Monday Morning MD: Ready or not?

With just under a month to go before training camp, much attention is paid to whether an injured player will be ready to go. Typically, this is the time of year for optimism. Players, coaches and management signal mostly confidence of good recoveries. Players are not going to doubt themselves and “coach speak” abounds. Joe Flacco declared himself ready for training camp and his coach said he was “ahead of schedule” coming off his ACL tear. Tony Romo (clavicle, Mumford) has been full go at practice. Jordy Nelson (ACL) is reportedly raring to go. Jamaal Charles is on pace for another quick ACL comeback. Pete Carroll expects Jimmy Graham and Thomas Rawls to be ready. Arian Foster (Achilles) is purportedly ready for camp. Even top-five rookie pick Jalen Ramsey who had recent knee surgery says he is 100% for camp. Despite this optimism, often teams will start a player on PUP, if even for a day, to provide insurance for a set back. When optimism is not rampant, it leads one to worry. The news has not been universally positive for Le’Veon Bell. First, he injured two ligaments (PCL and MCL) which makes recovery harder than if he had an isolated ACL tear. Bell hopes to be able to cut by training camp. He is not sure his knee is fine right now. It’s possible Bell will be just fine this coming season, but we are not hearing the usual early optimism. Hopefully, Bell can overcome this lack of usual optimism. For now, the Steelers have not extended his rookie contract which expires later this year. MMMD 1: Happy and safe Fourth of July Last year’s Independence Day news was dominated by the injury to Jason Pierre-Paul. This year, JPP has a public service announcement cautioning fireworks safety. He shows the significant damage to his hand (CAUTION: Graphic picture attached to link) during the PSA. Unfortunately, most of the 10 things to know about JPP fireworks injury that I wrote last July came true. Fortunately, he is still playing football as expected. Buccaneers cornerback C. J. Wilson also injured his hand with fireworks last year. He unfortunately retired from the NFL as a result of his injuries. Hopefully, history will not repeat itself this July 4th. MMMD 2: Players and guns I don’t know what the statistics are for men average age 25 and gun violence but it just seems like three recent incidents seem like too many. Aqib Talib was shot (or shot himself) in Dallas where details are still sketchy. Thankfully, he avoided major nerve, artery or structural injury. A Buccaneers rookie was shot up to three times. Ex-Colts Zurlon Tipton is tragically dead at age 26 from an accidental self-inflicted gunshot wound. He also had a December 2015 gun incident. With gun control a national topic, I don’t know what the answer is. It just seems to me enough players are injured during football that these gun related injuries seem senseless. MMMD 3: Players worth the pay? This week there was plenty of discussion if players were worth the extravagant pay. The bottom line is that some owner was willing to pay it, so that is the value. After all, the value of an oceanfront home is what someone is willing to pay for it. Before people hate on players for their high salaries, consider that top athletes make a fraction of what top Wall Street executives make. In addition, NFL salaries are not guaranteed for injury and corporate executives have much longer careers. MMMD 4: Al Jazeera HGH investigation Even though the main informant has recanted, the NFL plans to interview all players implicated by the report. I have no idea if Peyton Manning did or didn’t use HGH, but I do know that HGH would not have helped his nerve issues as some have claimed. If and when players are exonerated, I hope that generates the same publicity as the accusations have. MMMD 5: “Billionaire A--hole” Jake Plummer ripped the NFL’s marijuana stance and Jerry Jones for saying it was “absurd” to say there is a link between football and CTE. It may be ridiculous for Jones to say there is no CTE link, but it is also unproven for Plummer to say marijuana prevents brain damage. While it may be true that marijuana by-products may ease head injury symptoms, that is a long way from proof of preventing brain damage from concussions. Seems to me the owners and players need to listen to scientists and conduct more studies. Otherwise, it is just more concussion politics. MMMD 6: New medical lawsuit Just when we thought the health and safety litigation was finally ending with the concussion settlement and the dismissal of the painkiller lawsuit, now comes more litigation. The painkiller lawsuit has been reformatted into 32 individual cases against the team as opposed the league in general. If this legal challenge goes to court, I am sure the teams will claim that they do not practice medicine and that pain medicine decisions were made by the medical staff. I find it interesting that no individual team physician has been named over this issue yet. MMMD 7: ProFootballDoc scorecard Last week I showed a picture of Jaylon Smith continued use of an ankle foor orthosis (AFO) and how that means his peroneal nerve really has not improved. Ed Werder has now confirmed that there was no significant improvement in the injured nerve so far. As I first indicated before the Combine, Smith is unlikely to play in 2016. The question is now becoming if he will make 2017. I hope he can beat the odds. This makes the current 2016 record 10-0 from the previous 9-0.
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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