January 09, 2017 - Dr. David Chao
Monday Morning MD: Who is healthy for the Divisional Round?
Will Big Ben or Jordy Nelson play this week? How will injuries play a role in who moves on to the Conference Championships? Ben Roethlisberger made the collective hearts of Steelers Nation stop when he showed up at a post-game press conference in a boot. He injured his right ankle/foot on the final interception with 4:34 left to go in the fourth quarter up 18 points trying to extend a play. Big Ben was rolled up on with a plantar flexion sprain to his right ankle/foot. This is not a dreaded high ankle or Lisfranc sprain. Walking boots are commonly used as a precaution to help control swelling and will likely come off shortly. The Steelers QB may even skip a practice or two, adding to the drama. Recently, Roethlisberger has played through a meniscus tear, Lisfranc sprain and separated shoulder. I am expecting he is more hurt than injured here, thus Big Ben will undoubtedly be healthy and mobile when they face the Chiefs, but whether he has Ladarius Green as a target is up in the air due to concussion symptoms. Jordy Nelson took a helmet to the left lower postero-lateral ribs and did not return. Not only is there worry for rib fracture, there is some concern for internal organ injury. He left the field on a cart with a primary care physician (not orthopedist). If there is a fracture (and there may be more than one), it will be difficult to play in Dallas this week for not only the pain, but the risk of injury to his spleen/lung/kidney. Without a fracture, Nelson might have a chance to play with medication/rib block and a flak jacket. In other Packer news, Ty Montgomery who had recent ankle issues and was twisted up awkwardly and limped off the field. He returned to finish the game. By video, LB Blake Martinez injured his MCL. He had a similar injury in November. He could play and run well but would have trouble cutting. Tom Savage has a good chance to get cleared from his Week 17 concussion but would still be the back up as Brock Osweiler has already been named the Texans starter. Danny Ammendola returned to practice for the first time since the Week 13 apparent high ankle sprain. I expect him to be near 100% given he has had six weeks to recover by the time the Patriots kickoff. The Cowboys should be at full strength with Tyron Smith coming off a mild MCL sprain and Morris Claiborne finally returning to action after a groin avulsion injury in Week 8. I expect both Justin Houston (knee) and Spencer Ware (ribs) to both give it a go this week for the Chiefs. Russell Wilson shed his knee brace and looks to finally be himself after knee and ankle issues for most of the season. Let’s hope we see all players at full strength and may the better team win. MMMD 1: Should Matt Moore have been pulled? The Dolphins QB took a ferocious and penalized hit to the jaw. The internet was abuzz with outrage that he was returned to the game after missing just one play and thought that he could not have been properly checked for concussion. I took a stopwatch to the sequence of events. With the prolonged time tending to Moore on the field and the adjudication of the multiple penalties, there was exactly five minutes of elapsed time between the hit and his next snap. If play had resumed immediately, Moore would have missed a handful of plays or more. He only missed one play due to the protracted stoppage. Typically a sideline concussion screen only takes about two minutes. If positive, a full locker room evaluation takes approximately 10 minutes. The league appointed Unaffiliated Neurotrauma Consultant (UNC) was seen taking an active role. Remember, this is a local Pittsburgh area physician (who is likely a Steelers fan) and I would find it hard to believe he was influenced by the Dolphins’ desires to keep Moore in the game. A hit to the jaw can cause a concussion. After all, that is why mouthpieces can decrease head injury risk. However, Moore was hit with more of a rotational force to the jaw torquing his neck and thus may have escaped concussion symptoms. I don’t know the details of how the medical decisions were made but here is another reason for transparency. Referees are questioned by a pool reporter after the game. Why not let the UNC speak as to what he saw and what the medical thinking was? This would not be a patient privacy violation as the UNC is the league observer and is not there to treat the player and thus HIPAA would not apply. MMMD 2: Changing of the guard? Some are proclaiming Jadeveon Clowney as the new Texans defensive