Dr. Nirav Pandya Diagnoses the Root of the 49ers' Injury Problem
The 49ers can't seem to solve their injury issue.
Part of the issue is the violent nature of football, but the other part is the non-contact injuries during the offseason that require surgery. Most recently Tarvarius Moore and Jeff Wilson Jr. In the past, Jalen Hurd and Jerick McKinnon.
To shed some light on this problem, I interviewed the Director of Sports Medicine at Benioff Children's Hospitals and Associate Professor of Orthopedic Surgery at UCSF Dr. Nirav Pandya, MD.
Here is the interview:
Q: In general, are these non-contact football injuries, or is there something that happened in the athlete's past that led to that injury?
Dr. Pandya: "I think it's a combination of both. The No. 1 thing is what is there priory injury history? Did they have an ACL injury when they were younger? Did they have some sort of a meniscus injury? Once you've eliminated that, then you really have to look critically at what's going on in the offseason. Are they training? Are they not training? What kind of exercises are they doing? Particularly for those non-contact injuries, because football by nature is violent -- if there are contact injuries, there's not much you can do about it. But those non-contact injuries, I think it's critical to look at how they're training and what they're doing that's leading them to getting those injuries, particularly when you hear about someone standing up and getting a meniscus tear, or just having a muscle injury. So it's definitely a combination of things, but you certainly have to look at how they're training in the offseason."
Q: Are the non-contact injuries more a result of undertraining or overtraining in the offseason between January and May when players work out by away from the team facility?
Dr. Pandya: "I think it's a pretty even split. With Covid this year, it's hard to say how much access individuals had to regimented offseason training. So part of it may be that. Then you have the other group where players are catching up. I think it's the lack of consistency in training as opposed to one or the other. The body needs a balance. So you're either going to do a little bit and keep doing a little bit, or do a lot and keep doing. It's when you change the intensity where those non-contact injuries will occur."
Q: I want to ask you in particular about Jeff Wilson Jr. He was in the locker room, he stood up, turned and tore his meniscus. The 49ers are calling it a freak injury, saying there's nothing they can learn from it. They also said Wilson Jr. was doing a leg workout in their weight room under their supervision just before the injury occurred. Do you think the leg workout contributed and that's the most important data point, that workout, or should the 49ers simply focus on what happened in the locker room the moment it tore?
Dr. Pandya: "With a professional athlete, you would assume their meniscus is good quality consider all the beating it has taken through the seasons. Could that one maneuver potentially injure a meniscus? Absolutely, but there's probably some degree of irritation or injury that has already taken place in that leg that contributed to it. So it could potentially be that leg workout which was the final thing that pushed the knee over the edge when the muscles weren't ready to support the load. Or what it could potentially be is everything that led up to that, and that his meniscus was ready to tear. When you see 50-, 60-, 70-year olds, they can get up and tear their meniscus. But i's not typical for someone (Wilson Jr.'s) age to do that. So I think you definitely have to look at what was the athlete doing right before that injury occurred and what were they doing a week or two before that to put a strain on the knee."
Q: That seems to be the key point -- the 49ers keep talking about the moment of the injury, but they'll find more information and insight if they investigate the previous two hours and even the previous two weeks.
Dr. Pandya: "Exactly. That's where the important thing is. Before with Trent Baalke, they were drafting players who were injured. Now, it's a different regime. It's time for them to look at their offseason training program, look at what they're doing and see if they can find a pattern, and then act on it. You can always place blame if people don't act on it. I think now they have a good amount of information to where they can actually look at it critically and prevent these injuries. Because if all these people can be healthy, the 49ers have a great roster. But if you can't keep these people healthy, then by the middle of the season they're going to be wondering why all their players are injured when they could have acted on it sooner."
Q: The NFL has done so much the past decade to limit contact in practice -- this has been collectively bargained. But coaches still want to work their players, and it seems they've compensated by doing lots of running and competing without contact. And so you see a big uptick in these non-contact injuries. Have you noticed this trend?
Dr. Pandya: "Yes. When you look back to the '80s and '90s when people were doing a lot of contact, you'd see the ACL tear or the fracture, but now you're seeing a lot more of the soft-tissue injuries, and I think the reason is twofold: No. 1, the lack of contact, where you're doing something else that place the hamstrings and Achilles at more risk. The other thing you're also seeing is teams doing intense 90-minute practices, where you're not out there for three to four hours, so they try to get all this work done in 90 minutes, and there's very little time for recovery, and you're doing explosive activities. So you're not pounding your body by hitting one another, but you're out there going 95 percent all the time, which probably places you at risk for these injuries. It would be interesting to look at when these injuries are occurring in practice. Are they occurring at the beginning when they're not warmed up, or at the end when they're fatigued. So I agree, it's the way they're practicing, and across the NFL it's happening. Maybe there's something the 49ers are doing within that period of time that they need to change."
Q: If the 49ers came to you and asked your advice to reduce their injuries, what would you tell them?
Dr. Pandya: "No. 1 is taking a critical look at the injury history of these players. Did they have lots of soft-tissue injuries when they were younger? Looking at how they're running and jumping. Then you get a sense of the things you can modify, like how they strength train, what their flexibility is. No. 2 is critically looking at their training, and maybe decrease the amount of explosive activity, especially with a longer season. You've got an additional game -- let's preserve their bodies, because these players are athletic and talented. Do we really need to be pounding their bodies in this way in practice? So I'd try to cut back a little, and work more on prevention in practice. Instead of doing football-specific drills, let's spend 15 to 20 minutes working on those things that can keep us healthy for the season. Because what got the 49ers last year wasn't the fact that they're not skilled, it was the fact that no one was available. So let's shift that around and prevent these injuries so everyone can be healthy. I would definitely do lots of injury prevention, and make sure they don't draft these players who have little injuries that have plagued them in high school and college. And then really just preserve them, because if you can get players healthy for 17 weeks, that's the important thing. Because at this level, they have the skills, and they can get the reps without stressing their bodies.
