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Medical examiners

By Jody Foldesy



Washington Redskins officials perused the foreboding details of Courtney Brown's medical dossier in mid-March and weighed rolling the seemingly loaded dice.

A half-dozen injuries marred the defensive end's five-year career with the Cleveland Browns, who made him the top pick in the 2000 NFL Draft. Signing Brown after so many setbacks seemed akin to buying real estate in a flood plain or on a fault line. The medical report just went on and on.

"It was substantial," Redskins coach Joe Gibbs recalled. "We all kind of looked at it the same way, like, 'Good gosh.' "

After digging through reams of surgical notes and MRI reports, the Redskins were left with a simple but significant question: Was Brown injury-prone and therefore likely to be hurt again and again, or had he simply endured an unusually long run of bad luck?

Such medical uncertainty is common terrain for NFL clubs, but that doesn't make it easy to navigate. Teams constantly must scrutinize shades of grey and decide: sign or don't sign? Draft or don't draft? And in this era, in which the salary cap constrains spending and hampers depth, the stakes are particularly high because a winning club is often a healthy club.

"In '99, when we went to the playoffs, I think we only had 13 games missed by starters," Redskins director of sports medicine Bubba Tyer said. "Last year [when Washington was 6-10], it was over 100."

Swinging for the fences

From a medical perspective, cornerback Walt Harris had about as much business pocketing $1.4 million from the Redskins last spring as Gibbs has of piloting one of his stock cars 140 mph around a curve.

A former first-round pick, Harris underwent a risky operation in February 2004 to alleviate chronic patella tendinitis. A third of the tendon was removed, a procedure Tyer said has just a "50-50" chance of succeeding.

Dr. James Andrews, the renowned orthopedist and Redskins senior consultant, flatly told the club it was "not a good surgery." The Redskins had to weigh getting a top reserve against flushing $750,000 in signing bonus and $660,000 in base salary down the drain. Owner Dan Snyder eventually broke the indecision.

"There was a point in there where the owner said, 'Hey, let's get him,' " Tyer recalled. "That's the risk involved. He thought it was worth the chance, and it turned out to be great."

Indeed, Harris now is fully healthy and the odds-on starter when Washington's season opens Sept. 11. But for much of last summer, the Redskins weren't sure whether his knee would mend.

"It was a long rehab," Gibbs said. "In that case you hit the home run, obviously knowing when you go into it that you could bomb out, too."

Defensive tackle Daryl Gardener was another four-bagger by Washington. He signed a $775,000 contract in 2002, took a pain-killing shot in his bad back and won Redskins player of the year. But in 2003, after receiving a seven-year, $34.8 million deal with the Denver Broncos, Gardener played in just five games. He's now out of football with back troubles.

Not all of Washington's medical gambles have paid off. Guard Dave Fiore signed for four years and $6.4 million in 2003, but his chronically bad knees sidelined him after just three games. He ultimately was paid more than $2 million for virtually no production.

Then there's linebacker Jeremiah Trotter, a gutsy third-round pick by the Philadelphia Eagles in 1998. A sketchy ACL repair at Stephen F. Austin scared off many NFL clubs, but Trotter emerged at a Pro Bowl level in Philadelphia. In 2002, he got a seven-year, $35.5 million pact from Washington and limped through two injury-riddled and mistake-filled seasons. In 2004, he re-signed with the Eagles for spare change and promptly returned to the Pro Bowl.

"Any player that we look at, we look at on a risk-reward basis," Eagles president Joe Banner said. "When we drafted him, we felt like we got an awfully good player who made the risk-reward worth it. When we faced the decision last year to bring him back, we faced the same analysis. The short answer is in both instances we came to the conclusion that the value of what he brought to the team was worth signing him."

Ratings game

For some decision-makers, such as Kansas City Chiefs coach Dick Vermeil, the medical evaluation isn't "a complicated procedure." Vermeil and his like-minded brethren invest little of their own subjectivity, relying on medical staffs for detailed analyses of injured players.

It's up to the doctors and trainers to translate the medical jargon into projections on how much a player will practice or play and to guess whether the player might be reinjured.

"They kind of take the grey out of it," Cincinnati Bengals coach Marvin Lewis said. "There's a saying: You've got to defer to what the medical people believe. That's why there has to be built-up trust and a track record."

For doctors and trainers, there is a considerable amount of information to digest. Tyer sits in as the prospective player is evaluated by a Redskins team doctor. X-rays and other tests may be conducted at that time. He and Redskins trainers then sift through notes about the player's various surgeries. The club also may review specific injuries with a consultant, such as Charlotte-based foot specialist Dr. Robert Anderson.

