Dr. David Chao
The Training Room


Season-ending injuries have spurred more discussion of limiting preseason games. Are there really more preseason injuries? It certainly feels that way, but that may be the illusion created by increased media coverage of injuries. Nowadays, an ACL tear to the 3rd stringer that won’t make the team still makes news.

The NFL and the NFLPA rarely agree, but they both say there is nothing new or unusual and state injuries are not up overall. The aggregate numbers may not be statistically increased but I do believe there is a worrisome trend. Last week I indicated the highest number of preseason ACL tears in the last decade was 27 in 2013. We are now at 25 with a week of preseason to go.

A detailed look may explain our feeling of more injuries as more starters are injured in the era of the current collective bargaining agreement (CBA). By my count, the ten years prior (2001-2010) there was an average of 6.2 starters league-wide on injured reserve (Football Outsiders) at the start of the season. Since the new CBA (2011-2014), there were 10 starters per year who began Week 1 on IR. Of course, IR numbers are not in for this year, but with Raiders starting right tackle Menelik Watson’s Achilles rupture last night, it looks to surely exceed the average of 10. This represents a greater than 50% increase in starters being injured in the era of the current CBA.

I always have said that one season-ending injury to a key star and the feel is that of a “bad” injury year. Meanwhile, multiple injuries to those outside the projected 53 and the feel is that of a “healthy” preseason. By counting injured starters, I think we can account for our collective feeling of more injuries.

How do we prevent more starters being injured? Eliminating preseason games would be a knee-jerk reaction. First, most starters play sparingly in the preseason and that trend has not changed. Second, the vast majority of season ending injuries like ACLs, occur in practice. Jordy Nelson was a high profile exception, but Kelvin Benjamin, Orlando Scandrick, Dante Fowler, Jr,, and others all tore their ACL during practice.

The current CBA mandates less practice time, eliminates two-a-days and reduces the amount of player contact. Why would preseason/practice ACL injuries increase (or even stay the same) when they should go down due to the new protections started in 2011? The leading two season-ending injuries are ACL and Achilles tears and both predominately occur without contact. Limiting contact/padded practices doesn’t change the rate of these tears.

The current practice rules may also have unintended consequences. Some say there is too much rest and players are not in shape. I don’t buy that as we don’t see an early season injury spike and a later season drop in ACL tears as players “get into shape”. My theory is that limited practice time and contact has created the new mantra of tempo. There is a league-wide focus on practice speed/intensity, using multiple fields and maximizing plays with game urgency. Walk thru practice is now a run thru event. Another unintended consequence of limiting practice time is the starters will get their reps, but the third stringers get cheated with limited time. Ask veterans if camp is any easier for them now. My informal survey says “no”. These factors may contribute to the 61% increase in starters on IR for Week 1.

The NFL and NFLPA may be right that total preseason injuries are not up; however, the data seems to show there are more starters injured. Next week, I plan to discuss “sports science” and how analytics can or can’t help prevent injuries.

MMMD 1: Unusual happenings in Washington

In almost two decades working in the NFL, I don’t recall not being on the same page with the head coach. I am not aware of conflicting information between a doctor and coach with other teams either, at least not publically. In Washington, we have our third public misunderstanding in the last three seasons involving the same player.

I am not inside Washington’s team walls and I make no judgments as to fault. I have not spoken to anyone involved, nor am I an investigative reporter. I am not making any criticism of their medical care. As a former NFL team physician, I simply make the observation that this mixed messaging is not something typically seen.

Late in the 2012 season, a team doctor publically disputed head coach’s assertion that Robert Griffin III was cleared to go back in after a knee injury. At the beginning of 2013 season, the same head coach referenced a doctor’s concerns on RG3’s knee but the doctor publically denied that he had any. Now, we have a different head coach and a different doctor at odds on whether RG3 was cleared to play from concussion. This time Washington put out a public statement from the independent neurological doctor that contradicted the coach saying RG3 was cleared.

