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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Joe Messineo
NFP Fresh Voices


As the 2012 NFL draft approached, Alabama running back Trent Richardson was viewed as a can’t miss prospect.  Some said he was the best running back to come out of the college ranks in 15 years, while others were comparing him favorably to Adrian Peterson – who by then had run for more than 6,700 yards, 67 touchdowns and was about to embark on a campaign that would see him come close to breaking the single season rushing record – and why not…. in three years carrying the rock for the Tide, Richardson had amassed more than 3,000 yards rushing and scored 35 touchdowns, helping the program win two BCS National Championships.

The first two picks of the draft were quarterbacks Andrew Luck and Robert Griffin, III, who went to Indianapolis and Washington respectively.  After trading four draft picks to the Minnesota Vikings to move up from the fourth pick to the third, the Cleveland Browns selected Richardson with visions of building an offense around the strong running game he would provide.

Richardson’s rookie season went fairly well.  He played in 15 games, rushing for 950 yards and 11 touchdowns, but a 3.6 YPC average was cause for concern.  After two subpar outings in the Browns first two games of the 2013 season, they traded him to the Colts for a first-round pick, but the new surroundings didn’t help.  In his two years in Indy, Richardson barely managed to run for three yards per carry and was released after the 2014 season.  The Oakland Raiders gave him a chance to earn a roster spot in 2015, but he could not.  The Baltimore Ravens took a flier on him this offseason, but the results were the same.

So how did a can’t miss prospect, with a stellar college resume go from first round pick to NFL draft bust lists?  Three reasons: lack of ability in a key area for a running back, off-field distractions and injuries.

Former Browns CEO Joe Banner (who did not join the team until October 2012, meaning he was not involved in the selection of Richardson) said the Browns traded him because he lacked vision.  According to Banner, the inability to see where the running lane was going to be undermined the speed and power that Richardson possessed. Understanding blocking schemes and anticipating holes were not Richardson’s only problems.

As the third overall pick in 2012, Richardson received a guaranteed $20.5 million contract and then the leeches moved in.  Richardson was spending thousands of dollars a week for box seats for family and friends.  He would also constantly get calls from those same people asking for money to bail them out of various financial issues and it clearly weighed on him.

Finally, as is the case for many NFL players, the injury bug bit.  Richardson had his knee scoped during the offseason, and even though he was in the Ravens camp, he spent the entire time on the physically unable to perform list until he was released.  Despite the issues that have derailed his career, Richardson could still play in the NFL again at some point.  It’s not inconceivable – or unfamiliar for that matter – to imagine a good team like the Patriots or Broncos taking a chance on a guy like Richardson.  Even Ravens Head Coach John Harbaugh recently said the Ravens may still have interest in him. Richardson certainly isn’t giving up on himself.

 

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Dr. David Chao
Latest NFL News


The ACL used to be the dreaded injury, but now Achilles is catching up. Both injuries end seasons and necessitate surgery. Both are predominantly non-contact injuries that have not dropped in frequency despite the limited practice of the current CBA.

This week Seahawks players Brandon Cottom and Ronnie Shields suffered Achilles tendon ruptures essentially back to back during practice. The Lions Eric Ebron was feared to have suffered the same fate. Hopefully the latest report of no need for a boot means his Achilles is not torn.

Although it seems that way, Achilles tears are not more common than in the past, they just haven’t decreased with new CBA practice limits. This makes sense as Achilles are non-contact injuries, so limiting padded practices doesn’t decrease the occurrence. In fact, as practice tempo increases, the tendon is more at risk.

As players get bigger, faster and stronger, the Achilles tendon stays the same size. Essentially, it is like planting a bigger tree in the same size pot and thus something has got to give. In fact, the Achilles girth of an NFL athlete is no different than that of the average person.

The only good news is that recovery continues to improve. Cowboy Gavin Escobar has made a quick recovery and was not placed on PUP. Arian Foster has done well so far in Miami. I am less worried about his Achilles recovery than the fact that he will be a 30 year-old running back.

