Posts Tagged ‘monday morning md’

Monday Morning MD: 5-11-15

Manny

In wake of Pacquiao not disclosing shoulder problem, does NFL hide injuries too?

Few sporting events rise to the level of the NFL, but last week’s long awaited Mayweather vs Pacquiao extravaganza was hyped like a Super Bowl and ultimately produced even bigger controversy. After defeat, the Manny Pacquiao camp revealed he fought with a

In wake of Pacquiao not disclosing shoulder problem, does NFL hide injuries too?

Few sporting events rise to the level of the NFL, but last week’s long awaited Mayweather vs Pacquiao extravaganza was hyped like a Super Bowl and ultimately produced even bigger controversy. After defeat, the Manny Pacquiao camp revealed he fought with a rotator cuff tear and needed surgery.

The sports word was abuzz, lawsuits were filed and the Nevada State Athletic Commission postulated sanctions. The reaction was interesting to me as NFL athletes routinely play hurt and hide injuries with little uproar. Sure there are league mandated injury reports but one would be naïve to think that all injuries are disclosed or the magnitude of health issues revealed. We all know NFL players are tough and they play through many small ailments, but I am talking about significant injuries.

In Super Bowl XLIX, several starters played hurt and subsequently needed surgery. Seattle safety Earl Thomas stated his shoulder injury was a non-issue going into the championship event, even though it seemed significant to me. After the big game, the Seahawks revealed a labral tear and the need for surgery. New England linebacker Dont’a Hightower made a game saving tackle on Marshawn Lynch immediately before the goal line interception. The Patriots subsequently announced his shoulder labrum repair surgery after the season for this injury initially suffered in the regular season.

Even injuries to star quarterbacks are routinely under reported or not reported. For the postseason, official status on Peyton Manning’s thigh were very optimistic, even though I suspected a major problem. After a poor performance and a quick playoff exit, a quad tear was revealed. Tony Romo had a much-analyzed back injury last season, but in December revealed a September/October rib fracture that was never listed on an injury report.

I am not suggesting NFL teams break reporting rules. I am simply noting that this is how the game works. The requirement is only for disclosure of a body part and practice/game status. There is no mandate to disclose injury specifics or severity. The type of ailment or even indicating left or right is not required.

Lessor injuries are often not reported. If that were mandated, by season’s end, almost the entire roster would be listed, and many with multiple body parts. Players don’t want opponents to know about their ailments. If one sprains an ankle and needs to be spatted (taped over shoe), it is routine to spat both sides to not indicate a side of injury.

Like many NFL players, Pacquiao requested Toradol before the fight; however, he was denied. The medication is not on any banned list, but the boxing commission properly denied the shot as there was no declared injury. This is the same standard as usage in the NFL. The strong anti-inflammatory medication is used for a defined injury. If Pacquiao had declared injury, he likely would have gotten the medication. If a fighter had his own doctor there (which is routinely not the case), that physician could have legally administered the medication like in the NFL.

The big difference between boxing and NFL is that a game can’t be postponed due to injury. Reports indicate Pacquiao knew of his shoulder injury weeks before and even took a cortisone shot. I don’t know if his shoulder was hurt badly enough where he should have postponed, or if he was right to choose to fight through it. In any case, you know the public relations campaign is on anytime a person physician gets involved to reveal patient information as is the case here.  I don’t doubt the injury, but it is unlikely he boxed with a full-thickness rotator cuff tear. Even his surgeon who has spoken extensively publically on the surgery has not indicated that.

I am not an attorney, but suing over the Pacquiao non-disclosure of a shoulder injury seems frivolous. We watch sporting events like football games all the time where athletes are less than 100% where the viewing public is unaware.

MMMD 1: Third pick in draft tears ACL in first rookie practice

Dante Fowler, Jr. was the first non-quarterback selected in this year’s draft. The unfortunate injury occurred in a full-speed non-contact practice.

