Monday Morning MD: Smart to sit?

To play or not to play was the theme of the week for both college football and the NFL. Leonard Fournette and Christian McCaffrey ignited debate when they decided to skip their college bowl games to prepare for the draft. Meanwhile the Cowboys and Steelers rested their stars in meaningless games as other teams played their starters. Medically speaking, it is certainly smart to sit as it is the only way to avoid injury. McCaffrey’s teammate, Stanford QB Keller Chryst appeared to tear his ACL. Michigan’s high draft prospect TE Jake Butt tore his ACL which will affect his draft stock as there is no guarantee he will be ready for the start of the next season. The key is what do the 32 NFL general managers think of the decision to miss bowl games. The natural question is: are they “me” guys more than “team” guys? Sometimes the decision to miss the bowl game is clearly smart. Michigan’s Jabril Peppers was better off not playing for risk of making his hamstring injury worse and effecting his Combine as well as potentially being downgraded for not playing up to par. On the other hand, not playing sometimes hurts. Florida State’s Dalvin Cook had a spectacular bowl game performance, which may have catapulted him to the top of the RB draft board. Meanwhile, Fournette could not respond to reclaim his top status as he had elected to sit. NFL decisions to sit are made by the team not the individual player like in college. Weighing the potential of injury versus momentum/continuity is the playoff team’s dilemma. The Raiders clearly needed Matt McGloin to play to get more snaps but unfortunately he was injured. If the argument is to always sit for meaningless games then the majority of the NFL would not play as most Week 17 contests had no postseason implications. In retrospect, the Cardinals probably wish they had sat David Johnson (details below). There is precedent for NFL players to choose to skip meaningless “bowl” games. It is common for professionals to pull the injury card to skip out of the Pro Bowl. Tyler Eifert injured his ankle during the all-star game last year and needed surgery. He now says even if selected, he is never going back. The bottom line is many things factor into a “play or sit” decision for the individual and teams. I certainly can’t argue with a player’s right to decide or a team’s necessity to strategize. MMMD 1: Another QB concussion controversy? Questions arose after Tom Savage was returned to play and then pulled due to concussion. It certainly looks fishy when the Texans QB is cleared and the head coach says at halftime he will play but he is re-evaluated and pulled from the game. In reality, it is common to be fine and develop later concussion symptoms. It is routine for doctors to perform serial exams. Likely Savage had a routine re-check at halftime and doctors decided to pull him. This is another reason that I have lobbied for more transparency. Why not let the doctors speak or at least issue a statement? Even referees are interviewed by a reporter post game. Understanding what happened would help clarify these situations and help dispel the distrust the public and media have for the NFL when it comes to concussions. MMMD 2: Playoff QB injuries With Savage in the concussion protocol, Brock Osweiler will be the likely Texans starter for the Wild Card round. The majority of head injuries are not cleared in one week. This will be a short week with the game on Saturday. Even if Savage was cleared late in the week, he would still miss practice snaps important for a first time starter. Matt McGloin left the Raiders game with an apparent left AC joint sprain and later reports of trap muscle issues. It appeared that McGloin was not happy he was replaced and he was in uniform on the sidelines for the second half. It will be interesting to see if Connor Cook gets the playoff start and how much of this is coaching decision versus purely injury. Matthew Stafford’s injury appears to be a mallet finger. I have suspected this by the type of splint but media had only reported dislocation with torn ligaments. A mallet finger is a tear to the extensor tendon at the tip of the finger and requires full-time immobilization in extension for six weeks or there is risk for surgery. Stafford can play through without long-term implications but a mallet finger injury is significantly harder to deal with than a finger dislocation as it affects his grip since he is not allowed to bend the tip of his middle finger. This could explain his declined performance post injury. David Carr reports that brother Derek’s ankle ligament was not torn and the fracture was already healing. That may be a lay person’s interpretation but no way a bone starts to heal in three days. Also when your knee points “north” and your toes point “east”, the syndesmotic ligament is torn even before the fracture happens. Derek Carr will be back at 100%, but no way it will be in time for a potential Super Bowl appearance. Ryan Tannenhill seems to be getting closer to playing but I think it will be beating the odds for him to be the Dolphins Wild Card round starting QB. Even if it is just a grade 2 MCL, it is a stretch to go from a cast and a crutch to playing NFL football in three weeks. Aaron Rodgers seems to have put any worries about his calf strain and hamstring injury behind him. He moved and ran well during the Packers win to seize the NFC North crown. Tony Romo played in a real game for the first time in over a year. He is completely healed and at no further risk for injury. What a luxury for the Cowboys to have an experienced back up like Romo. MMMD 3: David Johnson escapes horrific injury By video, many feared the worst for the Cardinals star RB. Fortunately, it seems to be the best-case scenario for Johnson with only a significant MCL injury with his ACL spared. He is unlikely to need surgery and should be healthy for the offseason program. MMMD 4: Jets medical staff blamed Muhammad Wilkerson appeared to criticize his team’s training staff for not having a plan as he returned from ankle surgery. He did acknowledge his responsibility in the process as well. There is no question that hindsight is 20/20 and that medical staffs can look back and wish they had approached an injury differently. However, it is unusual to call out a teammate and indeed the athletic trainers are looked upon as teammates. Undoubtedly the medical staff was consulted before Wilkerson was offered an $86 million contract while he was injured this offseason. If anything, he should thank the trainers and doctors for vouching for his ability to recover. MMMD 5: Decreased injuries with more touchbacks? The rule change to place the ball on the 25-yard line has decreased kick-off returns but has it reduced injuries? Bill Belichick cited the Broncos Kayvon Webster’s concussion as an example of how the new rule has not worked. Sometimes injuries can happen when covering teams ease up as they see the runner kneeling down, but blockers don’t know the play is over. Full speed versus half speed will result in injury. I am eager to see the season long statistics on this rule change. The NFL usually releases this type of injury data during the Super Bowl week health and safety press conference.. MMMD 6: Non QB Injury rundown Vic Beasley left shoulder “popped out” but he returned to finish the game with a brace. Don’t be surprised if he needs offseason surgery similar to what he had on the right side last year. Zaire Anderson was placed on a spine board after a head down hit. Fortunately he was released from the hospital. Donald Penn left the game with a knee injury but returned. He will likely play against the Texans on Saturday. C.J. Mosely was carted to the locker room but I do not expect a serious left leg injury. Sammy Watkins injured his hip that he had surgery on in 2015. The hip does not appear to be severe but he will need to address his 5th metatarsal lingering fracture which may need a second surgery to heal properly. Quinten Rollins was placed on a spine board for head/neck injury but early reports indicate that he will be OK. DeMarco Murray played with a plantar plate injury this season to become the leading AFC rusher. This is essentially a turf toe injury. He will avoid surgery unless the plantar plate is retracted. Ryan Kerrigan exited with left hand/finger injury Ty Montgomery left the game briefly with and ankle issue but returned to be effective. Tyrod Taylor has a groin injury and don’t be surprised if he elects to have a sports hernia surgery. Tyler Eifert had back surgery. It has been a rough year after his ankle surgery from the Pro Bowl injury. Tyron Smith sat out with a mild MCL from last week where the knee brace may have saved him form more severe injury. MMMD 7: ProFootballDoc scorecard Only a few injury first takes this week as I was on vacation with the family in the mountains and did not have my usual set up and access to all videos. David Johnson fortunately with only MCL sprain. McGloin has an AC joint sprain and trap spasm. Quinten Rollins neck was OK. Tyron Smith did have a mild MCL. Last week’s 187-10 (94.9%) is now 191-10 (95.0%).
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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