011 NFL Draft has the versatility to play nose tackle, 4-3 defensive tackle or 3-4 defensive end. The talented Dareus is stout versus the run, and his 28.5 sacks in his four years in the league demonstrate his pass rush ability. His issues come off the field where he has numerous incidents, including ones involving drag racing and drugs.

On the Bills’ four-man line, Dareus lined up next to Kyle Williams, a high-motor player who has 16 sacks the past two years, last season.

Ryan will likely go with three down linemen this year, moving defensive ends Mario Williams — the No. 1 overall pick in the 2006 NFL Draft — and Jerry Hughes to 3-4 outside linebackers. Williams has 91 career sacks, and the duo combined for 24 sacks last season.

The Bills had the third best pass defense in the league last year not only because of their ability to get to the quarterback, but also because they have two former top 11 picks — Leodis McKelvin and Stephon Gilmore — starting at cornerback.

Ryan will love having those corners. He can trust them in single coverage, allowing him to blitz multiple defenders.

His penchant for doing that is why Ryan lobbied the Jets front office to re-sign Darrelle Revis and Antonio Cromartie, the cover cornerbacks who shut down receivers while the Jets advanced to the AFC Championship Game in 2010.

Unfortunately for Ryan, the Jets re-signed them only after he left.

Those secondary additions — and the free-agent acquisition of CB Buster Skrine — should drastically improve a New York defense that ranked sixth in the NFL last season but only 14th against the pass.

And the Jets D will have to be outstanding to compensate for an anemic offense.

The offensive woes begin at quarterback where New York has error-prone Geno Smith, who has turned the ball over 41 times in 30 career games.

Rookie quarterback Bryce Petty, drafted in the fourth round, has potential, but he is somewhat of a project because he needs to adjust from the spread offense at Baylor to the Jets’ pro-style attack.

There’s a reason Jets QB Ryan Fitzpatrick is on his sixth team; he is whom you want as your No. 2 quarterback but not your starter.

One of Fitzpatrick’s former teams, the Bills, have similar QB issues. Matt Cassel, the odds-on favorite to win the job, is like Fitzpatrick. An excellent backup, he could not hold onto the starting job in Kansas City or Minnesota.

EJ Manuel, the first quarterback selected in the 2013 NFL Draft, is not dynamic enough. He has completed under 59 percent of his passes in both seasons and never averaged more than 6.44 yards per pass.

Tyrod Taylor also has a shot at the starting job.

Whoever quarterbacks the Bills will at least have LeSean McCoy and Fred Jackson at running back, potentially allowing Buffalo to play a ball-control attack, which puts less pressure on the passer.

McCoy has 2,926 rush yards over the last two seasons, and Jackson has surpassed 925 rushing yards three times.

The Bills have young talent at receiver. Sammy Watkins enters his second year while Robert Woods enters his third. They combined for 1,681 receiving yards last year.

They also signed WR Percy Harvin to a one-year contract. Harvin played for Ryan last year in New York after the versatile receiver previously wore out his welcome in Minnesota and Seattle.

The Jets took on another talented — but somewhat troubled — receiver in Brandon Marshall to complement Eric Decker.

But like the Bills, the Jets would be better off taking the game out of the hands of whichever dubious quarterback wins the QB job and relying on a deep RB group.

The Jets ranked third in the NFL in rushing last year and are even deeper this year. Though lacking an elite back, New York has Chris Ivory, Bilal Powell, Stevan Ridley and Zac Stacy. Each has at least one 697-yard season to his name.

Time will tell if strong running games and defenses will be enough to make up for poor QB play — and enough to finally unseat the Patriots.

Follow Jeff on Twitter @JFedotin

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Matt Pearce
NFP Fresh Voices


No position in football is more important than quarterback and this is reflected in their contracts. Nineteen quarterbacks average more than $10 million per season in salary, according to Over The Cap.

The latest quarterback to sign a mega-extension was Russell Wilson, who inked a contract worth $21.9 million per year in new money just before the start of training camp.

It is only a matter of time before the next extension is signed. So, who are the next quarterbacks to have the Brink’s truck parked outside their house?

Eli Manning, New York Giants

A veteran of 11 seasons in New York, Manning is entering the last year of his contract. The two sides have been talking about a new deal and had hoped to have an agreement in place before the start of training camp. Obviously, this didn’t occur. It wouldn’t be surprising if the 34-year old was waiting to see what happened with Wilson. Now Wilson’s situation is resolved, Manning has a new number to base his negotiations off. A two-time Super Bowl champion, he had one of his best seasons in his first year in offensive coordinator Ben McAdoo’s system. The Giants are trying to find their way back to the postseason and there is no way they can do it without Manning. Expect a deal to get done soon.

Philip Rivers, San Diego Chargers

Around the draft, rumors swirled that the Chargers might trade Rivers. San Diego decided to keep their starting quarterback of the past nine seasons and now they want to sign him to a new contract, allowing the 33-year old to finish his career in San Diego. Rivers has made it known that he doesn’t want to play in Los Angeles, where the Chargers could potentially relocate to and most talk of him not signing a new contract is based off this thought. Jason Cole of Bleacher Report recently reported that Rivers hopes to have a deal in place in a few weeks. This is good news for the Chargers. A contract for Rivers would probably fall slightly short of the deal Manning will eventually receive.

