RG III Dislocation Without A Fracture

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The Washington Redskin’s week 2 game had barely gotten on its feet before Robert Griffin III was knocked off of his. Griffin rolled out to his right to pass. The Jaguars pass rush drove him towards the sideline. Griffin planted his left foot hard to throw the ball, but his body continued to move to the right. The momentum carrying his body was so great that it dislocated his tibia and fibula.

It was a familiar sight for NFL fans, conjuring memories of 2012 when Griffin tore his ACL at the end of his rookie season. As he lay on the ground Sunday, writhing in pain, it was clear that his foot was pointing in the wrong direction. Trainers took Griffin to the training room, and he wasn’t seen again until the post game press conference where he approached the podium on crutches sporting his typical RG3 toothy smile.

Not only did he suffer an extremely painful injury, but it’s also an extremely rare injury. Dislocated ankles generally go hand-in-hand with a fracture. The tendons that keep the ankle joint together are very durable and do an excellent job of holding the ankle in the correct conformation. When tendon lacerations occur, there is typically an associated boney fracture involved. As confirmed by the MRI this morning, that is not the case with RG3’s ankle injury. That’s a lucky break – pun intended.

A dislocated ankle should not be put back into place, prior to radiographic confirmation that the afflicted area is negative for a fractures. If there was a fracture, the ankle would require surgery to realign and stabilize the joint.

Now that Griffin’s ankle is back in place, his rehabilitation should begin post-haste. He’ll likely take the first 2-3 days to simply rest his ankle, allowing the swelling to reduce and his tendons to strengthen. He will then start light flexibility and strengthening exercises, as he tries to regain balance and stability in the joint. Next comes the fun part – putting weight on the joint. Water therapy is often used for this variety of injury, allowing function to return while minimizing full weight-bearing exercises. As Griffin progresses, his medical staff will give the green light for the Redskins training staff to start total high velocity weight-bearing training.

Griffin isn’t likely to return to the field for at least a month and most likely longer. How quickly his body repairs itself, and how confident he is with his ankle’s stability, will determine how soon he can return. Griffin didn’t look to be himself last season, after returning from knee surgery. He’s looked more mobile this season, making it that much more frustrating for him to suffer another lower extremity injury. Limiting his running in practice, as well as adding more offensive plays to the book that keep him in the pocket, will help to keep him on the field longer and hopefully lengthen his football career. With an elite player, known to get injured frequently, every little bit helps.

Ankle Surgery For Rams Chris Long

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One of the most commonly injured areas of the anatomy is the ankle. It is the first joint along the kinetic chain to absorb the impact of running, walking and cutting. The ankle is considered a synovial hinge joint, meaning that it’s durable enough to bend in every direction. Despite it’s extreme mobility, the tendons holding the ankle together make it stable enough to maintain a neutral position when standing, walking and running.

Any time a sport involves running, especially when quick direction changes are required, athletes can be at risk of ankle injuries. Basketball and soccer players tend to be at the highest risk for ankle injuries due to the lateral movement, quick direction changes and repetitive jumping. Football, on the more aggressive side of contact sports, adds its own risk to ankle injuries. Three hundred pound men rolling onto each other’s legs can force the ankle to bend in ways not conducive to healthy joints. This is what happened to Chris Long.

In the third quarter of the Rams’ loss to the Vikings, Long’s teammate, 313 pound defensive tackle Kendall Langford, was blocked into him. It appeared as though Langford rolled onto Long’s ankle, bringing Long to the ground. Long was able to get off the field under his own weight, but never returned to the game. In the days following the injury, coach Jeff Fisher announced that Long would undergo surgery, but didn’t elaborate on the specifics of his injury. Long was placed on the injured reserve with a designation to return later this year. In doing so, Long must miss a minimum of 8 weeks. This allows the Rams to open up a roster spot to fill Long’s void.

The Rams will miss Long. He’s played in 95 straight NFL games without missing a single one – the second longest active streak behind Jared Allen. With Long holding down the defensive end position, the Rams allowed the 9th fewest rushing yards per game last season. They were also 3rd in the league in sacks.