Perhaps this repeated doctor/coach misunderstanding is indicative of a larger team dysfunction as I wrote about previously. A report now surfaced about the Redskins brass being at odds over the RG3 era ending.

MMMD 2: All 1,184 players released this week need to be healthy

480 players will be cut by Tuesday and an additional 704 players by Saturday. All players need to be healthy to be released. A team can’t cut an injured player. If unable to play football, injured reserve classification is used or injury settlements much be reached. If a team cuts an injured player, he is entitled to file an injury grievance. Five players who are released can be signed back to the practice squad.

This is why I always said my goal as head team physician was to get everyone healthy, from the star player to the 90th player on the roster. I used to tell management I didn’t want to know if a player was about to be cut, my job was to get players healthy either way.

MMMD 3: Three things that don’t surprise me.

Having the fortune of being a medical insider, these three things may come as a surprise to some but not to me.

Manning’s triceps

Peyton Manning’s fingertips being numb is not surprising to me. Feeling is affected before muscles get weak. His triceps atrophy/weakness has been well documented. With his triceps affected, I would expect good feeling in the thumb and index finger but loss of feeling in the long and possibly ring/pinkie fingers.

Todd Gurley was only recently cleared to practice fully, but still is not likely a Week 1 starter. I don’t doubt his health or ability, but it is enough to ask any player to return the following season to his same level after ACL surgery. However, Gurley is being asked to do two things: return from surgery and play at a higher NFL level.

Geno Smith throwing at practice nine days from surgery is not surprising. As soon it was discovered that his jaw was not wired shut, I felt he would beat the initial 6-10 week recovery timeline. His practicing in a red jersey is a good medical sign. Of course, there may be other reasons he doesn’t play Week 1.

MMMD 4: Russell Wilson’s nanobubbles debunked

The Seahawks quarterback is an investor in special water and claimed the nanobubbles helped prevent a recent concussion. There is no scientific evidence to support that claim.

There is more we don’t know about concussion than what we do know. We do not know of any true preventative measures that work, other than avoid the blows to the head.

MMMD 5: Why narcotic pain meds are needed

For decades, sports team physicians from the Olympics to the NFL have routinely travelled with a limited quantity of pain medication. After all, if you could get your doctor to make a house call, do you want him/her to show up with medication or empty-handed. The Drug Enforcement Agency has made it clear over the last several years that travelling with even a single pill not already prescribed may be medically indicated but is not proper per federal laws.

Pain medicine is needed in the NFL for humanitarian reasons, not just playing to pain. Patriots’ fullback James Develin broke his tibia in Charlotte and stayed behind for immediate surgery. If he had access to pain medicine, would he have been able to fly home with the team in a splint instead of being left behind and hospitalized? He certainly deserved immediate pain medication at the stadium, which his team doctors are no longer able to have on hand.

This season, the league is instituting a visiting team medical liason (VTML). In the past the host team physician would assist the visitors. The VTML may be able to assist in obtaining medications, but my guess is the home team orthopedic surgeon still helped the visiting Patriots out with the tibial rodding surgery. Team doctors do not have privileges to perform surgery or admit players to the hospital outside their home state.

Taste at the Cove

MMMD 6: Taste at the Cove thank you

One of my passions is helping kids without access to medical care, obtain the care they need. 14 years ago we started the San Diego Sports Medicine Foundation and it has provided over $1.5 million in free surgeries and medical care. Our annual fundraiser was held this past Thursday. Thanks to all who attended or bid online.

Special thanks to honoree LaDainian Tomlinson and emcee Nick Hardwick as well as the countless teammates who came out to support. Extra thanks to Hall of Famers Marshall Faulk and James Lofton for coming.

Some former teammates at Taste of the Cove

MMMD 7: ProFootballDoc scorecard

Last week, I had my first miss for 2015 resulting in a 17-1 overall record. This week I tried to make amends to Packers fans as their other star wide receiver, Randall Cobb, was injured. The video indicated AC joint separation (shoulder sprain), which was later confirmed.

