January 18, 2016 - Dr. David Chao
Monday Morning MD: Don't be fooled by appearances
Injuries are not always what they seem to be. First impressions often can fool fans to needlessly worry, or trick viewers that everything is ok. These emotional over reactions intensify during playoff time. Just eliminated Pittsburgh fans went thru both undue angst and false hope. When Ben Roethlisberger was carted off last week, Steelers nation feared the worst. Add in the reports of torn ligaments and despite explanations that Big Ben’s arm strength would be fine, every warm up toss was needlessly scrutinized during pregame until he launched a first play pass that traveled 53 yards in the air. On the other hand, there was undue confidence that DeAngelo Williams would play these playoffs after seeing him jog on the sidelines immediately post-injury in Week 1, yet he was inactive for both playoff games. To avoid these misimpressions, I try to rely primarily on injury video and not a player’s reaction. Although not perfect, studying film to determine mechanism and severity of injury is much more informative than the team’s standard announcement of body part and “questionable to return”. Panthers fans pointlessly fretted when Greg Olsen received significant sideline medical attention after his collision with Kam Chancellor. By video, it was a stinger that is initially quite painful but subsides quickly and indeed the star tight end returned to finish the game. During a victory celebration, Patriots nation went into an unwarranted frenzy when reporters saw Julian Edelman headed for a post-game foot X-ray. Edelman played well nine weeks after his foot surgery and had no visible re-injury during the game. It is common to monitor healing fractures with serial imaging. The quick trip to get a picture seemed unalarming to me and likely was done to avoid the extra hassle of a Monday special trip to the doctor’s office for routine follow-up films. New England fans probably also have the memory of the last time they faced the Broncos when Rob Gronkowski was writhing on the ground in pain yet his injury turned out to be relatively mild. Rather than react, I try to model after Mike Pereira, the current FOX rules analyst. He uses his insider knowledge as a former NFL referee to objectively and accurately look at the mechanics of the play. Even on the rare occasion that the call goes the other way, his logic and analysis are impeccable. I attempt to use my insider medical knowledge as a former NFL team physician to analyze injury video and not get fooled by player or teammates reactions to an injury. When it comes to injuries, I can only hope to be as good as Pereira is at explaining calls. We are human and tend to be prisoners of the moment when a player goes down. Analytics is the new buzzword in sports. Nowhere can analytics be more helpful than when looking objectively at injuries. MMMD 1: Patriots continue as most injured team Despite leading the league in injuries, New England moves on to the AFC Championship Game. The five injured offensive starters (Brady, Edelman, Gronk, Amendola and Vollmer) all played well in victory. Now the worry is on the defensive side with Jamie Collins, Jerod Mayo and Chandler jones all exiting with injury. By video, Collins’ oblique muscle injury was confirmed and he is likely to play next week. Jerod Mayo with a shoulder injury has a chance to be active as well. Fellow LB Dont’a Hightower needed surgery, yet finished last season wearing a brace and Mayo could do the same. Chandler Jones’ knee is the bigger worry. I saw only limited video and one angle but the fear is patella subluxation or cartilage issue. He was announced with a non-specific knee sprain and headed for MRI with hopefully good news to follow. MMMD 2: Jared Allen foot fracture After the Panthers victory, word came of a potential season-ending foot injury. Another report confirms the injury but provides some optimism of continuing to play since he finished the game with the small fracture. By inference, Allen appears to have a 5th metatarsal fracture. It is possible to play through an avulsion at the base or a stress related Jones fracture where the cortex (boney wall) is still intact. However, even if he can play, his effectiveness will be limited. It will be very hard to come off the edge or even provide a bull rush. At best, the injury will turn Allen into a more static player. MMMD 3: Battle of injured running backs The return of Jonathan Stewart from foot injury and Marshawn Lynch from sports hernia type surgery was a microcosm of the Panthers versus Seahawks game. Stewart after a one-month absence for foot injury ran for 109 yards and 2 touchdowns while BeastMode was rusty after a two-month layoff. Certainly the Panthers dominated from the start, but the somewhat sloppy Carolina field may have something to do with why Lynch struggled and Stewart excelled. Poor footing affects someone coming off a abdominal/groin muscle injury more. An unstable plant requires more core