Writers of Pro Football Prospectus 2008

30 Jul 2013

Playing the "What If?" Game

While nominally about all sports, Dr. James Andrews (and Mike Philbrick) looks at some of the more famous NFL careers ended by injury for Grantland: Gale Sayers and Johnny Unitas. What would have happened to them today?

Posted by: Rivers McCown on 30 Jul 2013

38 comments, Last at 31 Jul 2013, 7:28pm by Karl Cuba


by Revenge of the NURBS (not verified) :: Tue, 07/30/2013 - 11:57am

Spoiler alert -- they'd be better off today. Not a big shock.

Actually, the most interesting section of the article was the part about Bill Walton. "Health is a skill" is something I've read here several times, but it's refreshing to see it acknowledged by the biggest name in sports medicine. If Bill Walton were playing today, he'd basically be Greg Oden. Something to think about when you're considering taking a chance on a player with an extensive injury history, or when you're plunking down good money to get a signed Bob Sanders jersey framed.

by JonFrum :: Tue, 07/30/2013 - 2:46pm

Greg Oden won two NBA championships?

by justanothersteve :: Tue, 07/30/2013 - 3:16pm

Not Walton. Oden is Sam Bowie.

by RickD :: Tue, 07/30/2013 - 5:09pm

Seriously. Bill Walton is in the Hall of Fame.

People forget how good Walton was before his feet fell apart. He was the league MVP in '78 - and this was during Kareem's prime. Oden's not going to ever have a whiff of that level of accomplishment.

I was interested in how this article, after saying "yes, of course he'd have had a better career!" for so many people just kind of shruged and said "Look, Walton had terrible bones and was doomed and would have been doomed today." To roughly paraphrase.

by sundown (not verified) :: Tue, 07/30/2013 - 8:36pm

That's kind of a poorly worded section. He ends with what you paraphrased, but he begins by saying great athletes can make the doctors look good by recovering so well. The two examples he gives are Walton and Sam Bowie. What I thought he was saying (though it's not worded very clearly) is that Walton is more of an example of somebody who could make the doctors look good, while Bowie was a guy who maybe would never had come back even today. First, Walton never broke his foot until he'd been in the NBA for like 4 seasons, so he got hurt considerably later in his career than Bowie did which would seem to indicate his bones weren't all that brittle. And while Bowie never really recovered at all, Walton played for several more seasons at a high level and was injury free the year he helped the Celtics win a title. There's a good chance Walton would have been benefited a lot from today's techniques.

by Kyle D. (not verified) :: Tue, 07/30/2013 - 11:06pm

Walton was great. But his MVP that year was rather odd in that he missed the last third of the season injured and his stats weren't all that great even when he was healthy. (Just under 19 ppg and 13 boards. He wasn't in the top 5 in points, rebounds or shooting percentage.) He benefitted hugely from the Blazers being defending champs and being off to a great start before he got hurt. And even given all that, it's still hard to say how he beat out Kareem averaging 25 and 13 while shooting 55%, George Gervin scoring 27 per game and leading the Spurs to a first place finish, Dr. J scoring over 22 a game with the Sixers finishing in first, etc.

by DD (not verified) :: Wed, 07/31/2013 - 4:35am

Walton was 2nd in the league in PER behind Kareem and PER doesn't account for defense well and Walton was widely considered the best defensive player in the league. And Kareem missed 20 games as well that year because of a sucker punch he delivered.

And from the voters' perspective, it's easy to see why they voted for Walton. Portland was a dominant 50-10 and challenging for the best regular season record of all time before his injury and 8-14 afterwards. That's a storyline that the voters couldn't ignore.

by markus (not verified) :: Wed, 07/31/2013 - 5:54pm

Being white didn't hurt him either.

by Karl Cuba :: Tue, 07/30/2013 - 12:38pm

I was hoping for an assessment of Greg Cook, possibly the ultimate career cut short.

Plus, doesn't Sayers' knee sound like a wreck?

by JoeyHarringtonsPiano :: Tue, 07/30/2013 - 12:50pm

I was hoping for a blurb about Greg Cook, too. From what his contemporaries say about him, he looked like could have been something special in Bill Walsh system.

by Will Allen :: Tue, 07/30/2013 - 1:46pm

It is interesting, and a testament to Walsh's intellect and lack of insecurity, that the Walsh system with Cook was very different than the Walsh system with Montana.

by Bowl Game Anomaly :: Tue, 07/30/2013 - 4:55pm

Fun fact: Cook led the league in completion % (and passer rating) in his only year as a starter. So maybe the system wasn't quite as different as people like to claim.

by Karl Cuba :: Tue, 07/30/2013 - 5:31pm

Fun facts within context:Cook averaged 9.4 yards per attempt and 17.5 yards per completion in his only season while his replacement Virgil Carter (below average arm strength but mobile, like the modern WCO prototype) averaged 5.9 yards per attempt and 11.5 yards per completion the following year after Walsh adapted the system to the less talented quarterback. Cook was pretty special.

