Prevalence of Musculoskeletal Disorders at the NFL Combine - Trends from 1987 to 2000

Robert H. Brophy; Ronnie Barnes; Scott A. Rodeo; Russell F. Warren


Med Sci Sports Exerc. 2007;39(1):22-27. 

In This Article

Abstract and Introduction


Purpose: The National Football League holds an annual combine where individual teams evaluate college football players likely to be drafted. As part of the combine, the players are evaluated with a medical history, physical exam, and review of imaging studies, and then they are rated medically as to their ability to participate in the NFL. The purpose of this study was to review the prevalence of musculoskeletal disorders in this population and to test the hypothesis that fewer players were medically disqualified over calendar time from 1987 to 2000.
Methods: The available summary data for all players reviewed at the annual combine by the medical staff of one NFL team from 1987 to 2000 was analyzed, including each player's position, collegiate division, medical rating, and their diagnoses and surgical procedures.
Results: A total of 5047 complete records were available for analysis. The average number of diagnoses per player was 2.45, and the average number of procedures was 0.53. The most common diagnoses were ankle sprain, burner, hand/wrist soft-tissue injury, knee MCL injury, and AC-joint injury. The most common procedures were meniscectomy, knee arthroscopy, ACL reconstruction, shoulder stabilization, and ORIF ankle fracture. Overall, 5.63% of the players were rejected for medical reasons. The risk of failure dropped during the study period (P < 0.0002). Over time, fewer players with a history of ACL reconstruction received a failing grade (P = 0.0005).
Conclusion: The percentage of athletes with a failing grade, particularly those with a history of ACL reconstruction, decreased over the study period. Knowing the trends in prevalence of injury and treatment for these athletes may help optimize their care and aid the development of injury-prevention and treatment strategies.


The National Football League (NFL) holds an annual combine to review college football players who have been scouted and are thought likely to be drafted by the NFL. At the combine, the individual teams evaluate the players for physical skills, and the players undergo a review of their medical history and imaging studies and a physical examination. This information is then used to rate players from a medical perspective with regard to their perceived ability to participate in the NFL. The specifics of the rating system vary from team to team, but the general scheme groups the players as follows: no injury; minor injury, treated successfully; successful surgical interventions or multiple problems; high-risk player (injury likely to recur and preclude participation); or reject. Players are rejected if they have a previous injury or condition that negatively impacts or precludes their ability to participate in the NFL.

Although a number of studies have reported on injury prevalence among college football players, including a recent review of injury patterns in Big 10 football,[1] the authors are not aware of any previous study reviewing the injury data from the NFL combine. The purpose of this study is to review the prevalence and trends of musculoskeletal disorders in this population and to test the hypothesis that in recent years, fewer players have been rejected than in the past. Our hypothesis was that fewer players received a medical rejection over calendar time from 1987 to 2000. Empirically, the senior investigator, an NFL team physician during the entire study period, has noticed less medical disqualification in recent years, particularly in subjects with a history of anterior cruciate ligament (ACL) reconstruction, and speculated that such a decline may be attributable to increased awareness and advances in surgical techniques of sports medicine at the college and high school level. Demonstrating that players leaving college may have had improved treatment of certain injuries is a significant comment on the overall quality of sports medicine over the study period. The prevalence and trends of various injuries provides information on the evolution of diagnosis and management of sports injuries over the study period. The specific data have obvious value to stakeholders in professional football, including team owners, administrators, coaches, physicians, and trainers, and these data also provide important information to physicians and sports medicine professionals who take care of college and even high school football players. Understanding the impact of previous musculoskeletal injury and treatment on medical rating at the NFL combine may help guide treatment and expectations for college and even high school football players after injury. Knowing the prevalence and trends of various injuries may be useful when devising injury-prevention strategies for this population.


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