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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

Concussions – Part 3: Football and CTE

We’ve all heard much about the dangers of football and the alarming incidence of concussions in the sport. Also about the NFL’s initial resistance to acknowledging the probable relationship of concussions to Chronic Traumatic Encephalopathy (CTE), which currently can only be diagnosed on autopsy.

CTE – as defined by the Boston University CTE Center16 – is “a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head… This trauma triggers progressive degeneration of the brain tissue, including the build-up of an abnormal protein called tau.  These changes in the brain can begin months, years, or even decades after the last brain trauma or end of active athletic involvement.  The brain degeneration is associated with memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia.”

The concern many have is not only for the health and safety of the athletes. Others who have suffered mild traumatic brain injury want to know if they are susceptible to CTE as well. No one really has that answer yet. However, lets look carefully at the information that is out there and how it can be interpreted.

First, scary as it may be, recognize that the high incidence of CTE reported in studies reflects several biases. The most significant of these is self-selection. The brains that have been examined on autopsy are primarily those of athletes who have donated their brains for research due to symptoms they’ve experienced, or those whose family has suspected the diagnosis. This clearly inflates the percentages of athletes diagnosed with the condition.

One such study done by Boston University and the US Department of Veteran’s Affairs17 established that 87 of 91 football players had signs of CTE on autopsy, while Boston University also found the condition in 79% (131 of 165) of football players across all levels.17

These frightening results are mildly contrasted by another study18 that looked at 60+ former NFL players – all aged 60-69 – to try to identify symptoms of CTE in living people. Their age range indicates that these were players who played before heightened concussion awareness and before protocols were initiated by the NFL. The results showed that 60% had completely normal age-appropriate cognitive decline. Of the remaining 40%, 6% met the criteria for dementia. It would be interesting – and possibly revealing – to be able to correlate the findings on these men with how their brains subsequently present on autopsy.

Though this group also played before helmets were improved, the sturdier helmets may even have encouraged harder hitting. The NFL’s response has included recent rule changes to modulate direct hits to the head, though the game will likely see an even greater proportion of debilitating but less threatening lower body injuries as a result. The players of today are also typically stronger, bigger and faster than those in the era of those tested in this study. This too likely influences the frequency and outcomes of traumas that they experience.

Though the brain has the ability to recover from one injury, long-term effects are more likely after multiple incidents.

However, keep in mind that football players sustain blows to the head (direct and/or indirect) on almost every play. This cumulative subconcussive microtrauma may be as much or more of a factor in causing CTE than one or few isolated incidents of concussive trauma. Not at all good for football or soccer players, but an encouraging note for others who fear the long term effects of having sustained a concussion, or even several of them.

Vulnerability differs amongst athletes on the field. Dr. Steven Erickson noted that offensive linemen face forces “that are generally linear and the players know they are coming. Consequently, the head doesn’t move very much, so the brain doesn’t move very much. This may still represent brain trauma, but less often to the degree of causing concussion.”

He contrasted this with receivers. Though the “magnitude of the forces they sustain may be lower, the rotational component to the trauma, the player not being able to anticipate the nature of the hit and the degree of subsequent brain motion all make it more likely they will sustain a clinical concussion.”

A study by the Mayo Clinic, published in December 2015, found that one in three amateur athletes who participated in contact sports while in school developed CTE. 19 That statistic will likely cause even more scrutiny of the games and cause some to weigh the risk-reward of participation differently than before. Again though, this study also reflected issues of self-selection.

I asked Dr. Erickson about the cheating (underperforming) on baseline screening that we have read about occurring in the NFL, and whether this effort by some players to lessen the likelihood that a subsequent concussion will be diagnosed can be detected.

His response was that “though it may be possible, there are internal checks with ImPACT™ whereby validity scores can generally identify when an individual is cheating.”

Dr. Erickson commented that “this is another advantage of the vestibular test (see Part 2 of this series) advocated at the Banner Concussion Center, because a non-physiologic response is detected with intentional underperformance or anxiety responses to testing, We benefit from the fact that athletes don’t know how to cheat to underperform on the test.”

He added that “of course, best medicine is for an athlete to put in best effort at baseline as well as post injury. The motivation factor is very real. Sometimes those not particularly motivated in baseline testing are very motivated to achieve in order to return to play,”

Hopefully more athletes and their coaches are acknowledging that playing through will not serve them well either in the short or long term.

The Takeaway

So, does the Banner Concussion team advocate keeping kids from playing sports? Most definitely not… Each member acknowledges the many benefits of sport, such as exercise, physical development and emotional growth. Developing mental toughness and learning life lessons such as teamwork and how to deal with adversity while enjoying a healthy social outlet that is fun, challenging and productive trumps fear.

