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
Unlucky Seven
Forget the original Unlucky Seven. Ben Roethlisberger is taking the concept to new heights. Did he walk under a ladder? Step on a crack? Who breaks his face in multiple places, along with his nose and jaw, then makes a remarkable recovery to return to the field, only to succumb to an emergency appendectomy a few weeks later? Luckily for Roethlisberger, he is the beneficiary of excellent surgical technique. First, his facial fractures were exquisitely repaired via ORIF (open reduction internal fixation). The important part of that jargon means that he did not have to have his jaw wired shut. That translated to no liquid diet, which allowed him to maintain a reasonable playing weight and recover more quickly. As far as his latest setback, he was able to have the procedure done laparoscopically, meaning surgical instruments were inserted through very tiny incisions to access the appendix. With this type of procedure, there is no direct muscle trauma (unlike a more traditional or "open" procedure where the incision is larger and the surgeon goes through skin and muscle to get to the appendix). This allows for quicker healing, and as one of my surgeon colleagues says, "I let them do whatever they want after one week." True, most patients aren't getting drilled by 300-pound linemen, and most don't have to heave the football downfield, which requires trunk strength. Because the laparoscopic procedure doesn't significantly affect the muscle, once the surrounding tissue heals, and the pain and swelling are down, there is little cause for concern. Given his youth, determination and track record as a quick healer, Roethlisberger could be ready to return for Week 2, as long as he doesn't cross paths with a black cat.
Question Marks
Several key players were listed as 'questionable' on the Wednesday injury report. Notably present were Stevonne Smith and his hamstring - oops, it's on the other side now. What does this latest development mean? Is it perhaps that Smith has been favoring the left side for a few weeks so now the right side is acting up? Is there something about his overall hamstring health that we should be concerned about? It could be neither - or both. Helpful, I know. The problem with these hamstring strains is that there are many possible contributing factors, but it's often hard to nail down any one reason as being definitively responsible. Unlike the left-sided injury, where Smith had to be carted off the field from practice, the right-sided injury appears minor. Smith's left hamstring, though improved, may not be quite 100 percent healed. With his right side now ailing, it would be a stretch for him (no pun intended) to both return punts and catch passes. Believe Coach Fox when he says that Smith will be a game-time decision, not only in terms of whether he will play, but also to what extent. A cautious approach now could enhance his season longevity so don't be surprised if he is held back.
Clinton Portis has a little extra time to get ready for Monday night but really hasn't tested the shoulder with any contact thus far. It has been less than a month since he subluxed his left shoulder during a pre-season game, so the tissue around his shoulder is still healing. The question remains: With everyone gunning for his injured shoulder, will it tolerate hard hits, either from an opponent or from the ground? According to Portis, he is only 75% and doesn't expect to play. Enough said.
Marcedes Lewis is on the list with his high ankle sprain. These are lingering, difficult injuries that may require a few months to fully heal. It has only been about four weeks since his initial injury, and he has been limited in practice so stay away from the rookie tight end in the near term.
Chad Jackson originally hurt his hamstring in July, came off the PUP list to participate in a few practices and then hasn't been able to practice since. The time frame for these hamstrings is highly variable, and the amount of time he has been away is worrisome, especially considering he's a rookie learning the ropes. Even though the Patriots can be tricky about disclosing the availability of their players, it is not likely that a rookie who has been on the sidelines through most of camp will be able to go full speed or have an impact early on.
Other News of Note:
Hines Ward was effective in his season opener despite his recent hamstring woes. He looks to be on the mend, even if not in full form, and should do well with 11 days until the Steelers' next game.
TJ Houshmandzadeh has been having problems with a bruised heel. The heel is significant because of the attachment of the Achilles' tendon on the back and the attachment of the plantar fascia (the tissue on the undersurface of the foot that helps support the arch) underneath. The bone of the heel itself (calcaneus) can be painful bearing weight when bruised. Although it's not clear where the bruise is, with all of these structures in the vicinity, it could impact Houshmandzadeh's ability to push off when running or jumping and could cause pain on landing. The fact that his status was downgraded on the team's website Friday indicates the heel is giving him more trouble than previously thought. He'll be a game-time decision this Sunday, and this could be a circumstance where a little caution prevents a bigger injury down the road.
Article first appeared 9/8/06