by Will Allen :: Tue, 07/30/2013 - 6:17pm

Cook was extremely accurate while throwing deep downfield, right from the beginning. Nope, them fellas don't come down the pike very often.

by Will Allen :: Tue, 07/30/2013 - 6:14pm

Fun fact. Bill Walsh said himself that the system he ran for Cook was rather different than he one he ran for Carter/Montana.

by Bowl Game Anomaly :: Tue, 07/30/2013 - 10:09pm

Jeez, guys, I wasn't trying to knock Cook, who was obviously talented, or to imply that Walsh didn't change anything when he was injured. I just find it interesting that Walsh clearly valued completing a relatively high percentage of passes even back when he had an extremely talented strong-armed downfield passer, and that maybe he already had some West Coast concepts in mind way back then. That's all.

by Karl Cuba :: Wed, 07/31/2013 - 7:28pm

Fair enough and to some extent you have a point. Parts of what became the WCO were in place for Cook, things like designing the routes to time up with the qb's footwork and camouflaging the run/pass releases.

by Will Allen :: Tue, 07/30/2013 - 1:42pm

Dick Butkus' career was greatly shortened by medical malpractice, even by early 1970s standards. Who knows how much longer he might have played, given competent care by today's standards.

by BaronFoobarstein :: Tue, 07/30/2013 - 2:09pm

Bo Jackson is an obvious one.

And it's not football, but Mario Lemieux.

by Guest789 :: Tue, 07/30/2013 - 2:20pm

Bobby Orr too. Imagine if he had been able to play into his 30s... Probably would give Gretzky competition for best of all time.


“Treat a man as he is, and he will remain as he is. Treat a man as he could be, and he will become what he should be.”

by Bright Blue Shorts :: Tue, 07/30/2013 - 2:42pm

Bo's problem wasn't his actual injury ... which I believe was that he dislocated his hip and then popped it back in.

His problem was that he got avascular necrosis ... the blood supply to the hip was cut off ... so the bone died.

That wasn't diagnosed at the time so it wasn't treated. I suspect that modern medicine wouldn't have dealt with it any differently if it had been spotted.

by RickD :: Tue, 07/30/2013 - 4:57pm

Well, the blood supply to the hip was cut off because he severed a blood vessel when he injured his hip. So it did trace back to the injury.

I think it's hard to say "modern medicine" wouldn't have dealt with the injury differently. This did happen 22 years ago. One thing I've noticed over the past decade is that MRIs are used far more often today than they were in the early 90s. I think for a dislocated hip, they certainly would be used today.

More on some of these guys from ESPN last year:


I think they're talking about doing a better hip replacement, but there's also the question of better detection of the severed blood vessel.

by akn :: Wed, 07/31/2013 - 12:05pm

Compromise of blood supply to the neck/head of the femur occurs in about 1/4 of people who get posterior hip dislocations. If caught early enough (6 hours) and treated, less than 10% progress to avascular necrosis (AVN). However, most are initially asymptomatic. Once AVN becomes symptomatic, your pretty much screwed (3/4 progress to collapse). Treatment is early reduction of the hip dislocation and temporary anticoagulation, with other medications and surgeries (core decompression) available if required.

20 years ago, doctors were well aware of the condition, but not how insidious it was. They did an x-ray, and moved on if it was negative. Now we know that in many cases it may take months for AVN-related changes to show up on x-ray. You are correct that MRI is the standard of care now, as it catches virtually all cases of vascular compromise even hours after the initial trauma.

What might be more relevant today is the fact that most cases of AVN don't occur because of hip dislocations, but instead because of chronic steroid use. I'm talking therapeutic steroids such as prednisone or corticosteroid injections. However, I wouldn't be surprised that anabolic steroids have similar effects. I'm not trying to imply anything, just an interesting fact.

by Aaron Brooks Go... :: Wed, 07/31/2013 - 12:16pm

I thought one of Bo's issues was that they didn't initially believe he had dislocated his hip -- it self-reduced. That doesn't happen with most humans.

by Marko :: Wed, 07/31/2013 - 1:06am

NHL goalie Ray Emery had avascular necrosis and then, after surgery and a very painful rehab process, was able to successfully resume his career: http://prohockeytalk.nbcsports.com/2011/08/04/ray-emerys-one-in-a-millio.... He played very well as the backup the past two seasons for the Blackhawks, especially in the recently concluded season. He had one of the best seasons ever for a backup goalie and then left as a free agent to return to Philadelphia, where he will compete for the starting job.

