November 21, 2016 - Dr. David Chao
Monday Morning MD: NFL players show incredible toughness every week
Few doubt how tough you have to be to play in the NFL. This week has many examples of how players react and play through injury. LeSean McCoy got up and casually walked to the Bills sideline as if almost nothing happened. He missed the second half with a dislocated thumb, which could not be reduced and now needs surgery. Yet, he is likely to play next week. The crazy part is this actually makes sense as by video, he dislocated his small (IP) joint without fracture. Once reduced with surgery today (as the flexor tendon blocks reduction). The thumb should be stable and relatively pain free. No one even knew Giovani Bernard was injured but he reportedly tore his ACL on his final catch. Since the Bengals were down by four with under a minute to go and no timeouts, he hopped up to avoid a 10 second runoff then went right back to line up for the next play and even attempted to throw a block before the play was called dead. With the stoppage, Bernard then subbed himself out. Now he will need major surgery and will have to race to return for Week 1 of 2017. A.J. Green’s season is likely over with a significant hamstring tear, yet his body language indicated a routine play with a minor issue. The injury appears to be high up and proximal hamstring tears take longer to recover. Safety Eric Reid acted like nothing happened when by video, he tore his distal biceps tendon. He almost continued to play until stopped by a delayed timeout. Typically, this injury ends one’s season and requires surgery. Terrell Suggs is delaying surgery and playing with just such a distal biceps rupture. Sunday he had a sure sack, but due to weakness to flexion/supination on his injured left arm, Dak Prescott stepped through the tackle. Even long snappers got in the tough guy act. Clark Harris limped badly with a foot/ankle injury and was about to be driven off. He hopped off the injury cart to play, even though he could no longer even jog to cover punts. In a bad injury week, there were plenty of examples of how the NFL is a real man’s game. MMMD 1: Emotional Luke Kuechly The former defensive player of the year was not showing weakness when he appeared to reveal vulnerability. Certainly he was red-faced and sweating from the game; however, Kuechly’s body was heaving to try and catch his breath, not blubbering in tears. By video, he took a blow to the chest/sternum and was gasping for air from having the wind knocked out of him. He also hit his head and it is a known medical fact that a concussion can cause mood alterations. Combine the fear of not being able to breathe and the loss of emotional control from head injury and you get Kuechly’s reaction to injury. MMMD 2: Seahawks RB carousel Seattle leads the NFC West but will start its third running back in three weeks. Christine Michael was released after a mild hamstring issue. Now C. J. Prosise is injured. By video, the worry was a scapula fracture for Prosise who did not return in the second half. Typically, a scapula body fracture does not need surgery but is very painful and leads to a 4-6 week recovery. A report surfaced that Prosise will not return until the playoffs. Fortunately for the Seahawks, Thomas Rawls is finally healthy after an early season fibula fracture. This truly has been “next man up” after Marshawn Lynch retired. MMMD 3 Accuracy of team reports Two weeks ago, I documented the differences in teams’ use of the “questionable” designation. “Questionable” also seems to be the tag whenever a player initially exits for injury, but is it accurate? Demetri Goodson suffered a horrific multi-ligament knee injury. (Video here but warning: graphic) The Packers officially classified him initially as questionable to return to the game. In reality, what is questionable is whether Goodson can return to a productive career as a cornerback. Best wishes to him. MMMD 4: Who is ready to return? Three quarters of teams have yet to use the single “designated for return” spot to bring a player off injured reserve. With six weeks left in the regular season, watch for more teams to start bringing players back. Ameer Abdullah is seeking a second opinion and may be the Lions player to return off IR. Sammy Watkins is slated to have a CT scan to assess fifth metatarsal bone healing and might be able to come off IR to help with Robert Woods’ absence. Everyone has forgotten about J.J. Watt after his second back surgery. I know the club wants to be cautious but he is eligible to come off IR after today. I expect Watt to be medically healthy now and lobbying to help his team to the playoffs. The Texans lead the AFC South and if they beat the Raiders tonight, they would be in position for a possible playoff bye. Branden Albert missed this week after surgery on a dislocated wrist and could be back next week. Rob Gronkowski was not allowed to fly to California this week with a pneumothorax, but I fully expect him to travel and play against the Jets next week. Mo Claiborne having torn “some bone off the pelvis” sounds ominous but it simply is a groin avulsion, which usually heals without surgery. A 6-8 week timeline from injury puts him back at Week 14-16. Hope his follow up MRI confirms this expected healing. Look for lots of late season roster moves. MMMD 5: Harvard health study A comprehensive report with medical recommendations for the NFL and NFLPA was released this week. I promised to analyze the top ten recommendations but there were just too many injury issues this week to find the space in this column. I will agree with one finding. Stop using player health as a bargaining chip in the collective bargaining agreement. My full thoughts are to follow in the coming weeks. MMMD 6: Injury rundown Zach Miller has a broken left foot and needs surgery. By video, Robert Woods has a MCL sprain and is on crutches. He is likely will miss several weeks. Cody Kessler is out with his second concussion of this season. Don’t be surprised if an extended absence is coming. Fortunately, Leonard Floyd seems to have escaped significant neck injury. He took a head down hit and was sent off on a spine board. Seattle FS Earl Thomas and CB DeShawn Shead both have hamstring injuries. Dee Ford has a hamstring issue as well. Justin Houston has returned from February ACL surgery to help the Chiefs linebackers. Ryan Matthews is reported to have a MCL sprain and Darren Sproles has a rib injury. Laremy Tunsil left with a shoulder injury and did not return for the second half. Rams LB Josh Forrest by video has a major knee ligament tear, which is likely the ACL. Matthew Slater was knocked out with a left foot injury and seen post-game in a walking boot. By video, Halapoulivaati Vaitai suffered a MCL sprain. Hopefully he can return in a week or two with a brace. MMMD 7: ProFootballDoc scorecard Even though Branden Albert finished last week’s game, he did have wrist surgery and missing this week but has a chance for next week. Tom Brady had no issues despite a scare. Rob Gronkowski was not allowed to travel with his pneumothorax. Jordan Howard avoided Achilles tear or other significant injury to play well. Kyle Long does have a high ankle injury requiring surgery. Kelvin Benjamin overcame mild AC sprain and returned in the same game. Cody Kessler does have a concussion. The Leonard Floyd news is encouraging. Jake Ryan and T.J. Lang missed this week after being rolled up on last week. C.J. Prosise has a presumed scapula fracture. Eric Reid does have a left distal biceps tear. Nick Perry’s mild ankle sprain is OK and he returned to play. This improves last week’s 117-6 (95.1%) scorecard to 130-6 (95.6%) through Week 11.