NFL medicine: Redskins doctors say they work to stay ahead of curve


Robert Griffin III comes off the field after again injuring his knee. (Toni L. Sandys/THE WASHINGTON POST)
March 18, 2013

Bubba Tyer, the Redskins’ longtime athletic trainer, met a man on the golf course not long ago who said he helped carry Joe Theismann off the field that night in 1985 when the Washington quarterback suffered a gruesome broken leg injury during a game against the New York Giants.

“I said, ‘You did? Who are you with?’ ” Tyer recalled recently. “He says, ‘No one. I just jumped out of the stands and helped carry Joe off the field.’ Sure enough, I dug out pictures and there was this one guy helping with the stretcher and we had no idea who he was.”

Medical care in professional football has evolved significantly over the years. When Robert Griffin III injured his knee against the Seattle Seahawks in January, no one was coming from the stands to offer help. Instead the team’s web of doctors, trainers and consultants leapt into action.

Quality of care in the NFL differs from city to city, but players and agents interviewed by The Washington Post seem to agree that, despite what happened with Griffin on Jan. 6, Redskins players receive above average medical services and attention.

“I feel like I got the best care,” said tight end Chris Cooley, a nine-year veteran who was drafted by Washington in 2004. “I feel my best interest was always taken into consideration by everybody.”

When Tyer started with the Redskins more than 40 years ago, the team shared a single trainer with Georgetown’s athletics department. Today that job is essentially divided between 13 positions, including five athletic trainers at Redskins Park. By comparison, those were the days of medieval medicine — second opinions were discouraged, medical records were often sloppy and incomplete, drinking water at practice was a sign of weakness, doctors bid for the right to be a a team's exclusive physician, aftercare and disability benefits that did exist were often an uphill battle to obtain.

Anthony Casolaro, an internist with specialties in pulmonary and critical care, joined the Redskins in 1999 and six years ago became the team's head physician, replacing Donald Knowlan, who had held the post for 25 years. Casolaro meets with the entire team each preseason and spends 45 minutes discussing medical care issues – topics ranging from prescription drugs to medicinal protocols to personal expectations.

“I say, ‘Years from now I want to look you in the eye and say, I did what was right for you,’” said Casolaro, a Washington native and graduate of Gonzaga High.

While medicine has changed across the NFL, Casolaro says the Redskins have strived to be ahead of the curve. They’ve had a neurologist on-hand for several years, usually in the stands, though he was stationed on the sidelines last season. When a player comes off the field with an apparent concussion, trainers immediately swipe his helmet. “Otherwise we know they’ll probably grab their helmet and run back on the field,” Casolaro said.

Starting next season, the entire medical staff will be connected via radio earpieces, provided by the league, so the training staff, team physicians and the athletic trainer stationed in the press box can communicate with each other about injuries.

They have to be diligent because players aren’t inclined to exercise caution in the heat of the game. “You always worry that they’re not telling you everything,” Casolaro said. “They’re telling you what they think you want to hear instead of what the truth is. Usually, you can figure it out.”

Casolaro has worked with six head coaches in Washington, and he’s not alone in saying he’s never felt any external pressure to rush a player back on the field before that player is physically ready.

“Ultimately, if I said a player couldn’t play, he didn’t play,” said Raymond Thal, a team orthopedist from 2000 to ’08. “Sometimes we’d say he can play, but the coach keeps him out because he doesn’t think he’d be as effective. But if I said he couldn’t play, the coach wouldn’t play him.”

There are rare cases still when medical expertise is overlooked or even overruled.

“I’ve been in that case,” said Tyer, who retired in 2009 as the Redskins’ director of sports medicine, “where I tell the coach two hours before a game when they’re making the list of inactives. I say, ‘This guy can’t play, coach.’ Coach is good with it. Then the player comes up to the coach and says, ‘Coach, I can go, I can go.’ You get ruled out of it sometimes.”

Redskins doctors agree that their relationship with players is key. The physicians all maintain regular full-time practices outside of Redskins Park. Most travel with the team and work on game days. In addition, they’ll visit the team’s training facility at least once a week, while the team trainers are on-hand to treat players every day.

“The issue of trust is really critical for us,” Casolaro said. “If the players don’t trust me or us as a medical team, it’s like any patient, it’s not going to work. If they don’t think I have their best interests at heart, it’s a rough road.”

The Redskins’ official health care provider is Commonwealth Orthopedics, an arrangement vetted by the NFL. In addition to James Andrews, the team’s high-profile orthopedic consultant, the Redskins use two area orthopedists — Chris Annunziata and Andrew Parker, both from Commonwealth — plus a team dentist, chiropractor and neurosurgeon. While the relationship could be a money-maker for some, it’s also a big time commitment.

“If you figure out your hourly rate, it’s not financially lucrative,” Thal said. “I make a lot more per hour being in the office of my practice than I do there. Does it help the practice? Yes, to some degree.”

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