UP CLOSE: Understaffed, Yale sports medicine struggles with student injuries

UP CLOSE: Understaffed, Yale sports medicine struggles with student injuries

Published on February 23, 2017

After backing up second-team All-Ivy quarterback Morgan Roberts ’16 for two seasons, Rafe Chapple ’18 finally got his opportunity: The junior earned the starting job ahead of the Yale football team’s first game in 2016. Chapple would throw five interceptions and complete just 51.2 percent of his passes over his next six quarters before being benched by halftime of the Bulldogs’ Week 2 loss against Cornell.

It would be a month before Chapple learned why his throwing arm had failed him. During the sixth week of the season, Chapple was diagnosed with a partially torn rotator cuff and internal impingement in his throwing shoulder — injuries which had likely plagued him since the beginning of training camp.

“Throwing every day, your shoulder is going to be sore, but I was having problems where I was losing arm strength the first few days of camp,” Chapple said. “Every throw was painful.”

Chapple had sought help in the Yale Athletics training room by the second day of camp in August, telling the athletic trainers that he had never felt so much pain while throwing. The injury was dismissed as fatigue or possible tendonitis. Soon after, a team doctor assured Chapple there was no structural damage in his shoulder and sent him back onto the field with a cortisone shot.

But even with the steroid shot, Chapple said he lacked the arm strength that had carried him to Division I football. Still in close competition for the starting job for which he had worked, the junior felt he had no choice but to keep playing. After losing the starting job, however, his performance deteriorated even further. He did not play again in 2016.

Desperate, Chapple insisted to the athletic trainers after the Week 2 game against Cornell that he undergo an MRI, which neither the trainers nor the team doctor thought was urgent, according to Chapple. The quarterback was handed a two-week waiting time, prompting him to reach out to his parents, who were able to schedule an MRI three days later after several phone calls.

The MRI confirmed the torn rotator cuff and internal impingement, and Yale doctors immediately recommended surgery. Chapple’s parents, however, sought a second opinion and consulted James Andrews, a renowned sports orthopedist who has treated countless professional athletes. According to Chapple, Andrews strongly advised against surgery due to the counterproductive effect it would have on his arm strength, suggesting instead a Platelet-Rich Plasma injection followed by physical therapy.

Chapple has not been the only member of the football team to miss significant time due to injury. Over the past two seasons, the team has seen an unprecedented number of players miss time; by the athletic department’s own count, 42 of the team’s 110 players were either injured or sick by Week 7 of the 2015 season. One quarter of the injured players were out for the season. And by Week 7 of the 2016 season, Yale’s offense had been gutted: A quarterback, a top running back and three of the top six receivers from the Week 1 depth chart were out for the year. Multiple would-be starters never saw the field in 2016, and Team 144 won just three of its 10 games.

“I feel that at any other [Division I] program I’d have been in an MRI the next day,” Chapple said. “I think the sports trainers do the best that they can, but they are just so understaffed. There’s not nearly enough trainers to deal with the entire football team plus all the other sports.”

Interviews with eight current and former injured Yale football players as well as members of the Yale athletic department revealed the extent of the struggle to adequately staff the sports medicine department. Football is a violent game and injuries happen, yet many student-athletes voiced concerns over a lack of sufficient staffing, resources and facilities. While Yale Athletics is aware of some of these issues and has made progress in recent years, including making plans to hire additional trainers, student-athletes say there is more that can be done to preserve the physical well-being of athletes across all of Yale’s varsity teams.

BY THE NUMBERS

Yale has fewer full-time trainers than almost all of its peer institutions. Compared to Yale, which employs 10 full-time athletic trainers currently certified to practice in the state of Connecticut, the other seven Ivy League institutions average 12.1 full-time trainers. Harvard and Cornell have 15 athletic trainers, the most of any Ivy League school, followed by Princeton with 13. Dartmouth, Brown, Penn and Columbia have 12, 11, 10 and nine trainers, respectively.

The National Athletic Trainers’ Association’s Appropriate Medical Coverage for Intercollegiate Athletics provides a recommendation for the number of certified athletic trainers needed by a school. The calculation is based on a multitude of factors, including the number of varsity athletes, travel dates and injury-risk calculations for individual sports.

According to head athletic trainer Jay Cordone, the most recently calculated AMCIA number for Yale is 14.34, which was determined using statistics from the 2014–15 school year. Based on this calculation, Yale would need 15 certified athletic trainers to meet the NATA recommendation. Yet, Yale only employs 10 full-time trainers. The department also employs a part-time athletic trainer, and Director of Sports Medicine Chris Pecora assists the staff though his license in the state expired last July.

