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19 Nov 2009

Black and Blue Report: November 19, 2009

by Will Carroll

Brian Westbrook

Another week, another concussion story. Look, I don't want to sound like a broken record here, but again, is it going to take someone dying for some change here? The Brian Westbrook story throws a new wrinkle into the management of post-concussion athletes. He's a talented No. 1 running back on a contending team. After a nasty concussion, the Eagles held him out a week and lost. Did that factor in to his return? We have to wonder now that we hear that Westbrook was not symptom-free when he was cleared to return. Westbrook reportedly had headaches late last week, before going into Week 10. One more hit to the head and Westbrook's season isn't the only thing on the line, it could be a career-ender. Now, Westbrook will see the experts in Pittsburgh and others to determine whether he can come back this year or even at all. All indications right now are that his season is done and that's not just a damned shame, it looks like it was preventable. Worse, public pronouncements from Donovan McNabb pressuring Westbrook return isn't going to make this any easier on anyone. It's this kind of thing -- or this kind of thing that makes this such a tough problem to even get a handle on.

Clinton Portis

We'll see how the Westbrook saga affects Clinton Portis' return. The Redskins aren't contenders and concussion or not, Ladell Betts has been as effective as Portis when in there. Portis is still having blurry vision and other post-concussion syndromes, so there's almost no chance that he'll be back this week. Sources tell me that Portis' symptoms get worse with activity, so playing football and inevitably taking hits are well down the line. Portis was, I'm told, not wearing a mouthpiece at the time he was hit. I couldn't confirm this from tape and the Redskins declined comment on that issue. If that's the case -- and even if it's not -- I think the NFL needs to think about mouthguard penalties. A simple visual check by the various officials before the snap would work. Once is a warning, second offense is a "send-off" where the team is not penalized, but the player is sent off the field for one play, would send the message. Using more advanced mouthguards would help as well, but since the Maher guard hasn't gotten much uptake in the four years since I first heard of it, I'm assuming there's some reason the players are avoiding it.

Ronnie Brown

Ronnie Brown is done for the season. What was initially thought to be an ankle sprain turned out to be a more serious foot injury. Details will come out soon on the exact nature of the injury, but sources now are conflicted on what it is that ended Brown's season. Sources tell me that it's a broken bone in the foot, the result of being stepped on. That's a very odd injury and usually indicates a fracture of the second, third, or fourth metatarsal. It could involve the Lisfranc joint, but the heavy force usually just snaps the bone. Brown may be headed for surgery, given the decision to IR him, which would mean he'd need a surgical fixation. He should be able to come back from this in time for next season, but he's injury prone and there's not much the Dolphins can do to change that, especially if he doesn't have someone like Ricky Williams to split the carries with. You can see now why Brown and Cadillac Williams shared carries at Auburn. I'll leave it to the real football guys to tell us what that means for the Dolphins, the Wildcat, and Pat White.

Michael Turner

People think I'm joking when I say I blame the Curse of 370 for Michael Turner's ankle injury. Yes, it was a traumatic injury, a roll-over hit that was a classic high ankle sprain and that has nothing to do with what Turner did last year or last week. Or does it? It's a reach, admittedly, but let's say that Turner could have been a half-step -- a yard or so -- ahead of where he was. If so, that doesn't happen. Is it too much to think that the fatigue Turner carries from his overuse last season might be costing him a half-step, a tenth of a second, this season? No, and I think that carryover fatigue is the biggest factor for seasonal and multiseasonal fatigue injuries. It's a small, insidious thing, one that's clearly more subtle than one big number, but I think 370 is a nice symbol. As for Turner, he's out this week and as we've seen with high ankle sprains, it usually takes at least a month before the player is 100 percent, even though many -- I'm looking at you, Anquan Boldin -- will try to come back early. This could be the chance Jerious Norwood needs to establish himself as more than just a Football Outsiders favorite, but he's a longshot to play because of his own injuries.

Cedric Benson

NFL teams lie. That's not a secret or even a surprise, but sometimes that confusion reigns. The Bengals aren't lying about Cedric Benson -- they're calling the injury both a strain and a bruise, allowing two confusing terms to do the obfuscation for them. The two muscles in the leg that move it in or out are the abductor and the adductor. It's easier to read than clearly say, leading to some engaging in the insanely annoying practice of sounding out the words ("ay-bee-duction" and "ay-dee-duction") in some schools of sports medicine. When Benson flipped out of bounds and landed on a conduit for wires (I'm assuming -- not sure what else the conduit could be there for), the bruising is much more like a hip pointer, just lower. Calling this a bruise is more true, though the weakness could have initially mimicked a strain. Benson is likely to play and the fact that Larry Johnson came in as a cheap insurance policy means nothing to reading the seriousness of the injury. It says a bit about how much they trust Bernard Scott and Brian Leonard.

