Dr. David Chao
The Training Room


MMMD 2.8.16

Injuries not an excuse

Everyone wants the game decided between the white lines. No one wants the “what ifs” of an injured key player or a referee’s blown call. Although Super Bowl 50 was not a mistake free game, fans got what they wanted. The better team (or should I say the better defense) won and no one is making excuses.

This was an essentially healthy Super Bowl. Sure there were key players from both teams that were on injured reserve, like Kelvin Benjamin, Charles Tillman, and Ryan Clady (all three out from ACL tears). However, key injuries on both clubs played and all were able to contribute.

There were no excuses coming from the Panthers. Thomas Davis played well as expected just two weeks after breaking his forearm. Jared Allen played despite a fractured foot. Coach Ron Rivera dismissed the ideal that Corey Brown leaving with a concussion changed the game.

The Broncos trio of injured defensive backs, T.J. Ward, Darian Stewart and Chris Harris all played. Peyton Manning played without obvious effects of his plantar fasciitis.

Concerns about the grass field at Levi’s Stadium being suboptimal or causing injury were unfounded. Sure there were some slips but a loose turf/poor footing actually helps to reduce traumatic injury.

Even with the halftime show and the post-game trophy presentation, the field seemed to hold up to my post-game inspection.

I am happy Super Bowl 50 involved no cart offs and few injuries. There was no concussion controversy like last year with Julian Edelman that led to the new medical timeout rule. Corey Brown did enter the concussion protocol, despite originally the calf being the main concern.

A positive injury spin for the golden Super Bowl is the way I like it. I wish every game would be more like this one.

MMMD 1: MVP for a reason

Of course Von Miller’s game changing play is what earned him the Most Valuable Player award. His 2.5 sacks and two forced turnovers were key.

The reason for his spectacular play is that he is finally 100% Although he played well last season, the second season back from ACL is usually the better year. I tell my patients it takes a minimum of 18 months to forget about your knee.

When I asked Miller about his knee last year during Super Bowl week, he claimed his knee was good, but when pressed, admitted there was more improvement to come. No matter how hard someone works, you just can’t speed up the biology of the ACL graft incorporating and becoming a ligament again.

MMMD 2: Ups and downs of being there in person

Although I sorely miss seeing the broadcast and don’t have access to replay, there are up sides to being in San Francisco. I learned a lot by being there asking the right medical questions and observing first hand.

There were reports of a laser healing Jared Allen’s foot fracture. When asked about it, the Panthers DE said he didn’t know if it was the laser that helped him or the myriad of other treatment modalities.

Thomas Davis had no swelling and no protection on his forearm during the week. I doubt the picture circulating of his “football-like” forearm was a current one. The photo Davis posted seemed to be taken well before arrival in the Bay area.

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I always suspected that Chris Harris, Jr. had more that a bruised arm. He confirmed he had a nerve injury that caused him considerable pain but won’t need surgery.

Reggie Bush explained at the NFL Honors red carpet that his surgery was more than simple arthroscopy. He had meniscus repair where his cartilage was sewed and requires more recovery time than trimming but he should be ready well before training camp.

Jamal Charles appeared on track for a second successful ACL surgery. In person, he had excellent flexion of his knee while making the rounds on radio row. Range of motion is the first step after ACL reconstruction and Charles seems well on his way.

MMMD 3: Athletic trainers are hardworking and underappreciated

As Broncos teammates, coaches and staffers were celebrating and passing around the Lombardi Trophy in the locker room, the athletic training staff was still hard at work. They emerged for a quick minute to get a group picture in front of a Champions banner, but then quickly returned to training room duties.

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Athletic trainers rarely get the spotlight they deserve. Even in defeat, the Panthers medical staff certainly deserves praise and Stephania Bell’s piece does just that.

Athletic trainers are the first ones to arrive and the last to leave. They are the unsung heroes of football.

