On February 1, 2022 Tom Brady officially announced his retirement from the NFL. So today,
I am going to speak about injuries that he has suffered during his monumental career and discuss
the physical price that has been paid en route to Tom Brady becoming the greatest quarterback of all
time. Brady has reached a pinnacle of performance that only few have achieved, and it is unlikely
that this has occurred without some toll. So let’s talk about what the price for his success has been
and I will let you tell me whether the return on investment is worth the ultimate prize obtained.
First, let’s talk about the achievements. Over the course of a 22 year career,
Brady led the NFL in total yards passing with 84, 520. He also led with total touchdowns at 624.
He is the only player in the NFL to win more than five Super Bowls with a total of seven victories,
and he was the MVP of that game five times. He has also won the NFL’s MVP award three times.
He has been selected to the Pro Bowl 15 times. His lifetime regular season record is 243 wins
73 losses, while his playoff record is 35 wins 12 losses. His teams have reached the playoff
19 times and they have won 18 division titles. His conference championship record is 10 wins
4 losses, and in the Super Bowl his record is 7 and 3. He is the only quarterback to lead a team
to successive super Bowl wins, and Brady has won nearly 13% of all Super bowls ever played.
And although the performance of many athletes deteriorates with age,
Brady appeared, like a fine wine, to get better.
After the age of 37, Brady won 4 Super Bowls, and had a playoff record of 17
and 4. His overall record in his remaining years was 95 and 30,
with a completion percentage of 65.2%. He amassed a total of 35, 571 yards,
and 265 touchdowns during his last 8 seasons. And when compared to others in the 2000 draft class,
Brady had more success in his later years, than any of his peers over their entire careers.
In his final season of play Brady led the NFL in yards passing with 5316, completions with 485,
attempts with 719, and touchdowns with 43 despite the fact that the buccaneers were
defeated in the divisional round of the playoffs by the LA Rams.
This is a lot for any franchise to achieve, let one man. Certainly,
this success does not come without sacrifice. In fact, Brady was known for his work ethic,
intense exercise regimen, and his strict diet. NFL commissioner Roger Goodell said about him that,
“An incredible competitor and leader, his stellar career is remarkable for
its longevity but also for the sustained excellence he displayed year after year.”
The buccaneers general manager Jason Licht said it best when he noted that for Brady,
“to finish a 22-year career while still performing at his peak was nothing short of extraordinary.”
Retiring at the age of 44, after 22 seasons in the nfl when the average career length in the
nfl is 3.3 years, and the average career length for quarterbacks is only marginally longer at 4.4
years, just from the viewpoint of longevity alone,
Brady’s career is remarkable. Apart from the first 4 games in 2016 while suspended, and the
2008 season after he suffered a season-ending injury in the first game of the season,
Brady has been under centre for every game since starting his first game on September 30, 2001. His
durability is otherworldly with a career that has been five times longer than average for his peers.
Upon announcing his retirement brady thanked his franchise and their leadership,
his teammates, his coaches, his trainer and agent, and his family. He stated that his teammates,
coaches, fellow competitors, and fans deserved 100% of him, and felt that at this time,
it was best that he leave the field of play to those more dedicated and committed. While only
Brady and those closest to him will ever know the reason for his decision, his statement suggests
that his dedication and commitment were not what they had previously been, and that he felt
that he should make way for those who were. His statement did not say anything about his health or
injuries. Clearly, there is an emotional toll, one which Brady no longer felt inclined to pay.
But what was the physical price for this excellence and for the extended output of success?
Obviously, with a career that extends over 2 decades it is unlikely that Brady suffered a
multitude of serious injuries. However, as I have already mentioned, he has suffered season-ending
injury in the past, and he has had surgery on more than one occasion. The Draft sharks injury
predictor rates his durability at 5 out of 5, with 5 being the most durable. They rated that
his chance of missing 2 or more quarters of play in 2021 was only 5%, and that his chance
of injury per game was only 0.3%. In fact, when reviewing his injury history, Brady has had only 7
injuries of note during his 22 year career for an average rate of only one injury every three years.
The first injury that Brady suffered was one of his worst. In the first game of the regular season
in 2008, brady injured his left knee. [need injury info here] In only the first quarter of the game,
he suffered combined injuries to his ACL (grade 3 or complete) and his MCL.
The major ligament stabilizers of the knee include the cruciate ligaments that cross inside the knee,
the ACL and the PCL, the collateral ligaments on either side of the knee, the MCL and the LCL,
and a number of smaller accessory ligaments on either the front anterior,
or the back posterior aspect of the knee. The MPFL is one of the ligaments on the front of the knee.
The ACL resists posterior translation of the femur off the back of the tibia. This
means that it stops the thigh bone from sliding off the back of the shin bone.
It is damaged with hyperextension or rotation of the knee. The MCL resists valgus opening of
the knee. This means that it stops the knee from opening sideways toward the midline,
so it is damaged when the knee collapses inward. These ligaments, when damaged,
will create a characteristic pattern of looseness or laxity in the knee during direction change,
which kind of makes it difficult to move around a lot. Talking about being confined to the pocket.