Even if Pecora and the part-time trainer were counted, Yale’s number of trainers would still fall below the AMCIA recommendation of 14.34. Still, Yale Director of Athletics Tom Beckett told the News that although the department respects the guidelines, the general consensus among Ivy League schools is that the AMCIA is not applicable because of conference limits on the length of seasons and offseason practices, among other factors.

Pecora and Cordone noted some factors which the AMCIA calculation does not take into account, such as the location of Yale’s athletic facilities. The pair said that the concentration of training facilities at Payne Whitney Gymnasium, Smilow Athletic Complex and Ingalls Rink allows the staff to cover more sports with fewer trainers.

While an advanced degree is not necessarily indicative of quality care, Yale falls short of its peer institutions in the number of athletic trainers with advanced degrees. Six of Yale’s licensed, full-time athletic trainers have master’s degrees, as does Pecora, whereas all of Harvard’s 15 have completed graduate work in athletic training, kinesiology, exercise science, human physiology or strength and conditioning, per Harvard Athletics’ website. According to their athletic departments’ websites, all 12 of Dartmouth’s trainers have master’s degrees and at least eight of Princeton’s 13 trainers have received postgraduate education.

“My suggestion would be [for Yale to add] a full-time rehab coordinator,” said a sports medicine expert with knowledge of the Yale football program, who spoke on condition of anonymity in order to talk candidly. “Most universities have them. They are both physical therapists and athletic trainers, and their job is to focus on rehab [post-operation] and treat injuries that the trainers don’t have a chance to work with.”

While there is not egregious understaffing, there is more that could be done in terms of providing the student-athletes with enough resources, this expert said. A misdiagnosis like Chapple’s would be less likely to slip through the cracks if there were staff whose sole purpose was to follow these injuries and manage their progress, he added.

“If you have enough resources, it lets you focus on those players who are specifically injured, whether it be [preoperative] or postop,” the expert said. “The recovery time is much faster. It takes pressure off the trainers so they can focus on what they need to do.”

Beckett said he began to recognize a need to expand the sports medicine staff in the last three to four years due to an increase in the frequency and intensity of student-athletes’ training, particularly out of season.

He told the News that the department is seeking to hire two trainers and a part-time physical therapist for the 2017–18 academic year. One of the two additional trainers will replace senior athletic trainer Richard Kaplan, who is retiring at the end of the 2016–17 academic year, while the other will bring the department up to 12 trainers.

GETTING TREATMENT

Offensive lineman Khalid Cannon ’17 came to Yale with two torn labra in his shoulders that were sustained in high school and had gone undiagnosed prior to his arrival in New Haven. After experiencing intense shoulder pain during the first week of preseason camp in 2013, Cannon sought out the Yale athletic trainers, who advised he sit out of one practice. Following this day off, Cannon claimed he was never contacted for a follow-up and participated unmonitored in practices going forward.

The lineman became well acquainted with the training room during his four years at Yale while undergoing and recovering from two shoulder surgeries. Ultimately, he grew frustrated with the length of time it took to receive treatment and the lack of attention upon arriving at the training room.

“As a double major in chemistry and geology, I don’t have time to wait around all day,” Cannon said. “Sometimes I’d wait 45 minutes to see a trainer.”

Cannon, who missed four games this season due to injury, is not alone in this sentiment. Experiences like his have shaped the culture of the football team to the point where some players question the benefits of even visiting the training room.

“The overall stigma on the football team is that you don’t want to go in the training room because it’s so busy and packed that you’re not going to be properly attended to,” Chapple said.

Former football captain and linebacker Darius Manora ’17 said the perception among players is that the training room is just a place for those with extremely serious injuries. This notion has prevented players from doing beneficial “prehab,” preventative measures to keep them healthy over the course of their season. Manora saw the lack of trust in the training room as a “vicious cycle,” where players do not get their minor injuries treated, leading to more serious and debilitating developments down the road.

The former captain was misdiagnosed during his junior season, when a wrist injury sustained in Week 4 was deemed a sprain or fracture by the Yale athletic trainers. The trainers put his arm in a cast and Manora played every game that season. After the season finale, Manora learned from an MRI that he instead had torn tendons in his wrist and subsequently underwent an offseason surgery.

The tight schedules of Yale student-athletes and the need to get treatment right before practice create the busy hours that players bemoan. Pecora said that activity in the training room varies on the time of day but that waiting in lines is not unique to Yale.