These are changing times with immediate information access. I came out of my day job of surgery to multiple texts from media insiders and tweet notifications with video links of the Fowler injury. Unfortunately, my interpretation of the injury mechanism was ACL tear. Hats off to the club for quick diagnosis, treatment and confirmation. Team physicians are not always at every practice, but the Jaguars have an excellent head ATC in Scott Trulock. He likely knew the diagnosis immediately from on field evaluation but within hours confirmed with doctors and MRI before announcement.

Fowler will need ACL reconstruction surgery. Central one-third patella bone-tendon-bone graft is the preferred and common graft choice among NFL physicians. The hope is for an isolated injury without cartilage or meniscus damage in order to have the best long-term knee.

MMMD 2: Dante Fowler had not signed contract, but Jaguars will not stiff him

Rookies commonly participate in minicamp without signed contracts; however, there is no financial worry. Teams routinely will honor the slotted contract values. If they didn’t, no rookies would participate in practices.

Besides teams acting in good faith, typically a rookie participation agreement is signed. This binds the club to negotiate in good faith as if the player weren’t injured.

MMMD 3: Star linebacker spring ACL tear for third straight year

Dante Fowler is not the first star linebacker to succumb to a minicamp/OTA ACL tear. In fact, it has happened three years in a row. Last May, the Cowboys’ Sean Lee tore his ACL and also had practice video document the injury. In 2013, Chargers linebacker Melvin Ingram tore his ACL in May as well.

Fowler has an outside chance to return to play for the Jaguars this season. Ingram returned in December, seven months after injury. However, he was in his second season and his team was in the playoff hunt. It may be wiser to sit the rookie, especially since video shows a likely MCL component to the injury as well.

MMMD 4: May injuries unfortunately common

Expect more minicamp and OTA injuries to come. Injury is part of the game, but it is even a part of spring football. In my two decades of NFL team physician experience, the vast majority of years, we suffered at least one season-ending injury during the spring.

Injuries varied from ACL tears to Achilles tendon ruptures. The key to team success is that it didn’t happen to a key starter. Anecdotally, ever other year, a key contributor went down in minicamp/OTA.

It may just seem like there are more injuries nowadays, as there is so much more instantaneous coverage. Mid and late-round picks get extensive coverage now too. (see next)

MMMD 5: Call for rules changes?

Broncos tight end and third-round pick, Jeff Heuerman tore his ACL in rookie minicamp as well. He was reportedly running on a non-contact special teams play.

Immediately combined with the Fowler injury, there were calls for a rookie period of weights and conditioning before minicamp practices. Although honorable in intention, I don’t think Fowler or Heuerman were out of shape or ill-prepared.

I have previously pointed out how there has not been the expected drop in ACL tears with the new CBA mandating less practice time and contact. However, ACL tears most commonly happen with cutting at high speed without contact and that is what practices focus on these days.

MMMD 6: Projected first-round pick now revealed to have worse injury

Former Oregon star Ifo Ekpre-Olomu was a projected first round draft pick until he injured his knee. As a cornerback who needs to react to be effective, an ACL tear already made him a “RED light” issue in my mind. Indeed he dropped to the seventh round.

It turns out there is more to the story as his injury is now reported to have been a knee dislocation in addition to ACL tear. With this information, Cleveland is really taking a seventh-round flyer with this potentially career-ending injury. In 2013 San Francisco drafted Marcus Lattimore in the fourth round after his knee dislocation hoping he could ultimately get healthy. Unfortunately, the 49ers’ running back never saw the field in two years and retired. We all hope the same fate doesn’t befall Ekpre-Olomu.

MMMD 7: Running record

I have written about the accuracy of real-time video injury analysis last year. It is far from perfect, but I documented being correct 136 out of 148 times. I have actually adjusted the record to 137-11 as I tweeted real-time while attending the Super Bowl that I was worried about Jeremy Lane’s knee when he left the game. He obviously broke his arm.

Jeremy Lane

Jeremy Lane’s arm break

However, several weeks after the Super Bowl, Lane was announced to have ACL surgery. Thus I am closing out the 2014 season with a 137-11 record.

This year I will keep a running tally here of correct and incorrect video analysis. This way, the public can see how I grade and arrive at my final statistics. It also will provide a forum to critique how I am self-grading my injury assessments.

