August 17, 2015 - Dr. David Chao
Monday Morning MD: "Coach speak" for preseason injuries
In my time in the NFL, I liked and respected all my coaches. This is an observation, not a criticism. Even in the preseason, “Coach speak” still occurs. Certainly all coaches play their injury cards close to the vest in the regular season and playoffs. I was the head team physician when head coach Norv Turner chose not to reveal surgery or an ACL tear for star quarterback Philip Rivers prior to the 2008 AFC Championship Game vs the undefeated Patriots. Deception/omission is understandable for competitive advantage, but what about in the preseason? There is little to be gained by hiding injuries when games don’t matter. If a player doesn’t practice the entire preseason, are you really fooling your first real opponent that he will play? “Coach speak” in the preseason takes on a different tone and often includes general managers and owners. It can’t be about hiding weaknesses for a meaningless preseason game. Some front office personnel might find it hard to shift to preseason openness when they are used to regular season patterns. Simply, I think coaches show optimism for injuries in the preseason for other reasons. Coaches are human and like all fans, they want to be optimistic about how their player is recuperating as hope springs eternal in the preseason. A leader needs to have faith in his player and show he is not giving up on him due to injury. The coach also may be sending a message to the player through the media that he is expected back sooner than later. In general, preseason “coach speak” tends to view injuries through rose-colored glasses leading to false hope for a quicker return. This can lead to unintentional misinformation on injuries. In Chicago, the return of first-round draft pick Kevin White was said to be any day since the start of training camp. Last week, reports remained optimistic about a quick return. “He’s got a shin. You can call it splints,” head coach John Fox said. “You see him out here. It’s not like we are covering up some awful injury where he is in a cast, a boot and crutches.” Late week, news came of a stress fracture, surgery and potential IR status. In Jacksonville, Gus Bradley used the words “small” and “stable” to describe the finger fracture of his newly acquired star tight end Julius Thomas and that no time would be missed. Turns out, the break is more in his hand and the finger was pointing in a different direction when it occurred. The fracture clearly required reduction, cast/splint and even possibly surgery. The coach now has acknowledged Thomas will miss the rest of the preseason and hopes for a Week 1 return. In Baltimore, head coach John Harbaugh used the “I am not a doctor” line to express his continued optimism for rookie first-round draft pick Breshad Perriman. The injury was originally described as a bruised knee where he might only miss one day. 11 missed practices later, the term strained tendon has been added. “It’s not something that’s going to keep him out for a long period of time…If I were a doctor, I would give you more. You come out here and we expect to have definitive answers about injuries from coaches. I didn’t take those classes in college. I wasn’t interested.” No one truly believes a quality Super Bowl winning coach like Harbaugh hasn’t gotten all the information that he needs from his medical staff. Lets just hope it is not a deep bone bruise where six-plus weeks could be missed. “Coach speak” abounds with preseason optimism. Every coach preaches that his team is set to win the division. That is just the nature of coaching to remain positive and set lofty goals. Say it enough and maybe it will come true. However, when it comes to injuries, it just doesn’t work that way. MMMD 1: Why do injuries seem to spread through one position group? Obviously injuries are not contagious but it certainly seems that way. Ask Washington who lost tight end Niles Paul to an ankle fracture/dislocation and then announced season-ending turf toe surgery on tight end Logan Paulsen. The Giants are experiencing the same thing at safety. Mykkele Thompson tore his Achilies, Landon Collins injured his MCL, and Nat Berhe has a calf issue. Berhe’s is the only one whose season isn’t over but calf injuries tend to linger. One reason injuries may spread through a position group in training camp is practice load. When one player goes down, the others in the position group are expected to take more reps as the rest of the team still needs the same amount of practice. This overwork (along with bad luck) potentially contributes to the rash of injuries at a single position. MMMD 2: Bears wide receiver injury woes Both rookie first-round pick Kevin White and Pro Bowl receiver Alshon Jeffrey are injured. White has a tibial stress fracture, an injury that is more common in NBA players than in the NFL. In surgery, a reamed, unlocked rod will be placed inside his tibia and possibly bone graft will be used. Since there was no video, I could not know what the exact injury was until it was formally announced; however, all along I opined it wasn’t going to be a day-to-day thing. Bone is alive and is constantly being added and subtracted. A stress fracture occurs when breakdown outpaces new bone formation. Even with surgery, this type of break heals more slowly than regular fractures. White will miss 3-6 months and likely will be a long-term IR candidate but will ultimately return to be 100% when healed. Alshon Jeffrey has a calf injury and a report indicates a mild strain with a one-week return. That may be more “coach speak” as John Fox originally described it as day-to-day. It would be beating the odds to go from boot and crutches (even if precautionary) to full-go in one week. Just ask Aaron Rodgers how his calf injury lingered at the end of last season and