MMMD 4: Head Health Initiative

Results of the NFL’s Head Health Challenge were on display during Super Bowl week. There was promising technology to provide an underlayer for artificial turf to lessen the blow as one’s helmet impacts the ground.  Two types of new helmets to help protect against concussions were in the works. Finally, two new diagnostic tools are being developed. One is a blood test and the other is a portable mini-EEG. Both have potential for sideline usage.

The hope is by next Super Bowl, some of these new products will be in use in Houston.

MMMD 5: Two people fired over JPP medial record leak

As expected the hospital realized it had a problem and started an aggressive investigation that included examining computer access. HIPAA privacy laws were broken by the hospital and whoever leaked the information.

Two people who had inappropriately accessed the information were fired. This does not mean either of them leaked the information to a reporter. They could have just done it out of curiosity. The actual source of the leak could have gotten away with it as he or she may have had legitimate access to the info but was wrong to let media know about it.

MMMD 6: Two best parts of Super Bowl week for me

I ran into Mike Pereira and had a nice chat. I told him how I describe what I am doing in media as the “medical Mike Pereira”. He was flattered and liked the idea. He sees a definite growing roll for medical analysis as has happened with rules analysts.

I also got a great look throughout Levi’s Stadium. This was the only current NFL stadium that I have not been to. The 49ers new stadium was finished after I resigned from head team physician duties in 2013. Not sure what difference it make but now I can once again say that I have been to all current NFL stadiums.

MMMD 7: ProFootballDoc scorecard

Other than adjustments when new info comes to light, this will be the final self-scoring update for the 2015 season.

Thomas Davis played and played well as expected. Chris Harris, Jr, confirmed he had a shoulder nerve issue as postulated. Both Broncos safeties started as indicated two weeks ago. Corey Brown did have a calf issue before he was entered into the concussion protocol.

The previous 160-10 (94.1%) record  now ends the football year at 165-10 (94.3%). This is similar to the 2014 season total of 137-11 (92.6%). The low 90s percentage is about equivalent to picking 15 out of 16 games correct each week. Video analysis will never be completely accurate or replace a hands-on examination, but I believe it gives a reasonable first impression.

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Greg Gabriel
The Director's Report


Austin Hooper – TE – Stanford

Size –

6040 – 250 – 4.68 (All Estimates)

Strong Points –

Very athletic, smooth, easy change of direction, very good hands and ability to adjust to the ball. Good route runner, can uncover versus both man and zone. Can be productive both short and deep. Good runner after the catch. Willing blocker. Has growth potential to 255-260.

Weak Points –

Seldom plays in-line as a Y. Lacks strength and power to be effective as a blocker. Needs to get bigger and stronger. Not play in short yardage situations. Does not have a lot of playing experience.

Summation –

Underclassman who is entering the Draft. Listed as a junior but still had two years of eligibility left. Did not play as a true freshman in 2013. Seldom lines up in-tight as a Y, usually flexed out as a slot, wing or wide. Very good athlete who has very good body control and speed. Good route runner who can uncover versus zone or man. Has excellent hands and can make the difficult catch. Strong runner after the catch. Effective short and deep. Needs to get stronger and improve blocking skills. Has to be used as a move tight end until he gets bigger and stronger. With his athleticism he has upside.

 

 

Glenn Gronkowski – FB/TE – Kansas State

Size –

6026 – 235 – 4.69 (All Estimates)

Strong Points –

Good athlete, strong blocker (run and Pass) Good short route runner, hands and run after catch ability. Inside run, can get tough yards and will get yards after contact. Tough and competitive.

Weak Points –

Role player in the Kansas State offense, doesn’t get to carry the ball that often.

Summation –

Younger brother of the Patriots Rob Gronkowski.  A fourth year junior who has graduated and will enter the Draft. Is a role player for Kansas State and is used mainly as a blocker. He is a strong lead blocker who is good at finding his block and adjusting on the move. Good inside runner who can get tough yards. Good receiver who runs good routes and had good hands. Can be a combo fullback/move tight end at the next level. Should also be a productive special teams player.

