We’re mostly in the dark when it comes to surgeries players undergo. Those of us on the outside are forced to rely on whatever we can find on the internet pertaining to rehab schedules and timetables to return from injury.
49ers quarterback Brock Purdy underwent surgery on March 10 to repair his UCL. To get a better idea about Purdy’s rehab process, I sat down with Dr. Jeff Dugas, an orthopedic surgeon who did the same surgery on former Niners quarterback Nick Mullens.
Dr. Dugas spoke about the difference between reconstruction and repair surgery, how difficult it is to deliver the hard truths in sports medicine, and everything Purdy will go through during these next six months.
Dr. Dugas works with Andrews Sports Medicine, where they have a home base in Birmingham, Alabama. He used to work at the same high school that Nick Mullens went to, which explains their connection. There are over 14 orthopedic surgeons and they have six clinical locations.
My first question was about Purdy’s swelling. Five weeks after the NFC Championship, Brock was still suffering from swelling. On the outside, we’re wondering, “why hasn’t Purdy had surgery yet? What’s going on?”
Should we be concerned that the surgery was delayed due to swelling?
You don’t want to operate on a limb with a lot of swelling where the motion is limited and there’s enough pain. You may be making the rehab process more difficult. So, we tend to wait, and this is true for all joints, ACL’s, UCL’s, shoulders, ankles especially, hands and wrists.
If there’s a lot of swelling, you have to let that swelling come down, or else you’re going to take some risks with skin, with infection, with loss of motion, pain, stiffness. Even though you want to get going because there’s a timeline and various people are going to get this thing going, you always have to do what’s best for the patient.
I have not spoken to Keith (Dr. Meister, who performed the surgery on Brock), but Keith is an elite elbow surgeon. He’s one of the best in the country. If he made the decision that this needed to wait a little bit, then it was probably for a really good reason.
Follow-up, what are some potential outcomes if you were to operate on a limb that was swollen?
I’ll give you an example in the knee. Sometimes the knee doesn’t want to move very well. You don’t want to walk on it. They’re real painful. Real stiff. Hard to bend. If you go and operate on that knee, as opposed to the ACL, that has great movement.
Surgery is perceived by the body as an injury. So if you’re going to go operate on that knee (the good one), and it’s ready for it. If you operate on that blown up knee, that really angry knee, you may be setting them back further than setting them forward.
You may have fixed the problem, but you may have created a longer recovery path for that person by doing it quickly. I tell people sometimes six weeks of waiting may save you three or four months of rehab.
So even though it sounds backwards, you’re going to wait a little bit, and you will get better quicker. That’s a decision I’m sure Keith was very comfortable making, and I’m sure he made the right decision.
Quite honestly, if I was giving Brock advice, my advice would be don’t prioritize game one. Prioritize the season. Prioritize your career.
I think that the people around Brock were probably giving him really good advice about seeing this as a long-term play, and not a short-term play. The timing of the surgery is less important than the long-term view of this.
The failure rate does not exist
According to Dr. Dugas, these UCL repair surgeries only began in 2013. It used to be your only option was reconstruction surgery. Here he is answering the question about whether this surgery will last:
Your ligament was built to last. It was designed that way. When you were born, it was designed to last you a lifetime. If it didn’t, it was because of an injury that you had. But if the tissue is still good, now you’ve got what was designed to last you a lifetime.
So, you’ve got an augmented situation from where you started. We don’t really see these things deteriorate over time. We haven’t seen that. The failure rate is not accelerating over 10 years. It’s not. It’s the same. So, that tells us the answer to that question is no. Just because it’s only been 10 years, relative to 50, it’s not going to deteriorate over time.
What will the next few phases of Purdy’s rehab look like?
I don’t have the benefit of knowing what the tissue looked like or how confident the position Dr. Meister is with letting him throw, what the throwing program he’ll be on in terms of returning to throw. I don’t have the benefit of knowing that.
I can tell you the order of operations after any operation. The first priority is healing. Typically, in that first 6-to-8 week period, we’re using some form of protection brace. We’re not really immobilizing them. We’re cautiously moving them with protection.
The idea is to get range of motion back while it heals, without putting any stress on the repair. Notice nowhere in there did we talk about strength. The priority in the first part of this is healing and range of motion.
Then we move into the next phase and we work on strength. Not just muscle strength, but the strength of the repaired tissue. They’ll start doing things called plyometric drills where they’ll use small weighted balls to push the tissue that’s healed, that new tissue in there, to push it a little bit to try and push it to fail.
Somewhere in that timeframe is when we usually let them do jogging or legwork. That’s usually in the middle section of the recovery. And then we get to more of the functional part of the recovery, where he’ll start working on more sports specific activities.
Is the 3-6 month period as simple as Purdy ‘getting back to normal?’
I’ll tell you how I did it with Nick [Mullens] and how I’ve done it with other quarterbacks. Let’s say we’re in-season. In-season is when you play a game on a day, and for the NFL, let’s take Sunday as the day.
You play on Sunday, you’re throwing 40 balls at full speed. Various distances, multiple parts of the field, different depths. You’re handing the ball off, you’re getting tackled. You’re fatigued. You’re running for three hours.
Monday, you’re not doing anything physically. You’re taking the day off. You might do a little light jogging, but you’re probably in the training room. Tuesday, you’re going to do a little bit, throw a little bit. Wednesday will probably be your biggest day of throwing. You’ll be in shells [shoulder pads and helmets]. Thursday, you’ll throw a little bit. Friday, you’ll probably travel. Saturday is a walk-through, and Sunday you play again.
So, in there, there’s three days in a row where he’s throwing some. Before he can get back to an NFL season, he’s got to go through a week or two, and maybe even more, of that cadence where he’s throwing balls anywhere from five yards to 50 yards, 60 yards.
Throwing velocity, touch passes, spot passes, out patterns, velocity over the middle. He’s got to throw in different angles, moving right, moving left. So, he’s got to be able to throw from different types of positions.
And to get to that point, where he can get to a simulated week, he’s got to have done all that. With Nick, we really pushed him to be feeling comfortable with range of motion and all that.
We delayed his throwing because we weren’t on a tight timeline. We wanted to make sure he felt comfortable where he had his body ready to throw, his shoulder ready to throw. That’s the other part of this, rehab wise, you can’t be ready to throw when just the elbow is ready, you have to have the whole body ready.
It’s not just when can he throw? It’s when can he throw from multiple angles and different depths and velocity? When’s his accuracy back? How much volume does it take to get that back?
The question is not if, but when
Brock is a competitor. He wants to play quarterback for the 49ers. He’s committed to that. I think this whole thing is set up for success. The question is not if. The question is when. And that’s a question we can’t answer right now.
I think Brock has the skill set. He has the drive, the personality, the toughness, the football brain. The ability to throw a football will come back. It’s not a question of if, it’s a question of when.
It doesn’t really matter at this point because he’s going to get back.
You can watch the interview in its entirety above.