Appreciating Assistant Athletic Trainers

John Norwig has the right to be proud.

Playoff football’s in the air. I’m here in Kansas City with NBC Sports’ Sunday Night Football crew to cover this weekend’s AFC divisional playoff game between the Kansas City Chiefs and the Pittsburgh Steelers.

Here’s one story line which probably won’t make the headlines: During Sunday’s clash at Arrowhead Stadium, Steelers’ long-time Head Athletic Trainer John Norwig will be working across the field from one of his former assistants Rick Burkholder, now the Chiefs’ Head Athletic Trainer.

Wait, it gets better.

Last weekend during Pittsburgh’s 30 – 12 Wildcard playoff win over Miami, John watched another one of his former assistants Ryan Grove at work on the opposing sideline. Grove is in his 3rd season as the Head Athletic Trainer for the Miami Dolphins.

By all accounts, this is the first time in NFL history two head athletic trainers (AT) faced their professional mentor in back to back games. Seeing it happen in playoff games makes it that much cooler.

Some may read this and say; “So what!”

I’m willing to bet those same individuals have never spent any time in an Athletic Training Room or had an injury requiring the care of a certified athletic trainer. If he/she had, they would have a greater appreciation for the skills needed to keep elite athletes healthy.

Being Grateful

I could not have done my job as the head athletic trainer/physical therapist for the Jacksonville Jaguars for 20 years without the efforts of my loyal and hard-working assistant athletic trainers. I owe much of my success and blessings to my talented assistants and interns who, from July to January, literally spent more time with me than we did with our own wives and children.

My assistants and interns were part of my family.

Every “head guy” in a professional or college settings will tell you the same thing: Assistant athletic trainers are the backbone of the day-to-day work needed to keep athletes safe.

My Reward

I was thrilled to see two of my assistants – John Burrell (Washington) and Joe Sheehan (Cleveland) – move on to become head athletic trainers in the NFL. They worked hard for the Jaguars and me and I owed them my very best efforts to help them succeed in reaching their professional goal of becoming an NFL head athletic trainer.

I firmly believe this responsibility also applied to interns who have proven themselves worthy of becoming full-time AT’s in the NFL.  An NFL internship is not an easy job. The low-paying position is filled with long thankless days and endless To Do lists.

I’m proud of my two former interns – Marco Zucconi (San Diego….I mean the Los Angeles Chargers) and Doug Quon (Washington) – who are employed as assistant AT’s in the league. A 2009 Professional Football Athletic Trainers Society (PFATS) survey of its members found 88% of head athletic trainers served as interns in the NFL and 86% of assistants were previously NFL interns.  Needless to say, an internship is a proven path into an NFL athletic training room.

Time For Athletic Trainers to Move On

A common goal for most head athletic trainers who truly appreciate and respect their assistants is to help their loyal protégés to move up the food chain.  That means helping their assistants to become a head athletic trainer in the NFL or the college ranks. It’s only fair.

Most of us who were fortunate enough to lead our departments previously worked as interns and assistants doing the same crappy jobs no one else wanted to do. Who do you think is cleaning the storage rooms late at night, packing the travel trunks, taping a majority of the ankles, bringing the injured rookie ice bags at 3 AM and setting up the road game athletic rooms at 5 AM? It’s the assistant athletic trainers!

When I asked John Norwig to describe his feelings when he looks across the field to see his former assistants in the role of head AT in the NFL, his reply was filled with passion and admiration. It’s a common trait of John, which makes him so genuine and likeable. “Proud,” Norwig replied, “I’m so proud to have helped them become successful.”

I think Rick Burkholder, Chiefs’ Head Athletic Trainer and current President of the Professional Athletic Trainers Society (PFATS) says it best; “Assistant athletic trainers are the life blood of the sports medicine teams in the NFL.

Like Rick, I was an assistant in the NFL before I headed south to join the expansion Jaguars in 1994. I was so fortunate to learn and grow under the guidance of my mentor and friend Ronnie Barnes with the New York Giants for 6 amazing years.  It was a wonderful opportunity for me and I’m forever grateful to Ronnie for his trust and guidance.

