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Tag Archives: NFL Injuries

Frequency of Chronic Traumatic Encephalopathy (CTE) in Football Players

Recently an article was published in JAMA by Mez, Daneshvar, and Kiernan et al that investigated the frequency of Chronic Traumatic Encephalopathy (CTE) in football players. It has become a topic of controversy because CTE has become a red flag for the public eye. It is now known to be correlated with repetitive trauma from popular impact sports such as hockey, football, and even soccer. While many hope to avoid or prevent the progression of this disease, there is currently no definitive causation and therefore no cure-all. CTE is a post mortem diagnosis that requires evidence of an accumulation of certain proteins along with other neurological criteria.

Mez, Daneshvar, and Kiernan et al used current classification systems to evaluate and assess 207 donated brains of football players. An overwhelming majority of them (87%) met the criteria for neuropathological diagnosis of CTE and the article detailed severity of symptoms (pre-mortem) associated with severity of CTE as well as mean age of death. While the article suggested a relationship between higher level of football participation (NFL) and worse disease presentation, the authors were definitely not stating a cause and effect relationship. The conveniance sample was for investigating possible relationships between activity levels and disease burden. This was an observational study with no constant or variables to compare.

Studies have shown that while living, a person with CTE may present with similar behaviors and cognitive impairments to that of a person with mood disorders, dementia, or Alzheimer’s disease. Mez, Daneshvar, and Kiernan et al outlined common characteristics and behaviors of the people that were diagnosed with CTE and therefore provided a foundation for future studies to help eventually determine causation, a sensitive and specific means of evaluation, and prevention. Until then, athletes of all levels must try their best to avoid repetitive and unecessary microtaumas. Playing smart and competitively, not aggresively, can help minimize repeated impact and trauma in every game.

Elizabeth Lamontagne PT, DPT, SCS, CKTP

Jeter, Oden And The NFL

Joe Girardi was quoted yesterday saying that Derek Jeter would be sitting out Saturday and Sunday because of lingering quad and calf issues. Today he announced that Jeter has a calf strain. No surprise. And, until both strains are completely resolved, each time he runs full out, they will linger all over again. If only Jeter could hit a home run every time…

Greg Oden, who underwent three microfracture surgeries since fracturing his patella in December of 2009, is getting another shot. That is a long time to be on the shelf, especially in a career in which Oden, now 25 years old, was oft injured – he played in only 82 games during his four years with the Portland Trail Blazers. The Miami Heat, reportedly ready to close the deal on the seven-footer, isn’t likely to expect him to play big minutes, even once re-acclimated, though the word is that Oden is looking good. The issue probably isn’t whether he can contribute in a limited role but for how long. If expectations are low, the experiment probably won’t be deemed a failure regardless.

Glad to see that contact in NFL camps is being limited these days yet, even in spite of this, the number of teams suffering season altering injuries has been remarkable. So many are already lost for the entire 2013 campaign. A total of 31 players are curently listed as either physically unable to perform, on injured reserve or out indefinitely, while another 18 are questionable for the start of the regular season. Imagine if they were tackling every day…

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NFL ACL Recount

In re-reviewing the updated NfL injury reports
http://sportsdirect.usatoday.com/football/nfl-injuries.aspx?page=/data/nfl/injury/injuries.html
I stand corrected on Tuesday’s post regarding the prevalence of ACL tears suffered by players this season. I’d counted ten, and the number appears to be at least 15, or possibly 16.

Joining his colleague Ernest Graham on my list is Tampa Bay Safety Cody Grimm, who tore his right ACL and MCL and was placed on IR at end-September. Like Grimm, Dominique Foxworth, a Baltimore Ravens CB, was placed on Injured Reserve on 9/28, only in his case, this was reportedly due to post-op complications that have rendered him ineffective following ACL surgery that took place after he suffered the injury during practice in July of 2010. Foxworth should get honorary mention on this list.
http://sports.espn.go.com/nfl/trainingcamp10/news/story?id=5423019
Jameson Konz, Seahawks TE, is out for the season after tearing his ACL during his NFL debut in the Seahawks upset of the Giants on October 9th.
http://www.cbssports.com/nfl/players/playerpage/1123488/rss
Other October ACL injuries include those to Indianapolis

