Calf Strain: A Running & Jumping Athlete’s Nightmare

Source: Pixabay
Source: Pixabay

He sits on the bench with an ice bag on the back of his lower leg.  A calf strain is a common sight with athletes young and old.  Everyone wants to know why.

Looking at athletes at every level of athletics, calf strains have become the Great Equalizer. It’s an injury that is way too prevalent.  One of my favorite running buddies is wrestling with a strained calf and I know, as both a certified athletic trainer and a competitive athlete, calf injuries suck!

In the NFL, last year was a bad year for injuries to the calf.  Fans, coaches and players were frustrated to consistently see way too many calf injuries on the NFL injury reports each week.  These slow-healing injuries negatively impacted NFL fantasy football rockstars like Victor Cruz (NYG), Crockett Gillmore (Balt) and Sammy Watkins (Buff).

The hamstrings on the back of the thigh get all the hype when it comes to what we call “soft tissue injuries” in the NFL.  But when you ask skilled players like wide receivers, running back and defensive backs what muscle injury frustrates them the most, calves and groins typically head up that list.

What is a Calf?

A small cow?  Yes, but that’s not important right now.Calf cow 22

The “calf” or calves (plural) is made of two long muscles on the back of the shin bones.  The gastrocnemius or “gastroc” is the bigger of the two muscles and it’s the more superficial of the two.  When you look at a calf “belly,” you’re looking at the gastroc.  It starts from two tendons above the back of the knee and it extends over the backside of the knee and anchors into the top of the Achilles tendon.

The deeper of the two calf muscles is the soleus.  It starts below the knee and it extends downward joining the gastroc at the top of the Achilles tendon.

Simply stated, the two calf muscles merge together to form the Achilles tendon, which we know attaches to the heel bone below the ankle.

The next time you look at a fast player’s calves, you’ll notice that most of these skilled players will have smaller muscle bellies that tend to be closer to the knees.  The bigger, slower players will typically demonstrate a bigger and lower gastrocs.

What Does the Calf Do?

Here comes the fun part.  The calf is not a big or powerful muscle but it’s a very important muscle group.  When running or pushing, the calf transfers all of the power from the legs, hips and back to the ground in a timely manner.  If the timing of that transfer of power changes ever so slightly, which can easily happen due to injury, fatigue, change in the surface area and/or a change in body mechanics, the calf muscle(s) can tear.

Because the calf crosses both the knee joint and the ankle joint via the Achilles, it raises the heel when running and it assists in bending the knee.  Both of these actions are vital when running fast and changing directions.  THAT’s why a calf strain can quickly bring fast players to a screeching halt.

What to Do When a Calf Goes Pop

Tear = strain = pull

When a muscle is injured, the small muscle fibers that make up the muscle belly pop or tear similar to cutting small rubber bands.  The more fibers that tear, the worse the injury. These fibers have a blood and nerve supply so when muscle fibers tear, they bleed into the wound and create pain.

NFL fans saw first hand in the 2014-15 playoffs how Aaron Rodgers’ ability to move and throw quickly changed because of his calf strain.

Initially, an injured calf muscle needs more rest than it needs fancy physical therapy techniques.  Scar tissue is a calf’s best friend.  Scar tissue fills that new injury wound/hole in the muscle and, in a sense, pulls the healthy fibers together.  A common mistake in aggressive sports medicine settings is to over-treat a calf strain by doing too much too soon.  As with a fresh calf injury, being too aggressive early will cause more bleeding, more pain, weaker scar tissue and a longer recovery.  NFL players are in great hands because NFL athletic trainers are exceptional at properly treating these injuries.

I strained my calf three times within two months as I trained for an Ironman triathlon in Austria in 2009.  It was a frustrating and painful injury for me.  It proved to be very valuable for me as an athletic trainer and physical therapist.  It positively changed how I treat NFL players with calf strains.

Truth be told: Rehabbing athletes is much more enjoyable than rehabbing yourself!

The Bottom Line for a Calf Strain

Calf muscles heal slowly.

The key physical therapy pearl that I learned from rehabbing my own calf and dozens of NFL calf strains since then:  When you think the athlete’s calf is ready to return to full speed with no limitations, give the healing calf one more week.  Your calf will thank you.

