Dr. David Chao
Latest NFL News

Tony Romo is not too old or too fragile. The Cowboys quarterback is not injury prone. Medically, when his compression fracture heals, he will be cleared to play and will not have increased risk for long-term problems or further injury.

Sure, Romo is 36 years old, but Tom Brady is 39. Yes, the Dallas signal caller has now had his fourth fracture since 2014. However, it would be unfair to say his body is too ancient to play football. 36 may be the tail end of a football career, but medically, weak bones or osteoporosis are decades away.

The L1 vetebral body compression fracture suffered Thursday is unlikely related to his previous back issues. Disc surgery is typically performed at a much lower level (L4-5 or L5-S1). Transverse process fractures are located to the back and side (posterolateral) of the spine, while this break is located in front (anterior). Details on his previous cyst surgery are sketchy but I still don’t see the relationship to the current injury. When healed, Romo’s back will not be physiologically weaker or prone to injury.

There is not an underlying weakness in Romo’s body. Anyone who has a 300 lb defender jump forcibly on a flexed spine would suffer these same injuries. In 2014, the same year Romo suffered, transverse process spine fractures, 23 year-old Baylor QB Bryce Petty had the same injury. Certainly, the then collegiate QB’s bones were not weak. Both returned after one missed game.

Likely the two clavicle fractures and now second spine fracture does not happen out of his fragility, but there may be another reason. Romo has always been among the best at creating a big gain out of a broken play. Now, his continued desire to extend plays versus his decreased ability to avoid big hits is catching up to him.

I wrote last year that Romo has to learn to protect his left collarbone and not take similar hits. At this point, it may be time to resist his natural temptations to create something out of nothing and throw the ball away. The Cowboys clearly need him, going 1-11 last season without their star player.

With his 2014 spine fracture, he recovered quickly and missed only one game. No way a fracture heals in two weeks but a transverse process fracture doesn’t have to heal, as it is not structural. The compression fracture is structural and there is no way to rush back from this injury. No surgery or kyphoplasty will be needed. No brace or special therapy either, just time.

Romo will definitely miss the season opener and should take a minimum of six weeks to return. If hit in a similar fashion, a compression fracture can progress to a burst fracture with potential injury to the spinal cord or nerves. No one can be allowed to take that risk. Once healed, the risk of paralysis or permanent injury is no greater than normal.

Romo could resume throwing in a few weeks, but the earliest I see him playing and being exposed to a hit is six weeks. In 2007 with the Panthers, David Carr only missed a couple of weeks with his compression fracture but admitted he wasn’t at full strength until much later.

Of course Romo could decide to retire, but if he does, it won’t be because he couldn’t pass a physical or was risking further damage. No one can question his toughness. How many other people can say that they walked off the field on two separate occasions with spine fractures?

MMMD 1: Paucity or plethora of injuries?

Some journalists have gotten the erroneous impression of 2016 being a good injury year a few days ago. The reality is that injuries are near the average.

Up until this weekend, we just didn’t have as many big name stars injured. Now with Romo injured and the parade of Achilles and ACLs continuing, within a day, the chorus has now come that this may be a bad injury year including calls to modify the preseason.

MMMD 2: John Harbaugh calls to change preseason

The Ravens head coach’s preference is for no preseason games at all to avoid injury. Harbaugh states that coaches can evaluate and ready players through practice and scrimmages. He also wants to add meaningful games.

While noble to try to find a way to decrease injuries, this would not do it. Injuries happen in practice and scrimmages as well. Adding regular season games certainly would also increase injury.

My long-standing proposal has been to eliminate one preseason game and add a second bye week, keeping the total length of players time the same. Having a week’s rest early and later in the season would be positive for player health. Paring Thursday games with a bye week would eliminate playing on four days rest. An added week of televised opportunities Sunday, Sunday night, Monday night and Thursday night games would boost revenue as well.

MMMD 3: Unusual in-game injury report

Last week we discussed how pre-game injury reporting was going to become more confusing this year. Sunday night, the Bengals broke form and went out of their way to give more than the typical cursory information.