All NFL teams use some type of numbered grading system to rate players on a medical scale. The Eagles rate players from 1 to 4, with grades at either extreme getting no discussion on the personnel side of the equation. A player who rates 4, for instance, will be stripped from Philadelphia's draft board, no questions asked.

Washington uses a 1-to-5 scale. Based on Tyer's description, a 1 "never had a history of injury," a 2 has "some history" and a 3 has "history of injury with some findings — you know, he sprained his knee, and now he's got a loose knee."

From there, players slide quickly toward the black list. Tyer recommends against acquiring players with a 4, while players with a 5 are considered unsignable and undraftable. Of course, there are always exceptions.

"You could say that players have failed the physical and we [have acquired them anyway]," Tyer admitted. "But that happens throughout the league."

The Eagles are among the teams that have taken notable gambles. Besides being two-time winners with Trotter, Philadelphia looked past shoulder troubles to select defensive tackle Corey Simon sixth overall in 2000 and didn't get scared off by second-round safety Michael Lewis' irregular heartbeat in 2002. The club also paid huge money to oft-injured defensive end Jevon Kearse last year.

But the Eagles permitted defensive end Derrick Burgess to leave via free agency this offseason and let beloved running back Duce Staley depart in 2004. Injuries factored into both decisions. Banner argues the club ultimately is fairly conservative.

"It's a very player-by-player type decision," Banner said. "I'd probably describe us on the somewhat-conservative-slash-cautious side. If you compare around the league, there are some players I've seen drafted, some even relatively high, that we wouldn't have pursued for medical reasons."

Meanwhile, some teams treat certain injuries like the kiss of death. Torn ACLs no longer are a big deal — the Redskins have a dozen players with old ACL injuries — but the absence of cartilage in a knee, for example, furrows the brow of Tyer.

"The bone-to-bone injuries — there's nothing you can do about those things in football," Tyer said. "I mean, you can take medicines. Some people are doing advanced surgery work, transplanting cartilage — that's not for football players. That's maybe to help somebody prolong the life of their knee before they have a replacement."


Gibbs said he was willing to bet on Brown, who ultimately signed with Denver, because Brown is "a 10 as a person." In other words, the fact Brown could be counted on to rehab properly and not cause off-field distractions made the coach much more apt to make an offer.

Still, there's little doubt Brown has earned a certain label.

"He's injury-prone," Redskins defensive end Phillip Daniels said. "Until he can play without getting injured, he's going to get that label."

Why has Brown been injured so frequently? Why did former Redskins offensive lineman Mark Schlereth endure 29 medical procedures during a 12-year career while Hall of Fame rusher Walter Payton played in 190 of 194 possible games?

Random luck obviously plays a big role. Redskins right tackle Jon Jansen didn't miss so much as a practice at the University of Michigan or in the pros until — untouched — he suffered an Achilles' tendon tear in last season's Hall of Fame Game.

"I've talked to 50 different doctors," Jansen said, "and they've all said there was really no explanation for what happened — 'You were just unlucky.' "

But Jansen still maintains theories about the seemingly random distribution of NFL setbacks. For instance, he thinks a given player's body might be "structured" to hold 260 pounds, but for football purposes he weighs 290. Jansen believes the player is just begging for a blow-out.

Lewis and Vermeil cite flexibility and elasticity. Said Vermeil: "Some [players] are gifted in other ways the Good Lord made them. And some are not as flexible. They're stiffer. Their bodies don't bend and roll with the punches as well."

Diet, according to Daniels, is another key factor. He takes vitamins each day and cringes when younger teammates wolf down fried chicken or hamburgers for lunch. Others interviewed for this article mentioned physical fitness and experience.

"What prevents injuries is technique, being in shape and knowing what the [heck] you're doing," said Redskins center Cory Raymer, whose multiple setbacks during a nine-year career have intermittently attracted the "injury-prone" label.

Generally speaking, there don't appear to be any reliable studies on how and why NFL players get hurt. The players association ranks playing surfaces to promote player-friendly turfs, but that's about it. The NFL, according to a league spokesman, hasn't conducted any such analyses.

Some teams have done smaller studies, such as the Eagles' position-by-position breakdown, but those results are proprietary and seemingly not earth-shattering. Said Banner with a laugh: "I think you can figure: Players who get hit the most get hurt the most."

Ultimately, though, the most crucial difference between a player who's injury prone and one who's relatively healthy might be toughness. Tyer's long-repeated mantra is "tough players make good trainers." Jansen believes that most players get the same number of ailments over the course of a career — some get taped up, while others head for the bench.

"I'm not talking about Courtney Brown, and I'm not going to name names," Jansen said, "but there are a lot of injuries that don't need to go reported.

"It's not about luck; it's about toughness."

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