Colts
Rookie Tight-end Ben Ijalana who was hurt in week 4
http://www.sportsoverdose.com/nfl-players/ben-ijalana
and Green Bay Packers RB , Alex Green, who succumbed to his ACL in week 7.
http://blogs.greenbaypressgazette.com/blogs/gpg/insider/2011/11/01/green-expects-mental-hurdles/
I couldn’t get a read on what is going on with Michael Sims-Walker, Jacksonville Jaguars wide-receiver, whose still or again ailing knee put him on IR this week. At 27, Sims-Walker has a “long” history of knee issues that included ACL surgery while in college, and a knee sprain and staph infection in 2008.
http://jacksonville.com/opinion/blog/429812/tania-ganguli/2011-11-03/jaguars-wr-mike-sims-walker-have-surgery-tuesday
Sims-Walker is slated to undergo a new knee surgery, the details of which have not been reported. He

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was added to this ACL list as a result.

Keep in mind that there are so many more players out with knee injuries, many of them sprains or cartilage damage. ACLs by no means corner this market. Add to that the insane number of hamstring strains and other extraneous related injuries and you will be astounded at the number of guys who are out or playing hurt. Also staggering are the stats on achilles, foot and ankle injuries, which seem far more prevalent than shoulder and back problems this season. Concussions, as always, remain a big concern as well.

My next post will be on hand fractures, such as the one with which Chargers RB Willis McGahee plans to play this weekend.

What injuries would you like to read about? Let me know!

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What’s Up With Lisfranc Injuries In The NFL?

Santonio Holmes, Jets wide receiver, Cedric Benson, running back for Green Bay and Carolina center, Ryan Kalill have something unfortunate in common; they recently suffered Lisfranc injuries. Mike Freeman wrote for the NFL Insider, that though some believe the prevalence of the injury may be increasing due to the ever-increasing speed of the game coupled with the size of the players, he feels, as do others, that it is simply a coincidence.

Freeman quoted Benjamin Wedro, a physician who writes extensively about sports issues, and who referred to the mechanism of Lisfranc injuries as resulting from a “low-energy” trauma where “a twist to the midfoot is added to a fall where the foot is plantar-flexed, or positioned like a ballerina on point.” Wedro commented that this often occurs “in a pile-up if the foot is twisted when another player stumbles over top of it.” It can also be a result of a foot being stepped on and torqued, particularly as a player tries to free the foot.

What is the Lisfranc Joint?
The midfoot joint complex formed between the metatarsals (the long bones of the midfoot) and the tarsals – the smaller bones closer to the heel) are also known as Lisfranc’s joint. A simple diagram of the area can be viewed here.

So, what exactly is a Lisfranc injury and why is this area particularly vulnerable?
The foot has many unique properties, one of which is that there are no ligaments connecting the base of the first and second metatarsals – the innermost of the five long bones in the midfoot. The configuration and tight fit of these bones is what substitutes for the ligaments in providing stability, thereby preventing side-to-side movement or dislocation of the

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bones in this region. That is unless the second metatarsal (which is generally the longest) is fractured – generally at or near it’s base. This is an area where the midfoot is rather vulnerable. With fracture, the other inter-metarsal joints may become dislocated (completely separated from each other).

Though it does not simply connect one bone to another, the primary stabilizer of the joint between the base of the first and second metatarsals is Lisfranc’s ligament, which is a strong fibrous tissue that extends from the bottom of the foot at a bone closer to the heel (the medial, or innermost cuneiform – a tarsal bone) and runs diagonally to the bottom of the inner aspect of the second metatarsal. In addition to also connecting the lateral (outer) metatarsals to the cuneiforms, Lisfranc’s ligament contributes to the bony stability of the region at the base of the second metatarsal. Because the dorsal (upper) aspect of Lisfranc’s joint lacks this stabilizing support, dislocation often occurs in this direction. However, there are many variations, some with the occurrence of associated injuries to the foot.

Disruption of Lisfranc’s ligament may be mild, and therefore treated with immobilization. In the event of fracture with more significant separation, immobilization also follows either closed positioning (reduction) of the bones with percutaneous pinning (from outside the foot to within), or internal fixation with pins placed entirely within the foot. Considerable separation of the bones in the region (greater than 2 mm. of displacement and 15 degrees of tarso-metatarsal separation) requires operative care. See this link for post-operative photos.