Stay the Course

I applaud assistant athletic trainers at all levels of sports medicine. You work extremely hard for others. It may not seem like it at times but everyone from the head AT’s, players, coaches, families and co-workers see your tremendous efforts and appreciate the positive impact you have on your athletes.

Assistant athletic trainers Note-to-Self:  WHEN you become a head athletic trainer, take care of your assistants and help prepare them to someday move up the food chain as you have done.

Microfracture Surgery for NFL Players

Source: Pixabay

As we await for the bright lights to begin Round 2 of the 2016 NFL Draft, the big looming medical question on the minds of the football fans is:  Will UCLA’s star linebacker Myles Jack’s knee injury negatively impact his career in the NFL and will he need microfracture surgery?  Everyone agrees that his knee was the reason he remains un-drafted after the 1st round.

The issue needing clarity relates to the potential need for a microfracture surgery on Myles’ injured right knee.  The whispers regarding such a procedure quickly became screams when Myles himself reported that he may require microfracture in the future.

Jack has not played since his September 2015 knee injury that required a repair, not simply a trim, of the lateral meniscus cartilage in his right knee.  A meniscus injury is not unusual in football but two key elements make his particular injury concerning to NFL teams.

  1. His injury involves the lateral or outside meniscus.  This lateral “compartment” bears more weight than the medial or inner compartment, therefore, it is often more symptomatic when injured.
  2. A repaired meniscus is less common for football players compared to the typical “trimming” of a torn meniscus.  Only a small area of the meniscus cartilage actually has a blood supply so that is the only part of the tissues that actually has the potential to heal.  Repairing the meniscus is wonderful, in theory, because it preserves the all-important meniscus.  With that being said, if the repaired cartilage fails to heal or is reinjured, the results are concerning.

Pothole in a Joint…Needing Microfracture Surgery

Unrelated to the meniscus cartilage, the articular cartilage at the ends of bones that come into contact with each other to form the knee joint is smooth and solid.  The slick surface of the articular cartilage protects it’s underlying bone, which has both a blood supply and nerves.

When the articular cartilage is damaged, from a high-force trauma or over time with arthritic changes, the articular cartilage can break away exposing the bone to the joint surface.  Unprotected and exposed bone in a joint is painful.  It often bleeds into the joint resulting in a chronically painful and swollen knee.

A defect in the articular cartilage and bone is similar to having a small pothole in the road.  The remainder of the road is fine and you can still drive your car over the hole.  Both the size and location of that pothole will ultimately determine how deep and impactful that pothole becomes.

Only when excessive pain and/or impaired function of the joint cannot be controlled by standard physical therapy techniques, will a microfracture procedure be considered as an option.  Microfracture surgery is an aggressive procedure and its rehabilitation is extensive.  In other words, no one rushes into a microfracture procedure until it is absolutely necessary because the recovery is long and the outcome is undoubtably cloudy.

What is Microfracture Surgery?

Don’t confuse the simplicity of the procedure with the complexity of the healing steps following a microfracture surgery.  The surgical procedure is almost barbaric in nature.  It consists of picking and drilling into the exposed bone in the base of the articular cartilage “pothole” with one simple objective: promote the bone to bleed to stimulate a healing response.

The healing, stated in very simple terms, consists of the production of a different type of cartilage to fill in the existing hole in the articular cartilage.  This new filler is mostly fibrocartilage, similar to the cartilage in your external ears and the tip of your nose.  It is not as strong or as smooth as the original articular cartilage.  If given ample time and the appropriate physical therapy care, the new pothole filler serves a valuable role.  It can improve both the mechanics and the symptoms of the injured knee.

Recovery From NFL Knee Surgery

A common myth with microfracture surgery is a lengthly recovery but the athletes will recovery 100%.  I’ve rehabbed dozens of NFL players following microfracture surgery and I can tell you that the first part of that myth is true.  The athletes are not allowed to put any weight on the injured leg for 6 to 12 weeks.  The rehab protocol is slow and methodical for good reason: the healing of that pothole is #1 factor related to a healthy knee 6 months after the surgery.