“There are [busy] times at any training room,” Pecora said. “If it’s an hour before a lot of practices start, [around 4 p.m.], it’s going to be crowded. You could walk into the training room at 1:30 in the afternoon and have no wait time.”

Pecora suggested that players could avoid the prepractice rush by coming in between 10 a.m. and 2:30 p.m. to do their necessary rehabilitative work with a team trainer. However, the late-morning and early-afternoon span is often the only block in which athletes can take classes, considering their early-morning workouts and afternoon practices.

“Only having a couple head trainers means it is very difficult to schedule time with them,” Manora said. “They do their best and are very flexible. But with a Yale schedule, it’s very difficult to match those two schedules together.”

In the training room, Cordone serves alongside two assistant athletic trainers, Kaplan and Lindsay Snecinski, and seven interns in sports medicine — although this term does not accurately reflect the group’s credentials. Those listed as interns by Yale Athletics are among the 10 certified Yale trainers, with four of them even holding master’s degrees. Pecora said the intern designation is a University title and simply refers to the temporary, two-year nature of the position.

The department also employs student athletic trainers, for whom the title “intern” more accurately applies. These trainers are undergraduates at Quinnipiac University working towards a degree in athletic training. They receive hands-on experience in the Yale training room, with five working with the football team as unpaid interns this past fall, according to Pecora.

He explained that the role of these student athletic trainers varies depending on their age; younger students may simply observe and assist senior staffers, while more experienced interns may tape ankles. The students are not allowed to work on athletes by themselves. Still, many football players expressed concern about the degree of responsibility that the student trainers hold due to the perceived understaffing in the training rooms.

“You always want to go to the full-time trainers because you feel more confident with them,” Manora said. “A lot of times the interns have to take roles that I would feel a lot more confident with a full-time trainer performing.”

“They’re real good kids,” cornerback Marquise Peggs ’19 added. “But they just don’t have the experience.”

“YOU MIGHT HAVE A DISC”

Quarterback and linebacker Spencer McManes ’17 feels that Yale’s athletic trainers are understaffed to the point where it inhibits them from following individual athlete’s injuries over the course of a season. McManes began to feel discomfort in the back of his left leg in December of his sophomore season, a pain which grew worse and spread throughout his leg in the coming months.

“When I went in to see the trainers, they consistently told me it was [tightness] and I needed to stretch    and roll my calf,” he said. “Then they told me it was a tight hamstring and I had to [roll it].”

Upon McManes’ insistence that the pain was not subsiding, a trainer told him that he “might have a disc” but that it was not serious; like Cannon, McManes was not contacted for follow up, he said. McManes continued to push himself in the weight room, loading up more than 400 pounds on his back for squats. By the end of the first week of spring practices, the Roswell, Georgia, native was having trouble even standing up due to the excruciating pain.

After the 2015 spring game, McManes said he pleaded with a team doctor to check on him, despite the fact that his appointment was not for another week; within minutes, the doctor had determined that the source of his pain was a herniated disc in his back. McManes would have two surgeries, a lumbar microdiscectomy in May and a spinal fusion surgery in December that removed a disc from his back and connected the vertebrae with rods, screws and cement.

“The severity could have been diminished significantly if they had just told me to stop lifting,” McManes said. “I don’t think any of the shortcomings of the trainers were from a lack of care, but from being spread so thinly throughout the team. You can only keep track of so many people.”

However, according to Pecora, the delays that McManes and Chapple faced are the exception rather than the rule. Pecora explained that between athletic trainers, team physicians and orthopedic consultants, the system has “a number of safety nets.”

“We would expect an injured student-athlete to be seen immediately,” Beckett said. “That is our goal, and we are in constant communication with our doctors.”

When asked about this communication, Cordone described weekly meetings between the athletic training staff and team physicians, which are held to “[go] over injury reports, rosters and any sorts of cases that are current.”

In a Feb. 20 interview, Pecora cited an example of an athlete who sustained an injury during an away game two days prior. The athlete was immediately treated by an athletic trainer, who scheduled an appointment for the player with the team physician on Saturday, the night of the injury. By 5 p.m. the following Monday, the athlete had already been examined by the team physician, an orthopedic surgeon and had a diagnostic test performed, Pecora said.

Even if initial treatment is timely and thorough, players expressed concerns with treatment in the long term.

Linebacker Remick Kawawaki ’17 tore his ACL, MCL and meniscus on the fourth day of preseason camp his freshman year. His initial experience with the athletic trainers was positive, he said, as the training staff knew the severity of his injury from the moment he went down. The linebacker had surgery to repair the ligaments in his knee and was impressed with the effectiveness of Cordone and then-head trainer Dave DiNapoli, who no longer works for Yale Athletics and did not respond to multiple requests for comment, in helping him regain strength in his knee.