It is thought that Lisfranc injuries without fracture are likely to have worse outcomes, with the possibility of later midfoot collapse or metatarsalgia (inflammation of the region)… A reason to be more encouraged by the long-term prospects faced by the player who is out for the season after surgery (like Holmes) than one who escapes the scalpel.

Follow Abby on Twitter @abcsims
.

NY Jets Are Hamstrung

The New York Jets are lean and not in a good way. Excluding Santonio Holmes, who was placed on Injured Reserve following week four with a Lisfranc injury to his left foot, the Jets have 19 players on their injured list – most in the NFL.

Listed as out for week five but likely lost for the season with an ACL tear is Darrelle Revis.

John Conner (hamstring), Stephen Hill (hamstring), Dustin Keller (hamstring), Sione Pouha (back), Bart Scott (toe), Bryan Thomas (hamstring) are all likely to

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be watching from the sidelines.

Following only limited practice and listed as questionable are Eric Smith (hip/knee), Aaron Berry (ribs), LaRon Landry (heel). Look for limited time if they do play.

The Jets’ hamstring woes are clearly hampering them. Muscle strains are injuries that can be nagging, take more time than is thought to be fully rehabbed and can easily be exacerbated by returning to play too soon. This can result in more time lost than might have been the case had healing been complete before play was resumed.

The ten players rounding out the Jets’ injury report are all probable for this Sunday, but their injuries remain a factor. Playing hurt, clearly a part of the game, generally hampers performance in some way and may even exacerbate an injury, leading to time lost or further limiting a player’s effectiveness. It also has the potential to result in other injuries due to compensatory mechanisms or an inability to perform with the same speed, agility or strength as when healthy.

Look for a post on Lisfranc fractures and a review of the hamstrings in the coming days.

Follow Abby on Twitter @abcsims

NFL Week One Injuries

Week one of the NFL resulted in the usual array of injuries, and the tally looks like this:

Foot and ankle (3) : John Skelton, Arizona Cardinals (QB); Pierre Garcon, Washington Redskins (WR), Dwight Freeney, Indianapolis Colts (LB)
Knees (3): Fred Jackson, Buffalo Bills (RB); Rashad Jennings, Jacksonville Jaguars (RB); David Nelson, Buffalo Bills (R)
Shoulder (1): Jake Locker (QB)
Neck (1): Rodger Saffold, St. Louis Rams (OL)

Diagnoses and Prognoses:
John Skelton, Arizona Cardinals’ QB, initially thought to have a high ankle sprain, was subsequently reported to have a low sprain. The difference? The more feared high ankle sprain affects the ligaments that connect the tibia and fibula in the lower leg, while the low sprain impacts the ligaments connecting the base of these bones to the talus or calcaneal bones of the rear foot. The severity of a sprain influences the ability to bear weight on the affected side and, as with any injury, determines the recovery time needed. Sprains are graded on scale from one to three, with the mild Grade 1 resulting in little damage to the involved structures, Grade 2 involving a partial tear of variable degree and Grade 3 entailing a complete rupture. The worse the sprain, the more a joint’s stability is impaired. Instability refers to a laxity or loosening of the joint. The instability of the high ankle sprain is generally more problematic and requires a more extended recovery. Surgery may be indicated in the event of a complete rupture. Learning he has a low sprain is a bad news – good news situation for Skelton. Some reports have him returning in 2-4 weeks while others don’t rule him out for Sunday. If we weren’t talking about football, even the more conservative estimate would be overly optimistic.

Pierre Garcon’s foot injury was a cause for early concern, but he is looking to be back on the field this weekend. X-rays were evidently negative, though the specifics of the injury were not available. However, as a wide receiver, Garcon is counted on to run and cut, and if a foot problem forced him to leave the field one week, he isn’t likely to be at full capacity the next.

Dwight Freeney’s MRI results had not been reported and accounts of the extent of his ankle sprain are not known.

Fred Jackson’s MRI was reportedly negative, and it is thought he will miss 3-7

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weeks with what looks to be a lateral collateral ligament sprain in his left knee. As noted above, recovery is predicated on many things, most importantly, the grade of sprain. Even seven weeks is optimistic in the real world if the injury is anything but a Grade 1.

