Podiatrist Matthew Hotchkis travelled to Washington DC, USA to assess and treat a player in the National Football League. Matthew shares his account with fellow podiatrists; to unlock his lessons learned and explain why the saying ‘better never stops’ holds relevance for us all.
Recently I was asked to travel to Washington DC to assess and treat a National Football League (NFL) player during his post op rehab. Given the unique nature of this injury, my role was focused around in-shoe plantar pressure testing to evaluate any asymmetries, assess the player’s orthoses/clete function, and identify any risk of re-injury.
Approaching the facility from the backseat of an Uber, the enormous bubble enclosing the temperature-moderated training field was impossible to miss. Passing through security, into reception and guided down to the medical department, the atmosphere immediately had an aura of significance to it.
The gym (which they call the weights room), the athlete treatment area and the practitioner offices were excellent but nothing out of the ordinary compared to Australian elite football, but the striking feature is the franchise history printed all over the walls, which gives a sense of pride in the organisation. The weight room crew (S&C equivalent), athletic trainers (physio equivalent), physical therapists (exercise physiologist equivalent), and student interns finishing their degree were all very welcoming and interested in how podiatrists do things in Australia.
Due to Australia’s high allied health standards, it is common knowledge that Aussie health practitioners are valued over here in the US, with at least one or two Aussies in most professional sporting organisations. This is, however, more in the physiotherapy/S&C fields.
Given podiatry is a medical degree in the US, the pathway to become clinically involved can be tricky (not to mention insurance-wise). The opportunity lies in offering niche skills that provide huge value to the players, and given the NFL is a results-based industry, anything that improves performance is revered.
There is so much focus put into preseason camp. With only an 18-game regular season, there can be huge ramifications to having a six-week injury mid-season, particularly to one of the key players like the quarterback (QB). There are medical staff members whose job is solely dedicated to conditioning the quarterback to withstand the physicality and avoid injury.
A team’s season can quite literally go down the drain with a major injury to the starting QB. There are times when rehab needs to be accelerated and times when players must play in pain. Although they are portrayed as Herculean warriors, they are still human; they bend and break like the rest of us.
Today started with introductions to all the medical staff, then a facility tour, followed by lunch in the team dining area. It is worth noting that this dining area, which provides all meals, can seat over 120 members. They have everything an athlete could possibly need, including cooked meals which rotate each day, a salad bar, fridges of yoghurts/juices and drinks, a dedicated protein area and of course, a coffee bar (although it is filter coffee). One massive tick is that everyone in the organisation eats like a king.
The monster profile of the NFL is apparent from any podiatry waiting room or home TV in Australia, given its global presence. The 36-team juggernaut is arguably the biggest brand on the planet and it’s easy to see why. An example of the enormity of the brand is evident in their prep for the upcoming preseason camp which will include 90 athletes; they have 50 anti-gravity chairs and 40 pairs of recovery compression boots in addition to the 20 massage tables, sauna and a cryotherapy area. Safe to say, there are a lot of moving pieces to manage.
I then sit in a 1pm medical staff meeting which outlines the players’ recovery logistics and the internal phone app they have to track this, in addition to highlighting the progress of players in rehab and the upcoming camp schedule. It’s obvious the Commanders are big on both preparation and daily collaboration amongst the entire medical team.
After a 5.30am gym session with the medical staff, followed by breakfast, it’s time to get prepped for what I came here for.
I meet the athlete, do some assessments on his feet and orthoses and then we head to the domed arena to do some drilling and measure his pressures. This involves a variety of NFL-specific drills, and this player is impressive – he has genuine power and athleticism. He would compare to an NRL/Super Rugby front rower, but with very different attributes, given he weighs in at 304 pounds (138kg) and moves at 21mph (33kmh).
The difference is that his play times would be a maximum of six seconds instead of repeat hit ups and tackles, so speed and power are much more valuable attributes than endurance. In saying this, I do notice that there are some NFL body type similarities to that of NRL/Super Rugby. The quarterbacks have a similar body shape to that of Nathan Cleary (Penrith Panthers), the ball carry and body contact of the tight ends is similar to Rob Valentini (Wallabies), the wide receiver is zippy and agile like a Ryan Papenhuyzen (Melbourne Storm) and the running backs glide through space similar to Tom Wright (Wallabies). I didn’t manage to see any punters but for the AFL lovers, this is where the Buddy Franklin comparison would be!
After the session I spend the morning collating the data with specific reference to the injury, grouping patterns in the data and identifying a report to present at the medical meeting that afternoon.
