(Al Tielemans/SI)

Faces of Football:
Dr. James Andrews

As an orthopedic surgeon and the go-to ACL man for football’s elite, James Andrews has had arguably as big an effect on the game of football—extending the careers of men like Peyton Manning, Drew Brees and Adrian Peterson—as any other person. By day he saves the athletes who play the game he loves, serving additionally as the team physician for Alabama, Auburn and the Redskins. In between, he finds himself weighing the game itself. Where is it headed? What have we learned? What can we possibly do to make football safer? In mid-October, Andrews, 74, in a checkered suit and wearing a foosball-sized championship ring, shared his wide-ranging thoughts.

Football is. . . a collision sport. Not a contact sport, a collision sport. And we’re always going to have injuries. But we have to continually look at what we can do to keep the injuries at a minimal rate.

Let me preface my remarks with: I’m in love with football. Oh yeah. Hell, I’m glued to the TV on Monday, Sunday night. My wife is too. In the south, football is a social event. The whole family goes. That’s my favorite sport. Any level—high school, college, pro—that’s where you’ll find me, watching football. Now that you know where I’m coming from. . . .

If we started a new sport today and we wrote up the rules and regulations and we called it football, they probably wouldn’t allow it. We’re all trying to do everything we can to make football safer, but that’s the way the sport is: There are always going to be injuries. We’re aware of that, and we’re all working to keep it that way. We want it to continue, believe me.

(Mari Darr-Welch/AP)

I’ve been around football since college, at LSU. And I’d say that since 2000—with our athletes getting bigger and stronger, hitting harder, running faster—injuries have really escalated. There’s so much emphasis on being the best you can be now, and a lot of that is driven by the dollar. There’s so much at stake financially to play professional football, both for players and coaches. It’s made the drive to win and to hit harder, run faster, be better—it’s escalated that.

Just look at the size of these players today. I look back at old programs from when I was at LSU and we won the national championship. Guess who weighed more than anybody else on that whole team? Billy Cannon. The running back. He was 205. That just shows you where the game has gone. You get a 350-pound lineman falling into your running back’s knee these days and something’s gotta give. All of that has created a need for figuring out how to prevent injuries.

Hell, look at the quarterbacks now. They’re 6’ 5”, 6’ 6”, 6’ 7”. . . . Look at the tight ends: 6’ 7”, 260 pounds and running 4.6 40s. And it’s going to continue. Will we have any 8-footers? Who knows? I wouldn’t doubt it. It’s been that way through the history of mankind. If you go back 150 years, door frames were only about two-thirds the height of that door frame right there (pointing).

If we started a new sport today and we wrote up the rules and regulations and we called it football, they probably wouldn’t allow it.”

I probably got a concussion once, but we didn’t know what a concussion was in those days. I got hit in the head with an elbow once. We had a guy at LSU named Fred Miller who was an All-America, later played for the Baltimore Colts for 19 years. Offensive, defensive tackle. On one play I was on defense and I fell down in front of him and blocked him by mistake. Then we got into practicing extra points and he decided to get even with me. I ran in to try to block a kick and he caught me like this (he demonstrates an elbow to the eye). You can probably still see the scar. I left him alone from then on.

On Mondays, I’m picking up the pieces from the college and pro games—the wreckage. This Monday morning my phone started ringing at 6 a.m. So and so got hurt. . . Can we send you an MRI? . . . I need some advice. That goes with the territory. Most of it is people looking for advice about some problem I don’t even know anything about, like the spine, which I don’t do. I probably get anywhere from 20 to 40 calls on a Monday. What I’ve learned to do is: When I finish work on Monday and I’ve got all these calls to return, rather than make my wife mad at me for being on the phone I’ll pull in the driveway, sit in my car and make all my calls. The problem is we’ve got two dogs and when I drive up they start barking. Now she knows I’m out there. So it doesn’t work 100% of the time.

(John McDonnell/Getty Images)

To make the game safer we have to start at the youth level. In sports, unfortunately, a lot of the emphasis is on the most elite level—but a lot of the injuries at the elite level actually started when those athletes were kids. And they’re more preventable when you’re young. We used to think kids were less vulnerable to injury because they’re young—they can bounce off the floor, it doesn’t hurt them. But that’s not true. They’re more vulnerable when they’re young. And a minor injury when you’re young can become perhaps a major injury. I saw a major league pitcher today with a bad elbow; I’m going to operate in the morning. He had a problem with his elbow when he was 13 and it’s compounded through the years. So instead of having a 25-year-old pitcher’s elbow, he has a 40-year-old pitcher’s elbow. Same thing happens in football. Most of the concussions are at the youth level. The percentages are higher. And when they occur at the youth level they really need close attention because you’re trying to prevent a second occurrence. If you don’t, the [kid] will get more and more, all the way up to the NFL.

