INDIANAPOLIS — Prospective NFL draftees don't flinch at benching 225 pounds until exhaustion or trying to beat their personal best at the 40-yard dash. They do dread one sentence: "The doctor will see you now."
The NFL combine began Wednesday with orthopedic and medical exams for 320 draft prospects, all of whom gave blood and were subjected to X-rays and impact testing — to establish a baseline for subsequent concussion tests — the night before. Players were asked to bring medical records and information on any conditions or family history — i.e., a heart condition — that might affect their ability to play.
During the exams, some will be reminded of injuries long ago forgotten, others about fractures they didn't know they had. One or two will learn their path to a pro career ends in an examination room, because of ailments ranging from undetected heart conditions to joint injuries beyond repair.
Small wonder young men who don't fear collisions with hard-hitting linebackers or fullbacks get nervous thinking about several hours being gently poked, probed and questioned by a battery of experts, all trying to predict how well the players will last in this brutal sport.
A rundown on the day's medical sessions:
The doctor is in
A group of 15-20 players enters the first of six orthopedic exam rooms in the basement of Lucas Oil Stadium at 8:30 a.m. Inside each are orthopedic doctors and head athletic trainers representing five or six teams. Nearby is a portable MRI machine provided by Methodist Hospital.
Each player's medical history, with detailed reports on previous surgeries, is presented to the panel during open discussion. All information is shared and there are follow-up questions if necessary — directed by specialists on shoulder, knee and foot injuries, etc. — and more X-rays if requested.
"The only thing proprietary about the process is the grade each team gives every player," said Dr. Matt Matava, who runs the medical operation for the St. Louis Rams and is president of NFL Physicians' Society.
Each team uses its own grading scale, generally from A-F or 1-5. Doctors consider previous injury history and current medical condition, and attempt to make a judgment of each player's longevity. An overwhelming majority fall into the "C'' range, since most have been injured and operated on at least once.
"We might see up to two dozen 'A's' every year, but that's mostly kickers" laughed Matava, who's working his 15th combine. "Otherwise, they've got to have remarkable genes and be really, really lucky."
Sessions average 20-30 minutes; each group of players moves on to a second room for a second orthopedic exam, then repeats it four more times for the other groups of teams.
Like all the other offensive linemen, Duke tackle Takoby Cofield submitted to an additional X-ray — of his spine, a frequent source of injury problems at the position. Leave it to the Duke kid to turn the exam into a study session.
"They told me I was one of the healthiest guys they'd seen," he said. "But when I saw the X-ray of my back, man, I couldn't believe how big the vertebrae were."
Think of your latest physical exam, only more thorough, then multiply by three. Each of the three rooms for primary care sessions will be staffed by close to a dozen NFL team physicians.
"No stone unturned, that's how I'd describe it," said UNLV lineman Greg Boyko. "But I get it. They're making a big investment."
Dr. Robert Heyer, a pulmonary specialist who works for the Carolina Panthers and will succeed Matava as head of the NFL physicians group, said the only people tested as extensively as the players "might be astronauts."
"This is my 21st combine and the toughest part is always the same," Heyer said. "There's usually one or two guys who, for various reasons, can't safely play in the NFL, and we have to break the bad news."
One year, doctors found a cancerous tumor, close to eight pounds, wrapped around a player's aorta.
"He was big enough that it wasn't discovered at the start and it grew as he grew. He went straight from here to the hospital and an oncologist. He's not playing," Heyer added, "but I'm happy to report he's otherwise healthy."
With the league's increased scrutiny on concussions, establishing each player's real history has become a priority. Heyer said there are three to four players a year who claim not to have had a concussion but have had at least one. Similarly, some players are surprised to discover they have what doctors call "athlete's heart" — a slightly enlarged ticker because of the increased blood flow necessary to power a large ballplayer during peak exertion. The kidney is another organ that routinely draws attention, because of the constant pounding players endure.
"We also look closely for hypertension, diabetes and a few other things," Heyer said. "But to be fair, these are young men, for the most part, in prime health."
Heyer said each team's doctor meets with the coach and general manager and receives a list of potential draftees who get special attention. Otherwise, the biggest challenge is trying to project how long each player can endure the rigors of the NFL. Heyer proudly acknowledges his biggest miss — center Ryan Kalil, the club's second-round pick in 2007.
"I kept looking at him and I just couldn't figure out how he was going to last," Heyer laughed. "Eight years later, he's been to the Pro Bowl four times and he's still going strong."