Open letter to Tom Brady: Protect your other blind side


Dear Mr. Brady,

Congratulations on your MVP caliber season thus far!

As of this past Sunday, your team, the New England Patriots is 12-2 and you’re at the top of your game. You lead the National Football League in passing yards and for the 7th consecutive season, your team has wrapped up the AFC East division leading to yet another playoff run.

And you’re doing this with many of your offensive weapons having spent weeks on the sideline with various injuries (1). Through all of this, your team has persevered with the “next man up” and the oft-quoted “Do your job” mentality.

The talking heads have said, “As long as they have Bill Belichick and Tom Brady, the New England Patriots will always have a chance to win.”

Your intense game-day preparation and a strict training regimen as documented in a 2014 Sports Illustrated article seem to be paying off.

However, as an ophthalmologist and life-long Boston sports fan (2), I must take issue with one small aspect of your training.

I must warn you about the danger of exercise bands.

It’s well known that you prefer exercise bands to free weights for resistance training and you’ve been seen warming up on the sideline during games with elastic bands to stretch out. Now, it’s not the bands themselves that concern me, it’s what they can do to your eyes.

These elastic bands consist of latex strips of varying lengths. With repeated use, the can weaken and eventually break. When they are under tension, a broken elastic band can recoil and strike your eye. In other cases, the elastic band can inadvertently slip from where it’s anchored and fling towards your face.

As a retinal surgeon who covers the Level 1 trauma center in Austin, Texas, I’ve seen plenty of sports injuries to the eye. More recently, cases of elastic band injuries smacking one's eye have come about.(3)

These injuries are similar to ocular injuries caused by bungee cords (4) where the maximum velocity (5) can reach 74.3 m/s or about 1.5x as fast as a Nolan Ryan fastball. Given that the cord is only a few feet from your face, you won't be able flinch and get out of harm’s way.

I know that you play in one of the more violent contact sports we have. It seems that season ending knee injuries fill up every Monday morning’s injury report wreaking havoc on fantasy rosters. The NFL concussion epidemic has littered our 24-hour mainstream news cycle prompting parents across the country to pull their children out of youth leagues. Will Smith just made a movie about it.

In comparison, getting smacked in the eye seems more like a freak accident that is unlikely to happen… except that it does happen.

And when it does, the damage it can do is severe.

The estimated amount of transmitted energy an elastic cord can deliver is about 60.7 Joules.(5) I’ll admit, I have no idea what that amounts to in a Newtonian physics sense, but I have seen what it can do to one’s eye.

When an elastic cord or any blunt force hits the eyeball with that amount of power, for a split second, the eyeball compresses and snaps back into place. It's this jarring action that can lead to serious ocular complications.

This impact can lead to a shearing force that can rupture the muscle tissue and tiny blood vessels in the iris (the colored part of your eye) causing a hyphema (or bleeding into the front of the eye) leaving one with a temporary loss of vision.

The force can also transmit to the vitreous jelly which fills the middle of the eye. The vitreous may in turn pull on the retina leading to a retinal tear and bleeding into the middle of the eye (vitreous hemorrhage) or possible retinal detachment.

If the initial impact on the eye is strong enough, it can transmit this energy to break the bones encasing the eyeball leading to orbital bone fractures.

Worse yet, it can cause a ruptured globe where a large laceration allows the internal contents of the eye to be expulsed out putting it at risk for infection and potential loss of the eye itself.

With any of these, it will be difficult to read defenses and call the necessary audibles. “Rex Ryan!”

Enough medical speak. Let me translate into football talk:

Corneal Abrasion: Out at least 1-7 days with serious eye discomfort.

Hyphema: Out 1-2 weeks; frequent eye drops and limited action until it clears.

Fractured orbital bones: May need surgical repair. Out 3-6 weeks.

Vitreous hemorrhage: May clear in 1 to 12 weeks, but blood can persist leaving floaters in your vision for several months and up to a year.

Retinal Detachment: Will require urgent surgical intervention. Out 3 to 12 weeks with the potential for permanent vision loss. If a gas bubble is placed, no flying and so you’ll be watching away games from home, possibly with your head in a face down position.

Ruptured Globe: Requires immediate surgical intervention. Out 12 weeks and you may even lose the eye, much less play football again.

Listen, I’m not advocating that you stop using exercise bands. In fact, you should continue to do whatever you need to do to prepare. It’s worked thus far.

But if you do continue to use them, you’ve got to wear eye protection.

Put on your helmet or sport goggles made of polycarbonate while warming up and that will reduce the risk of ocular injury. I’m telling you this because, with all these players filling up the disabled list this year, the Patriots Nation needs a healthy Tom Brady for the final push come January.

Sincerely,

Robert W. Wong, MD

Board Certified Ophthalmologist specializing in Vitreoretinal surgery and Pats Fan

Citations:

(1): Julian Edelman, WR#1 out with broken foot; Dion Lewis, RB#1 out for season with torn ACL; LeGarrette Blount, RB on season ending IR for thigh injury; Danny Amendola, WR#3 out one game with knee injury; Rob Gronkowski, TE#1 out 1.9 games with knee injury; Brandon LaFell WR#2 missed 6 games on IR; Aaron Dobson WR#4 season ending IR; Scott Chandler TE#2 out 1 game with knee injury; Offensive Line: Too many to list...

(2) Homer alert! Born in Brighton (St. E's!) and grew up in Lexington, MA. Yes, I remember the Grogan and Eason years.

(3) Joondeph SA, Joondeph BC. Retinal Detachment due to CrossFit Training injury. Case Reports in Ophthalmological Medicine. 2013: 1-2.

(4) Cooney MJ, Pieramici DJ. Eye Injuries Caused by Bungee Cords. Ophthalmology. 1997; 104: 1644-7.

(5) Litoff D, Catalano RA. Ocular injuries caused by elastic cord [letter, comment]. Arch Ophthalmology 1991; 109: 371-2.

#trauma #sportsinjury #nfl #nflinjury #concussion #exercise #eyewiki #eyeinjury #elasticbandinjury

Robert Wong, MD
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