September 05, 2016 - Dr. David Chao
Monday Morning MD: Doctors overlooking injuries?
Media outlets reported Fred Taylor was unhappy with his NFL doctors for withholding information about his injuries. Who is he unhappy with and what really is going on here? After analyzing the articles and Taylor’s twitter tirade, this is primarily about NFL appointed neutral doctors determining his disability benefits. “I never complain as a player or now.” The focus is not about team doctors lying about diagnoses to get the running back to play through injuries. He has not directly implicated his long-time Jaguars team doctors or Patriots medical staff. He directly criticize NFL “neutral” docs. First off, let me be clear. It is WRONG to ever overlook injuries or withhold information from a player or patient at any time. To do so is illegal and considered malpractice which carries civil liability and is actionable by state medical boards. Contrary to sensational media reports, Taylor makes no direct accusations against team doctors that treated him during his 13 year NFL career. His complains against league appointed “neutral” doctors in determining his post-NFL disability. After Taylor was unhappy with being denied his “line of duty” benefits three times, he sought out his own doctor who performed 11 MRIs and a dozen X-rays. Taylor says he unknowingly played through a fractured clavicle and bilateral partial labral tears. As much as one might suspect a player’s current team doctors might minimize injuries, when the player changes teams, the new team doctors provide quite a bit of scrutiny. Just this week, two players passing physicals for current teams failed physicals for the new team (see MMMD 5 below). If Taylor had active clavicle or shoulder issues, the Patriots doctors certainly would be incentivized to call that out on their post-Jaguars physical. If the NFL neutral doctors are underreporting injuries to deny disability, that is certainly inappropriate and justifies Taylor’s indignation. However, lets not turn this into something along the lines of the concussion or painkiller lawsuits. NFL neutral doctors are typically jointly appointed by the NFL and NFLPA. If there are “shady practices”, I hope the players union steps forward to help advance these claims rather than take the position that they only represent current players. I can see why Taylor holds a medical grudge about being called “Fragile Freddy”. That certainly is not a fair nickname. Anyone who plays 13 years in this day and age has to be tough and endure to play through plenty of injuries. Retiring as the 15th all-time rusher, he deserves consideration for the Hall of Fame and a fair shot at disability benefits. MMMD 1: Teddy Bridgewater dislocated knee and subsequent trade The worst injury to date for 2016 is the Vikings QB’s knee dislocation. Details of how a non-contact injury can be so severe and my medical analysis have already been explained at Real Football Network. What does giving up a first round pick (and more) imply for health of Bridgewater’s knee going forward? Would a team pay that price to get Sam Bradford to start for just one year? Certainly this move confirms that Bridgewater is out for 2016. It may indicate the Vikings know that the start of 2017 is not a guarantee. As Vikings GM Rick Spielman said, “no one knows how long it's going to take Teddy to recovery”. I knew it was bad when I saw paramedics were called and not just an ambulance. In my 17 years as a head team physician, I never called an ambulance much less 911 for a player injury. I hope Bridgewater can recover to be 100%, but that would be against the odds. MMMD 2: Carson Wentz will be game one starter With the Eagles trading Bradford, there was news that Carson Wentz would start when healthy. Medically you can book that Wentz will take the first Philadelphia offensive snap of 2016. Wentz’s rib fractures may not be healed 100% but they will be healed enough to play. It would be very unusual for a rib injury to prevent play five weeks after occurrence. Teams rarely wait for full healing with players routinely playing with added protection and rib blocks. If Wentz were an established starter, I would be 100% certain he would start. The only reasons he would not is if Eagles want to protect the rookie or feel that he missed too many practice reps with the injury. MMMD 3: Cramp not knee dislocation On the heels of the horrific Bridgewater injury, a video purported to “pop leg back into place” received over 100k combined retweets and likes. Instead it was just a cramp, as I indicated based on video during the college game. Sometimes