The Minneapolis Star Tribune reports that the MRI exam on the injured right knee of Adrian Peterson, the sensational rookie running back for the Minnesota Vikings, showed enough healing that he'll practice this week and if all goes well he'll play in Sunday's key home game against the Detroit Lions.
The Vikings are 5-6 and in the thick of the NFC wild-card race, tied with six other teams one game behind the reeling Lions for the last playoff spot. And Minnesota has arguably the easiest schedule of any team in the scrum.
It's uncontroversial that a team in that situation would want its best offensive player back on the field, but two weeks ago the decision wasn't so obvious. The Vikings looked finished. They were 3-6 and coming off the 34-0 drubbing by the Green Bay Packers in which Peterson was injured.
After the team announced that Peterson would miss at least one game, but not the rest of the season, a prominent orthopedic specialist from Florida, Johnny Benjamin, made the media rounds saying the Vikings should shut Peterson down for the rest of the year.
He argued that while he hadn't examined Peterson, a lateral collateral ligament tear, which Peterson has, is a six-week injury. Rushing him back, Benjamin said, would be a matter of the Vikings trying to keep fans interested in an otherwise poor season for the team and coach Brad Childress trying to get a few wins to save his job. The risk for the team would be minimal, Benjamin said, because NFL contracts are not guaranteed.
Several other physicians interviewed for this column, as well as famed orthopedist James Andrews, said it's possible Peterson could safely return within two or three weeks. The Vikings issued a statement by Andrews on Nov. 14 saying Peterson should be evaluated on a week-to-week basis. Peterson himself was lobbying to get back onto the field on the day he was injured.
While Benjamin was roasted by some Vikes fans and compared by the Star Tribune to Drs. Al Bendova and Vinny Boombatz, comedic quacks in the comedy routines of Johnny Carson and Rodney Dangerfield, he also had some supporters.
The AOL Fanhouse blog ran an item headlined "Please, Please Let Adrian Peterson Sit," and one commenter wrote, "I could see if Minny was 10-1 but still there is no way I would let the franchise play until he is 100 percent."
ESPN's resident certified strength and conditioning specialist, Stephania Bell, laid out the risks of Peterson coming back too quickly and concluded, "Let's root for Peterson to come back healthy, even if it means we all have to wait just a little longer."
So what role should the fortunes of the team play in the decision of when to return an athlete to the field?
"With seven weeks to go and the Vikings going nowhere, it doesn't make sense not to shut him down for the season," Benjamin had told the Scout.com Web site Viking Update when the Vikings were 3-6.
Two Vikings wins later, I asked Benjamin, the chief of orthopedics at Indian River Medical Center in Vero Beach, Fla., if the fact that the Vikings are no longer "going nowhere" changed his view of whether Peterson should return.
"Medically, it doesn't matter what their record is," he said. "The problem is reality, and the business side of sports medicine, comes up. And that has very little to do with the medical indications."
Dr. Ned Amendola, the director of the University of Iowa Sports Medicine Center, agreed that the team's record shouldn't be part of the decision about when an injured athlete should return.
"The decision to let an athlete return to play should be based on what's best for the athlete, and therefore it doesn't matter if they're not going anywhere for the season or if it's the Super Bowl," he said. "The importance of the game would be trumped by any significant risk to the athlete that would jeopardize his function following that game."
But in the real world, it's obvious that team considerations weigh heavily. One need look no further than Curt Schilling's legendary bloody sock in the 2004 baseball postseason. The sheath that holds Schilling's peroneal tendon in place was torn, so Boston Red Sox team doctors sewed his skin to his bone so it could hold the tendon in place and he could pitch in the playoffs and again in the World Series.
It's safe to say that that operation wouldn't have been performed had the game in question been a September Tuesday in Kansas City with the Red Sox 12 games out.
"I think the weight of the game, the time of the year that the injury happens, are all factors you take into account," Amendola said, adding that it's important to note that Schilling wasn't risking further injury by pitching. "But if Curt Schilling had a different injury, had an unstable ankle fracture, for instance, nobody in their right mind, no matter which game it was, would have numbed up the ankle and let him play with that, because the risk and subsequent risk of problems with the ankle would be much more severe and detrimental."
Dr. William Dexter, the director of sports medicine at the Maine Medical Center, a fellow of the American College of Sports Medicine and an unabashed Curt Schilling fan, says the role of the physician is to make recommendations to the athlete, who, "just as any patient who comes into our office to seek consultation and care, can certainly choose to do what they think best for themselves."
"There are various things that weigh into that," he said, "so sometimes that gets a little gray in terms of pressures that are brought to bear on athletes who are paid to play. The concern has always been that if a physician is being paid by the organization, then do they have so-called divided loyalties?"
"That's part of the dilemma of sports medicine," Benjamin said. "Who are you working for as a physician? Are you working for the best interest of the athlete, or are you working for whatever the team thinks their best interest is at that particular moment? Really, that's the interesting part, because in a league such as the NFL, with very few guarantees to contracts, that becomes a very, very big question."
For that reason, while the other physicians interviewed all said an athlete's wishes should weigh heavily in the decision about when he can return to the field, Benjamin said those wishes should be weighed "very little. And the reason I say that is you don't hear professional baseball or basketball players doing that. Why? They have guaranteed contracts.
"They say, 'Hey, man, do whatever's right by me, because I don't want my career foreshortened.' NFL players say, 'You know what? The third guy on the depth chart ain't all bad. I've seen him in practice. And I'm in the option year of my contract.' Or 'This isn't guaranteed money.' Or 'I've got a knock on me like A.P. [Peterson] coming out of college that he's injury prone.' I want to show you that I've got heart, I'm a warrior. You know, I'll spit on it and walk it off and put dirt on it and rub it and I'll get out there and play. Pay me my money."
Benjamin, who has been criticized by some outlets, including the excellent Pro Football Talk, for sending out a press release highlighting his opinion about Peterson, said he's not selling anything, but wants to be a voice for the players, who he says can't afford to speak for themselves.
"The last thing in the world one of those guys wants to be seen as is a complainer or a guy who won't play injured," he said. "And they don't have guaranteed contracts. So who's going to speak for them?"
Dexter, the Maine physician, said that doctors and athletes have the same goal, "to get the athlete back as quickly but as safely as possible." That involves a complex risk-benefit analysis that takes into account a number of factors including the athlete's basic health, the demands of the sport, the timing of the injury and the likelihood that playing will create unacceptable injury risk for either the returning athlete or others on the field.
"It's a complicated decision," he said.
And while ethical guidelines such as "The Team Physician and Return-to-Play Issues Consensus Statement," developed by six U.S. professional associations involved in sports medicine, and the International Federation of Sports Medicine Code of Ethics never mention it, the fortunes of the team are a part of the decision.
I asked Benjamin what he'd say to Peterson if the Vikings' next game wasn't a Week 13 tussle with the Lions, but the Super Bowl.
"My advice to him wouldn't change at all," he said. He'd ask Peterson to think hard about a number of issues, including the risk of doing permanent damage to his knee and the fact that his team had come this far with him on the sideline.
Peterson, who by all accounts has been itching to get back on the field since the moment he was injured, would almost certainly decide to play.
"'You're a grown man,'" Benjamin said he'd say at that point. "'Here's your brace, not that it's going to protect you from injury.' It's never been shown to protect people from injury, regardless of what the bloggers say. 'Here's your brace. Go get 'em.'"
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