March 23, 2015 - Dr. David Chao
Monday Morning MD: Why Chris Borland has become the early retirement poster child
In this fast moving NFL world with its quick news cycle, why does Chris Borland’s decision to quit football over concussion fears continue to make news? The announcement caught everyone off guard. I wrote about the early retirement trend the day before Borland’s announcement and it still surprised me how quickly he has become the face for the dangers of football. Borland makes the perfect poster child because his story is airtight and he makes a direct link to neurologic worries as the sole reason for his resigning from the 49ers. He is an intelligent person who expresses his thoughts clearly. His team clearly wanted him back and he is not justifying his exit from the league. With Patrick Willis’ early retirement and Borland’s play last year, he was slated to start and potentially make millions in his next contract. He has no health issues and no current head injury symptoms, although he admits to one NFL concussion and several previously. He speaks eloquently that football is an “inherently dangerous” sport, but doesn’t appear to have an axe to grind. He is not saying others shouldn’t play football, only that the risk is not worth it for him. Borland has no regret of having played football, still loves the game and would do it again. He even expressed remorse and worry about leaving his team shorthanded as Willis, who plays in front of him had recently retired. Borland is such an honorable guy, he is even giving the majority of his 617k signing bonus back. ProFootballTalk points out that he could have “half-assed it in camp this year, gotten cut and kept the money”. Even more easily, he could have claimed concussion symptoms that are undetectable, medically retired and kept all the money. He is not doing any of these things and his intentions seem pure. I don’t think the football world knows how to react to this. Some initially questioned his motives as someone trying to renegotiate his rookie contract. Others have downplayed his returning his signing bonus saying he comes from a rich family. Many have questioned his love of football. None of this seems to be true. I don't believe this is the end of the sport as we know it. NFL popularity remains at an all-time high. Over two thousand former players applied for the just over 100 spots at the Veteran Combine where one pays his own way plus a $400 registration fee for the chance to workout in front of scouts. Sure there is a decline in children playing organized tackle football but the youth leagues continue. I do believe that when we look back years later, the Borland early retirement will be a significant event on the concussion evolution timeline. Borland is hardly the first person to retire due to concussion risk. Famously, Troy Aikman, Merril Hoge, Stan Humphries and others have retired after head injury. The fact that Borland only played one year, had no current concussion issues, and has so much upside has everyone caught off guard. MMMD 1: Steelers doctor takes heat for saying CTE being "over-exaggerated" Neurosurgeon Dr. Joseph Maroon made these comments on NFL Network and has undergone significant criticism. He also stated Chronic Traumatic Encephalopathy was a “rare phenomena” and youth football is safer than riding a bike or skateboard. Many immediately jumped to the erroneous conclusion that Maroon is a paid mouthpiece for the NFL. He indeed is a longtime Steelers team physician and a member of the NFL Head, Neck and Spine Committee, but he is not paid for these activities. His highly decorated career has been dedicated to head trauma safety. He co-developed ImPACT (the gold standard test to detect and evaluate concussions), is a clinical professor of neurosurgery and has written over 250 medical papers as well as 40 book chapters. Maroon is also a former Big Ten football player who has had a life long interest in youth football safety. One can disagree with his medical conclusions but one cannot impune his credentials or accuse him of being a paid mouthpiece for the NFL. MMMD 2: Medical timeout in play? The public pressure on concussions continues, and Borland’s early retirement just fuels that fire. I personally witnessed that the concussion protocol was followed during the Super Bowl on Julian Edelman, but the controversy continues. The issue is that despite the “eye in the sky” calling down, Edelman wasn’t immediately evaluated as play continued. Under the current system, no mechanism exists to stop the game. All of that may change after this week with the introduction of a “medical timeout”. Media speculation seems to indicate that immediate evaluation of a player tabbed by the spotter will be mandated going forward. The question is whether the medical timeout will only be to remove the player from the game for evaluation while play immediately resumes or if play will be stopped waiting for the evaluation. Holding the game could lead to a rushed medical evaluation but resuming play might cause a key player to unnecessarily miss a game-changing third down play or even miss a final drive. MMMD 3: No surprises at Veteran Combine Last week we discussed how it really isn’t a Combine but a Pro Day. There were no medical evaluations, player interviews or drug tests. Early media reports of yesterday’s first-ever veteran event did not reveal any surprises (unless you consider the negative reviews on Michael Sam a surprise) Some of these veterans are not on rosters due to medical questions. Bleacher Report’s Matt Miller asked about Adam Carriker’s health status after his third quadriceps surgery. If the NFL was serious in giving these veterans the best chance to catch on, a medical evaluation system should be included, especially since they are paying their own way to be at the workout. It is expected that 5-10 of these veteran players will be signed to the 90-man roster. The question is will any of them make the final 53 MMMD 4: Chop block still will not be completely outlawed A new proposal would further restrict blocking at the knee when engaged, but it still would not be completely illegal. Running backs would no longer be able to go low outside the box when another player is engaged up high. Chop blocks have been shown to cause season ending lower extremity injuries. In my 17 years as a team physician, I have performed knee and ankle surgery on victims of low blocks. In this health and safety era, why not eliminate chop blocks entirely? MMMD 5: Back issue discovered during free agency Jermaine Gresham was looking to sign with Oakland among other teams when apparently a herniated disc was discovered. The former Bengals tight end underwent surgery and likely will be out a minimum of three months. Notable previous players with similar disc surgeries include Tony Romo and Rob Gronkowski. Last year the Raiders had a deal on the table for Rodger Saffold but withdrew when a shoulder issue was discovered during a physical. Are the Oakland doctors better or more thorough? More likely, management is more careful and unforgiving of signing injured free agents. MMMD 6: War room story With the announcement of Antonio Cromartie re-signing with the Jets, it brought back memories of when he was drafted in 2006. What is the team doctor’s role on draft day? Those duties vary from team to team and in my case varied based on the general manager in charge. More often than not, I had an assigned seat in the war room and felt fortunate to witness the inner workings of the team. Most years, my contributions were done before the draft but in the year Cromartie was selected, medical played a big role on draft day. I can still remember the general manger saying to me, “it’s all on you now”. MMMD 7: Rugby players in NFL Ex-Kenyan rugby star Daniel Adongo signed his tender to return to Indianapolis. Last season ended with a torn biceps in preseason but he is being brought back. Joining Adongo in the rugby to NFL transition is Australian star Jarryd Hayne who signed with San Francisco. Having worked internationally with the USA rugby team, I am always asked to compare to the NFL. The crossover from football to rugby has been done but is difficult due to the continuous nature of rugby, importance of instinctual play and necessity to play both ways. The Colts and 49ers are hoping the rugby to football transition will be easier. In the NFL, the specific tasks of situational play might be considerably easier to learn than the instincts required to be a top rugger. 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.