Black and Blue Report: November 12, 2009
by Will Carroll
I've been talking about the Carroll Guide to Sports Injuries for a while, and as of today it is now on sale. Like the Football Outsiders Almanac, you can buy either a printed copy or a PDF file. The printed copy is now on sale through Createspace for $19.95 plus shipping, and will be available through Amazon in a few days. The PDF file is sold through the FO store for $12.
With most books, you have to jump through hoops, check proofs, looks for typos. With this book -- a tome full of medical information, illustrations and technical details -- it took a bit longer. There's probably still a typo or two in there, but there's no more authoritative and exhaustive guide to sports injuries available. I'm not the lead writer on this one, but I'm no less proud to be a part of it or to see my name on the front. If you read this column, you have some level of interest in sports medicine. Many of you have kids that play youth or scholastic sports. More than a few of you are involved in the Football Industry. I really hope that everyone will take a look at this book because it really could make a difference. A little knowledge could fix so much and the start of an appreciation for sports medicine could be a big step in preventing the epidemic of injuries we're seeing today. So let's get to it:
It's officially Colts-Patriots Hype Week, so we have to start there. The story of this game may end up being more about who's not there as much as who's there. Neither team should have a material talent advantage, so losing even a small part could tip the scales. The Colts have lost a lot more than a small part, starting with the loss of Bob Sanders. The team is used to playing without him, so yes, injuries to Kelvin Hayden and Marlin Jackson might be more costly, but Sanders' injury -- a torn biceps tendon -- is worth looking at closely. While the Colts refuse comment on injuries, there's some indication that there's a connection between Sanders' knee surgery and the torn tendon. One of the drugs used to control infection is Levaquin, which carries an increased risk of tendon rupture. It's a bit of a double-edged sword: It corrects the infection, something the Colts have seen time and again with surgeries, and the extra risk. For Sanders, a player already considered both fragile and perhaps overmuscled, the risk was even greater. Again, let me be clear -- the rupture happened and it's unclear whether Levaquin played any part in this, but considering that a similar injury on a similarly fragile player, Tyjuan Hagler, occurred, it certainly bears consideration.
It's also notable that the Colts let Anthony Gonzalez go outside their normal physicians for "minor" knee surgery. There are rumors -- and again, these could not be confirmed -- that Gonzalez is also dealing with infection, much in the same way that Peyton Manning did returning from his own knee surgery. The Colts official line is that Gonzalez re-injured the knee in rehab and needed a cleanout. Either way, Gonzalez is very iffy for the regular season and given the options and the depth issues, the IR will be a possibility going forward unless he shows rapid progress. Gonzalez isn't a speed player, so this is possible, but his role of slot reciever has clearly been taken by Dallas Clark. If and when Gonzalez comes back, he could be the fifth option out there.
Oh, but there's more here in Indy. Pierre Garcon has a sore ankle that he was able to play through, in large part because he was at home. The Colts are unique in that Lucas Oil Stadium is not a crowned field. It's flat, so that a basketball floor can be put down for NCAA Final Four games, which helps Garcon. That flat, predictable surface allowed the team to tighten up his ankle and let him play. It worked out well and he's likely to be in much the same condition with another home game coming up. Austin Collie left late with what's being called a neck injury. It appeared that he had a stinger, which we know can be very unpredictable. Given the opponent, I can't see a situation where Peyton's new movie buddy won't be out on the field. Finally, Donald Brown is expected back from his shoulder subluxation. Sources tell me that he could have played last week, but that the team was looking ahead to the Pats game and anticipating that Brown would be more needed there. It also speaks to depth, as Manning has gained confidence in Chad Simpson's ability to pick up blitzes.
The Pats aren't without injuries themselves coming into the big game. Of course, Tom Brady and the eternally-probable shoulder will be listed, but really the team is pretty healthy. The biggest question mark comes with Sammy Morris. His knee problem, now confirmed as an MCL sprain, has allowed Laurence Maroney to re-establish himself, but Bill Belichick isn't exactly known for loyalty or consistency when it comes to running backs. He'll go with the hot hand and the Pats, with Morris, have a bigger RB to smash at the undersized line (Yes, they're bigger up the middle, but Dwight Freeney and Robert Mathis are both below their listed weights.) Morris' knee will affect his lateral movement, but that's not what he does, anyway. Despite not practicing, I expect him to play in a limited role as a change-of-pace back. Perhaps most importantly, he's the best blocker the Pats have in the backfield. The Colts blitz now, something the Pats haven't seen them do during their decade of Manning-Brady fueled November and January matchups.
Garrett Wolfe had a pretty nasty injury on Sunday. Initially thought to be a back injury, it turned out that he had a lacerated kidney. This gives me a chance to show you what you'll see in the Carroll Guide to Sports Injuries, since we have a section on kidney contusions. The symptoms are essentially the same, though the laceration is obviously more serious. Click here for the sample from the new book.
