By Stephania Bell, PT, MS, OCS, CSCS
Orthopedic Clinical Specialist
Certified Strength and Conditioning Specialist
RotoWire Injury Expert
RotoWire Injury Page
Internal Affairs, Part Deux
Bills wide receiver Josh Reed was hospitalized for two nights after suffering a bruised kidney in last Sunday's game against the Packers. Just when it looked as if his consistent performance might pay off with more plays being called his direction, Reed is now expected to miss a couple of weeks while the kidney heals. The kidneys are bean shaped organs located just below the rib cage on either side of the trunk. They are critical organs that help process waste products out of the blood and into the urinary tract. Normally the kidneys are well protected by the large back muscles and the lower ribs, however a hard blow in the right direction can result in kidney bruising. Bleeding can hamper kidney function and, if severe, could become life threatening. Keeping Reed away from contact until there is opportunity for satisfactory healing makes obvious sense, but once healed, he should not suffer any residual effects.
Meanwhile Titans offensive tackle Daniel Loper was placed on injured reserve after suffering a lacerated spleen last weekend. The spleen, an organ made famous when Buccaneers quarterback Chris Simms ruptured his earlier this season, has a hard outer shell that can sustain a laceration or crack due to trauma. If the damage and bleeding are significant, as was the case with Simms, the spleen must be removed surgically. If however the injury is not too severe, the spleen can heal on its own over 3-6 months with rest. This latter scenario appears to be the case for Loper, hence the IR designation. As any surgeon will tell you, whenever the ability to preserve an organ exists, that's ideal as it was originally installed in the body for a purpose. Although one can survive quite nicely without a spleen, it plays a significant role in fighting off bacterial infection and is worth keeping when that is an option.
Bills running back Willis McGahee is out with a broken 9th rib (as well as cracks in two others) after landing awkwardly on another player's leg. Anyone who has experienced a broken rib, or even an injury to the rib cartilage (the fibrous connective tissue that connects the ribs to the sternum or breastbone), knows how painful this type of injury can be. As with any fracture, the pain of a broken bone, even a small one like a rib, is excruciating because bone has nerve endings that scream when damaged. Broken bones hurt when they are moved, which is why they are typically casted – that, and it helps the two bony ends to heal together. There is no casting a broken rib however. Now consider that the ribs move every time we take a breath, allowing the lungs to expand and contract. Ribs also move when the arms are elevated overhead and when the spine bends, extends and twists. That pretty much sums up a good number of the requirements for a running back. Oh – and the ribs have to absorb the contact that is delivered during a tackle. Sure, there are rib pads, but they're not completely effective in protecting the area, especially when it comes to the lower ribs which are more exposed. There are 12 ribs and McGahee injured 8-10 which are more at risk for re-injury if hit again. Depending on the extent of the fracture, McGahee could miss significant time (remember frank fractures take six weeks to heal). The concern regarding further injury, in addition to incomplete rib healing, would be a displaced rib fracture that could result in a lung puncture. If McGahee appears to be healing well, he could return with a rib belt which is an elastic corset that helps minimize, but does not prevent, rib movement. Keep an eye on McGahee's activity over the next few weeks to see how he is progressing.
Chiefs Guard Brian Waters was carted off the field after suffering an injury to his right MCL (medial collateral ligament) during the first quarter of Sunday's game against the Rams. This is the same injury that Matt Hasselbeck is dealing with and poses similar problems in terms of instability at the knee. For an offensive lineman, medial instability particularly affects pushing off towards the inside of the knee - in Waters' case, pulling to the left. Since he protects the left side, he especially relies on that medial stability of his right knee any time he is facing a rush from the outside. The good news is that the Chiefs are not placing him on IR, indicating that his timetable for return should be in the low end (like Hasselbeck's) – potentially 2-4 weeks. Many linemen wear knee braces that provide medial-lateral reinforcement at the knee, either because they have been injured in the past, or in some cases proactively. Waters will likely be braced upon his return.
Bears linebacker Brian Urlacher suffered a sprained big left toe against the Dolphins last Sunday when his foot got caught behind him in a pile of tacklers. He has not practiced the last two days, and despite being listed as questionable, he is giving all indications that if he can go, he will. Like we said last week while discussing Tatum Bell, Urlacher might be challenged by pain in his big toe with pushing off and cutting, even if he's able to play this weekend.
Giants Pro Bowl defensive end Michael Strahan suffered a right Lisfranc sprain (ligament injury in the midfoot region) while playing the Texans. Fortunately Strahan's midfoot sprain is not serious enough to require surgery, but he's expected to miss 2-4 weeks. The Giants got lucky here because if this injury were a fracture or dislocation, it would be season-ending. The Giants are not so lucky in that their other defensive end, Osi Umenyiora is still listed as doubtful with a left hip flexor (muscle) strain. Hip flexors help provide explosiveness off of the line and speed when engaged in run pursuit, qualities that Umenyiora will need to return successfully.
Other News of Note
Bad backs are running rampant in the league. Ray Lewis is being treated for one. Plaxico Burress is still dealing with his back issues, as is Lamont Jordan. Marcus Robinson has also joined the club. Unfortunately, as is the case in the real world, many back problems don't ever result in a specific diagnosis. Part of the challenge is that there are many structures in the spine that can cause pain, and many presentations are similar. Imaging studies in the spine can be misleading in that there can be many so-called positive findings that might not correlate with the patient's actual symptoms. Likewise, there can be a "clean" picture in a patient that has very real signs and symptoms. Back spasms are usually a result of the large spinal muscles trying to "protect" the player from further injury. In other words, if the brain perceives there to be a back problem, the muscles in the area can spasm in an effort to limit mobility, thus keeping an athlete from being able to perform. These situations are highly individual and difficult to prognosticate because in the absence of serious injury, many of these players will be limited by pain only, usually making starting or sitting a game-time decision.
Donte' Stallworth is not on the injury report this week. Now that he has given his hamstring adequate rest time and passed a minor test in Week 8, he should be 100 percent against the Redskins. Brian Westbrook, no stranger to the injury report himself, appeared with a new ailment in his ankle this week. Although it's unclear exactly what Westbrook's ankle trouble was, Donovan McNabb implied that all was well with the Eagles offense. McNabb appeared on the NFL Network's NFL Total Access on Thursday and was responding to a question about how excited he must be to see Stallworth healthy. McNabb responded that he was glad to have "all of his weapons" back and healthy for this week, implying that Westbrook is good to go.
Article first appeared 11/10/06