Monday Morning MD: New injury reporting rules will cause confusion

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.
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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