As for the outcome, it ranges greatly based on the size of the athlete, the extent of the lesion and the length of time since the initial injury.  With that being said, with the players that I have been fortunate enough to rehab following microfracture surgery I have never had a player tell me that he was ever greater than 90% of his pre-injury abilities.

In closing, knee microfracture surgery is a proven technique to improve the function of a damaged joint for high-level athletes like NFL players.  It is not an option for every knee injury nor is the decision to perform the procedure ever rushed into.  Lastly, when the surgery is performed, the recovery is long and the end results are optimistic yet always in question.

Fantasy Football Dominance Using NFL Injury Reports

Fantasy Football 62The NFL season is two weeks away and that means that the Fantasy Football Drafts are coming soon.  Fantasy Football popularity is very impressive and the number of football fans participating in fantasy leagues around the world continue to rise at an amazing rate.  As the Head Athletic Trainer/Physical Therapist for the Jacksonville Jaguars, I’m often too close to the sports to truly appreciate the impact fantasy football has on the NFL itself.

Because of fantasy football, fans are following all 16 games each week because of the all important stats instead of focussing solely on the final scores.  Looking at the trend in NFL stadiums themselves with the installation of bigger and bigger scoreboards, it’s to share live league-wide stats not just the current game’s replays.

My #1 Rule

I have a simple rule that I follow each and every year.  When it comes to medical information about NFL players, I never discuss any details about my players’ injuries that hasn’t already been reported in the newspaper.

It’s a simple rule I learned from one of my mentors, Ronnie Barnes, Head Athletic Trainer of the New York Giants.  I don’t discuss details about medical injuries involving my players with my wife, best friends, family or anyone, period.  It’s easy to understand why and, as a full-time employee of the NFL for the past 26 seasons, it protects the private medical issues of my players.

Reading Between the Lines of an NFL Injury Report

With that being said, sharing how the medical reports are created within an NFL team would be helpful for fantasy football owners as they prepare their weekend roster moves.  Each NFL team has their own philosophy on how they practice injured players, how they manage an injury during the week and when they test injured players during the weekend.  A few years ago the NFL standardized how each team reports injuries to the league office to help avoid surprises when it comes to disclosing medical issues involving players.

Knowing how to read between the lines of these reports can make your job as a fantasy football owners’ job so much easier and make you look like a genius.  While the new guy in the league is drafting a kicker, you’ll be benching the player who is simply a medical decoy being used to confuse the opposing team’s game planning.

Trust me, it’s a chess match on this side of the fence.  I’ll share with you tips on how to “crack the code” to use NFL injury reports and player statuses as a huge advantage for your fantasy football team.

Fantasy Football Injury FAQ’s

What’s really the difference between questionable, doubtful & probable?”

If someone is limited in practice, is that player just playing the role of a backup for the starters during practice?”

If player X has a concussion, will he typically be cleared to play in the game the following weekend?”

These are some of the questions that many of you ask yourselves as you prepare for the weekend games.  Here’s the inside scoop on the manner in which the injuries are managed by the clubs.

Inside the Percentages

Probable – 75% chance of playing in the game.

Questionable – 50% chance of playing in the game.

Doubtful – 25% chance of playing in the game.

Counting the Reps

The number of reps that the starting offense and defense has on Wednesday, Thursday and Friday are very limited.  These reps are treated like gold by the offensive coordinator (OC) and defensive coordinator (DC).  Therefore, players that take “snaps with the number ones” are expected to play on Sunday.

If a team doesn’t think the star veteran corner back will be ready for the game, they surely want their young corner to “get the reps” with the starters to be ready for the game.  Those quality reps with the other 10 starting players on that side of the ball are very valuable and are usually given to the player expected to play on Sunday.

So if you read that an injured player is only taking “some of the reps” and is “rehabbing on the side”, especially late in the week, it’s more than likely you’ll see him on the field Sunday…..in street clothes.

