Football is a violent game, and injuries are inevitable. Doctors and athletic trainers work to discover techniques to minimize problems and enhance healing once they occur, but it's not a perfect world. Sometimes the best minds struggle to find proper solutions.
For instance, there has been concern at Illinois in recent times about recurring stress fractures. Illini football athletic trainer Nick Richey is perplexed about the problem but has discovered he is not alone.
"Because we were in a situation where I wanted to make sure we weren't crazy, I sent a survey out to about 50 different Division 1 football programs. I was comforted to know we were in the same boat everybody else is, and doing a lot of the same things that everybody else is doing from a surgical intervention standpoint to rehab to return to play, shoes to training surfaces, everything.
"We were maybe a little more cognizant of the issue because it was boom, boom, boom for us. What we've had here with a couple of guys, we're no different than anybody else. For whatever reason, all of ours hit within about 18 months of each other. It was kind of a tough pill to swallow. We were scratching our heads trying to figure out what we should do to change this."
Illini senior fullback/tight end Zach Becker is one of those with recent problems. He has seen minimal action in more than 18 months, and he has endured multiple surgeries on his feet. Richey has been working with other support staff to find solutions.
"We've done a lot here working with Nike and our nutrition staff, working with the coaches and everybody involved to evaluate playing surfaces, shoes, training techniques, dietary habits and different vitamin and mineral intake levels to look at what has been going on here."
Shoes became a major focal point in the evaluations.
"We worked with Nike to see what kind of shoes our kids were wearing, how much time they were spending in those shoes, how many days a week we were training certain techniques and agility sessions. Trying to put together a comprehensive look at the program to see if there were changes we needed to make.
"Coach (Ron) Zook has been great working with us to enforce to the guys, 'Now we're going take a certain shoes out of circulation and make further suggestions for shoes based upon position and weight. It's gone as far as talking about adjusting winter workouts each year and altering the amount of days we do certain things."
Nutrition must also be considered a factor.
"We've had several guys who have spent time with Susan Kundrat our dietician, and she's wonderful. She spent a lot of time with our kids, and I think we've made some headway there."
Becker now appears ready to make a contribution again this fall, barring another setback.
"Knock on wood, Zach's doing great now. He's having no problems. He participated at a limited level toward the end of spring. We just need Zach to continue to get better for us."
Cornerback Terry Hawthorne suffered a stress fracture in his foot shortly before the start of the 2010 season. He was eager to play and made the effort to return quickly, but he suffered a relapse and wasn't at full speed until the Texas Bowl. Even when proper procedures are followed, there is no guarantee the problem won't resurface.
"When Terry went back the first time, Terry was close to 100%. The protocol we followed with him is the same protocol that 90-95% of the football programs in America would follow.
"It was kind of luck of the draw I guess. It happened, and we had to deal with it. Terry's been great to work with. He followed our instructions implicitly. He just maybe needed a little more time."
Concussions are becoming a major problem at all levels of football. Despite major improvements in helmets, the strength and athleticism of the players, accompanied by the violent nature of the game, take their toll.
"We have a concussion policy here. I think trend-wise, we had less episodes of concussion here this year than a lot of other schools in the Big 10. That is because we, along with the equipment staff, have worked diligently, one at maintaining our helmets, and two evaluating the helmets the guys are in.
"Trent (Chesnut, equipment manager) does a great job with fit and finish as far as making sure a particular chin strap is the right one, or that a particular face mask is better than another one for a certain guy, or depending on the position, certain helmets are more recommended for the position you're in, so we change it."
The Illini had been relatively free of concussion problems until a couple instances this spring.
"It may just be the luck of the draw too. We may have more concussions this spring than we did in the fall. I think we'll see that those things will be cyclical. Those numbers will fluctuate from year to year, like a lot of the other injuries we have.
"We may have a run on shoulders one year and then not have any the following year. We may have a run on ACL's and then not have any the following year. There's an ebb and flow to injury patterns."
Concussions are of special concern because they involve the brain. The potential for permanent damage is too great to take chances. There is no way of estimating how soon a concussion victim can return to play. The level of severity determines when they can be cleared for action.
"It's got to be the doctor's decision. In the end, we see this in all concussion policies around the country. The ultimate return to play decision is by the team physician.
"There can be athletic trainers, neuropsychologists, neurosurgeons, psychiatrists all involved, and they can pool their information and report back to the team physician. Once the team physician is satisfied with the information provided, he can grant a return to play."
In part 6 of this 8-part interview, Richey discusses his role caring for surgically repaired knees.