But ultimately, the senior felt he experienced a decline in the quality and quantity of care he received as his recovery progressed.

“Initially I felt like I got the right amount of attention, and then eventually it just fell off,” Kawawaki said. “Even with the best athletic trainers, which I think [Yale’s trainers] are in terms of care and the amount of time they put in, it’s tough to keep tabs on everyone, and little things slip by that turn into big things.”

With less attention from trainers, however, Kawawaki eventually hit a wall in his rehab, and the swelling in his knee would not recede. The following fall, he eventually discovered that he had a patellofemoral defect in the operated knee that would require a second surgery.

Though he eventually recovered from the knee injury, Kawawaki would have more troubles during his senior year. In October, he approached trainers about a pain in his back and sought a doctor’s opinion when they initially told him it was just a strain, he said.

After hearing the ordeals of McManes and other teammates who suffered herniated discs, Kawawaki said he believed he should get an MRI since he felt a similar pain down his leg. However, the Yale doctor he saw told him an MRI was not worth it and unnecessary, and diagnosed him with a bulging disc. A month later, another doctor on Yale’s staff diagnosed Kawawaki with a herniated disk, which represents a more advanced degradation than bulging. The senior felt the initial dismissal of an MRI hindered and delayed his eventual rehabilitation.

YALE LOSES KAI

Kawawaki attributed much of his success in recovering from his original knee injury to physical therapist Kai Aboulian, a former member of Yale’s staff. Chapple, Cannon and others echoed Kawawaki’s comments.

“[Aboulian] was essential to all guys who were dealing with shoulder injuries,” Chapple said. “As soon as he was gone, it led to the demise of a lot of the guys’ injuries.”

Aboulian is a physical therapist and certified athletic trainer who worked for the Yale sports medicine department on a part-time basis from 2009 to 2012. He returned in a part-time capacity in 2015 and worked until May 2016 exclusively with the football and men’s lacrosse teams. He briefly helped the football team during the 2016 preseason on an even more limited basis.

Aboulian had a close, working relationship with many players on the team; according to several of those players, he had expressed interest in working for Yale full time. The players on the football team said they have noticed a steep decline in the quality of their rehabilitation and physical therapy since his departure.

While recovering from an injury this fall, wide receiver Bo Hines ’18 chose to make the hourlong round-trip drive to receive treatment from Aboulian in the physical therapist’s home on the Connecticut Shoreline. Hines transferred from North Carolina State University following a rookie season that garnered him Freshman All-American First Team honors. Yet in his two seasons at Yale, he has played in just three quarters of a single game, all in 2015, due to a gruesome shoulder separation his sophomore year and a collarbone injury his junior year.

“The [shoulder] injury was probably a cumulative thing [from my time at NC State],” Hines said. “That being said, if we had the proper resources here and the trainers [were able to] invest the proper time, they could have seen the weakness in my shoulder and given me things to do to strengthen it.”

Cornerback Marquise Peggs came into Yale with a pre-existing left shoulder injury which was diagnosed as a torn labrum by Yale staff during preseason camp. He played his freshman season with the injury by wearing a brace and underwent surgery in November, six days after the season finale.

According to Peggs, the Yale coaching staff ensured that the rising sophomore would partake in rehabilitation to strengthen his shoulder on campus over the summer. However, this did not happen: Cordone said Aboulian was not under contract with the University in June and July 2016. Peggs said that no other physical therapist coordinated with him — a fact the coaching staff was not aware of until after training camp had started.

Peggs, who missed half of the 2016 season due to injury, never got his shoulder feeling close to full strength leading up to the season, he said. While he knew this lack of strength was due to a shortage of rehabilitation, the staff kept telling him it was a confidence issue.

“[It went wrong] once the summer came along and Kai [Aboulian] wasn’t here,” Peggs said. “The coaches thought he was here. Ultimately, it was a huge miscommunication. It shouldn’t happen at the level of college football that we play.”

RAMIFICATIONS BEYOND YALE

According to Cordone, the Dwyer Sports Medicine Center — the training room at Payne Whitney that serves as the sports medicine department’s central hub — is open from 9 a.m. to 7 p.m. Either he or Snecinski has coverage of the room during these hours. The training room at the Smilow Center is typically open from 2 to 7 p.m. to care for athletes before and after practice.

