Today’s story on what former South Carolina running back Marcus Lattimore can expect in the NFL combine’s medical exams leaned heavily on the expertise of two orthopedic surgeons who have both attended the combine in mostly observing roles – Jeffrey Guy and David Geier.
Guy is USC’s team doctor and Geier is the Medical University of South Carolina’s director of sports medicine. Both said a lot of interesting things that didn’t make the story, and here they are …
** Lattimore is doing well in his recovery, Guy said, but as with all knee ligament injuries, the doctors wanted to make sure he fully developed his muscles before he started running on solid ground.
“From a conceptual standpoint, two things hold your knee together – ligaments and muscles,” Guy said. “You have to get your muscles back up to 100 percent before you let them go do stuff.”
Lattimore has been lifting weights and running on a water treadmill.
“Water therapy is probably the biggest thing we’ve started doing with injuries in general,” Guy said, adding that when the water level is at your chest, that takes 75 percent off your body weight while running on the treadmill, and when it is at your waist, that’s about 50 percent off. “The water therapy allows kids to watch themselves run. They have a TV monitor. It allows them to run and watch how they run.
“Any time you are looking at situation where you’re rehabbing kids, you have to also put into perspective: What exactly are you trying to do? Some kids, like Marcus’ (left) ACL, he was almost close to nine months before we really had to put him in a game situation. We had plenty of time. You’re not rushing somebody back. If he had gotten hurt three months later, you’re talking about trying to be a little bit more aggressive.
“Remember, Marcus is coming back from a multi-ligament knee injury. While his ligaments are maturing around four months, he’s got multiple ligaments maturing around four months. We’re a little bit more cautious (than with just an ACL)
“He might be running by the pro day (USC’s pro day on March 27), but he’s nowhere near going to be able to run for time.”
** How thorough are the combine’s medical exams?
“We had one of our athletes (at the 2011 combine) that they found at the combine had a stress fracture,” Guy said. “They find lots of stuff at the combine. They’re going to determine where (the players) really are from (the doctors’) standpoint.
“It’s pretty amazing. They have these two big MRI machines (in the exam room area) and if they see something (they say), ‘OK, you need to go get an MRI.’ They want to get a health status on the kids and where they think the kids are. There was one kid that came through from one school (who had had multiple surgeries), and they said, ‘This kid doesn’t even belong here. He’s a disaster.’”
During the time when the NFL doctors interview the athletes about their medical history and how they recovered from injuries, “it’s important to tell the truth,” Guy said. “I’ve done athletes that have gone to professional teams and they found out they lied on your physical, and they released you. You can’t lie.”
For Lattimore’s exams, “They’ll give his first (left) knee (from 2011) just as hard of an exam. I would suspect being it’s a multi-ligament (right) knee (injury), I suspect most people are going to get up and poke at him. It’s a big injury and a very prominent player. I imagine a representative from all the teams will at some point give him a tug. The best thing for him is he’s already come through another surgery and did great.”
** Lattimore will go through another checkup just before the draft. Why?
“Two months from an ACL or knee surgery, that’s a pretty big chunk of time (to make further progress),” Guy said.
But so far, Guy said, “Every time that’s he’s had points that he can turn left or right (in his rehab), he’s turned in a positive way. He’s doing great.”
Still, “It’s a business,” Guy said. “These guys aren’t going to take somebody who they draft and who cost them a lot of money and try to rush them back. Listen, the funniest thing is, look at Adrian Peterson. Adrian Peterson did not come back early. I think everybody thinks that he did. He did not. But he came back playing at a higher level than he was before. He didn’t come back until almost nine months after a surgery. They didn’t rush him back. He didn’t come back quicker than anybody else did. That’s when NFL teams like you to come back, around nine months. The trick is, how quickly does it take you to get your confidence back (coming off a knee injury)? But they didn’t let (Peterson) come back and let him play at six months.”
** Geier said the doctors at the combine will gauge Lattimore’s knee based on how far along they expect him to be in his rehab.
“I would imagine that every team that’s potentially considering a running back would have their doctors lay hands on his knee, because they’re going to want to feel it,” Geier said. “There’s going to be a projection for where he is, versus where he is expected to be. I think there’s going to be a lot of people that want to see if his knee is actually stable now.”
** Geier saw first-hand just how thorough the NFL doctors could be in their questioning of players at the combine.
“Those guys just start firing away questions,” he said. “One of the Patriots’ doctors, every single kid with an ankle sprain, he’d just yell out, ‘Was it a low ankle sprain or a high ankle sprain?’