video makes injuries look bad, but they are not. Other times replay makes it look mild, but injury is severe. A trained medical eye is needed. In this case, a cramp can be very painful and it is essentially a “seizure” of the muscles. Anyone who has had a cramp knows it can be very painful, but it is far from a knee dislocation. MMMD 4: Why is Nick Chubb playing but Jaylon Smith is not? Visually, the two players suffered very similar injuries. Congratulations to Chubb who made a terrific collegiate return gaining 222 yards. Meanwhile, Smith was placed on the non-football injury list and has not practiced or passed his physical for the Cowboys. The big difference is the peroneal nerve injury for Smith where he still is using the AFO. Structurally, Smith’s knee should be sound. The question is when and if the nerve will return to normal. MMMD 5: Bizarre saga of Browns cornerback continues K’Wuan Williams was waived by Cleveland while serving a two-week suspension for not playing in a preseason game. Two independent doctors are said to have recommended surgery and now the Bears have failed him on a physical. His agent is now asking the Browns to pay for his ankle surgery. There is no doubt in my mind that the Browns will need to pay for his surgery. This is the “old maid” principle of NFL injuries. The last team to pass a player on a physical owns all of the injuries. Unless there are facts not disclosed yet, the only question here is the argument over the ensuing missed pay. How many weeks will the Browns owe the player in injury settlement? There likely will be a grievance coming unless there is agreement. It is not uncommon for one team to pass a player and another to fail him. This week, Patriot Bryan Stork failed a Redskins physical. I wrote in detail about the famous 2014 Rodger Saffold failed Raiders free agent physical after there was agreement to terms. http://footballpost.wpengine.com/what-happened-in-oakland/ This case is unusual as the Browns have not acknowledged the injury at all. MMMD 6: Injury rundown Tony Romo’s status is still in limbo, but that is good news. After a CT scan this weekend, the Cowboys QB was not placed on injured reserve yet. An IR stint would mean missing eight games. Medically, he will miss a minimum of six weeks but that could mean only four games. Hopefully staying off IR means his recovery may be closer to the six week estimate than the 10 week one. J.J. Watt is off PUP and likely for Week 1. This would keep his playing streak of never missing a NFL game alive. Watt may play but is unlikely to be 100% until mid season as was the case with Dontari Poe of the Chiefs last season. Josh Doctson is off PUP and on the 53 man Redskins roster. Hopefully the rest has put the Achilles tendonitis behind him, but be careful as this injury can linger. Kyle Long gets Bears new deal despite a reported labral tear. This likely means he will play in a shoulder harness this season and have offseason surgery. Neither Andrew Luck nor Keenan Allen are at significant risk for kidney re-injury. Both are hoping for a healthy 2016 after several injuries in 2015. Is Ladarius Green’s ankle hurting or is he suffering from headaches? He is now on reserve/PUP and will miss minimum six games. Either way it is unusual for a free agent signing to be on PUP as that indicates residual medical problem from the previous season. Dion Lewis is on reserve/PUP after ACL surgery and will have at least an additional six weeks to recover. Will Jamaal Charles be ready week 1? The Chiefs have hinted he may not be, but clearly he is not far away or he would have been placed on PUP. Darren McFadden was placed on NFI for his elbow fracture. Dennis Pitta is back after finger fracture but the bigger news is his comeback from his second hip dislocation that had him out two seasons. Tyrann Mathieu is expected to play every single play during Week 1 after ACL surgery. Justin Houston coming off February ACL is on PUP and may be out for longer than the minimum six weeks. He would have until Week 12 to be activated. Dion Jordan will not come back from suspension yet as he was placed on the NFI list for his knee. Jimmy Graham’s status is up in the air after patella tendon rupture. As expected, this is a harder injury than an ACL to bounce back from. MMMD 7: ProFootballDoc scorecard Unfortunately, Mike Jenkins of the Cardinals did indeed tear his ACL as it seemed by video. Fortunately, A.J. Green does not have a significant injury corresponding the impressions on game tape even though he was pulled from the final preseason game. This takes the 2016 tally sheet from 23-1 to 25-1 at 96.2%.