 Follow Greg on Twitter @greggabe

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Greg Gabriel
The Director's Report


Graham Glasgow – OC – Michigan

Size –

6063v – 306 – 5.15 (est)

Strong Points –

Excellent size to play any position on the O-Line. Has started games at both guard and center while at Michigan. Can snap and step and get into his blocks. Stays low on run blocks. Very athletic and can get out in front of backs in space. Alert player. Tries to be physical and finish.

Weak Points –

Can get tall. Especially in pass pro. Have seen him give ground to bull rushers. Needs to add strength in both his upper and lower body. Not always adjust well on the move in space.

Summation –

His versatility has value. Can come in as a rookie and backup at center and guard which means he dresses on Sundays. He is very athletic for a tall guy and flashes playing with top bend. Still he can get lazy with his technique and play tall. Like many college linemen, he needs to get stronger but he has the traits to be an eventual starter at center or guard by year two or three.

 

Rees Odhiambo – OG – Boise St

Size –

6036 – 302 – 5.15

Strong Points –

Athletic, strong and explosive. Plays a physical game. Can use his hands. Has “snap” through his hips to explode through opponents. Able to get movement with run blocks. Quick set in pass pro, has a strong punch and can mirror. Good anchor. Runs well

Weak Points –

Has trouble staying healthy. Has missed time in each if the last three seasons. Plays tackle but is lacks the height clubs want for a tackle. Inconsistent finisher in both the run and pass game. A bit small at 302.

Summation –

Talented player with the versatility to play tackle or guard at the next level. He is strong and athletic to go along with strength and power. Has long arms and that helps him overcome his lack of height when playing tackle. Needs technique work and also needs to gain a little bulk but he has the talent to be an eventual starter if he proves he can stay healthy. His durability concerns will get him drafted later than his talent level.

Follow Greg on Twitter @greggabe

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Greg Gabriel
The Director's Report


Cyrus Jones – DC/RS – Alabama

Size –

5096v – 196v – 4.48 (Est)

Strong Points –

Tough and competitive. Has the required quickness, flexibility and speed. Tracks the ball well. Can play press or zone. Good in run support and a good tackler. Very good punt returner. Has long arms allowing him to play taller than he measures.

Weak Points –

Being that he is under 5’10, some clubs won’t have him on their draft board. Can give too much cushion in off coverage. Transition needs to improve.

Summation –

Two year starter for Alabama and their punt returner. Has been a productive corner with 7 career interceptions. Shows some inconsistencies in coverage but when he is on his game he can be very good. His lack of ideal club with keep some clubs from drafting him. Can come in and be a clubs number 1 punt returner while he further develops his coverage skills. See him eventually becoming a starting slot corner. His punt return skills will get him drafted higher than his coverage skills.

 

 

Deiondre’ Hall – DC – Northern Iowa

Size –

6015v – 192v – 4.50 (Est)

Strong Points –

Tall with rare length (34 ¾” arms). Good athlete with deceptive speed. Plays the ball well (13 career interceptions). Quick to support the run and a good tackler. Good jam and can turn and run. Alert in zone. Has the frame to get to 210-215.

Weak Points –

Raw, gets tall with his pedal and isn’t real nifty with his footwork. Played some free safety and would bite on play action. Needs to add bulk and strength. Plays at a lower level of comp.

Summation–

Reminds me some of Charles Tillman when he was coming out. Hall is very tall and long but also lean and raw. Tillman has awful footwork entering his first camp and Hall’s may be a little better. Can play press and reacts to the ball. With his long arms he has a distinct advantage and he has good hands. Going to need a year to develop the finer points in coverage but the upside is there. Tillman was a high 2nd round pick, Hall won’t go as high but he won’t be far behind because of his upside.

