By Bill Bradley, contributing editor
Training camps started this week in the NFL, but the new season for team physicians began about two months ago.
Team doctors have been performing team physicals since the NFL Draft. They have been talking to players about the warning signs of concussions and dehydration. And they have been preparing for the wave of injuries that will occur during the first few weeks of training camp practices.
"Hamstring injuries seem to always occur during the second or third day of practice," said Dr. Matt Matava, the team doctor for the St. Louis Rams and the president of the NFL Physicians Society. "Players are fatigued, they're running hard, they're not in top condition and they are more prone to tearing the hamstrings.
"Ankle sprains occur during training camp, too. You'll occasionally see the ACL tear across the league -- there was a significant number of them during training camps last year. And then you'll see small fractures in the hand from catching balls. Sometimes you'll see concussions, but typically the contact is limited so you don't see too much of that."
Rams coach Jeff Fisher allowed Dr. Matava to address the players Thursday, something his peers also have been doing this week for their respective teams.
"We (addressed) a whole number of health-related issues," Dr. Matava said. "We talk to them about how to stay hydrated in this heat -- drink until your urine is clear -- and we always weigh them after every practice because any weight they lose is almost always water weight.
"We talk to them about MRSA (staph infection) and tell them what to do and how do deal with that. And we always tell them to be overly conservative when it comes to an injuries. Let the doctors and trainers determine an injury. ... We always remind the players that this is a team and to let us know if they see a teammate showing concussion symptoms or signs of heat illness."
Physicals for all players were performed as long as two months ago -- "Ideally you want to do physicals six weeks prior to the start of any sort of competitive practice," Dr. Matava said -- so the biggest worry at the start of camp is injury prevention.
With the players placed into a competitive situation in trying to make the team, Dr. Matava said he sees one interesting trend.
"We tend to see more injuries in those players less skilled than those who are skilled," he said. "You can see the players who have survived long enough in the league to make it this far from a health standpoint."
Dr. Matava said he is on a constant vigil during training camp practices, watching for anything that could show a player is not doing well.
"I'll see them in the morning; I'll check on players who might have been hurt in the previous practice," Matava said. "Then during practice, if a player has a condition, you just stand close to (Rams head trainer) Reggie Scott and keep an eye on them.
"During training camp, your team may be spread over two or three fields. We have communication now with walkie-talkies. If a player goes down on one field and I'm on another field, then I can quickly respond to that. ... And after practices are complete, some players are able to get through the practice but have some lingering injuries going on. I'll evaluate 5-10 players or so that have had injuries throughout the day or have had previous injuries that had to be re-evaluated.
"One thing in St. Louis, it gets very hot and humid here in July and August. I might put in 10 IVs during the day just to replenish their fluids lost during practice. That's despite all the water and the sports drinks we give them during practice. ... Some players might still have significant body cramps or they might lose body weight solely in water volume."
With a large support staff of athletic trainers and other doctors, a team physician doesn't spend 15 hours a day at training camp like they used to. The latest collective bargaining agreement, which prohibits more than one practice a day, has been the biggest driver in that change.
However, the physicians still get to the camp about an hour before the first full-contact practice.
"The ones who have to get there really early are the athletic trainers because they might have some special work taping players," he said. "They get there about 6 or 6:30 (a.m.). ... I show up about a half-hour to an hour (before practice) to make sure there are no players that have any injuries that preclude their ability to participate in practice that day.
"I'll stay for practice and then stay for an hour or two afterwards. It used to be a lot longer than it is now because there used to be two-a-day practices. ... Now there's just one practice. Since we are have training camp here in St. Louis, I can actually go back to office and go back to surgery."
That's a situation which Dr. Matava said most of the members of the NFLPS prefer. That's because most teams have state-of-the-art medical equipment at their training facility. Normally, that's not the case when teams leave town to have training camp at a small college.
"When we went out of town for camp several years ago, we had our exams done on a portable MRI machine that comes in by a truck," he said. "It was very inconvenient for the patient.
"If I had a player who needed surgery, instead of doing it in a hospital you're familiar with or nurses you're familiar with, you have to do operations potentially in a hospital you've never been to before."
Dr. Matava also is preparing for the league changes in the upcoming season. For instance, beginning this season all 32 NFL teams will have their medical information loaded onto electronic tablets for use on the sidelines.
"We will also have the sideline concussion tool on that tablet, so we can go to that tool in a very practical fashion," he said. "Also, we're fine-tuning the work with (independent) neurospecialist on the sidelines. That worked very well last year.
"Each team will have up to five people available so we have some sort of continuity of treatment. We know the neurosurgeons that will be over there and that they have a certain level of expertise about concussions."
Dr. Matava said that during last season there no instances in which the independent neurospecialist and the team physicians disagreed on how the player should be managed.
"We found that to be very encouraging," he said. "It tells us that the team physician has been evaluating concussions in an appropriate fashion all along.
"Yet it does give us one more check before we put a player back in the game."