Achilles injuries are caused with a sudden eccentric load with an explosive first step or change of direction. As the size of players and speed of the game increase, Achilles tears have become the new ACL.

MMMD 1: No requirement for injury reporting

During the regular season, injury reports are the norm. In the offseason and preseason, injury updates are not mandated.

All injury information at this time of the season is provided at the grace of teams, coaches and players, as there is no mandatory reporting. Packer fans fretted about Jordy Nelson’s ACL recovery when he was placed on PUP without a given reason. However, the player himself later revealed it was a “hiccup” to his left knee, not the right side which had ACL surgery.

The in-season reporting requirements are far from full disclosure. As predicted, the Colts were never fined for the non-disclosure of the rib injury to Andrew luck. Therefore, in the preseason, we are left to guess when Jamaal Charles, Jimmy Graham and Dion Lewis will come off PUP.

MMMD 2: Reggie Ragland limbo

The Bills have already temporarily lost their first-round pick Shaq Lawson to shoulder surgery. Now their second-round selection is in jeopardy of missing the season.

There was early worry about an ACL tear and an inconclusive MRI added to the mystery. In my NFL experience, a gentile lachman exam was always more accurate than a MRI. We always knew whether an ACL was torn or intact before we left the field. I suspect the Bills know as well.

The key is whether the exam shows the knee to be stable or unstable. A partial ACL tear that is stable will mean a good return for this season. A partial ACL tear where the knee is unstable means surgery and IR.

Lets hope for the best as we await the second opinion. The Bills already know, but it is fair for the player to be sure before deciding his fate for 2016.

MMMD 3: Thomas Rawls comes off PUP

There has been much confusion about the Seahawks starting RB and his ankle injury. Despite early reports of no surgery, I always said surgery was necessary. That has now been confirmed by Pete Carroll this week.

The PUP stint was expected. Now look for Rawls to move forward with a productive season. After all, his injury is similar to the ones previously suffered by Danny Woodhead and Darren Sproles. Those two certainly have not looked back after their surgery and recovery.

MMMD 4:Different outcomes for pectoral injuries

The key to pec injuries is whether they involve the tendon or muscle .

William Jackson of the Bengals tore his pec tendon, thus will need surgery and be placed on IR. Manny Lawson of the Bills is thought to have a pec muscle injury and thus hopefully will be available soon.

Coaches, players and reporters often confuse pec tendon and muscle. The key is to determine the location of the tear as tendons detach and need surgery while muscle doesn’t hold suture and can heal with time.

MMMD 5: Hall of Fame game cancelled

In a sign that the NFL is serious about player safety, the first preseason game was cancelled due to poor field conditions. This certainly caused much embarrassment and millions of dollars but good to see the league acting on behalf of safety.

There have been five major medical changes for 2016. Among them is the addition of a Field Surface and Performance Committee that would be responsible for this type of issue.

MMMD 6: Cupping takes center stage

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With the marks left behind on Olympic athletes, cupping therapy will likely become the new rage. Kinesio tape has been around for decades but exploded into the public eye with the 2012 Olympics. Now the centuries old Chinese cupping therapy has come to the forefront with the 2016 Olympics.

There is no scientific evidence that cupping or kinesio tape works. Then again, ankle taping comes loose within the hour and many pregrame IVs are given to already well hydrated NFL players. Never discount the placebo affect.

MMMD 7: ProFootballDoc scorecard

Dolphins fans worried about a long absence for Jay Ajayi when reports of a knee bone bruise surfaced, but my prediction of a quick return fortunately came true.

Cowboys fans worried and sent me video of Devin Street’s injury and fortunately it turns out to be a mild injury as expected.

When Corderelle Patterson of the Vikings landed on his shoulder, there were fears of clavicle fracture and serious injury. By video, it appeared to be an AC joint sprain and he is already back at practice.

Seahawk Thomas Rawls indeed entered camp on PUP and now has quickly come off the list and is ready to go after his ankle fracture that required surgery.

Adding these four to the previous 12-0 record takes the 2016 scorecard to 16-0 but one miss still takes us below last season’s 94.6% mark.

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