December 21, 2015 - Dr. David Chao
Monday Morning MD: Hope the NFL "movies" end well
The NFL will have one drama featured on the Hollywood big screen this week. Meanwhile, the stage is set for more theatrics involving the Chargers, Rams and Raiders. Prior to release, we already know how the much talked about Concussion movie will portray a David (Will Smith) vs Goliath (NFL) storyline. The film only takes us to the realization of the problem linking chronic traumatic encephalopathy (CTE) to football. The real life production of how to treat and handle this information is only beginning. The stage is set after an emotional farewell Sunday in San Diego and with potential final home games for St Louis and soon in Oakland. The climax will come with the league stewards convening to make a relocation decision in Houston next month. Whether you are a NFL conspiracy theorist or not, science should be embarrassed that there is still so much more we don’t know about concussions than what we do know. Contrary to how the movie depicts it, CTE was actually discovered in boxers almost a century ago in the 1920s and was named well before the Mike Webster autopsy. Some have called for the banning of boxing as early as the 1950s. Not only is there no sure-fire prevention, medically accepted treatments (other than rest) are not available. Medicine cannot even agree on how strong the link is for football and CTE. Take the two real-life doctors portrayed as heroes in the Christmas day release movie who started a brain research institute together and now can’t agree with each other. One, the forensic pathologist, states football should be banned for those under 18. The other, the neurosurgeon, supports youth football as safe. I take no sides and reserve a decision on whether to allow my son to play football as he is not even in kindergarten yet. The discovery of a CTE link only raises more questions and we need answers (not politics) from the top brain researchers. Whether one blames greedy owners or spineless politicians, it is just a bad look to tear franchises away from fan bases. My son was too young to understand but there were real emotions and tears from current and former players Sunday in San Diego. Having worked 17 years with the Chargers, I have been asked often this week about my favorite Qualcomm Stadium memory. Despite many great victories, I have to say attending Sunday’s game with my son has to be near the top. Both sagas are very personal to me. I enjoyed my 17 years caring for my hometown team and the dozens of friendships developed. Sunday, I loved taking my three year-old son to his first Chargers game (not counting when he was too young to crawl and my wife brought him when I was team doctor). The head injury issue is also very personal too. I have many ex-NFL friends and worry about CTE. I have one friend who committed suicide and was found to have CTE. The NFL relocation sequel will air January 12th and 13th with a vote of the owners. The head injury saga will undoubtedly continue for decades. I hope both of these real-life screenplays work out to positive conclusions. MMMD 1 $30 million concussion study Preliminary results of NCAA and U.S. Department of Defense research document concussion rates in various sports. Per 10,000 exposures (one athlete practice or competition), wrestling leads the way (10.9), followed by men’s (7.9) and women’s (7.5) ice hockey, then football (6.7) and women’s soccer (6.3). When I tweeted these early findings, it created a stir that football concussions were being downplayed. This was not a CTE study and severity or sub-concussive trauma was not included. Factoring in the number of participants, I find the results to make intuitive sense. College football leads the way with a documented concussion approximately every two weeks, next is wrestling (one per month), followed by ice hockey (one per 1.5 months) and then women’s soccer (every two months). In my coverage of all of these sports, these numbers seem to be about right. Let’s keep politics out and let researchers do their jobs. MMMD 2: Patriots dual training rooms. Tom Brady and his “body coach” have come under scrutiny. If the Patriots are circumventing the salary cap, the amount is minimal compared to the QB’s salary. What I do find interesting is the Patriots, who are know to be control freaks, provide room for Brady’s guru to treat players separate and away from the main training room. Dual systems don’t usually work well. Imagine what would happen if the offensive coordinator and QB coach don’t share a philosophy. We know what happens with two starting quarterbacks. On a team, everyone needs to work cooperatively. Even the strength and conditioning coaches and athletic trainers need to see eye-to-eye on injury prevention. I have seen other NFL teams with dual training rooms before and it usually does not work. What if the philosophy on rehabilitations differs? Although we have not seen any issues arise