Bypassing the Blame Game—Private vs. Team-Based Injury Care in Sport

An All-Star takes a step—SNAP! An equally valued teammate comes down from a dunk attempt—KaPOW! No, we were not watching an episode of the 1960’s Batman featuring Adam West; we were watching the NBA finals. The backlash from both of these catastrophic injuries has been “Who do we blame?” and “Where should we point the finger?” Accordingly, some of the first “suspects” identified by the traditional media and the social media “experts” were team medical staff. The Twitter Mob was out for blood and desperately looking for scapegoats. “Who authorized this? How could they do this to him? When are they going to fire these guys?”

However, if you followed the news article trail, just the month before, the members of the team performance and medical staff were lauded for a new “flavor-of-the-month” sport science term known as “load management.” So, which is it? Are they heroes or goats? People need to make a choice and move on. In the immortal words of Jeff Spicoli, Sean Penn’s character in Fast Times at Ridgemont High, “Make up your mind dude. Is he gonna shit or is he gonna kill us?”

The one thing that is certain is that we may never know who, if anyone, was at fault for what transpired in the 2019 Finals. What we do know is there may be long-term repercussions for how professional athletes—particularly the highest earners—proceed with their overall health and preparation moving forward. Accidents do happen and team staff may have less control over decision-making than we might ever know.

There may be long-term repercussions for how professional athletes—particularly the highest earners—proceed with their overall health and preparation moving forward, says @DerekMHansen. Share on X

However, the growing perception, whether true or not, is that professional athletes need to advocate for themselves and take matters into their own hands. We must also acknowledge the fact that the player agents are even more motivated to maximize the longevity of their star players, as it has implications for not only their bank accounts, but also their reputation as the caring “Jerry McGuire”-like patriarch/mentor for their clients. So, what does that mean for the “management” of athletes moving forward?

Historically, there has been growth in the use of personal trainers by athletes ever since Michael Jordan revealed that he used a private trainer for off-season workouts. Heck, I could even go back to the days of Lew Alcindor working with Bruce Lee on martial arts during his off-season period, although nobody would argue that they were doing functional or sport-specific training in Bruce’s backyard. But since then, other superstars have followed suit and have credited “my guy” with much of their success and longevity in the sports world.

In some cases, the year-round use of private trainers has created significant friction within organizations, as we have seen with Tom Brady and the New England Patriots. Regardless, the perception that “my guy” has a significantly greater interest in the welfare of the player than the team’s staff may be growing. And let me be perfectly clear—even though I use the term “guy” throughout this article, it could apply to female specialists (surgeons, physical therapists, strength coaches, and nutritionists) as well, in both the private sector and within a performance team’s staff. This is not a gender-specific issue.

I do think it is important to look at the pros and cons of both situations: private sector care versus team-based care. There is no single right answer for everybody, and we would need to conduct a case-by-case evaluation to truly do this topic justice. Since I’m not being paid for such an intensive exercise, we will at least identify the key issues around external versus internal interventions that others can rant about on their own social media accounts.

It’s Not Just About Rogue Personal Trainers Anymore

A private personal trainer doing exotic workouts in scenic settings is no longer enough for the modern pro superstar. While this is still a big deal for the uninformed Instagram audience (insert sand-based speed ladder drills with 60-pound weight vest here), the uber-serious professional athletes will have a team of experts supporting their careers. This can include, but not be limited to, at least a number of the following:

• Orthopedic surgeon
• Sports medicine physician
• Physiotherapist
• Chiropractor
• Massage therapist
• Strength and conditioning coach
• Personal fitness trainer
• Speed and agility coach
• Recovery/load management coordinator
• Yoga instructor or stretching specialist
• Sports nutrition professional
• Personal chef/cook
• Sport psychologist and/or motivational coach
• Spiritual advisor
• Social media manager (to show everyone you have your own team behind you)

I’m certain that this list is incomplete, although I don’t know who else could add value. Of course, we can add in ultimate fighting coach, Pilates instructor, smoothie maker, and a whole lot of other specific “professionals” who think they are the key to the success of the athlete—natural selection aside—but you get the idea. This is not to say that professional sport teams do not employ some of these positions, at least on a contract basis, to give the impression that they are meeting the needs of their athletes.

However, sharing one Pilates guru with the entire team just isn’t going to cut it in today’s toxic environment of egocentricity, narcissism, insecurity, and anxiousness. And let’s be honest, a number of professional teams sometimes bring in these “specialists” to simply comply with the desires, fetishes, and personal requests made by the higher-paid athletes on the team. Keeping the “talent” happy may be the most important “performance” intervention team staff could provide in this day and age of thin-skinned superstars with a “what have you done for me lately” attitude.