I believe Cobb is likely to return to play for Week 1. This injury does not truly healing, but is a matter of controlling swelling and pain. Any elevation of the end of the clavicle stays up and never comes back down, but functionally is not an issue.

Cowboys CB Orlando Scandrick was injured in practice but we were lucky enough to still have injury video courtesy of local news. Unfortunately, he did suffer an ACL and MCL tear from accidental contact from a teammate.

Patriots FB James Develin had a rotational injury similar to UFC’s Anderson Sliva and predictably suffered a tibia fracture that required surgery. An initial report indicated a “clean break” and hope of a 6-8 week return but I think it is much more likely a season-ending injury.

When Giants safety Nat Berhe injured his calf a month ago, I tweeted the opener was in doubt as calf injuries tend to linger. Now the entire season is in doubt after calf surgery to remove a blood clot.

I will count the above four as correct but I will hold off on counting the predictions of Arian Foster, Zach Ertz and Chris Hogan. Foster and Ertz had similar surgeries and Foster is following my prediction of quicker than indicated return and is doing modified running. Ertz original target of Week 1 was optimistic and it now looks like he will miss the opener. Chris Hogan’s injury is pegged at 2-4 weeks and consistent with PCL but I have yet to hear the specific diagnosis, so that can’t be counted.

I never saw any video on Leonard Williams and Bryan Bulaga video was very limited so I took a pass on these two.

That leaves the record at 21-1 so far for 2015.

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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Greg Gabriel
The Director's Report


As most of you who have read my work here know, I was critical of the Jacksonville Jaguars selecting Blake Bortles with the third overall pick of the 2014 NFL Draft. It’s not that I felt Bortles wasn’t worthy of being a first round pick, I felt that neither he nor any other quarterback in the 2014 class was worthy of being drafted in the top 10. The better strategy would have been trading down and then selecting Bortles.

Based on how Bortles played as a rookie last year I felt justified. His stats were average and his play regressed as the season wore on. For the season, Bortles completed 280 of 475 passes for 2,908 yards, 11 touchdowns and 17 interceptions. In the stat that counts the most, the Jags won only three games. Bortles did not look like a quick-reacting, instinctive quarterback.

During the offseason, the Jags did everything they could to revamp the offense. Offensive Coordinator Jedd Fisch was replaced by Greg Olson, who I feel is one of the most underappreciated offensive minds in the NFL. Olson did a remarkable job last year working with rookie Derek Carr in Oakland. Kelly Skipper was also hired as the new running backs coach, Doug Marrone as the offensive line coach, and Nathaniel Hackett as the quarterbacks coach.

General Manager David Caldwell also brought in some new veteran players to help out Bortles. The biggest new name was tight end Julius Thomas from Denver whose presence will help young wide receivers Allen Hurns, Marqise Lee and Allen Robinson.

I have been able to watch the Jaguars twice so far this preseason and the improvement in Bortles play is remarkable. Friday night, in his most extensive action in the preseason, Bortles completed 20 of 29 throws for 245 yards, and a touchdown. For the preseason he is 39 of 60 for 461 yards and a touchdown.

Bortles is playing with more confidence, reacting quicker, making better decisions and getting the ball out of his hand quickly. He is doing a very good job going through his progressions and finding the open man. Most importantly, is he is not forcing throws into coverage and throwing interceptions. He does not have a turnover so far in the preseason.

Not only has Bortles completed a high percentage of his throws (65%), but his ball placement has been very good. Ball placement is what it’s all about. If a quarterback has good ball placement skills, the receivers have a chance to make plays after the catch and it greatly reduces the amount of turnovers a team has.

While I attribute much of Bortles improvement to Olson, a lot of credit has to go to Bortles also. He has done the work necessary to improve his game and that work should pay off in the success of the Jags.

While it may be too early to say that Jacksonville will challenge for a playoff spot, I will say that the Jaguars will find their way out of the AFC South cellar and could finish as high as second in the division. Bortles just may be a little better than I gave him credit for when he was coming out. If that turns out to be the case, give the credit to Greg Olson.