into the playoffs. MMMD 3: Achilles is the new ACL First written about in 2014, the trend continues. Achilles has become the dreaded word for a non-contact season ending injury similar to how ACL has been. Vikings right tackle Phil Loadholt tore his Achilles, as did Giant safety Mykkele Thompson. They suffered the same consternation as when Steelers kicker Shaun Suisham tore his ACL without taking a hit in the Hall of Fame game. Suisham’s teammates tried to blame the turf but the matted down old turf from HOF ceremonies would likely serve to make the field more slick (and less chance of ACL tear) as the usual mechanism is foot stuck in ground. The only good news is they all have time to recover for 2016 with the early injuries. So far there are 14 ACL tears this preseason with Achilles ruptures a close second. [caption id="" align="alignright" width="300"] Smith outside his home on August 15th[/caption] MMMD 4: Geno Smith throwing again, complete with eye black In my two decades in the NFL, I never heard of a player with a fireworks injury. I also never experienced a quarterback being punched (although I did treat a quarterback who injured his hand punching someone). The unique Geno Smith story continues. He was released from the hospital Saturday after plates and screws were inserted on Friday. The next day he was seen throwing outside his apartment complex. His jaw was not wired shut, indicating stable fixation. The fact that he felt well enough to throw is another good sign. The Jets told him to stop due to infection risk, but that doesn’t make medical sense. Much has been made that his jaw was fractured in two places, but that is typical whenever a jaw is broken. Even when initial estimate for return was 6-10 weeks, I always thought it would be closer to six. With the news of presumed stable fixation without need to wire the jaw shut, he can eat immediately and return even faster. Smith will need some extra protection against a hit, but medically there is no reason he won’t make the regular season opener. With the lost practice time and need to familiarize with a new coach and offensive system, it will be more likely a coaching decision than medical restriction if he doesn’t play Week 1. MMMD 5: Zach Ertz and Arian Foster procedures similar Both players had sports hernia type surgery by the same surgeon. Other names like athletic pubalgia, core muscle or groin surgery are often used interchangeably but the procedures are very similar. So should the return timetable be similar. To be clear, neither player had true groin tendon reattachment surgery as speculated in the media. The Philadelphia tight end is said to be ready Week 1. The Texans running back’s return has been estimated by media to be three plus months. I feel both of their returns should be more similar than different. It may be harder for a running back to return from such a surgery due to the acceleration and cutting, which are groin dependent activities. I estimate it is possible, but not guaranteed that Ertz is ready for the opener. Typically sports hernia recovery is 4-6 weeks. Foster’s recovery should be similar but may be slightly longer due to his position and as the bell cow running back, the Texans may want to make sure he is 100% to avoid any flare ups throughout the season. Why the difference in timetables? I am not aware that the Texans have even set one. The three plus month number is from media speculation. I anticipate a quicker return like what the Eagles projected for Ertz. MMMD 6: Preseason injury carnage continues “The injury carnage that mounts just a few weeks into training camps is truly stunning. Teams already just looking for warm bodies” was the tweet from CBS NFL insider Jason LaCanfora. A team is lucky if it only has one season ending injury since training camps opened. In addition to those discussed above, here is only a partial list from this week. Vikings TE Alan Reisner has an ankle fracture. Bills DE Jarius Wynn tore his ACL. Rams CB E.J. Gaines Rams had lisfranc foot surgery. Browns QB Connor Shaw broke his thumb and will require surgery. Patriots RB Tyler Gaffney was placed on IR with an undisclosed injury. Bucs RT Demar Dotson injured his MCL and will be out six weeks. Free agent Knowhson Moreno is out for 2015 with knee issues. Saints RB CJ Spiller had a surprise knee scope that was initially discovered thru a photo posted online, but unlike the others, expects to play Week 1. MMMD 7: ProFootballDoc scorecard My thoughts about Arian Foster's and Geno Smith’s earlier than expected returns are still pending but the analysis on Niles Paul and Todd Gurley seemed to be correct. Kevin White’s injury was assumed to be stress related and led me to conclude that the day-to-day return was not going to happen. Of course I did not specifically predict full on stress fracture requiring surgery but that was at the extreme end of my expectation, I will not count this a second time as I scored it last week already. I had clear video on Niles Paul thanks to a tweet from a twitter follower and was able to see ankle dislocation with likely fracture. This is different than the injury RG3 had last year where his subtalar joint was dislocated without fracture and returned in six weeks. Paul had surgery and is done for the year. I have said all along it was a lot to assume that Todd Gurley would be ready to go Week 1. The “Adrian Peterson” type expectations were just not realistic. After ACL tears, 95% of athletes return to the same level, but Gurley is being asked to recovery from ACL and leap to a higher level from the college to the pro game. Unfortunately, it makes sense that he is now reported to miss the first few weeks but should be fine in the long run. With these two added to last week’s total, the 2015 season record stands at 16-0. 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.