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
Collision Course
For too long, concussions have been downplayed as a normal consequence of the game, but this season the abundance and severity of these injuries have people finally paying attention. Trent Green continues to be sidelined (though improving) since a brutal hit early in Week 1. Steve McNair is still recovering from his first major concussion (sustained two weeks ago), though he appears likely to play this week. The Vikings have two wide receivers, Travis Taylor and Troy Williamson, still on the mend following concussions.
Perhaps the most notable individual on the concussion watch list is Ben Roethlisberger who got sandwiched between three Falcon defenders last Sunday and took another blow to the head. It was deemed a minor concussion, and Roethlisberger is expected to be a game-time decision on Sunday. This has been cause for much discussion in the sports community because Roethlisberger in particular has been through so much in such a short time. This is Roethlisberger's second concussion within a four-month period. Can he possibly be OK to play? We have talked in the past about the concern with concussions - both in terms of severity per episode and the frequency of occurrence. It is worth reiterating that there are a battery of tests that the medical staff puts a player through after any concussion to assess readiness to play. A player is not medically cleared at random; he must pass these tests in order to return to light workouts and then must pass some more to return to practice. Progressively increasing practice intensity becomes a test gradient for return to play. The main determinant is whether as the intensity of workouts increases, any concussion-related symptoms return (headaches, nausea, visual disturbances, cognitive impairments).
The challenge here is that much is still unknown about concussions and post-concussion syndrome. There is consensus in the medical community that the more concussions an athlete has and the more severe they are, the worse it is long term. What isn't known is the threshold for a serious consequence should another big hit occur.
Take Roethlisberger for example. Let's assume that he is cleared to play this week. He might suffer another concussion in that game. What if he were held out an extra week? Would he be any better off if he were to return a week later, or maybe two - no, make that three weeks later - and then sustain a head injury? What would the long-term effects be? What might the long-term effects be of the injuries he has already sustained? No one knows.
Some sports have mandatory no-return times following concussion. Some medical groups have position statements as to what the proper timelines should be for return to sport following concussion. Although these sound sensible, there is disagreement among the experts as to what the magic number or timeframe is, because the definitive evidence to support these recommendations does not exist. Until that evidence emerges (and there are projects in the works, like developing sensors to place inside helmets to assess collision impact for instance), this debate over when to return to play will continue.
For all we know, Roethlisberger might play another two years - or maybe even the rest of his career - without suffering another concussion. He might however take another blow to the head that would leave him with permanent symptoms (One only has to look at the emotional retirement of NHL player Keith Primeau of the Philadelphia Flyers to understand the toll that takes on an individual). No one wants to see this be the end result for anyone, much less a young athlete like Roethlisberger who has so much of his other life ahead of him. In the absence of hard science, common sense should prevail. It's the Raiders this week Ben. Sit a little longer.
Zebra Down
Umpire Bill Schuster took one for the team when he connected with the Leon Washington's helmet on Sunday. Washington was spinning away from a defender and spun right into the umpire's nose, smashing it sharply and creating a deep gash that bled immediately. Despite how bad it looked at the time (and we got to see it over and over, thanks to instant replay), the umpire was able to get a quick bandage and get right back into the game. This was a reminder of the dangers of being an unprotected regular human in the middle of a sea of large, powerful athletes who are also sporting major gear. Officials have to be close enough to the action to call it correctly, while avoiding becoming factors in the game, or statistics for that matter. I think that eventually, as in hockey, the officials will be wearing protective headgear. I just hope it does not take a catastrophic injury happening first in order for this to occur.
Hawks Injury Hassles
Quarterback Matt Hasselbeck suffered a Grade II (moderate) MCL (medial collateral ligament) sprain on Sunday. Hasselbeck had just released the ball and was shifting his weight back onto his right foot when the Vikings' EJ Henderson rolled into his knee. This contact folded Hasselbeck's knee inward (also called a valgus stress). The MCL is a broad flat ligament on the inner part of the knee that connects the femur (thigh) to the tibia (leg), and it reinforces the inner aspect of the knee joint. Tearing of this ligament opens up the inside portion of the knee joint rendering it unstable in the medial/lateral direction. This injury was scarily similar to Carson Palmer's in terms of the location and direction of the hit that Hasselbeck took. One of the things in Hasselbeck's favor is that he was relaxed when the injury happened (he had already released the ball and he wasn't expecting a hit) which may have allowed his whole body to fold, thereby preventing a more severe injury.
Treatment for this type of injury usually involves bracing to protect the ligament while it heals, followed by progressive strengthening and gradual return to sport. Depending on the degree of injury, this can take anywhere from a few weeks to months to resolve. Fortunately for Seattle, Hasselbeck appears to be projected on the low end of the timetable.
Double Trouble
Browns Cornerback Gary Dexter suffered bilateral patellar tendon ruptures (tendon attaching the quadriceps muscle on the front of the thigh to the leg bone) on Sunday while trying to break up a Broncos pass in the first half of the game. In case there was any doubt, this is a season-ending injury and perhaps beyond. As soon as I heard about Dexter's injury, I had a flashback to Wendell Davis in the old Veterans Stadium in Philadelphia. Davis suffered a similar injury, and it reinforced the notion that the turf at Veterans had to go. Davis returned to play for a brief period after his injury, but was never really the same. Will Dexter fare any better? It is hard to know as there's a long road ahead. Consider the case of Corell Buckhalter who struggled not once, but twice to come back after a similar injury to one knee. Now imagine the same work being required of both legs. Dexter has had the knees surgically repaired already (to reattach the patellar tendons). He will likely be wheelchair bound for a while since both legs are out of commission. The progression will then be for him to restore his range of motion and strengthen his quads enough to support his weight for everyday activities. Only then can he begin the long road toward returning to sports.
Other News of Note
Giants running back Tiki Barber took a hit on Monday night that initially looked like it might send him to the injury report this week. The swipe that caused Barber to fumble the football also gave him a good smack to the helmet, snapping his head forward quickly. Barber looked briefly disoriented and was described as being "shaken up on the play" during the broadcast. He returned to the game shortly thereafter and was highly productive, alleviating any concern about his well-being. He was not on the Giants injury report and appears ready to take on his brother this week when the Giants face the Buccaneers. Nonetheless - the brief scare makes it seem like Barber's career transition plans might be coming at a good time.
Lavar Arrington was finally healthy, or so it seemed. By the second quarter of the Monday Night Football contest against the Cowboys, Arrington was on the ground, holding his left ankle. When an athlete goes down in that manner, essentially untouched, it typically indicates a serious injury. As it turns out, Arrington suffered a torn Achilles and will be out for the remainder of the season. Following surgery, Arrington will face intense rehabilitation but should be able to return next season.
Donte' Stallworth has been upgraded on the Eagles' report to Probable, joining his teammate Brian Westbrook in the "Will he or won't he?" game-time decision club. Latest practice reports suggest that both players will be on the field this weekend. We know what Westbrook is capable of, despite the ongoing swelling management of his knee. Stallworth remains more of a mystery, especially since he reports feeling "good, not great." He's still expressing concern about aggravating his hamstring, a valid one because he already returned prematurely once this season and set back his recovery timetable. Stallworth may return initially in a limited role to give him a chance to test the hamstring without fear of overdoing it. He may equally be that late scratch at game time if he doesn't feel confident his hamstring will hold up to the rigors of a game situation. Pre-game warm-ups are worth watching here.
Article first appeared 10/27/06