Follow Greg on Twitter @greggabe

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Dr. David Chao
The Training Room


 

Case Keenum

MMMD 2.1.16

Why have concussions increased 58%?

The NFL announced concussions diagnosed during 2015 regular season games jumped to 185, up from 115 in 2014. Last year, the NFL announced the opposite, a 25% decrease in overall concussions. Why the conflicting trends in head injury?

Overall, there were 271 concussions during the 2015 season, up from 206 in 2014 This season, total concussions were up 26% over the average of the last three years.

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The NFL panel on the injury data results conference call cited more screening, better detection, improved record keeping and more self-reporting of concussions as the reason for the 2015 increase. Crediting rules changes as the reason for the 2014 drop in concussions, the NFL said players were “changing the way they’re tackling” and “changing the way they play the game”. The contrasting explanations for this year’s increase versus last year’s decrease seem too simplistic.

Don’t get me wrong, I don’t think there is a continuing concussion conspiracy in the NFL. I would even applaud the NFL for being forthright with the bad news in pointing out the worst statistic of a 58% jump in concussions during games when they could have cited a much lower 32% overall increase in concussions. It is difficult to generalize injury data without a closer inspection of the information. I don’t doubt there is increased screening, detection, record keeping and self-reporting. I don’t doubt that some players have made a conscious effort to avoid helmet contact. It is also possible to just have “bad luck” year with more concussions.

Although I think all of these reasons play a role, I feel there may be an additional factor. I agree there has been a culture change towards concussions but I witnessed it happening well before 2015. As early as 2012, then 49ers QB Alex Smith self-reported a concussion (and subsequently lost his starting job). The final NFL panel speaker referred to this culture change happening over the last three to five years, not just 2015. The Rams head team physician spoke of “co-lineman…notifying us when they think something may be awry”, although that certainly did not happen with Case Keenum when two Rams linemen tried to help their stumbling QB up.

In addition to the above-cited reasons for more concussions, I think the medical atmosphere has changed. There is more scrutiny, criticism, and lawsuits targeting the NFL and team physicians. I think it is only natural for medical personnel to react and be even more careful. In the end, taking an increasingly cautious approach may be a good thing, but it can skew the statistics.

This increased caution results in the fact that twice as many players were placed into the concussion protocol. There were also twice as many “call downs” this season (2.8 per game vs 1.4 last year). The threshold to diagnose a concussion has also been lowered.

When a player has been determined to have a concussion, they seem to be returned more slowly in 2015. Most concussions now miss the next game (average time 10-12 days) whereas last year it seem more returned the next game. Very few, if any, players who were concussed Sunday returned to play in a Thursday game this year, where that seemed to happen more regularly last year. Also just look at the increasing number of “cart-offs” for non-head injuries this year as a sign the medical atmosphere has become more cautious. In the past, most games did not see a cart on the field; however, this season “cart-offs” were a regular occurrence.

The increase in concussions is alarming and needs further evaluation as to why it is happening. Recently, former Giants safety Tyler Sash was diagnosed with CTE. He only played two years (27 games) in the NFL, but played 16 total years of football. This is why in addition to protecting its own players, NFL physicians have a societal obligation to take the lead on football safety at all levels. A more cautious approach is a good way to start.

MMMD 1: Thursday games do not lead to more injuries

The injury data also touched on the rate of injury in short rest games. Many have felt that Thursday games pose additional risk.

Although the sample size is limited, the NFL data indicates there is one less injury with Thursday games compared to those on Sunday or Monday. Across the last four years, there has not been an increase associated with mid-week games. This data does not address if the already injured athlete has enough time to recover properly.

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MMMD 2: ACLs same while MCLs higher

The NFL also reported on some common knee injuries. ACL tears were about the same across the last four years.

On the other hand, MCL injuries had a 25% jump. This means that one third of teams have a medical collateral ligament sprain each week, which is not surprising based on my experience.