Unfortunately, my initial analysis on Dante Fowler proved correct with an ACL tear and we start 2015 season with a record of 1-0.

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.

Dr. David Chao

Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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Monday Morning MD: Medical re-check

Todd Gurley

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

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.

 

Dr. David Chao

Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

Read More 1062 Words

Monday Morning MD: Comments on Jameis Winston out of line?

Jameis Winston

Comments on Jameis Winston out of line? 

Lawyers and doctors have special duties to their clients and patients. This is why it took me back when I heard Winston’s attorney saying Jameis “is not ready to be an NFL player off the field”.

Medical professionals have HIPAA (patient privacy laws) and legal professionals have

Comments on Jameis Winston out of line? 

Lawyers and doctors have special duties to their clients and patients. This is why it took me back when I heard Winston’s attorney saying Jameis “is not ready to be an NFL player off the field”.

Medical professionals have HIPAA (patient privacy laws) and legal professionals have attorney/client privilege. Both professions have similar ethical obligations to protect their patients and clients. This continues to be true even for former patients and clients.

I am not an attorney, and I don’t know all the rules or the different state/federal laws that may apply, but I do know lawyers and doctors have to place client and patient interests in front of their own. I was made out to look bad in the beginning of the 2007 season when it seemed I didn’t offer Shawne Merriman necessary knee surgery at the end of the previous season. The fact has since come out that I did recommend surgery; however, at the time, I could not violate confidentiality to defend myself by disclosing what I had recommended to the player.

As a team doctor, I never spoke about injuries on or off the record. Now in my media life, I don’t use information about previous players I have treated unless the facts are public knowledge or I have their permission. Even when the story was innocuous, I obtained Vaughn Parker’s consent before relating it. I suppose it is possible that Winston’s attorney obtained permission to speak, but that doesn’t take away the duty to not cast his client in a negative light.

Winston’s attorney later softened his comments by saying his client is not unique and will be fine and adding this is why we have rookie symposiums and player engagement programs. The attorney further backtracked by saying “Jameis is more ready than most”.

I would argue that Winston is unique as he is the projected first pick of the draft. A franchise’s direction depends on this young man and any quarterback is already held to a higher standard. To say no entering NFL player is ready is patronizing to the majority who are prepared. Does anyone think Peyton Manning wasn’t ready when he was the first pick? Andrew Luck sure seems to have been ready.

I am not faulting the potential accuracy of the statements. If they did not come from his own attorney, they may be appropriate (and it wouldn’t have made any news). The implication is these conclusions were drawn from inside information he learned while representing Winston. Not to mention the fact an attorney is duty bound to not say or do anything to potential harm his client. The potential correctness of his comments are superseded by his duty to protect his client.

I currently tweet and comment on many player injuries, but these are athletes I have not treated and thus  have no duty to them. I only analyze information and video that is in the public domain. I still treat NFL players but I refrain from commenting on any patient I have cared for. I use my insider knowledge but I never use any insider information.

Certainly the Winston comments may have been taken out of context, but any attorney, much less a heralded and high profile one, should be smarter than that. One shouldn’t put out statements that could be interpreted negatively or use words that need later clarification.

I have previously written how personal physicians comments/letters have to be supportive and thus have little impact. The same should be true for attorneys/agents representing a client. I certainly could never publicly call out a player for being lazy in his rehab, even if it were true.

Later news reports portray the comments as coming from Winston’s advisor and not attorney.  However, the fact he is an attorney puts the attorney/client privilege into play. Just like if I advised a player over the phone but never performed surgery or treatment, I still would be held to HIPAA laws and patient confidentiality.

I agree with the statement that Jameis like other young players may need some help transitioning to the NFL. I applaud the honesty of the attorney’s comments made at a conference. Perhaps he thought his words would stay in house and remain confidential; however, even the rookie symposium tells players that they are always being watched by a smart phone carrying public.

Doctors and lawyers should know better.