NFL Rookie Hamstrings Beware

Source: Pixabay

Dear Rookie Hamstrings,

We all know the deal.  You busted your ass all last summer, during a long and stress-filled season, into the high-intensity NFL Combine and all the way to your big Pro Day.  It’s been at least 9 solid months of hard work with one goal in mind: “Get into the NFL!!”

Since your last Pro Day, things have certainly changed, huh?  You flew all over the country to meet & greet with NFL teams, your high intensity workouts/rehab routines were put on the back burner, your “social gatherings” with your family and friends were ramped up, you were super busy with your school work (wink, wink) and we all knew that your strict nutritional plan was put on hold.

I can’t say I blame you after the impressive effort you put into the past year.

Congrats, man, you’ve been Drafted or invited to this weekend’s Mini Camp with your new NFL team.  Approximately 0.08% of high school football players get Drafted into the NFL so you have plenty to be proud of!

Wakeup Call

The party’s over.

The hoopla and the hundreds of texts from the festive weekend have faded.  Now it’s time to get back to work.  Your first major step to making your new team starts this weekend:  Your first Mini Camp.  As you enter that new facility, you will quickly realize that everything around you has changed.  From the color of your jersey to how you get your ankles taped to verbage in your playbook, life is different now.

The Truth

While you were celebrating, your new team was planning out every one of your drills, team plays and workout reps for this weekend’s Mini Camp.

While you were toasting with your friends and family, your new team’s coaches, scouts, GM’s and owners were raising your expectations before you even got on the plane.

Hamstring Strains

In my 26 years as an athletic trainer and physical therapist in the NFL, I treated hundreds of hamstring strains in Mini Camps.  About 70% of those strained hamstrings involved rookies.  Why did I consistently see very high numbers of torn hamstrings during the first Mini Camp?  I believe it’s based on the following formula:

Deconditioned Post-Draft Rookie + Fired-Up NFL Coaches + High Tempo Competitive Drills/Practices + Dehydration = Torn Hamstring

Game Planning for Healthy Hamstrings

1.  Stay Well Hydrated – My “50/50 Rules”: Consistently drink 50% water & 50% Gatorade before, during and after all workouts, practices and games.  As for any supplements, leave them at home because they won’t help your hammy’s this weekend.

2.  Embrace Your New Athletic Trainers – NFL athletic trainers are the best in the business.  Their job is to keep you healthy.  Consistently seek their advice, learn from them and benefit from their expert care.

3.  Freeze ’em – Use the team’s cold tank after every workout and practice.  Sure it hurts getting into 48 degree water.  If it’s too cold for you, you can either:  “grow a pair” or be plenty warm enough on your couch come September.

4.  Commit to a Routine – The very successful veteran NFL players I’ve had the pleasure of working with all had one thing in common:  They all had a routine they did every day.  It wasn’t a routine they did when they felt they needed it or for that big game or when they were sore.  They did it EVERY day.  Be one of those guys.

Welcome to the big league, gentlemen.  Now it’s time for you and your hamstrings to show ’em why you’re here.

Jimmy Graham’s Shoulder Injury Plan

Graham Jimmy716As New Orleans Saints tight end Jimmy Graham prepares for Sunday’s 2015 NFL Pro Bowl, he’s still dealing with an injured right shoulder.  As with many players suiting up for the annual event, most of them have injuries, aches and pains from the long NFL season which started playing games 25 weeks ago.  Pain and professional football are common bedfellows.

Graham nor the Saints have not completely divulged the exact details of his season-long shoulder injury.  He wore a shoulder harness, which stabilizes his shoulder joint by limiting his range of motion, the entire season.  He did not miss a game all season for the second year in a row.

I like Jimmy Graham’s plan for his shoulder by using the Pro Bowl as a test to determine if he needs surgery.  “Damn, isn’t a 16 game season a long enough test?” you might ask.

No and let me explain why.

A Look Behind the NFL Medical Curtain

During a long NFL season, a tight end with an injured shoulder has no time to truly rest his shoulder.  Meanwhile he never has ample time to regain the strength in his rotator cuff.  Both reducing the swelling in the injured shoulder AND increasing the muscular stability of that shoulder are clearly the two most important rehab needs for Jimmy Graham’s shoulder.

During the season, I’m sure the Saints’ athletic training staff were busy just maintaining Jimmy’s range of motion and controlling his pain.  But now that Graham has had a solid four weeks to both reducing his shoulder swelling and increasing the shoulder muscle strength, he’s ready to realistically test his shoulder.

Surgery or No Surgery?