These injuries would make a quarterback completely one-dimensional, which is OK I guess if your
offensive line is rock solid, and your receivers are ninjas. But if not, you are screwed. Now it
is possible for an athlete to play with these injuries using a custom-fitted ligament brace,
however, the brace offers only a degree of protection and it is not 100% effective.
At the top level of performance, bracing is not the standard first line treatment and is generally
only used for protection after the knee ligaments have been reconstructed. Brady underwent surgery
during the season and had his ACL reconstructed. [check if mCl also repaired in 2010 surgery]
There are several techniques that can be used to repair the ACL. But whether you
use a one- or a two-tunnel technique, or a trans-tibial or an all-inside approach,
there are generally 4 graft choices that can be used to recreate an anterior cruciate ligament:
the semitendinosus hamstring tendon, the patellar tendon, the quadricep tendon all
of which are taken from the patient themselves, or an allograft tendon from a donor. Although
the 3 types of autograft taken from the patient are generally comparable in terms of strength
and overall results, there is a tendency toward use of the patellar tendon graft
for AC reconstruction in NFL and collegiate level football players in North America.
At the time that his surgery was performed, it is likely that Brady would have undergone
a transtibial ACL reconstruction using a patellar tendon autograft harvested from his
own knee at the time of surgery. Given that rehab typically continues now for 12 months or more,
and his return to competition the following season, it is clear that his rehabilitation
was likely around 9 months following his surgery. Studies have shown that NFL and
NBA athletes don’t return to pre-injury abilities until 2 years after surgery,
which gels well with Brady’s performance after his return to play. Although he performed well
after his return, it was not until the 2015 season that he was able to garner another super bowl win.
Brady’s second injury was a stress fracture in his [which] foot during the 2010 season.
To be more accurate, this is when the stress fracture was actually diagnosed.
It is reported that he played much of the 2010 season with this injury, but given that he had
had symptoms in his foot for some time prior to his diagnosis, it is possible that this injury
dated back to 2008. Brady was able to complete the season despite his injury. He underwent surgical
treatment for the stress fracture in january 2011. Although surgery is not the typical first-line
treatment for this injury, the duration of time that this injury had persisted and
Brady’s elite level of competition are two factors that would have favoured a surgical approach.
When indicated, surgery for this injury includes an open debridement of the stress fracture site,
an open reduction and internal fixation of the fracture with either screws or plates,
and bone grafting of the fracture site to promote healing of the stress fracture.
Typical healing time after surgery is 6-8 weeks, with total recovery time ranging from 4-6 months.
The 2014 season was Brady’s worst in terms of durability. He suffered two injuries in
that season. During the pre-season prior to the season-opener, Brady suffered a left calf strain,
which is an injury to the calf muscle. A muscle strain occurs when the muscle fibres that comprise
the muscle have been stretched beyond their functional length. Minor strains occur when
the muscle fibres have merely been stretched, but not torn. Major strains occur when the
muscle fibres have been torn, either partially or fully. The natural history of muscle sprains
is that they are self-limited meaning that they recover on their own without surgical
intervention in approximately 6 weeks. Brady’s muscle strain was quite minor in nature as he
was ready to play for the season opener only a short time after the injury was reported.
His second injury that season occurred five weeks after he returned when he
rolled his ankle in practice on october 10, 2014. Brady suffered an undisclosed,
low grade ankle injury at the time. Given the mechanism of injury where he rolled his ankle
(inversion), it is likely that he suffered a Grade 1 ankle sprain. Like muscle strains, sprains range
from minor in nature (grade 1) with tissues that are stretched, but not torn, to major (grade 3)
where tissues are completely torn and stability of the involved joint is fully compromised.
However, strains affect muscle tissue, influencing contractility and strength, whereas sprains affect
ligaments, thereby influencing joint alignment and stability. Brady’s ankle injury was similarly
benign as his calf injury as he did not miss any games as a result. The natural history of ligament
sprains is generally favourable with a return of function within 6-8 weeks for minor injuries.
However, for more serious injuries, since the rate of ligament metabolism is generally slower
than that of muscle or bone, and since ligaments confer joint alignment and stability, more serious
injuries are often associated with problems of recurrent instability and more prolonged
recovery. In all likelihood, Brady’s injury was not entirely resolved on his return to play, but
was minor enough that with bracing and concurrent rehabilitation, he was able to perform adequately.
Brady’s next injury occurred in 2018 in the week leading up to the AFC championship game.
Only 3 days prior to the game on wednesday, Brady suffered a laceration to his throwing hand
(right) during practice. The laceration was deep and long enough to require stitches
for its closure after the wound was cleaned. However, it was not serious
enough to preclude him from playing in the championship game on sunday. It is hard to
know how this injury affected his performance when he was playing in the championship game.
It is conceivable that depending on its location,
a laceration, even if sutured, could limit his ability to grasp the ball as forcefully
as what he was accustomed to, which might in turn affect his accuracy. However, in hindsight, this
is not testable and will have to remain unknown. What is known on the other hand, is that Brady
did not make it to the Super bowl that season, for one reason or another. What do you think?
