One of the NFL's brightest (and therefore most expensive) stars, playing with a 4 week old lateral collateral ligament injury and wearing a heavy duty knee brace, in arguably the biggest game of his career, biggest game of the team's season, until he broke. Should he ever have been put in that situation?
Now, if you haven't kept abreast of the details of this story, it's quite convoluted and full of "he said/she said". These articles may help:
http://www.sfgate.com/sports/article/Did-Shanahan-lie-about-RGIII-s-injury-4171624.php
http://www.washingtonpost.com/blogs/early-lead/wp/2013/01/07/rgiii-injury-a-guide-to-the-qbs-knee-and-the-shanahan-criticism/
http://www.washingtonpost.com/blogs/football-insider/wp/2013/01/06/nfl-playoffs-seahawks-vs-redskins/#10550
A lot of the criticism has been leveled at Mike Shanahan (Head Coach) and at Robert Griffin III (RGIII - player), but for me there has been a lack of focus on the medical decisions made by the Redskin's medical staff on Sunday and in the lead up to the game.
First of all, we'll rule out RGIII from this. It's his body, but it's not his decision. "Players often have to be protected from themselves and Griffin, Andrews said, is “a competitor. He didn’t want to let his team down.”" A quote from the article by Cindy Boren. Absolutely right. This was 100% my mentality as a rugby player - I was there to compete, to put my body on the line for my brothers left and right of me. You sacrifice your own health and well-being for the cause and if you don't take that attitude into a game, you'll come off second best. It's why the top players are the top players, complete disregard for their own body for the good of the whole (see Jonny Wilkinson, 2003 WC final, smashing the Australian number eight 30 seconds after picking himself off the deck with a neck injury that would eventually require spinal surgery to decompress a nerve). Of course he's going to want to play. Of course he'll say he's "hurt, not injured". I haven't yet met an elite sports man or woman who doesn't share the same point of view.
So, Mike Shanahan, the coach. I'm not sure if he has any kind of medical degree. I'm assuming not. He's the coach. His job is to win. RGIII is his number one superstar, the rookie who's been leading his team, the rookie that is his captain (chosen by the rest of the team as the man to lead them), the rookie who has been winning. Why would his mindset change in this, the biggest of games? So often coaches will risk it all to win, the poker mentality, putting the tick in the W column as a higher priority to athlete's health. Players get injured, right? That's just normal? The only decision Shanahan should have made on RGIII is whether to pull him when it was obvious he wasn't right and his play was damaging the team's chances of winning.
In the lead up to the game, Shanahan (and the player, to an extent) should have been led by constructive and reasoned information from the medical team. The medical team MUST have overriding control of ALL medical matters. It's not their job to call the next play, as per it's not the coach's job to make medical decisions. So when you hear Dr. James Andrews (the Redskins sideline Doctor, a knee specialist no less) saying that he was "still worried" about Griffin's knee and that watching RGIII being sent back out to play "scared the hell out of me"; frankly that makes me feel a little uneasy about the whole situation. This is a quote regarding the initial injury when RGIII was sent back on for 4 plays after a sickening looking knock to his knee:
“[Shanahan] didn’t even let us look at him,” Andrews told Robert Klemko. “He came off the field, walked through the sidelines, circled back through the players, and took off back to the field. It wasn’t our opinion. We didn’t even get to touch him or talk to him. Scared the hell out of me.”
As a medical team it is your job to be proactive - would you wait for the coach to give you the go-ahead to administer care after seeing a bad head injury on the pitch? We know that the coach wants him to play, and you can be sure the player wants to play, the voice of reason must ALWAYS be the medical team. Take your time, assess, make a reasoned clinical decision, present this information to the coaching staff/player, and act upon it. In this instance, seeing the player go down injured, the medical team should have been on hand to greet RGIII as he came off the pitch, walked him to a quiet corner, and assessed the injury. Essentially, putting their foot down. I couldn't care less if the coach wants his player back on there and then. There's been an injury, it needs assessing, regardless of who the player is.
Regarding the game on Sunday, I do have some sympathy with the medical staff. It's been reported that RGIII passed all the functional tests etc that were prescribed. If this includes game specific work including collision work, then fine. If it doesn't, I once again question the medical staff. In an intentional collision sport, a player can't be cleared to play unless they can get through a collision session without symptoms during, post and the day after. If they can't, it's like putting a footballer back on the field who can't kick a ball. They will be re-injured, because of the nature of the situation you're putting them back into. RGIII has also got history of working above and beyond during the rehab process. After ACL reconstruction in the same knee whilst at Baylor in 2009, his surgeon Mark Adickes stated "all efforts post-operatively were spent trying to slow him down". However, during the game, when it was obvious that he wasn't right, why wasn't he assessed? After he was tackled during the 1st half when he was off-balance on his injured leg mid-pass and hobbled around the next two plays, why wasn't he assessed when he came off the field?
As a medical staff we, you, have a duty of care to all our athletes. That duty of care extends far beyond the wishes of the coaching staff. Regardless of whether this player is at the beginning or the end of his career, that duty of care still applies. If this situation shows us anything, it's that we must be proactive in finding the information, and firmly fight our cause with a well informed and reasoned argument outlining not just the immediate outcomes but the long term implications of any decisions.
Even if the Redskins had won, would RGIII have been able to play next week?
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