Based on his position, the shoulder harness, the manner in which he used his right arm during the season and his comments, it’s very likely Graham has some type of shoulder labral injury.  It’s been my experience during my 26 years in the NFL that most teams have multiple labral injuries every year.  Most of these labral tears do not need surgery unless joint instability or joint “catching” directly limits the player’s ability to do his job.  If the instability or the “catching” are significant, the player’s surgery is scheduled in days not months.

When a player ends his season with an injured shoulder and stops banging on it, his shoulder quickly feels better.  The difficult decision for the player/team is: Even though a rested shoulder with a labral tear will certainly feel better, will the limitations and symptoms return in Mini Camp when he starts hitting again?

I’ve had 30+ discussions exactly like this with players in the last 20 years.  I can tell you that it’s rarely a crystal-clear decision.  The player wants to be healthy and he trusts his ability to heal.  Meanwhile, he obviously wants to avoid shoulder surgery with 3-6 months of rehab if possible.

What Jimmy Graham is doing by rehabbing for a month and then taking advantage of a rare opportunity to truly test his injured shoulder 4-5 month before his spring Mini Camp is brilliant!

The Question

The question for Graham’s injured right shoulder:  Is rehab enough or does he need surgery to truly correct the problem(s)?

After Sunday’s Rehab Bowl, Jimmy and the Saints’ medical staff will have their answer.


Top 5 Factors Causing Hamstring Strains

Source: Pixabay
Source: Pixabay

 “What’s he got?” the coach shouts with frustration as I approached with my exam findings of the injured football player.

Before I could even start with my reply, he barked back with double the volume and triple the disgust; “It’s a damn hammy, isn’t it?!”

That conversation, if you want to call it one, took place more often than I want to admit over the past 20 years as Head Athletic Trainer/Physical Therapist with the Jacksonville Jaguars.  Strained hamstrings have a way of adding to the stress level of everyone as the player, the coaches and the athletic trainers continue to search for the mystery cause and illusive solution.

Training Camp Strained Hamstrings

This year’s NFL Training Camps are producing more pulled hamstrings than anyone expected.  Reading over the NFL injury reports this weekend, only a week into a long season, it’s hard to find any teams without at least a couple of players not practicing because of a strained hamstrings.

What the Hell are the Hamstrings?

That’s not a typo.  It’s supposed to be plural because there are three (3) muscles that make up the hamstrings located on the backside of the thigh.  All three muscles originate on the lower back of the pelvis and extend below the knee behind the upper calf muscle.  Two of those hamstring muscles pass the knee on the inner or medial side while the third “hammy” inserts on the outer or lateral upper shin above the lateral calf muscle belly.

Simplifying the Function of the Hammies:

(in order of their importance for a football player)

  • Decelerate or slow down the extension (straightening) motion of the knee while running.
  • Assist in extending the hip.
  • Bending the knee.
  • Assist in rotating the shin in relationship with the femur or thigh bone while changing direction.

Terminology Check

Strain (medical) = Tweak (optimistic player) = Pull (pessimistic player) = Tear (bar guy)

They all simply mean that some of the muscle fibers within any of the three hamstring muscles has been torn.  More fibers torn means more bleeding, more pain, more weakness, more loss of function and more downtime.

Factors Contributing to NFL Hamstring Strains

  1. Fatigue – Weaker muscles are vulnerable muscles.  Have you noticed most NFL players with hamstring strains are the players in the skilled, speed positions?  The wide receivers, defensive backs and running backs typically head the list of positions who suffer most of the pulled hamstrings.  They are running and changing directions fast on every play.   When their muscles fatigue the important role of the hamstring is magnified, increasing the potential for fiber failure.
  2. Dehydration – Muscle dehydration is grossly overlooked in relationship with muscle strains.  Simply stated; a dehydrated muscle becomes less effective when forced to contract and relax quickly.  During high speeds and/or high volume activities the “drying up” of a muscle can quickly lead to a strain.
  3. Muscle Imbalance – Strong muscles tend to be tight muscles.  Weak muscles tend to be longer muscles.  When the strong or primary muscles, such as the hamstrings, are doing most of the work the less important muscles, such as the hip rotators or lower Abs, often become too weak.  This imbalance, much like a shimmy in your car, becomes worse high speeds.
  4. Poor Warm-up – Sweating on the outside doesn’t mean your muscles on the inside are prepared to contract/relax at full throttle.  A player who’s been standing around for 10 minute and is suddenly thrown in for a special teams play or a high-intensity drills is immediately at risk for a hamstring injury.
  5. Body Compensation – NFL players move very fast.  When the work load on hamstrings is high, other muscle such as the calves, groin and “glutes” (butt muscle) need to help more.  When other muscles above or below the hammies don’t do their job, the long hamstring muscles pay the price.