Nick Foles, St. Louis Rams

Acquired early in the offseason in a trade with Philadelphia, the Rams are hoping Foles can be the quarterback to lead the team to the postseason for the first time since 2004. In 2013, the 26-year old put up astonishing numbers, throwing for 27 touchdowns with just two interceptions. He quickly fell back to Earth in 2014, with his completion percentage falling below 60 while throwing 13 touchdowns and 10 interceptions in eight starts. Given his inconsistent history and no professional tape outside of Chip Kelly’s quarterback-friendly system, the best bet for St. Louis would be to take the wait-and-see approach. By no means would Foles break the bank, but he still will command more than $10 million per season.

Sam Bradford, Philadelphia Eagles

Easily the biggest unknown on this list, Bradford hasn’t played in a regular season game since Oct. 20, 2013. Two ACL injuries have derailed the career of the former number one overall selection. An essential part of Chip Kelly’s wild offseason, Bradford will put up quality numbers for the Eagles if he can stay healthy––and that is a big if. Due to the uncertainty about his health, Bradford is expected to play out the season on the last year of his rookie contract. This will allow him to maximize his value. Right now, there is no way Philadelphia would sign him to a contract worth a significant amount of money. If he stays healthy, then he will be able to cash in at the end of the season when he will still be 28 years old.

Andrew Luck, Indianapolis Colts

Of the five quarterbacks here, Luck is the only one whose contract doesn’t expire after the 2015 season. Indianapolis exercised the fifth-year option on his rookie contract in April, putting the 25-year old under contract for $16.155 million in 2016. With two years left on his contract, neither side is going to be in a hurry to put together a new deal. The most likely scenario is he plays out the 2015 season and then signs an extension during the offseason. Luck isn’t likely to sign anytime soon, but when he does, he is sure to become the highest-paid player in the NFL.

Matt Pearce is a graduate of National Football Post’s Introduction to Scouting and Scouting Boot Camp and is a journalism student at the University of Nebraska. Follow him on Twitter@Matt_Pearce13

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Greg Gabriel
The Director's Report


NFL training camps are now in session around the league. By the end of next week, most of the major college football programs will have started practice as well.  Historically when training camps opened in late summer both NFL and college teams were having double sessions. This is no longer the case for several reasons.

One of the main reasons for the decline in double sessions is year-round conditioning. When I was playing football and when I started working in the NFL in the early 1980’s there was no such thing as OTA’s and off-season programs. In the past, players had to be motivated to train on their own. I started working for the New York Giants in January of 1985, just after the Giants had built there first cutting-edge weight room at the old Giants Stadium. In the early 1980’s clubs were beginning to hire full time strength and conditioning coaches.

Double sessions began because football was only played in the fall and the money being paid to professional football players was minimal compared to today. Many players had off-season jobs. Once training camps opened there needed to be double sessions just so the players could get in shape and prepare for the long, grueling season.

As for colleges, players weren’t around all summer preparing for the season. They were home during the summer months and many participated in other sports. As the game evolved double sessions stayed more because of the tradition than anything else.

Not only were double sessions prevalent when I started working in the NFL but they were also much more physical. I remember very vividly my first training camp with the Giants at Pace University in Pleasantville, New York. The players reported on a Sunday and double sessions began the very next day. At the opening practice just after the players finished stretching the first period of practice was 20 minutes of the old “nutcracker” or “Oklahoma” drill. Head Coach Bill Parcells said at the time…”I just wanted to see who was ready to play”.

There was “live hitting” for a good part of both practice sessions seven days a week. You never see that anymore. One of the reasons is the players are being paid too much money and teams can’t afford any injuries. Another reason is that the players are physically ready to start the season the day camps opens.

In the past, the vast majority of a team’s offense and defense wasn’t installed until the team got to training camp. Now clubs get a good portion of their offense and defense installed during the off season program and OTA’s. Once camp opens, after a short review, clubs just pick up where they left off in late June. While there is always some “hitting” going on, it is not nearly as aggressive as it used to be. Training camps are now focused on mental preparation, whereas in the past the pre-season games focused on physical preparation.

The one exception is when a new coaching staff comes on board. They are unfamiliar the players and use part of training camp to find out who their players are. Training camps are now country clubs compared to the way they used to be run. In all honesty, I miss the old days, camps were fun and you could see your team come together. We don’t witness that anymore, and in my opinion it is not as exciting.

Follow Greg on Twitter @greggabe

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Greg Gabriel
The Director's Report


One of the big stories of the 2014 NFL season was the turnaround of the Houston Texans. Going into training camp a year ago, not many would have expected a winning record out of the Texans. However, they finished the season 9-7, largely as a testament to the outstanding coaching job by first year coach Bill O’Brien. In his second season, the arrow is pointing up and a playoff berth is possible.