Rashad Jennings’ MRI results have not yet been reported, but his knee injury is not thought to be particularly serious as he played briefly after sustaining it.

David Nelson begins this week on the IR due to a torn right knee ligament (details were not reported but the ACL, plus or minus other related injuries, seems a likely suspect). He will be out for the season.

Jake Locker reportedly separated his non-throwing shoulder but expects to play (in a brace) this weekend. The term shoulder separation generally refers to injury to the joint formed by the outer clavicle (collarbone) with the acromion (the extension of the shoulder blade that essentially provides a hood over the shoulder joint). This is distinguished from a shoulder dislocation, which disrupts the ligaments connecting the ball at the end of the humerus of the upper arm to its socket (glenoid). Clearly, this same injury to his dominant side would have kept Locker out of action for a while. Regardless, he won’t be too comfortable.

Rodger Saffold’s early diagnosis of a severe neck strain, though painful and limiting, was great news. With initial testing negative for fracture or neurological involvement, Saffold will have to take it slow and undergo further testing. Don’t look for him to be back in the next few weeks.

Patellar Tendon Injuries in the NFL

Knee with ruptured patellar tendon

This has been the week of the patellar tendon tear in the NFL.

Gerald McRath, a Tennessee Titans’ linebacker who had missed some playing time at the close of last season in part due to knee pain, is set for surgery to repair the partially torn left patellar tendon that has continued to hamper him. He is expected to be out for the year.

The Tampa Bay Buccaneers lost right guard Davin Joseph to a what is likely a season-ending right patellar tendon tear suffered on August 24th during a preseason victory over the New England Patriots,

Rounding out the list is promising Steelers’ rookie guard David DeCastro, who hit a terrible trifecta with a dislocated right patella, torn MCL (medial collateral ligament) and partially torn patellar tendon on August 25th in a preseason game against Buffalo. In spite of what is clearly a “severe knee injury”, optimistic reports have DeCastro returning in three to five months.

Jim Leonhard, Ryan Williams, Nate Allen and Clint Sintim are amongst NFL sufferers from recent seasons who could counsel the newest members of the patellar tendon club.

 

The Patellar Tendon

A tendon connects muscle to bone, while a ligament connects bone

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to bone.

The patella is also known as the kneecap, and the patellar tendon, which connects it to the tibia (the larger bone of the lower leg), is sometimes referred to as the patellar ligament. This tendon is a part of the extensor mechanism of the knee. The extensor mechanism also includes the quadriceps muscle (located at the front of the thigh), the quadriceps tendon (which attaches the quads to the patella), ligaments that connect the patella to the femur (thigh bone) and tibia, connective tissues that help secure and stabilize the patella, as well as the tibial tubercle (the point of attachment of the patellar tendon to the tibia).

Ruptures of the extensor mechanism occur either to the quadriceps tendon or patellar tendon and may be complete or partial. Patellar tendon ruptures generally occur in those younger than than 40 years of age, while quad tendons are more likely to rupture in those over 40. Prolonged steroid use is thought to increase the risk of rupture. When either the quad or patellar tendons are completely ruptured, the knee cannot be actively straightened at all. With a partial tear, it is generally possible to extend it at least somewhat.

Most ruptures of the patellar tendon occur when the knee is bent and subject to more of a demand than it can tolerate. Ruptures occur more frequently at the upper part of the tendon and its attachment to the patella than at the lowermost portion where it attaches to the tibia. A patellar tendon rupture may also be referred to as an avulsion, which is the term used to describe the tearing away of a body part. In the case of a tendon tear, a portion of the attaching bone may be torn away as well. Without the tendon to anchor it, when someone has a torn patellar tendon, the kneecap will ride upward and remain there. Interestingly, there is a greater incidence of patellar tendon ruptures amongst those of African decent. The reason for this is not absolutely clear.

Complete rupture of the patellar tendon requires surgical repair, and surgery is best if performed promptly to optimize outcomes. Partial tears may heal sufficiently depending on the degree of disruption and the demands placed on the muscle tendon unit. Newer operative procedures allow patients to avoid prolonged immobilization in a cast and work on mobility of the knee in the post-operative period. This generally accelerates recovery. However, healing and rehab is a process that cannot be rushed. A gradual restoration of full range of motion, muscle flexibility, strength and endurance as well as balance and agility is

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all a part of that process.