Long having surgery on Thursday all but confirmed that his ankle was broken. Long walked off the field under his own power, but ankle fractures come in many different shapes and sizes, and often times a player will be able to place weight upon the fractured joint without much problem. The fact that the Rams opted for surgery suggests that they were worried about the injury destabilizing his ankle.

Often times, ankle surgery involves making an incision to see the fracture, returning all bones to their correct positions, and then bracing them with a plates and/or screws. Long’s official diagnosis and surgical procedure has yet to be released by the team.

Average recovery and rehabilitation from ankle surgery can take up to a year, in the most severe cases. Professional athletes tend to beat those recovery times a bit due to state of the art medical facilities, access to the most experienced surgeons in the business, and the fact that they’re generally at the pinnacle of health. 

Look for Long to return quickly after his mandatory 8-week absence is over, though don’t expect it to be at day 57. He will most likely take a few weeks to get his full ‘push’ back. While Long will technically be released, by NFL rules, to return in as little as 8 weeks, it is more likely that he won’t be back in the game until somewhere closer to Turkey Day.

 

“Saving Brace” For Bulaga

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Green Bay Packers fans’ collective heart skipped a beat on Thursday night when Bryan Bulaga collapsed to the ground and grabbed his left knee. It was a familiar sight, as Bulaga missed the 2013 season with a torn ACL, also in the same knee. Just as the Packers were getting accustomed to having the former All-Rookie Teamer back in action, the training staff was on the field, and an injury timeout was in place. After the game, coach Mike McCarthy called the injury a sprained knee. He minimized the magnitude of the sprain, saying, “We do not fear a major injury.”

Knee injuries are obviously never good news, but the severity of each injury ranges from minimal to “can’t-walk” depending upon which part of the knee is involved, and how badly that part is damaged. The injury is not, “major,” but let’s not be quick to call it, “minor.” There is another adjective in play here, and that is, “moderate.” The only thing we can really take away from McCarthy’s statement is that Bulaga likely doesn’t need surgery.

A knee sprain means, more than likely, a torn ligament in his knee. His ACL, MCL, PCL, and patellar ligaments were all technically a possibility, and the severity of the tear was initially unknown. It wasn’t clear if he had undergone a MRI on Thursday night, but the Packers training staff no doubt performed the Lachman Test on Bulaga to evaluate whether or not he had an ACL injury. Had this manual test indicated ACL damage, the team would have waited for an MRI before ruling out a major injury.

Often times, an MRI cannot be performed immediately, either due to access to the MRI, or to swelling rendering the results unreadable. The afternoon following Bulaga’s injury, it was announced that Bulaga had indeed torn his MCL. He will reportedly miss 2-4 weeks. Bulaga passed on the media availability opportunity Monday night, but sent a teammate to retrieve some personal affects from his locker.

This is certainly a hit to the Packers offense, who are already missing their starting center, J.C. Tretter, for 8 weeks due to a left knee fracture. The team is also missing Bulaga’s backup, Dan Barclay. Derek Sherrod took the field at Bulaga’s position after he left the game, and he struggled at times. On several occasions, Seattle defensive linemen blew by Sherrod completely untouched.

Since having surgery on his left knee, Bulaga has worn a hefty knee brace. Knee braces provide support to the muscles and ligaments that act to keep the body in place. His knee brace essentially acts as a weightlifting spotter for the ligaments in his knee. While braces won’t prevent injuries completely, especially in a sport such as football where the forces on the field are so intense, they can help to reduce the risk of injury, as well as give athletes a renewed level of psychological confidence in their joints following major surgeries. There’s no way of knowing for sure, but it’s definitely possible that Bulaga’s knee brace worked to limit the damage to his MCL, or possibly even prevented damage to his ACL. While these braces may seem uncomfortable or slightly restricting, many players consider them a necessity – specifically those players that know first-hand how much time and money an ACL injury can cost them.

