Monday, July 24, 2017

How Will Your NFL Team Perform? - Know Their Injury Rates - Part II

Last week we talked about the Read study and some of the implications that an ACL injury can have on an athletes performance after RTPlay.  This week, we are going to disect this a little more the investigate what this means to the team and to the player.

Players starting in less games.  One thing the authors spoke about was that players r
eturning to sport post ACLR started less games following RTPlay.  This can come from multiple factors including a coaching decision, a medical decision or player decision.

  • Coaching decision.  The coach may choose to not start the player due to their current performance.  They see that the player is making less tackles which means more players are getting by them which may result in more yardage per carry for the opposing team or TDs.  Net result is a decrease in the team’s performance.  The coach may also see that one of their star players is no longer one of their star players.  Coaches are there to win games and that depends on results of the individual players.  If a player’s stats drop, that means an opportunity for another player to move up.
  • Medical decision.  We know that athlete who have an ACLR are at greater risk for other lower kinetic chain injuries.  They also tend to have more knee problems and knee pain with RTplay.  This may result in the ATC or MD pulling them out of play or modifying their play based on how their knee is responding.
  • Player decision.  This is one that typically does not last long.  If the player is self-limiting their play, they may be pulled by the coach or cut from the team.  A lot of times, athletes will suffer from Kinesiophobia (fear of movement) after an ACLR.  This is where the athlete has not developed 100% confidence in their knee and its ability under the high demands of this sport, so they may self-regulate.  This is most common with those who suffer a non-contact ACL injury and typically have kinesiophobia with explosive movements and cutting movements.  Net result is a decrease in agility which may be one reason for a decrease in number of solo tackles.

Considering the above, what is the overall impact to the team and does this impact team performance.  Keeping in mind what this study showed us, one of the things we know is that the athletes that did return to play were the better defensive players prior to their injury.  That said, this study also clearly shows they did not return to the same level of play.  For defensive players, one of the game performance measures is number of solo tackles.  The number of solo tackles dropped dramatically and brought their individual ranking down from a star player to an average player.  Taking star players out of the game can and will have a dramatic impact on overall team performance in individual games as well as overall seasonal performance.

On a personal level, what is the impact to that athlete?  This is obviously the individual that is impacted the most.  NFL players know this impact and it is one reason that in 2014 and 2015, knee injuries were ranked the #1 concern among NFL football players in the NFL Players’ Association.  This is above concussion or any other injury.  Why?  Because they know how much this impacts earning potential.  This has a direct impact on the NFL player’s earning potential in 2 ways.  If their contract is up for negotiation, this is going to be based on prior year’s performance.  If they are starting in less games and making less solo tackles, then they do not have as strong negotiating power as they may have had previously.  In addition, what this study shows and what the athletes know, is that their professional football career is cut short.  Although this study shows an impact, what industry experts say is that their professional career may be reduced by 3-4 years.  On a multimillion dollar contract, that is a lot of potential income that they lose out on.

So why is this study so important?  ACL injuries are common in the NFL.  How common?    Let’s look at the numbers by season. 
  • 2016/17 – 46 ACL injuries 
  • 2015/16 – 48 ACL injuries  
  • 2014/15 – 45 ACL injuries 
  • 2013/14 – 63 ACL injuries

Over four seasons that is 202 ACL injuries.  If you look at the overall cost of those injuries, you must look at time loss, ACLR cost, rehab cost, positional replacement costs, emotional capital and impact to team performance.  Industry experts put this cost at ~1M/player.  Over 4 seasons, that is $202M in injuries.  

Sadly, over 73% of those are non-contact in orientation.  Studies suggest that you can reduce non-contact ACL injuries by as much as 80% if those athletes are properly identified and put on an appropriate program.  So over four seasons, that is a potential $118M cost savings if they had been identified and trained appropriately. 

So why is this not being done?  One is time.  How do you do that efficiently?  Here is an interesting fact.  66% of all NFL ACL injuries are associated with 5 positions. 
  • Wide receivers – 19.4% 
  • Linebackers – 15.5% 
  • Cornerbacks – 11.7% 
  • Offensive lineman – 10.7% 
  • Defensive ends – 8.7%

What does it take to make a change?  First and sadly, you need to tie it to performance.  How does this impact athletic performance, team performance and revenues.  The above study highlights the impact this will have to the individual performance of the player but also the impact this will have to the team’s overall performance.  Secondly, we need to know we can somehow efficiently identify those at risk.  With the advent of wearable sensor technology and the knowledge that 66% are associated with 5 key positions, then we now have an efficient manner to address.  Finally, having a solution.  Once those at risk have been identified, how do we change that?  There are multiple programs out there that can efficiently impact these pathokinematics and improve the movements that put athletes at risk. 

Insanity - To do the same thing over and over and expect a different outcome.  Is it time for the insanity to be over or are we going to continue what we have always done and expect a different result?  I chose the former.  

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the developer of an athletic biomechanical analysis, is an author of a college textbook on this subject  and has performed >5000 athletic movement assessments.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Chairman of Medical Services for the International Obstacle Racing Federation and associate editor of the International Journal of Athletic Therapy and Training.   He is also a competitive athlete in Jiu Jitsu.