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
Anger Management
The Titans' Albert Haynesworth received an unprecedented five game league suspension after his inexplicable cleat to the unprotected head of the Cowboys' Andre Gurode. Gurode needed 30 stitches to close his lacerations and reportedly experienced blurry vision for a few days. As of mid-week those symptoms had thankfully resolved, though Gurode reportedly was still experiencing headaches. Assuming his vision is back to normal, then the primary issue for Gurode is skin healing, which generally feels tight and uncomfortable, sometimes itchy. Combine a helmet and a sweaty head, and it's likely to cause him increased discomfort this weekend, but will not risk worsening the actual soft tissue injury.
Off Balance
Jaguars wide receiver Matt Jones now has a hamstring injury to accompany the groin injury he sustained in Week 2. According to Jones, he suffered the hamstring injury early in the game against the Redskins, which explains his limited appearance last week. The question then becomes: "Is the hamstring strain related to the groin?" The answer is a resounding "maybe" since both muscle groups can be injured independently, yet both work together to control movements about the hip. All joints rely on muscle balance to stay healthy. To achieve balance, muscles around a joint need to be comparable in both strength and flexibility. There is also a timing issue related to the sequence in which muscles fire to control stability on either side of a joint. When one muscle group, (for example in Jones' case the groin) is injured, the athlete may unconsciously try to stabilize by over-recruiting other muscles around that joint. This abnormal pattern of muscle firing, resulting in a muscle imbalance, can itself lead to an injury which may explain, at least in part, what happened with Jones.
This is not unlike the situation with Ahman Green, the Packers running back who went out early last year with a torn quadriceps (quad) tendon. The quadriceps is a huge torque generating muscle group on the front of the thigh balanced by, you guessed it, the hamstrings. Last week Green suffered a hamstring strain, his second strain within three weeks, this time in his "good" leg (the prior strain was in the same leg that had sustained the quad injury). Again, this is an issue perhaps related to muscle balance. There were reports that Green complained of stiffness during the preseason in his newly healed knee, perhaps an indicator of decreased flexibility in his recovering quadriceps. A tight quad causes the hamstring to work harder when contracting to overcome the stiffness of the quadriceps. According to Coach Mike McCarthy, Green is expected to play this week, but this quad/hamstring combo could affect his stride length and his speed bursts.
Jones is out this week and with next week's bye, the rest should afford him time to heal, though as we've seen with other receivers this season, muscle strains can linger. Even when cleared to play, many recovering wideouts are not running as fast or jumping as high, thus diminishing their roles in the offense.
Clipped Wings
The Eagles' offense has been hampered by key injuries. Talk about game-time decisions - Brian Westbrook's own teammates, who saw him earlier that day, didn't know Westbrook would sit against the Packers. We're now finding out that he had his knee drained a few weeks ago, that he is dealing with a bone bruise and that he may have some cartilage damage (there's a shocker). Westbrook's knee has had the appearance all along of the "wear and tear knee" so typical of running backs. That the swelling has been lingering over the last few weeks, however, means that his knee has grown less tolerant of activity. What are his options? When there is recurrent swelling of this nature, the first choice is usually to rest the knee for a longer period of time to give the inflammation an opportunity to settle down. Another scenario could be arthroscopic surgery so that the knee can truly be visualized. The problem with a scope is that the extent of damage, and therefore the extent of intervention, is not known until the middle of the procedure. A simple procedure involves cleaning up the joint, removing any cartilage "debris" that might be irritating the joint and, if minimal, might only keep Westbrook out a few weeks. If the cartilage damage is more extensive, then there are various surgical options, all of which spell a longer recovery period. Either way, it looks grimmer for Westbrook than it did a couple weeks ago, and his status may be touch and go over the next few weeks.
Donte' Stallworth went out during Monday night's game after aggravating his hamstring and given how limited he was, it doesn't look good for him for this week, either. On a happier note, Reggie Brown, who suffered a sprained AC (acromioclavicular) joint, looks likely to play. The AC joint is the tip of the shoulder where the acromion (bony tip of the shoulder blade) and the clavicle (collarbone) meet. With an AC sprain, the ligaments that reinforce this joint are injured, usually by a fall or a hit directly onto the point of the shoulder. Although it's painful when it happens, unless you are a thrower, you can generally function well fairly quickly after such an injury, but certain movements are uncomfortable. Tape can help reinforce the joint if necessary, and since Brown has been practicing (and with Stallworth likely out), he is bound to see plenty of action.
Packing It In
Packers QB Brett Favre said in his media conference Wednesday that his head was "ringin' pretty good" and that his neck and right arm were tingly. These are pretty accurate lay descriptions of a concussion and a stinger. Latest reports indicate that Favre suffered a "pinched nerve" in his neck. Actually, these terms (pinched nerve and stinger) are very similar. A stinger accurately describes the electric zing one experiences when nerves between the neck and shoulder undergo rapid stretching or compression, such as what happens when a large human delivers a big hit to the upper body. A pinched nerve implies that a particular nerve root (the portion of the nerve that emerges from the spinal cord adjacent to a vertebra) was affected at the neck. Both can result in pain, tingling and/or weakness in the upper extremity. Either way it translates to Favre getting hit hard enough to have a head injury and some nerve involvement.
In order for Favre to be cleared to play, his concussion symptoms (headache, dizziness, nausea, ear ringing or any other variant associated with the hit) would have to be completely resolved, and he would have to have adequate strength in the arm to throw normally. Favre wants to keep his consecutive starts going, no doubt, but nerve and head injuries are not something to fool around with. By Favre's own report he still gets pain in his arm when he turns his head a particular direction, a typical finding associated with pinched nerves. His decision may be of the game-time variety.
Wide receiver Robert Ferguson's foot got rolled on Monday night, and while X-rays were negative for a break, he no doubt sprained several ligaments. I was in pain just watching his foot get forced into excessive rotation. He is reportedly dealing with significant swelling. This injury will likely take a couple weeks minimum to resolve. Donald Driver (hip, ribs) is expected to play but nonetheless appears on Green Bay's injury report. Thank goodness Koren Robinson is still on the outside - for the time being.
Other News of Note
Terrell Owens and his reinforced finger did quite well last week. He is raring to go this week as the crescendo leading up to "the reunion" builds.
Adam Vinatieri appears healthy enough to go this week since the Colts waived Martin Gramatica. The extra week allowed Vinatieri to rest his ankle and his groin. The two places where a kicker needs to be strong are what ailed Vinatieri - both the leg he plants on when he kicks, and through the trunk and pelvis to counter all the shear and torsional forces created during hard kicking. Vinatieri is one player who knows his abilities extremely well. I expect he'll be back in good form, with only the longest of kicks presenting any potential challenge.
Daunte Culpepper is now looking like all the other football players who come back from knee reconstruction and take two years to fully recover. Remember when everyone was talking about his amazingly speedy recovery? And it was! - but it was speedy returning to the playing field, not returning to football shape. Culpepper does not appear mobile; in fact, he appears somewhat hesitant to run, staying in the pocket longer and getting sacked more this year than the Texans' David Carr. There is no denying that complete recovery from such a major surgery takes time - don't expect Culpepper to change much this season. Now add to his woes a non-specific shoulder injury on his throwing side. The hope is that his shoulder does not suffer from extra contact with the ground as a result of his inability to elude the sack. Watch from a safe distance.
Jeremy Shockey has had some extra time to rest his ankle - and his temper. His performance should improve this week as his ability to pivot, turn and land is restored.
Article first appeared 10/6/06
