October 24, 2016 - Dr. David Chao
Monday Morning MD: Easy to just blame the coach
When a player returns early and is re-injured, it is too simplistic to blame the coach for pushing a player to hurt. Bills head coach Rex Ryan faced that criticism when LeSean McCoy played through and aggravated a hamstring strain in a Dolphins loss on Sunday. Mid-week, McCoy was originally declared with only muscle tightness that turned out to be “coach speak” for a mild to moderate strain per media reports. It would be easy for me to say “I told you so” after the Bills star RB left the game in the second half feeling pain after 8 carries for 11 yards. I did warn of ineffectiveness and aggravation but that is nothing the Bills medical staff would not be aware of and had considered. The offensive coordinator even said earlier this week, “I don’t want to do what we did last year. I don’t want him playing 85% re-injuring the hamstring and this thing lingering all year.” Return-to-play decisions are not solely made by the team doctor or the head coach. Typically it needs to be a unanimous group decision between three parties: the medical staff, the team and the player. Any of the three has “veto power” and must share in the responsibility of all return-to-play scenarios. The medical staff input is a combination of the doctors and athletic trainers. The team decision requires varying input from coaching (head coach, coordinators and position coaches) and management (general manager and sometimes owner). The player component includes the athlete, agent and often family. (Certainly agents have stepped up and prevented their guys from playing before.) All three combined parties must agree, otherwise a player doesn’t step on the field. Decisions like these are always joint discussions and are never made in a vacuum. Ryan acknowledged, “We never play a guy our doctor and trainers don’t clear”. I am sure the medical staff was aware of and discussed risks of re-injury and ineffectiveness. McCoy accepted his role in the decision to play as well, saying “I felt good…I wouldn’t play, if I wasn’t 100%”. Given this situation plus the Sammy Watkins, Aaron Williams and Shaq Lawson decisions to play through injury, it is inevitable critics will blame the Bills for allowing these players to push the envelope and get back to action prematurely, causing a bigger risk for re-injury down the line; however, that would not be telling the whole story. At least in this case McCoy himself acknowledges his role in pushing to play and admitted it might have been better to hold off. MMMD 1: Geno Smith injury “not too significant” The Jets Sunday starter exited with a left knee injury. By video, there was no major ligament injury but there is some worry for a meniscus tear (similar to Roethlisberger’s injury last week) that will be cleared up by a MRI. Smith himself indicated it wouldn’t be “anything too significant”; however, he spent the second half in street clothes on the sidelines. Unlike Big Ben who was cleared to play the 2nd half, doctors didn’t clear Smith to return as a precaution. The thought is Smith will avoid a knee scope and it doesn’t appear to be serious, even though he may not be the starter anymore. MMMD 2: Steelers hope to get healthy with bye week Antonio Brown took a knee to the quad and was hampered the rest of the game. Fortunately muscle contusions heal quickly and the week off comes at a perfect time for the Steelers star WR. With rehab, expect Brown to be 100% for the next game. It would also help if Ben Roethlisberger would be throwing him the ball. Despite some doom and gloom reports of missing up to six weeks, I have never waivered (and a new CBS report agrees) http://www.cbssports.com/nfl/news/big-ben-unlikely-to-miss-more-than-two-games-could-return-after-bye/ from my feeling that Big Ben is most likely to return for the post-bye divisional games versus the Ravens. MMMD 3: Giants injury designation faux pas Odell Beckham Jr. and five other players were listed as “probable”, a designation that doesn’t exist anymore on the Friday injury report. Perhaps, the Giants share in the thoughts of fantasy players in wanting that category reinstated. All six players were subsequently removed completely from the injury report, as downgrading to “questionable” would have proven the fallacy of the new system. Beckham did play as expected with a hip pointer, but he was seen working with trainers pregame and perhaps was not 100%. With the post overseas game bye, OBJ should not be hobbled for his next game. MMMD 4: No Reggie Bush touchdown It didn’t matter in the outcome of the game but it could matter for future safety. A play is dead when the ball carrier’s helmet comes off. Reggie Bush’s helmet was completely off just before he crossed the goal line yet he was still awarded the score. Officiating guru Mike Pereira agreed. The NFL and NCAA rule are similar here except that the professional player is not required to leave the field for a play after his helmet comes off like the collegiate players. I would lobby that non ball carriers deserve the same protection. If the helmet comes off, any player should be deemed a non-participant meaning he can’t tackle, be hit, block or be blocked. MMMD 5: 2016 Health and Safety Report The annual medical update was released this week. The NFL has been far from perfect in dealing with head injury over the years but before anyone criticizes the league’s current action, they should read this comprehensive 39 page report of all of the health initiatives. One piece of unfinished business is the NFL has yet to announce it’s new Chief Medical Officer. The often maligned previous medical adviser was forced to retire in July but the new full-time position has yet to be filled. MMMD 6: Injury rundown Jay Ajayi was cramping and not injured. Who can blame him after two consecutive 200+ yard performances in Miami. Russell Wilson still seems to be hampered by the knee and ankle injury, which I expected to be behind him after the bye. Jamaal Charles was limited by knee swelling and only had 1 carry for 0 yards. Knee effusion is common after ACL surgery but the swelling usually goes away quickly. Only if it persists, is it time to worry. Tevin Coleman left with a hamstring strain but it is difficult to discern severity off video so his absence is yet to be determined. Brian Hoyer’s doctors were working Sunday despite the Thursday game this week. The Bears QB underwent surgery with plate and screws into his radius (forearm) bone. Contrary to popular belief, team doctor’s have “day jobs” outside of the NFL and likely the regular weekly workload made the off day schedule more convenient. Ron Brooks of the Eagles ruptured his quad tendon and will need surgery. This injury is similar to patellar tendon tear and will require a minimum of 6-9 months recovery. Aaron Williams left the Dolphins game in an ambulance for a precautionary MRI that was negative and flew home to Buffalo with his team. Jarvis Landry apologized for the penalized hit that may still draw a fine. Jeremy Hill seemed to aggravate again what by video seems to be a left AC joint sprain. Jerick McKinnon by video suffered a high ankle sprain but had a limited return for the Bears. Josh Norman and Cody Kessler suffered concussions. Jordan Reed was out again and admitted to hiding his concussion. John Brown missed the game as his sickle cell trait work up continued. Expect a full return as most teams have at least one player with the trait that play without issue. Saints special teams ace, Jake Lampman is hoping to avoid major knee ACL and/or MCL injury. Josh Doctson was placed IR for recalcitrant Achilles tendonitis. Dez Bryant cut his fingers making soup, but his knee and digits should be fine after the Cowboys bye this past week. MMMD 7: ProFootballDoc scorecard Please be clear that I take the time to chronicle the correct/incorrect video and injury analysis to publicly vet my stats. This allows readers and twitter followers the chance for a public audit of my numbers. This week, Russell Wilson does not seem to be over the knee and ankle injury as I expected, thus will count as a mistake. Unfortunately LeSean McCoy did aggravate his hamstring. Carson Palmer played with his as expected. Jerick McKinnon had a mild high ankle sprain confirmed. Brian Hoyer did have an isolated radius and needed surgery, Dwayne Allen missed the Colts game with a high ankle sprain. Michael Bennett did avoid serious knee injury and played. Add these into last week’s 83-3 (96.5%) drops the numbers to 89-4 (95.7%).