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09 Dec 2009

Black and Blue Report: December 9, 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.

Matt Schaub

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.

Matthew Stafford

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.

Michael Turner

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.

DeAngelo Williams

Ankle Sprain

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.

Mark Sanchez

PCL Sprain

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.

Kurt Warner

Hip Injury

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.

Steven Jackson

Strained Back

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.

Hines Ward

Hamstring Strain

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.

Clinton Portis


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.

Devin Hester

Calf Strain

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.

Posted by: Will Carroll on 09 Dec 2009

24 comments, Last at 11 Dec 2009, 6:03pm by PatsFan


by Fan in Exile :: Wed, 12/09/2009 - 11:39am

Thanks, I'm going to be benching DeAngelo again it seems.

by Blotzphoto :: Wed, 12/09/2009 - 11:54am

Having just messed up my shoulder lugging luggage at Thanksgiving, I seriously feel for Schaub and Stafford. They at least get immediate medical attention (not that Stafford would listen to a doctor). I've had to chase three children all day with my bum wing!

by dmb :: Wed, 12/09/2009 - 12:10pm

At first, I was hoping that Dr. Carroll would respond to this comment with an anatomical explanation of the bum wing... but on second thought, I have no need or desire to learn of your particularly curious appendage.

by Kevin from Philly :: Wed, 12/09/2009 - 5:33pm

I got a bum wing once, too. But I sent it back and they gave me a new plate of 'em. Spicy!

by Phil O'sopher (not verified) :: Wed, 12/09/2009 - 12:10pm

I noticed only marquee (or close to it) players are mentioned.

The Browns had CJ Mosely blow out his knee this last week. I know that no one knows who he is, but think NJ Jets and Mangini and you will remember.

Are there any stats on teams that have the most people (or starters, if easier) on IR year after year? Is there a correlation between the years? Strength and Conditioning coach is better, for example or is it completely random?

Do losing teams put more people on IR? Is it because with nothing to play for, why risk the player's career? Or is it because of the injuries that they are losing?

Watching Cleveland Football (if you can call it that), I get the feeling that we have many many IR'd starters and key players each year, but that they may play through some of that if we weren't cellar dwellers. I don't have the stats to back this up though.

I would be curious to see the percent of IR players and starters for each of the 32 teams for the last ten to fifteen years and see the correlation to win percentage.

by dmb :: Wed, 12/09/2009 - 12:12pm

I would be curious to see the percent of IR players and starters for each of the 32 teams for the last ten to fifteen years and see the correlation to win percentage.

The problem is that causality can work both ways on that -- you're probably right that losing teams are more inclined to place players they intend to keep on IR (e.g., Chris Cooley), but at the same time, having a lot of key players on IR is going to hurt your chances of winning.

by theshadowj :: Wed, 12/09/2009 - 4:16pm

They have articles in their books that rank the training staffs of the 32 teams. However, they say that injuries from year to year do tend to regress to the mean. In case you were wondering, this year the Browns had a three year rank of 31.

While what you say about losing teams putting more people on IR simply because they are losing might be true, it would be very difficult to measure that. A losing team with a lot of players on IR is probably losing because of all their players being on IR, not the other way around.

by dmb :: Wed, 12/09/2009 - 12:35pm

Okay, I'll stop the stream of comments after this, but Portis went on IR yesterday.

by Eddo :: Wed, 12/09/2009 - 12:59pm

"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[.]"

At this point, I'd say the Falcons really need to win out to make the playoffs, essentially making every remaining game like a playoff game, so if Turner's needed for the playoffs, he is needed for every remaining game.

Of course, I don't think Atlanta needs Turner at all; he's better than the alternatives, but I don't really think he's the difference between winning and losing.

Matt Ryan, on the other hand, is essential.

by andrew :: Wed, 12/09/2009 - 1:06pm

Any thoughts on the likelihood of EJ Henderson making a recovery? Obviously not this year, but is it a matter of next year or the year after, or is it something that might end his career?

by theshadowj :: Wed, 12/09/2009 - 4:18pm

I've read elsewhere that Henderson's injury, while ugly, is not career threatening, and probably is not even going to affect next season.

by Led :: Wed, 12/09/2009 - 1:12pm

I'm not surprised Steven Jackson has got a sore back. He's been carrying the Rams all season.

by Capitan (not verified) :: Wed, 12/09/2009 - 1:14pm

Will, thanks for the update. At this point, would you start Schaub or roll the dice with Jay Cutler? Sad options I know.

by Kevin from Philly :: Wed, 12/09/2009 - 5:36pm

Shaub on the bench might get you more points than Cutler on the field.

by Eddo :: Wed, 12/09/2009 - 6:32pm

Eh, Cutler's been an OK fantasy QB this year. I know from experience. Even his five-interception game was worth five points.

He tends to throw for a lot of yardage and/or touchdowns when he throws a bunch of picks. Otherwise, he has a "safe" day with mediocre positive numbers.

by Karl Cuba :: Wed, 12/09/2009 - 1:16pm

It turns out that it's Will Carrolls all the way down

by tuluse :: Wed, 12/09/2009 - 1:36pm

Haha, nice one.

by andrew :: Thu, 12/10/2009 - 1:30am

Well its the time of year to go caroling...

by Purds :: Wed, 12/09/2009 - 11:57pm

Any news? He's a pretty important player in the Colt D. Went out with a hamstring injury, I think.

by Subrata Sircar :: Thu, 12/10/2009 - 5:38am

While your style is definitely different from your son's, I see turns of phrase and certain idioms have been passed on. Welcome to the Outsiders :)

by Paul R :: Thu, 12/10/2009 - 9:27am

"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..."

Will this be on the test?

by Spielman :: Thu, 12/10/2009 - 10:32am

Speed merchant is a phrase that always gets me. I have this mental image of a smiling Devin Hester hawking his wares in an open bazaar, with the ability to move really quickly spread out on tables under an awning.

by mm (not verified) :: Thu, 12/10/2009 - 8:54pm

Jabari Greer is now the 4th Saints' starter to get a sports hernia in the last 2 years. Is there something the team is doing to make these more probable?

by PatsFan :: Fri, 12/11/2009 - 6:03pm

Brady's been downgraded to questionable.