All teams are required in-game is to give a body part and a status. When A.J. Green injured his knee, the team released more than that. Instead of the usual “knee – questionable (or out)”, the Bengals tweeted Green’s right knee as “reported as not serious”.

This helped calm fans worry. After the game, Green said he “banged knees”. I bet fans wish all teams would be this forthcoming with injury information.

MMMD 4: Achilles tears continue

Ben Watson TE Ravens tore his Achilles tendon. Brandon Oliver RB Chargers had a classic eccentric load Achilles rupture as well that was well documented with HD video. This is another example of how obvious some diagnoses are off publicly available images.

Achilles tears continue to be the second most common season ending injury to ACL tears. As players get bigger/faster/stronger, the size of the Achilles remains essentially the same. It is the strong muscle that overcomes the tendon to cause a tear.

MMMD 5: Preseason injury rundown

Bengals RB Cedric Peerman has a forearm fracture that will need surgery and is likely to be 6-12 weeks for return, making him an IR candidate and possible return.

The fear by video is Cardinals DB Mike Jenkins has an ACL tear. I hope my eyes deceive me here.

Ravens RB Kenneth Dixon has a mild MCL sprain. While media have said 4-6 weeks for return, I am hoping for 2-4 weeks.

Colts G Jack Mewhort does not have an ACL tear despite initial reports to that effect but will still miss some time.

Bears backup QB Connor Shaw has a tibia and fibula fracture and likely had immediate rodding surgery.

Steelers OT Marcus Gilbert hyperextended his elbow and is seeking a second opinion. As a lineman he should be ok for the season to play with a brace. By video, Steelers DE Cam Heyward had a mild high ankle sprain. Being seen in a boot but putting full weight on it is a good sign for Week 1 appearance.

Redskins RB Keith Marshall has a strained elbow and I fear ligament damage, but won’t need surgery and will return in weeks. LB Ryan Kerrigan has a groin strain. RB Matt Jones has a previous mild AC sprain and I expect a Week 1 return.

Tyler Eifert just started jogging and is targeting a Week 4-6 return and may be a PUP candidate.

Falcons S Keanu Neal will miss 3-4 with a “clean up” knee scope.

Rams WR Pharoh Cooper is said to be out several weeks. By video, he suffered a left AC joint sprain on a spectacular catch Saturday vs Broncos.

Texans LT Duane Brown with a torn quad is not expected to he ready for season and likely will be on PUP. Meanwhile C Nick Martin had ankle surgery and his season is over.

Patriots TE Rob Gronkowski is back practicing.

Bears OT Kyle Long has a torn labrum. Offensive lineman can play with a shoulder harness, unless the labral tear is in the more unusual posterior location.

Ravens WR Breshad Perriman is finally practicing.

Chiefs LB Tamba Hali is off PUP now.

Packers WR Jordy Nelson has been off PUP but is only doing individual drills and not full go yet.

MMMD 6: Eddie Lacy cutting his hair?

Hair is considered part of the body. Although tacking a player from behind by grabbing his hair is just as dangerous as a horse collar tackle, it is not illegal.

After just such a tackle, Lacy is considering cutting his hair. The Packers running back is not worried about the pain of losing some hair but rather the safety of his legs.

In this era of health and safety, I am surprised the competition committee has not outlawed pulling a player down from behind by any means, including hair.

MMMD 7: ProFootballDoc scorecard

One can never be perfect and I will definitely call my initial Tony Romo assessment a mistake. I didn’t see the injury when it happened as I was at the 15th annual Taste at the Cove fundraiser. Although when I saw the injury video the next morning, it had me worried about compression fracture. However; by then it was reported that Romo did not have X-rays at the stadium. I read too much into the fact that team doctors did not get films at the game. Dallas has a spine surgeon as one of it’s regular team doctors. I am right about it not being related to previous injuries, but the bottom line is this is an error in video diagnosis.

Brandon Oliver’s Achilles rupture was fairly easy and a classic example for the eccentric load injury.

Connor Shaw does indeed have a tibia and fibula fracture and had immediate surgery with a rod.

