The Dynasty Doctor

Editor’s Note: We’ve received messages for years asking for coverage of medical issues facing the NFL and fantasy football owners.  ”The Dynasty Doctor” is a series we run on an as needed basis.  If you have any questions in regards to concussions, ACL procedures, recovery times from specific injuries or anything else related to medical science, submit your question here and it may be featured in an upcoming article with our own resident M.D., Dr. Scott Peak. He’s a board certified neurologist, neuro-oncologist and is the Director of Neuro-Oncology in the Department of Neuroscience/Neurosurgery for a large health care system.

After the last installment of The Dynasty Doctor series, Bryan L. asked a question about Ryan Mathews, his injury situation, the likelihood of him being ready in 2013 and the risk of recurrent injury.

The idea of an NFL athlete being prone to injuries is the subject of intense debate. There are two sides to this polarizing issue and fantasy football enthusiasts will argue intensely depending on their perspective. Athletes are seen as either injury prone or just unlucky. To be fair, football is a brutal sport, with extremes of force that non-players do not experience in most occupations. It seems logical that a human body can only take a certain amount of abuse before it breaks, no matter how much body armor is worn. Yet, there are athletes who play an entire career without serious injuries, such as LaDainian Tomlinson or Tony Gonzalez. There are also players like Darren McFadden, DeMarco Murray and Ryan Mathews who seem to be injured every year.

In the current medical literature, there are no studies comparing NFL players with a long history of injuries to others who stay relatively healthy. However, there are studies of interest describing certain psychological factors, anatomical variations and behavioral reactions that may predispose an athlete to injury. These studies provide evidence to support the notion that certain NFL players are more prone to injury. It may not be an issue of toughness, but genetics, and this is out of control for an athlete. The trick is how to use this data to predict which athletes will ultimately end up hurt.

The first study may be of interest to those who have players with chronic foot injuries on their teams. This study evaluated athletes with high arches versus those with normal arches, and risk for injuries. The authors evaluated force on both feet by having football players perform cutting movements at maximum effort while wearing shoes fitted with special sensors. High arches subjected both feet to increased force, particularly with cutting movements, in the forefoot and back of the foot. Players with high arches may be at greater risk for injury, as a result of this data. The authors concluded that athletes with high arches could be identified and fitted with special shoes that provide more support to the midsole.¹

The second study evaluated certain types of personality that may predispose an athlete to injury. The authors followed a group of hockey players over the course of one season, and used a series of reliable surveys to evaluate the degree of sensation-seeking behavior and perceptual sensitivity (how much pain is felt).² The results showed athletes who scored high on both sensation-seeking behaviors and perception of pain were more likely to sustain injuries.² This might seem logical, but it shows such surveys could help NFL teams predict which players are more likely to sustain injuries. Fantasy owners can use this data to identify players with a lower pain tolerance or those with reckless playing styles who may be at greater risk for injury. Whether Ryan Mathews has a lower pain tolerance, or reckless playing style, is an opinion that will be determined by each owner of a fantasy football team, but this study does give reason to believe something more than bad luck may be at play.

There are numerous studies suggesting several factors increase risk of anterior cruciate ligament (ACL) ruptures, such as knee position upon landing, gender, weakness of hamstrings relative to quadriceps strength, increased laxity in the knee joint, a more narrow intercondylar notch (space that holds the ACL and posterior cruciate ligaments in the knee joint), and artificial surface versus natural grass.³ As covered in my recent article on ACL injuries, certain athletes tend to plant their feet in the ground in a way that increases risk of ACL ruptures. This is most common when the foot is flat on the ground, the leg is completely straight (extended fully), and the knee is bent inward (valgus position). Proprioception is an unconscious sensation, and athletes cannot easily control this position, given movements are instantaneous and not subject to conscious thought. Females are also more likely to sustain ACL ruptures, as high as nine times more than males. Reasons given include hormonal influence, increased laxity in the knee joint and greater disparity in strength of quadriceps to hamstrings. If the quadriceps is stronger than the hamstrings, it will exert more force on the ACL and increase risk of rupture.

There are studies to show alcohol usage and sleep patterns might also increase risk of injury in athletes.

I mentioned these studies not to prove Ryan Mathews is injury prone, but to show that certain factors do predispose athletes to injury, whether it be psychological, anatomical or behavioral. It seems reasonable to conclude athletes like Mathews, with a long history of injuries, have something about them that make further injury a likely occurrence.

I should disclose I am a Chargers fan, so I may be biased. When I first received this request from Bryan, I got excited and was ready to excoriate Mathews. Like most fantasy football owners, I am frustrated by his inability to reach his potential and his chronic injuries. Rather than let my emotions get the best of me, I decided to calm down and take an objective look at Mathews statistics. I was actually surprised to find some good numbers in favor of Mathews. Here are examples, provided in part from Pro Football Focus (PFF):

