Long-term interests win out in Rodgers debate
Editor's note: This column originally was published Jan. 22, 2013.
There's a plausible and maybe even compelling argument for the Green Bay Packers to play Aaron Rodgers now that he's seven weeks removed from the broken left collarbone he sustained Nov. 4.
Judging by Rodgers' curt manner during a short news conference Thursday, by which time he knew he wouldn't be playing today against the Pittsburgh Steelers, he's espousing it himself in meetings with his bosses.
It goes something like this:
Your chances to win championships are limited in the NFL, even for elite quarterbacks. The Packers will qualify for the playoffs if they win their final two games, and if they get there, though they won't be the favorites to win the Super Bowl, they'd at least have a chance with Rodgers playing.
Furthermore, the Packers are paying Rodgers $18.7 million a year to try to win titles in a tough business, and taking physical risks is part of that bargain. He'll have had seven weeks for his collarbone to heal by today's game, so the risk of a re-break has diminished.
And, the argument goes, if Rodgers breaks his collarbone again, so what? Doctors can repair it surgically. Rodgers can take three months or more into the offseason to recover, and still be ready to go well before training camp next year. No harm done.
So why hasn't the Packers' physician, Dr. Pat McKenzie, and general manager Ted Thompson decided the risk is worth the potential reward and cleared Rodgers to play?
"Everybody wants their guy to play," said Dr. Luga Podesta, a sports medicine physician at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles and former team doctor for the Los Angeles Angels baseball team. "But a lot of times the doctor has to be the bad guy and sometimes err on being conservative. You don't want a catastrophe to happen, and it can happen."
So, there it is. The Packers have the most valuable asset there is in the NFL, an elite quarterback, and are looking to avoid catastrophe.
In this case, according to three sports orthopedists I consulted Friday, a catastrophe could happen if Rodgers is reinjured and sustains collateral damage to the nerves under his collarbone. That damage can happen in surgery, where there's also the risk of infection, blood clots and an adverse reaction to anesthesia. And it can happen because of the trauma upon reinjury.
"This is rare now," said an orthopedic surgeon who works for another NFL team. "This isn't like 50 percent (chance). But there is risk of nerve or avascular injury with a clavicle fracture that's displaced.
"What I'm thinking is, the fracture pattern must be funny, and it's not healing as well as they'd like it to heal. So his risk if he fell on it is greater to crack."
That Rodgers hasn't played seven weeks removed from sustaining a broken collarbone isn't unusual, though it suggests something about the nature of the injury. The Packers never have confirmed national reports in the days immediately after the injury that Rodgers had a mild break in his left collarbone, and that indeed might have been the case.
The rule of thumb is broken bones take about six weeks to heal, but in fact that can vary widely depending on the injury. Collarbones often heal slowly because of poor blood supply, and different breaks heal at different rates. Collarbones sometimes can take 12 weeks or more to heal fully, all three doctors said.
"What if it's not healing the way they want it to heal, and it's only 50 percent healed?" said the orthopedist for another NFL team. "Then he has a much greater chance of fracturing it on a sack. It's supposed to withstand 500 newtons of force, and you're only half-healed and it only withstands 250 newtons of force, you can crack it a lot easier."
The catastrophe then would be a reinjury, which almost surely would be a displaced break that also damaged the brachial plexus, which is the network of nerves that control arm movement and run beneath the collarbone.
Though it's uncommon, violent clavicle displacements can damage those nerves. That level of trauma usually is caused by extremely violent actions such as a long fall or gunshot, but it's well within the range of possibilities that a 300-pound man falling hard on Rodgers could generate enough of force on a compromised collarbone.
"That's where the major risk comes," Podesta said, "because if he damages that (brachial plexus), then he can't lift his arm up, and that's a very difficult problem to deal with, especially if the nerves get permanently damaged. I'm sure that's where his doctor is coming from. I would probably err on the side of holding him, especially if there's still fracture seen on the X-rays."
The unnamed orthopedist said many NFL teams will clear a player if his clavicle injury is 80 percent healed as measured by a CT scan. He didn't know if the Packers were among those teams.
But the CT scan, which provides a far more detailed picture of healing than an X-ray, brings another issue: radiation. The numbers can vary based on the machine, but CT scans can expose a patient to the radiation equivalent of about 400 X-rays.
Radiation also slows bone healing. So while Rodgers and coach Mike McCarthy haven't revealed how many scans Rodgers has had, there's good reason to not scan him weekly.
"If he was our player," the unnamed team orthopedist said, "we'd say, 'He's 80 percent healed by X-ray, we're pretty confident,' so we CT scan him, and if the CT scan shows he's 80 percent healed, we're going to let him play."
A second concern is how much a re-break might cut into Rodgers' offseason training. Though on the surface that appears to be a secondary matter, offseason training is crucial for a player to improve or, if he's older, ward off decline. Every week spent rehabilitating an injury is a week lost to football training.
Washington paid the ultimate price this year for such an error. Coach Mike Shanahan left quarterback Robert Griffin III in his team's playoff game against Seattle last season despite an obvious knee injury, and when Griffin's knee collapsed and burst his anterior cruciate ligament, it effectively ruined Washington's 2013 season as well.
Rodgers isn't at higher risk of a torn ACL, but if he broke his collarbone again, he likely would face a two- to three-month recovery, which would take him into March or April. If there were complications from the injury or surgery, that could push it further into the offseason.
"Look what happened with Griffin," Podesta said. "(A collarbone) is different, but it isn't that much different."
When the Packers meet to discuss Rodgers' status for the week, there likely are several people present in person or on speakerphone: Rodgers and his agent, David Dunn; McCarthy and Thompson; McKenzie; and possibly trainer Pepper Burruss.
Numerous issues and agendas likely play into their thinking, beginning with the chance to get into the playoffs with two wins.
Rodgers feels fine and wants to play. He and McCarthy also are aware of the Packers' locker room, where the culture is all about the willingness to suffer and sacrifice for teammates. The impact of that sacrifice filters through the locker room and mutliplies thousandfold when it's a quarterback.
McKenzie is in the inherently conflicted position of a team physician in professional sports. He works for the team and can be subject to its pressures to get players on the field. But his first obligation is to his patient.
Thompson has to look out for the franchise and consider the long-term investment.
To that end, Rodgers in the offseason signed a contract extension that guarantees him $54 million even if his career ends today. He's 30 and might be only halfway through his NFL career. As long as Rodgers is in relatively good health, the Packers should be a Super Bowl contender for the next eight or so years.
"It's a decision made between the medical staff, the administration and the agent," the orthopedist for another NFL team said. "Everybody has kind of a say in that. It's a risk-benefit ratio. What is the risk? What is the benefit?"
Based on their Thursday news conferences, Rodgers and McCarthy were pushing hard for the quarterback to play. McCarthy said after Rodgers' performance in practice that day, "I would state him ready to play." Rodgers, on the other hand, was unusually subdued and short in his 2½-minute meeting with reporters, and everything in his demeanor suggested he was unhappy with the answer he expected to get Friday morning.
And that answer from McKenzie and Thompson was no. Looking at the NFL in the harshest light, most or nearly all players in the league are disposable to their teams. Rodgers is one of the few who isn't.
— firstname.lastname@example.org and follow him on Twitter @PeteDougherty.