April 20, 2015 - Dr. David Chao
Monday Morning MD: Medical re-check
Medical re-check: the little known Combine may shape the draft The NFL Scouting Combine draws media attention second only to the Super Bowl. Even the first-ever Veteran Combine warranted NFL Network’s on-site continuous coverage. In comparison, the medical re-check Combine happened this weekend in Indianapolis without a single reporter or camera present. Despite the obscurity, these medical evaluations have a large role in shaping the top of the draft this year. Ex-Georgia running back Todd Gurley is a projected first-round pick; however, the status of his reconstructed knee is in question. At the main Combine, he deferred a full orthopedic evaluation of his rebuilt ACL until the medical re-check on Saturday. How his knee looked will play a major role in determining where he is selected. This can have a domino effect on the rest of the draft. All 32 team physicians and athletic trainers in attendance had a chance to examine Gurley’s knee this time and “tug” on his graft. Fortunately, the ACL tests (Lachman, drawer, pivot-shift) are not painful maneuvers. The outcome will impact where the star running back is selected. Ian Rapoport reported that Gurley’s knee “checked out fine” and was “good to go for the draft”. Those statements may be true but that doesn’t tell us the whole story. Certainly his knee is not ready for football today. The question is when he will be ready to play and if there will be any long-term consequences. Being draftable doesn’t necessarily mean being ready for training camp or week one. How teams interpret this medical data will determine if and where in the first round Gurley will be drafted. Typically, a reconstructed ACL doesn’t reach full strength until the second season after surgery, but this does not mean Gurley can’t be effective this fall as Adrian Peterson has proven during his first year back after ACL. The medical re-check has been a part of the Combine process for as long as I can remember and I have personally attended 17 of these Saturday morning gatherings. Because it is only medical, no general managers, coaches, scouts or other team personnel attend. Details on this process were chronicled in my column from this time last year. Gurley’s knee and how it looked during examination in a medical center basement this weekend will have a significant effect on how the draft plays out. MMMD 1: Precedent for Gurley’s first-round selection coming off torn ACL A knee does not have to be 100% in order to be drafted in the first round. I was in the war room when my team decided to select Antonio Cromartie in 2006. He was still recovering from ACL surgery and had a swollen knee at the medical re-check, but he projected well enough for the Chargers to select him as the 19th overall pick. Of course not all ACL tears recover smoothly. The 49ers drafted Marcus Lattimore in the 2013 fourth round as a rehab project. After two seasons on the inactive list, he retired without playing a down. Admittedly he was not an isolated ACL injury but tore other ligaments as well. MMMD 2: Re-check Combine isn’t only place for medical evaluation Physical exams can be performed during team visits. Sometimes this is the main reason for a team to request a visit. This maybe the logic behind Gurley having so many late team visits including the Browns and the Patriots. Clubs may have waited to get a better look at how is knee was recovering. MMMD 3: Jameis Winston did not attend re-checks The projected first overall pick’s was not required to attend the follow-up examinations. When his shoulder nerve issue was first discovered at Combines, I did not feel it was a big deal. Winston’s absence from the medical re-checks indicates team doctors agree his shoulder health is a non-issue or they would have had him attend. MMMD 4: Very unusual to refuse medical re-check Top receiver prospect Jaelen Strong was slated for medical re-check due to a reported fracture of a small bone in his wrist. Instead, he skipped the examination, which may lead to some unanswered questions. His wrist was reportedly cleared by the Steelers medical staff in a team visit and that information will be passed along to the other 31 clubs. In my almost two decades involved with the Combine, I do not recall a player forgoing medical re-check. I am not saying Strong did anything wrong or that he has a wrist issue that lowers his draft stock. I am just observing skipping re-checks is unusual. He reports having played five games with the injury. The question is whether it has healed or might affect him in the future. MMMD 5: Wonderlic test scores routinely get leaked Results of the general aptitude test routinely become public and this year is no exception. The NFL does attempt to keep the findings confidential, but the newsworthiness of the intelligence test for top quarterbacks seems to win out over discretion annually. There is some controversy as to why the leaks continue to occur. Some suggest players should refuse to take the 50-question test since the league can’t keep the results confidential. Medical results also generate considerable interest but these should be kept private as well (and there are laws to keep them confidential). I know the vast majority of medical personnel in the NFL, but I don’t think it is right to try and obtain private information from them. Even though many are my friends, team doctors would not break their patient duties and I would not insult them by asking them to do so. I only comment on what is already reported in the public domain. MMMD 6: Voluntary offseason workouts start but players have already begun working As players assemble for workouts, I would point out most have been already hard at work. Players do train on their own but I am talking about how the average NFL training room never slowed down. Rehab from surgery and preventative therapy occurs regularly throughout the offseason. In fact, offseason is a busier medical time than in season. MMMD 7: NFL schedule released this week The opponents have been well known for a while, but the actual dates and times of play will be revealed this coming week. Fans will look for good road trips or big home games. Players look at the bye week first and then night/primetime games. Meanwhile, wives look at the holiday schedule and if Daddy be home for Christmas. 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.