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Ben Roethlisberger’s Rotator Cuff

Took a look at the current NFL injury report and had to mention that (including a few due to suspensions) it is 80 men deep – as of August 1st!

Not on the list is Steelers’ quarterback, Ben Roethlesberger, who yesterday just happened to mention that he has been playing with some shoulder pain due to a partial rotator cuff tear since sustaining the injury in a loss to Baltimore on November 6th, 2011. As with many of his prior injuries, Roethlisberger evidently has no intention of sitting this one out and is simply limiting his throwing in practice. I saw no mention of any medical treatment in the media. Though he reportedly laughed off the possibility of the tear worsening, that outcome wouldn’t be shocking.

The rotator cuff muscles are important to the overall function of the shoulder girdle, and particularly so for a throwing or overhead athlete.

What is the Rotator Cuff?

Four muscles that originate on the shoulder blade (scapula) all essentially converge into a common tendon to attach at the front, top and back of the head of the humerus (the bone of the upper arm). Collectively, they constitute the rotator cuff. You may recall that tendons connect muscle to bone. Those of the rotator cuff are no different.

The muscles that contribute to this tendon are responsible for different actions. The Subscapularis tendon is the foremost. Its muscle belly is on the undersurface of the scapula and the tendon wraps around the front of the humeral head. The action of the muscle is to internally (inwardly) rotate the humerus By virtue of its location, the subscapularis tendon also helps to protect the front of the shoulder. The Supraspinatus, insertion is the uppermost of the cuff tendons. When it contracts, the supraspinatus raises the arm out to the side (abducts). Infraspinatus & Teres Minor, the next two in order of attachment, are the primary external rotators of the shoulder. These tendons come around the back of the head of the humerus, thereby providing the leverage to rotate the bone outwardly.

Why is the Cuff so Important and how is it Injured?

In addition to enabling the shoulder to move in the directions described, the muscles of the rotator cuff help to foster normal mechanics of the joint. Weakness and strength imbalances of the cuff lead to abnormal mechanics, which then result in injury. This is particularly so when combined with the increased demand of sports or other repetitive overhead activities.

When they have rotator cuff problems, younger people tend to suffer from tendinitis, which is simply an inflammation of a tendon. The cuff tendon most likely to be involved is the supraspinatus tendon because of its uppermost position immediately below the hood of the shoulder, known as the acromion.

The narrow space below the acromion (the “subacromial” space) can be narrowed even further by poor posture (forward head, forwardly tilted shoulder blade/rounded shoulders), by variations in the shape of the acromion itself, and by the presence of bone spurs. This space also becomes smaller when the outward rotators are weak and do not adequately control the position of the head of the humerus when the arm is elevated overhead. The end result is impingement of the cuff tendons.

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“Impingement” is as it implies – a pinching of the structures involved. At first the tendons just become inflamed. The swelling that accompanies this inflammation can further diminish the subacromial space” and create a vicious cycle. Over time, the wear and tear from impingement leads to degenerative changes of the tissue, and that is called tendinosis. Tendinosis can be likened to gliding a rope back and forth over a rock until the rope begins to fray. Give it a little more time and overuse, and the fraying of the cuff tendons (particularly in the over 40 crowd of recreational athletes), results in degenerative rotator cuff tears.

Younger athletes with cuff tears are generally those who do an inordinate amount of overhead activities like pitching. Overuse and irregular pitching/overhead mechanics can also play a role in predisposing these players to injury.

Another cause of rotator cuff tears is outright trauma, such as in a dislocation. A traumatic tear of the cuff is also the likely outcome for the person who holds onto a banister for dear life while falling down a flight of stairs. Though without dislocation, Roethlisberger’s injury may have been of the traumatic variety. However, now that he has the tear, experiences pain and may have weakness in the involved muscle, Roethlisberger’s joint mechanics may be altered sufficiently to contribute to further wear and tear.

Loss of mobility in the shoulder joint, whether from inflammation, scar tissue that forms in response to inflammation, immobilization, or disuse can make impingement more likely. If diminished, mobility must be restored to provide normal joint function, lessen the risk of injury and ensure the success of surgery (if it becomes necessary).