MMMD 1: Lawrence Tynes sues Buccaneers for $20 million

Tynes contracted MRSA (bacterial infection resistant to common antibiotics) after a routine toenail procedure and never played for Tampa Bay. He was placed on the non-football injury list but was paid for the season.

He now claims he is in daily pain and that his career was ended by the infection. Tynes cites poor conditions in Tampa Bay and blames their former head athletic trainer Todd Toriscelli. Three Bucs players contracted MRSA in 2013.

I wrote about MRSA and the Bucs in my first column ever in October of 2013. Resistant infections first began to appear in the NFL in 2003. Since then protocols for prevention and treatment were worked out by the league and the Center for Disease Control. Every NFL team is well aware of these guidelines. It would be shocking to me if the Bucs didn’t follow these protocols. The Titans clearly don’t believe Toriscelli has done anything wrong in this case as they subsequently named him their new Director of Sports Medicine in February 2014.

It would be unusual for someone who was previously treated with MRSA to be in daily pain. I hope Tynes can find a way to solve his medical problems so he can enjoy his two Super Bowl rings.

The injury that sidelined Bowman

MMMD 2: NaVorro Bowman set to make return

The 49ers star linebacker missed all of the 2014 season due to a multi-ligament knee injury. It was an unfortunate play where his knee was not even contacted that tore both his ACL and MCL.

After sitting out the year, he is slatted to return to minicamp later this month for his first on field action. Hopefully Bowman can return to form as this type of injury can be considered career threatening.

MMMD 3: Victor Cruz has a long way to go

Recently, Giants head coach Tom Coughlin expressed optimism about his star receiver; however, I explained here previously how teams tend to be optimistic this time of year. Now we are hearing more of the truth.

Cruz recently admitted he is not even close to 100% after his torn patellar tendon that required surgery.  I expect he will make it back on the field eventually this season. The question is whether he can regain his explosiveness after this career threatening injury.

MMMD 4: Two defenders injured while celebrating sacks look towards new season

Stephen Tulloch tore his ACL doing the “discount double check” after sacking Aaron Rodgers.  Lamarr Houston tore his ACL celebrating his sack of Tom Brady’s backup in a blowout loss.

Tulloch says he is way ahead of schedule and Houston vows he will be better than ever. The two players may be contractually on the bubble. I hope both players make strong returns. Although their injuries were self-inflicted, I would hate to have either of them end their careers this way.

MMMD 5: Boxing for ACL rehab

Miami left tackle Branden Albert tore his ACL in week 10 last season. Now five months out from reconstructive surgery, he is using boxing to help rehab his knee.

Cross training is often a good way to keep therapy fresh and a player motivated. Frank Gore and others have used boxing as part of their routine offseason training to improve endurance, speed and quickness. With ACL rehab, it likely helps with footwork, balance and strength.

MMMD 6: Emmit Smith played through concussion symptoms

The NFL’s all-time leading rusher admitted “a lot of times I came to the sidelines and smelled some ammonia [to] clear the cobwebs”. He followed up by saying that wouldn’t happen today. Awareness of concussion has been the biggest change, not the science behind it.

The Hall of Fame Cowboys running back also said despite all the concussion talk and potential dangers, he would do it again.

MMMD 7: Recheck Combines this weekend

What is recheck combines? It is a second chance for all 32 teams to examine players with medical injuries right before the draft. This will happen back in Indianapolis on Saturday morning, April 18th.

Todd Gurley will finally get his much anticipated knee exam after deferring at the Combines. More on this process in the next Monday Morning MD.

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.

Dr. David Chao

Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

Read More 1431 Words

Monday Morning MD: Why Athletes Struggle in Retirement

Nick Hardwick

This is not another alarmist concussion piece. It is my attempt to humanize professional athletes and explain what they may be going through from my medical and insider’s perspective.

The end of any career is always hard. A professional musician who can no longer play music will struggle. A sportswriter who can’t write anymore will

This is not another alarmist concussion piece. It is my attempt to humanize professional athletes and explain what they may be going through from my medical and insider’s perspective.