(Al Tielemans/SI)

Look at the deaths from youth sports. Four states lead the way: Georgia, Florida, Texas and California. They produce as many catastrophic deaths—mostly in football—as all the other states combined. That’s because of year-round sports; those are sunshine states.

Will football go away? I doubt that’s going to happen. It’s part of the American culture. We may have to revamp it to some degree, but I don’t think you’re going to see us playing flag football only. Nobody’s going to watch that. . . . There’s always going to be room for collision sports. Its been that way since way back in the Roman days. It’s probably going to continue that way.

Flag football is a good way to play, but the problem is that most places are doing that in addition to tackle. They’re playing that in the summer months, before they’re allowed to start high school football.

You know the old saying, If you take your helmet off I’ll take mine off? That would help make the game safer. But nobody is going to do that.

Violence—that’s what filled up the Forum in the Roman days. And that’s where football came from. People like that.”

Let me tell you the things you should do in football. They’re very simple. You shouldn’t have any contact practice until after the sixth day of preseason practice. That acclimates kids for concussions, the heat, cardiovascular problems. . . . You should limit your contact days to two days a week, preferably one day a week. Don’t hit every practice day. Some teams hit Monday, Tuesday, Wednesday and even on Thursday before a Friday game. But Ivy League schools have stopped contact during the week completely, as I understand. That’s a little bit extreme, but that tells you: Smart coaches aren’t having contact three or four days a week anymore.

We have to teach kids how to play fair. There’s still that mentality in football: Let’s knock him out of the game. Let’s take a cheap shot. We need to not allow that to happen. We’ve got rules about this, and the rules need to be enforced by the referees. A couple weeks ago Cam Newton kept getting hit, two or three times, helmet-to-helmet. People thought he had a concussion. And the announcers made the excuse that the hits were so fast the officials couldn’t see them. What they should do—we do it in college—is if there’s a suspicion of targeting, we stop the play, look at the replay and decide. They need that same rule in the NFL. It’ll slow the game down and they don’t like that because you’ve gotta finish a game in three hours. But for safety reasons, if they they’re suspicious of targeting they should look at the damn replay, figure it out and call the penalty. They’re not doing that in the NFL.

(Aaron M. Sprecher/AP)

At the same time: Referees get so much into the game that they ruin football. A flag every five minutes, or every other play. . . . Some of those flags are not for safety purposes, and those need to be eliminated. All these holding penalties that are so minimal, we need to do away with some of that and have more rules that are related to safety. Let ‘em play, I guess, is the phrase.

I know our commissioner is all for safety. He’s trying to do everything he can to make sure that happens. Thank goodness.

Will football go away? I doubt that’s going to happen. It’s part of the American culture. We may have to revamp it to some degree, but I don’t think you’re going to see us playing flag football only. Nobody’s going to watch that.”

Violence—that’s what filled up the Forum in the Roman days. And that’s where football came from. People like that. They like the contact. We just need to try to keep it as safe as possible. You’re always going to have injuries. But professional football players have more coverage for injuries at a high level than any other sport—multiple doctors on the sidelines, multiple specialists, independent neurosurgeons, spotters. . . . The problem is we don’t always have that at the high school level, or below. We have to mandate athletic trainers in all public high schools. A lot of these small schools—particularly in rural areas like where I’m from in Alabama, Georgia, the panhandle of Florida—don’t have athletic trainers, and those are the first people, typically, to pick up an injury and keep it from being compounded.

Coaches don’t want to do anything that decreases performance level. They’ve been the missing factor in most sports medicine presentations. I’ve tried every trick I know to get coaches to come listen to injury-prevention talks. You almost have to trick them to come. They have a taboo about even talking to a team doctor. Maybe they’re afraid that brings them bad luck. We’re there to help them.

Before surgery once, an NFL player said, “I don’t know why the hell I play football.” But as soon as they’re up and going, they want to play again. One of them woke up from sedation hollering for his mother—a big old defensive tackle. A week later, he wanted to play. That’s part of the mental recovery from being hurt. That takes a little while.