Bulaga has indicated that he thinks he will be able to play next week if practice goes well. The team is saying that he will miss 2-4 weeks. It’s not at all unusual for a player to underestimate his recovery timetable. NFL players are some of the most confident people in the world when it comes to their physical abilities, and rightfully so. That said, it would be surprising to see Bulaga rushed back to the field. Even if he beats the odds and is fully healed by Sunday, the trainers will exercise plenty of caution, considering the seriousness of knee injuries, as well as his own history with torn knee ligaments. Even if he takes the full 4 weeks to return, it’s a much more positive outcome than the initial fears.

Wes Welker Suspension Wrap-up

Wednesday afternoon, news broke that one of the NFL’s best known players had been suspended for 4 games, after testing positive for amphetamine use. Welker had been a favorite receiver of Peyton Manning, as the Bronco’s offense broke every major single-season passing record. He had recently been in the news after suffering his 3rd concussion in the past year.

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 As is normally the case, when a player of his caliber tests positive for performance enhancing drugs (PEDs), speculation ran wild. Mike Florio of Pro Football Talk reported that Welker had taken “Molly” at the Kentucky Derby, which was cut with amphetamines. Molly is a common name for MDMA. It is a street drug that has become popular with partygoers, and it is very often cut with other substances, such as adderall, to make it cheaper. More recently Tom Brady, QB for the New England Patriots, was brought into the mix after attending the Kentucky Derby with Welker. Brady’s response, when asked if he observed Welker using any form of drugs at the Derby, was a twisted and noncommittal version of “no”….I think.

The Dallas Cowboys’ cornerback, Orlando Scandrick tried and failed to use this defense in his appeal for a similar positive test earlier this year. As one doctor familiar with the creation of the NFL’s drug policy told Michael Shottey, “Oh, you mean a drug dealer lied to you?”  For his part, Wes Welker vehemently denied the “Molly” report, saying he isn’t sure how the drug got into his system.

Immediately following the release of the test results, Will Carroll reported that the failed test was a result of adderall use. Adderall is a very common medication used to treat patients with ADHD. Players can get a Therapeutic Use Exemption (TUE) for ADHD medication, but the process to obtain a TUE is not easy, and requires a diagnosis from an NFL-approved physician. Adderall is a commonly abused substance by athletes as well as students. Adderall is an amphetamine that helps to improve focus and energy, and athletes have been using them to elevate their game for years. On the downside, adderall use can increase the risk of severe cardiovascular problems and stroke. 

Some have speculated that Welker was taking adderall to improve his focus after his recent concussion. While there has been extensive conversation about whether the use of ADHD medication is helpful following a concussion, there has yet to be any significant evidence indicating that this is true. That point is likely moot, anyway, as Welker’s positive test most likely occurred prior to his concussion. His appeal was heard two weeks ago, and players are generally given at least a month to prepare for an appeal following a positive test.

Welker will miss 4 games to start the 2014 season. While this will hurt the Broncos’ offense, Peyton Manning should be more than capable of finding other targets to supplement Welker’s absence.

Professional sports have been working for years to combat PED use. In order to compete in international competition, a sport must comply with the World Anti Doping Agency’s (WADA) drug testing policies. In addition, all major professional sports have penned their own policies. This is especially important in contact sports like football, as players with unfair advantages can cause serious injury to other players.

The NFL has a serious concussion problem. Stopping PED use is one, albeit small, step towards minimizing concussions.

Dominic Espinosa’s Broken Ankle Costs Him The Season

The Texas Longhorns lost a vital piece of their offense on Saturday when center, Dominic Espinosa, left the game with an ankle injury. It was later reported that Espinosa suffered a broken ankle and will miss the rest of his senior season.

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The Longhorns are in the process of rebuilding their offensive line. Espinosa was the most experienced player amongst a group of young offensive linemen. He was expected to be the leader that held the group together, but he will now have to watch the games from the sideline.

The offensive and defensive lines are often referred to as the trenches of a football field, and rightfully so. Linemen tend to be the biggest and strongest players on the field, and their job is to knock each other down. When they fall, they tend to fall hard, and unfortunately, injuries are often the result. On Saturday, a North Texas defender rolled into Espinosa’s right leg, knocking Espinosa down. Espinosa was unable to place any weight on his leg, and he needed to be carted off of the field. He had an X-ray later that night, and an MRI the next day, revealing the broken ankle. 

