In more than 30 years as the Steelers' team physician, Anthony Yates has seen countless instances in which injured players face the complicated decision of whether to go back into a game. Just like the case involving Redskins rookie quarterback Robert Griffin III in Sunday's playoff game against the Seahawks.
"There is a multidirectional communication that happens," said Yates, president of the NFL Physicians Society. "The player is advised of his status, the pros and cons of playing, and the player assesses this in terms of the value of the game. All these features go into making a decision, as to whether a player can go or not. Everyone goes in with their eyes wide open."
Coach Mike Shanahan has been criticized heavily for allowing Griffin to continue playing when it was clear that Griffin, who had a mildly sprained lateral collateral ligament (LCL) in his right knee, was struggling. His knee buckled, and an MRI on Monday revealed tears to the LCL and anterior cruciate ligament (ACL). He underwent reconstructive surgery on Wednesday, and his surgeon, James Andrews, said it's "everybody's hope and belief" that Griffin will be ready for the 2013 season.
Shanahan insists the Redskins' medical staff cleared Griffin to keep playing, and that Griffin said he desperately wanted to help his team.
"Robert's our franchise quarterback, and I'm not going to take the chance on his career to win a game," Shanahan said. "But I also know that when you've got the belief in a guy, and you feel he can play at a certain level, and the doctors are telling you that he's OK to go in, then you've got to do what you think is right."
While not commenting specifically on the Redskins' case, Yates said doctors and trainers work with player and coach to determine whether it is prudent to take someone out of a game.
"I respect the Redskins' medical staff immensely, and I would think that throughout the league itself, we do not take this responsibility in a cavalier fashion," Yates said. "These are high-priced, thoroughbred athletes. It is standard operating procedure to make sure everyone knows what's going on."
Yates said if a coach defies a diagnosis and puts an injured player back in a game, doctors are encouraged to come forward. He said he has not received such a complaint since becoming physicians society president in 2011.
"I can assure you that as president I have the ear of the commissioner (Roger Goodell) should a member of the NFL Physicians Society brings this to my attention," Yates said. "I've been doing this for 35 years, and coaches say, 'I need this guy,' and we still do the right thing. Although we're employed by the clubs, we still have that player-patient relationship, and it's that person we look at when we go with, 'You can't go.'"
Former Steelers coach Bill Cowher suggested Shanahan might have been better off taking Griffin out once he saw how limited he was.
"You look at it and says he can go, but you watch him play and say, 'I'll show you tomorrow on tape,'" Cowher said. "You may think you're (playing effectively), but you're really not. You're not in a position where you can protect yourself. These are calls you have to make, but it all starts with one decision, from the medical staff. Is this guy cleared to be able to play? And from there you have to go to the player."
Former Giants quarterback Phil Simms said Griffin faced the same dilemma as so many others over the years by trying to play through pain and injury.
"When you're a quarterback and you're hurt, of course it's going to affect you physically. But what people don't understand, it affects your mind," Simms said. "You can't think as clearly. You don't make the right decisions on who to throw it to, so it changes everything.
"I never played injured as bad as he is, but I played hurt, and there is one thing that always happened when I played hurt: I played awful — awful — every time. Because it was too much to overcome, worrying about, 'Oh, I have to plant my foot, throw early, do this,' and then you can't physically perform the way you want to, so that affects your whole confidence.
"It just stacks a lot of things up there, and I saw all those things in Robert Griffin III the last couple of weeks."
Yates said decisions on playing with pain and/or injury have to be part of a collaborative, but often come down to the player himself in all but one area.
"The only black-and-white medical situation where we will tell the player he cannot go in is in the realm of concussions," Yates said. "The other decisions are made in an individual setting, and career decisions are made with the player intimately involved. Players make these decisions regularly."
The NFL Players Association has advocated that independent neurologists attend games and regulate players' availability related to concussions.
"You can't get an independent person in there to make a decision on people they don't know," Yates said. "The physician provides continuity of care. You need to understand what the kid's going through in the 20 games he's played in a season."