January 04, 2016 - Dr. David Chao
Monday Morning MD: Which QBs will be healthy for the playoffs?
Half of the AFC playoffs starting quarterbacks have health issues. Which ones will play and be effective? Tom Brady limped off an interview podium post game. Peyton Manning continues with foot issues. Andy Dalton hopes to get his cast removed. Ndamukong Suh rolled onto the back of Brady’s legs and he limped off the field. Video analysis in real time correctly indicated Brady would stay in the game as fortunately, his foot was not planted and pinned. He played on after being tended to by team personnel. Of note, Brady’s “personal guru/body coach” was on the sideline but did not participate in his care. Although Brady avoided more serious high ankle sprain, he will be sore and was limping significantly after the game. Don’t be surprised if he is spotted in a boot, as it is often a means to control swelling. With the bye week, I fully expect Brady will be good to go and the ankle will have minimal affect on the playoffs going forward. This seems to be now confirmed. Many narratives had Peyton Manning being done, but careers are not ended by plantar fasciitis. The HOF QB made a second half appearance and rescued the Broncos from five turnovers to clinch the division and home field advantage throughout the playoffs. Interesting that days ago some called for retirement and now he is the unquestioned Denver starter for the playoffs. Manning’s foot injury is not behind him. There is no way to cure a lingering issue during the season. The hope is he can continue to manage his plantar fascia issue. His arm is still weak but his mind is still strong. Andy Dalton hopes to have his thumb spica cast removed today at his doctor’s visit. Even if it comes off, a removable splint is likely to be put on. Any fracture takes a minimum of 4-6 weeks for early healing and the Wild Card Round is at the four-week mark. With Dalton’s apparent base of the thumb fracture, the issue will be gripping the ball. He also needs to be able to take a snap and handle the ball for hand-offs. Medically, it is unlikely for a cast to come off Monday on a throwing hand and that quarterback plays just five days latter. The Bengals will have to rely on AJ McCarron to get them out of the first round. If that happens, a Dalton return could happen. Brady and Manning have first round byes. Hopefully we will see all three injured QBs playing in the Divisional Round. MMMD 1: DeAngelo Williams back for playoffs? The Steelers have had their share of injuries this season. Ben Roethlisberger has had two absences with a MCL injury and a Lisfranc sprain. Le’Veon Bell had surgery on his MCL and PCL. Now Bell’s replacement was knocked out of the regular season finale. By video, Williams has a mild high ankle sprain. Fortunately, his foot was not planted when fallen on from behind. Not all high sprains mean extended absences, as it depends on severity. I am expecting this one to be short. Post game, Williams was in a boot, but the good news is he was not on crutches. Overnight swelling will be the key, but even with a short week, I believe he has a good chance to play; however, there is no guarantee of full effectiveness. Earlier this year, Fred Jackson did return for the Seahawks six days after a mild high ankle sprain. MMMD 2: Beast Mode vs AD? The Vikings victory sets up a potentially epic running back match up. Both Marshawn Lynch and Adrian Peterson have health issues, but expect both to play in the Wild Card Round. Beast Mode will be six and a half weeks post sports hernia type surgery where the average NFL return is six weeks. He is slated to practice with the Seahawks this week. I am optimistic that Lynch will play although no one, including Seattle, can know for sure. AD missed a good part of the NFC North clinching victory with lumbar strain/back spasms. As there was no sign of radiculopathy, expect the recovery from low back muscle injury to be quick and Peterson should be in full form. MMMD 3: Busiest medical day of year for 20 teams For the teams whose seasons are now over, today marks the busiest medical day of the year. Exit physicals involve the examination of all players to document injuries and establish a plan to get healthy. MRI machines will be humming all day today and into Tuesday. More surgeries happen in the offseason (up to 15-20) than during the season. Often during my time as head team physician, I would have a full week of player surgeries scheduled immediately after the final game. Just like “Black Monday” for coaches has become “Black Sunday Night”, the medical timelines are also sped up. Team executives want to know the status of