by Will Carroll
I really wish I could just point you to page 120 of the soon-to-be-published Carroll Guide to Sports Injuries (which will be available through Football Outsiders). It would give you to a full explanation of plantar fasciitis. PF is a painful condition of the heel and mid-foot that has a tendency to linger. It's not terribly common in football, but is common in sports that use cleats. The band of tissue under the foot is stretched or torn, causing swelling and pain. Manning's pain is near the heel, which usually indicates the presence of heel spurs. Treatment usually involves the normal control of swelling and painkillers, but also can get more advanced. The initial approach is usually to use orthotics to put the foot in a position that is less painful, but the dynamic movements of the foot during the stride are altered by this approach (and there continues to be quite a debate in the running community about the use of shoes at all). The other approach is lithotripsy, which uses shock waves to break up any underlying osseous bodies (i.e. bone spurs) in much the way they're used to break up kidney stones. This was used with Albert Pujols a couple years ago. It was successful, with Pujols missing very little time, but the procedure could be compared to being hit on the soles of the feet with a baseball bat. With the Giants facing the Raiders, we also bring in the element of schedule. While we all know the "any given Sunday" mantra of the NFL, facing the Raiders with an injury to Manning at least has to make the Giants think "we could get away with David Carr, couldn't we?" Eli Manning is ranked fifth overall by DYAR (second among Mannings). The Giants will make a decision by Friday, though we'll likely hear talk of game-time decisions.
Sticky rice. Sticky tape. Sticky icky (I don't know what that last one is, but I heard Snoop Dogg mention it). All these things are more important than "sticky rib." Donovan McNabb has a broken rib. Yes, has. It's still broken. There's very little chance that the fracture is completely healed and frankly, it doesn't matter. What does matter is whether or not McNabb can deal with the pain of being hit and if the fracture would be opened back up. McNabb will rely on a flak jacket, tape, and a pair of offensive tackles in the hope that he can avoid most of the hits a quarterback usually takes. He's going to get hit, but if he can keep from taking a blindside shot or one on the run, he'll be ahead. Watch for the Eagles to put some extra pass blocking into the game plan, which could hurt PPR numbers and Brent Celek, if he's asked to cover the end more. I expect McNabb to play and be productive.
A subluxated patella sounds pretty serious. For those of you that are basketball fans as well, Andrew Bynum's injury quickly comes to mind (the Lakers center missed significant time with a similar issue). The difference between Bynum's months out and Stafford being merely questionable a week later is one of severity and function. The patella (kneecap) pops out of its groove and stayed out a bit, with it self-reducing before doctors could examine it on the sideline. That self-reduction (popping back in) tells us that it didn't come too far out and that it didn't tear too much on its way out. The underlying soft tissue damage is the real concern and it appears from the lack of swelling that Stafford didn't have too much damage. The difference in function is key; Stafford isn't reliant on jumping, pivoting or acceleration, all things that Bynum or any basketball player would be asked to do. If Stafford was a wide receiver, I'd be more concerned. Heck, if he was more of a scrambler, I'd be more concerned. If Stafford plays -- and I expect the Lions to be uber-conservative here -- then there are braces or taping that can gently hold the patella in place. In the long term, this shouldn't be a significant problem, although some doctors say this could be a sign that Stafford could be a bit more susceptible to knee issues in the future.
Donovan McNabb isn't the only Eagle coming back this week. Brian Westbrook had the bye week plus a week to heal up his ankle and things look good. The Eagles won't push him right back to a feature load, as they gained some confidence in LeSean McCoy, allowing them to get Westbrook off the field a bit more. There's some concern that Westbrook actually needs more time on the field and less getting cold, but this isn't basketball, where you play both sides. Westbrook is going to have to come off the field about half the time anyway, so look for the team to use some creative substitution methods to keep Westbrook productive and comfortable. The key won't be his play, but how he recovers after he plays against the Bucs. Next Wednesday is much more important to the Eagles than this Wednesday.
Note to the Internet: If you decide that your favorite player needs a cool nickname and that the nickname needs to be abbreviated, don't expect the rest of us to know. "FWP?" Oh, Fast Willie Parker, I get it. Guess he'll be HWP or SOSWP this week, depending on whether he's hobbling or just standing on the sidelines. Parker has turf toe and, while it's described as a mild case, it kept him out last week, giving Rashard Mendenhall a chance to shine. Pittsburgh doesn't have their bye until Week 8, so Parker doesn't really get a break there. With him out of practice on Wednesday, it looks as if the team will take a conservative/replaceable tack with this. As long as Mike Tomlin is happy with the alternatives available -- in this case Mendenhall and Mewelde Moore -- he'll be happy to let Parker rest and heal. It's harder for Parker, who's got to be feeling Pipped, but coming back before the toe is healed isn't going to help him in any way.