Despite these wide hours of operation, former Bulldog and National Football League running back Tyler Varga ’15 had a different experience during his Yale days.

“As an athlete at Yale, I had to befriend Payne Whitney staff [members] so I could sneak into the training room when it was closed during the daytime during its regular hours so I could do rehab by myself,” Varga said. “It wasn’t open when it was supposed to be because our staff was spread too thin.”

Varga’s most important run-in with the sports medicine department proved less effective than he would have liked. During his junior year, the running back suffered multiple broken bones in his foot and ankle. He said he was disappointed to find that Yale lacked what he considered a common machine used to treat such injuries, called a bone growth stimulator.

Varga was unable to play his junior season and took up upwards of eight months to get back on the field. Yet the injury never healed properly, with the still-damaged bones in his foot continuing to hurt the professional prospect. The former Indianapolis Colt remembers waking up the week of the NFL Scouting Combine and not being able to walk.

“A year and a half down the road, I had complications from this injury and missed the NFL Combine, the biggest stage you can be invited to as an NFL prospect,” Varga said. “Then I had to get ankle surgery before the NFL Draft. It couldn’t have helped my resume, and I think it possibly could have been avoided if the training staff had the necessary tools available.”

While the burden of rehabilitation undoubtedly falls on the players in addition to the sports medicine staff, Varga said he felt that the trainers were not able to maximize the effectiveness of his rehabilitation.

“You got a couple full-time guys that really care and are doing a great job,” Varga said. “I just felt they weren’t getting the resources they needed to do their jobs to the fullest of their abilities, whether that be manpower or different modalities [of rehab equipment].”

Many players echoed Varga’s praise of the training staff members and their care but raised similar concerns about limited staff and resources.

Chapple recalled several instances in the offseason when he went to the training room after a workout, only to be told that treatment priority was reserved for in-season athletes.

And according to Cannon, the facility at Smilow contains just one column of resistance bands ,which are key for rehabbing shoulder injuries. He estimated that 15 members of the 2016 football team battled shoulder injuries, meaning “we’re just piling around [the column], and it’s not very effective.”

Though the department has no plans to expand the size of the training rooms, Beckett and Pecora speculated that the space could be used more efficiently to give players more room.

STEPS IN THE RIGHT DIRECTION

Yale Athletics has made improvements to the facilities and modalities in the past. According to Pecora, almost all of the equipment at the Smilow Center was replaced within the last two years, and the Dwyer Center has received some upgrades as well. However, members of the football team note that requests made to the Yale athletic department regarding improvements in resources, which in turn go to the Provost’s Office, have not seen much success.

“The most common thing I hear is that we are always on a budget,” Manora said. “Even the trainers themselves say we need more trainers and resources. This year was a step in the right direction as far as receiving more equipment.”

Manora cited an increase in the number of Game Ready machines in the training room as an example of increased protection of Yale’s student-athletes. A Game Ready is a compression wrap connected to a machine that runs cold water through the wrap, which, according to Cordone, delivers more benefits over a conventional ice pack. Yale currently has six machines.

Manora credits alumni donations for providing the machines, saying that they have been an enormous success with athletes from all sports. The former captain believes this is a positive step for Yale Athletics to build on in terms of providing student-athletes with adequate resources to keep themselves healthy.

Pecora characterized a different experience with regard to obtaining funding. While noting that every department at any institution has to be realistic about how much funding it will receive, Pecora said the sports medicine department has had largely positive experiences with the Provost’s Office.

The Provost’s Office did not respond to multiple requests for comment.

The athletics department is currently in the process of securing funding for the addition of another two athletic trainers and a part-time physical therapist in anticipation for the 2017–18 school year, though Beckett said the process with the Provost’s Office can take months.

“It is a very fair process,” the athletics director said. “No matter where you are in an organization you need to have accountability, you need to be prudent and you need to go through all of your … needs versus wants.”

In terms of other advancements, Yale has also invested in NormaTec Recovery Systems, which are compression boots that help move fluid out of extremities. Additionally, Cordone said members of his staff have recently started dry needling, a method of muscle stimulation for the purpose of pain relief.

Cordone hopes to create an endowment in the coming years to help the department become more sustainable and also help it meet five-year goals, although he noted that the endowment is still in the “idea phase” and few support staffs have their own endowment.

“People go to Yale for one reason: because it’s one of the best institutions in the world, if not the best,” Varga said. “That should be across all the phases of the student-athlete experience. … Whatever it is, you should be empowered to do that at Yale. If you aren’t, then we are not living up to the Yale pedigree.”

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