Are extra NFL games worth injury risk?

Editor's Note: Dr. Geier is Director of MUSC Sports Medicine and an orthopaedic surgeon. He writes a bi-weekly sports medicine column for The Post and Courier.

How many of you were watching the NFL playoffs this weekend? I was. And judging by the TV ratings, a huge percentage of Americans were.

By all accounts, the popularity of the NFL has never been higher. According to the NFL, TV ratings for the first week of the NFL playoffs were among the highest in 20 years, dwarfing ratings for the NBA, college basketball and even the BCS national championship game in college football. And despite season ticket sales declining slightly for the third straight year, TV revenues have skyrocketed, with the four major networks which show games paying over $20 billion during their current contracts. It is no wonder that the NFL and the owners want to increase the length of the regular season from 16 to 18 games.

The players' union publicly opposes the idea of an 18-game schedule, citing concerns about increased injuries. Whether injuries are the real motivation for their opposition is subject to much debate right now. From the perspective of an orthopaedic surgeon who treats athletes on a regular basis, injuries are my main concern with an extended schedule.

Football is a contact/ collision sport, and injuries are an inevitable byproduct of that contact. NFL players are bigger, stronger and faster than at any point in the sport's history. When two or more of these athletes collide, they can get hurt. Fractures, torn ligaments and tendons, and concussions can and do occur. I would estimate that there are anywhere from three to 10 injuries to players among a team's 53-man roster each week. It seems logical that if the league adds two games, there will be two more opportunities for that number of players to get injured. As I suggested to Tim Dahlberg in an interview with The Associated Press, "Cumulatively, the effects on the team will be great. There will be more holes to fill so you won't have the depth on your roster."

Proponents and critics of the extended schedule point to seemingly conflicting statistics to make their case. The NFL argues that injuries are down this year from previous seasons. John Powell at Michigan State University compiles data from each team's medical staff. According to The Washington Post, Powell found that through the first eight games this season, teams had an average of 3.8 injuries that caused a player to miss more than six weeks. In the first eight games of the previous season, teams had an average of 5.9 such injuries.

On the other hand, more players have been placed on the injured reserve list this year. According to the NFL, through the first 10 weeks of games, there were 106 players on IR -- meaning they were essentially out for the season -- compared to 89 in the first 10 weeks during the previous season.

To me, these statistics seem somewhat misleading. An eight-game sample is not really adequate to conclude that injuries are decreasing. I think data from an entire season, or even three or five seasons, would be better. And even if the rate of injuries is truly dropping, that doesn't mean that no injuries will occur in those two extra weeks. Conversely, the injured reserve numbers might be an aberration as well, since 2010 is an uncapped season. There is no penalty to placing players on IR, since the teams do not have to pay replacement players with money under the salary cap.

I want to point out that I am not taking the side of either the owners or the players. But I do think that injuries are a real concern. The technology of the helmets and pads is improving, and certainly making equipment that provides better protection is desirable. I would argue that both sides need to consider a number of options if the extended schedule is adopted. Increasing the 53-man roster, decreasing or eliminating preseason games, decreasing offseason training camps and workouts, and adding one or more bye weeks during the season might be reasonable changes to offset the expected injury increase.

I believe that the NFL, the owners and the players will come to some sort of agreement. There is too much money at stake, and both sides risk alienating a fan base that is more passionate about pro football than any other sport. I just hope they can work to keep the players on the field and out of the training room or doctor's office.

Read more about football injuries and other sports medicine topics on Dr. Geier's blog at drdavidgeier.com.