Ravens RB Kenneth Dixon did indeed have a MCL sprain.

These take the previous 20-0 record to 23-1 or 95.8%.

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Joe Messineo
NFP Fresh Voices

As the regular season draws closer, one big name free agent is still sitting on the open market, defensive end Greg Hardy.  Despite his struggles, which include lackluster play during his one season in Dallas and his continued misbehavior on and off the field, which he has been in counseling to deal with, Hardy is still a 28-year old with 40 sacks in his career (27 of which came in his last two full seasons) in a pass happy league that craves pass rushers.  

Despite that, the Cowboys let him walk, the Redskins decided not to take a flier on him after another season-ending injury to linebacker Junior Gallette and there hasn’t been much of a market for him to this point.  While things can certainly change in a hurry thanks to injuries or teams seeing that their current crop of sack artists don’t quite live up to the hype, there are three spots right now that make sense for Hardy and his potential suitor.

First up are the Jacksonville Jaguars.  Despite having a defensive-minded coach in Gus Bradley, the Jaguars only mustered 36 sacks last season (ranked 20th in the league).  It’s true that last year’s first round pick Dante Fowler is back from injury, but if he isn’t 100 percent or gets injured again, the Jags will be in need of help off the edge.  They’ve already had Hardy in for a fact finding workout, but they don’t have immediate plans to sign him.  The Jags have an offense poised to score a lot of points, but they need to be able to stop teams too.  With their sack numbers seemingly tied to the health of Fowler, Hardy makes sense here.

Next up are the Buffalo Bills, whose putrid sack total of 21 ranked them 31st in the league.  Head Coach Rex Ryan and his brother, Defensive Coordinator Rob Ryan, certainly wouldn’t shy away from a controversial player, especially if they thought he could help.  After all, Ik Enemkpali was signed by the Bills after he was released by the Jets following his cold-cocking of Geno Smith. The Bills are also dealing with key injuries to top draft picks Shaq Lawson and Reggie Ragland, further weakening an already suspect defense.  Looking at the team on paper, Hardy’s potential for disrupting offensive backfields is sorely needed in Buffalo.

Finally, you have a team that is always a dark horse candidate, but really shouldn’t be with their history of taking fliers on players others thought were washed up physically or mentally; the New England Patriots.  It usually doesn’t matter who they bring into the fold, with the way the team is run, everyone on the roster ends up doing things the “Patriot Way” very successfully.  Randy Moss was seemingly done after two sub-par years in Oakland, but then came to the Patriots in 2007 and caught 98 passes for almost 1,500 yards and 23 touchdowns.  Corey Dillon wore out his welcome in Cincinnati, but came to the Patriots in 2004, rushing for almost 1,700 yards and 12 touchdowns. While the Patriots 49 sacks last year were second best in the league, 12.5 of those were traded to the Arizona Cardinals in the form of Chandler Jones.  With nobody else in double digits, the Pats could find a spot for Hardy.

While it may take some time, the NFL is a league of many second chances (if you can still play) and Hardy is likely to get his.

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Dr. David Chao
Latest NFL News

The intent of new injury reporting rules is to provide clarity. Instead, the changes are likely to provoke more confusion. If the NFL wanted to make injury reporting more transparent, the new system is likely to have the opposite effect and cloud the issue.

Previously, injury reporting was broken up into “Probable”, “Questionable” and “Doubtful”. These words essentially corresponded with “75%”, “50%” and “25%”. Now the “Probable” category has been removed and “Questionable” and “Doubtful” has been redefined. It is like changing a traditional “A, B and C” grading system to “pass and low pass”. There is less delineation of injury grades.

Instead of 50-50, “Questionable” will now mean “uncertain whether the player will play”. “Doubtful” now means it is “unlikely the player will participate”. “Out” still means the player will not play as that designation does not change.

For practice designations, “Out” will no longer be used. The practice categories of the new policy make sense. “Full”, “Limited” and “Did not participate” are easy to understand practice designations.

Certainly the new definitions make injury designations more vague. As it is, only the body part and status is listed. No side or specific diagnosis is required. Now the status becomes murkier with the removal of a category.