Adequate strength of the muscles that stabilize the scapula (the rhomboids, middle and lower trapezeii and serratus) facilitates good joint mechanics with overhead movement. This is also crucial to preventing or rehabilitating impingement and avoiding degenerative rotator cuff tears or the progression of existing small partial thickness tears.

Roethlisberger’s Tear is Partial; if it Tears More – Then What?

Most degenerative tears of rotator tendons are partial thickness – they don’t extend through the entire structure – as when you just begin to cut a piece of beef. Other tears are full thickness, as though the beef is cut from top to bottom but remains attached to the rest of the piece. In the case of a complete tear, or rupture, total detachment occurs, separating one end of the tendon from the other. These result in complete loss of use of the involved muscle/tendon unit – it cannot be rehabilitated or strengthened without surgical repair.

Repairs are also performed on partial and full thickness tears that are not complete tears. The choice to have surgery generally depends on the extent of a tear, the age of the individual, the demands of the individual’s activities as well as the mobility and overall health

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and function of the shoulder joint. Oftentimes surgery is for more than one condition rather than an isolated cuff repair. This is because issues such as impingement must also be addressed in order to have a favorable outcome.

Roethlisberger is a tough competitor – he rarely lets an injury get in his way. We’ll have to see how this one plays out. There is no doubt though that he is more vulnerable.

Follow Abby on Twitter @abcsims

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ACL’s and Achilles Ruptures Plague the NFL

It appears that torn ACLs (Anterior Cruciate Ligament) and Achilles Tendons are the injuries that will account for the most time lost in the NFL at this early juncture of the season.

The Ruptured Achilles Roster includes:

Terrell Suggs – Baltimore Ravens linebacker – who suffered the injury while playing basketball in the off-season.

Chris Gocong – Cleveland Browns’ linebacker – who was injured in pre-season.

Mario Fannin – Denver Broncos running back – hurt in a recent scrimmage.

Jason Peters – tackle for the Philadelphia Eagles – who was sidetracked in an early off-season workout.

And, on the rebound from an Achilles tear is cornerback Leon Hall of the Bengals, who had been cleared for training camp 8 months after his Achilles tear and is back on the team’s starting defense.

All these players underwent surgery to repair the Achilles tendon, a fibrous band that attaches the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone). These muscles act to point the foot downward (ankle plantar flexion) – enabling us to rise onto our toes. They are very important in the push-off phase of walking and running, providing power to help propel us forward. For more information on the Achilles, it’s predisposition to injury and on issues related to recovery, take a peek at a previous Injury Breakdown

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column on the Phillies’ Ryan Howard.

To date, the NFL’s 2012 All ACL team includes:

Travelle Wharton – star left guard for the Cincinnati Bengals – who suffered his injury on the third offensive play of last week’s first pre-season game.

Reggie Corner – Jacksonville Jaguars’ cornerback – who was hurt in a recent practice.

Adrian Peterson – running back with the Minnesota Vikings – who hit the jackpot tearing both his ACL and MCL last season, and has not yet rehabbed sufficiently to return to competition.

Dane Fletcher – New England Patriots’ linebacker – injured in an Aug 9 pre-season game.

Travis Beckum – Tight end with the NY Giants – who continues to progress in his recovery from ACl surgery after suffering the injury in last February’s Super Bowl.

Terrell Thomas – NY Giants’ cornerback – injured recently in training camp.

Rashard Mendenhall – Running back with the Pittsburgh Steelers – another player who is still recovering from last season’s ACL surgery. Mendenhall was injured in the final play of a week 17 game and reportedly will miss at least the first 6 games of the 2012 season.

Tim Hightower – Washington Redskins’ running back – reportedly continuing his rehab and out for the early part of the upcoming season after having his surgery last October.

Honorable Mentions:

Kyle McCarthy – defensive back on the Kansas City Chiefs – reportedly suffered an unspecified but serious knee injury in practice. When a knee injury is not detailed but considered serious and threatens the season, the ACL is always the first suspect.

John Carlson – tight end with Minnesota – who suffered an MCL sprain and for whom there is no definitive time-table for return.