Joseph Addai

The Colts running game is quietly effective and Joseph Addai's fantasy points show it. Just look at who he's ahead of on the season and you'll see that Bill Polian is right when he says he's happy with how the team is running. Polian also said on his weekly radio show that he was more worried about effectiveness than "balance for balance's sake." Addai was effective, but he was also out for a portion of the game. The story behind that is fascinating: Addai was running for a touchdown when a Pats' player swiped at him, hitting his hand. The hit came hard enough and at the right angle to dislocate two fingers, his index and middle. The medical staff had to take him into the locker room to reduce the middle finger (pop it back in) and he needed a quick painkiller shot to do so. Back in, they taped his fingers together as a splinting and had to wait for the numbness to wear off before they were confident he could feel the ball. So why was Addai out? The Colts fear fumbles more than they fear using their No. 3 running back, Chad Simpson (who's quietly taking over for first round pick Donald Brown).

Julius Jones

When Andre Johnson was coughing up blood and was diagnosed with a bruised lung, a doctor I know who is an ER guy told me "That's something we see after a good car crash." Not one Trainer or doctor I spoke with had seen it in football or even hockey. Now, we have a second one in a matter of just weeks. I know few agree with me, but I think the bigger-stronger-faster of the NFL has bodies near their maximum potential and that potential is dangerously close to the breaking point. Hits are so jarring that, while the rib cage stays intact, the internal organs are taking the beating. The physics of this go back to car crashes. If you watch a Mercedes supercar getting smashed, you'll see it crumples like paper in the off-set crash. While it's good that the human body doesn't do this, it's also bad. The organs inside are like the driver and the impact forces have to go somewhere. Let's be realistic and say that the forces aren't going to get lower and the hits aren't going to be restricted. The answer then is better protection. Nike's shown that they're willing to blow up tradition and have some ridiculous looking uniforms, but we're going to need to go past shoulder pads and flak jackets and come up with something more. I'm not sure we're ready for football that looks more like those damned Fox robots, but there's an intermediate step in there somewhere that's focused on safety and it's time someone did something about it.

Josh Cribbs

The hit wasn't dirty, just unfortunate. The play was meaningless, but as Josh Cribbs lay on the field after the Monday night game was over, there was a tangible reminder that every play, every decision has a cost. The big question here is not only how serious the injury is and how much time Cribbs will miss, but what is the injury? While the obvious thought has to be "concussion", Cribbs never lost consciousness and seems to have more of a head/neck injury from the odd angle of impact than anything else. The head being forced back is, once again, a car crash like problem and one that used to be quite the issue. In the 70s and 80s, players regularly had "Cowboy Collars" and other devices that would keep the neck from being overtaxed by a hit, keeping the head upright more, but limiting flexibility. We see these less now because it actually increases some other issues. Cribbs will be watched closely and his pain and function will determine how much time, if any, he misses. As of right now, I'll say he's likely out this week just on risk.

Troy Polamalu

Troy Polamalu's hair still looks great. The knee? Not so much. He suffered another sprain, this time to the PCL, which tells us that the MCL sprain left the knee less stable. It's a classic cascade injury. Could it have been prevented? Probably not. The PCL sprain is minor -- sources say "Grade I, maybe" -- but that the overall stability of the knee is the big concern. It's an injury where holding him out for a week might help keep him healthy into the playoffs. The Steelers have shown they can play without Polamalu, but that they're not as good when he's not flying around. With weak opponents three out of the next four weeks, it could help the Steelers and Polamalu out. The injury-proneness of Polamalu, Bob Sanders, and Ed Reed makes me wonder if there's a balance between the reckless excellence that makes them so valuable and health.

Dwayne Bowe

Dwayne Bowe was suspended for a violation of the drug policy and its very instructive how this went down. While the NFL is getting a pass from the Wall Street Journal on its woefully inadequate testing policy, it is showing that players are willing to try things they know are banned, even to do something as simple as cut weight. The drug Bowe was popped for is a simple diuretic. While it's listed under the NFL policy as a "masking agent," it's more often used for cutting weight. This isn't the same drug as was caught in the Starcaps scandal, but it's similar. The difference here is that Bowe knew what he was taking and why. Evidently, Todd Haley has pressured players about weight, even after training camp. The interesting part of this is that while Bowe did not appeal his suspension, he played at least two weeks after being informed. My guess is that the "B" sample was being tested for confirmation, resulting in the delay, but I'm not sure. Bowe made a stupid mistake in using a banned substance, but it gave him no performance gains.