yet, I am surprised that Bill Belichick allows this. MMMD 3: Much ado about nothing The Giants have been under fire for leading the league in injuries. Now a report attacks them for their intravenous fluid use. The article contents present a reasonable picture but the headlines make it seem like the medical staff is doing something wrong. Use of IV’s is not illegal in the NFL. Yes all medical treatment comes with some risk, including taking an aspirin. Their frequency of usage is probably higher than required but there has not been a documented complication ever in the NFL and it has been used for decades. Ask any athlete who has cramped. It can be one of the most painful and distressing experiences, especially when your entire body locks up. One needs to look into if there is any reason (besides bad luck) that the Giants have so many injuries. I can tell you their described IV usage is not dangerous or out of line with the NFL. MMMD 4: Adrian Peterson sprains ankle The Vikings running back returned to the game after heading to the locker room to be evaluated and taped. No X-rays were taken and no word of MRI as of yet. By video, AD had a mild high ankle sprain. He escapes more severe injury as he foot was not planted when he was rolled up upon. I am sure the team had him wrapped/immobilized post-game to prevent overnight swelling, which will be key. MMMD 5: Tyrann Mathieu injured in Cardinals victory Arizona may have clinched the NFC West but they would rather have the Honey Badger healthy. He went down awkwardly after a fourth quarter interception. Two years ago he tore his ACL and LCL on his left. This time he had a non-contact injury to his right knee. There is no question that this one is less severe but there is still worry of an isolated ACL injury. He was able to walk post-game but that does not rule out tear. Clinical exam will be confirmed with MRI. Here is hoping for good news. Fans want to see all teams as healthy as possible for playoffs. MMMD 6: Medical potpourri Carson Palmer appeared to dislocate his index finger on follow through. Typically, this does not significantly hamper a QB, like a thumb injury would. Palmer was reduced, taped and missed one play. Cam Newton’s shoulder/pec injury might have been more significant but since he already released the ball, there would be no tendon or muscle tear. He may be black and blue from the hit but he easily finished the game. Marcus Mariota, by video, suffered a very mild MCL sprain to his right knee. He finished the game with a grade 2 MCL on his left knee earlier this season. His sitting out may be about preservation of the prized rookie with the team out of contention than anything else. Danny Amendola appeared to re-aggravate his presumed PCL strain as he tried to stop and cut on a punt return. No one can be sure if he will play next week but I have little doubt he will be ready to go for playoffs. Patrick Chung by video suffered a hip pointer from friendly fire. Depending on swelling he could be ready next week but will undoubtedly be healthy for playoffs. As of this posting, I have yet to see any definitive video on Dont’a Hightower’s knee injury; however, maybe that is a good sign. Russell Okung suffered a calf strain. Pete Carroll is correct in saying “those can last for a little bit”. Although easier for an offensive lineman than and explosive position player, look for Okung to rest and try to get healthier for playoffs. Andrew Luck could return next week, which would be seven weeks from kidney laceration. My original estimate was 6-8 weeks. Marshawn Lynch is about four weeks from sports hernia type surgery and was not ready to replace Thomas Rawls who broke his ankle. I anticipate Beastmode will be ready to go for playoffs or late season tune-up as the average return is six weeks. As Chris Johnson won’t be back until potential Super Bowl and Andre Ellington missed his third straight week with a turf toe, David Johnson survived a knee scare. By video, it appeared to be a contusion rather than hyperextension and he returned effectively for the second half. Byron Jones did not dislocate his knee and pop it back in as was the internet sensation. There is no way to continue playing with an injury that severe. It is possible he has a lesser cartilage or other issue but he finished the game. MMMD 7: ProFootballDoc scorecard Glad to have many calls of minimal injury to be correct this week. Cam Newton (shoulder), Carson Palmer (finger), Adrian Peterson (ankle), David Johnson (knee) and Eric Decker all returned to play with mild injuries. Unfortunately, Thomas Rawls’ season is officially over and Marshawn Lynch is not back yet. Dominique Easley’s quad strain turns out to be a bigger deal. T.J. Yeldon found it hard to play RB with even a mild MCL. I will count my LeGarrette Blount assessment as wrong. I may be right on the hip injury but I did not recognize it as a season-ender. Last week’s 120-7 (94.5%) now becomes 129-8 (94.1%).