The problem with a kidney injury, as noted, is that it presents as one very believable problem that's typical -- back pain. It's a very serious, even life threatening problem. Wolfe got the proper initial care which led to the proper diagnosis and treatment. As noted, a kidney bruise should keep a player out a minimum of two weeks. A laceration? Obviously more, but this is the NFL and according to the Bears, it's the short week that is going to keep Wolfe from having a chance to come back in Week 10.
Clinton Portis and Brian Westbrook
Another week, another set of concussions. If there's any "win" in all of this for the NFL, it's that more and more, we're seeing a shift to a more medical look at this issue, allowing the doctors, rather than the coaching staff, to make the determinations and erring on the side of caution. With Brian Westbrook, the Eagles did a textbook job of watching Westbrook closely, repeating his tests as necessary, making informed decisions, and -- this is key -- making it very clear to the public what they were doing and why. Fantasy owners might thank Rick Burkholder for making the early call, but his press conference shows that taking a strong position could put the NFL where it needs to be on this issue: a leadership position. Westbrook will be back at practice and is facing the same protocols. With a further week's healing, it's more likely but not assured that he will play.
Clinton Portis had a bad concussion. Jim Zorn said he was knocked out and after the game, Portis had no memory of the incident. Right there, at best, Portis is looking at a Grade II concussion, though the time of unconsciousness isn't always the best indicator of how severe the concussion is. As Dr. Jorge Cantu, one of the leading experts in the field, explained to me earlier this year, the only way to grade a concussion is after all the symptoms have cleared. (Cantu should know -- the grading scale is named the Cantu scale because he invented it.) Portis will undergo ImPACT testing and other medical tests to help determine when he'll be back. We'll have to watch to see if he's exhibiting any symptoms at the end of the week, but it's very unlikely that he'll play this weekend, leaving the carries to Ladell Betts.
Sometimes I forget to look and see what teams are on bye week. Honestly, I hate the bye week as much as I hate the idea of expanding the season. I don't hate it quite as much as preseason games, but this is my way of burying some errata from last week. I said that McFadden should be able to play last week, but with no game, that obviously wasn't going to happen. It's the "could" that makes these things tough, not because it makes me look at the schedule, but because many times, the "could play" is a very amorphous thing. Philip Rivers never missed a game with his ACL tear, nor did Carson Palmer, all because they had the foresight to do it in the playoffs. Figuring out recovery time is nearly impossible. Were Rivers or Palmer game-ready in May or July? We just don't know. With McFadden, it's a bit easier. He could have played last week. He will play this week, showing a normal recovery time post-meniscectomy.
I'm curious if there's any sort of correlation between bad lines, sack rates, and quarterback concussions. Probably not, but that won't help Trent Edwards. He'll be back on the field behind a porous line after a couple weeks off recovering from a particularly nasty and lingering concussion. He's passed all the tests at this stage and while he should be fine back there, there's always the concern that a recurrent concussion could cause more damage. Facing a struggling defense might give him the soft landing he needs. Don't ask me why, but I don't have a good feeling about this return, even with the month off.
Is it just me or is Anquan Boldin just Terrell Owens with worse PR and less talent? Boldin's a fragile player, though he's always shown quick healing. That healing nudges just a bit here as there was a dispute between Boldin and the Cardinals staff on whether he could play. Boldin's in the wrong for being so public, but he's done that before. The real question here is whether he could have played. It's very hard to question a player's own assessment on this ... oh, I hear you. I know that I've said over and over that a player's assessment is often the worst indicator and that's true, but note that I'm referring to a diagnosis. A player doesn't often know the difference between one type of hamstring strain over another. He doesn't often know if a calf strain is as bad as a quad strain. But ask them what they can and can't do and these physiosavants can often give eloquent answers. A week off should help Boldin going forward, but there's obviously more than a high ankle sprain going on here.
Bumps and Bruises:
Thursday game alert! Glen Coffee is out with a concussion for the Niners ... Chris Henry's broken forearm could have him back for the playoffs, but it's iffy. It can't be protected in a wide receiver the way it can with a lineman ... Chris Cooley continues to be "way ahead of schedule" according to Redskins sources ... In 2006, Larry Johnson had a great season, but went over 370 carries. Since then? Not so much. Just sayin'. Maybe Michael Turner stays healthy and productive this season ... Matt Hasselbeck has some bruising on his throwing shoulder, the result of making a post-interception tackle, but it's not going to keep him out. Affect his throwing? Maybe ... Matthew Stafford might not blame his knee for his terrible performance last week, but he could. His mechanics were a mess, but it seemed mostly a mental reluctance to really step into his throws ... "I slipped and fell in the grocery store." I don't know if Justin Gage is saying something in code, but he was out late in Sunday's game ... Terrell Owens has a strained hip flexor, which will affect his quickness and cutting. That's tough, especially given his lack of production this season ... Lance Moore is out again this week for the Saints, as is Kevin Curtis for the Eagles ... Did you see the play where Andre Johnson took a big hit in his back near the goal line? The bruised lung is not fully healed, as a red spot on the turf shows ... The Steelers appear to understand that Willie Parker is going to be slowed all season by turf toe ... If you get a chance to watch the play where Ryan Moats fumbles near the goal line, watch his arms. He was unconscious briefly as it happened.