Bumps and Bruises

Eli Manning is suffering no symptoms from plantar fasciitis, he says. This means it was a mild case or that it's lingering back there. I'm sure the Giants will keep treating him ... Kyle Orton's ankle is day-to-day, but a simple ankle sprain. Expect him to play, since he's not that mobile to begin with ... I have no idea how a thumb injury would affect blocking but not carrying the ball, but that's what the Cowboys say is going on with Marion Barber ... Who's got the line on what NFL player tries this first? ... Jordan Gross is done for the season with a broken leg (you'll see it reported variously as ankle and leg -- it's semantics) but the running game didn't suffer with him out, as the passing game is where Gross excelled ... Speaking of the run game, the short week isn't going to help Jonathan Stewart, who usually rests his Achilles. It will help with the long week heading into Week 12 ... If you saw the "chop block" that Brady Quinn threw on Terrell Suggs, you know how serious this could be for Suggs. I'm glad Quinn was fined for this one ... Remember that the Carroll Guide to Sports Injuries is now available, in physical or electronic form, at a very reasonable price for a reference guide.

Posted by: Will Carroll on 19 Nov 2009

31 comments, Last at 23 Nov 2009, 7:11am by DeltaWhiskey

Comments

1
by tally :: Thu, 11/19/2009 - 2:39pm

Good stuff as always, Will. This is one of the most enlightening articles every week and all the better as a San Diego fan whenever LDT isn't mentioned.

2
by Jacob Stevens (not verified) :: Thu, 11/19/2009 - 2:40pm

Thank you, Will, for everything.

3
by Karl Cuba :: Thu, 11/19/2009 - 2:46pm

This isn't really an injury question, more of a medical issue but is it possible that Cutler's abject performances in prime-time games this year could be due to low/high blood sugar levels resulting from his diabetes? He's thrown 3 touchdowns and 11 interceptions in 3 late games compared to 11 TD and 6 picks in other games. Of course, he could just be bottling it but could the diabetes be a factor and could the Bears do a better job of controlling his condition?

6
by DrewTS (not verified) :: Thu, 11/19/2009 - 3:08pm

Is it ever possible to see something about diabetes and not thing of Wilford Brimley saying "dia-beet-us"? I say no.

8
by Karl Cuba :: Thu, 11/19/2009 - 3:28pm

Quite possible, as I have no idea who Wilford Brimley is.

15
by DrewTS (not verified) :: Thu, 11/19/2009 - 5:14pm

Cocoon? China Syndrome? Quaker Oats? Diabeetus?

Nothing?

19
by Bobman :: Thu, 11/19/2009 - 6:19pm

DrewTS, try this: some soft music... candle light... a couple glasses of champagne... a 300 lb octagenarian with a walrus moustache?

Ring any bells now?

Good, it means you're sane.

11
by Andrew Potter :: Thu, 11/19/2009 - 4:17pm

It's an interesting suggestion, but at a glance I'd say quality of opponent has more to do with that imbalance. GB and SF are #1 and #2 in defensive DVOA, and the Atlanta game was on the road and only accounts for two of the eleven picks (two picks on the road to a competitive opponent strikes me as average rather than disastrous).

12
by socctty :: Thu, 11/19/2009 - 4:26pm

I think I saw that before this year, Cutler has performed slightly above his career average on nationally televised games.

28
by Jimmy :: Fri, 11/20/2009 - 4:15pm

Cutler only demonstrated symptoms of his diabetes (beet-us?) two years ago when he lost a load of weight mid season. Short of getting access to his medical records it might be difficult to discern when it may have begun to affect his play.

What makes me wonder about Cutler in this regard isn't just his play but the way in which red mist seems to descend making him more irrational. I am similar when I am tired and hungry (where the similarities between Jay Cutler and myself start and end), which leads to possible questions arising about blood sugar. There is of course the massive risk I may be taking of overly Jimthropomorphising Cutler. I am not particularly similar to an NFL QB.

5
by devlin51 (not verified) :: Thu, 11/19/2009 - 3:02pm

Will, is Andre expected to play? Any idea how bad his bruised lung is?

7
by Jack G (not verified) :: Thu, 11/19/2009 - 3:18pm

Was the chemical in Dwayne Bowe's case clenbuterol?

9
by TheSlinger :: Thu, 11/19/2009 - 3:48pm

Anything on Rashean Mathis?

13
by Key19 :: Thu, 11/19/2009 - 4:28pm

Thanks as always. The Carroll Guide is excellent as well, just got it in the mail yesterday.

14
by Scot (not verified) :: Thu, 11/19/2009 - 4:48pm

What is the recovery time for the bruised/bleeding lung? 1-2 weeks, or longer?

