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
Scares of the Week
Vince Young entered to a raucous ovation at LP Field, but the crowd went silent when he stayed on the ground, grabbing his ankle after he was tackled from behind during the Titans' preseason game against the Saints. Getting the leg rolled on from behind, especially as the foot is pushing off, can be a recipe for disaster. This is commonly the mechanism for a Lisfranc injury (sprain of the midfoot), the injury that ended Brian Westbrook's season last year. Luckily, Young's injury was just a mild, garden-variety ankle sprain (minor stretching of the ligaments that connect the leg to the foot). He was back to practice Monday, and the injury is a non-issue now.
Usually known for his offensive prowess, Clinton Portis hurt his shoulder Sunday while making a tackle on an interception return. In wrapping his arm across the player to make the tackle, Portis exposed his left shoulder. When the arm is forced back in a collision, the shoulder is stretched beyond its normal range, an easy way to get a dislocation. Subluxation was later reported to be the official diagnosis. Unlike a dislocation where the shoulder completely comes out of the joint, with a subluxation the shoulder slips a little further than normal, but quickly goes back into place. The problem with subluxation is that it can overstretch or tear the soft tissue around the joint resulting in local pain and swelling. In more severe cases, it can render the shoulder more vulnerable to the risk of recurrent subluxations or even dislocation. Portis will undergo rehab focused on decreasing pain and swelling and above all protecting the shoulder until the season opens. He will then have to regain the strength of the supporting muscles around the shoulder. It will likely be a work in progress even as the regular season starts. This should not present much of a challenge for him when running and carrying the ball, but may be problematic when blocking. Don't be surprised when opposing teams target ways to challenge (read: drill) that shoulder in their defensive schemes.
Fear Factor
Palmer was the talk of the evening Sunday, garnering more coverage than the actual game. Palmer's sideline interview confirmed that his anxiety about taking a hit to his surgically repaired knee is delaying his return. This is no surprise (see the Unlucky Seven), as his reaction is extremely common after this type of traumatic injury. Quarterbacks in particular are the ultimate targets since everyone is trying to take them down. The good ones are lauded for their ability to stand in the pocket until they find their receiver, knowing that they risk increased bodily punishment for doing so. Palmer is a pocket quarterback, therefore in order for him to succeed, he must be confident standing there and surveying the field. If the footsteps of approaching would-be tacklers make him jittery, he will not be effective.
It is also important to remember that it has only been seven months since Palmer's injury and subsequent surgery. Time is a big factor in gaining confidence. Although Daunte Culpepper tore an additional ligament, the rehabilitation is quite similar, and he has three more months on Palmer, so it is not completely fair to compare their return dates. Palmer was seen Sunday night running and cutting rapidly in pre-game practice, and he claimed that this was the first time he had tested the knee that hard. He needs to repeat those movements enough that they feel second nature, and then he needs to do those same things under the pressure of rushing defenders (starting with friendly defenders such as his teammates) and then he can progress to the unfriendly opponents. Palmer is a sharp quarterback with a long future in the NFL, if he is allowed to move forward at his own pace. Anyone who has experienced a significant injury understands that playing scared is a way to create further injury, or at the very least, perform ineffectively. If Palmer comes back too soon, he runs the risk of re-injuring himself or playing at a sub-par level, neither of which serves him, the fans or the organization. I say kudos to him for being willing to talk candidly and firmly about what he can and cannot do. It is not clear whether he'll be back by Week 1, but when he does come back, he's more likely to be healthy.
Sleepless in Seattle
Jerramy Stevens is no doubt losing sleep tonight as he deals with the pain of a torn meniscus and a serious delay to his regular season start. Stevens had surgery in April, supposedly to address cartilage damage, and now he finds himself about to go under the knife again. He has been projected to be out for 6-8 weeks. This timetable suggests that he will have the damaged piece of meniscus removed followed by some rehab to get his range of motion and strength back to performance mode. The wild card here is that since Stevens has had prior knee problems, there may be more damage inside the joint than if this were a first-time injury. The meniscus is a fibrocartilage disc that helps provide cushion and stability within the joint. When a torn meniscus piece is removed, the knee can recover but there is a likelihood of increased joint changes (arthritis) down the line. That coupled with Stevens' prior history for this knee could translate into a slower recovery time. Keep an eye on this situation.
Other News of Note:
Domanick Davis continues to struggle with persistent knee swelling and pain. Most recently, it was reported that he had a bone bruise which will cause pain whenever there is contact on the bone. Namely, any time Davis is bearing weight it is likely to be uncomfortable. Bruises on the bone do heal, but they can be very slow, as Davis is demonstrating. Earlier in the year he had a scope, reportedly to remove part of his lateral meniscus (the meniscus on the outer aspect of the knee joint) according to the Houston Chronicle. Lateral meniscus problems are notoriously harder on the knee than medial meniscus problems, both in terms of recovery and long-term management. The repeated wear and grind of being an every down back is taking its toll on this young player's knee. He will likely have some level of discomfort to deal with on a regular basis, even if the swelling gets under control.
Facial fractures? No problem. Thumb sprain? Well, it could be a problem. Ben Roethlisberger is suggesting that it's no big deal, and perhaps it isn't. But Roethlisberger sprained his thumb, and we all know how important the thumb is for proper grip and throwing mechanics. If indeed it is minor, then we will know in a day or two if Ben starts throwing again. If a few days turn into a week, then it suggests a more significant sprain. Remember, Roethlisberger hurt his throwing thumb last year also. Sure, I suppose last year ended up working out OK for him, but consecutive injuries to the same body part can mean that the ligaments will be weaker overall. Stay tuned.
Good news! For Correll Buckhalter the third time just might be the charm. After tearing his patellar tendon two consecutive seasons during camp, Buckhalter looked fully recovered against the Ravens, running explosively and absorbing tackles without a trace of hesitation. Steve Smith, Thomas Jones, Terrell Owens and Chris Chambers - all hijacked with hamstrings during camp - returned to play this week to varying degrees and survived. At this point they all appear on track for Week 1.
Article first appeared 8/18/06
