You are a football GM who had a pick at the top of Saturday’s first round and a need at wide receiver. Who led your list? Well, prior to his March 4th surgery, the man had to have been Michael Crabtree. But, with the seventh pick on April 25th, the Oakland Raiders selected Marius Heyward-Bey out of Maryland. Why? Pure speed seems to be the answer. With Crabtree not having timed out head-to-head in the 40 at the combines because of a stress fracture in his fifth metatarsal, the competition was virtual. But it seems that Oakland didn’t look at the complete picture nor weigh the overall talents of each man for the job. That was San Francisco’s gain because, with the tenth pick, they made Michael Crabtree, probably the second best athlete in the draft (and a man gifted with his hands and his feet), a Niner. And what about Percy Harvin? He, of the other talented WRs, dropped down to 22 (picked by the Minnesota Vikings) at least in part because of a history of injuries and questions about his durability. So, who am I to comment? As a sports physical therapist who has worked with many collegiate, professional and recreational athletes during my long career, I’ve a thing or two to say on the matter…

Let’s start with Percy Harvin. Though he put up stellar numbers and didn’t miss more than 5 complete games in his three year college career as a Florida Gator, Percy Harvin’s musculoskeletal injury history includes April 2008 heel surgery to combat Haglund’s deformity (*), a condition that had plagued him since high school, a hairline fracture (originally thought to be a high ankle sprain) with which he played in January’s National Championship game, a hip pointer and patellar tendonitis. However, after undergoing a recent series of MRIs at the combine medical facilities, Harvin reported that all his tests were clean (except it seems that for marijuana, but that’s another matter entirely). On the other hand, he has also lost playing time to other unrelated medical issues that included migraine headaches, a concussion and sinus infection.

Harvin sees himself as a pure receiver and has been quoted as saying that his injuries tended to occur as a result of playing running back. Whatever the case may be, athletes who come off as ‘tweeners and especially those with an injury rap sheet (not to mention a history of any off-the-field issues) can be a risky investment, especially at the top of the salary chain. Though he has been described as a young man with great energy and perseverance as well as a relentless competitor, Harvin’s long-term future as a pro remains difficult to predict. The key phrase here is “long-term”. Though he may, as he has stated, have matured because of the adversity he has confronted, a predisposition to injury is sometimes beyond one’s control. Even a solid work ethic and expert medical care cannot always overcome the wiring of one’s genetic makeup. When that is the case, adversity can lead to more adversity…Coping mechanisms and perseverance aside, the bottom line is playing time and numbers.

And then there is Michael Crabtree. Though he opted out of Pro Day, and some have questioned his ability to rebound from March surgery to repair a stress fracture (**) of the fifth metatarsal of his left foot, Crabtree seems to have played it smart and safe. The stress fracture was reportedly discovered during routine MRI testing at the combines after Crabtree had recently completed a speed-training program to improve his time in the 40 (he hadn’t shown quite the quick burst that Harvin nor Heyward-Bey have exhibited). Crabtree claimed in interviews not to have experienced pain due to the fracture but is also quoted as having said that he thought his foot was simply sore after a season of play. Still other reports (see CBS Sports NFLDraftScout.com) had him playing through “nagging foot and ankle woes” for much of the ’08 season. Well, which was it? The latter seems most likely.

As I tell my patients, soreness registers on the pain scale, albeit at the lower end. Playing with pain (or causing pain with rehab for that matter – with the exception of that to restore range of motion), and therefore not listening to one’s body, is generally a hindrance to recovery and is likely to lead to a more chronic problem, if not one that is exacerbated. Playing with pain is something football players, as well as other athletes, do all the time however. Of course, that doesn’t make it smart in terms of their long-term muskuloskeletal wellbeing or general health but it is a fact of life in the big-business world of sports, especially in the stretch run for a title or championship.

As for predisposition to injury in general, it is important to note that any imbalance or deficit, whether in strength, joint range of motion or muscle flexibility, can increase the likelihood an athlete will experience injury. The physical stresses caused by intense training and play serve to heighten the effect of any limitations and create a natural compensation that transfers those stresses to other areas of the body which can then also break down. Playing with pain can have the same impact. As a result, athletes such as Percy Harvin may have experienced knee issues as a result of playing on a painful ankle.

Okay, back to Michael Crabtree. In his two seasons at Texas Tech, Crabtree proved himself a model of consistency. A dedicated competitor, who it’s been reported works diligently on all aspects of his game, Crabtree put up amazing numbers in ’07. Though his numbers weren’t quite as lofty in ’08, Crabtree still had a standout year. But, what about that stress fracture…

Then there’s Heyward-Bey waiting at the finish line of the 40, no crutches or CAM boot in sight. But is he the skilled player that Crabtree has proven himself to be? By most accounts, well…no.

So, Michael Crabtree, Heyward-Bey or Percy Harvin? Until the rehab jury is in and we look back after a few seasons of NFL competition, we are only guessing. Also, without the opportunity to perform my own physical assessment of each athlete I have to go only on what I’ve read. But, that said, with my first round pick and a void at wide receiver I’d have gone with Michael Crabtree. San Francisco can thank Oakland for a gift likely to keep on giving.

(*) Haglund’s Deformity involves a bony protrusion on the back of the heel bone (calcanius) that generally leads to an inflammation of the bursa in this area. A bursa is a fluid-filled sac between tendon and bone. Harvin’s Haglund’s deformity, which caused the soft tissue near the Achilles tendon to become irritated, had previously been misdiagnosed and treated as Achilles tendonitis.

(**) A stress fracture, may not show up on x-ray until the bone’s attempt to heal around the fracture site is visible. The stress response or fracture (there may not be an actual hairline crack) is generally due to repetitive/cumulative stresses to an area that results in breakdown if the response of the bone cannot balance the degree of stress. Rapid alteration of the speed, duration, incline or method of training; different training shoes, etc., can all contribute to a predisposition to stress fracture. Surgery for a fifth metatarsal stress fracture is more prevalent in the treatment of professional athletes who cannot afford the healing time that is likely to be required with conservative management of the condition. An excellent article on stress fractures can be found at http://www.theacc.com/genrel/092005aaf.html.