“It’s actually a good process. It sounds kind of comical. There’s just so much on the line. Most of the players are very gracious. Nobody is trying to get them. They’re trying to identify guys who aren’t going to do well.
“When I was with the Rams (at the 2005 combine), there was a player they were trying to sign as a free agent, and this guy was probably a year and a half out from shoulder surgery. His rotator cuff strength was weaker on one side. They failed him. It’s that level.
“The Rams did an ABCDF (grading system). If they list it as an F, then the chances of the coaches or general managers signing them are very low. Most guys get A or B. (Player personnel departments) lean on the doctors a lot. The doctors are expected to make these black and white decisions and get them right. They want to know everything possible. They don’t want any – ‘well, he had an ankle sprain last year and he seems to be doing fine,’ and then it crops up.”
“It’s calculated risk and it’s based on evidence. It’s all based on what we know from the literature. It’s trying to quantify how likely it is that somebody is going to get back to 100 percent. I remember one guy that got drafted in the top 10 (in 2005) had at least one particular surgery he had (that made teams think), ‘I don’t know about this.’
“There’s a lot of money in it for these guys, that first round pick, if you miss and that guy stinks when you could have had a superstar. I couldn’t get over what a production it was (at the combine), how much money was spent on that. It’s bizarre, and not just the medical part. I didn’t have any idea until I was up there in how much money was invested (in putting the combine on). They’re just trying to get this right. If the doctors have serious reservations, my experience was the teams take that very seriously.”
Geier clarified that the top 10 pick in 2005 who he referred to had surgery about a month before the combine and has gone on to have a productive NFL career.
** Though Lattimore’s surgery was done by the well-respected James Andrews, the combine will be important for NFL doctors to confirm Andrews’ statement to USA Today that Lattimore is ahead of schedule.
“I think that’s going to be why Marcus is so interesting, because his is way more than just an ACL,” Geier said. “I think there’s not going to be anybody that relies solely on Andrews saying, ‘Yeah, he’s good to go.’ They’re going to want to see it for themselves. They’ll want to look at his MRIs because they’re the ones that get burned (if they miss something). It doesn’t affect Andrews if Marcus gets drafted by the Rams and he starts having trouble. It’s on the (Rams’) team doctors.”
As for the orthopedic stations where players are examined and “presented,” Geier said, “I’d give anything for that to be televised. It’s not like anything anybody would believe unless they saw it. I think everybody is pulling for (Lattimore), including orthopedic surgeons. He’s going to be far and away one of the most talked about, scrutinized players there. We know that he’s not 100 percent now. They just want to make sure he’s progressing appropriately.”
Geier said the operation notes that are presented to doctors at the combine typically include things, in the case of an ACL surgery, such as: “Did they find cartilage damage under the knee cap? What did the cartilage look like? Where was the cartilage damage? Was a meniscus tear found? Was it trimmed out or sewn back together?
“They want to make sure it looks like a stable knee and it feels like a stable knee, and that there are no worries that it’s going to fail in a year or two years. It’s not in a malicious way. They just want all the information possible. The good thing about sports medicine over the last 10 years is it’s gotten much better as a field (so players can recover more effectively from injuries because they have better surgeries).
Lattimore’s physical exam will involve “touching all the structures, putting it through a range of motion. Everybody kind of does that differently. There are 15 to 20 tests that you do to test all the ligaments, meniscus structures, knee cap motions and tracking. It can usually be done in 45 to 90 seconds. You compare it to the opposite side. It’s a pretty standard thing. It’s really more testing the stability. There’s a variety of physical exam tests, stressing the knee and comparing to the other side. They’ll look at his quad to make sure his muscle strength looks the same as the other side. We’ve all done this long enough to know what a stable knee feels like, or a (successful) ACL graft feels like.
“I absolutely think that the physical exam is the key part (for Lattimore). They’re just going to want to know how his knee is now. Multi-ligament knee injuries, the success rates just aren’t that good (for returning to play). They’re going to want to see: Is he going to beat the odds? They just need to know for themselves.
“It’s hard because he’s not far enough along, so that exam will be different in two months. This becomes with him even more of a speculation. Is he where he should be at four months? That’s where this is really hard. We know where just an isolated ACL should be at four months. What we don’t know is where a multi-ligament injury (should be) where only one ligament was done (because Guy said Lattimore only had to have his ACL fully reconstructed). People are going to want to know that are the (two other) ligaments that weren’t (fully reconstructed), are they OK?
“That’s the advantage of having the op notes and the MRI. They’ll actually know what was done and have pictures of it. That’s why there will be a little bit more attention paid on Marcus. That injury is so bad and you just don’t see that in football that much.”