1. The Chargers offensive line finished 28th in the NFL in run blocking last year. I can attest to the Chargers horrid offensive line play, having watched every game as a fan. Defensive players were often in the backfield before Mathews could hit the line of scrimmage. Jared Gaither played like a player who got a fat contract and lost his motivation. At one point, a free agent, Mike Harris, was the left tackle for the Chargers. Jeromey Clary has been a swinging gate at right tackle for years. Nick Hardwick is undersized and aging fast. The only offensive lineman worth much is Louis Vasquez at right guard. Clary was the best run blocking tackle on the Chargers, and he finished 41 out of 80 offensive tackles in the NFL (per PFF). Mike Harris finished 75 out of 80 offensive tackles in run blocking scores. Yuck. Tyronne Green finished 45 out of 81 guards, and Hardwick finished 27 out of 36 centers – not exactly stellar run blocking for Mathews.
2. Mathews finished 11th in elusive rating, 7th in yards per route run and 5th in drop rate in 2012. He did poorly in breakaway percentage, but poor run blocking played a part. In 2011, he was a top seven running back in points per reception leagues, and he finished in the top ten running backs for elusive ratings, yards per route run, drop rate and breakaway percentage.
3. I reviewed all plays where Mathews got the ball (run or pass), in 2012. Mathews looked explosive, with good vision and was able to break tackles on several occasions. He had excellent hands, again supported by a low drop rate.
4. There is the prevailing notion that Mathews was underutilized by Norv Turner in 2012, but I do not think the numbers support it. Excluding four games missed due to injury, and game 15 when he left with a second broken clavicle, he accounted for 66% of all touches at running back for the Chargers (games 3 to 14). Jamaal Charles played all 16 games, and accounted for 64% of all touches at running back for the Chiefs. I do not think Mathews problem was lack of utilization, but injuries crushed his value in 2012. In fact, given Mathews was rarely used on third downs and at the goal line by Turner, he could improve his numbers if new Chargers head coach Mike McCoy uses him more often in this capacity.

Mathews suffered an unusual injury, breaking both clavicles. I could not find articles on athletes with both broken clavicles sustained during game play. As a result, we will have to extrapolate outcomes using data for single clavicular fractures in NFL athletes. One study evaluated management of clavicle fractures in NFL players.⁴ 19 players experienced a fractured clavicle over a five year time period. Six non-displaced fractures healed in 7.3 weeks. Six of thirteen displaced fractures were treated surgically and healed an average of 8.8 weeks. The rest were treated without surgery, and healed an average of 13.3 weeks. Four out of nineteen (21%) players fractured the clavicle again, all treated without surgery.⁴ Other articles report surgical success rates 94% or higher for broken clavicles.⁵ One study described return to play in 2.6 months for athletes treated without surgery, while 3.2 months for athletes treated with surgery.⁶ In this study, 3 out of 40 patients treated surgically refractured their clavicles (7.5%).⁶ Based on these data, the best estimate for refracture of clavicles is 7.5% (surgically repaired) to 21% (not surgically repaired). Notably, players like Adrian Peterson and Tony Romo have returned from fractured clavicles without injury recurrence, so that is good news for Mathews.

Even though I love Mathews’ natural talent, I do not think he can hold up for an entire NFL season. There are examples of NFL players like Ricky Williams overcoming injuries to become productive players later on in their careers. However, there are far more NFL players with careers derailed by chronic injuries, and I have a feeling Mathews is heading down that path. The Chargers offensive line is still poor, and might take a few years to repair. Ken Whisenhunt, the new offensive coordinator (OC) for the Chargers, was OC for the Pittsburgh Steelers when they finished top ten in rushing offense between 2004 to 2006. Then again, he was also head coach for the Arizona Cardinals when they finished 29th (2007), 32nd (2008), 28th (2009), 32nd (2010), 24th (2011) and 32nd (2012) in rushing. That’s right, Whisenhunt guided a Cardinals team that finished dead last in rushing three out of the past six years. Not good.

The good news is plenty of owners may still exist who salivate over Mathews’ potential. I would consider selling him now, before his value bottoms out. According to Dynasty ADP Data on DLF, Ryan Mathews has an ADP of 43. Players like Justin Blackmon (ADP 51), Roddy White (ADP 43) and Mike Wallace (ADP 47) are just a few names who seem less risky and potentially more productive long-term for dynasty owners. Quarterbacks like Colin Kaepernick, Matthew Stafford, Matt Ryan, Tom Brady and Russell Wilson are available at ADP 46 to 60, all of which I would rather take than Mathews.

There may be some owners who want to believe in Mathews, and I completely understand it from a talent perspective. Mathews clearly has natural talent that could make him a top five dynasty asset at his position. If owners choose to believe in Mathews, now is the best time to acquire him. His value is probably never going to be cheaper at a point where enough owners still want him.

References used in this article

1. Carson DW, Myer GD, Hewett TE, et al. Increased plantar force and impulse in American football players with high arch compared to normal arch. The Foot 22(2012): 310-314.

1. Osborn ZH, Blanton PD, and Schwebel DC. Personality and Injury Risk Among Professional Hockey Players. J Inj Violence Res. 2009 July; 1(1): 15-19.

1. Alentorn-Geil E, Myer GD, Silvers HG, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009 Jul;17(7):705-729.

1. Morgan RJ, Bankston LS Jr, Hoenig MP, et al. Evolving management of middle-third clavicle fractures in the National Football League. Am J Sports Med. 2010 Oct;38(10): 2092-2096.

1. Rabe SB and Oliver GD. Clavicular Fracture in a Collegiate Football Player: A Case Report of Rapid Return to Play. J Athl Train. 2011 Jan-Feb;46(1):107-111.

1. Grassi FA, Tajana MS and D’Angelo F. Management of midclavicular fractures: comparison between nonperative treatment and open intramedullary fixation in 80 patients. J Trauma 2001 June;50(6):1096-1196.