Essentially, the old probable and questionable categories are now combined into one. It seems to me the new system will have teams listing anyone in doubt to be questionable. The new rule explicitly states “if there is any question concerning a players availability for the game, he should be listed as ‘Questionable’”. Now anyone with a 50-50 chance of playing is lumped with someone who is 99% certain to play.

Teams will be incentivized to liberally use “Questionable” as anyone not listed who doesn’t play puts a club at risk for possible discipline. The move to list more players as “Questionable” was already happening. Now the rules justify it even more often.

A new cottage industry will be created. Information on the “questionable” players will be at even more of a premium. The 90-minute inactive list release will take on higher importance. Perhaps the real motivation of this is to create ratings for the pregame shows.

As a fan, I am not in love with the new changes, which provide less specific information. On the other hand, as an injury analyst, I think this is going to be good for my twitter handle as fans, fantasy players and gamblers seek more specific information on their own.

MMMD 1: ACL tears continue at high rate

There are 17 ACL ruptures to date this league season. Torn ACLs through all of preseason 2015, 2014 and 2013 were 25, 22 and 31. With week 2 preseason games just concluded, the league is on track to hit the average in the mid 20s.

The new CBA limited contact has not lowered ACL tears since it is primarily a non-contact injury. With the high tempo of practices, one can argue that introduces more high-speed cutting activity, which puts ACLs at risk.

MMMD 2: Dion Lewis 2nd surgery

The Patriots running back recovering from a torn ACL was rumored to be coming of PUP soon. Instead, he had additional surgery.

The only good news is that the procedure is not directly related to the ACL, but instead is a “cleanup”. Having follow up surgery after an ACL is not uncommon and is usually related to associated scar tissue, meniscus tears or articular cartilage damage.

Lewis is eligible for Reserve/PUP come the regular season since the team placed him on Active/PUP at the start of training camp despite practicing in June. At least the early news is the set back does not involve an ACL re-tear and there is a good chance to return later this season.

MMMD 3: Alex Okafor decides to play without surgery

The Cardinals linebacker had previously torn his distal biceps tendon and had surgery which cost him the season. Now in a contract year, Okafor will try and avoid surgery and play through the injury.

Typically, proximal biceps tendon tears near the shoulder do not need to be fixed, but ruptures distally near the elbow do. Okafor has experienced the surgical route before, I hope the non-surgical option goes well for him.

MMMD 3: What headaches?

Ladarius Green denied headaches have been keeping him from practice and insisted it was his ankle injury. Last week, we discussed the Steelers only big free agent signing and the controversy.

Despite being reported to be in the concussion protocol, Green now denies the headaches. Medical personnel cannot come out and clarify the truth due to HIPAA privacy laws so we will just have to wait and see what happens.

MMMD 4: J.J. Watt uncertain for first two games

Texans head coach Bill O’Brien acknowledged that Watt may miss the first two games of the season. This would break his perfect streak of never missing a game in his NFL career.

When he first had back surgery, I indicated the procedure was relatively simple, but the rehab was difficult. The disc is about five inches deep in the back and that means a deep dissection through core muscles making for a long recovery. I hope the defensive player of the year can come back to form quickly.

MMMD 5: Preseason injury rundown

Jamaal Charles is off PUP and practicing. I am expecting a productive year as he ran for a career high 1506 yards coming off his previous ACL surgery.

Jordy Nelson is back practicing after a stint on PUP for the presumed patellar tendonitis in the other non-ACL knee. Packers may have been smart to get this better to avoid a nagging injury.

Steve Smith, Sr. is off PUP and soon starting practice for his 16th NFL season. Normally, Achilles ruptures can end careers for a wide receiver in his thirties, but not for this 37 year-old.

Larry Fitzgerald is already back practicing after a mild MCL sprain. Seems his missing time was truly a preseason precaution.

Tyrann Matthieu is off PUP and practicing. He overcame a previous multi-ligament knee injury, so this isolated ACL should be easy for him to overcome.