They stress that concussion can happen almost any time – even to those who don’t play sports – and that sports can be made safe. The key to addressing concussion is education and diligence. It is important to be able to identify concussion if/when it happens and seek appropriate assessment and care. By managing the symptoms, recovery is accelerated and the likelihood of recurrence minimized. The value of baseline testing cannot be stressed enough nor can the importance of not allowing an athlete of any age to return to play after sustaining a head trauma resulting in symptoms without undergoing an evaluation.

Though most who suffer a concussion recover fully and within a four-week period, the caution is to understand that symptoms left untreated – can result in long lasting consequences.

As for those who sustain multiple head traumas and, quite possibly – or especially – those who have also suffered repeated microtrauma, the long term effects are coming into better focus with the further study of CTE.

References for Parts 1-3 of the Concussion Series:

  1. http://www.cdc.gov/concussion/headsup/pdf/Facts_for_Physicians_booklet-a.pdf
  2. Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control. Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem. Atlanta (GA): Centers for Disease Control and Prevention; 2003.
  3. Lescohier I, DiScala C. Blunt trauma in children: causes and outcomes of head versus intracranial injury. Pediatrics 1993;91(4):721-5.
  4. Langlois JA, Rutland-Brown W, Wald M. The epidemiology and impact of traumatic brain injury: a brief overview. Journal of Head Trauma Rehabilitation 2006;21(5):375-8
  5. Finkelstein E, Corso P, Miller T and associates. The Incidence and Economic Burden of Injuries in the United States. New York (NY): Oxford University Press; 2006.
  6. Fung M, Willer B, Moreland D, Leddy J. A proposal for an evidence-based emergency department discharge form for mild traumatic brain injury. Brain Injury 2006;20(9):889-94.
  7. Alexander, Andrew L., Lee, Jee Eun, Lazar, Mariana, Field, Aaron, S.

Diffusion Tensor Imaging of the Brain. Neurotherapeutics. 2007 Jul; 4(3): 316–329.doi:  10.1016/j.nurt.2007.05.011

  1. Field M, Collins M, Lovell M, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. The Journal of Pediatrics 2003;142(5):546-53.
  2. Bryan Kolb, PhDand Robbin Gibb, PhD: Brain Plasticity and Behaviour in the Developing Brain . J Can Acad Child Adolesc Psychiatry. 2011 Nov; 20(4): 265–276.
  1. Guskiewicz K, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003;290(19):2549-55.
  2. Pellman EJ, Lovell MR, Viano DC, Casson IR. Concussion in professional football: recovery of NFL and high school athletes assessed by computerized neuropsychological testing–Part 12. Neurosurgery 2006;58(2):263-74;discussion 263-74
  1. Kashluba S, Casey JE, Paniak C. Evaluating the utility of ICD-10 diagnostic criteria for postconcussion syndrome following mild traumatic brain injury. Journal of the International Neuropsychological Society 2006;12(1):111-8.
  2. Dean PJ, O’Neill D, Sterr A. Post-concussion syndrome: prevalence after mild traumatic brain injury in comparison with a sample without head injury. Brain Inj. 2012;26(1):14-26. doi: 10.3109/02699052.2011.635354.Epub 2011 Nov 22
  1. McManus, C. Stress-Induced Hyperalgesia: Clinical Implications for the Physical Therapist Orthopedic Physical Therapy Practice. 2012;24(3):165-168. (http://carolynmcmanus.com/publications/mcmanus-stress-induced-hyperalgesia.pdf)
  2. UPMC Sports Medicine Website
  3. Boston University CTE Center: http://www.bu.edu/cte/about/what-is-cte/
  4. http://www.pbs.org/wgbh/frontline/article/new-87-deceased-nfl-players-test-positive-for-brain-disease/
  5. Hart, J.J., JAMA Neurology 2013
  6. Mayo Clinic Press Release: Mayo Clinic: Evidence suggests contact sports played by amateurs increase risk of degenerative disorder http://newsletter.carehubs.com/t/ViewEmail/j/2B6E3073A3AD413C/59F3204D88C0AFA89A8E73400EDACAB4
  1. Aubry M, et al. Summary and agreement statement of the first International Conference on Concussion in Sport, Vienna 2001. Clinical Journal of Sports Medicine 2002 Jan;12(1):6-11

 

 

 

 

A Triangle Of Triceps Tears

One of the significant NFL injuries this month is a torn triceps. Eugene Amano of the Tennessee Titans had the unfortunate distinction of giving Levi Brown and Jason Hunter a preview by tearing his right triceps in practice on August 2nd when he was hit by a helmet while blocking on a pass attempt. Brown, a starting center for the last two seasons, had been fighting to hold off competition for his starting job. Amano had surgery and, though estimates vary, is likely out for the season.

Next in line for a triceps tear this preseason wasDenver Broncos’ Jason Hunter. Hunter, who had only recently joined the first team at defensive end, suffered his injury during a training camp drill on the 14th, and had surgery the following day. He was quoted as saying that “it was like 95% torn… They told me mine was hanging on like a piece of rope.” This significant loss for Denver’s defensive line follows two previous seasons in which they lost key linemen to torn muscles in the preseason – In 2010 Elvis Dumervil tore his pectoral, while in 2011 Ty Warren also suffered the now popular torn triceps. Like his colleague from Tennessee, Hunter is likely to miss the season in spite of some reports otherwise.