their players immediately as they plan roster moves and for the draft. MMMD 4: Careful with 5th metatarsal fractures Jones fractures are known to be problem fractures due to a lack of blood supply. Dez Bryant is having more foot surgery to ensure healing, not for re-fracture. There is no way for the bone to completely heal in the 6-8 weeks that most athletes return to play. Up to 20% of the time (Julio Jones, Kevin Durant), a second surgery is needed. Dez should have plenty of time to heal for 2016. Julian Edelman and the Patriots will be careful. He will be nine weeks from Jones fracture by the time he plays in the Divisional Round. Edelman’s underneath, quick cut and change of direction style puts extra pressure on the 5th metatarsal bone. This is his second Jones fracture and he knows the recovery process. Edelman will play and hopes to be close to 100%. MMMD 5: Injured players still have responsibilities I don’t know if Johnny Manziel was in Las Vegas the night before a game or not. I do know he had responsibilities Sunday even though he was ruled out of the game due to concussion. As is common, Manziel wasn’t required to be at the game but he was required to attend a medical check Sunday morning, which he missed. Missing a medical appointment is a fine-able offense. It will be interesting to see if the Browns choose to fine Johnny Football or if they are too busy trying to hire a new general manager and head coach. MMMD 6: Medical potpourri Muhammad Wilkerson did indeed suffer the severest form of high ankle injury. After the syndesmotic ligament tears, the next step is fibula fracture. The pending surgery is more for the torn ligament than the bone. The only good news is this injury should only have a small impact on his free agency. Wilkerson should be healed and in full form by start of training camp 2016. J.J. Watt celebrated his cast/club removal with a big day (3 sacks, 2 batted passes, 8 tackles, a forced fumble and fumble recovery). “So today is a reminder of what it is like when I have both hands.” Hands do make a difference and this is why Jason Pierre-Paul will be good but has an uphill battle to be great again. Texans make the playoffs but will have to play without their starting left tackle. Duane Brown torn his quad and leg gave way, which explains why he lost the collision with a smaller linebacker. He will need surgery and will return for 2016, but don’t be surprised when he starts the season on PUP. Tampa fullback Jorvorskie Lane had the gruesome injury of the day. He fractured his tibia and fibula necessitating rodding surgery. This is similar to the injury Patriots FB James Develin suffered earlier this year. Paul George, Julius Randle and Anderson Silva are other notable professional athletes who have returned from the same injury. It is still unbelievable to me that Lane would not have immediate access to pain medicine at the stadium, but that is the law of the land. Sean Lee decided not to play with his hamstring injury and cost himself a $2 million bonus. “I didn’t feel like I would be effective enough to help the football team.” Much respect to Lee for having honor for the game. I hope the Cowboys respect Lee and find a way to honor his bonus. This column is reserved for NFL coverage but Notre Dame linebacker Jaylon Smith was a projected top ten pick. With his gruesome bowl game injury (postulated to be PCL and PLC knee ligament tears), his draft stock is sure to unfortunately drop. Seahawks Jeremy Lane has an oblique muscle injury. This is essentially a rib injury and hurts just as much. Many remember his forearm fracture after his Super Bowl interception, but most forget he tore his ACL on the same play. He came back for that and he will find a way to play through this injury. MMMD 7: ProFootballDoc scorecard Patrick Chung and Devin McCourty both escaped more serious injury to return to play this week well before the playoffs. Marshawn Lynch did not return in 3 weeks or by the end of the season but is on track for the typical six week return. Tony Romo will not need a plate for his collarbone. Despite having sickle cell trait, Geno Atkins played without issue at the altitude of Denver last week. Jorvorskie Lane needs surgery for a tib/fib fracture. Muhammad Wilkerson has the severest form of high ankle injury with fracture. Tom Brady, Jeremy Maclin and Adrian Peterson were all correctly pegged in real time to be minor injuries. Adding to the 129-8 (94.1%) record, we end the 2015 regular season with a 139-8 (94.5%) mark. I will continue the tally throughout the playoffs and Super Bowl for a complete season count. 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.