Matt Jones was said to have a “slight” AC joint sprain. Normally this is a 0-2 week injury if mild. Caution, he did leave the stadium with a sling which is not always needed for low grade shoulder separations.

Breshad Perriman feels like déjà vu. Last season a PCL injury teased fans for a return that never happened. This year a “partial” ACL is the culprit and as of yet no timetable for return.

MMMD 6: Texans permanently switch to artificial grass

There have been many complaints about the seams in the natural grass due to pallets in Houston. Now it has been decided to permanently switch to artificial surface and this presumably includes for Super Bowl LI.

Interesting that the switch was made for safety. Typically, grass fields are safer than field turf. Although, the new sport grass is clearly better than the old astroturf for injury. In this case, it wasn’t the surface of the natural grass that was the problem, it was the connections of the patchwork field that caused issues.

MMMD 7: ProFootballDoc scorecard

We haven’t tallied right or wrong in awhile. Soon we will have plenty of access to video with the regular season. In the meantime, previous predictions about Jordy Nelson and Julio Jones minor injuries were correct. Add in Watt likely missing time and Lewis’ knee scope not related to ACL. This takes the previous record from 16-0 to 20-0.

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Joe Messineo
NFP Fresh Voices

Jameis Winston and Marcus Mariota will be forever linked. These two met in the very first College Football Playoff Game at the Rose Bowl. They came into the game carrying the last two Heisman Trophies and the previous year’s National Championship. The first half of the game was really good, but the second half was Mariota and his Oregon Ducks running up a huge score on Jameis and his Florida State Seminoles.

They met again in their first NFL game after both were selected with the first two picks in the NFL Draft; Winston #1 by the Tampa Bay Bucs and Marcus #2 by the Tennessee Titans. Different uniforms, different leagues, both getting a hefty pay check, but similar results as Mariota again lit up Winston’s team.

It looked as if the Titans were geniuses at the time, but by season’s end, it looked as if the Bucs may have gotten the better quarterback. Winston had the Bucs to 6-6 at one point, thinking they might have a shot at the playoffs. The “P” word was never uttered in Nashville though as Mariota ended up going 3-9.

However, upon further review, Marcus had some really good stats. He passed for 19 touchdowns compared to only 10 interceptions and had a quarterback rating of 91.0. If he keeps that QBR over 90, he will be very successful and so will the Titans.

Winston was also very good, especially for a rookie. He threw for 22 touchdowns and 15 interceptions and his QBR was 84.2. Not too shabby.

So what will happen in their second year? You’ve heard of the “Sophomore Jinx” of course. There is a reason for that. Many times, that second season can be tough. Defensive coordinators have film on you now, and you now have expectations you that were not there in your rookie season.

But, these guys have dealt with a lot of pressure for several years now. College football, especially at the top of the sport, is every bit the pressure cooker the NFL is. And there was no shortage of film from college ball for the defensive coordinators to check out.

It seems evident that the second year will only get better for these two young talents.  Both Winston and Mariota seem to grasp their offenses very well, and can also read defenses. This is seen when you notice the low number of interceptions each threw. They should only get better in this area the more they play.

They also both have fantastic leadership qualities. Even as rookies, it was clear that they were the voice of their respective teams. Neither shied away from the press even after things did not always go well.  These are not easy things to do as a rookie.

The Bucs schedule includes the Arizona Cardinals, Broncos, Bears, Chiefs, and Chargers as well as the six NFC South teams.  While Tennessee has the Dolphins, Chargers, Packers, Vikings, Lions and Bears as well as the Raiders, Browns and their six games against the AFC South.

Both of those schedules have some land mines, but both could be a lot tougher. Both of these teams should go into the season with playoff aspirations. Will both make it? Probably not. Of the two, the Bucs have the best chance, but making the playoffs for any team in the highly competitive NFL is never an easy task.

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Dr. David Chao
Latest NFL News

Whenever something goes wrong, the blame game is started. We look for whom to blame with the league concussion issues. When injuries pop up, the same thing often happens.