Strained hamstrings will tests the patience of the player, the athletic trainer and the coach.   Addressing these factors starting on Day #1 can help keep the players on the field and to help you avoid being the bearer of bad news.



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… 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.

Gameday For An NFL Athletic Trainer

Gameday in the NFL.  It’s easily the best day of the week for players, coaches, athletic trainers and, of course, the fans.

I’m often asked: “What do you do on gameday during the season?”  I’m currently in Minnesota with the Jaguars as we prepare for our season opener against the Vikings.  This is the start of my 25th full-time season in the NFL so I know how blessed I am to be able to work in my dream job for over 1/2 of my life.

Let me show you what a typical gameday looks like for an NFL athletic trainer for a road game.

5:00 AM– Wake-up, workout, do my own core & flexibility exercises and review notes for pre-game injury updates for the head coach.  This is the last quiet time I’ll have until later tonight so I enjoy the last of my  “me time” while I can.

8:00 AM – Refreshed and relaxed, its time to head to the team breakfast.  I check on injured players with my medical staff for any last-minute surprises. Note: we don’t like medical surprises on gameday.

8:45 AM – With medical staff and supplies, we head to the stadium to prepare for the game ahead of the players.  The prepping of supplies – about twenty-five miles worth of tape, twenty-five gallons of fluids and forty-five jock straps along with the trunks of emergency equipment is completed the night before by my awesome assistants Justin Bland and Rod Scott.  We’re fully dressed in game attire – minus the game shirt in favor of a T-shirt – it’s “work time” to prepare 45 players and staff for the game.

9:30 AM – The first of the buses arrive and it’s “go time” for us athletic trainers.  What does this mean? We put to use our sports medicine skills such as taping 80+ ankles, aggressively preparing the players with massage, manual therapy techniques to increase joint range of motions, soft tissue treatment to enhance muscle and fascia blood flow, flexibility drills to promote movement patterns and the many pre-game routines that these world-class athletes need to compete at an elite level for 3+ hours.  Most players have little rituals that they need to strictly follow in the athletic training room in order to have that “great game” – some may call it superstitions. Each player has a solid routine that they always follow such as a certain sequence of stretches or exact placements of athletic tape.

10:30 AM – The fast pace and high energy pre-game work continues along with updating the staff about important medical issues related to the players for the game that may impact coaching strategy and player availability.

12:10 PM – As the players head to the field for pre-game warmups, the medical staff follows.  The unwritten rule: “If the Athletic Training Room gets quiet, you’re probably last for something.”  Run to the field!

12:20 PM – Check every sideline trunk, supply and emergency gear one last time.  I like to watch my injuries players to see how they move during warmups as well.  I introduce myself to the sideline support staff, review emergency details with the paramedics, meet the airway management physician, review the communication format with the athletic trainer field observer and have fun catching up with the other NFL teams’ medical staff.  We traditionally wish them few injuries but the “good luck in the game” is always said with a smile on our faces because we know it’s a lie.  As one of my fellow PFATS athletic trainer said to me before a big game: Don’t give me that BS Ryan! We want to kick your ass just as much as you want to kick ours!”  He was 100% right!

12:45 PM – Update the team VIP’s of anything related to the health of our players.  I strongly stress to the player the need to hyper-hydrate and to get any needed sports medicine assistance now.  The locker room is buzzing with energy as we get ready to take the field and do our job. It an awesome and fun environment to be around.  This is the first time I usually put my “To Do List” aside and really get fired up for what’s about to happen on the field!

1:00 PM – The loud “They’re Heading Out!” cries out and the medical staff, with our pockets and medical belt packs properly stocked, excitedly head to the tunnel.

1:04 PM – The traditional high-fives, ammonia caps, words of encouragement and nervous claps on the shoulder pads are handed out as the deafening crowd noise makes it impossible to keep my composure.  I shake the Head Coach’s hand as I hand him a drink of water and follow through on a few player pre-game rituals, it’s time for the kickoff.  The energy, the noise and the look in our players eyes is addicting!  “THIS is why I love this job” echoes in my head and it’s such a rush to be right there as the stadium begins to rock!  As to what I scream at that point, I’ll keep that to myself….