The ankle is made up of three bones that come together, called the tibia, fibula, and talus. They are connected by multiple ligaments. Because so much weight is placed on the ankle joint, ankle injuries are very common in athletes. Often times an ankle is rolled, resulting in a torn ligament, or an ankle sprain. Depending on how badly the ankle is sprained, where the injury occurs, and how quickly the injury is treated, recovery timetables for ankle sprains can range anywhere from days to months. The initial hope for Longhorns fans was that the injury was a high ankle sprain. Espinosa was one of only 2 returning starters on Texas’ offensive line. He has now been replaced by redshirt freshman, Jake Raulerson.

Raulerson replaced Espinosa in Saturday’s game, and muffed several snaps. He will have to put in plenty of extra work in practice to become comfortable with quarterback, David Ash. Unfortunately, Ash suffered a concussion, and likely won’t be able to  work with Raulerson much until he recovers. Protecting the quarterback could be a major issue for Texas moving forward. If an inexperienced, and now depleted, offensive line cannot pull their own weight, David Ash is going to be at serious risk of suffering additional injuries.

It was confirmed a few hours ago that Espinosa will undergo surgery on Wednesday morning. The specifics of the surgical intervention will be determined by the degree of dislocation. If the ankle bones are only minimally out of alignment, he could be able to bypass any metal placed in the wound and opt for a closed or open reduction of the fracture. That is the best case scenario and would have Espinosa simply wearing a brace to keep the bones stable. Anything more severe that a minor fracture-dislocation will likely include metal plates, rods, and/or screws being put in his ankle to hold the bones in place while they heal. Ankle fractures are very painful, and the rehabilitation process can be lengthy and difficult. The injury is incredibly unfortunate for Espinosa, but he will be able to receive treatment from some of the best doctors and trainers in the world. Hopefully he can recover quickly and be pain-free with no lingering issues.

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Mixed Reports on Diego Costa’s Hamstring

 

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Chelsea got some bad news about their £32 million striker, Diego Costa this week, as they prepare for their match against Everton on Saturday. Costa pulled up lame during practice this week with a hamstring strain. Some initial reports said that Costa could miss up to 6 weeks, but the team is characterizing the strain as a “minor muscle injury,” and is not even ready to rule him out for Saturday’s Everton match.

Reports with a discrepancy in timetables of this magnitude is not wholly unusual, but it means that there is either some serious misinformation or some serious misdirection. The key to how much time Costa will miss lies in the severity of his hamstring strain. If the injury is a grade 1 strain, Chelsea fans should be optimistic that the medical staff will have him on the field this weekend. If the injury is a grade 2 strain, he should be doubtful for this weekend, and will need a few weeks to recover. A grade 3 strain is more serious and will take much longer than 6 weeks to recover. It’s unlikely that the injury is a grade 3 strain since no reported timetables are characterizing the injury as such.

The team is trying to downplay the injury, but they are also being very vague. They have not reported the severity of the injury. Make no mistake, “minor muscle injury” is not an official medical diagnosis. The team’s suggestion that Costa could play on Saturday suggests the strain is a grade 1. However, Chelsea has every reason to put up a smoke screen. By creating uncertainty over whether Costa will be active forces Everton to plan for two scenarios: One in which they must defend Costa, and one in which they don’t. Costa is a feared striker, and has scored 2 goals on just 5 shots in 2 games during the current Barclays. The 25 year old Spaniard is just entering his prime, and his best may be yet to come. 

On the other hand, the reports of Costa missing up to 6 weeks are very curious. It’s not clear where the 6 week figure has come from. Did someone within Chelsea’s medical staff leak the news? This isn’t unheard of, but taking a players medical diagnosis to the media without the player’s or team’s permission is unethical and puts their job at risk. Perhaps somebody close to Costa leaked the timetable. Second hand sources are notoriously unreliable when it comes to medical information. It’s also notable that this timetable was reported as “up to 6 weeks”. It’s unusual to have a maximum timetable with no minimum. Perhaps this is just a matter of a report being spun to look more dramatic, or perhaps the report is erroneous to begin with.

