Alastair's Injury Corner

[Alastair]

Hey everyone. As there seems to be good players dropping all over the field these days, I figured I would tip my hat in the ring with an injury thread. I know most of you have seen my write ups, and I've received some praise for them, so I'll do my best to keep them coming. I host people over during most games which is why I'm usually absent from the in-game threads. If you have an injury question, post it here and I'll do my best to answer it.

If you can, please provide as much information of the injury as possible. Links to video of the injury occuring are gold to me. If I can see it, I can string together a ton of clues and make good sense of it. Be as specific as possible. If you say "Dude hurt his shoulder, how long is he out for?", I'll probably respond with "Sometime between next week and the rest of his career."

As far as where I get my information from, I'm a student Physical Therapist Assistant who will graduate in the next couple of months (during this year's playoffs). I've worked in the medical field for about 4 years, and seen plenty of texts, so I'll try to give as much info as possible. I'm also planning on taking continuing education to be an on-field athletic trainer at sporting events. Also, if I don't know the answer, I'm not afraid to say it, so please don't compare this to my 3rd grade analysis of player abilities.

[Alastair]

I’m going to start with Andre Johnson. Most of you saw him go down last week with an injury. Here’s the tape:



As you can see, he goes down and grasps the back of his knee on the outside. What he’s grasping at is the biceps femoris tendon. That’s one of the hamstrings that flexes your knee. Hamstring injuries are known to be bad for football and also tough to come back from. The fact is, it depends on the severity of the injury. If the tendon severed completely, he wouldn’t have been walking on the sidelines later and I’ve read reports that this is a Grade II tear. There are three grades. Grade I is extremely minor and most NFL players would likely try to play on this injury. Grade III is severe and involves a complete separation of the tendon or muscle belly. This usually ends up with the muscle balling up near the injury site as can be seen in this image:



In a grade II tear, the tendon is not completely torn, but it isn’t a micro-tear like a grade I. General recovery on these is 4-6 weeks, but Mr. Johnson had a procedure to speed the recovery. It took me a while of googling before I could figure out what procedure he had, and it turns out that he got a very new thing that involves injections of Platelet-Rich Plasma (PRP) to the injury site. These injections heal the tissue more effectively and replace it with collagen rich fibers instead of scar tissue. The recovery time is about the same at 3-6 weeks, but it should heal stronger than a regular injury. This process is really interesting and still in the research phases, but it could really revolutionize sports injury. As far as Andre is concerned, seeing him back in 3 weeks seems very optimistic, but I think he’ll be back on the field in a month or so.

[Alastair]

Oh, just so you know what I'm interpreting for you guys, this is what I have to decipher into layman's terms:

In vivo use of PRP, but also of PPP to a certain extent, in tendon injuries might accelerate the catabolic demarcation of traumatically injured tendon matrices and promote angiogenesis and formation of a fibrovascular callus. Whether this will also be beneficial for degenerative tendinopathies remains to be elucidated.

[SanchoPanza]

Off to a great start, can see this being one of the best threads on the site

[Morgus]

Awesome idea for a thread! I was thinking there should be something like this after reading some of your posts about Arian Foster. I just hope I never have to ask you about any injuries.

[Morgus]

I am curious about what you think of Colston's miraculous return though. Do you think it was a bad idea for him to come back so soon?

[Alastair]

I am curious about what you think of Colston's miraculous return though. Do you think it was a bad idea for him to come back so soon?

I find this one really confusing. You can see his injury in the following video, and it follows the routine for an AC seperation or a clavicle fracture:



There's a direct impact to the side of the shoulder (in this case delivered by the ground, not a defender) and the force is too much for the shoulder to take. It's essentially a dice roll to see what gives first: the ligaments around the clavicle, or the clavicle itself. In this case, the bone took the force. What I find really odd with this quick recovery is every report I've read indicates he received surgery on the fracture. Surgery implies a few different things, but those can be quickly narrowed down by the fact that he is returning so soon. The only indication for surgery that would coincide with a quick recovery is if the fracture happened in the distal 1/3 of the clavicle (the part of the collarbone closest to your shoulder). This is backed up in the video (at 0:12) as Colston is trying to place his fingertips on the injury*. If the fracture was in the distal 1/3, then that creates issues for the shoulder joint as that part of the clavicle serves as an origin point for the deltoid and the insertion of the upper trapezius. Now that I've said that this surgery is the most likely with a quick recovery, it still doesn't make sense to me. Bone fractures typically take 6 weeks to recover, but clavicles even longer (taking about 16 weeks to appear completely healed under x-ray). This is why clavicle injuries are usually season ending.

He apparently received a titanium plate with 6 screws in his clavicle which is a fairly major operation. Colston tweeted that he attributes his quick recovery to sleeping in a hyperbaric chamber (I'm not making this up), but there's no conclusive reasoning on why that would make a difference (if it did, people in Denver would heal at extremely different rates than those on the coast). Personally, I think the Saints are taking a huge risk at putting him in the lineup this quickly. It would make a bit more sense if Colston was the only decent receiver on the team, but that's not the case. Sean Payton says he is fully healed and Colston himself said "The collarbone felt good. If I wasn't ready, the coaches wouldn't have played me. I just have to continue to find my groove and hopefully it's sooner rather than later."

NFL players have a way of healing really fast or just playing through a ton of pain, but I can't wrap my head around this. Everything I've found to read on broken clavicles says he should still be in a sling right now.

*I mentioned him trying to put his fingertips on the injury. There is a very prominent theory in rehab known as the pain-gate theory. Essentially, you have nerve fibers that give pain signals and nerve fibers that give tactile touch signals (pressure, rubbing, etc.). If the pain nerves give a stronger signal than the tactile nerves, your brain interprets it as pain. This is why when you hurt yourself, your first reaction is to rub the sore spot or put pressure on it. It's also why massage feels nice, and why we use electrical stimulation to provide pain relief.

[Morgus]

It now seems clear to me that Colston is an alien. That or he and the FO are taking a huge chance on his health. If he does reinjure it, is it a lingering injury, or does it fully heal in time?

[Alastair]

It now seems clear to me that Colston is an alien. That or he and the FO are taking a huge chance on his health. If he does reinjure it, is it a lingering injury, or does it fully heal in time?

It fully heals. It'll be similar to what happened to Stafford. He tried to come back before his AC separation had fully healed and ended up reinjuring it. There's a couple of differences between Stafford and Colston though. Stafford's injury was to the ligaments and he didn't have hardware installed. Stafford had the end of his clavicle shaved off to help the muscles reattach in a way that is more functional. Clavicles have a tendency to heal with a lifetime remnant of a lump at the fracture site, but that probably won't be noticeable with the hardware fixing things in the right spot. If Colston reinjures, I would expect him to be out for the rest of the season and may need a follow up surgery if the plate and screws were displaced. By the time next season started he would be fine and at no additional risk of reinjury.

[Daidai]

Any chance you could analyze Jon Beason's injury on the Jeff King TD pass in week one vs the cardinals?

I can't tell how severe the tear is nor whether Beason will be able to come back from it