 

Follow Greg on Twitter @greggabe

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Erik Oehler
Guest Stars


Hi, Rex. It’s me, Erik. Great win Saturday!

I mean it, you guys looked great!

Yeah, I know! EJ looked good! I saw both of his touchdowns.

Yeah…that’s kinda what I’m calling about. Listen, I know you’re getting it from all sides right now. You’ve got guys in your ear, in the locker room, maybe even in the front office, and they’re telling you things. Things that don’t sound so bad right now. Things that, after yesterday, you might be thinking about.

Well, things like the Earth is flat, dinosaurs didn’t exist, EJ is the guy…but yeah, mainly EJ is the guy.

No, I know. I know. I’m not saying he didn’t play really well Saturday. He did! Absolutely! But Rex, I’ve been here a while. I’ve watched a LOT of bad quarterbacks. And I’ve watched a lot of new coaches try to work with those bad quarterbacks. It’s not pretty, Rex. But, I’ve got good news for you. You don’t have to do that! You went out there. You got not one, but TWO solid guys in Matt Cassell and FROM VIRIGINIA TECH, WEARING NUMBER 5, YOUR STARTING QUARTERBACK OF THE FUTURE, TYROOOOOOOOOOOOOD TAYYYYYYYLOR-AYLOR-LOR!!!!!!

No, I don’t really have a favorite.

I mean, yeah, if you’re asking me, Tyrod played pretty well…Great, even! And then there’s Matt right behind him. And then EJ.

Yeah, so actually it’s just like Tyrod and then Matt…yeah.

So basically, Tyrod.

Tyrod.

Tyrod.

NOOOOOO! REX! No, Rex don’t do this! Don’t do this Rex. Rex, I want to tell you a story. A story about wasted years and lessons learned. It’s a story about a guy named “Dick”. Dick got a head coaching gig, right around here actually, and inherited the previous guy’s quarterback: a first round pick. We’ll call him “JP”. Dick liked what he saw of JP in camp and in the preseason, and couldn’t believe what they were hearing about him from the year before.

Oh, just things like, “He’s a bust”, and “We should draft another quarterback”, and “We benched him for Kelly Holcomb”.

Yeah, THAT Kelly Holcomb.

Well, if you really want to know, they were 7-9, Rex.

SEVEN and NINE. Oh, no, he wasn’t benched after that year. Oh no! You see, he had played JUST well enough to start again the NEXT year, even over the guy they drafted. He got injured shortly into the season, and they switched to another in a long line of sub-par QB’s…

But that’s nothing like this situation, no, not at all…except…

Well, except, you didn’t draft EJ, right?

Yeah, you didn’t draft him, and, oh wait, this is weird…but, he did get benched last year, pretty quickly for Kyle Orton, right? Kinda like JP did, right?

And they were both first round picks weren’t they?

At least their names aren’t similar or anything. JP. EJ. Losman. Manual. Man. J. J. Man.

Yeah, not similar at all…

Oh, Dick’s second year? 7-9.

Third was 7-9, too.

Fourth was 3-6 and they fired him.

Yeah, I’m not sure how he lasted that long either. But you know, new owners now. Team with playoff potential. Shorter leash, if you know what I mean.

What do you mean what do I mean? I just mean that maybe you should go with your gut back before this game. Let’s pretend this game didn’t happen. Wipe it out. I mean, it wasn’t exactly Revis and Cromartie out there. So, go back. And what was your gut saying?

Yeah? Mine too. Mine too, Rex.

Why should we forget how that felt just because we feel another way now? And why should we start JP, I MEAN EJ, when we’ve got someone you “hand-picked“, that you knew back when you were with the Jets was something special.

Do the right thing, Rex. We’re ready for something exciting in Buffalo. Someone who takes off forward when the pocket collapses, not someone who runs for their life. We want someone with a non-acronym first name, even if it makes people who don’t follow football think you’re talking about a car repair at first. We want someone with a visor, dammit.

