Monday Morning MD

With three games played on the Thanksgiving holiday, let’s take a look at the safety and feasibility of Thursday football.

We hear complaints about Thursday night games, but don’t hear many complaints about Thanksgiving games. The Lions and Cowboys gladly play host every Turkey Day and the Ravens have now hosted two of the last three. Baltimore head coach John Harbaugh wants to make it a Ravens tradition and called it an “honor.” If three games on short rest are embraced on holidays, why shouldn’t one (or two) be accepted on other weeks?

Thursday games do not seem to increase injury risk. I am not aware of any statistical increase in injury for these games. I was a team physician for over 20 NFL games played on short rest and have not observed increased injury. Fatigue has not been shown to be a significant injury factor in these contests. Even late season games with more cumulative fatigue have not shown to have resulted in more major injuries.

However, short rest can make injury recovery more difficult. This week, Panthers running back Mike Tolbert would not have been ready to play on Thursday due to his hamstring injury, but was able to start three days later on Sunday in the Panthers’ victory over Tampa Bay. In addition, it is very difficult for a concussed player to pass the five steps of the NFL return to play protocols in just four days.

The recovery issues for Thursday games are the same for both teams and, thus, there is no real competitive advantage. By contrast, the playing field for the Buffalo Bills has not been level this season. The Bills are at a disadvantage by playing six games against teams with increased rest (coming off a bye or a Thursday night game).

The NFL does mitigate the issues of a short week. Routinely, teams do not have an away game on the Sunday prior to traveling for an away Thursday night game. The only exception this season featured the Pittsburgh Steelers, who travelled to Cleveland (115 miles) and then to Baltimore (196 miles). In addition, the majority of the Thursday night games pit teams from the same time zone.

Thursday games do not provide the most difficult travel or scheduling issues. Teams make more scheduling accommodations for the London games. When the Chargers played overseas, we left directly from our Buffalo game and headed straight overseas to spend the week in England. This week’s Monday night game between New Orleans and Seattle will have the Saints lucky to arrive home by breakfast on Tuesday.

Players have told me they prefer Thursday games to some of these above examples. In a future column, I will detail how these midweek games can be safely expanded. In any case, I believe Thursday games are here to stay.

MMMD 1: Concussions dominate the week

From the Thanksgiving goal line double concussions sustained by Steelers running back Le’Veon Bell and Ravens cornerback Jimmy Smith, to Oakland’s Rashad Jennings, Minnesota’s Christian Ponder, St. Louis’ Jake Long, Washington’s Reed Doughty, Kansas City’s Anthony Fasano, Tennessee’s Delanie Walker and Cleveland’s Brandon Weeden, it was a bad week for head injuries.

LeVeon Bell
LeVeon Bell

Bell exited Thursday night's game after taking a big shot that left the running back dazed.

The Brandon Weeden situation illustrates the difficulty that medical personnel encounter on a frequent basis. Despite increased awareness, an ATC spotter, sideline replay, independent neurological specialists and referees empowered to remove players, the Browns quarterback finished Sunday’s loss to Jacksonville. There was no apparent hit on a single play and Weeden didn’t develop symptoms until after the game.

Concussions are like snowflakes. No two are the same. They present themselves differently and affect players differently in onset and duration. This illustrates the difficult situation that medical personnel face in diagnosing and treating concussions. Symptoms aren’t always immediate.

MMMD 2: Concussion culture changing for the better

Washington tight end Jordan Reed suffered a concussion two weeks ago and, as a result, missed the Redskins’ Week 12 game. He was cleared by an independent doctor and was expected to play Sunday night against the Giants. However, Reed experienced a pregame headache and was ruled out of the game. In fact, it was so last-minute and unexpected, the team inactive list required “white out” to enter Reed’s name.

Although it is not a good sign that the Washington tight end has headaches two weeks after his initial injury, it is a good sign that the culture has changed to the point where Reed felt comfortable reporting the problem. Without the player coming forward, there is little chance that medical staff could have acted properly to hold him out of action.

MMMD 3: The losses continue for the Chiefs

Justin Houston
Justin Houston

Star pass rusher Justin Houston missed Sunday's loss vs. Denver due to an elbow injury.