The end of any career is always hard. A professional musician who can no longer play music will struggle. A sportswriter who can’t write anymore will have to adjust. A lifelong police officer entering retirement will have transition issues. A career military officer entering civilian life will have to adapt. NFL players are no different; they are human too.

I am not discounting any role chronic traumatic encephalopathy may play. I am simply pointing out the humanistic and well-being factors that I have observed as a physician. The retirement adjustment issue really hit home for me last week as I read Nick Hardwick’s Finding Myself piece penned for The Player’s Tribune.

I know the longtime Chargers center and his family well and he always struck me as someone who was well grounded and very intelligent. He was a team leader, players union representative, had his life planned and anticipated retirement. He is not in financial trouble of having any other personal issues. Maybe I am too close to the situation but I never thought he would have any transition issues. The good news is Nick is fine as he has a great wife and two awesome little boys. But  reading the piece made me think. If this guy has to “find himself”, then the retirement issue is even larger than I had ever imagined.

I have witnessed plenty of players struggle with their identity post football. The average fan might think: “get over it, you got paid well to play a game”. The reality is that in order to succeed, most of these athletes had to define themselves as a football players and dedicate fully to their craft. When that goes away, a void inevitably exists.

My observation shows players that defined themselves as a father, husband or son first don’t seem to struggle as much with after-football life. A person who happens to play professional football seems to have a much easier transition than someone whose life was defined as a football player.

Imagine doing something you are passionate about for over half your life and all of your adult life, then quitting and never being able to do it again. Add to that, you are in your 20s or 30s and have your whole life ahead of you. Everyone needs a purpose in life. When your focus is on one thing for so long and that one purpose is gone, it is easy to feel rudderless.

As Nick points out, retirement sets an easy trap to fall into. The adrenaline rush of the game, the strict regime of football and the irreplaceable camaraderie of teammates make football unique.

In a much smaller way, I experienced post-football transition after 17 years as a NFL team physician. However, my adjustment was much easier as I always had my private practice during and after my NFL career. Being newly married for the first time and having twins also gave me tremendous focus and purpose. Finally, my media exploits allowed me an easy continued connection to football and in many ways excite me more as I had become accustomed to the NFL medical routine but I am still learning everyday on the media side.

My situation is not nearly the same circumstance but being a NFL team doc was my job, not who I was. Team physician wasn’t even my full time job as I always had my private practice too. The better comparison would be if I lost my ability to be a doctor.

My advice to NFL players is to be dedicated to your career but to always define yourself as someone who plays football and not only as a football player. Don’t limit yourself to being just a football player and the inevitable end of your career will be an easier transition. As much as we idolize and glorify NFL players, lets remember they are human.

MMMD 1: Tom Brady violates contract?

The Super Bowl winning quarterback was on vacation with his supermodel wife when he posted a Facebook video of himself jumping off a Costa Rican cliff. The question was asked if this violated his contract.

The standard contract does have language that prevents engaging in dangerous activity. In my experience, this is very loosely enforced. Teams rarely investigate off-season injuries or enforce the restrictions. If a team did, it really signals the end of the player/team relationship.  Since clubs rarely enforce the clause on players who aren’t the Super Bowl MVP, there is little chance the Patriots even entertained invoking the contract.

MMMD 2: How did Aaron Hernandez avoid testing positive for marijuana?

Testimony during the murder trial made it clear that the former Patriots tight end smoked pot regularly. How did Hernandez never test positive or be suspended if the NFL drug program has random testing?

Performance enhancing drugs are tested randomly throughout the season. The separate substances of abuse test is conducted once a year prior to the start of the season in a defined time period and thus could be avoided. The NFLPA even issues a warning to players a month before the testing window as cannabis can remain in the body for up to 30 days.

Outside of a few well-publicized cases including Josh Gordon and previously Ricky Williams, this is how almost 1700 men with an average age of 26 rarely test positive for recreational drug use.

MMMD 3: Combines do test for substances of abuse

Randy Gregory, a projected first-round draft pick, tested positive for marijuana in Indianapolis. It was already known that he tested positive for pot twice while at Nebraska so his cannabis use is not new information.

