published Thursday, January 9th, 2014

Cleaveland: Football medicine needs an overhaul

By Dr. Clif Cleaveland

In its present form, football, especially at the professional level, inflicts excessive injuries on players. Players are bigger, run faster and, when they collide at top speed, serious, season-ending injuries occur.Physical durability rather than skill may be the determining factor in a team’s success.

Many will argue that pro players are well-compensated for their work. They are adults who are aware of the risks of the sport. They can access expert medical care when injured.

But a recent book by a former professional player offers a counter-argument.

“Slow Getting Up: A Story of NFL Survival from the Bottom of the Pile” by Nate Hamilton presents an engrossing, insider’s look at the life of a professional player. Hamilton, a graduate of a Division III college, signed as a free agent for the San Francisco 49ers in 2002. Dropped after a shoulder separation, he sat out the season. After training camp in 2003, he was dealt to the Denver Broncos, where he spent the next six years while battling an array of injuries. He played on the practice squad before moving to special teams and backup roles. A wide receiver initially, he was moved to tight end, which required that he increase his weight substantially. Near the end of his career, Hamilton spent brief intervals with the Cleveland Browns and an arena football franchise.

Hamilton was never a star but one of the many role players who spend a few years in professional football before injuries halt their participation. In many respects, they are expendable.

By the end of his career, Hamilton’s body was a wreck. While in the NFL, he had repeated steroid injections at the site of hamstring and groin injuries to block pain and inflammation so he could resume practice and play. Along with other players, he often lined up for injections of potent, non-narcotic pain relievers before games. Platelet-rich plasma was injected on other occasions to speed healing of damaged tendons and ligaments. A fractured leg was in the mix of injuries. At the end of his football career, he learned that he had never been informed of a complete hamstring tear sustained years earlier.

The NFL does not prohibit nor monitor the use of prescription narcotics by players. It is unclear from Hamilton’s book if these drugs were used along with steroids to deaden pain from injuries.

What emerges from the memoir is a picture of a sports medical program that is less interested in a player’s health and safety than in returning him to action as soon as possible. No one seems to question the dangers of repeatedly numbing injured joints or using experimental therapies alleged to speed healing. Was detailed information on risks and benefits of various treatments offered to injured players?

Attitudes and practices developed in the NFL influence what happens in football at collegiate and high school levels. A new set of rules is needed throughout the sport to ensure expert, independent evaluation and treatment of injuries. Physicians and trainers on a team’s payroll may not provide this. Leagues at all levels need to carefully analyze patterns of injury and subsequent treatment.

An overhaul of training practices may be indicated as well. An unconventional program at Stanford University has dramatically reduced injuries for football players. Designed by strength and conditioning coach Shannon Turley, the regimen emphasizes balance and flexibility along with strength. Training protocols differ according to position on the team. All emphasize extensive stretching before and after workouts. The incidence of injuries resulting in missed games has dropped by 85 percent during Turley’s seven-year tenure at Stanford. Only one player sustained a season-ending injury during the 2013 season.

A great sport and its participants deserve a fresh appraisal to assure safety and appropriate medical oversight. Prevention of injuries must also be a priority.

Contact Clif Cleaveland at cleaveland1000@comcast.net.

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