ACC forms team physicians group to focus on players’ health

Few sports glorify toughness and playing through pain more than football. Generating and enduring collisions, then acting like they don’t hurt, are central to the game’s ethos. But a parade of injuries accompany the hits. That inevitably produces tension between impaired athletes who want to perform – abetted by those who want them to perform – and those who possess the cooler heads that supposedly prevail.

Doctors fall into the cautionary category, or should. So it’s no surprise a recently formed consortium of ACC team physicians joined the league’s top administrators in advancing a plan to oversee player welfare from the press box during games. “If it helps and it makes the players safer, we’re all for it,” says Dr. Dave Diduch, Virginia’s 14-year team physician.

Last week the ACC followed the example of other conferences by enlisting observers familiar with their roster’s medical issues to quickly determine when a player is in trouble. Those on-high can’t stop the game, but can speak immediately with physicians on the sideline.

“I’m sure there was some combination of altruism and pressure brought to bear to make that happen,” says Dr. Claude “Tee” Moorman III, the president of the ACC team physician’s service group, founded last year. “I would say that we were behind the curve on that one.”

More significantly, the ACC also remains behind the curve in tracking injuries. The lack of a comprehensive ACC medical registry limits analysis of data to avoid problems. “I hope that the ability to study injuries will permeate all of our sports,” Moorman says.

Even for internal purposes, schools vary in how they monitor what goes wrong. “It’s been really hard to get everyone’s minds around injuries: How do you track them, because people don’t track them the same way,” notes Bubba Cunningham, UNC’s athletic director. “It surprised me when I first got to Carolina…It’s much more difficult to get your hands on than I thought.”

Moorman and his medical colleagues intend to change that – potentially a far more enduring outcome of their joint efforts than supporting the observer initiative. Overextended team trainers have collaborated for years. But organized attention from physicians may bring fresh approaches to treatments as well as rule proposals to better limit injuries.

First, though, some ACC officials had to be convinced the basically toothless observer protocol was not another step toward coddling athletes. “They’re like, ‘Well, for crying out loud, we’ve got nine medical personnel on the sideline. Do you think we’re really going to miss something?’” recalls Moorman, an orthopaedic surgeon who played football at Duke during the early 1980s. “But what I say is, what’s the harm?”

A clear view

Moorman suspects the greatest benefit of giving medical staff an elevated perch may be quite unanticipated – they’ll have a clear view of the opposite sideline, “the one blind spot that I think is consistently there.”

He cites a contest in which an opposing player suffered an ankle dislocation fracture and was “laying there in agony” literally at Moorman’s feet by the Duke bench. But doctors and trainers across the way were slow to respond, their view blocked by the crown of the field. “That may be a case where a medical observer who’s located up top may have seen that,” says Moorman. Ignoring normal inter-team protocol, he reset the ankle on the spot to alleviate the pain.

Currently the most pressing injury focus in sports, particularly football, is avoiding concussions. Moorman, 54, says he got “dinged” about every other game – “which means that you probably had a mild concussion” – when he played guard under coach Shirley (Red) Wilson at Duke after a career at Concord High School in Concord, N.C. The 6-3 offensive lineman also tore his medial collateral ligament playing for the Blue Devils. (He recovered without the sort of reconstructive surgery for which he’s now widely known, attracting patients such as top prep basketball prospects Harry Giles and Dennis Smith Jr.)

The ACC’s concussion efforts are buoyed by having nationally prominent experts at Duke, Pittsburgh, UNC and Virginia Tech. “We are really ground zero for much of the science that’s happening in football,” claims Moorman, a Duke professor in orthopaedic surgery and evolutionary anthropology, as well as executive director of the cutting-edge Duke Sports Sciences Institute. A former team physician for the Baltimore Ravens, his curriculum vitae runs 65 pages.

But scientific evidence is not always well-received, in or out of sports. Moorman says responsible parties in football “were not all that interested” in concussions until the injury’s severe long-term effects grew incontrovertible.

“We’re tuned into things that we were ignoring 10 years ago,” concedes the Blue Devils team physician for football and basketball since 2001. “Now that we know the cumulative impact of the head injuries, we’re watching very carefully and so are the players. It’s still under-reported, though, it’s grossly under-reported.”

But no longer downplayed.

“As a league, and personally as a former player, we are supportive and an advocate for making the game of football as safe as it can possibly be, and not just focusing on concussions,” John Swofford, the ACC commissioner, said in July in announcing the observer program.

Injury challenges

Concussions are only the latest major injury challenge to confront football. Deaths due to head trauma nearly led to abolishing the sport early in the 20th century. Football’s viability was questioned again when there were 34 instances of quadriplegia nationwide in 1976, most caused by players leading with their heads, according to Moorman. By the 1984 season the number of quadriplegias (paralysis of all four limbs or of the entire body below the neck) was down to five thanks to changes in standard tackling technique that included penalties for spearing.

Coaches once cultivated toughness by prohibiting breaks to replenish fluids during practices, sometimes to devastating effect. Now hydration is unquestioned. Keeping players off the field if they show signs of concussion is not debated anymore, either. Moorman and UVa’s Diduch expect the physicians’ collaboration to yield progress on anticipating and treating other common football maladies such as heat-related illness, ACL tears and shoulder dislocations.

“Medical information is a totally different world,” Moorman says. “It’s a really benevolent, altruistic environment that we find ourselves in when we get together as a group trying to make things safer for our kids. That’s what this ACC thing, when it comes to fruition, that’s where I think it will be.”

At Diduch’s suggestion ACC doctors – each team has at minimum an orthopaedist and a primary care physician on the sidelines – agreed to study “shoulder instability.”

For instance, each year four to eight Duke players dislocate their shoulders. “We think the best thing is to put the shoulder back into place and then, if the kid is able to play, when they get their full strength and motion back we let them go back,” Moorman says of best medical practice. “Even though we know that 95 percent of the time it’s going to happen again. Over the years we haven’t really seen the harm in that long term for the kid. But how am I going to know?”

The solution, Moorman believes, may lay in having all ACC schools pool their data, multiplying by 15 the annual cases any orthoepedist faces individually. “What if we had an injury registry in the ACC, supported by our athletic directors, and we could answer that question in five years?” he asks. “Wouldn’t that be beautiful?”

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