Without going into player or injury specifics, the data did identify some risk factors which led to me advising on an orthoses change. In my head, this did have an element of risk to it (an outsider podiatrist coming in for one day and advising change) but that is what I was there to do. The medical team took it on board, but not before requesting detailed evidence outlining the reasons behind the change. It’s clear that, like every professional sporting organisation, they strive for any 0.1% of improvement. Yet they do it with their antennas up and the ‘no BS’ sensor is well and truly out.
I finish the day talking to the team in the ‘kit room’ where they have two staff members who are solely responsible for the clothing and equipment. No players pay for their equipment in the NFL including footwear, and it is in this room that I got my ‘podiatry geek’ on!
The NFL puts out a clete scoring system each year where they test and rate every shoe on traction and flexion. This then determines what brands and cletes can be worn, and which ones are too dangerous (this year Under Armour is no longer represented in the league, so Nike and Adidas have the market).
Given that a lot of the matches are played on artificial turf, the outsole design on all the cletes is completely different to that of any Australian boot. Each player stands on a foot scanner which scans and provides a 3D foot image, the US foot size, and the recommended clete model for the player.
Sponsorships aren’t a big thing over here (only the very elite players are paid to wear certain cletes) and the cletes are categorised into speed models, hybrid models or power models in both moulded and detached models (equivalent to screw-ins). Some of the bigger feet (US size 16+) even need to have boots steamed and stretched to get an adequate width sizing.
I couldn’t help but try a helmet on and they are deceptively heavy! I started to ask about the helmets and their technology, but it was something that was just over my head (needed to get one pun in there).
Another 5.30am gym start for the medical team, followed by a breakfast on the run before the rookies start to roll in. The rookies are the drafted players who are in their first year at the franchise.
In NFL preseason, the rookies start a week before the veterans to improve their conditioning and ability. Immediately there is some royalty in the place as the current Heisman Trophy winner (best College player) is in camp. It is important to perform well given the roster size of 90 players gets cut to 53 for the season.
My role is dual-focused today: re-test the rehab player and present a CPD seminar to the athletic trainers and physical therapists. I did an interactive presentation on foot orthoses and in-shoe modifications in football cletes; showing them a range of orthoses and pads that can treat a variety of football specific injuries. I was then asked to critique their prefabricated orthoses range and advise on improvements, and I finished the session showing the interns and trainers some foot-specific taping techniques.
At around lunch time the player arrives for re-test. I make some changes to the orthoses and head to the pitch to evaluate if there is a change in plantar pressures and/or a reduction in injury risk. I collate the new data and compare it to yesterday’s results before getting a detailed report ready for the medical meeting. The outcome was positive and going through the results on a big screen to the medical team finished our meeting. The medical team were satisfied and my last job for the day was to call their orthotist and advise on the new orthoses prescription for the player.
Today started with a 6.30am run with the director of medical, followed by breakfast with the entire medical team. It has a real family vibe to it given how much time you spend with each other, and I even used this time to talk to some of the players about their perspectives and experience. They really love football, it’s their life and their passion.
The discussion came up: In the eyes of Americans, are the various franchise NFL training camps bigger than the Olympics? To even the most biased of Australian NFL supporters, the answer would obviously be no, but in the eyes of the die-hard NFL staff and supporters, it is close. Football is a religion here.
My last responsibility was to summarise the results into a report to submit to the coach and the vice president of operations. Nothing like the pressure of getting a document together to present to the hierarchy of a 6.05 billion dollar franchise.
Upon reflection, I experienced a lot in four days about the game of American football, the day-to-day processes involved and what happens behind the scenes. It seemed like a mutual learning experience with a trade-off between Australian-based foot assessment techniques and orthoses prescription with that of the might of how an NFL franchise functions in its entirety.
A big lesson that I learnt was that although there are so many roles and responsibilities in the life of managing NFL athletes, there is definite value for podiatry input. There is still overlap in some of the roles (similar to podiatry and physiotherapy in Australia), but there is a ‘perceived high value’ placed on the MSK knowledge Australian practitioners have.
As an Australian podiatrist, having some input in the NFL isn’t a dream that hovers on the horizon, but a realistic option for those with ambition, a specific niche skill set, and great people skills.
Looking from a broad lens, it is obvious that the passion and desire for results is cutthroat and more competitive than ever. The search for any little edge or advantage is never-ending. It’s not optional, it’s a requirement. The NRL/Super Rugby and AFL clubs of Australia also share this intense desire for results, it is just that the NFL budget for it is on another planet.
Getting in an Uber leaving the facility, I felt a sense of sadness leaving the medical team that I had only known for four days, given how well we connected and how warmly they welcomed me into the team. The Commander’s mantra is ‘Brotherhood’, I definitely got that feeling and my sense of sadness was validated.
The Commander’s preach, ‘Better never stops’ which is a valuable lesson for us all. It’s something that we can take on board not only in our podiatry careers, but in our lives.
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