09 Dec 2009
by Dr. William Carroll
Will is off covering baseball's winter meetings for our sister site, Baseball Prospectus. Filling in for Will this week is his father, Dr. William Carroll, the author of The Carroll Guide to Sports Injuries. Dr. Carroll is the Director of Athletic Training Education and a Professor at the University of Mobile in Alabama. Dr. Carroll has a wealth of experience working with various organizations of national and international competition, both amateur and professional.
Subluxation, left shoulder
Schaub has, at best, a fifty-fifty chance of playing this week after suffering a subluxation of his non-throwing shoulder. A subluxation is less than a dislocation because the head of the humerus (upper arm bone) does not get trapped outside the glenoid (shoulder) rim and because it reduces itself (goes back into place). This sounds good, except for the fact that this action causes stretching of the ligaments that hold the joint in place. If he is able to play, he will need to wear a brace to prevent abduction and external rotation (think of the first half of a tennis serve). Pain and functionality will be the keys to Schaub's ability to play. He will need the brace and a lot of protection from his offensive line to play with this injury.
Sprain, left A-C joint
Another quarterback with an injury to his non-throwing shoulder. It is probably no coincidence that these two quarterbacks get sacked a lot. Stafford's injury is to the acromioclavicular (A-C) joint, which basically connects the collarbone and the shoulder blade. Probable mechanisms of injury were either direct trauma from a hit or falling on the left shoulder after contact from a charging defensive lineman. Stafford will probably miss at least two weeks with this injury and may need an A-C brace when he does return.
High Ankle Sprain
Turner will be somewhat limited in his effectiveness if he plays while his syndesmosis (high ankle) sprain slowly heals. This sprain involves the two ligaments that attach the tibia and fibula and is often referred to as a "boot top sprain." This sprain heals more slowly than the garden-variety inversion ankle sprain and is more difficult to tape or brace for functionality and protection. Atlanta may not need the "Burner" in their lineup to make the playoffs, but they will definitely need him in the lineup when they do make the playoffs, so Turner may put himself at some risk by returning early to help his team. If he does return early, look for him to have problems making rapid changes of direction.
Ankle sprains are common in football and are especially problematic for running backs. The most common sprain is the inversion sprain, where the ankle rolls over to the outside of the foot. This injury damages the ligaments on the lateral aspect of ankle, which connect the bones. Once the swelling is resolved and range of motion is restored, the issues become pain and functionality: Can the player perform without the pain overwhelming him? Williams has had some time to rest, but ankles do not heal completely in a few weeks' time. He should be able to handle straight-ahead running with no visible loss of speed but sharp cuts will be difficult for him, even with the ankle taped and braced. I would not look for a normal level of production immediately upon his return.
Sanchez has suffered a sprain of his posterior cruciate ligament, the ligament that prevents backward translation (movement) of the tibia on the femur. The laxity caused by this sprain will make the knee feel unstable. This injury commonly occurs when the knee is flexed beyond its normal range of motion (such as a defensive player landing on you, forcing your knee to bend, or "hyperflex"). Although Sanchez is not really a running quarterback, this injury could affect his ability to scramble and could also affect his throwing motion, which begins with the leg plant and step into the throw. He will probably have to wear a brace on the injured knee, which could possibly have an adverse effect on his mobility and throwing biomechanics. Yes, he can play with this injury, but the big question is how effective he can be with the injury and the brace.
Warner had hip surgery after last season to repair a damaged labrum (lining) in his hip, thus the natural concern when he came up limping after being hit in the Vikings game. Word out of Arizona, however, is that Warner suffered a hip pointer-a bruise to the iliac crest (a prominent bone on the top of the pelvis). This is a painful injury since there is little tissue between the skin and the bone in this area. Thankfully, it is much less serious than a reoccurring labrum tear. Warner has been a tough guy going all the way back to his Arena Football days, so expect him to get the area padded and be right back out there this week if it is indeed a hip pointer. Although there will be some pain -- more if hit directly -- look for Warner to put up his usual big numbers.
Jackson's back injury has been controlled just enough to allow him to play on Sundays. This is a tribute to his toughness and the treatment he receives during the week from the Rams' athletic training staff. At this point, he is basically being "held together with baling wire" to allow him to play. He is playing well, but without rest the back muscles are not going to heal until the Rams season is mercifully over. Look for Jackson to continue his daily treatment regimen and continue to perform just short of his normal level of production. Basically, he is day-to-day or week-to-week at this time and, if the injury gets worse, his season may end early.
The hamstrings are the large muscles in the back of the thigh that are so important to acceleration and stop-and-go action, both of which are a large part of Ward's repertoire as a wide receiver. Since he is not the fastest receiver in the league, Ward is dependent upon his cleverness and ability to make sharp cuts in his patterns to succeed against defensive backs. Fortunately, the tear (strain) in Hines' hamstring is in the belly (middle) of the muscle rather than at the top or bottom. Ward will receive a lot of treatment this week and could possibly play with a neoprene sleeve (which compresses the leg and traps heat) on his leg. His biggest problems will be in getting away from the bump and run and in rapid acceleration. Ward is a wily receiver and motivated not to miss a game, so I would expect him to play with only a slight drop-off in production.
This is the year of concussion awareness in the NFL. There are too many horror stories about players who returned too soon after suffering a concussion. A concussion is a contusion (bruise) to the brain and should be treated with great care. Portis will be fully evaluated by the Redskins medical staff before he is released to return to activity. The biggest key is that all of the symptoms must disappear before the athlete is cleared to play. The last symptom to usually disappear is a headache and this information can only come from the player, not an MRI or other medical analysis. Hopefully, Portis will be honest with the doctors and allow them to make their decision with all the facts on the table. Unless he is absolutely ready medically, he should not play. The reward is not worth the risk in this case.
Hester strained his gastrocnemius (calf muscle). Since he is a speed merchant, this can be a troubling injury. The gastroc is responsible for the plantarflexion of the foot so essential to running. It is connected the Achilles' tendon, which can become at risk if Hester were to change his running motion to protect the calf or to get forced into dynamic dorsiflexion -- a foot pushed upward toward the front of the leg. There is no effective way to brace or tape the gastroc, so it will be the treatment he receives in the athletic training room that will, along with his great physical talent, enable him to perform. If he plays, and it is likely that he will, he may exhibit some loss of speed and ability to perform stop-and-go maneuvers.
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