October 10, 2016 - Dr. David Chao
Monday Morning MD: High ankle is not always dreaded injury
The average fan knows and fears the high ankle sprain. We have come to know this injury can knock players out for extended periods of time. However, does every high ankle sprain lead to a player missing multiple weeks? Like any injury, there is wide variety in high ankle severity. Yes, players can perform thru mild sprains while severe sprains can even lead to surgery. Early in the game by video, TE Martellus Bennett suffered a high ankle sprain and was in obvious pain. He channeled his inner superhero and returned to play, catching three touchdown passes for the Patriots. How sore and how much swelling he has this am, will determine if he can also play next week. Steve Smith Sr. also appeared to suffer a high ankle sprain. He continued to play for awhile but ultimately limped off the field. By video, Eddie Lacy also suffered a high ankle sprain. The Packers RB left the game but hopefully that has as much to do with the score at the time as the severity of the injury. Meanwhile, high ankle injury can be very severe. Last week, Kevin White limped off under his own power but has been reported with a severe high ankle sprain with an associated fibula fracture. The injury to the Bears receiver has nothing to do with his tibia stress fracture from last year but he has been placed on injured reserve and likely needs surgery. By video the worry is Trumaine Johnson may have suffered the same fate as White. The best case scenario is a severe high ankle sprain with a prolonged absence. The worst case for the Rams cornerback is season ending surgery if an associated fibula fracture is found. Neither possibility is good for someone playing on a franchise tag without a long-term deal. We have chronicled both ends of the high ankle injury spectrum. Of course there are plenty of scenarios in the middle as well. Bottom line is the high ankle sprain is not always the dreaded injury it is made out to be in the media. MMMD 1: Early stats for new injury categories With PROBABLE being removed, what does QUESTIONABLE now mean? It used to mean a 55% chance of playing in 2015. Now with the two combined, the early returns show about a 75% chance to be active. It makes sense that when combining a 50/50 and 95% category that the results are somewhere in between. The challenge now is to figure out which players are truly questionable to play and which ones were always very likely to make it. Of note, zero DOUBTFUL players have been active in 2016. Jay Cutler, Stefon Diggs, Dwayne Washington and others continued the no-go trend here. Seems like this should have been the better category to remove for the league. MMMD 2: Browns can’t get started Every offensive play starts with the snap. Cleveland can’t keep their centers or quarterbacks on the field. With the Cody Kessler injury to his chest/ribs, the Browns have now used eight players at these two positions. Kessler’s X-rays were negative so he has a chance to return next week. Meanwhile, recently acquired backup QB Charlie Whitehurst was the fourth Browns QB injured when he hyperextended his left knee but hopefully escaped serious injury. Both Robert Griffin and Josh McCown suffered shoulder fractures previously. MMMD 3: Trevor Siemian could return for Thursday The Broncos starter was reported by Jay Glazer to have a grade 3 AC sprain and was inactive Sunday but that doesn’t rule him out for the midweek division clash versus the Chargers. The injury is to his non-throwing shoulder and contrary to some speculation, will not need surgery. With aggressive treatment and medication, I think Siemian has a good chance to play despite the high grade AC injury. Jimmy Garoppolo had a reported grade 2 injury to his throwing shoulder and missed 2 weeks but was healthy enough to back up Tom Brady and play in mop up duty this week. MMMD 4: Gary Kubiak hospitalized after game. I hope it is just illness and nothing more as flu-like symptoms sent the Broncos head coach off in an ambulance post game. In 2013, he collapsed at halftime as the Texans head coach and suffered a mini stroke. Hopefully this is all precautionary and Kubiak will be fine. MMMD 5: Injuries no excuse All teams have injuries and need to make adjustments. The Vikings head into their bye as the only undefeated team at 5-0. They lost their franchise QB, star RB, starting left tackle and others, yet still remain undefeated. Kudos to the GM, coaches and players for their success. Versatility often helps a team as well. There is no better example than Texans LB Brian Peters. He had kick off duties Sunday and has even stepped in as long snapper. As they say in the NFL: the more you can do. MMMD 6: Injury rundown. Tevin Coleman had no issues with sickle cell in Denver. He tied the Falcons record for most receiving yards (132) for a running back as he helped hand the Super Bowl Champions their first loss. A.J. Green was rolled up on late in the game but returned after six plays. Jeremy Hill left with a shoulder injury after his previous chest injury but should not miss significant time. Josh Norman injured his right hand/wrist and finished the game with a splint and tape. By video, Terrance Williams had a mild left AC sprain, which he confirmed. He should not miss any games. Cam Heyward will have a MRI on his hamstring to determine severity. Letroy Guion said he had a complete tear of MCL from week 2 but returned this Sunday with a brace and will not need surgery. WRs Randall Cobb and Chris Hogan had ugly looking hits but neither suffered significant injury, but likely both will be sore. Tony Romo will have a repeat MRI Monday. Expect good news as compression fracture heals reliably. Despite a long list of injuries there is no medical reason for Romo to retire. With his replacement playing well, expect Romo back after the week 7 bye. Dez Bryant was inactive Sunday but will beat Romo back as he does not have a true fracture. Latavious Murray was out with a turf toe and his return is undetermined. Senquez Golson was placed on IR as Lisfranc injuries are hard for defensive backs to play through. Zach Ertz was active after his early season first rib dislocation. No surgery was needed and he should do well going forward. Tyler Eifert has yet to play after a Pro Bowl ankle injury and surgery. His return is now delayed by a back issue. Jacoby Brissett needed thumb surgery. Likely his ulnar collateral ligament injury kept the Patriots from having a full offense last week. Kudos for toughing it out and delaying surgery until Brady returned. Josh Doctson’s Achilles tendonitis continues to linger. I am sure the Redskins are doing what they can but this is just one of those frustrating issues. Eric Decker is still out. Optimists will say it is good news the team has not put him on IR for his partial rotator cuff tear. Pessimists will say he is done and needs surgery. The truth will depend on the extent of the tear, where greater than 50% thickness spells trouble. MMMD 7: ProFootballDoc scorecard Lee Smith was confirmed with an ankle fracture. Kevin White had a severe high ankle sprain with fracture. Randall Telfer did miss the game with a high ankle injury. Zach Ertz returned to play without surgery on his dislocated first rib. Sickle cell indeed was a non-issue for Tevin Coleman. Senquez Golson was placed on IR for long standing Lisfranc injury. Randall Cobb and Chris Hogan were ok despite nasty looking hits. Charlie Whitehurst knee hyperextension seems mild as expected. Martellus Bennett had a mild high ankle sprain. Josh Doctson Achilles tendonitis is lingering. Cody Kessler seems ok with no fracture. This makes the previous 61-2 mark, now 73-2 (97.3%), but one or two misses will bring it right back to the 95% target.