ON THE CLOCK: How the combine medical exams affect the Bills draft plans

Posted Mar 5, 2016

It’s the most overlooked part of the NFL Scouting Combine. No cameras provide coverage and records are not made public. Aside from game tape, the player medical exams over four days of the Combine carry more weight for NFL clubs than almost any other part of the pre-draft process.

It’s 6:30 AM on the first day of the NFL Combine. Players won’t be performing on the field for two more days, but in the bowels of Lucas Oil Stadium the medical exams and physicals are already underway. Groggy players just a day removed from travel to Indianapolis file in, sit and wait their turn, not unlike a doctor’s waiting room. The only difference here is most of them are not at all ready for the thorough and sometimes aggressive examinations they’re about to undergo from six different teams of physicians and athletic trainers in succession.

For players like TCU WR Josh Doctson, who is fully recovered from November wrist surgery, or UCLA LB Myles Jack, who had knee surgery for a torn anterior meniscus in late September, there is particular interest in the surgical repairs. NFL team orthopedists were eager to test how physically sound Doctson’s wrist and Jack’s knee were post-surgery.

“I had a lot of doctors pulling and tugging on me,” said Doctson. “It was a little different. Everybody had a chance to look at my wrist. I spent a lot of time with doctors and getting MRIs.”

“They were pretty blunt, they were pretty up front as far as moving my knee, twisting it,” Jack said. “But everything was fine. My agent told me they were going to be really aggressive with it and just trying to kind of make it hurt to see if it was hurt. But it was fine. I got down there at 8:30, so I was down there all day.”

Players first undergo a regular medical exam with drug-testing and a baseline concussion test. They then take their paperwork and medical history with them in a packet to the orthopedic exams. NFL clubs have their medical and athletic training staffs consolidated into six or seven groups with five or six teams per group.

Every prospect moves through each of these six team groups for the same orthopedic examination. Doctors take their time as just about every joint in their body is twisted, flexed, turned and extended to check for functionality, tightness and structural integrity.

Sometimes players who think they’re perfectly healthy heading into the exams learn there are issues with their body that had previously gone unnoticed.

"I had an issue with my left knee and my right knee and an issue with my AC (shoulder) joint,” said Memphis QB prospect Paxton Lynch. “When I hurt my AC joint back in my redshirt sophomore year of college in Cincinnati, I didn't realize that I had, I think they said it was a small fracture in my clavicle. So that popped up on the X-ray, but it was healed.

“But there was just some like piece of the bone I guess just floating around in there. So it spooked a team or two, I think, and that's why they requested the MRIs and all that.”

Magnetic Resonance Images (MRIs) are the most popular requests, which is why there are mobile MRI lab trucks stationed in the bottom of Lucas Oil Stadium all week. Ordering MRIs wasn’t possible at the NFL Combine until 1988 and their use has skyrocketed since then.

“More than 535 MRIs were performed over four days this year,” said Bud Carpenter Bills head certified athletic trainer. “We shattered the record for MRIs for a single player. It used to be six. This year one player had eight.”

It might sound like overkill, but for a projected first-round pick like Jack, the opinion on his knee is crucial. Is it healing properly? Does he look good to return to the dominant playmaking linebacker he was in college at the NFL level?

What about Lynch’s shoulder joint? Might that present a problem for the quarterback prospect’s arm strength down the road?

Player health is a commodity
Every general manager in the NFL will tell you the medical exam is the most critical piece of information gathered on a prospect at the NFL Combine. When you’re investing millions of dollars in players you want to know whether they’re fit to play at the pro level, how long they could play and anything that might stand in the way of a long and successful career.

That’s why every NFL club invests a sizable amount of expertise and resources to gather as much medical information on each of the 300-plus players invited to the NFL Combine.

“For us we come with five doctors and five athletic trainers so obviously we’re doing stuff in depth both orthopedically and medically,” said Carpenter.

Carpenter, who has been around long enough to witness the NFL Combine in its infancy in the mid-1980’s to what it has become now, maintains that the medical still trumps everything else.

“It used to be called the Combine Physicals,” recalled Carpenter. “They did a couple of other odds and ends, but it was basically to get everybody together and instead of each team trying to bring in 25 to 200 players, they brought them all to one location.”

Courage of conviction

Not all team opinions on players are going to be the same. Perhaps Buffalo’s most famous example is its decision to draft Hall of Famer Thurman Thomas in 1988 in the second round.

