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The Doctor Is In: Was Tomlin Right Or Wrong To Hold Ben Back?

The Pittsburgh Steelers suffered a crushing loss yesterday in Oakland, losing to a team that had a 2-10 record coming in to the Sunday afternoon matchup.  A lot went wrong, all of which contributed to the Steelers finding themselves now at risk for missing the playoffs.

One of the most controversial decisions was Steelers head coach Mike Tomlin keeping future Hall of Fame quarterback Ben Roethlisberger on the sideline while backup quarterback Joshua Dobbs struggled to convert 3rd downs without the help of their starting running back, James Conner, who was out with a sprained ankle.  We may never know exactly what the true reason was for Tomlin holding Ben back, but here’s my Monday speculation based on my medical background and a long history of following this team’s triumphs and misadventures (with the usual obvious disclaimer that I do not have access to Big Ben’s medical records and have never treated him as a patient).

Let’s start with the facts:

With 5:15 left in the second half, Ben was sacked on a 3rd and 9 at the Oakland 15.  He finished the half with a TD pass to JuJu Smith-Schuster with 10 seconds left.  Without waiting for the extra point, Ben jogged to the locker room with Dr. James Bradley, the Steelers team physician.  He was subsequently reported to have a rib injury.

Ben returned to the sideline with 8:45 left in the 3rd quarter when the Steelers had a 1st and 10 from their own 49.  Dobbs completed a total of 4 drives in the 2nd half, ending in:

Punt
Turn over on downs (failed fourth down conversion attempt)
Interception
Punt

Then the Raiders scored a go-ahead TD, taking a 17-14 lead.  Roethlisberger returned to the game with 5:20 left in the 4th quarter, orchestrating a 7 play drive that ended with a TD to JuJu and a 21-17 lead for the Steelers.  The Raiders took the lead again, and Roethlisberger returned to the field with 0:15 on the clock.  He completed a pass to James Washington, who tossed it off to JuJu, positioning the Steelers for a game-tying field goal and a chance to win it in OT.  We all know how that turned out.

So why didn’t Roethlisberger play as soon as he came back from the locker room?  What were the issues involved in Mike Tomlin’s decision?

Here’s how I think it went down.

Ben was taken to the locker room for Xrays to rule out a fracture.  Obviously, his pads and flak jacket would have to be removed for imaging, so this took a few minutes.  We can assume that there was no fracture or possibly a minor hairline fracture, or the team medical staff would not have cleared Ben to return to play.

It’s fairly standard operating procedure for injured players to receive pain medication in this scenario (injured and questionable to return, i.e., there is a chance they might play).  Steroids would not have any benefit in this scenario.  The most common pain medication used is Toradol, an NSAID (non-steroidal anti-inflammatory drug) which can be administered PO (by mouth), IM (intramuscular injection), or IV (intravenous injection).  An IV injection can be given with a butterfly, rather than inserting an actual IV.  I don’t know whether athletes more commonly receive Toradol IM or IV in the locker room.  Either way, it takes effect fairly quickly.  An IV dose of Toradol hits maximum concentration in the blood anywhere from 1-3 minutes after administration and an IM dose can reach maximum concentration with 20 minutes.

Assuming that Ben received a dose of Toradol, it was probably effective by the time he got his pads and flak jacket back on, tried a few practice throws in the tunnel, and returned to the sideline.  And per Tomlin, he was cleared to return to play.

Ben came out carrying his helmet but put it down and was seen on the sidelines wearing a baseball hat as he watched Dobbs play.  By all accounts and the game video, he didn’t appear to be talking to Tomlin.  It wasn’t until the Raiders took the lead that Roethlisberger tried to come back and save the day, but it was too late.

According to Ed Bouchette, when Big Ben returned to the huddle, he told his O linemen “protect me, guys”.  Safe to assume that Ben was hurting – he sure looked uncomfortable after the TD pass to JuJu as he walked off the field, rather than elated.  I played rugby at the college level with a couple of cracked ribs, and it was not pleasant.  Every breath hurt.  I can’t imagine what NFL players endure taking the hits they do with similar injuries.  So I understand if Ben was reluctant to take a chance on getting hit again.

My guess is that Tomlin and Roethlisberger had agreed that Ben would not play unless it was necessary to win the game.  To be fair, Ben might not have been sure how well he would play and initially thought that Dobbs would give them a better chance to close out the win for the Steelers.  But once the Steelers fell behind, they had no choice.  After the game, Ben told reporters that he was waiting for Tomlin to tell him to go back in.  C’mon now.  He’s a franchise QB trying to win another Super Bowl.  He should have been pushing Tomlin to get him back in as soon as he warmed up his arm, if that was even necessary.  We’re talking about a QB who had his nose broken so badly by Ravens defensive tackle Haloti Ngata that it was practically sideways and never missed a down.  I don’t question Ben’s toughness, so if he was not trying to get back in the game, I suspect he wasn’t confident he was the best option.  Throwing on the sideline can’t simulate game play.

We may learn more tomorrow when Roethlisberger does his radio show and Tomlin holds his Tuesday presser.  But the simplest answer is one that fans won’t like.  The QB was hurt and the head coach hoped the backup could rise to the challenge, as he did earlier this season in Baltimore.  They gambled and lost.

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