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
High and Dry
It may still be the pre-season but already we have seen all of the Unlucky Seven strike. The high ankle sprain is only the latest to get our attention with three notable players (Marcedes Lewis, Brandon Stokley, Will Shields) sitting out the rest of the preseason, and maybe longer, as a result. Of course, the difficulty with the high ankle sprain is that the timetable can be somewhat unpredictable. The "high" in high ankle sprain refers to ligament injury at the joint that is formed by the two lower leg bones across the front of the ankle, as opposed to the more traditional sprain, which occurs lower where the ankle meets the foot. Much depends on the gap that is created across the front of the ankle joint when those ligaments are damaged. The wider the gap, the more healing time required. Too wide of a gap, and surgical stabilization is required. Coming back too soon results in ineffective play (especially for heavy running positions) and can lead to long term joint problems and instability. This is not an ankle injury that can just be taped up for games. The injury is actually aggravated by running and pivoting as these stresses can further separate the two leg bones that form the roof of the ankle joint (tibia and fibula). Average time for recovery is six weeks but is variable depending on the degree of injury and player position. Of the three players mentioned here, Shields sounds like the most likely to get back for the season opener. I'll bet Larry Johnson is happy about that.
Cruisin' for a Bruisin'
Torry Holt left the Rams' preseason game last week with a bruised sternum after falling on the point of the football while making a catch. This injury conjures up sympathy pain reminiscent of glory days in flag football. Remember impressing everyone with your highlight reel worthy game-winning catch, so focused on the task that you forgot you're not in pads, then landing awkwardly on the ball, suddenly unable to breathe for the better part of a minute? Most importantly, you made that catch. Two weeks later however, when it still hurts to cough, you're wondering if it was all worth it. Whether it's a cracked rib, a bruised sternum, or damage to some of the cartilage in between, it all feels lousy. This is a delicate area; all the bones of the rib cage are intermeshed with pliable cartilage, which allows your ribs to expand when you breathe. When that cartilage or the bones it secures are injured, however, every breath is painful, especially the deep ones. In Holt's case, X-rays were negative, so once the inflammation settles down he should be fine. That would be a big relief to Rams fans who may remember that in 2004 quarterback Steve McNair suffered repeated injuries to his sternum that cost him eight games and eventually required surgery to help the bone to fully heal.
Kickers get Injured too
Rarely are they injured as a result of contact, but kickers can certainly fall victim to many of the same non-contact injuries as their counterparts. This week Adam Vinatieri is out with an ankle sprain that sounds more serious than initially reported. Two other kickers suffered groin injuries over the last two weeks - Mike Vanderjagt, now in Dallas, and John Kasay in Carolina. Kasay kicked over the weekend and again this week and appears on track. Vanderjagt went down before the Monday night game, apparently re-injuring himself in warm-ups and did not play. Groin injuries are much like hamstring strains. Groin strains are not only unpleasant in terms of location (usually pulls occur right near the attachment at the pubic bone), they can become chronic if not rehabbed fully. A kicker especially depends on groin muscles to help stabilize the pelvis on one leg while delivering a boot with the other. An underlying nagging groin strain could spell chronic problems for a kicker. For that reason, keep an eye on Vanderjagt over the next few weeks.
Other News of Note:
Bad hammies: Chad Jackson (Patriots) has been limited in practice, and we may not see him this preseason. Hines Ward aggravated his hamstring last Monday after initially injuring it two weeks ago. The Steelers are being cautious with one of their elder statesmen from here on out. David Givens will not be playing for the Titans during the preseason. It is unclear where that leaves him for Week 1. Steve Smith has been listed as day-to-day, but there is still optimism that he will be ready for the start of the season. Terrell Owens continues to draw headlines, but is it really because of his hamstring? Or because he suggests that Parcells can watch game tape of him if he wants to see how he performs? I maintain my same opinion of two weeks ago - at this point the injury isn't a big deal.
Good hammies: Thomas Jones, who injured his hamstring on July 27th, was back Monday for his first full-pad practice this preseason and is scheduled to play in the Bears' next preseason game. Sorry Cedric Benson.
Why is the list of bad hammies so much longer? Is it because they are all wide receivers, long considered the divas of football? More than likely it's an indication of how challenging these injuries can be to heal. Short of a complete muscle tear (also called a Grade III strain), it can be very difficult to determine how long it will take a muscle strain to heal. Factors that can affect muscle healing include the degree of damage to the tissue, where within the muscle the injury happens and whether it is a first-time occurrence or the latest in a series of injuries to the area.
The degree of damage can sometimes be determined by a diagnostic test such as an MRI that can show major defects in the muscle as well as inflammation. The problem with relying on diagnostics is that they don't always tell the whole picture. Minor muscle tearing can equal major pain and limitation, so recovery periods vary.
Most muscle strains happen near the musculo-tendinous junction, which is where the soft, muscular tissue changes to more fibrous tendon. It is this transition of tissue type that makes it somewhat more vulnerable. Some injuries happen where the tendon attaches to the bone - if a piece of bone gets pulled off (an avulsion fracture), then the bone has to heal first (can be 4-6 weeks typically). When the injury happens within the muscle there is a good blood supply available, which helps in healing, but it can be more easily re-injured once scar tissue forms.
First-time injuries generally heal faster. More frequency = increased presence of scar tissue. Scar tissue is potentially easier to re-tear. It is thicker and less flexible without a good blood supply so it is harder for this tissue to stay healthy when subjected to the same stresses.
The moral of the hamstring story: Be more concerned when it is a repeat injury in an aging player, particularly if there are frequent minor setbacks.
Article first appeared 8/25/06