leader. Certainly he played well and with a skinny J.J. Watt in street clothes on the sideline, that was an easy narrative as we are prisoners of the moment. Don’t count Watt out yet. First, the team is just being cautious after the second disc surgery. Second, I expect a full recovery, as disc surgery does not typically end careers. Third, it is easy for a workout warrior to lose muscle mass quickly but it is also relatively easy to regain weight with the start of lifting, if you have been that big before. Expect a double-headed monster for the Texans defense next year, not a passing of the torch. MMMD 3: Tyrod Taylor contractual controversy? The Buffalo QB underwent sports hernia surgery as expected. The Bills announced Taylor “elected” to have the procedure. Is that wording posturing for the looming $27.5 million March contract guarantee? Typically core muscle surgery takes 6-8 weeks to return to play but three months to be 100%. The March date comes in between this timeline. By contract, the team physician will be the one to determine if Taylor is healthy. This does present a potential conflict. When I was a team doctor, I avoided these situations by asking the team to never inform me about the business side. It was my job to get all players healthy as soon as possible. The best player needed to be healthy to get on the field and the worst player on the team needed to be healthy to get released to make room for roster improvement. I did not want to be influenced by factors other than my medical judgment. I hope the Bills ownership and Taylor can get on the same page MMMD 4: Injury rundown Dominique Rodgers-Cromartie suffered a thigh bruise early against the Packers. With a quad contusion and stiffness, it is hard to run and play cornerback. The challenge to get and stay loose was made harder in the cold and he was thus ineffective. Jason Pierre-Paul will return to be 100% from his sports hernia surgery but there is no rush anymore as the Giants were eliminated. Donald Penn reportedly has a small fracture in his knee but will not need surgery. Ryan Tannenhill did not return from his ACL/MCL sprains. The MCL heals with conservative care but do not be surprised if surgery is announced for his ACL. Jay Cutler’s shoulder labral surgery is recovering well. Whether the Bears will keep, cut or trade their QB, they need him healthy as soon as possible for all three potential reasons. Trevor Siemian had left shoulder surgery. He finished the season but it is not unusual to have clean up procedures. This is why the end of the season is the busiest medical time of the year. Terrelle Pryor had finger ligament surgery and is expected to have a full recovery. Sammy Watkins finally is having his much anticipated second Jones fracture surgery. This time, likely bone graft and a larger screw will be used. Dez Bryant and Julian Edelman had similar second surgeries last offseason and recovered well. Matthew Stafford will not need surgery on his mallet finger. The extensor tendon heals well with immobilization. MMMD 5: Coaches union? Brandon Marshall said, “It’s time for our coaches to unionize. We’ve had four coaches in the hospital this year. If people understood how many hours, and what it takes to be a head coach, how many hours they put in, it would be an issue.” Perhaps instead of a union, it could be a competition committee issue. Even if hours were limited, coaches would take work home. However, that is still better for their health than long hours at the office. MMMD 6: Jaylon Smith back in the news The Cowboys high second round pick says he is still recovering and wearing his ankle foot orthosis (AFO) but can run a 4.5 40-yard dash. I appreciate Smith’s optimism but I have never seen anyone in the NFL play with an AFO. Mike Ryan, a long-time NFL athletic trainer and now sports medical analyst for NBC, concurred. A tendon transfer is not the answer either as those procedures are done to help everyday people to walk, not get around the corner to rush a QB. I wish Smith the best and hope he can make history. MMMD 7: ProFootballDoc scorecard Matt McGloin was available but the Raiders played Connor Cook. Tom Savage was not cleared. Ryan Tannenhill was not ready to go. There was no way for Derek Carr to even travel to the game. Matt Forte did have a knee scope. C.J. Mosely had a calf strain and no surgery needed. JPP did not return. Tyrod Taylor and Sammy Watkins did have surgery as predicted. Jordy Nelson injured his ribs. Ty Montgomery is OK and returned. DRC had a quad contusion. The previous 191-10 (95.0%) record is now 203-10 (95.3%).