The New York Giants medical staff has taken some heat over the years for leading the league in injuries. Now the Buffalo Bills and Pittsburgh Steelers medical staffs are being questioned.

It would be entirely unfair to place blame on anyone without a thorough analysis of the particular injuries. Certainly the Bills defense has taken four hits already this year, but are they the fault of the medical staff?

Indeed Buffalo’s first and second round draft picks have been injured. Shaq Lawson aggravated a pre-existing shoulder injury and had surgery. Reggie Ragland tore his ACL. IK Enemkpali has now met the same fate. Manny Lawson injured his pec, but at least his season is not over.

The medical staff doesn’t cause injuries. There is some evidence of effectiveness in soccer of ACL prevention exercises in young players, but it has not been proven in football. Clearly traumatic ligament tears are not the fault of the medical staff. ACL tears are rarely partial and it was too much to hope for that Ragland’s season could be saved.

We don’t know the dynamics of the Bills decision to draft Shaq Lawson given his shoulder issues. In my 2016 draft medical guide, I indicated that Lawson had a labral tear and would need shoulder surgery. If this was obvious to someone who didn’t examine Lawson, it is unfathomable that the Bills medical staff didn’t know it. The question is what stock management placed in the medical assessment and what played into the decision to initially risk playing with the injury. In my time in the NFL, my club has drafted players with poor medical grades based on perceived value. Just because a player with medical risk was drafted high doesn’t mean the team didn’t know about the problem.

In Pittsburgh there are questions about Ladarius Green and his headaches. Some are asking if the Steelers bungled the $20 million free agent signing. The replacement for retired Heath Miller has yet to practice and also is coming off ankle surgery. Some fans question why the Steelers medical staff would allow Green to be signed and whether they should have been able to predict his lack of availability.

I know the Steelers to have a top quality medical staff that has been involved in the leadership of the Pro Football Athletic Trainers Society and NFL Physicians Society. There is no way they did not have access to Green’s medical records as all 32 teams are on the same electronic medical records system. It is highly unlikely the medical team “missed” the ankle injury or lingering signs related to previous concussions with the Chargers.

To suggest his previous team did not properly document headaches or concussion symptoms would be extremely hard to believe. First, this was not a trade and there would be no benefit to a club to downplay medical findings. Second, the penalties for inaccurate medical records go way beyond any potential NFL fine or discipline. Falsifying, altering or purposely under reporting medical findings could result in state Medical Board action and/or civil litigation with career threatening implications for a medical provider. This is why I say the new NFL penalties for violations of medical protocol will have little affect.

Word has come out that Green reportedly never told the Steelers about his headaches when he was signed. This makes it near impossible that the medical staff is to blame. It is possible the player was not having headaches when signed or under reported symptoms to the team. To blame his previous club for allowing Green to play through headaches would be saying the independent and unaffiliated neuro consultants were in error.

Unfortunately due to HIPAA privacy laws, the team physicians involved cannot come out and tell their side of the story in New York, Buffalo or Pittsburgh. This leaves their roles up to speculation and any public accusations or implications cannot be refuted by the medical staff.

The Jaguars are poised to simultaneously add three first-round talents to their defense, but does their medical staff get any credit? Last year’s first pick Dante Fowler tore his ACL early in offseason but has rehabbed well. Jalen Ramsey had a post draft injury this year with knee surgery and has made a quick recovery. Clearly the Jaguars medical staff had some input in the evaluation for top of draft talent Myles Jack and his early second round selection despite medical concerns. I don’t hear any kudos coming to the Jaguars medical staff now that Fowler is back, Ramsey dodged a bullet and Jack seems to be performing well.

The blame game is one reason I started my media efforts. Most medical staffs are not allowed by their team to speak out and federal law prohibits the disclosure of private medical information. I am not here to defend anyone. I only try to provide an insider’s prospective of what may be happening.

Injuries always affect teams. So far it seems the injury bug has hit the Bills defense several times, and fortune has smiled on the Jaguars defense so far. In some ways, medical staffs are like long snappers. It seems when something goes wrong they get the blame, but when it goes right, the credit is given elsewhere.

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