Do you think that his hand affected his play during the playoffs?
Almost two years later in his final season with the Patriots, Brady injured his right elbow, again
during practice, sometime during the week before the Nov 24, 2019 game. The injury was inlcuded on
the Patriot’s injury report, but it did not stop Brady from playing in the game against the Cowboys
on november 24. Without further information about the injury, it is hard to speculate on what it
might have been. However, Brady’s ability to play in the Cowboy’s game in spite of it
speaks to the minor nature of the injury, making it a low grade injury of some kind. Given that it
was the elbow of his throwing arm, I can conceive of two minor injuries that might have occurred.
One injury might have been a repetitive use injury of the elbow from frequent throwing, given that
this was later in the season when the injury occurred. This would result in a tendinopathy
of the flexor pronator muscles of the forearm which would cause pain at the inner elbow. This
injury would resolve with activity modification and forearm flexibility exercises and could
be managed in a way that would allow Brady to continue playing in a modified capacity, that is
to say, less throwing. Do you remember that game? Did Brady throw less or the same as usual? Let me
know in the comments. Another injury might have been an elbow contusion, that could have occurred
if his arm had contacted a teammates helmet while throwing in scrimmage during practice.
This would result in a contusion or bruise, that would cause pain in the elbow when the arm was
extended while throwing. This injury would also resolve with activity modification and supportive
treatment with rehabilitation and pain control. Game time management would be the same for
Brady. Do you recall his output being less than normal during that game? What are your thoughts?
Brady’s final injury occurred during early 2021. Well, it was actually taken care of in 2021,
although it had occurred sometime during the final season with the Patriots in 2019. On February 21,
2021, Brady underwent another knee surgery to repair an MCL injury to his left knee. This time,
the MCL had been injured in isolation. It had not immediately been unstable since
it had been managed non-operatively for more than a year after it had occurred.
However, eventually, he had come to the conclusion that the persistent
instability associated with this ligament injury warranted surgery.
For a right handed quarterback, an isolated MCL injury would be
problematic when rolling to the right with some degree of instability when throwing in
that direction. It could also be problematic when throwing from the pocket to the right,
when his back was to edge-rushing defenders, where the defenders,
or even his own linemen could roll up on the leg while planted, forcing his knee to the
inside. Unlike the ACL injury, an isolated MCL injury is much more amenable to bracing,
which can be used as the first-line treatment for athletes who cannot discontinue competition
after injury. In fact, only days after winning the 2019 Super bowl, the NFL Network's Tom Pelissero,
reported that Brady had played most of the 2019 season with some discomfort in the knee. Although
the injury was intially reported as a partial MCL injury by the Tampa Bay Times’ Rick Stroud,
Ian Rapoport, later reported that the MCL had been full torn. So it appears that Brady had
been playing with this injury for some time prior to his decision to have it operated on.
Bucanneer’s coach Bruce Arians reported that Brady had undergone
a simple clean up, suggesting that he had only undergone a simple arthroscopy and debridement.
However, Brady, who declined to give specifics about his surgery later stated that his injury,
and his surgery, were “pretty serious.” Although, it is quite possible that he had
his MCL repaired in the procedure, given the history of pain, not instability,
for the season prior to surgery, I suspect that it was intra-articular pathology within the knee,
rather than the ligament injury itself that prompted the surgery. Those who have suffered an
injury to the ACL in the past, have an increased incidence of arthritis of the knee in the future,
and an increased incidence of meniscal pathology following ACL injury. Given that Brady’s
initial ACL injury occurred in 2008, it is quite conceivable that 11 years later, his knee would
show some degenerative changes and possibly some meniscal pathology that would cause persistent
joint discomfort when vigorously active. “Pretty serious” damage would not be unusual for a 43 year
old quarterback who had already undergone knee surgery for an ACL tear more than a decade before.
“Pretty serious” damage might be enough to limit the shelf life for elite level competition to only
one more season. Which begs the question, was it a lack of motivation and competitive drive that
forced Brady to walk away from the game, or was it really the physical toll that had finally become
too steep a price to pay that forced him away. What do you think prompted his decision?
So in the end, Brady, arguably the greatest quarterback of all time amassed a collection
of records that supersedes that of several hall of famers combined. He demonstrated a durability that
extended his career 5 times the average duration, suffering only one major injury and having
undergone only 3 surgeries. He is the only athlete to have won the super bowl 7 times, and been the
super bowl mvp 5 times. He is the only quarterback to have guided his team to back to back
super bowl wins. He alone has one almost 1 in six super bowls and is the oldest quarterback to have
won the super bowl. And he is walking away from the game while his performance is peaking at its
highest level, and with relatively little damage to show for it. Only Brady can truly say whether
the scales are balanced at the time of check out, but from my point of view, I would say the return
on investment, after being overlooked and drafted 199th overall in 2000, was well, well worth it.
Thanks for watching and subscribing. As always,
that’s been a word from dr chris, not your everyday ortho.