That’s right Rex. It’s Tyrod time.

Follow me on Twitter @erikoehler

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Greg Gabriel
The Director's Report


 

There has been much discussion in the last few weeks as to whether or not Notre Dame should be forced to join a conference in football. As we all know, they have been an independent in football since they began playing football. They are one of the few truly national universities and as such they would like nothing better than to remain an independent.

Last year in the first year of the college football playoff era, the four teams that made it into the playoffs all won a conference championship game in order to earn their way into the playoffs. The four schools were: Florida State, Alabama, Oregon and Ohio State.

These schools all played a 12 game regular season schedule, plus a conference championship game. The Big 12 had a worthy champion last year in TCU but they were left out of the dance mainly because they didn’t play that 13th conference championships game. In my opinion, TCU got shafted last year and deserved to be in the playoffs.

This year Notre Dame has a very strong team with 21 starters returning plus two players who were starters in 2013 but missed 2014. Their overall depth is as strong as any team in college football this year.

Granted they don’t play in a conference, but they play 12 solid regular season games and have no FCS level cupcakes on their schedule. Looking at the playoff teams for last year, Alabama this year plays Middle Tennessee and Charleston Southern. Oregon plays Eastern Washington and Georgia State. Ohio State doesn’t play an FCS school but has games against Northern Illinois, Western Michigan and Hawaii. Florida State plays Texas State and Tennessee – Chattanooga. Every practice these schools go through is tougher than those opponents. They should be penalized just for scheduling them.

While Notre Dame doesn’t play a conference championship game, they do have a schedule that includes: Texas, Virginia, Clemson, Georgia Tech, USC, Stanford, Pitt and Boston College. I agree that if they don’t go 12-0 or at worst 11-1 they shouldn’t be in the playoff conversation, but if they do have an unblemished record they have to be in the discussion!

Looking at their team, they are strong at every position. The quarterback will be Malik Zaire who only has one start under his belt, but that was in their bowl game victory over LSU. In that game, Zaire completed 12 of 15 passes for 96 yards and a touchdown. He also ran for 96 yards. While he isn’t the passer that Everett Golson was, he is more dangerous because of his elite running skills.

Last year’s leading rusher returns in Tarean Folson who ran for 889 yards in 2014. Six of the top seven receivers from a year ago return including their leading receiver William Fuller who had 76 receptions and 15 touchdowns in 2014.

The offensive line has four starters back, including Ronnie Stanley, who looks like a future first-round draft pick.

On defense just about everyone returns with the main loss being nose tackle Jerron Jones who injured a knee earlier in camp. Defensive tackle Sheldon Day will be a very high NFL draft pick and may be the best 3-technique in the country.

Linebacker just maybe the strongest positon on the team as five players who started games return led by All-American Jaylon Smith, who is one of the more athletic linebackers in the country.

In the secondary three starters return, as well as KeiVarae Russell, who missed last year but started every game in 2012 and 2013. He is the most talented player in the secondary and one of the best corners in the country.

Notre Dame will be a strong contender for playoff contention once the season begins next week. Like it or not, conference or no conference, my feeling is that if they go 12-0 they are in!

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Greg Gabriel
The Director's Report


In Sunday afternoon’s NFL preseason game between Green Bay and Pittsburgh, the Packers lost star receiver Jordy Nelson to an ACL tear. For most teams, this would be a difficult loss to overcome, but in the case of the Packers, it may not be as bad as it looks.

Green Bay General Manager Ted Thompson does an excellent job putting a roster together, and he always finds ways to find players to fill in when a starter goes down. The best example of this was in 2010 season when over 10 players, many of whom were starters, were placed on injured reserve. The Pack won the Super Bowl that year.

Part of the reason is the system. They have, basically, been in the same offensive system since 2006 when Mike McCarthy became the Head Coach. Thompson and the Packers personnel department find plays who are fits for that system, and the coaching staff does an excellent job developing the players.

