Of all of the workouts at the NFL Combine televised this week by the NFL Network and discussed at length by draft experts, which aspect do you think has the greatest effect on the players’ draft status? The bench press? The 40-yard dash? Skills demonstrations? Interviews? The Wonderlic? I would argue that one of the most important, if not the most important, is the medical evaluation.

The medical evaluations of players cannot be televised for confidentiality reasons. Rarely in draft coverage do the media ever talk about a player’s health. But the evaluation process is a fascinating one, so let me describe it with a hypothetical player and injury history.

Player X is brought by a chaperone with a small group of the 300+ players into one of the medical stations. This station has the orthopaedic doctors and athletic trainers for the Colts, Vikings, Patriots, Browns, Ravens, and Rams. This group of doctors produces the report that contains the medical evaluation of all the players that is distributed to all the teams, although the players will have to go to other stations with the other teams’ doctors and one station for assessment of medical issues such as heart or high blood pressure issues.

Players' prior injuries are extensively examined to determine if they have fully recovered.

The player is taken into one room of the station, where one of the team doctors asks numerous questions about any and all prior injuries, surgeries, missed games, and any current problems. Then the doctor performs a thorough physical examination of the players and extensively examines the previously injured areas.

The doctor then reviews the x-rays and MRI’s performed on that player during the Combine. Basically, if a player has ever had an injury, he gets x-rays and often MRI’s of that body part. Often players will have 3-4 sets of x-rays and 2-3 MRI’s. I don’t know the number of MRI’s done for the Combine, but it must be staggering because MRI facilities in Indianapolis perform the tests around the clock that week.

Next, the examining doctor takes the player into the station’s second room to present the player to the other doctors and athletic trainers of the teams mentioned earlier. Again, the following presentation is hypothetical but exactly how the process goes.

“This is Player X, a wide receiver from University of Y. He suffered an ACL injury in 2009 and had ACL reconstruction using a patellar tendon autograft. He returned to play last season but missed two games due to knee soreness. His knee exam has a relatively firm endpoint with Lachman’s test and his pivot shift test is negative. A KT-1000 test shows a 2 mm side-to-side difference with the ACL on his opposite knee. An MRI of the knee from earlier this week shows the graft intact with the hardware in good position and no other findings. An isokinetic test shows that his quadriceps strength on that leg is about 80% of the strength on the opposite side. Also, he has a history of three right ankle sprains during college. He didn’t miss any games due to his ankle last year, and he only requires taping prior to games. His ankle exam is normal, and his ankle x-rays are unremarkable except for a small bone spur on the anterior aspect of his distal tibia.”

Then the doctors and trainers listening ask more questions of the player. “Do you feel any giving out of your knee when you play?” “Does your knee swell often?” They might come up and examine player X themselves. Then each team’s medical staff rates the player based on this information. Each team probably does it differently, but the Rams used an A-F grading scale. Player X, with a history of ACL surgery and ankle sprains might be a B or B-. Each team has to judge for itself how risky a player is medically.

The team’s scouts, coaching staff, and general manager have to evaluate players based on playing ability, physical measurements, and all of the Combine workout results and decide whom they would like to draft. They then consult with their team’s doctors if the player’s medical grade might make them rethink their pick.

Hypothetical GM or coach: “We really like Player X and want to take him with our first-round pick. Can he stay healthy?”
Team doctor: “I’m a little worried about his knee. He missed 2 games last year due to knee soreness, and his strength still hasn’t completely returned from his surgery almost two years ago.”
And then the team decides what decision is best.

The NFL Combine and NFL Draft essentially involve speculation. Scouts look at films from a player’s college games, tests to judge size, strength, and athletic ability, and skills demonstrations to try to find a future All-Pro player. The team’s medical staff is speculating as well. They try to predict how likely a player will be healthy and play without injury based on prior injuries. The top picks earn a lot of money, and they are needed to play right away, not stand on the sidelines in street clothes.

Tweet about the NFL Combine.

Note: This post appears as a column in Wednesday’s edition of The Post and Courier.