Why it is news is that he now enters the NFL in Stage 1 of the program. This means his free strike is gone and will be subjected to year round testing. Since pot can be detected for up to 30 days after use, if he continues to smoke, he will inevitably be caught. The next positive test results in suspension. It will be interesting to see how teams factor that into their draft selection process as he likely will drop out of his projected spot in the top 10.

MMMD 4: Current helmet sensors not reliable to detect concussions

The NFL had placed accelerometers in some helmets during the last two seasons. The data was found to be unreliable and the program was cancelled.

Please don’t scream NFL conspiracy here. The Head, Neck & Spine Committee member speaking out in favor of stopping the sensor study is also an outspoken concussion critic that co-founded the Boston University CTE center.

Right now, the technology is not accurate in measuring the forces unless it is a direct hit. Tangential, rotational and off-center hits do no register well. Hopefully, a more reliable sensor system will be developed soon.

MMMD 5: Sammy Watkins hip surgery

The Buffalo star rookie receiver injured his hip in Week 13 and finished the season. Off-season hip scope was announced last week.

The good news is this surgery could make Watkins even better as hip flexibility is vital to a receiver’s fluidity. The bad news, if he had a labral repair as suspected, he is likely to miss much of OTAs and mini-camp as a new offense is installed. A labral trimming would allow him to return for the off-season workouts.

MMMD 6: USC reaches settlement with former player over Toradol use

Armond Armstead sued the school and doctors blaming Toradol for a 2011 heart attack. He missed his senior season, went undrafted, played one year in the CFL, was signed by the Patriots but has never played in a NFL game. A confidential settlement was reached to avoid pending trial.

Whether one believes Toradol is dangerous or not, there is no theory that ketorolac (generic name) can cause continued “clotting issues”. If anything, Toradol is an anti-inflammatory that thins the blood.

MMMD 7: Veteran Combine players signed

To date, the first ever Veteran Combine resulted in nine player signings. That certainly is a positive given a rookie friendly CBA. The real question is whether any of these players will make the opening roster.

Right now they are signed to the 90-man roster, That is a long way from making the final 53-man list. Good luck to the veterans.

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.

Dr. David Chao

Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

Read More 1380 Words

Monday Morning MD: Are team return-to-play projections accurate?

Jadeveon Clowney

Off-season news is made whenever injury prognosis for a star player is provided. How reliable or meaningful is this information? With the league meetings last week a plethora of key updates were announced.

Texans head coach Bill O’Brien said Jadeveon Clowney had his best week of rehab yet and “can be great”.  Giants head coach

Off-season news is made whenever injury prognosis for a star player is provided. How reliable or meaningful is this information? With the league meetings last week a plethora of key updates were announced.

Texans head coach Bill O’Brien said Jadeveon Clowney had his best week of rehab yet and “can be great”.  Giants head coach Tom Coughlin went on record hoping for a week one return for Victor Cruz.  Colts owner Robert Irsay said Robert Mathis will return from Achilles rupture to make an impact next season.

Are injury estimates from owners or coaches meaningful? Although the update may be honest, usually this type of information is understandably issued through rose-colored glasses. After all, none of the above have any medical training. Just like letters from personal physicians are always positive, so typically are these team estimates.

One certainly hopes Clowney can reach his number one overall draft pick promise but he had a second knee surgery that included a microfracture procedure. Although his operations were performed by his team physician who I know to be a top surgeon, there is no guaranteed recovery when articular cartilage is worn down to bone. A likely nine-month recovery is required and he had the procedure in December. History would indicate that even if Clowney comes back and plays well this season, the long-term odds are against him making it through a big second contract and having a 10-year Hall of Fame career. I am rooting for Clowney but cartilage regrowth surgery has signaled the beginning of the end for many players. A head coach optimistically commenting on a great week of rehab doesn’t change the injury severity.

Like Giants fans, Coughlin is hoping for a week one return for Cruz; however, a patellar tendon rupture can be career threatening for a wide receiver. I have not doubt that he will return, the question is when and how effective he will be. Regaining explosiveness after such an injury is the issue for a player like Cruz. The head coach really hasn’t given fans any specifics by enthusiastically hoping his player returns for the first game. Coughlin does hedge by adding he won’t rush a Cruz return either.

