Monday Morning MD: Top five medical changes for 2016 season

Health and safety continues to be the highest priority for the NFL. Last year, I chronicled the top five medical changes for 2015. What does the league have in store for medical improvements for the 2016 season?
  1. New Chief Medical Officer
The often-criticized league medical advisor was forced to retire by the commissioner. Critics have been calling for his head since he lied on his resume, downplayed head injuries, made himself lead author on concussion papers as a rheumatologist and led the league Mild Traumatic Brain Injury committee into being disbanded. For decades, he was the only physician at league headquarters on Park Avenue. The transition has been coming for a long time. Even before the appointment of an outside chief health and medical advisor last year, his public role has been reduced. I hope two things happen with the transition. First, hopefully both sides can stop with the politics and focus on meaningful improvements to player health. Second, I hope the league hires a strong replacement that is well respected and above reproach. This will be a key hire. No offense to the current advisor, but she has a full-time job outside the NFL and only works with the league one day a month. Directing health and safety efforts for players is more than a full-time job.
  1. Fines and loss of draft picks for teams
Violation of NFL medical protocol now has defined penalty parameters. The new rules put teams and medical staffs on notice. Although this new penalty system has made much news, I am not sure it changes the game. First, the potential of fines and/or loss of draft picks won’t change the behavior of NFL doctors. A physician’s fear of being sued if the standard of medical care is violated will always be much greater than any league penalties. The maximum first time penalty is $150,000 and paid by the team, while a malpractice lawsuit could directly cost the doctor millions. Second, the threat of fines and loss of draft picks were always there. I am not a legal expert but I believe the commissioner has the power to fine a team or dock draft picks for any transgression. Certainly, monkeying with medical protocol would be considered conduct detrimental to the league and a threat to the integrity of the game. The commissioner has always held the power of discipline in these issues. The only difference now is the penalties are defined. It is a huge positive that the NFL and NFLPA showed good cooperation in coming up with this new system. However, the reality is that it may not change much. Contrary to popular opinion, I think NFL doctors will welcome the new fine system. It will give medical personnel further reason to preach safety protocol in case any players, coaches or management want to push the envelope.
  1. Second “eye in the sky” to be added
Going forward, there now will be two ATC spotters up in the booth in addition to the video assistant. When the “Edelman rule” of a medical timeout was first introduced last year, I indicated one person would be hard pressed to keep up and human errors would be made. Although the single spotter was not solely to blame for the Case Keenum situation last year, a second spotter could have helped. Not only does it help to have a second pair of eyes, a second mind to bounce video off of is helpful. The single spotter was asked to keep up with the action, review previous plays, notify sideline personnel of injuries and instantaneously determine medical timeouts. Now one ATC can follow the game and keep up, and the second can review video, notify medical staffs on the field and coordinate requests when they call up. It would be a mistake to assign one spotter to look for injuries on the home team and one for the visiting team. The two need to work in concert. Both spotters are human and ultimately I still predict here will be eye in the sky and medical timeout controversy this year as I said before. However, there should be fewer problems with a second person in addition to the video replay assistant. It is still an impossible job, but two sets of eyes are better than one with all the action that happens.
  1. Designated for return player can be named later
Previously a player upon initial roster move had to be declared to be on injured reserve (IR) and ineligible to return the same season or be placed on injured reserve-designated for return (IR/dfr) and eligible to play again. Now teams still have one IR/dfr spot but they can designate that player to come back from IR. In other words, the medical staff no longer has to predict recoveries and general managers no longer need to worry about using the single designation too early in case a star is later hurt. The Steelers medical staff had the best intentions that Maurkice Pouncey would return from an early season ankle fracture/dislocation. They could not predict that their star center would get an infection and need seven subsequent surgeries and never recover enough to return during the same season, thus wasting their lone IR/dfr designation. The new procedure leaves all IR players “alive” for potential return until a team uses the single IR/dfr designation. This keeps IR players motivated to rehab and around the team in hopes of a return. It also takes hindsight out of medical predictions on potential recovery.
  1. New safety committee
Over the years, the NFL has had multiple committees dedicated to player safety including a Shoe Committee and the current Head, Neck and Spine Committee. There is even a Foot and Ankle Committee. Now add the Field Surface & Performance Committee to the list. The new group will be charged with performing research and advising on injury prevention, improved testing methods, and the adoption of tools and techniques to evaluate and improve field surface performance and playability. Future As the regular season approaches, the only thing we know is the NFL will continue to change in the quest for health and safety. These five improvements won't solve everything but at least yearly progress is being made.
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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