Which Injuries Should Be Considered ‘Red Flags’ During The NFL Draft Process? Very Few

The 2020 NFL Draft is mere hours away.

Front offices are in the throws of trade discussions, prospect evaluations, refining their Big Boards, and making last second tweaks to their rosters. The league’s 32 general managers and other front office personnel even conducted a dress rehearsal early Monday afternoon for the upcoming virtual draft and early reports were…well, let’s just say that Thursday evening could be interesting.

One component of prospect evaluation involves reviewing the medical records and past injury history of a given team’s potential selections. This process, usually completed during the NFL Combine and in the ensuing weeks, ultimately provides teams and their medical staffs a clearer picture of what injuries a player has suffered and recovered from. However, this year, with the waters muddied due to the COVID-19 pandemic, the process has become more trying.

Players and their agents have more leverage in regards to the dispersement of past medical history than in previous years, as they are better able to pick and choose who receives what information as well as the mode in which that information is disseminated. With teams unable to complete in-person physical examinations, the current health status of a draft hopeful is often determined via other methods, such as by letters written by the doctor who recently performed surgery on said athlete.

It is not an uncommon practice for front offices to “red flag” a potential draftee due to current or past medical concerns, which are more often than not orthopedic injuries. This occurs when the team’s front office – with input from the medical and athletic training staffs – determines that the athlete’s potential risk for future injury or decrease in production is too great to justify selecting the athlete at a certain draft slot; in some cases, teams remove an athlete from their big board entirely. This seems to be the case with former University of Alabama quarterback Tua Tagovailoa, who is likely to be selected within the first 10 picks Thursday night, though his injury history has left a few teams wary.

But does this hold up? Should athletes be red flagged during the pre-draft process? The answer is difficult to produce without bias, analytical or personal.

Many studies have been conducted and published in reputable academic journals over the years assessing how prospects with various – previous and/or current – orthopedic conditions ultimately fared during their first few seasons in the league. The data is often collected during the combine and/or retrospectively from publicly available web-based sources, with counting statistics such as touchdowns, tackles, and interceptions used to analyze a prospect’s overall production.

Quite often the data suggests that most injuries are associated with a decrease in performance at least one to two seasons afterward. Injuries to power-producing structures – such as the quadriceps/patellar tendon, pectoralis, and Achilles tendon – as well as certain stabilizing structures – such as the anterior cruciate ligament (ACL) of the knee – produce poorer outcomes than others and are often associated with shorter career length.

However, sample sizes are often small and occasionally not very specific (i.e. specific player position isn’t taken into account), which when combined with the retrospective nature of the data increases the likelihood for bias and decreases the quality of the study. “[F]uture studies utilizing more rigorous methodology would allow medical professionals to provide more accurate predictions of a prior injury’s impact on an athlete’s NFL career,” write the authors of the previously linked systematic review – a document that conglomerates all available data – which assessed outcomes amongst NFL prospects who suffered various injuries prior to the Combine and was published in The Orthopaedic Journal of Sports Medicine in 2018.

And then there is the fact that prospects are often drafted – or not – for a variety of reasons and that NFL careers are notoriously short to begin with; this study suggests that the average length is a hair under four seasons. Write the authors, “[M]easurement of draft status, games played and started, snap percentage, and game performance metrics are influenced by a multitude of factors (i.e. player position, team needs, opponent game plan, depth chart), which can ultimately confound the results. Many currently available studies do not account for these factors.”

All of this is to say that it’s likely that many NFL hopefuls are unnecessarily red flagged during the pre-draft process due to prior experience and low quality research. There is a paucity of high quality research displaying the direct effects of previous injury on athletic performance amongst NFL athletes and interpretation of the current evidence holds a significant risk for being influenced by bias. We remember the athlete selected in the first-round with an injury history whose career was derailed by further injuries, but not those who went on to thrive; we remember the “failures” and conveniently forget the “successes.”

Should some injuries be taken seriously and scrutinized to the fullest extent possible? Yes. There is enough evidence to suggest that certain injuries – again the power-producing and stabilizing structures of the knee for example – suffered by athletes who play certain positions – particularly on defense where most action is reactionary, which places a unique stress on the body – can negatively impact future performance. However, conclusions should be drawn on a case by case basis. It is far more likely that too many prospects are being red flagged than too little; this may ultimately result in a negative impact on the athletes’ livelihood, particularly when it comes to finances.

Should athletes be red flagged during the pre-draft process? The answer is likely some, but not as many as ultimately are.