The Influence of Social Media

I often ask close friends in the “business” if they think there are more catastrophic, season-ending injuries than there were in the past. Accurate injury statistics are not so easy to come by these days, with “fantasy” websites often providing better information than any official league resource. Thus, it is very hard to compare injury stats with those documented 30 years ago.

I don’t recall ever seeing two major stars from the same team go down with season-ending injuries in the NBA Finals, significantly influencing the outcome. One friend claimed that social media puts everything front and center in our attention these days, so you never miss a highlight or spectacular injury. Thus, perhaps it only appears that there are a larger number of catastrophic injuries today simply because we get to see them replayed over and over again as animated GIFs on our personal devices.

Perhaps it only appears that there are a larger number of catastrophic injuries today simply because we see them replayed over and over as animated GIFs on our personal devices, says @DerekMHansen. Share on X

The other side of social media is that private sector professionals used by many athletes often have a significant social media presence, showcasing their facilities and their sensational exercises every chance they get. Use of the hashtags #NFL, #NBA, #NHL, #MLB, and #MVP is imperative on the part of private sector operators to give the impression of expertise, efficacy, and credibility. Professional team staff do not have this same luxury of public self-promotion as pro sport organizations often restrict or prohibit content from being shared regarding work with players, for obvious reasons. However, this keeps team staff in the social media “shadows” and may even work against their perceived credibility by their very own players.

When private sector trainers post dozens of videos and images on a daily basis on their virtual resume, this is most often the information upon which professional athletes base their training and rehabilitation decisions. And this type of social media marketing is not limited to personal trainers. Medical professionals are jumping into the fray and providing their thoughts on injuries, surgical procedures, and rehabilitation approaches. As such, it may be prudent for pro team staff to have their own “side” business where they can promote their expertise on social media outside of the shadow of their employer. However, this would have to be negotiated with and approved by their employers, with no guarantees the teams would allow this to happen, seeing that they have already lost their grip on players’ extracurricular activities.

The impact of social media will not go away any time soon and will likely be even more influential moving forward. Players are attached to their phones and it is their “window” to the world outside of their team activities. If they have a negative experience or interaction with staff on their team and they then see an Instagram influencer giving out advice on training and rehabilitation in a sensational manner, you can bet the combination of those two experiences will make an impression. If you couple that with a teammate or friend from another team singing the praises of their private sector guru, now you have a recipe for mistrust and possible dissent.

Although social media and the internet itself provide greater access to a larger amount of information and opinions, the window-shopping effect takes hold and the next guru is always better than the previous one, with no consistency or commitment ever achieved. It reminds me of a middle-aged buddy of mine who says that internet dating is great, but never seems to be in a relationship longer than six weeks because the perception is, “I can always do better!”

The True Responsibilities of Team Employees and ‘Fake News’

While it is often easy to blame team staff for problems accumulated by the players, things are not always as they seem. It is often said that medical professionals are in a “conflict of interest” in the case of clearing an athlete to play, as the team pays for a doctor’s livelihood and players need to do what they are paid to do. Common sense would tell us that anything that preserves the health of the player would be in the best interests of both the player and the team. Injured players do not contribute to winning records in either the short-term or long-term. So, what is the problem?

There is a significant amount of secrecy and, to some degree, deceit that goes into managing and reporting injuries in professional sports. On the one hand, teams like to collect information on every comment and request made by players relating to health and potential injury.

There is a significant amount of secrecy and, to some degree, deceit that goes into managing and reporting injuries in professional sports, says @DerekMHansen. Share on X

I had one player I had trained in the past who attended a training camp with an NFL team. After each practice session, he would ice down his knee, as he had a previous ACL reconstruction and simply wanted to manage any inflammation that may have accumulated from the reps in practice. One of his teammates commented, “Hey, I wouldn’t do that if you don’t really need to. They keep track of everything. If you are asking for ice all the time after practice, they can use that against you!” It was a rude awakening to the perception among players, whether valid or not, that team staff aren’t always on their side. The players may have misinterpreted this attention to detail and due diligence exercised by team staff as a way to weed out the weak.

On the other hand, some teams do not want significant information on injuries reaching the public domain, to avoid having that information used against them. You will see some injuries in professional ice hockey listed as “upper body” or “lower body” injuries with no specifics whatsoever provided. In addition, a very informative website documenting NHL injuries called “NHL Injury Viz” clearly states that:

“There will be inconsistency between my numbers and ‘official’ team man-games lost (MGL) figures due to teams’ different reporting standards.”