The Colts owner sounded confident in Mathis “re-emerging” to have a strong season. However, he also indicated the return might not be until November as a worst-case scenario. Only time will tell if a 34 year-old edge rusher has his full get-off after his Achilles rupture. Lets not forget there were earlier rumors of off-season setback.

In the end, the league meeting injury updates from coaches, management and owners create fan interest. Ultimately, I am not sure if it provides much real information. After all, when is the last time a team official was pessimistic about a key injury or his team’s playoff chances.

MMMD 1: Failure to remove players leads to “medical timeouts”

Based on film study of the last three seasons, the NFL says a player in distress was not immediately removed on 25 occasions. It obviously was not just the Julian Edelman incident in the Super Bowl that led to the new rule where the “eye in the sky” can immediately stop play to remove a player.

I applaud the new rule, but it would be naïve to think that medical timeouts will be a cure-all to the concussion protocol. I predict the new rule will lead to more controversy this season.

MMMD 2: Four other safety enhancement rules

The new medical timeout is the biggest rule change to come out of the league meetings, but four other rules changes were also made for health reasons.

Defensive players are now banned from pushing teammates on punts. Offensive players are prohibited from peel back blocks. Defenseless receivers get continued protection even if the pass is intercepted. Chop blocks by running backs against engaged players were outlawed.

I applaud all of these changes but feel all chop blocks should be outlawed as I have personally witnessed a high rate of knee and ankle injuries that result.

MMMD 3: Team visits are not for workouts

Prior to the draft, each club will fly in up to 30 former college players. These team visits are for interviews and physicals only.

A medical concern may be the reason for the visit. Perhaps the draftee was not invited to Combine and never had a physical. Often a team just wants to spend more time with a player. Sometimes a team arranges a visit just to throw the media off of its true intentions.

Be careful not to read too much into these visits. Often it is just teams doing there due diligence as no workouts are involved.

MMMD 4: Necessity is the mother of invention

A calf strain limited Aaron Rodgers mobility during the playoffs. I tweeted prior to the post-season how the injury would make it difficult to take snaps under center. Sure enough, the Packers lined him up in the backfield to reduce the need to drop back. Now Green Bay with a healthy and mobile quarterback will continue to utilize the pistol formation as a part of the regular offense.  Rodgers and the coaches liked the new look and fans will see more of it this season.

MMMD 5: Not all concussion news is bad

Recently it seems all we hear about is more negative head injury news or another player suffering problems. Especially in the wake of Chris Borland walking away from football, it is refreshing to hear some positive news that not everyone is suffering post-concussion symptoms.

Troy Aikman retired in 2000 and had two major concussions, as well as 6-8 others. He reports undergoing significant head injury testing and shows no signs or problems. He remains mentally sharp as lead NFL analyst for Fox.

In the end, I hope we find this is the norm and not the exception.

MMMD 6: Worst stadium may soon see its last NFL game

All the talk about teams relocating to Los Angeles certainly has fans in St Louis, San Diego and Oakland on edge. One positive side effect may be the end of the medically most outdated and most dangerous stadium in the league.

Oakland Coliseum has been called a travesty and the Raiders are the only NFL team remaining that shares a field with Major League Baseball. This leads to injury issues related to the dirt infield. I have also written about the difficulty in providing appropriate medical care in Oakland and how it is the worst stadium in the league.

I always root for a team to stay in their home market. San Diego’s Qualcomm Stadium may be seriously outdated but at least it is not medically dangerous to play there. The Raiders need a new place to play most of all and that may be a side benefit of all the LA talk.

MMMD 7: Eric Berry upbeat on beating cancer

The star Chiefs safety left football to get lifesaving treatment for Hodgkin’s Lymphoma. Berry remains “positive and upbeat” about his chemotherapy which has a reasonable chance to cure him.

There is no timetable for return to the NFL yet. Even if cured, he may never return. Obviously, football is secondary and all fans wish him well.

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.

Dr. David Chao

Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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