Monday Morning MD: "Witch hunt" season is on

As the numbers of games dwindle, there is more time to deal with unfinished business. Thus the administrative “witch hunt” season is on. The Dolphins were admonished (but not penalized) over their handling of Matt Moore during the Wild Card round. There was no criticism of the care he received. The Unaffiliated Neurotrauma Consultant participated and agreed with the treatment and return to play process. Bear in mind it was a road game where the UNC is local to the Pittsburgh area and probably a Steelers fan. The purpose of the UNC is to first hand witness and provide player protection. Despite the UNC not requiring a locker room evaluation and agreeing with care, the team medical staff was still criticized for not following the concussion protocol. There was the perception of rushing Moore back into the game since he only missed one play. With the referee and TV delays, I timed that Moore was out for exactly five minutes before he returned, which is the equivalent of seven or eight plays of real time. A sideline screening exam takes two to three minutes. Blood in the mouth is considered by the league to be a sign of concussion requiring locker room evaluation. Apparently there was a trace amount on Moore, but not enough to concern the Dolphins or independent doctor. Of course the slight blood could have come on a different play but on this technicality the Dolphins were criticized and warned of future penalties. Now attention is focused on the Chiefs for their handling of Chris Conley in the AFC Divisional Round. With last year’s announcements of potential team penalties/fines for medical staff transgressions, it seems the NFL and NFLPA are destined to find someone to punish. The Chiefs head ATC is the current president of the Pro Football Athletic Trainers Society, which makes him a high profile target. Add to that the fact that he has been in the news this season and previously related to head injury and sets the Chiefs up to be a prime candidate to become a scapegoat. I do not know the details of what the Chiefs did or did not do in their evaluation of Conley. This is why I have advocated for transparency. Why not let the UNC describe what happened on the field, sideline and locker room? Referees talk to a pool reporter after the game to help explain what the officials were thinking. Allowing the UNC to do this might clear up the perception that players were not cared for and might even apply more pressure to do the right thing with the doctor knowing he/she will have to answer publicly for it. Currently the NFL does not have a full-time medical officer. Normally that person would jointly conduct the investigation with the NFLPA physician. With only one physician involved, penalties become more likely as the NFLPA physician has no counter. It is like only one side having an attorney in court or only one side having an expert witness in trial. The outcomes potentially get skewed. Protocols are guidelines not rules. The NFL and NFLPA should stop practicing medicine and allow the UNC and team physicians to operate. They should allow them to speak to clear up misperceptions. If the independent physician is complaining, that should be fully and aggressively investigated with full representation from both sides. MMMD 1: “Witch hunt” part 2 There has been lots of conjecture on fines/penalties for the Seahawks not disclosing Richard Sherman’s MCL injury. I have explained why I feel Seattle will escape punishment. Sherman has now confirmed my thought that the MCL injury was minor. Thus, there was no requirement to list it on the report. Now the Steelers are undergoing scrutiny for not listing Le'Veon Bell’s groin injury. Last year, the Colts were investigated for not listing Andrew Luck’s rib injuries, but no penalties resulted. The reality is there are many more injuries on every NFL team than listed in the injury report. The speed limit is 55mph but everyone on the highway is going 65mph. Only the ones going 75mph will be ticketed. Or as Mike Garafalo tweeted at me, the “Ferarri’s” (star players) get all the attention from the cops but the “Kia’s” (average players) are ignored when it comes to getting pulled over. MMMD 2: Everyone will play in SB51, but how well? Everyone gets healthy in the two weeks before Super Bowl. Fortunately, both the Falcons and Patriots are relatively injury free. The Falcons have no one listed on the game status injury report. Julio Jones is still dealing with his turf toe and is said to have two ligament injuries and a mid foot issue. This is the same foot that has had two previous 5th metatarsal fracture surgeries. I do not think the extra week will allow Jones a full recovery. Despite a monster Conference Championship game, don’t expect a repeat performance. Center Alex Mack, by video, suffered a high ankle sprain and finished the NFC title game but has now missed considerable practice. No doubt he will strap it up for the big game. Of course the Patriots will miss Gronk (on IR for back surgery) but everyone else should play. Nate Ebner is on pace to be cleared from concussion and may accomplish an unprecedented feat. In the last six months he will have played in the Rio Olympics (for USA rugby) and now a Super Bowl. All of his many teammates listed as “questionable” should be available as well. It is the Super Bowl. Everyone will be available. MMMD 3: Teddy Bridgewater not back for 2017? A small uproar was created when it was reported that the Vikings QB would miss next season. This is a case of don’t shoot the messenger. Jason Cole correctly quotes the typical recovery time from a knee dislocation, where multiple ligaments are torn, to be a year and a half. When NaVorro Bowman torn his ACL and MCL, he missed the following season and still struggled after that. There is optimism for Jaylon Smith after his multi-ligament knee injury but he is still wearing an AFO indicating a nerve problem. The point is that all knee dislocation/subluxation injuries are far harder to return from than the average ACL tear. There is no guarantee for 2017 for Bridgewater. Typically there is always offseason injury optimism but head coach Mike Zimmer has said he does not have a timeline for return. After all, did the Vikings trade for Sam Bradford just for one season, or were they also buying insurance for the next year and beyond? MMMD 4: League injury data The annual NFL injury data was released early instead of at Super Bowl week. The league data showed concussions remained essentially the same over a five-year span with 244 total this past season. ACL tears remained constant over the last five years with just under two per team as the average. MCL tears also were similar, averaging just under five per club. With the new touchback rule, there was not a big statistical change on kick-off related injuries. If anything, knee injuries increased. Thursday games continue to have fewer injuries than Sunday games. MMMD 5: Three unusual situations Cyrus Kuoandjio had hip surgery after a fall at home. Details were not released but the implication is a potential hip fracture. That is not unusual for grandma, but extremely unusual for a young healthy NFL player. We will need to wait to hear more details on whether there is some underlying pathology or if this truly was a fluke. Dexter McCluster was signed by the Chargers and had a previous forearm fracture and re-broke it with an at home luggage incident. Josh Doctson is still dealing with his Achilles tendonitis. I am sure the Redskins medical staff has tried all sorts of conservative care, modalities and likely PRP/stem cells. If he doesn’t turn the corner soon, surgery to debride the Achilles may become an option. Ryan Tannenhill finally had surgery ruled out this week. He injured his ACL and MCL but only recently determined that no ACL reconstruction was needed. There are reports of him flying to Germany for treatment despite PRP and stem cells being legal and routinely used in the US. Players will literally go to the ends of the earth if there is a chance for something better. MMMD 6: Hardest part of retirement Steve Smith, Sr. on the “Know Them From Adam” podcast talked about one of the hardest adjustments to post-NFL life. He singled out medical care. Indeed now he will need a new set of doctors. All player’s (and sometimes family) needs are met by the team doctors. Most times, the physicians make “house calls” and come to the facility. There are even preferential appointment times for the dentist. Indeed, life after football involves getting to know what a doctor’s waiting room is for. MMMD 7: ProFootballDoc I did not watch the Pro Bowl and thankfully there are rarely injuries in that all-star game. Having covered two of these exhibitions, anyone with the slightest of medical conditions is pulled for safety. No injury analysis this week and thus the 95.1% accuracy rate stands. I am in Houston this week for Super Bowl and the media activities. I hope there will not be a need, but will be at the big game to provide live injury analysis from NRG stadium.
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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