1:05 to 4:15 PM – monitoring the field, racing out to evaluate and treat injured players, updating the Head Coach, position coach and special team coach on every injury on issues that affect performance, administering first aid to injured players, conversing with our doctors and assistant athletic trainers on medical injuries, taping/splinting/bracing injuries as needed and providing positive reinforcement to struggling players are just some of the duties that I juggle on the field during a game.  It’s multitasking at it’s best in a high energy and testosterone-filled setting with one eye on the field and one eye on the players on the sideline.

4:30 to 5:45 PM – The post-game buzz. No matter a win or a loss, I evaluate and treat post-game injuries and prepare them to fly back to Jacksonville.  The use of x-ray, specific sports medicine techniques and supplies helps this medical process run smoothly.

5:45 to 5:55 PM – Strip, run to the shower, put on suit and tie and race to the waiting 5 team buses.

6:30 PM – Security check and board the plane, hopefully with a victory in hand.  Update the VIP’s on medical issues, coordinate the icing and positioning of the players with my assistants for the long ride home.  Finalize any special tests and morning treatment lists.

30,000 feet – Eat something healthy & relax.

I love my job as an athletic trainer & physical therapist in the NFL.  It’s not easy. It’s a 7 day a week job for 6-7 straight months but I’m not complaining.  I love the challenge and the responsibility associated with my role.  I have an outstanding medical staff with a simple objective:  To keep the players in the very best of health to help them to do their job.


Concussion Management in the NFL: 2011

Concussions are the hot topic in the NFL, as it is with every level of modern-day athletics.  If an athlete in any sport has an opportunity to have his/her head impacted in any way, chances are that head injuries are a concern.

Sunday night’s game between the Atlanta Falcons and the Philadelphia Eagles showcased the interaction between one of the game’s most dynamic players and the dreaded “C word”.  Eagles’ QB Michael Vick left the game with a concussion after a blow to the head.  Philly’s Head Athletic Trainer Rick Burkholder and his staff are exceptionally qualified to manage his injury.

Michael Vick is not alone with many of his fellow pro ballplayers suffering from concussions during this new 2011 season.

What is the NFL doing to manage concussions?  Let me show you what the NFL medical staffs are doing to protect our players with concussions.

Appreciating the Seriousness of Head Injuries

First of all, it’s important to stress how serious the NFL views concussions.  The NFL league office and all the individual team medical staffs work extremely hard to learn from leaders within the concussion medical community and utilizing the latest advances in concussion management to protect our athletes.

I’m proud to part of the process that has taken great strides in improving all areas of concussion care for athletes at all levels of athletics.  We clearly understand the responsibility that we have at developing a sound concussion model that will immediately impact the manner in which younger athletes will be treated with concussions.  That role is not taken lightly, nor should it be.

Making the Right Call

Here are some of the key steps that the NFL has implemented over the past two years to improve the prevention and treatment of concussions in the NFL:

  • Mandatory educational concussion seminar and conference calls for NFL medical staffs.
  • The formation of the Head, Neck and Spine Committee that continues research all factors related to head and spine injuries for players in the NFL.
  • On-field rule changes to protect vulnerable players.
  • Reinforced the protective medical philosophy towards concussions: “When in doubt, leave them out”.
  • Mandatory involvement of a neutral concussion specialist before any concussed player is allowed to return to play.
  • In-depth documentation for all head injuries is reinforced for individual clubs.
  • Baseline neuropsychological testing to allow for comparative test after a player has suffered from a concussion.
  • Educational posters, in-services, memos and handouts for players, coaches and medical staffs related to the signs and symptoms of concussions, risks factors and resources for additional information related to concussions.
  • New sideline assessment examination to assist in the testing for any player showing signs of a concussion during a game.
  • Implementing the new Madden Rule, where any player who is diagnosed with a concussion must leave the field and be allowed to relax in the team’s athletic training room and away from the noise of the field.