Both sides are being vague, here, but it seems fair to trust what the team is saying. While it’s reasonable to suggest that Chelsea is being facetious leading up to an important match, this report has come first-hand from the team’s medical staff, and is in line with a grade 1 strain, while the report of a 6 week timetable seems to have come out of thin air.

Kiko Alonso Tears ACL, Likely To Miss 2014 Season

This offseason, the Buffalo Bills have continued to improve their already impressive defensive front with the addition of linebacker, Brandon Spikes. The plan was to have Spikes take over for Kiko Alonso at middle linebacker, while Alonso would slide over to the weakside linebacker position, where he could get more opportunities to rush the quarterback and create havoc on opposing offenses. Those plans will have to be scrapped, as the Bills announced this week that Alonso had torn his anterior cruciate ligament (ACL) while training in Oregon.

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With Mario Williams rushing from the outside, Kyle Williams and Marcel Dareus clogging the middle, and Nigel Bradham exceeding expectations, the Bills have enough pieces that the loss of Alonso shouldn’t be crippling. That isn’t to say he won’t be missed. Alonso had skyrocketed the start of his career. The Bills 2nd round pick compiled 159 tackles in his rookie campaign, as he became a premier run-stopper at the professional level. The Bills hit the jackpot with Alonso, who fit seamlessly into one of the game’s best front sevens.

It is not yet clear how the injury occurred. Alonso was rehabbing from hip surgery that he underwent earlier in the offseason, to repair a torn labrum. Injured athletes, both consciously and subconsciously, compensate for injuries by changing their mechanics. This redirects the load of force from an injured joint to a healthy joint, increasing the healthy joint’s workload. This is quite possibly what happened with Kiko Alonso. If his hip was not ready to handle the stress of his workouts, he could have been putting extra strain on his knee, potentially leading to this injury.

Despite Sean Lee’s recent ACL tear during organized team activities, major knee injuries are not common during the NFL offseason. Players are avoiding contact during offseason workouts. They also generally avoid training that involve intense lateral movement, such as explosive side to side movement. Rapid lateral movement puts stress and strain on the ACL. The ACL acts to resist side-to-side movement in the leg, allowing the foot to plant firmly in the ground and push forward. When the ligament is stressed beyond its resistance capabilities, it can tear. When the ligament tears, it often requires surgical repair, followed by a lengthy rehabilitation. Alonso is expected to miss seven-to-nine months, which will rule him out for the 2014 season.

Buffalo’s front office is trying to rebuild a team that is in the midst of the NFL’s longest playoff drought. Since the team wasn’t necessarily expected to contend in the AFC East this season, this injury shouldn’t be too damning for Buffalo’s future. With Alonso being only 23 years old, his body should heal quickly and respond well to treatment. He has access to world-class doctors and training staff. There is little incentive to rush his recovery and get him back on the field this season, but Buffalo should expect to see Alonso fully healthy next year. Fans have plenty of reason to be optimistic about 2015.

Novak Djokovic’s Shoulder “Injury”

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At 1:00 ET today, top-ranked Novak Djokovic will face 14th-ranked Jo-Wilfried Tsonga, with the winner advancing to Wimbledon’s quarterfinal. Djokovic has been there before. As a matter of fact, he’s made the quarterfinals in five straight Wimbledons. He will have his work cut out for him, however, with Tsonga as a very tough opponent; having reached the Wimbledon semis in two recent years.

His toughest opponent, however, might be his own shoulder. In Friday’s match, Djokovic fell, landing on his left arm. He immediately clutched his shoulder and called for a medical trainer. Djokovic said he heard a pop when he stood up, but after a short break, he was cleared to resume play. The shoulder is a very complex joint composed of cartilage, ligaments, tendons, bone and two separate linings called the synovium and the bursa. If any one of these structures are injured, the smoothly functioning shoulder can produce a pop, snap or click. These sounds can be simply due to everyday use, chronic repetitive stress of sports or because of a significant trauma, fall or accident.

