Monday Morning MD: Achilles is the new ACL

The ACL used to be the dreaded injury, but now Achilles is catching up. Both injuries end seasons and necessitate surgery. Both are predominantly non-contact injuries that have not dropped in frequency despite the limited practice of the current CBA. This week Seahawks players Brandon Cottom and Ronnie Shields suffered Achilles tendon ruptures essentially back to back during practice. The Lions Eric Ebron was feared to have suffered the same fate. Hopefully the latest report of no need for a boot means his Achilles is not torn. Although it seems that way, Achilles tears are not more common than in the past, they just haven’t decreased with new CBA practice limits. This makes sense as Achilles are non-contact injuries, so limiting padded practices doesn’t decrease the occurrence. In fact, as practice tempo increases, the tendon is more at risk. As players get bigger, faster and stronger, the Achilles tendon stays the same size. Essentially, it is like planting a bigger tree in the same size pot and thus something has got to give. In fact, the Achilles girth of an NFL athlete is no different than that of the average person. The only good news is that recovery continues to improve. Cowboy Gavin Escobar has made a quick recovery and was not placed on PUP. Arian Foster has done well so far in Miami. I am less worried about his Achilles recovery than the fact that he will be a 30 year-old running back. Achilles injuries are caused with a sudden eccentric load with an explosive first step or change of direction. As the size of players and speed of the game increase, Achilles tears have become the new ACL. MMMD 1: No requirement for injury reporting During the regular season, injury reports are the norm. In the offseason and preseason, injury updates are not mandated. All injury information at this time of the season is provided at the grace of teams, coaches and players, as there is no mandatory reporting. Packer fans fretted about Jordy Nelson’s ACL recovery when he was placed on PUP without a given reason. However, the player himself later revealed it was a “hiccup” to his left knee, not the right side which had ACL surgery. The in-season reporting requirements are far from full disclosure. As predicted, the Colts were never fined for the non-disclosure of the rib injury to Andrew luck. Therefore, in the preseason, we are left to guess when Jamaal Charles, Jimmy Graham and Dion Lewis will come off PUP. MMMD 2: Reggie Ragland limbo The Bills have already temporarily lost their first-round pick Shaq Lawson to shoulder surgery. Now their second-round selection is in jeopardy of missing the season. There was early worry about an ACL tear and an inconclusive MRI added to the mystery. In my NFL experience, a gentile lachman exam was always more accurate than a MRI. We always knew whether an ACL was torn or intact before we left the field. I suspect the Bills know as well. The key is whether the exam shows the knee to be stable or unstable. A partial ACL tear that is stable will mean a good return for this season. A partial ACL tear where the knee is unstable means surgery and IR. Lets hope for the best as we await the second opinion. The Bills already know, but it is fair for the player to be sure before deciding his fate for 2016. MMMD 3: Thomas Rawls comes off PUP There has been much confusion about the Seahawks starting RB and his ankle injury. Despite early reports of no surgery, I always said surgery was necessary. That has now been confirmed by Pete Carroll this week. The PUP stint was expected. Now look for Rawls to move forward with a productive season. After all, his injury is similar to the ones previously suffered by Danny Woodhead and Darren Sproles. Those two certainly have not looked back after their surgery and recovery. MMMD 4:Different outcomes for pectoral injuries The key to pec injuries is whether they involve the tendon or muscle . William Jackson of the Bengals tore his pec tendon, thus will need surgery and be placed on IR. Manny Lawson of the Bills is thought to have a pec muscle injury and thus hopefully will be available soon. Coaches, players and reporters often confuse pec tendon and muscle. The key is to determine the location of the tear as tendons detach and need surgery while muscle doesn’t hold suture and can heal with time. MMMD 5: Hall of Fame game cancelled In a sign that the NFL is serious about player safety, the first preseason game was cancelled due to poor field conditions. This certainly caused much embarrassment and millions of dollars but good to see the league acting on behalf of safety. There have been five major medical changes for 2016. Among them is the addition of a Field Surface and Performance Committee that would be responsible for this type of issue. MMMD 6: Cupping takes center stage CpT3wFvUsAAhcC1 With the marks left behind on Olympic athletes, cupping therapy will likely become the new rage. Kinesio tape has been around for decades but exploded into the public eye with the 2012 Olympics. Now the centuries old Chinese cupping therapy has come to the forefront with the 2016 Olympics. There is no scientific evidence that cupping or kinesio tape works. Then again, ankle taping comes loose within the hour and many pregrame IVs are given to already well hydrated NFL players. Never discount the placebo affect. MMMD 7: ProFootballDoc scorecard Dolphins fans worried about a long absence for Jay Ajayi when reports of a knee bone bruise surfaced, but my prediction of a quick return fortunately came true. Cowboys fans worried and sent me video of Devin Street’s injury and fortunately it turns out to be a mild injury as expected. When Corderelle Patterson of the Vikings landed on his shoulder, there were fears of clavicle fracture and serious injury. By video, it appeared to be an AC joint sprain and he is already back at practice. Seahawk Thomas Rawls indeed entered camp on PUP and now has quickly come off the list and is ready to go after his ankle fracture that required surgery. Adding these four to the previous 12-0 record takes the 2016 scorecard to 16-0 but one miss still takes us below last season’s 94.6% mark.
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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