That is the case at the wide receiver position. In the 2014 NFL Draft, the Packers drafted three wide receivers. Fresno State’s Davante Adams was selected in the second round, Wisconsin’s Jared Abbrederis came in the fifth round, and Saginaw Valley’s Jeff Janis was a seventh round selection.

Adams became a significant player as a rookie, especially later in the season and the playoffs. Janis was a role player as a rookie, and Abbrederis was on injured reserve with an ACL injury. Adams and Janis have had strong camps this year and are ready for bigger roles. Abbrederis has spent most of the time on the sidelines recovering from a concussion, but when and if he is ready to play, he can be a contributor.

As for the depth chart, fifth year player Randall Cobb moves up to be the primary receiver. He was second in receptions to Nelson last year with 91 catches for 1287 yards and 12 touchdowns. He is ready to become a number one receiver in the league. Adams will become the starter opposite Cobb, and he is also ready for that role. As a rookie, he had 38 receptions, and now that he is comfortable within the system, he is ready to roll. He was one of the more physically gifted receivers in the 2014 draft and is capable of putting up big numbers.

Janis is an interesting player. Coming from Saginaw Valley, he wasn’t as developed as much as players who came from BCS level schools, but he has the natural physical traits. He has great size (6’3 – 220) and speed (4.4) and is becoming a much better route runner. In the first two preseason games this year, he has five receptions, and I would bet he will get a lot of playtime this week in the dress rehearsal game.

Don’t get me wrong, I am not underplaying the significance of Nelson’s injury, I just feel that because Green Bay is Green Bay, they will be able to overcome the injury much better than most. The Green Bay offense is a finely tuned machine led by Aaron Rodgers, who, in my opinion, is the best quarterback in football. While Nelson was his most trusted target, Rodgers will adapt, and the offense will still put up huge numbers.

USC Bans Alcohol from their Football Locker Room

This report came out late Monday evening. It was reported that last year during Head Coach Steve Sarkisian’s first season at USC, there was alcohol available to the coaches in the locker not only at home games but on the road as well. It was further reported that when Lane Kiffin was the Head Coach, alcohol was also available. The ban comes after Sarkisian got in trouble with the University after reportedly being drunk at a University football function this past Saturday.

Why alcohol was available at all? Many college stadiums do not sell alcohol to the fans because the stadiums are on a college campus. If alcohol is available to the coaches in the locker room, who is to say that underage players aren’t enjoying a taste when someone isn’t looking? That can be a dangerous precedent and a liability waiting to happen.

Reading that brought back memories of a funny story from 25 years ago. At that time, I was working as a scout for the New York Giants. On Labor Day weekend of 1990, I was assigned to watch the Long Beach State at Clemson game. Long Beach State was, of course, not a power, but what made this game interesting is they had a new head coach that season. The coach was none other than NFL Hall of Famer George Allen. Allen had not coached since the USFL folded in the mid 1980’s and was 72 at the time.

That weekend I happened to be staying at the same hotel as the Long Beach State team in the Greenville-Spartanburg area. The night before the game, I was with George Allen’s son Bruce (now the president of the Redskins) and former Bills and Chargers General Manager, the late John Butler. We were in the lobby of the hotel talking football and swapping stories when Bruce told us this one…..

When George Allen was coaching in the NFL, he would always have some beer available for his players after a game. His thought was that it helped replenish the fluids the players lost during the game. That afternoon, George was having a conversation with the Long Beach State Athletic Director about the coming game. He said to the AD (Corey Johnson) that because it was going to be so hot at game time, he needed three or four cases of beer for the players to drink after the game. The AD looked at George and said, “George, this isn’t the NFL, most of these kids aren’t old enough to drink. If you want to give them something to drink, it will have to be water”. George just looked at the AD still not realizing how young his players were and said, “Oh!”

That was the last season George Allen coached football. When he was hired by Long Beach State, he promised the administration a winner. He fulfilled the promise by finishing the season with a 6-5 record. George Allen died shortly after the end of that season. He went out the winner he always was.

Follow Greg on Twitter @greggabe

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