August 29, 2016 - Dr. David Chao
Monday Morning MD: No medical reason for Tony Romo to retire
Tony Romo is not too old or too fragile. The Cowboys quarterback is not injury prone. Medically, when his compression fracture heals, he will be cleared to play and will not have increased risk for long-term problems or further injury. Sure, Romo is 36 years old, but Tom Brady is 39. Yes, the Dallas signal caller has now had his fourth fracture since 2014. However, it would be unfair to say his body is too ancient to play football. 36 may be the tail end of a football career, but medically, weak bones or osteoporosis are decades away. The L1 vetebral body compression fracture suffered Thursday is unlikely related to his previous back issues. Disc surgery is typically performed at a much lower level (L4-5 or L5-S1). Transverse process fractures are located to the back and side (posterolateral) of the spine, while this break is located in front (anterior). Details on his previous cyst surgery are sketchy but I still don’t see the relationship to the current injury. When healed, Romo’s back will not be physiologically weaker or prone to injury. There is not an underlying weakness in Romo’s body. Anyone who has a 300 lb defender jump forcibly on a flexed spine would suffer these same injuries. In 2014, the same year Romo suffered, transverse process spine fractures, 23 year-old Baylor QB Bryce Petty had the same injury. Certainly, the then collegiate QB’s bones were not weak. Both returned after one missed game. Likely the two clavicle fractures and now second spine fracture does not happen out of his fragility, but there may be another reason. Romo has always been among the best at creating a big gain out of a broken play. Now, his continued desire to extend plays versus his decreased ability to avoid big hits is catching up to him. I wrote last year that Romo has to learn to protect his left collarbone and not take similar hits. At this point, it may be time to resist his natural temptations to create something out of nothing and throw the ball away. The Cowboys clearly need him, going 1-11 last season without their star player. With his 2014 spine fracture, he recovered quickly and missed only one game. No way a fracture heals in two weeks but a transverse process fracture doesn’t have to heal, as it is not structural. The compression fracture is structural and there is no way to rush back from this injury. No surgery or kyphoplasty will be needed. No brace or special therapy either, just time. Romo will definitely miss the season opener and should take a minimum of six weeks to return. If hit in a similar fashion, a compression fracture can progress to a burst fracture with potential injury to the spinal cord or nerves. No one can be allowed to take that risk. Once healed, the risk of paralysis or permanent injury is no greater than normal. Romo could resume throwing in a few weeks, but the earliest I see him playing and being exposed to a hit is six weeks. In 2007 with the Panthers, David Carr only missed a couple of weeks with his compression fracture but admitted he wasn’t at full strength until much later. Of course Romo could decide to retire, but if he does, it won’t be because he couldn’t pass a physical or was risking further damage. No one can question his toughness. How many other people can say that they walked off the field on two separate occasions with spine fractures? MMMD 1: Paucity or plethora of injuries? Some journalists have gotten the erroneous impression of 2016 being a good injury year a few days ago. The reality is that injuries are near the average. Up until this weekend, we just didn’t have as many big name stars injured. Now with Romo injured and the parade of Achilles and ACLs continuing, within a day, the chorus has now come that this may be a bad injury year including calls to modify the preseason. MMMD 2: John Harbaugh calls to change preseason The Ravens head coach’s preference is for no preseason games at all to avoid injury. Harbaugh states that coaches can evaluate and ready players through practice and scrimmages. He also wants to add meaningful games. While noble to try to find a way to decrease injuries, this would not do it. Injuries happen in practice and scrimmages as well. Adding regular season games certainly would also increase injury. My long-standing proposal has been to eliminate one preseason game and add a second bye week, keeping the total length of players time the same. Having a week’s rest early and later in the season would be positive for player health. Paring Thursday games with a bye week would eliminate playing on four days rest. An added week of televised opportunities Sunday, Sunday night, Monday night and Thursday night games