Quarterback

Last year, four different quarterbacks started games in 2015. This year, it looks as if it’s a two-man battle for the job between Brian Hoyer and Ryan Mallett. Hoyer, who the Texans signed as a free agent, started 13 games for the Browns last year. While Hoyer lacks outstanding physical traits, he is smart and instinctive and knows how to play within himself. He also has excellent leadership qualities that will help him win the job.

Ryan Mallett may have better physical characteristics, but he lacks the mental toughness and decision making skills to be a starting NFL quarterback. The third quarterback will be Tom Savage who is similar to Mallett in that he has physical traits but lacks the mental.

Running Back

In Arian Foster, the Texans have one of the best running backs in the league when he is healthy. Unfortunately, he came into the league with an injured knee and has already missed time in his career.

Alfred Blue is the primary backup and he did a nice job as a rookie running for 528 yards. Kenny Hilliard and Chris Polk are two other players to watch at the running back position. The fullback is Jay Prosch who is a blocker only.

Wide Receiver and Tight End

The big loss in the receiving corps is Andre Johnson, the Texans all-time receiving leader. While Johnson is not the player he used to be, it will be tough to replace his leadership. Third-year man DeAndre Hopkins, who had 76 receptions a year ago takes over as the number one target. He has big shoes to fill, but he could be their next great receiver.

The other starting wide out will be Cecil Shorts III who was signed away from Jacksonville. The third receiver will most likely be Nate Washington another free agent signee. In his 11th year, Washington has seen his best days.

In the third round, the Texans drafted Jaelen Strong. Strong had first-round talent but there were questions about his overall competitive nature and attention to detail. There is no questioning Strong’s talent and if he plays to his ability the Texans got a steal.

The tight end will be Garrett Graham who is more of a receiving threat. I look for second-year man C.J. Fiedorowicz to come on strong this year now that he is acclimated to the NFL game.

Offensive Line

Many thought Houston would take an offensive lineman early in the draft but that wasn’t the case. Going into camp the starting line looks to be Duane Brown and Derek Newton at the tackle spots with Xavier Su’a-Filo and Brandon Brooks at guard and Ben Jones at center. Su’a-Filo has to step it up as he was a disappointment last year as a rookie.

The depth is thin with Tyson Clabo and Jeff Adams. The feel good story would be if David Quessenberry makes it back on the field after battling lymphoma last year. He reported to camp but hasn’t yet been cleared to play.

Defensive Line

The Texans have the best defensive lineman in football, J.J. Watt. This is only his fifth year in the league and he hasn’t yet become the player he will eventually be. The new face on the line is former New England Patriot All-Pro Vince Wilfork. Wilfork isn’t the player he once was, but the reliable veteran should be able to give the Texans 40 strong snaps a game. The end opposite Watt is Jared Crick who had his best season last year but still needs to become a better pass rusher.

The depth is questionable but Brandon Deaderick may be the most reliable. Jeoffrey Pagan, in his second year has to come on and show he is worthy to play in the rotation. The big question mark is second-year nose tackle Louis Nix III. Nix was a bust as a rookie and the hope is that he has matured in the last year. He has the natural talent to be very good, but questions surround his dedication to the game.

Linebacker

Last year’s number-one overall draft choice Jadeveon Clowney had a forgettable rookie season. Because of knee injuries he did virtually nothing and now coming off micro-fracture surgery his impact level is questionable. Clowney has the talent to be a great pass rusher, but will this come to fruition?

Opposite Clowney is Whitney Mercilus who does a solid job defending the run and rushing the passer. While he may never go to a Pro Bowl, he is a good player to have on the roster. The depth outside is a question mark. Jason Ankrah has talent but he’s inexperienced and has not been able to show it yet. John Simon is another talented, but inexperienced guy waiting for his chance.

Inside Brian Cushing isn’t the player he was a few years ago and we may never see that player again. I really like rookie Benardrick McKinney. I felt he was one of the better inside linebackers in the draft and he should start right away. If he isn’t ready than Akeem Dent is ready to step in. The former Falcon started seven games last year.

Secondary

The strong defensive line helps the secondary. I remember when Houston fans were calling for corner Kareem Jackson’s head when he was a young player. Now he is the best cover guy in the Houston secondary. Across from Jackson is very reliable Johnathan Joseph who is entering his 10th year. While he may be getting up in age, he still plays well.

The safeties will be Rahim Moore who was a starter with Denver last year and most likely Stevie Brown. Moore is better suited to play the free safety spot.

I look for first round pick Kevin Johnson to be the nickel corner as a rookie. It would not surprise me if he strongly challenges Joseph for the starting slot. The fourth corner should be A.J. Bouye. The depth at safety will be Eddie Pleasant and most likely free agent rookie Kurtis Drummond, Many draftniks felt Drummond would be at worst a mid-round selection.

Outlook

Houston has a solid team at just about every position but quarterback. For the Texans to challenge for a playoff slot they have to get good play from that position. While the defense is strong, the unit lost much of their depth to free agency and they have to hope the key players stay healthy. Also Jadeveon Clowney’s  injury recovery will be important for the Texans.

At this time, Houston doesn’t have enough to overtake the Colts for the division crown but they should challenge for an AFC Wildcard spot.

 

Follow Greg on Twitter @greggabe

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