March 30, 2015 - Dr. David Chao
Monday Morning MD: Are team return-to-play projections accurate?
Off-season news is made whenever injury prognosis for a star player is provided. How reliable or meaningful is this information? With the league meetings last week a plethora of key updates were announced. Texans head coach Bill O’Brien said Jadeveon Clowney had his best week of rehab yet and “can be great”. Giants head coach Tom Coughlin went on record hoping for a week one return for Victor Cruz. Colts owner Robert Irsay said Robert Mathis will return from Achilles rupture to make an impact next season. Are injury estimates from owners or coaches meaningful? Although the update may be honest, usually this type of information is understandably issued through rose-colored glasses. After all, none of the above have any medical training. Just like letters from personal physicians are always positive, so typically are these team estimates. One certainly hopes Clowney can reach his number one overall draft pick promise but he had a second knee surgery that included a microfracture procedure. Although his operations were performed by his team physician who I know to be a top surgeon, there is no guaranteed recovery when articular cartilage is worn down to bone. A likely nine-month recovery is required and he had the procedure in December. History would indicate that even if Clowney comes back and plays well this season, the long-term odds are against him making it through a big second contract and having a 10-year Hall of Fame career. I am rooting for Clowney but cartilage regrowth surgery has signaled the beginning of the end for many players. A head coach optimistically commenting on a great week of rehab doesn’t change the injury severity. Like Giants fans, Coughlin is hoping for a week one return for Cruz; however, a patellar tendon rupture can be career threatening for a wide receiver. I have not doubt that he will return, the question is when and how effective he will be. Regaining explosiveness after such an injury is the issue for a player like Cruz. The head coach really hasn’t given fans any specifics by enthusiastically hoping his player returns for the first game. Coughlin does hedge by adding he won't rush a Cruz return either. The Colts owner sounded confident in Mathis “re-emerging” to have a strong season. However, he also indicated the return might not be until November as a worst-case scenario. Only time will tell if a 34 year-old edge rusher has his full get-off after his Achilles rupture. Lets not forget there were earlier rumors of off-season setback. In the end, the league meeting injury updates from coaches, management and owners create fan interest. Ultimately, I am not sure if it provides much real information. After all, when is the last time a team official was pessimistic about a key injury or his team’s playoff chances. MMMD 1: Failure to remove players leads to “medical timeouts” Based on film study of the last three seasons, the NFL says a player in distress was not immediately removed on 25 occasions. It obviously was not just the Julian Edelman incident in the Super Bowl that led to the new rule where the “eye in the sky” can immediately stop play to remove a player. I applaud the new rule, but it would be naïve to think that medical timeouts will be a cure-all to the concussion protocol. I predict the new rule will lead to more controversy this season. MMMD 2: Four other safety enhancement rules The new medical timeout is the biggest rule change to come out of the league meetings, but four other rules changes were also made for health reasons. Defensive players are now banned from pushing teammates on punts. Offensive players are prohibited from peel back blocks. Defenseless receivers get continued protection even if the pass is intercepted. Chop blocks by running backs against engaged players were outlawed. I applaud all of these changes but feel all chop blocks should be outlawed as I have personally witnessed a high rate of knee and ankle injuries that result. MMMD 3: Team visits are not for workouts Prior to the draft, each club will fly in up to 30 former college players. These team visits are for interviews and physicals only. A medical concern may be the reason for the visit. Perhaps the draftee was not invited to Combine and never had a physical. Often a team just wants to spend more time with a player. Sometimes a team arranges a visit just to throw the media off of its true intentions. Be careful not to read too much into these visits. Often it is just teams doing there due diligence as no workouts are involved. MMMD 4: Necessity is the mother of invention A calf strain limited Aaron Rodgers mobility during the playoffs. I tweeted prior to the post-season how the injury would make it difficult to take snaps under center. Sure enough, the Packers lined him up in the backfield to reduce the need to drop back. Now Green Bay with a healthy and mobile quarterback will continue to utilize the pistol formation as a part of the regular offense. Rodgers and the coaches liked the new look and fans will see more of it this season. MMMD 5: Not all concussion news is bad Recently it seems all we hear about is more negative head injury news or another player suffering problems. Especially in the wake of Chris Borland walking away from football, it is refreshing to hear some positive news that not everyone is suffering post-concussion symptoms. Troy Aikman retired in 2000 and had two major concussions, as well as 6-8 others. He reports undergoing significant head injury testing and shows no signs or problems. He remains mentally sharp as lead NFL analyst for Fox. In the end, I hope we find this is the norm and not the exception. MMMD 6: Worst stadium may soon see its last NFL game All the talk about teams relocating to Los Angeles certainly has fans in St Louis, San Diego and Oakland on edge. One positive side effect may be the end of the medically most outdated and most dangerous stadium in the league. Oakland Coliseum has been called a travesty and the Raiders are the only NFL team remaining that shares a field with Major League Baseball. This leads to injury issues related to the dirt infield. I have also written about the difficulty in providing appropriate medical care in Oakland and how it is the worst stadium in the league. I always root for a team to stay in their home market. San Diego’s Qualcomm Stadium may be seriously outdated but at least it is not medically dangerous to play there. The Raiders need a new place to play most of all and that may be a side benefit of all the LA talk. MMMD 7: Eric Berry upbeat on beating cancer The star Chiefs safety left football to get lifesaving treatment for Hodgkin’s Lymphoma. Berry remains “positive and upbeat” about his chemotherapy which has a reasonable chance to cure him. There is no timetable for return to the NFL yet. Even if cured, he may never return. Obviously, football is secondary and all fans wish him well. 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.