It's too bad that Darren McFadden is hurt again. It's a simple meniscus tear, necessitating a scope -- a simple procedure -- and a couple weeks of rehab. In a month, he'll be as good as new, but McFadden is getting a reputation as being a bit fragile. True or not, we just don't have enough information on McFadden yet. His foot problems last year and this knee issue are in no way related, so let's call this what it is: bad luck. McFadden should have no trouble coming back from this and getting back into his role, but the Raiders depth isn't helping McFadden stay healthy. That's making some wonder if he needs to be used more like Reggie Bush, keeping him outside the tackles.
There's something to learn about the new-look Lions from how they handled Kevin Smith. Winning one game isn't going to change the fact that this year's Lions aren't very good, so any player that is part of the long term plan, like Smith or Stafford, is going to get the conservative track from the also-new medical staff. (New to Detroit, anyway; it's actually a very experienced staff.) Smith's shoulder wasn't a big issue last week, but there was no reason to risk him. Now that he's had a week off, Smith is back at practice and likely to be back in his full feature role. The shoulder is still a bit sore, so the Lions will be watching him for a couple full-contact practices to make sure that playing won't cost him time down the road.
Which sounds worse: broken ribs or rib cartilage damage? There's no right answer here, since both are bad. For a football team, the question is which will keep a player out longer. We've seen broken ribs in a couple situations this year, but Roy Williams' ribs held and the soft tissue gave when he took a monstrous hit. This is a pain management issue and there's some evidence that Williams heals quickly, so the Cowboys are going to have to watch Williams closely to see when he could go back and when he can safely go back. The focus has been too much on what the Cowboys gave up for Williams rather than what he's capable of doing, but this kind of injury is going to make him harder to convert physical gifts into points.
I'm a bit lighter in the wallet after saying that I'd make a donation to Freeney's charity if he played in Week 4. He did, though he was spotted in carefully. Freeney played only in "sack situations" and was limited in his repertoire of moves, staying away from his favored spin and sticking to a straight speed rush. If you watched closely, you'd also note that Freeney was in more of a track stance -- his feet staggered -- which was an adjustment he made to keep his injured quad from being taxed with the push. Now that we know Freeney can play, the question remains if he's doing any damage by doing so. Using him in select situations with a clear limitation on what he can do physically seems safe, but it only takes one instinctive adjustment to overtax the already weakened muscle and put him back to square one with the Grade I+ strain. Expect him to be similarly limited in Week 5 against the Titans.
It's always very scary when a player is down as long as Jared Gaither was on Sunday. The backboard comes out, the ambulance is ready, and the player goes from being a purpose-built machine to a piece of wreckage before our eyes. But let's be clear: Time down means next to nothing. The NFL takes neck and spine injuries very seriously (though they could do more to support research into a cure ...) and they would rather keep a game on hold, going through every precaution, before moving the player. This has worked well for them and certainly helped with bright-line cases like Kevin Everett and Reggie Brown. These helped keep Gaither safe as well, although it appears he had nothing more than a spinal cord concussion. You might remember that Ben Roethlisberger suffered from that injury last year. Gaither is still sore and is wearing a neck brace as a precaution, but it's possible he could play as soon as this week. It looks like that's unlikely, but Gaither should be back quickly and without long term consequences.
Bumps And Bruises:
Like Donovan McNabb, Matt Hasselbeck is likely to play this week despite a healing broken rib ... Marc Bulger is throwing again, but his range of motion is still an issue. He's unlikely to play Sunday ... I hate the word "tweak," but we have to at least note when it's used regarding Adrian Peterson. The words that Brad Childress should have used: cramp in his hamstring. Keep your eye on it ... Calvin Johnson has a mild strain of his quad and missed practice Wednesday. His size makes him useful even if limited, though it could make the other Johnson -- Bryant Johnson, that is -- more of a play this week ... It's hard to tell how much is Dwayne Bowe's hamstring and how much is the Chiefs' "offense." It's safe to say that the hamstring wasn't at 100 percent last week and will still be an issue this week ... The Raiders think that Zach Miller will be back after suffering a concussion. He didn't lose consciousness and hasn't had any symptoms besides a headache ... The Texans just had plain ol' flu, not swine flu as originally suspected. They had several players out last Sunday, including Chris Brown and Xavier Adibi, who should be back this week ... Brendon Ayanbadejo is done for the season after suffering a "severe quad strain" last week. Surgery is possible ...