Caring for Craniums, Young & Old

When it comes to football injuries, concussions have changed the game of football.  Today’s medical community understands that and is continuing to take on the challenges facing the management of this injury.  In my opinion, I think the NFL has done an outstanding job of embracing the role of setting the standard that others are watching closely when it comes to concussion management for our youth.  From all levels of the NFL and our medical affiliations, everyone involved with the care of our athletes is willing to work together to improve all aspects of this medical problem.  From the equipment to the pre-concussion baseline testing to the evaluation of a concussed player to the return-to-play protocol, we all know how important the “big picture” is to the health of an athlete.

Everyone in the sports medicine profession realizes that we have a considerable amount of work to do when it comes to concussions.  With that being said, we’re excited about the wonderful advances still to be made which will better protect our athletes, young and old.


What I Learned in (Training) Camp This Summer

How Ending the NFL Lockout Changed My Perspective on Sports Medicine

Tonight is the first pre-season game of the awoken 2011 NFL season and no one is more excited than yours truly.  The 120+ day NFL lockout stressed the fans, the players, the team owners and the team support staff members like me.

Unable to treat and care for our Jaguars’ players was a strange position for me as I enter my 24th season employed as an athletic trainer and physical therapist in the NFL.

The players have returned to work approximately 3 weeks ago and resumed their sports medicine treatments with my staff and me.  During these two weeks of training camp I’ve learned many valuable lessons.  These lessons have made me a better therapist and will help me improve the quality of the care that I provide for my followers of

My Learning Points:

#1 – Preventative Care Does More Than Prevent Injuries

Most players will tell you that this lockout made it much more difficult to take care of their injuries.  Typically NFL medical staffs address almost all of their rehabilitation needs twelve month a year.  Peyton Manning stressed that point by saying: “…you can’t use your athletic training room and can’t use your athletic trainer” during the lockout and it slowed his recovery from his neck injury.

Elite sports medicine care enhances performance while significantly reducing injuries in athletes, young and old.

#2 – Knee Pain Doesn’t Care How Old You Are

Knee injuries are a big deal in the NFL.  When our players returned and I was able to assess their medical status after 4 months away, it was interesting to see the changes in knee symptoms.

It showed me knee pain in athletes at any age can be controlled effectively when it is addressed on a consistent basis.  Improving joint range of motion, enhancing lower extremity soft tissue mobility and utilizing the proper combination of ice/heat can reduce knee pain for any and all athletes.

#3 – Roller Are Here to Stay

The players that used rollers had better flexibility and less pain then those that didn’t use them.  It was that simple.

Rollers can be used on any part of the body.  It is an easy way to improve the body’s ability to reduce pain and allow muscles to do their job.  I use them on a daily basis with my athletes and myself.  Today’s smart athletes include soft tissue rollers as a valuable tool to stay healthy.

#4 – Fitness is Not a Passive Process

Some players came back in great shape while others didn’t make fitness a high priority.  A normal off-season program provides a well-structured and organized fitness plan for our players.  There is great value in having such a plan for an athlete.

Fitness, even for a young professional football player, just doesn’t “happen”.  In other words, fitness needs to be an active process and the more time spent working on it the greater the yield.

#5 – Flexibility Never Comes Easy

One key point consistently echoed by my players since they returned after the lockout is that they missed having certified athletic trainers available to keep them loose and flexible.  Specific massages, soft tissue treatments and stretching techniques, normally provided to our the players every day, helps to keep their joints loose and flexible.  Without access to these treatments, most of the players returned with worse flexibility than normal.

This point became obvious to me when I looked at my body.  To improve flexibility it takes a consistent effort.  Not necessarily a large amount of time but consistency is the important element to increase the painfree motion of an athlete’s joints and muscles at any age.

Back Where it All Began

Football gets started tonight for me and the Jacksonville Jaguars tonight right where my dream of becoming a NFL athletic trainer and physical therapist began: Foxboro, Massachusetts. Born 30 minutes north of the stadium, I was the wide-eyed kid in the bleacher seat of Schaefer Stadium with my Red Sox hat on screaming for the Patriots.

These past 4 months have made me realize how important the NFL is to me and how blessed I am to be living my childhood dream.  As for that Sox hat, I still have it.  As for my NFL alliance, it’s no longer the Pats.  Nothing personal….

Football Injuries: Learning from the Best

Football Injuries Happen
Football Injuries Happen

I arrived home last night after a wonderful “working” vacation in Destin, FL.  I was very fortunate to be asked to speak at the Andrews Institute’s Injuries in Football Conference 2011.  The event is the brainchild of Dr. James Andrews, one of the most respected orthopedic surgeons in the world.  The conference is one of the most organized seminars for athletic injuries in the country and a true credit to the efforts of those associated with the Andrews Institute.