“Thurman Thomas sat there on the draft board in 1988,” said Carpenter. “We happened to have a strong conviction that his knee was going to hold up. Medicine isn’t an exact science so you’re going to have different opinions and what is your tolerance? Look at Willis McGahee.”

McGahee, who sustained a torn ACL and MCL after a horrific knee injury in the National Championship game in 2003, still wound up being a first-round pick of the Bills when they made him the 23rd overall selection.

Notre Dame’s Jaylon Smith, much like McGahee was 13 years ago, is considered a top five talent. Unfortunately Smith also suffered a severe knee injury in the Fiesta Bowl. He tore his ACL and LCL and though he is walking now he might have additional damage in his knee as well.

“I feel great. There’s no soreness in the knee and there’s no pain,” said Smith at the Combine. “I’ve been off pain pills for almost a month. It’s the matter of the recovery process. I don’t know when the nerve and everything will heal, but it’s just a matter of me taking it day-by-day and controlling what I can control.”

Medical opinions will undoubtedly vary from when he’ll be able to return to the field to if he’ll be able to have a professional career.

“Here we take an educated opinion and it’s a highly educated opinion,” said Carpenter. “It’s not a dart on the board. Sometimes you roll the dice. Sometimes you don’t.”

Critical to Smith’s final draft grade for teams will be the medical re-check in mid-April. That’s when players who are recovering from surgeries too close in proximity to the NFL Combine for a full exam return to Indianapolis in the spring for a follow up. NFL clubs again send their physicians and athletic trainers for a final once over.

Draft value impact
A team’s medical grade is one thing. How that grade impacts a prospect’s draft grade is another. The only exception is when a medical grade effectively takes a prospect off a team’s draft board. Bills GM Doug Whaley says there are close to a dozen such examples every year.

“Absolutely, if they do their evaluations and they don’t recommend the guy, he’s off the board,” said Whaley of the Bills medical staff. “There are varying degrees of bad physicals.”

There are also incidences of players with medical concerns who still make a team’s draft board. Notre Dame’s Smith is probably an example this year. If a team believes they’ll have to wait until 2017 before he’s back on the field that’s naturally going to affect his draft value in 2016.

“After the medical re-checks, a week or two before the draft you make your decision on his value and then if you take him you get him to your facility as soon as possible,” said Whaley. “Then your medical staff starts supervising his rehabilitation.”

Just making sure
Even on draft day there are several instances where the medical staff is consulted one last time. In the draft room the team’s medical director and head athletic trainer are usually stationed somewhere near the front of the room with all the medical files of the draft eligible players both on paper and on computer.

Often times when a team is close to making a pick and there are a few players that are targeted, if one or two have a medical concern the general manager will check in with the team doctors one last time to sign off on the player.

“We might be close to being on the clock and they’ll be looking at three guys and they’ll ask do we have any concerns about those guys,” Carpenter said. “If all things are equal they might ask which one is healthier.

“We’ve gone over it and over it. They know what our medical evaluations are and what our dictations are, but it’s no different than when they look to the area scout for a player right before they pick and ask if they’re comfortable with the player for a final sign off.”

“It’s just a final question as to whether the guy is healthy, or it could be something the guy has, but it doesn’t preclude us from picking him,” said Whaley. “Sometimes it’s just a refresher for what was ailing the player. Sometimes it’s to reinforce that maybe the longevity of a player’s career might not be 12 years, but eight years based on a previous condition. Those types of things.”

For the good of the player
While some agents dislike when team physicians find a medical issue with their client during the exams that could harm the prospect’s value in the draft, there is an inherent benefit when a team’s medical staff finds something.

“We come across about half a dozen players a year where we’ll find something on an EKG or an echocardiogram and we’ll tell a player that he needs to get a full workup,” said Carpenter. “They’ll probably be okay, but they need to get it checked thoroughly.”

So as much as the 40-yard dash is the most hyped event on NFL Network and as much as what players said during their press conferences is billed as a headline event, league talent evaluators consider the medical exams the most important event.

“The key is the medical,” said Carpenter. “Are they going to hold up playing? Is there something that would preclude you from taking them? That’s why they’re here to do a complete physical. For the 333 guys this year, we now have a good benchmark on how healthy they are and do they fit in medically with what you want to do with your team.”