I am not aware of any other professional athletes in a major sport who have made a similar recovery.

by Bowl Game Anomaly :: Tue, 07/30/2013 - 5:00pm

I don't know that Lemieux would have been helped as much as some of those other guys. Aside from cancer, his injuries were mostly related to his back and hips, two areas which seem to have had fewer advances than say, knees and shoulders.

by Deelron :: Tue, 07/30/2013 - 2:24pm

They're certainly be better off today in terms of repairing those specific injuries, but who can say how their bodies (in the NFL in particular) would have held up with today's bigger/stronger/faster. Hell during Sayers career they still played the NFL/College all star game (not that the pros didn't dominate the last years, but the field wasn't littered with bodies like I'd suspect it would be today).

by RickD :: Tue, 07/30/2013 - 5:03pm

Bo Jackson was the most physically gifted athlete I've ever seen. I say that sincerely. I'm not given to hyperbole. He was better than Deion Sanders at both football and baseball. If a young Bo Jackson were in the NFL now he'd be rivaling Adrian Peterson.

As for Bill Walton, the NBA right now has less than a half dozen high quality centers. A healthy Walton would be 1st team All-NBA. This is such a down era for centers that the NBA didn't even include them as required starters in the All-Star game last season. Who is there now? Dwight Howard has way too many issues and is on the decline. I like Roy Hibbert but Walton's prime was considerably better.

by Will Allen :: Tue, 07/30/2013 - 6:21pm

Goodness, in terms of low post moves and passing, Hibbert isn't in the same solar system as Walton. Neither is Howard, for that matter. Also, Walton was a truly great defender when healthy. He used to give Kareem fits, relative to other defenders.

by Kyle D. (not verified) :: Tue, 07/30/2013 - 11:15pm

SI just did a Where Are They Now on Rony Seikaly. (He's a DJ at big-time dance clubs, of all things.) Seikaly said Howard was the only guy playing now who is anywhere close in terms of playing style to the centers of his era (and we're talking mostly the early 90s, so not the glory years of Kareem, Moses, Walton, etc.). As he put it, when he played there were guys who lived on the block and you absolutely couldn't get them off of it, either offensively or defensively, but now everybody just floats around the court and frequently don't even try to post up. He thought he'd have a much better career playing now.

by Aaron Brooks Go... :: Wed, 07/31/2013 - 12:19pm

For all of his objections, Duncan is absolutely a center. In fact, he's basically a healthy Walton, much like Sanders was a durable Sayers.

by Bright Blue Shorts :: Tue, 07/30/2013 - 2:38pm

Wonder if Terrell Davis would have been better off despite his injury happening only a little over a decade ago?

by Bowl Game Anomaly :: Tue, 07/30/2013 - 5:02pm

Probably yes. Sterling Sharpe, too.

by Theo :: Tue, 07/30/2013 - 5:21pm

if you see how guys can come back nowadays, even at the lowest levels of play, this is a sound 'yes'.

by Kyle D. (not verified) :: Tue, 07/30/2013 - 11:21pm

It's more recent cases like that which make you scratch your head about some of the comebacks we're seeing now. Has the medical side really improved THAT much in the past decade? Or have "other" factors made great strides? Cycling was actually trying to catch Lance Armstrong and he still never tested positive; the NFL puts in pretty minimal effort and hasn't even been testing at all for some things like HGH. I prefer just not to think too hard about that sort of stuff, but I still occasionally wonder about it.

by David :: Wed, 07/31/2013 - 9:52am

Technically, and I don't want to come across as a pedant here, but Armstrong did test positive for drug use (steroids, actually). By the rules at the time, he should have been suspended for two years, but a medical certificate was supplied (which was allowed) after the fact (which wasn't).

There are also strong indications that Armstrong tested positive for high haematocrit levels, and bought off the UCI with a bribe (though this is still denied by the individuals involved).

All of which is to challenge the assertion that cycling was trying to catch Armstrong. Unfortunately, it appears as though the UCI wasn't really trying, as he was making them too much money.

FWIW - I strongly believe that PEDs are still rampant in the NFL, across all teams, and all positions, and the league is really not that interested in stopping them

by akn :: Wed, 07/31/2013 - 12:30pm

Many of the surgeries/interventions have remained largely the same (the biggest surgical revolutions were scope-based procedures with flexible fiber optics 30-40 years ago).

What has changed significantly is the rehab process. Even 10-15 years ago, everybody was immobilized and rested, causing significant atrophy/arthrosis, which lengthened recovery time and affected final function. Now, rehab begins immediately after surgery, and in some cases, before surgery. This shift in philosophy has had profound impact on recovery, and explains most of the recent advances in sports rehab.

A word about HGH: while the theoretical benefit is clear, unlike steroids there exists no good evidence that HGH actually works as a PED or even a rehab agent. No double blind, placebo controlled studies, and certainly no studies with large sample sizes. In fact, the most recent studies have been unable to show any performance benefit. They show increases in lean muscle mass, but this was shown to be mostly related to water retention within muscles, not any increase in strength or speed.

I'm glad that the NFL is starting to implement HGH testing (personal opinion--this whole NFL-specific baseline stuff is BS), but I believe the NFL should be spending more time educating players about what the actual evidence really shows. Then ask them if the risk of suspension/loss of salary is really worth it.

by Aaron Brooks Go... :: Wed, 07/31/2013 - 12:20pm

His knee injury is still fundamentally unrecoverable, and his migraines would still be a problem.