would boost revenue as well. MMMD 3: Unusual in-game injury report Last week we discussed how pre-game injury reporting was going to become more confusing this year. Sunday night, the Bengals broke form and went out of their way to give more than the typical cursory information. All teams are required in-game is to give a body part and a status. When A.J. Green injured his knee, the team released more than that. Instead of the usual “knee – questionable (or out)”, the Bengals tweeted Green’s right knee as “reported as not serious”. This helped calm fans worry. After the game, Green said he “banged knees”. I bet fans wish all teams would be this forthcoming with injury information. MMMD 4: Achilles tears continue Ben Watson TE Ravens tore his Achilles tendon. Brandon Oliver RB Chargers had a classic eccentric load Achilles rupture as well that was well documented with HD video. This is another example of how obvious some diagnoses are off publicly available images. Achilles tears continue to be the second most common season ending injury to ACL tears. As players get bigger/faster/stronger, the size of the Achilles remains essentially the same. It is the strong muscle that overcomes the tendon to cause a tear. MMMD 5: Preseason injury rundown Bengals RB Cedric Peerman has a forearm fracture that will need surgery and is likely to be 6-12 weeks for return, making him an IR candidate and possible return. The fear by video is Cardinals DB Mike Jenkins has an ACL tear. I hope my eyes deceive me here. Ravens RB Kenneth Dixon has a mild MCL sprain. While media have said 4-6 weeks for return, I am hoping for 2-4 weeks. Colts G Jack Mewhort does not have an ACL tear despite initial reports to that effect but will still miss some time. Bears backup QB Connor Shaw has a tibia and fibula fracture and likely had immediate rodding surgery. Steelers OT Marcus Gilbert hyperextended his elbow and is seeking a second opinion. As a lineman he should be ok for the season to play with a brace. By video, Steelers DE Cam Heyward had a mild high ankle sprain. Being seen in a boot but putting full weight on it is a good sign for Week 1 appearance. Redskins RB Keith Marshall has a strained elbow and I fear ligament damage, but won’t need surgery and will return in weeks. LB Ryan Kerrigan has a groin strain. RB Matt Jones has a previous mild AC sprain and I expect a Week 1 return. Tyler Eifert just started jogging and is targeting a Week 4-6 return and may be a PUP candidate. Falcons S Keanu Neal will miss 3-4 with a “clean up” knee scope. Rams WR Pharoh Cooper is said to be out several weeks. By video, he suffered a left AC joint sprain on a spectacular catch Saturday vs Broncos. Texans LT Duane Brown with a torn quad is not expected to he ready for season and likely will be on PUP. Meanwhile C Nick Martin had ankle surgery and his season is over. Patriots TE Rob Gronkowski is back practicing. Bears OT Kyle Long has a torn labrum. Offensive lineman can play with a shoulder harness, unless the labral tear is in the more unusual posterior location. Ravens WR Breshad Perriman is finally practicing. Chiefs LB Tamba Hali is off PUP now. Packers WR Jordy Nelson has been off PUP but is only doing individual drills and not full go yet. MMMD 6: Eddie Lacy cutting his hair? Hair is considered part of the body. Although tacking a player from behind by grabbing his hair is just as dangerous as a horse collar tackle, it is not illegal. After just such a tackle, Lacy is considering cutting his hair. The Packers running back is not worried about the pain of losing some hair but rather the safety of his legs. In this era of health and safety, I am surprised the competition committee has not outlawed pulling a player down from behind by any means, including hair. MMMD 7: ProFootballDoc scorecard One can never be perfect and I will definitely call my initial Tony Romo assessment a mistake. I didn’t see the injury when it happened as I was at the 15th annual Taste at the Cove fundraiser. Although when I saw the injury video the next morning, it had me worried about compression fracture. However; by then it was reported that Romo did not have X-rays at the stadium. I read too much into the fact that team doctors did not get films at the game. Dallas has a spine surgeon as one of it’s regular team doctors. I am right about it not being related to previous injuries, but the bottom line is this is an error in video diagnosis. Brandon Oliver’s Achilles rupture was fairly easy and a classic example for the eccentric load injury. Connor Shaw does indeed have a tibia and fibula fracture and had immediate surgery with a rod. Ravens RB Kenneth Dixon did indeed have a MCL sprain. These take the previous 20-0 record to 23-1 or 95.8%.