MMMD 3: Player health survey misleading

The Associated Press released a non-scientific survey of 100 players that showed only 47 thought their best interests were being protected.

Don’t mistake this for a player health survey as the question lumps NFL teams, coaches and doctors together. 39 players who thought the team, coaches OR doctors didn’t have their best interests at heart answered negatively. The key is did they feel the team doctor didn’t have their best interest or was it the team or coach?

The CBA requires the NFL and NFLPA to jointly perform a scientific league-wide player medical satisfaction survey. This survey was professionally administered during the season and I eagerly await the results.

MMMD 4: Both teams on track for a healthy Super Bowl 50

A lot of injuries “heal” in the two weeks before a Super Bowl and that is indeed the case again this year.

The Panther’s no longer even list Jared Allen (foot fracture) on the injury report. Ryan Kalil’s has practiced and indicated his knee won’t be an issue. Expect Jonathon Stewart and Mike Tolbert to be full go. Even Thomas Davis, who broke his forearm and had surgery, will be ready to play with a cast/splint. Davis will be able to tackle, wrap and grasp; however, his chances at an interception may be hindered.

The Broncos and their pair of safeties should be healthy too. Darian Stewart has a mild MCL and should play alongside TJ Ward (ankle). Peyton Manning’s plantar fasciitis is not gone but largely behind him as evidenced by his 12 yard run in the AFC Championship Game. His weak triceps is the same as it has been due to chronic nerve damage from neck issues.

MMMD 5: Offseason surgeries the norm

News came that Aaron Rodgers had surgery, but he is not alone. In my time as a NFL team physician, there were always more surgeries after the season than during the season. The Packers QB reportedly had a clean up knee scope and should easily be back for OTAs.

On average, a team will have about 10 surgeries at the end of the season. Most procedures are clean up and preventative in nature. Offseason is where a team medical staff tries to take care of any ailing issues and perform any preventative procedures, like the one being discussed for Tony Romo’s clavicle.

Since there is no requirement to disclose offseason surgeries, often the public is kept in the dark or we find out late. This leads to unnecessary speculation and worry when a routine offseason surgery is later discovered.

MMMD 6: NFL team physicians have “real jobs” and “real lives”

Most incorrectly assume that a team doctor’s primary job is for the team. Not only do team physicians have their own separate practices, typically far less than 10% of their livelihood is tied to the club.

When the Patriots head team doctor resigned last week, some incorrectly assumed that he was forced out as a result of New England leading the league in injuries. By video, the Pats injuries were largely traumatic and unrelated to the medical staff. Along with the athletic training staff, many potential season ending injuries successfully returned to play, like Rob Gronkowski (knee) and Julian Edelman (foot).

There is no question that there is prestige involved with any team physician job, but the reality is the doctor gets the team job because of his successes rather than becoming successful because of his NFL appointment. For example, Dr. Matt Provencher already had a prestigious position leading sports medicine at Massachusetts General Hospital prior to being named the Patriots head team physician two years ago. Now he is moving on to another prestigious job in Vail that will be a better fit for his family and four kids.

The team doc job is essentially a full-time job with part-time pay that is done after hours and on weekends. Team docs have calculated their time to be over 2000 hours per year, which is equal to a 40hr/week job.

It is incorrect to assume a team doc’s resignation is code word for being fired. After all, the Combine evaluations are one of the most important tasks for a team physician and my understanding is that the Patriots are happy to have there soon to be former team doctor join them in Indianapolis before he moves on to his new life in Colorado.

MMMD 7: ProFootballDoc scorecard

The Pro Bowl is not supposed to generate injuries so nothing new to grade this week. Tyler Eifert did leave the stadium with a walking boot, but I doub there is anything serious. With one game left the season long record is still 160-10 (94.1%).

I document these numbers on a weekly basis and welcome readers to go back to inspect the validity of the analysis. Please tweet at me or comment below if you don’t agree with any of my self-assessed scoring. That is the whole point of making this process public.

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