After a 9-0 start, Kansas City has lost more than just their last three games. Last Sunday the team lost their two best pass rushers in Tamba Hali (back for Week 13) and Justin Houston (did not play in Week 13).

Sunday, franchise left tackle Branden Albert was carted off the field with a significant non-contact hyperextension left knee injury. The hope is that his anterior cruciate ligament was spared. At a minimum, Albert has a sprain and bone contusion. Even if Albert dodges this bullet, don’t expect him back next week.

MMMD 4: Injury bug catching up to the San Francisco offensive line

San Francisco had the amazing feat of starting the same five offensive linemen in every game since 2011. That streak ended two weeks ago with All-Pro guard Mike Iupati’s left knee MCL injury.

Sunday, left tackle Joe Staley suffered a right knee ligament injury. Video replay analysis appears to show his ACL was spared. However, an MRI is expected to show a medial collateral ligament tear. The MCL is the “best” of the four major knee ligaments to injure. Staley reported the knee feeling unstable as he put weight on it. This likely means a more severe grade 3 tear and could mean up to 4-6 weeks for recovery.

MMMD 5: Lance Dunbar suffers major left knee injury

The Dallas running back was just beginning to emerge as a force, but now needs season-ending surgery. Dunbar suffered a contact hyperextension injury that tore ligaments including the posterolateral corner. Unfortunately, this type of injury can be considered career threatening. Pro Bowl linebacker Shawne Merriman returned to action from such an injury, but was never the same after.

Good luck to Dunbar in his surgery and rehab. The Cowboys have a top medical staff, so his chances are improved.

MMMD 6: Has Geno Smith hit the rookie wall?

The first-year Jets quarterback started the season well enough, but his play has tailed off as of late. Physically, Smith appears to be healthy. But what about mentally?

Except for bowl or conference championship games, many college seasons have concluded by this time of the year, but the NFL regular season is only three quarters done. And that doesn’t account for four preseason games and the playoffs. In addition, colleges limit football practice and meeting time. Most NFL players put in a ten-plus hour day (practice, meetings, film review, lifting, treatment, rookie orientations, media obligations, etc). Remember, these are 22-year-olds with their first career job with many other social and living adjustments.

Rookie players have often told me how this wears on them. It’s not just the physical issues, as the mental fatigue sets in due to the long season and long days. Rex Ryan must decide if rest will benefit his young signal-caller.

MMMD 7: The Mike Tomlin sideline incident

Mike Tomlin
Mike Tomlin

Tomlin and the Steelers should expect to hear from the league office for this little stunt.

Tomlin and the Steelers are facing significant discipline for the coach “losing his placement” and stepping onto the field during Thursday night’s loss at Baltimore. On game day, each team’s two strength and conditioning coaches become “get back” coaches, with one policing the direction the ball is going and the other behind the ball. Teams typically have these coaches enforce the sideline rule, but it is rare for anyone to tell the head coach.

In addition to affecting the game and interfering with the referee, there is injury risk to sideline personnel and players alike. Sideline injuries do occur, as I have seen several. The wave of players comes quickly.

I anticipate that the NFL will make a strong statement that all coaches stay off the two-yard white stripe to allow the referees to work, and players stay behind the yellow line to allow the coaches to work. This is how the sideline box was intended to be used.

MMMD extra: When will Aaron Rodgers return to action?

The NFL Network’s Ian Rapoport reported that Green Bay’s star signal-caller will be “lucky” to return next week and may be shut down for good if the team is out of the playoff race. Meanwhile, ESPN’s Chris Mortensen indicated that a “strong consensus” from doctors and team will be required.

Medically, a distal clavicle non-displaced fracture takes 4-6 weeks to heal. Fractures typically take a minimum of six weeks, but the end of the collarbone is cancellous (spongy) bone that heals quicker than a cortical (hard) bone of a mid-shaft fracture. Three weeks ago, on this medical basis, I estimated Rodgers’ return at 4-6 weeks and that has not changed.

What could change is that Green Bay may be out of playoff contention in the near future, forcing the team to hold out its quarterback.

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.

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