The ACL is the primary stabilizer of the knee and the MCL (Medial Collateral Ligament) is the ligament that stabilizes the inner compartment of the knee. Ligaments attach adjacent bones and, though they allow for some accessory movement, their role is to stabilize joints by limiting their mobility. For a quick read on the anatomy of the ACL and MCL as well as factors related to their injury and rehab, take a look at a previous injury Breakdown on the topic.

There are a number of others, like the Redskins’ Kory Lichtensteiger, Dre Kirkpatrick of the Bengals, Trent Richardson of the Browns, the Dolphins’ David Garrod, and Louis Delmas of the Lions, who assuredly don’t consider themselves fortunate to be dealing with fresh knee injuries even before the first official play of the season. However, they will be back at some point soon. It is all relative…

Follow Abby on Twitter @abcsims

ACL’s and Achilles Ruptures Plague the NFL

It appears that torn ACLs (Anterior Cruciate Ligament) and Achilles Tendons are the injuries that will account for the most time lost in the NFL at this early juncture of the season.
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The Ruptured Achilles Roster includes:

Terrell Suggs – Baltimore Ravens linebacker – who suffered the injury while playing basketball in the off-season.

Chris Gocong – Cleveland Browns’ linebacker – who was injured in pre-season.

Mario Fannin – Denver Broncos running back – hurt in a recent scrimmage.

Jason Peters – tackle for the Philadelphia Eagles – who was sidetracked in an early off-season workout.

And, on the rebound from an Achilles tear is cornerback Leon Hall of the Bengals, who had been cleared for training camp 8 months after his Achilles tear and is back on the team’s starting defense.

All these players underwent surgery to repair the Achilles tendon, a fibrous band that attaches the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone). These muscles act to point the foot downward (ankle plantar flexion) – enabling us to rise onto our toes. They are very important in the push-off phase of walking and

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running, providing power to help propel us forward. For more information on the Achilles, it’s predisposition to injury and on issues related to recovery, take a peek at a previous Injury Breakdown column on the Phillies’ Ryan Howard.

To date, the NFL’s 2012 All ACL team includes:

Travelle Wharton – star left guard for the Cincinnati Bengals – who suffered his injury on the third offensive play of last week’s first pre-season game.

Reggie Corner – Jacksonville Jaguars’ cornerback – who was hurt in a recent practice.

Adrian Peterson – running back with the Minnesota Vikings – who hit the jackpot tearing both his ACL and MCL last season, and has not yet rehabbed sufficiently to return to competition.

Dane Fletcher – New England Patriots’ linebacker – injured in an Aug 9 pre-season game.

Travis Beckum – Tight end with the NY Giants – who continues to progress in his recovery from ACl surgery after suffering the injury in last February’s Super Bowl.

Terrell Thomas – NY Giants’ cornerback – injured recently in training camp.

Rashard Mendenhall – Running back with the Pittsburgh Steelers – another player who is still recovering from last season’s ACL surgery. Mendenhall was injured in the final play of a week 17 game and reportedly will miss at least the first 6 games of the 2012 season.

Tim Hightower – Washington Redskins’ running back – reportedly continuing his rehab and out for the early part of the upcoming season after having his surgery last October.

Honorable Mentions:

Kyle McCarthy – defensive back on the Kansas City Chiefs – reportedly suffered an unspecified but serious knee injury in practice. When a knee injury is not detailed but considered serious and threatens the season, the ACL is always the first suspect.

John Carlson – tight end with Minnesota – who suffered an MCL sprain and for whom there is no definitive time-table for return.

The ACL is the primary stabilizer of the knee and the MCL (Medial Collateral Ligament) is the ligament that stabilizes the inner compartment of the knee. Ligaments attach adjacent bones and, though they allow for some accessory movement, their role is to stabilize joints by limiting their mobility. For a quick read on the anatomy of the ACL and MCL as well as factors related to their injury and rehab, take a look at a previous injury Breakdown on the topic.

There are a number of others, like the Redskins’ Kory Lichtensteiger, Dre Kirkpatrick of the Bengals, Trent Richardson of the Browns, the Dolphins’ David Garrod, and Louis Delmas of the Lions, who assuredly don’t consider themselves fortunate to be dealing with fresh knee injuries even before the first official play of the season. However, they will be back at some point soon. It is all relative…

Follow Abby on Twitter @abcsims

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