NFL Injury Analysis: Making Sense of the Luck Situation

Andrew Luck

One of my mentors on my route to becoming an athletic trainer once told me diagnosing an injury is a bit like being a detective. You have to gather as much information and evidence regarding the "case" to determine the cause of the problem and how to address it. However, even an All-Star collection of Batman, Sherlock Holmes, Colombo and Jessica Fletcher would struggle to decipher what in the world is going on in Indianapolis regarding Andrew Luck. Let's take a look at the presented evidence and do our best to make sense of the situation.

We know Luck is dealing with an injury on the lower leg near the ankle, but a number of possible issues have been mentioned.

Initially, the injury was described as a calf strain with Luck sitting out Colts' OTAs in May. Calf strains are common injuries in the NFL and can be a problem for quarterbacks as the plant their legs to throw. Fortunately, Luck was cleared for the start of training camp and was able to participate in early activities. However, the calf did not progress as expected, and Luck was removed from activity. He has remain limited ever since with the team remaining tight-lipped about specifics.

That changed a bit early last week when Colts owners Jim Irsay mentioned Luck's injury involved "mo-something else, but it's a small little bone." The information, combined with the previous diagnosis, led many to assume the quarterback was dealing with a condition known myositis ossificans. Myositis ossificans can develop in well vascularized muscle tissue if the area is inadequately treated or not provided enough time to heal following an injury. In the condition, tiny calcified formations (think bone spurs) develop in the damaged tissue limiting the range of motion and often exacerbating the associated symptoms.

However, Irsay took the confusion one step further though when he compared Luck's injury to one sustained by former Colts offensive lineman Ryan Diem. Diem did not have myositis ossificans but a different condition known as Os Trigonum. Os Trigonum is a congenital condition, meaning it is present since birth. The injury involves the talus, a bone in the foot that articulates with the lower leg bones to form the "true" ankle joint. During development, a tiny piece of the talus fails to fuse completely creating the Os Trigonum. This superfluous bone remains attached to the talus by a band of connective tissue. Those born with Os Trigonum may never know they have the extra bone unless it becomes symptomatic following an injury. 

But we aren't done yet. Indianapolis general manager Chris Ballard has since stated that Os Trigonum isn't the problem and that the medical staff is treating the front of the ankle in the "high ankle-ish" region. The high ankle is generally used to describe the distal tibiofibular (tib-fib) joint, an area fortified by strong ligaments and connective tissue. Ballard's understanding is that the injury is referring pain to Luck's calf and Achilles.

So where does this leave us besides confused? Well we know the team is not currently considering surgery, a decision that could alleviate symptoms related to myositis ossificans and Os Trigonum, as the problematic tissue is removed. Instead they are opting for conservative treatment and rest, and will not allow Luck to take the field during the preseason. The hope is he will progress enough to take part in the season opener against the Chargers. He took a small step toward that goal over the weekend, actively completing a pregame warm-up prior to his team's preseason loss to the Browns. He reportedly moved well in multiple planes while applying stress to the affected area.

Fantasy owners will still want to proceed with the utmost caution, particularly with so many unknowns still lingering. Couple this with the unpleasant memories of 2017, and it doesn't take a super sleuth to see why Luck remains a risky investment. 

Turf Burns

Keenan Allen: The veteran wideout is nursing a minor ankle injury and is unlikely to see any further action during the preseason. He also dealt with a knee issue after hitting the area during a recent joint practice with the Rams. Given Allen's checkered medical history, you can't fault the Chargers for taking a proactive approach to protecting the health of their top aerial threat. After dealing with multiple injuries over a two-year stretch, Allen has not missed a game since returning from the torn ACL that cost him most of the 2016 season. 

Amari Cooper : The heel injury that kept Cooper off the field is being described as muscular and not a ligament injury. The news is slightly encouraging, as a sprain of the area could be complex and result in instability of the foot. However, the Cowboys will continue to limit his level of participation for the remainder of the preseason with an eye on the season opener. 

Kenyan Drake: The preseason is over for the Miami running back, as an undisclosed foot injury will shelve him for the immediate future. Drake was seen sporting a walking boot on his right foot, though the injury was described as nonstructural. He is currently being considered day-to-day, though his regular season status does appear in flux. As a result, Kalen Ballage becomes the lead back for the Dolphins and could be a nice value pick at his current ADP. 

George Kittle: The 49ers tight end has not practiced over the past few days due to tightness in his calf. He is listed as day-to-day and will look to return to practice sometime this week. If Kittle is able to return to action without any setbacks, he will retain his value as a top-tier tight end.

Aaron Rodgers: The former MVP did not play in Thursday's preseason game at Baltimore as he managed tightness in his back. The injury isn't overly concerning at this point but will be worth monitoring in the week ahead. The team did describe the decision as precautionary, suggesting Rodgers' value should hold for the moment.

Sterling Shepard: The Giants wideout has been recovering from a fractured thumb suffered in the early days of training camp. Fortunately, he is making great progress and has been able to maintain his conditioning throughout his rehab. He recently completed practice without a non-contact jersey and it's reasonable to assume he will be cleared in time for Week 1.