I’ve known Dr. James Andrews personally for over 15 years and admire his commitment to helping athletes at all levels of sports.  Anyone who has witnessed his devotion to the care of athletes, both young and old, can attest to Dr. Andrews’ passion for his role as a true leader in the sports medicine field.  He continues to amaze me with his schedule and the number of elite athletes that he cares for all over the world.

Dr. Andrews continues to be a true inspiration to me in the world of sports medicine.

The conference was uniquely informative with an impressive lineup of speakers and attendees.  The topics were all focused on football related injuries, which was perfect for me with my present position with the Jacksonville Jaguars.  Preventing, treating and rehabilitating football injuries is very different than other sports.  The best way to learn the “art & science of pigskin medicine” is to learn from those who live and breath football.

The various groupings of topics included Concussions, Upper Extremity Injuries, Lower Extremity Injuries, Traumatic Head & Neck Injuries, Treatment of the Spine, Athletic Performance Enhancement, Catastrophic Head & Neck Management and priceless hands-on labs to practice all of the material covered.

Needless to say, it was a comprehensive 3-day seminar for the hundreds of attendees and speakers alike.

Sports Medicine Presentations

I presented three talks and co-managed a hands-on lab session titled “Catastrophic Injuries Spineboarding and Facemask Removal”.  The titles for my talks were as follows:

  • “Non-Operative Management of Ankle Sprains”
  • “Emergency Management in the NFL”
  • “Life After Football: The Truth”

In my opinion, learning from my peers and sharing our experiences about football injuries and sports medicine are two of the most important steps to success.  The medical field is not an exact science and opportunities such as the Andrews Institute’s conference last week helps all of us to get better at taking care of our athletes. It’s also this unique experience that I share here online with you, which keeps all athletes competing each and every day.

Having fun and enjoying those that I learn with sure helps the process!

The Door: Inside the NFL Draft

Oz had the famed Curtain.

Babylon had the mighty Walls.

The NFL has The Door.

Only “Authorized Personnel” are allowed through the NFL Draft Room door. And, everyone knows it.  Often referred to as the “War Room”, the Draft Room is where franchise impact decisions are made and openly discussed.  Hence, the reason why only the chosen few are allowed to enter. I’m lucky to be one of the chosen few. Tomorrow, the NFL will hold it’s annual NFL Draft.

What’s in the Draft Room?

Although it varies from team to team, the secret Draft Board is the Holy Grail of this treasured plot of real estate.  Players are evaluated on every aspect of their game. Many factors such as the overall scouting grade, 40 yard times, workout stats, body size and weight and various intangible grades as well as what I’m responsible for evaluating: medical grades. Everything is clearly listed for each player on the Draft Board.

The higher up the Draft Board a player is positioned, the better the player’s grade. And, hence the more valuable they are.  The grading scale is represented on the side of the board next to a players name.  Therefore, higher graded players are moved “up the board” assuming that they will be picked earlier in the Draft. This is compared to those lower graded players dwelling down next to the plugs on the bottom of the wall.

The variable in any Draft Room is the amount of work and effort that each club puts into this process.   From the tireless hours of traveling and film work put in by the scouts to the painstaking medical grading of up to 900 players by the NFL athletic trainers and physicians to the hundreds of evaluations coordinated by the coaches, that NFL Draft Board is the result of a Herculean effort by many loyal worker bees.

The long Fall season of watching college players perform and the findings from the NFL Combine in February are far behind us now. We now stand on the cusp of knowing who made the grade.

The Secret Sauce of Knowing Who to Draft #1

You didn’t think I could actually disclose the trade secret, did you? Seriously, that answer is too detailed and I’m never going to be the person to disclose that sensitive information.  I’m the “medical guy” and I know my role.

Now comes the exciting part.  This weekend marks the collision of hard work by players who have spent a lifetime cultivating their skills and NFL staffs who have completed their homework to evaluate those players. Our staff will be dreaming of highly skilled and healthy players.  And, personally, I look down the road to see how well my staff’s medical evaluations panned out for players across the league. We evaluated nearly a thousand players and I’m always assessing how players perform medically compared to how we medically graded them.  It’s a great measuring tool to help improve the skills of me and my medical department.  It’s the only way that I’ll continue to be allowed to pass through The Door.