May 18, 2015 - Dr. David Chao
Monday Morning MD: Instant Injury Analysis
As most of you know, I post my real-time video injury analysis on twitter immediately after a suspected injury. For the 2014 NFL season, I tallied a 92.6% success record in being correct. Using the television to make injury diagnosis is far from foolproof, but I want to explain how it is no accident either. Besides my study of injury as an orthopedic surgeon, I spent 17 years analyzing NFL injury video. Every Monday morning after a game, I would visit the team video room with the head athletic trainer to review injury tape. This is after having tended to a player on the field, treated him in the training room, obtained x-rays/MRI and re-examined the following morning. With the specific diagnosis known, we could reverse engineer the mechanism of injury. I feel tremendously lucky to have this unique perspective and that is what gives me an advantage over others trying to do the same thing. Even with this experience, it is only video analysis without hands on exam. I have doumented 11 “misses” in my 148 “calls” last season. There is no question that there may be bias as I am self-grading my injury predictions. There is also no way I can be completely specific. For example, when last week I indicated Dante Fowler’s likely ACL tear, I also felt there may have been a MCL component as well. However, I count any confirmed ACL tear as correct regardless of the presence or absence of associated injury. I am very careful to term what I share as “insider knowledge” but not “insider information”. Insider knowledge comes from my almost two decades as an NFL team physician. Insider information is knowing facts from actually treating a patient or from leaked sources. I don’t ever comment on a player that I am or have treated without their permission. I also never trade on my friendships with other team physicians or athletic trainers to obtain insight. In fact, on occasions where I am contacted by another medical professional to discuss a case, that also makes that info off limits. I have offered to let people audit my numbers. In fact, my calls are all on my twitter timeline and this column. However, going back to analyze 148 cases would be quite tedious. This is why I will have a running record at the end of this column each week. Currently, I am 1-0 after the Fowler ACL tear. There were no injury videos this week. I hope to have a quiet 2015 but whenever I give my analysis, I will grade and explain each week so it will be a live document as we go along. Many have asked about other sports. I do have experience in the NBA, MLB and NHL, but it is not as extensive as my football credentials. When there is video of a traumatic injury, I have commented where I fell I have a good enough look. Recently, I indicated Kevin Love dislocated his shoulder and would need surgery. Also, Patrick Kane by video broke his clavicle and was even correct saying he would be back in 6-8 weeks (returned in seven) when official news indicated 10-12 weeks. I will leave these predictions of other sports out of my NFL scoring. I am happy to have any additional comments. I always welcome addition video links for more angles. I certainly am not always aware of every injury. Keep sending injury video to me through twitter as many already do. MMMD 1: No offseason for injuries Last week we discussed the two rookie minicamp ACL tears. Despite teams' best efforts to curtail injury, they inevitably continue to happened even in the offseason. In addition to the knee ligament tears of Dante Fowler and Jeff Heuerman, Ravens rookie cornerback Julian Wilson broke his leg and needed surgery. Vikings starting defensive end Brian Robison suffered a pectoral injury during offseason workouts. No comments yet on specifics or projected absence. If a pec muscle injury is found, he should recover well in the coming weeks. If the pec tendon is torn, that means bad news with surgery to follow and missing significant time this season. Even with the new CBA that limits practice and eliminates contact, injuries are still inevitable. It seemed during my time in the NFL, every other year we suffered a significant offseason injury to a potential starter. MMMD 2: Jaguars make good on Dante Fowler contract The number three overall pick will indeed get paid as expected even though he had not signed his contract when he tore his ACL. Last week, I indicated that Jacksonville would honor his slotted value and that has indeed happened. Fowler signed a four-year deal with a guaranteed $23.5 million. If teams didn’t make good, no one would practice prior to a contract being signed. MMMD 3: Shane Ray toe injury still in question The Broncos top draft pick didn’t participate in minicamp due to great toe issues. I indicated he was a “RED light” medical issue with a turf toe variant. Reports were that he still may need surgery. Ray is slated to “be able to participate at least some” starting today. How his toe responds will determine if he still needs surgery. I haven’t seen his medical chart but by public reports, he likely has a sesamoid issue. These two small bones are notoriously slow healers after turf toe type injuries. If this is the problem and it doesn’t heal, he may need to have his sesamoid bone excised, and that means minimum 3-4 months recovery. For an edge rusher, the great toe is vital for explosive push off. For the Broncos, it is vital that they know his toe is healthy because if not, surgery needs to be done immediately to salvage the season. MMMD 4:Tevin Coleman has sickle cell trait Sickle cell trait is common in the NFL. Sickle cell anemia would preclude a NFL career. Fortunately, the now Falcons running back only has the trait. It should be a minimal factor in his NFL career. Players with sickle cell trait just need to be careful with hydration when in extreme heat or at altitude. Most NFL teams have at least one player on their current roster with sickle cell trait. The Atlanta medical staff will be aware of Coleman’s situation and it should not be an issue for his career. MMMD 5: Physicals before rookie minicamps Every NFL team conducts full physicals on rookies before minicamp. In fact this may be one of the most important parts of the weekend. Teams have already examined most draft picks, but most free agents have not been seen medically. Usually the day before minicamp is spent on full physicals. It is not unheard of to fail a player if the team doesn’t want to take a chance on the injury. In the NFL, once you pass a physical, the team owns the ailment. For example, a knee with a chronic arthritic problems could be the responsibility of the club even if the player is released after one minicamp. If a club is concerned about an injury, they may require the player sign an injury waiver. This releases the club from long-term responsibility for a pre-existing injury. MMMD 6: Jameis Winston prohibited from playing baseball Player contracts often have clauses restricting dangerous activities like skiing, motorcycle riding or skydiving. In the case of the first overall pick, baseball is excluded. Throwing a baseball might cause injury to a quarterback’s shoulder or elbow, In this case, it is probably more about Winston devoting full time to football than it is about potential injury. MMMD 7: Rugby crossover Rugby crossover continues into football. The 49ers have been pleased with Rugby League star Jarryd Hayne. It turns out Cardinals and former BYU running back Paul Laskie is from New Zealand and was a rugger growing up. He never played football until college. I have strong rugby roots and have been a long-time USA rugby team physician. I have to take this moment to congratulate the mens sevens team on a historic feat. For the first time ever, the USA squad won an IRB tournament defeating Australia in the Cup final in England this weekend. The USA team is peaking at the right time. Rugby returns to the Olympics in Rio for 2016. 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.