In the NFL, many players are now listed as “questionable” or “doubtful” after the NFL eliminated the “probable” designation in 2016 heading into games. But the number of players listed as “questionable” who end up playing can vary significantly between teams, with one team having as many as 90% of “questionables” ending up active, while another team may have only 25% actually playing in the upcoming game. As a 2018 San Diego Tribune article by Dr. David Chao on the subject noted:

“The system inherently allows for vagueness. Besides the body part, the injury designation is all the team needs to say. A team does not need to say right or left knee, nor identify the exact structure (i.e., MCL), just generically say ‘knee.’ Add to this nebulous injury report how teams differ in their listings and you have what can be a confusing picture.”

These disparities can be seen in a table published in Dr. Chao’s article showing the percentage of “questionable” and “doubtful” players who actually were designated as “active” for game day.

 

While this vagueness probably creates more stress and anxiety for Fantasy Football participants, it does make you wonder how teams manage injuries and classify athlete readiness leading into game day. It could also create a degree of mistrust on the part of the players, particularly when they move from one team to another and experience a completely different approach to injury classification and management. These issues and statistics may also come up when an athlete and their agent are trying to find a new home and negotiate a fair contract.

It is clear that some teams use the grey area to keep their opponents in the dark, as could be said of Tom Brady’s injury history statistics. While Tom Brady has been identified as “probable” (prior to 2016) or “questionable” with almost 200 ailments listed on the injury report throughout his career, he has only missed a handful of games due to his torn ACL in 2008 (entire season following season opener) and his Deflate-Gate suspension back in 2016 (four games in total). Otherwise, you can bet that he’ll be on the field for kick-off regardless of what the injury report has indicated.

It is important to note that the lack of transparency in professional sports injury reporting may also be perceived by players, and the players’ union, as a loophole for forcing players back onto the field when there may be some question as to their actual readiness following an injury. As we know, most players want to get back onto the field or court as soon as possible to support their teammates and contribute to a win, despite their condition and the possibility of reinjury. However, it is extremely unethical for teams to use this rationale for approval of an early return-to-play decision. Such an approach makes about as much sense as giving in to a 10-year-old’s request for a cellphone with unlimited data and text messaging and full access to social media, from a mental health point of view.

If there are no clear standards of reporting for all teams and we continue down the road of teams making their own rules around documentation and classification of injuries in what is deemed in the “best interest” of their organization, there will continue to be an air of mistrust around the entire process, whether you are a player or a Las Vegas bookie. In an environment where many decisions are based on fear of loss, paranoia and irrational behavior cannot be far behind.

How Do We Improve the Situation?

“The road to hell is paved with good intentions,” so let’s be careful with what we propose moving forward. It is clear to me that communication, both internal and external, must improve and become more transparent as part of any professional team’s strategy in dealing with injuries and return-to-play decisions. Watching some teams handle an injury prognosis or debrief is like watching a politician explain his motives in a press conference after selfies of his groin have been circulated all over the internet. It is very hard to fool the public these days, when it is clear that everyone is trying to minimize liability, deflect blame, and further their interests wherever possible. And having your general manager sobbing during a press conference, saying there is nobody to blame, and then taking the blame is probably not the best way to convey to the general public that you had everything under control.

Communication, both internal and external, must improve and become more transparent as part of any professional team’s strategy in dealing with injuries and return-to-play decisions. Share on X

We want to hear the presentation of facts and a clear process around those facts in a professional manner. Emotion need not be part of this process. If this type of information is not presented to the media and the public, speculation will follow, and most of that speculation will not be positive.

Creating a Forum for Discussion

If there are issues with trust around the internal workings and decision-making by professional team staff, the best way to address these issues is with a direct approach. If a team’s top player is not happy with the way things are going with team staff, burying your head in the sand and hoping the problem disappears is not a wise course of action. Opening up discussions around any identified issues will at least initiate a process whereby the team can determine if a player’s concerns are reasonable and may warrant some discretionary measures. As mentioned previously, keeping the top players happy will go a long way toward minimizing distractions and encouraging team harmony.

However, the process may also determine that a player is being unreasonable and making egregious demands that would be detrimental to the player’s performance and health, and may also damage team cohesiveness. The team can then make a decision when it comes to future contract negotiations, trade options, and the overall strength of the relationship moving forward. But at least the process can be documented, and the team can be viewed as having acted in good faith. In many ways, the team can develop a reputation for providing a fair and objective process for managing decision-making around personnel, as well as disarming conflicts in an organized and rational fashion.

