May 09, 2016 - Dr. David Chao
Monday Morning MD: Youth movement in pro sports
The NFL has always valued youth, and with the current CBA it really seems like any player approaching 30 becomes expendable. Fueled by analytics, the youth movement has reached coaches and management across all sports leagues. This week, the NHL’s Arizona Coyotes hired a 26 year-old analytics expert as their general manager. Examining the current roster, the new GM is younger than over half of his players. In MLB, Theo Epstein was 28 when the Red Sox hired him. His success may have encouraged other owners and leagues to hire young Ivy League brainiacs. The Browns have gone that route with young Harvard educated executives Sashi Brown and Paul DePodesta who then in turn hired 28 year-old fellow Crimson Andrew Berry for the top personnel job. The NFL has long embraced the youth movement. Howie Roseman was 36 when he became the Eagles GM. The Bears Ryan Pace was 37. At 31, Lane Kiffin was the youngest NFL head coach. Bill Cowher and Mike Tomlin were both only 34 years old when they each started their long Steelers tenures. I am not against this youth movement. In fact, I was part of it. There is no official record keeping of age for medical personnel, but I was likely the youngest head NFL team physician ever. Being 32 when I first started as a team doc, the first 8 years I was younger than at least one active player on the roster. William Fuller was older and when he retired, we acquired Jim Harbaugh who was three months older. When Jim moved on, I thought my streak was over; however, Doug Flutie joined the roster and he was two years older. There was nothing significant about being younger than a player except it made me feel more part of a peer group all trying to achieve the goal of a championship. I related and cared personally about the guys off the field, which made it easy to do the best thing possible for them to keep them healthy and on the field. The last nine years of my 17-year NFL tenure, players were all considerably younger than me but many felt like my little brothers. This camaraderie made it easy to spend time on the road and enjoy going the extra mile to help out my teammates. The youth movement eventually caught up to me too. When my GM and head coach became younger than me, it was a sign of how the times have changed. I will always feel lucky to have been in a position to have these special friendships that extended beyond the traditional doctor/patient relationships. It meant a lot to me when players accepted me into the special fraternity made possible by age. My biggest compliment was when Philip Rivers called me a teammate saying I “wasn’t a doctor that also happened to be a team doctor. He was a Charger all the way. He’ll be missed.” Time marches on. Many say the NFL stands for “not for long” and that has never been more truthful. The only seemingly constant is the owners. MMMD 1: Unprecedented suspension reversal The NFL has long enforced the policy that a player is responsible for what is found in his own body, no matter what. The league seems to have shown some compassion when Duane Brown proved his positive test was related to eating meat in Mexico. Brown’s Texans teammate once claimed “over trained athlete” syndrome for his positive test, but Roger Goodell did not buy that excuse. The league has never accepted tainted supplement arguments either. In an unusual but positive step, the NFL overturned Brown’s suspension. As a result, warnings about eating too much meat in Mexico and China was issued to players by the league. My guess is this will be a one-time exception to the hardline policy of being responsible for what is in your body regardless of the circumstances. MMMD 2: Will Jaylon Smith play? Owner/GM Jerry Jones said Smith will not start the season on injured reserve (IR) for 2016. Some interpreted that as optimism for the knee and nerve recovery. In reality it is just wordplay as Smith undoubtedly will start the 2016 season on the non-football injury (NFI) list. NFI refers to any injury not happening in a NFL season, so collegiate injuries qualify. The Cowboys were in a unique position to draft Smith as the GM is the owner and the trusted team physician (and Smith’s surgeon) has enough political capital with the team where his job will not depend on his being right about nerve recovery. The Patriots were reported to covet Smith late in the 2nd round but I would be surprised if that were the case. Certainly Bill Belichick doesn’t worry about answering to the owner; however, New England has a new team physician this season. I find it hard to believe that any new doctor would put his job on the line to clear a player with a nerve injury with unpredictable recovery. Smith has a multi-ligament knee injury plus a nerve issue. Ifo Ekpre-Olamu was a projected early pick last year and fell to the seventh round after dislocating his knee. The Browns released him without playing a down and he is now with the Dolphins. Marcus Lattimore had two years of rehab with the 49ers but retired without ever being activated. Navarro Bowman had an ACL/MCL injury, missed an entire season and returned to play last year, but his knee is far from normal. Willis Magahee did return after his severe injury to have a productive career. Not all of these severe knee injuries are similar. The point is a multi-ligament injury without nerve issues already is career threatening. Adding nerve recovery makes it even more daunting. Here is hoping Smith beats the odds to make it back. With some luck and lots of hard work, he could be a quality player, but it would be unprecedented to have 100% recovery and reach all of his pre-injury potential. MMMD 3: Medical analytics Much has been written about Myles Jack. Some argue he needlessly dropped. Other say his knee is a time bomb. I think he was drafted in the expected spot. Jack can play football today but the question is for how long. The general manager makes the final decision but he relies on his team physician’s input. Many thought the Packers should have selected Jack with the 27th pick. An inside look at how draft decisions are made show why he wasn’t. Analytics may be new to the NFL, but medical analytics is exactly what team physicians have been doing at draft time for decades. MMMD 4: Sports science seems to work for soccer Coincidence or cause and effect? Leicester City has been transformed from bottom feeder to Premier League champions. They certainly aren’t the only European team that embraces sports science but they are among the leaders in integrating its use. Chip Kelly, now with the 49ers, aggressively brought sports science to the Eagles with modest success. Other teams have adopted some new age medicine techniques. I don’t think just sports science is solely responsible for Leicester City’s championship, but it certainly was a factor as they were among the leaders is lowest injuries. The question now is how might this translate to football. MMMD 5: Cold weather games cause more injuries? In my 17 years in the NFL, I often noted that wet or snowy games made for poor footing and made for less traumatic injuries. Now a study comes out that claims cold weather leads to more concussions and ankle injuries. Although I applaud the authors for their work, calling a warm weather game 70 degrees Fahrenheit and marking a cold weather game at 50 degrees Fahrenheit, may skew the data. 50 is probably the average temperature of an NFL game. The increased injuries seen might simply correlate with games played later in the season as the weather happens to be colder. Much more research needs to be done and this is a good start. MMMD 6: BFR at NFL course Last week the NFL had its bi-annual course with the American Orthopedic Society for Sports Medicine. I have been fortunate enough to be invited to lecture several times as team physicians present the latest breakthroughs to other sports medicine practitioners. Being asked to speak at this meeting is an honor and means the topic is being endorsed by NFL physicians. The latest on blood flow restriction (BFR) was presented. This is another indication that this new rehab and workout technique is reaching the mainstream. KAATSU is the world-wide leader in BFR and I have meet with the inventor in Japan over five years ago. As I predicted, BFR is catching on as shown by its inclusion in the NFL course. Over half of pro teams now incorporate BFR techniques. MMMD 7: Genetics matter The QB lineage of the Mannings is well documented. Both Peyton and Eli have successfully followed in father Archie’s footsteps. There are plenty of other famous football families. Three recent examples involve the city of San Diego. Third overall pick Joey Bosa’s dad played in the NFL. Fullback Derek Watt was drafted and will face brother J.J. Watt this season. Ian Seau was signed by the Rams and will always face comparisons to his Hall of Fame uncle Junior Seau. I hope all of these legacy players can make their own names in the NFL.