After the match, scans on the shoulder revealed no structural damage. Trainers told Djokovic that he will have to deal with some soreness for a couple days, but aside from that, his shoulder is healthy. Had he separated or dislocated his shoulder, he would not have been able to continue his match. He may have even been prescribed rest in leiu of his next tournament. Serious shoulder injuries can have lasting effects and as such, vigorous rehabilitation is ofteb needed to regain full movement and strength.

It was a scary moment in London but the crisis seems to have been averted. Luckily for Djokovic, the injury is to his left-side. Anti-inflammatories will work to minimize soreness during his match, but he will likely still feel the effects of his fall, especially on backhand shots. No doubt he is experiencing some swelling of the joint. That swelling will be aggravated by movement, and will possibly limit his range of motion during play today. 

Djokovic played through the injury on Friday, and did so successfully. However, for best results, the injury needed to be treated immediately. Icing the shoulder as soon as play concluded would limit the amount of swelling and decrease recovery time. Since the injury occurred in the middle of a match, Djokovic was not able to rest or ice the injury immediately, as he would have wished. Fortunately for Djokovic, the injury is not serious. It could be limiting in the short-term, but hopefully the swelling has decreased to the point that it will not be a distraction during his match with Tsonga.

Tsonga will surely be attacking Djokovic’s left side this afternoon. If Djokovic has any limitations due to the injury, Tsonga will sense it immediately. Decreased range of motion will keep Djokovic from maximizing his range of motion. It will also likely reduce the speed of his swing. If Djokovic can’t perform at his typical ability, it could cause him to second-guess his play. Any hesitation at this elite level of tennis could result in the loss of crucial points. The bottom line is that Djokovic will need to put the injury out of his mind if he wants to defeat Tsonga.

How Far Will Joel Embiid Fall In Tonight’s Draft?

Joel Embiid left the NCAA as the top player heading into the NBA Draft. His immense talent, combined with his size, overshadowed his history of back and knee injuries. However, his newest, recently discovered injury is forcing teams to think twice about committing their franchise to the young center, at the 2014 NBA draft, tonight.

Navicular BoneEmbiid has been diagnosed with a stress fracture in his foot, more specifically the navicular bone. The navicular bone is on the medial side of the foot and supports the longitudinal arch. Navicular bone stress fractures are notoriously tough to diagnose. The injury wasn’t discovered until the Cleveland Cavaliers examined his medical records during routine draft preparation. The duration of the fracture is not known, and unfortunately for Embiid, studies have shown that treatment is significantly more successful when the injury is diagnosed and treated immediately.

This could be a brand new injury, or it could be something that Embiid has been dealing with for some time. That said, the injury had not progressed to the point where he couldn’t play through it, suggesting it may have been diagnosed and treated earlier than most navicular fractures. It’s possible that Embiid was keeping the pain a secret in hopes of preserving his draft status. Either way, he’s undergone surgery to repair the fractured bone, and his recovery will take anywhere from 4 to 6 months. He’s talented enough that he shouldn’t fall too far down draft boards, as the team that drafts him will likely be a team that is undergoing a rebuild, and whose presence in 2015 won’t be vital to the franchise. 

Like many NBA big men, Embiid is no stranger to injury, although he is relatively new to the sport. He suffered a stress fracture in his back, which forced him to miss the NCAA tournament. While the two injuries are not directly related, having multiple stress fractures is cause for concern. It is possible that Embiid might to be putting more force on his musculoskeletal system than it can handle – pushing his infrastructure to its limits. Navicular stress fractures have a tendency to recur, so it’s likely that this is something Embiid will have to deal with for his entire NBA career. It bears noting that this is the same injury that ended Yao Ming’s career.

When healthy, Embiid is a franchise-changing talent, whose game is only going to improve with time. His talent can take him far, but his ability to avoid future injury will be what determines whether he has the career trajectory of Greg Oden, Hakeem Olajuwon, or somewhere in between like Yao Ming or Andrew Bogut. Right now, one thing is certain. On Thursday night, one general manager will close his eyes, cross his fingers, and cringe as Adam Silver introduces the young center out of Kansas. That GM’s fans will likely have the same reaction. 

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