This article is part of our Injury Analysis series.
Condition Critical
By Stephania Bell, PT, MS, OCS, CSCS
Orthopedic Clinical Specialist
Certified Strength and Conditioning Specialist
RotoWire Injury Expert
RotoWire Injury Page
Jaguars Jinxed at Running Back?
Fred Taylor left the game against the Titans early after aggravating his hamstring during a 30-plus-yard burst. If you were watching the game, the problem was immediately apparent when Taylor pulled up a little short in his stride just before the play ended. The danger is always the same with these hamstrings; being big muscles, they're very delicate and easy to re-injure. Taylor didn't practice all week and will miss Sunday's game. Maurice Jones–Drew lasted longer than Taylor in last week's game, and his calf appeared to be fine, but ultimately he had to leave because of an undisclosed injury to his knee (later officially described by Coach del Rio as "jamming it"). The good news on Drew is that he was feeling much better by Monday and he has been practicing all week. He'll see the bulk of the carries this Sunday against the Patriots.
French (Lis)Francs
The Lisfranc injury is a midfoot sprain, quite a serious one in fact, which can be career threatening if not recognized and treated appropriately. But, you may be wondering, how did the Lisfranc get its name? Interestingly, the name is attributed to a field surgeon in Napoleon's army (Jacques Lisfranc) who described this injury, which often resulted in amputation, in soldiers who fell from their horses and got a foot caught in the stirrup, or so the story goes. It seems to me that somehow this maneuver would lead soldiers to suffer far more significant injuries than just to their feet. Be that as it may, the name Lisfranc has stuck, and when it happens in football, it's usually a result of the athlete being on a flexed foot while undergoing a torsional (twisting) stress.
The Lisfranc joint is essentially the area of the foot where the metatarsals (the long bones of the forefoot that articulate with the toes) connect to the midfoot bones that form the high part of the arch. Each time the athlete transfers weight towards the front of the foot (pushing off, cutting, pivoting), this region is stressed. There can be a sprain of the ligaments that connect the bones, or a fracture of some of the bones involved. If there is significant displacement (movement) of the involved bones, as often happens with a fracture/dislocation, surgery is required. A common complication of this injury, and certainly a big risk factor if it is not managed appropriately, is post-traumatic arthritis (think stiff and painful).
Michael Strahan, the notably absent defensive end who suffered a less severe form of this injury, has hinted that he will be back this week. Strahan is now in his 6th week since sustaining the injury, which gives an indication as to how hard it is for this area to heal.
Strahan has practiced three days in a row (which is a big deal because until now, Strahan experienced such pain after one day of work that his foot required an off day) and is expected to play against the Saints, though he is listed as questionable. He probably won't be let loose for the entire game, but instead will test his ability to perform in a game situation.
Detroit running back Kevin Jones had a more serious Lisfranc injury (the fracture-dislocation type), one that required surgery last week to stabilize it. Rehab for this type of surgical repair typically includes a period of non weight-bearing while casted to limit foot motion. After approximately two to three months, weight bearing is gradually introduced while wearing a protective shoe. Functional strengthening is then progressed until the athlete is able to achieve sport readiness. The total time frame can vary from six months to a year, or longer, depending on healing.
After these types of injuries, some players move to a less flexible shoe and may use a rigid arch support to limit the bending stresses across that part of the joint. So how do players fare after this type of injury? If your name is Brian Westbrook (his season ended last year with the non-surgical type), you go on to have a 1,000-yard rushing season in the next year. Jones' teammate in Detroit, linebacker Teddy Lehman, had a more difficult recovery however, taking over a year to get back to the field, and he even acknowledges that he still deals with pain in the foot. Much of the recovery likely has to do with the degree of injury and how quickly it is diagnosed. In Lehman's case, he was walking around on it for over a week before it was confirmed. The stress of putting weight through the joint set him up for a more complicated outcome. Jones luckily was diagnosed almost immediately, but unfortunately for him, the injury appears rather severe. Until he is further along in weight bearing activities, it will be hard to assess his potential for next season.
Other News of Note
Laveranues Coles took a big hit from a helmet to his back as he got sandwiched between two Vikings defenders last week. Fortunately, all X-rays were negative (and the precautionary MRI apparently didn't yield anything newsworthy). The problem with taking a shot in the mid-back like that is that the ribs attach to those vertebrae so even a deep bruise can make breathing less comfortable. Overhead shoulder movements also cause that area of the spine to move so reaching and twisting may be a little tough. Speaking of tough, Coles is as tough as they come, and the extra day before the Miami game should help him to be more comfortable.
Here's one we don't get to talk about too often. LaDainian Tomlinson took a shot to the left side of his jaw late in the game Sunday and looked a little uncomfortable after the game. X-rays to the temporomandibular joint (TMJ - a.k.a. the jaw) revealed no significant damage, and Tomlinson is set to go this week. Good thing it's not worse, or he would be on a soft foods diet – definitely not the way to get psyched about the pre-game meal. Although TMJ problems can be challenging if chronic, it sounds like Tomlinson is over this one already.
Steve McNair had his throwing hand stepped on early in the game on Sunday. Ouch. X-rays were negative, but there's not a lot of cushion around the muscles of the hand. On top of that, there are many pain receptors in the hand, as anyone can attest to who has had their own hand stepped on or cleated. McNair is one of those perennially tough guys though who was prepared to shake it off and go back in the game last week. Although he does admit to some soreness, McNair should be fine to throw this week. The Ravens may opt to mix in some shotgun formations to decrease the repeated contact to his hand.
Joseph Addai is expected to play Sunday for the Colts after suffering a right ankle sprain on Monday night. He did practice on Friday after taking two days off and "did well" according to Tony Dungy. It sounds like a garden-variety sprain, which should heal without incident, but the Colts may limit his activity in order to protect him for the playoff stretch.
Michael Vick is dealing with a groin injury. He looked to be in a fair amount of pain last week. Supposedly, he'll start this weekend, but a groin injury of any size can hamper the type of plays that Vick is accustomed to making. Quick lateral movements, scrambling in and out of the pocket, sprinting to hit that 1,000 yard mark – these are all things that require stability where the groin muscles attach. Even if there's no major tissue damage, pain in the area will inhibit the ability of the muscle to generate power, potentially slowing Vick and limiting his stride. Vick has been struggling lately, along with his receivers, to make the passing game effective. His ability to throw hard, and certainly his ability to throw on the move, could potentially be compromised by this injury. Luckily, the other Falcons running backs, Jerious Norwood and Warrick Dunn, are both listed as probable and are expected to play.
Article first appeared 12/22/06