16
by Sean D (not verified) :: Thu, 11/19/2009 - 5:46pm

ESPN is reporting that the ankle sprain is a tear. That would imply that it's a grade II sprain. Is that what was meant by "simple ankle sprain" or were sources saying that it was a grade I when the article was written?

20
by Will Carroll :: Thu, 11/19/2009 - 8:22pm

All sprains are tears. It's the very definition. A sprain is a tearing of a ligament, in the same way that a strain is a muscle or tendon tearing. I don't know how people don't get this and that I have to say it over and over.

A SPRAIN IS A TEAR.

21
by Sean D (not verified) :: Thu, 11/19/2009 - 8:31pm

I had thought that based on reading all your articles, but I was shown up when someone told me that a Grade I was not a tear. I tried to follow your definition, but then I looked up the definition of a Grade I sprain almost everything I could find said that its a stretching of the ligament, while a Grade II is a tear and a Grade III is a full tear. Trust me, I've heard you say this many times, but it seems like there are a lot of places that disagree with the "sprain is a tear" mantra for Grade I sprains.

22
by Will Carroll :: Thu, 11/19/2009 - 11:42pm

For more on this and why it's difficult to say, check this out:
http://www.radiologyassistant.nl/en/42764e8fe927e
I'll refer everyone especially to MCL, image (2).

31
by DeltaWhiskey :: Mon, 11/23/2009 - 7:11am

"All sprains are tears"

The American Academy of Orthopaedic Surgeons begs to differ.

http://orthoinfo.aaos.org/topic.cfm?topic=A00111#What%20is%20a%20sprain?

As do the folks at U of M.

http://www.med.umich.edu/1libr/sma/sma_medollig_sma.htm

"I don't know how people don't get this and that I have to say it over and over."

Perhaps you don't get it?

17
by jpg30@earthlink.net :: Thu, 11/19/2009 - 5:51pm

I always thought there were only two ways you could hurt your neck.

23
by dryheat :: Fri, 11/20/2009 - 10:03am

We should check out his car.

18
by Bobman :: Thu, 11/19/2009 - 6:17pm

Any Browns fans want to comment on Cribbs's injury circumstances? It may have been legal, but reminded me an awful lot of the Sapp on Clifton hit a few years ago that ended Clifton's season. It too was legal, but seemed pretty dirty to me. Nailing a guy who is away from the play, or "crippling the dummy" as Dr. Z called it back then.
If that was a Colts returner... okay, I'd probably be fine with it (joking). If it was the best player on the Colts, which is a more apropos description, I'd be yanking out fistfuls of hair--some of it my own.
It just seemed so pointless.

25
by JayB (not verified) :: Fri, 11/20/2009 - 3:59pm

What was really pointless is that they ran the play at all. There is no 16pt play in football so why were the Browns calling timeouts to extend the game and why did they call a hook and ladder on the last play?

BTW-- When the players start lateraling the ball, nobody is away from the play. That especially applies to the most dangerous returner in the NFL.

27
by JayB (not verified) :: Fri, 11/20/2009 - 4:07pm

In fact, if you watch the play. Royal was looking to lateral it back to Cribbs when he was tackled. He was very much in the play still.

26
by Arnold (not verified) :: Fri, 11/20/2009 - 4:03pm

Here is one Browns fan reaction: http://www.youtube.com/watch?v=vVPyaIU7yz4

They play didn't look dirty. Was the Ravens' player supposed to move out of Cribbs way?

29
by Bobman :: Sat, 11/21/2009 - 2:26am

Okay, okay, I retract. I just remember seeing that play and focusing not on the ball but on that hit because it looked so unusual--like a guy standing relaxed (mistake, yes) and someone just steamrolling him and his body flying like a rag doll. I had no idea who it was at the time but remember thinking "I bet that guy's hurt." It really did remind me of the Sapp-Clifton collision.

I THOUGHT Cribbs had just lateraled the ball himself and was then sort of jogging away from the action, but may have been mistaken.

No 16 pt play, but they were playing for pride.

Okay, sorry, I couldn't type that with a straight face.

24
by lechrus2 (not verified) :: Fri, 11/20/2009 - 11:54am

Jason La Canfora of NFL.com reports that a "league source" says that Benson is "likely" not to play Sunday. (http://blogs.nfl.com/2009/11/19/bengals-rb-benson-likely-out-vs-raiders/)

He also reports that Benson’s teammates would be surprised if he is able to go, but that goes along with your "NFL teams lie" statement.

Unfortunately, the Bengals game is in the afternoon. Could be caught gambling between Scott, Benson, or LJ.

30
by lechrus2@yahoo com :: Sun, 11/22/2009 - 12:29am

Well, Benson made the trip to Oakland but he's officially "Doubtful".