The Stats Killers: Hammys & Groins

As you’ve read in my past sports medicine blog postings on hamstring and groin injuries, these are difficult injuries to return from quickly for skilled positions such as RB, WR and DB’s.  Until the reports say he is running at least 85% by Wednesday and “full speed” on Friday, don’t expect that player to impress you on Sunday.  When a skilled player with a lower extremity soft tissue injury is being interviewed and he gives you the “day-to-day” quote, Sunday might not be his breakout performance.

With both of these injuries, the player’s top end speed is always in question.  The opposing players know it too and they use it to their advantage.  That’s why a player coming back from a strained hamstring or a strained groin may be playing in the game but their stats will be watered down for the first week or so.

Looking for The Edge

As a fantasy football owner, you’re not alone as you look for THE EDGE.  The players, the coaches and the GM’s want to find it just as badly as you do.  It’s the “X Factor” that helps you put the perfect team on the field Sunday afternoon that results in crazy numbers all over the stat sheets.  All of your fellow owners are brain storming to make the key roster move resulting in the WR having a career day or the trade for the young QB mid-week who turns out to be a hometown hero with a monster game.

Understanding NFL medical reports and using sports medicine tips will help you think like an NFL GM and give you the X Factor advantage to dominate your fantasy football league week after week.

An NFL Athletic Trainer’s Life During the Off-Season

It’s been 184 days or 6 months since the very first NFL pre-season game when the Chargers hosted the Seahawks on August 11, 2011.  Every week for the past 6 months we’ve had football every weekend ending with one of the most exciting Super Bowl games every played last weekend.

“….Are you ready to miss some football?”

You have to admit it: Coming off a very volatile off-season with “the lockout”, the NFL season proved to be exciting and considered to be a huge success on many levels.  Unfortunately, my Jacksonville Jaguars didn’t have the kind of season we hoped for.  Wait ’til you see us next year….

“What do you do for the next 6 months?”

It’s a common question NFL athletic trainers are asked after the conclusion of every NFL season.  The off-season is a busy time of the year with lots of professional projects on our To Do List.  The end of the season medical issues and the planning for the upcoming season makes for plenty to do during the winter and spring seasons around the country.  As we say in the NFL:  “We have two seasons in the NFL:  One with games and one without.”

Off-Season Projects for an NFL Athletic Training Staff

1.  Finalize end of the season documentation, reports, special tests & medical files.

2.  Complete the rehab of all injured players from the season and end of season surgeries.

3.  Prepare for the NFL Combine for screening potential new NFL players.

4.  Prepare for NFL Free Agency.

5.  Inventory and projected upgrades of medical supplies and equipment to improve all levels of medical care for your organizations.

6.  Medical screening and grading of all new players with team physicians.

7.  Attend multiple sports medicine seminars to maintain state and national medical licenses.

8.  Prepare for and cover all team Mini Camps, team practices, workouts and team functions to help prevent and treat all injuries.

9.  Educate medical staffs, players, football staffs, community youth athletes and anyone who will listen in an effort to help reduce injures and to enhance the health of others.

10.  TBD

Time to Recover

As an NFL athletic trainer and physical therapist, I’ve made a career of taking care of other people’s medical problems.  I love that about my profession and it’s very rewarding to me personally.  This time of the year is also a time for my staff and me to recover from working 7 days per week for over 6 months straight.  My 2 great assistant, Rod Scott & Justin Bland, and I have each had a grand total of two (2) days off since mid-July.

Needless to say, the off-season is an important time for all athletic trainers, team football staffs and players in the NFL to reunite with our devoted wives and children.  Our families deserve this break in the schedule for the loyal sacrifice they’ve made to us and our profession.

A Time of Change in Jacksonville

There is so much excitement in Jacksonville with the many changes within the Jaguars’ organization.  A new owner, a new head coach, about 15 new assistant coaches, a new attitude within the organization and a passionate community that deserves a winning football team at EverBank Field.

I’m thrilled to continue to be a member of the Jaguars’ family as I start my 25th season in the NFL.  I can tell you this:  It won’t take long to prove that these new changes will be making the Jags’ 2012 season something special!