The real reason for the NFL Scouting Combine

Athletes focus on the flashy 40-yard dashes. The mind-blowing vertical jumps. The monstrous bench presses and the spryness required for the three-cone drills.

This is the stuff they've trained for — on the football field. The feats they are sure will prove their worth to be NFL players.

But inside a hospital room, far from the green turf or sweaty lure of a weight room, sits an idle machine.

It's an unassuming contraption that looks like a retro computer with wires sprouting out. The electrocardiogram, whose job it is to check the spikes and dips of the electrical activity of a heart.

This machine, with not an ounce of effort from these athletes, is what first will prove their worth as NFL prospects. By proving the health of their hearts.

As more than 300 football players descend on Indianapolis this week for the biggest job interview of their lives — the NFL Scouting Combine —  the first place they will visit won't be Lucas Oil Stadium.

It will be IU Health Methodist Hospital. Inside that room. Hooked up to that machine.

All of the athletes will undergo a five-minute EKG test that could make or break their chances at a multi-million dollar football career.

"We’re the choke point,” said Richard Kovacs, one of the cardiologists at Methodist Hospital who will administer EKGs to the players this week and who serves on the NFL Cardiovascular Safety Committee. “No one goes to Lucas Oil Stadium until they go through us.”

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The first two days of the combine are devoted entirely to medical testing.

That includes full physical exams and testing of bones, muscles and joints. These exams will reveal to NFL teams — which bring owners, coaches, general managers, trainers and medical staff to the combine — that the athlete they have their eyes on is a good pick. Stellar blood pressure, fine reflexes and not injury prone.

And if the player doesn't have good blood pressure? If he is injury prone? That likely doesn't end a career.

What happens inside Methodist Hospital might. The heart is a different beast.

Hours upon hours will be spent administering EKGs to the athletes by Kovacs and Michael Emery, a sports cardiologist at Methodist and the director of the IU Health Center for Cardiovascular Care in Athletics. Then they will decipher  the results. It takes a special eye from cardiac experts trained to read the nuances of an athlete's heart.

A normal heart for a 65-year-old man with diabetes who is a smoker is very different from a normal heart of an elite, trained 200-pound football player. And it even gets more specific within the NFL, "because linemen are very different than a running back or a wide receiver," said Emery.

The EKG can diagnose a heart attack in progress or one that has happened in the past. It can reveal that there is some sort of abnormality that could be worrisome. It might be cardiomyopathy, a disease of the heart in which the muscle becomes enlarged, thick or rigid.

"Unfortunately, the way an athlete's heart looks can overlap with the way these cardiomyopathies look, forming what we call the gray zone," said Emery. "So differentiating the two can be difficult. One would end an NFL career, but potentially save a life. One would say you're fine. This is what you're supposed to look like. We've got to figure out the difference between them."

All players’ results from Methodist are passed along to team doctors at Lucas Oil. If something suspicious shows up, a red flag, athletes will then get an echocardiogram, an ultrasound of the heart. That happens on site at Lucas Oil in a makeshift medical facility where Kovacs and Emery will read the results in real time.

If further testing is necessary, the athlete is sent back to Methodist for a cardiac MRI or a cardio-pulmonary exercise stress test. This will examine how the heart functions during exercise to see whether any underlying heart muscle oxygen-supply problems exist that could potentially emerge during strenuous activities, like playing in the NFL.

In the end, decisions will be made  by a team of doctors. Life-changing decisions that will influence the fate of the athlete's career.

"The absolute gospel truth is the one and only reason for the combine is the medical tests," said Bill Polian, who spent 14 years as the Indianapolis Colts president and is now an ESPN analyst, "and if they did away with everything else but the medical tests, the combine would still be exceedingly valuable and worth every penny we pay out to put it on."

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The safety and health of the players are part of what make that medical testing worth it, of course. That is the first concern. But, there is also the money.

"We do have a gigantic investment in these players," said Polian. "And, more and more, the prevention of injury is becoming the single largest issue that faces the NFL in the coming years."

At stake are millions of dollars. Teams don't want to draft a player, sign a contract, only to have him falter on the field because of a serious medical issue.

"The combine and pro sports are a whole different ball of wax than screening of high school athletes, screening of college athletes," said Emery. "Totally different stakes, financial and contracts, all that kind of stuff. Healthwise, it's the same. The financial stakes? Very different."

Take Star Lotulelei, a defensive tackle standout at the University of Utah. When he arrived at the combine in 2013, people were already talking.

NFL.com suggested he might be the first player taken in the 2013 NFL draft. ESPN had him rated at least third, all because of his on-field dominance.

But then came the medical testing at the combine in Indianapolis.

"He had a heart abnormality," said Kovacs. "He was not allowed to participate at the combine."

Lotulelei's draft stock plummeted. The Carolina Panthers took him at No. 14, as four defensive linemen were taken ahead of him. Dropping 11 positions likely cost Lotulelei $10 million.

"For him and his family, (that) was a lot of money," Kovacs said. "Tens of millions of dollars in lost revenue."

The upside was that Lotulelei's life was potentially saved because of the medical testing at the combine. His heart problem was cured. Earlier this month, he played in the Super Bowl.

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Lotulelei's case is a rarity. The athletes who descend upon the combine almost always are given a green flag after heart tests.

"So we don't find a whole lot, but we don't need to find a whole lot," Emery said. "Because it's not like it's a sprained ankle we're trying to find. We're trying to find something that could increase the risk of that athlete dying."

The NFL just completed a five-year study examining how in-depth medical testing at the combine should be. Results of that study have not been published.

As part of the study, at the five past combines, the NFL required all athletes to get an EKG and an echocardiogram with many prospects going through an MRI and stress test, Kovacs said.

"With the knowledge that we gained from that five years? Now we're not going to do everybody," he said, "because we feel it's not necessary to do everybody."

Just 2 to 3 percent of those 1,500 athletes during the five years showed any heart concerns.

"We've not found the kind of inherited problems that you expect you might find," Kovacs said. "Now why is that? It might be because these are really special athletes, maybe they're resistant to some of the other effects. Maybe they've already been screened out at college."

But the study resulted in a big change at this year's combine. Only the EKG will be required of all athletes. That along with any physical symptoms players reveal or family history will determine the need for any further targeted testing.

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What's the harm? People ask Kovacs and Emery that all the time. Why not just do extensive testing on all the players?

"There's a lot of harm," Kovacs said. "The biggest harm is if you misdiagnose."

False positives are common when screening athletes, Emery said, because their hearts are so different.

A false positive could land an athlete on the sidelines, missing out on a once-in-a-lifetime opportunity to play in the NFL.

Polian isn't concerned. As he prepares for his 40th NFL Scouting Combine this week, he is 100 percent behind the medical testing the league has instituted.

"Every year, there is discovered a medical condition that a player did not know about previously which could affect either his life, in the case of heart issues, and his very function in society if left untreated," he said. "The player health side of the combine, it has proven to be one of the greatest instruments for diagnosing problems that players never knew they had."

Follow IndyStar reporter Dana Benbow on Twitter: @DanaBenbow.

About the combine

More than 300 top college football players have been invited to the 2016 NFL Scouting Combine in Indianapolis. Representatives from each NFL team will evaluate players  in a four-day job interview. It’s Tuesday, Feb. 23 – Monday, Feb. 29. Each athlete is evaluated for four days, in groups arriving on different days. The event is not open to the general public.