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Why medical exams are the most important part of the NFL’s Scouting Combine

What happens away from the cameras and behind the scenes holds more weight when it comes to the final evaluation of a player.

NFL Combine - Day 2 Photo by Joe Robbins/Getty Images

The annual NFL Scouting Combine has achieved a status that I am not sure anyone originally envisioned.

It has gone from something attended by a handful of people outside of the NFL to now a full-fledged event. As someone that had to be a part of the inner workings of the combine, this always amazed me—that people could find such interest what we once called the “underwear olympics.”

The visuals of the annual event occur later this week with workouts, measurements, drills and interviews on NFL Network. That part is interesting for some, but what do people learn about players that they didn’t already know?

I always found it interesting that people would like a player more or less based upon something that doesn’t occur in an actual football game.

I believe the greatest value to be taken away from the event is from a portion no one gets to see on television...the medical exams.

Medical exams

Kansas City Chiefs v San Diego Chargers Photo by Sean M. Haffey/Getty Images

Each NFL team sends a contingent of athletic trainers, physical therapists, and orthopedic and medical doctors to the combine annually. These individuals are arriving sometime Monday or are already there. The action begins well before anything you see on television.

There are educational meetings, professional society business meetings, vendor and trade shows, social gatherings and much more in the days and nights leading up to the actual workouts and exams.

After all those events have mostly concluded, the real work begins. For the medical team, that is sorting out the 300-plus players invited annually and identifying both known and unknown issues.

I was once told the following:

“It’s not our job to tell a team who to pick; it’s our job to tell them who not to pick.”

This resonated with me, as it holds true in the fact that you must think of players in terms of career duration from a medical perspective. Availability and longevity are two highly-prized traits in the NFL.

We weren’t allowed to discriminate if the player could play or not. We didn’t have that luxury and it wasn’t in our job description. We had to stand up and tell people if someone’s knee, back or shoulder was going to make it to a second or third contract, or in some cases, through the first.

Therein lies the heart of the matter: will an athlete be of value to the team and more importantly, how long?

Make no mistake about it—there have been famous cases of players bucking trends and having long careers with injuries that no one thought they could play through. Outliers happen in every industry. The medical staff’s goal is to catch the majority and the severe. I would venture to guess that overall, NFL medical staffs are accurate with their information a higher percentage of the time just because there is so much riding on every selection.

The process

NFL: Combine Trevor Ruszkowski-USA TODAY Sports

Here is a quick synopsis of the whirlwind process of medical analyzation at the combine.

Players arrive and are assigned times to complete all medical exams and workouts. They typically get in late and rise early for a full day of testing. They are divided into position groups for each day of testing and exams go by position.

Previous injury history is taken subjectively by the athletic training staff on hand and logged meticulously. While I would love to say that players are honest about all of this, it doesn’t happen. It can go as far as cases of players stating that they never had a knee injury when we could all see the surgical scars.

All known injuries and conditions are given diagnostic imaging (MRI, X-rays, CT, etc.) before players are actually seen by physicians, so the results are hopefully known. Medical staff members will order additional imaging to check on issues that come up during clinical exams. I have seen players with as many as seven MRIs. Some of these guys can be pretty beat up, and specific college programs are known for this.

NFL teams are divided up fairly evenly into a number of exam rooms. Every room runs a bit differently, but the goal is the same—to gather all the information as quickly as possible. This is an all-day event for four consecutive days.

Both orthopedic and medical physicians clinically examine the players. Athletic trainers record data and inquire about pertinent follow-up issues and questions. Each player will disclose known conditions and often new information about injuries or conditions is found (both orthopedically and medically). There are famous cases of both urgent and severe medical conditions being found during this process, so its importance cannot be downplayed.

Each player is given a preliminary medical and orthopedic grade. Every team uses a grading system that suits its needs and is specific to that team. These grades change multiple times once the result of an MRI or X-ray is known or further information is unearthed. Teams and medical staffs all have unique grading criteria, so a given condition held by a player is not always graded the same by every team.

A team’s personnel or coaching staff will often want these preliminary grades before watching the players work out. This is so they can have a frame of reference and begin the process of slotting the players where they may want to select them (if at all).

Some players come to the combine knowing that they cannot work out or test due to recent injury or surgery. These players are left as incomplete or preliminary grades knowing that they will come back for something known as “rechecks,” which are typically held in April.

If they are not going to return for final grading, it typically means their condition this week wasn’t severe enough to warrant a trip back and it’s resolved on its own. Many of these are re-graded after their performance at a pro-day.

A key point to keep in mind is that a given condition will be graded differently based upon a player’s position. Wrist and hand injuries are different for someone that handles the ball more than a linebacker or defensive lineman, for instance. The grading process cannot leave this out, as it is bad practice to grade a condition across the board without considering the positional demands.

All this information is compiled both electronically and in paper form. It is summarized for brevity and clarity and teams can dive into the details as needed. There is a mountain of information and lists and lists of names. File folders upon file folders are used annually and stored for references over the years.

None of this considers all the players that are eligible to be selected but are not invited to the combine. That is a whole different discussion altogether.

The big picture

The combine is just the beginning of an arduous, multi-month process culminating with the NFL Draft. Getting the information as correct and concise as possible in these four days is paramount to assisting the team in its decision as to who they will or will not draft or take as an undrafted free agent.

Again, the process dictates that you must be correct in your assessments.

“It’s not our job to tell a team who to pick; it’s our job to tell them who not to pick.”


Aaron Borgmann is the founder of Borgmann Rehab Solutions. He spent 12 years in the NFL as an assistant athletic trainer and physical therapist before joining Arrowhead Pride.