Monday Morning MD: 3-2-15

What does it mean when a team orders extra medical tests on a draft prospect? During draft season, any team move is read into as interest (or disinterest) in a college prospect. At the Scouting Combine a Dallas team physician ordered a special nerve test (electromyogram) on Jameis Winston’s “weak” shoulder. Does that mean the Cowboys have high interest in trading up for Tony Romo’s replacement? Not necessarily. At the Combine, the task for each doctor is to perform a thorough evaluation on each and every player regardless of draft position. For example, Buffalo is without a first round draft pick this year, but their medical staff undoubtedly fully evaluated Winston, Marcus Mariota, as well as the other 300+ potential draftees. In my NFL experience, teams do give their medical staffs a “watch list” of 50-60 players. I would pay extra attention to these players but it would not mean that I would ignore the others. It is true that is there was any question as to a player on the special list’s health, I would go ahead and order additional tests. However, there were plenty of occasions when I ordered additional evaluation when they were not on the list. When it comes to draft time, clubs don’t always abide by the list anyways. In 2006, Antonio Cromartie was not on my team's original special attention list as we were drafting at 19 and he was a projected top pick. As he fell out of the top ten, I was grilled in the war room about his knee as Cromartie was coming off ACL surgery. The same has been asked about pre-draft team visits and what it means. Whether a prospective player visits a club doesn’t necessarily correlate to who will be drafted. In my almost two decades as team physician, many first round picks were not invited for a pre-draft visit. On some occasions, clubs may invite a draftee to throw off media and other teams. I recall my team bringing in the first round prospect that most mock drafts had us drafting but when he didn’t have a confirmatory physical and the position coach alone (without coordinator, head coach, GM or ownership) took him to a casual dinner at a local sports bar, those were sure signs that he wasn’t high in our projected draft scenarios. Sometimes a pre-draft visit is scheduled because more medical info is needed or because the club didn’t get enough time with him at Combine. Players a team is already sure about don't get invitations. When a particular team orders additional testing on a Combine player or invites a draftee for a visit, it doesn’t necessarily mean that club is particularly interested. It could easily be a matter of due diligence with a doctor or GM being thorough in doing the job. MMMD 1: Three offseason surgeries for Brian Cushing Players often delay surgery until after the season and there are more surgeries performed in the offseason than regular season. However, three surgeries for the same player is not unheard of but is uncommon. The Texans linebacker was known to have surgery on a fractured wrist but he also announced left knee and ankle arthroscopy. The preventative maintenance should help Cushing but let’s hope there is nothing more to the knee. The left is the same side that had 2012 ACL and then 2013 LCL surgery. The scope is mild by comparison but the hope is not to have progressive articular cartilage damage. Cushing lost his last two offseason training opportunities due to major knee surgery but these three surgeries should still allow him to participate in OTAs for the first time in three years. MMMD 2: Everyone is ahead of recovery schedule Victor Cruz is reported to be ahead of schedule after his patella tendon rupture. Carson Palmer is a month ahead of schedule on revision ACL rehabilitation. Stephen Tulloch, who tore his ACL celebrating a sack, says he is way ahead of schedule. I am not sure who is making the “schedule” but you only hear about players being ahead of it, rarely behind it. These reports come from the player, coach or the treating medical professions and are always going to be optimistic. No doctor will ever say his patient is behind schedule as privacy laws prevent medical professionals from saying anything without patient approval. The question on these three players isn’t when they will play but when they will return to full form. Cruz has the biggest uphill battle to return to explosiveness. Tulloch will struggle to start the season in full form. Even though Palmer has the ACL re-tear, his path is the easiest for a good 2015 season. MMMD 3: Making chop block completely illegal The chop (high/low) block is illegal most, but not all, of the time in the NFL. In this health and safety era, the competition committee is considering removing it from the game completely. Knee and ankle injuries have been attributed to this technique of one player engaging a player high while another blocks down low. Catching a leg while the foot is planted leads to higher risk of injury. I would applaud this long overdue rule change. MMMD 4: All 53 dress for Thursday games? With all the health and safety talk surrounding Thursday games, the NFL is considering removing the inactive list and allowing all healthy players to dress for the short week games. All 53 players get paid. If healthy, why not allow them to play? The only argument is competitive balance. If one team has more injured players, It would be theoretically possible to have 53 players versus 46. However, with only 11 at a time on the field, this rule change still makes sense. MMMD 5: Roster expansion? A report indicated the NFL may expand roster size from 53 to 55. Since currently only 46 players dress, this would allow clubs to carry more injured players on its active roster. Typically, the extra seven roster spots are used to help manage injuries. Except for one designated for return spot, all injured reserve players are out for the entire season without chance of return. An Injured reserve player is paid anyways. Why not keep the possibility open that he may return if healthy? MMMD 6: Dolphins hire sports performance director The NFL does change with the times. More and more teams are embracing sports performance, and Miami hired a new director. What is unique about this hire is not only the position but the fact that the he has a soccer and rugby background as opposed to football roots. For a long time, the NFL has stayed within its circle. Hiring of outsiders can only help broaden perspective and enhance the game. MMMD 7: My other sports experience I claim my primary roots in the NFL with 17 years with the Chargers and some additional time with the Vikings and assisting with the Bears. Recently, I have been asked to comment on NBA and NHL injuries. I have served as team physician for professional basketball and hockey as well. I don’t follow NBA or NHL like I do NFL, but twitter followers this week sent video and asked for thoughts on Derrick Rose, Patrick Kane and Russell Westbrook, among others. When I feel I have a good look, I have commented. Based on public reports and my knowledge of medicine, it was clear to me there was too much initial doom and gloom on Rose. I had only one angle of video on Kane’s injury but correctly postulated clavicle fracture. Westbrook pictures and video indicated a zygomatic arch fracture before the official announcement. My football video injury analysis technique is applicable to other sports, but certainly, my experience is greatest in the NFL. Follow David on Twitter: @profootballdoc Dr. David Chao is a former NFL head team physician with 17 years of sideline, locker and training room experience. He currently has a successful orthopedic/sports medicine practice in San Diego.
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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