Egos are often a problem in every professional sports realm. Show me a top professional sports athlete, head coach, performance director, head athletic trainer, or head strength coach who doesn’t exhibit a higher level of narcissism than the average person, and I’ll show you some wonderful vacation spots in Chernobyl. This is not to say that there are not good people in these positions, but it does highlight the prevalence of stronger personalities in high positions in pro sports. Couple this with the egos of the top professional athletes who, for the most part, have had their way through most of the youth and adult sporting careers, and you have a recipe for dysfunctional relationships.

When people don’t talk, the silence can be deadly, and paranoia can take hold very quickly. Couple this with access to Twitter and Instagram, and the wrong message could be conveyed almost instantaneously. Thus, letting down your guard once in a while and having a calm, face-to-face talk can go a long way toward dispelling rumors and rebuilding relationships.

Identifying Consistent and Proper Training as a Solution

Honestly, if everyone was doing what they needed to do in the off-season—ensuring that the correct volume and sequence of training was done when no other practice requirements were interfering with building, healing, and recovering—we wouldn’t be in as many of these injury conundrums as we now see on a regular basis. I know, it’s easier said than done. You can blame team staff all you want, but if the athletes are not taking care of business in the off-season and accumulating a reserve of strength, speed, and general fitness, they will start in a hole every pre-season and never be able to climb out of it.

Many players’ approach to off-season training and pre-season physical preparation is akin to the Payday Loan business model, where financially illiterate individuals spend their paychecks well before the money has been earned, and then find themselves in significant debt, paying exorbitant interest rates with little chance of ever finding themselves ahead of the game. Every year, if players do not accumulate a broad enough training foundation in the off-season (i.e., they incur an annual training deficit), they will gradually find themselves in more and more training debt over their careers. Declaring pro sport career bankruptcy may take the form of not being re-signed and being forced into retirement, or it could take the form of catastrophic injury that all but retires the athlete prematurely. Either way, your account is closed for good.

If players don’t accumulate a broad enough training foundation in the off-season, they will gradually find themselves in more and more training “debt” over their careers, says @DerekMHansen. Share on X

Because current collective bargaining agreements (CBAs) in North American pro sports limit team involvement in the off-season, addressing this issue from the team side can be very difficult. Training programs are sent out to players every off-season, but compliance is difficult to monitor and impossible to enforce. Attempting to “persuade” or “coerce” athletes to stay in shape with pre-season testing protocols and fitness evaluations is not an intelligent way to gain compliance, and can create animosity and, even worse, result in injuries at the worst possible time. It is also a great way to pre-exhaust athletes before the ramped-up insanity of training camp. Physical training must be attained through a collective and innovative approach that brings all of the critical stakeholders to the table.

Extending the Olive Branch in Both Directions

Given that there are many actors in the mix for this production, cooler heads must prevail. The recognition that common goals can be achieved through a unified approach must be made sooner than later. In the near future, I cannot envision a scenario where the various leagues and respective owners claw back control of off-season activities from the players’ unions. When ownership is trying get more money from extra games, expanded markets overseas, and the proliferation of live streaming games and other events online, the unions will only look to limit the time, energy, and perceived “risk” contributed by their membership moving forward. Thus, if team staff will not be given the time and control for physical preparation and evaluation in the off-season, the onus will ultimately fall on the private sector.

While we know that there are egregious and ineffective private sector “professionals” in the mix with many well-paid athletes, we have to acknowledge that there are many good people doing more than adequate work in the private realm. As such, teams must work harder to identify these individuals—whether they are doctors, physical therapists, strength coaches, nutritionists, or mental trainers—and build relationships. Likewise, if these private specialists have the attention and trust of the professional athlete, it is their responsibility to connect with team staff and provide updates, programming information, performance data, and any other information that will make the team’s job easier and more seamless from off-season to pre-season to in-season periods. When an athlete sees that both sides are communicating for the betterment of their health and performance throughout the year, trust will be strengthened and paranoia will hopefully be minimized. 

Working Together

As with any issues relating to health and human performance, there is no one satisfying answer to the problem of getting all of the necessary tasks completed internally and externally where professional athletes are concerned. In fact, professional team staff must tread as carefully as possible, more so than any time in history. They are under exceptionally more scrutiny than any private sector specialist because the cameras are off—well, mostly off—during the off-season period and statistics are not kept for weightlifting reps and loads, mileage run, and time shrouded in NormaTec sleeves. But injuries—and more importantly, wins and losses—are tracked closely during the season when health and performance are of utmost importance.

The private sector specialists are no longer off the hook, either. As their prominence increases and their profile is raised through both social and conventional media, they will have to answer to many questions from the team, the media, the fans, and, ultimately, the players themselves. As we all know, misery loves company, so all the better that both sides get cozy with each other as soon as possible as we head into a brave new world of elite do-it-yourself (DIY) performance and health.

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