muscle strength. On the other hand, a soft field helps dampen stress on a sore foot. Lynch medically will be fine but likely has seen his last days in a Seattle uniform. Stewart admitted to being sore, but will be ready to host the NFC Championship Game. MMMD 4: Bruised lung for Randall Cobb The Packers star wide receiver was knocked out of the game and then his team was knocked out of the playoffs. As if we needed a reminder of how rough football can be, Cobb was injured without contact from another player. He leaped to make an all-time catch and fell hard to the ground. By video there was blood around his mouth. True hemoptysis (coughing up blood) could be dangerous, while spitting up blood much more common and benign. Cobb turned out to have a bruised lung (pulmonary contusion) and was hospitalized. While potentially serious, he was released the next day. Likely the overnight stay was precautionary, especially with the long flight home to Wisconsin. The good news is there should be no long-term issues for next season or this offseason once he fully recovers. MMMD 5: Another Manning versus Brady matchup For the 17th time, we get to see our era’s premium QB matchup. For the last 13 years, the AFC quarterback in the Super Bowl has been Peyton, Brady or Big Ben with the lone exception being Joe Flacco. Manning undoubtedly still has plantar fasciitis, which will not improve until the offseason. Ironically having the bad wheel might have helped. In a key play, he fell to the ground untouched and as coverage relaxed, got up to make a key completion. His arm strength is what it is with all of the neck issues and will not change. Brady is healthy despite a reported high ankle sprain suffered two weeks ago. He showed no signs of problems as he even had a rare scramble for a contested touchdown but was ruled out just short before he sneaked it in on the next play. Both will be healthy enough to play in this epic, and probably final, quarterback matchup. MMMD 6: Medical potpourri The Cardinals late use of short-term IR is one game from paying off. They placed Chris Johnson on IR/dfr with a tibia fracture and his first eligibility to return is for the Super Bowl. If Arizona prevails and CJ2K plays again, the latest ever invocation for this relatively new roster designation would pay off. When there is no tomorrow, players suit up and try. Jeremy Maclin was heroic to try to play but he was clearly hampered with the ankle (and knee). He surprised most by even suiting up but played limited snaps and had two catches. Russell Okung appeared to aggravate a previous shoulder injury. He had a 2014 labral tear and was using a brace when his left shoulder appeared to sublux (shift out of place). He is a free agent and may need labral repair surgery that carries a six-month recovery Cliff Avril left the game with a neck injury but returned to the sideline sans uniform. Sebastian Vollmer played effectively with his high ankle sprain. Earlier in the week, he was filmed limping in practice and was a big question mark. He and the Patriots gave up no sacks versus the vaunted Chiefs pass rushers which likely was the key to victory. Justin Houston barely played and seems still hampered by his knee. Despite his statements that he only came out of the game last week to “adjust his knee brace”, Houston clearly has not been the same player. Hope he can get better this offseason. Rob Gronkowski played well despite a report of needing an injection at the hospital on Thursday. I have no insider information but I can’t think of a knee injection that would need to be done two days before a game at a hospital that couldn’t be done in the training room. On the other hand, Gronk was listed as having a back issue as well and an epidural steroid injection at the hospital would make sense with his previous disc issues. Indeed a report indicated his back, not knee, was the bigger issue. Arthur Moats left the game with a pec injury. Hopefully it is a muscle strain. If it is the pec tendon, then surgery will be in the Steelers linebacker’s future. Micah Hyde left his game with a hip pointer. He could have been ready in a week but his team was eliminated after another heroic “Hail Mary” Aaron Rodgers comeback. MMMD 7: ProFootballDoc scorecard Big Ben indeed played and had minimal problems throwing deep. Greg Olsen did turn out to have a stinger, alternately described as a burner. Julian Edelman did return from foot surgery to have a big game. Tom Brady had no ankle issues. Gronk’s issues did seem to be more back than knee. Jamie Collins has been confirmed with an oblique muscle strain. Micah Hyde had a hip pointer and Justin Houston indeed seems to have aggravated his knee issue. The previous record of 146-9 (94.2%) now improves slightly to 154-9 (94.5%). Follow David on Twitter: @profootballdoc Dr. David Chao is a former NFL head team physician with 17 years of sideline, locker and training room experience. He currently has a successful orthopedic/sports medicine practice in San Diego.