Levi Brown, starting left tackle for the Arizona Cardinals, tore his triceps in an August 17th preseason game versus the Raiders. Initially expected to be out for 3 months, Brown will, like his colleagues, require surgery and will likely warm the bench throughout the season.

The Triceps

The triceps, as its name implies, is a three-headed muscle whose primary role is to exert a force to extend (straighten) the elbow. We rely on our triceps to push open a revolving door, to perform push-ups and to use crutches. A secondary role of the long head of the triceps is to assist with movement of the arm toward the body/midline (adduction) and assist with shoulder extension (movement of the arm toward or into the plane behind the body).

Located in the back of the upper arm, the longest head of the triceps originates on the scapula (shoulder blade) at a point below just below the socket for the humerus bone. The lateral and medial heads of the triceps originate at points on the surface of the humerus itself. The medial head has an intimate relationship with the radial nerve, which innervates the entire muscle.

At its lower attachment, the triceps inserts at the uppermost rear surface of the ulnabone of the lower arm; the ulna and the humerus form the elbow joint. The triceps also inserts into the deep fascia of the forearm.

Recovery

Surgery to repair the triceps is likely to shorten the muscle-tendon unit. In addition, the immobilization required in the early stages of recovery contributes to this problem while also resulting in loss of motion at the elbow joint, particularly restricting the amount of flexion (bending). Bending the elbow puts the triceps muscle on stretch. Disuse in the early phase of recovery leads to muscle atrophy and weakness, not only of the triceps, but also of the other muscles of the shoulder girdle and upper extremity. Rehab addresses all these issues as well as focusing on controlling inflammation and swelling (particularly early on) and working to enhance soft tissue mobility. Once strength, mobility and flexibility are sufficiently restored, an athlete will get into sports specific training before returning to competition.

Wishing a full and straightforward recovery to Amano, Hunter and Brown…

Follow Abby on Twitter @abcsims

A Triangle Of Triceps Tears

One of the significant NFL injuries this month is a torn triceps. Eugene Amano of the Tennessee Titans had the unfortunate distinction of giving Levi Brown and Jason Hunter a preview by tearing his right triceps in practice on August 2nd when he was hit by a helmet while blocking on a pass attempt. Brown, a starting center for the last two seasons, had been fighting to hold off competition for his starting job. Amano had surgery and, though estimates vary, is likely out for the season.

Next in line for a triceps tear this preseason wasDenver Broncos’ Jason Hunter. Hunter, who had only recently joined the first team at defensive end, suffered his injury during a training camp drill on the 14th, and had surgery the following day. He was quoted as saying that “it was like 95% torn… They told me mine was hanging on like a piece of rope.” This significant loss for Denver’s defensive line follows two previous seasons in which they lost key linemen to torn muscles in the preseason – In 2010 Elvis Dumervil tore his pectoral, while in 2011 Ty Warren also suffered the now popular torn triceps. Like his colleague from Tennessee, Hunter is likely to miss the season in spite of some reports otherwise.

Levi Brown, starting left tackle for the Arizona Cardinals, tore his triceps in an August 17th preseason game versus the Raiders. Initially expected to be out for 3 months, Brown will, like his colleagues, require surgery and will likely warm the bench throughout the season.

The Triceps

The triceps, as its name implies, is a three-headed muscle whose primary role is to exert a force to extend (straighten) the elbow. We rely on our triceps to push open a revolving door, to perform push-ups and to use crutches. A secondary role of the long head of the triceps is to assist with movement of the arm toward the body/midline (adduction) and assist with shoulder extension (movement of the arm toward or into the plane behind the body).

Located in the back of the upper arm, the longest head of the triceps originates on the scapula (shoulder blade) at a point below just below the socket for the humerus bone. The lateral and medial heads of the triceps originate at points on the surface of the humerus itself. The medial head has an intimate relationship with the radial nerve, which innervates the entire muscle.

At its lower attachment, the triceps inserts at the uppermost rear surface of the ulnabone of the lower arm; the ulna and the humerus form the elbow joint. The triceps also inserts into the deep fascia of the forearm.

Recovery

Surgery to repair the triceps is likely to shorten the muscle-tendon unit. In addition, the immobilization required in the early stages of recovery contributes to this problem while also resulting in loss of motion at the elbow joint, particularly restricting the amount of flexion (bending). Bending the elbow puts the triceps muscle on stretch. Disuse in the early phase of recovery leads to muscle atrophy and weakness, not only of the triceps, but also of the other muscles of the shoulder girdle and upper extremity. Rehab addresses all these issues as well as focusing on controlling inflammation and swelling (particularly early on) and working to enhance soft tissue mobility. Once strength, mobility and flexibility are sufficiently restored, an athlete will get into sports specific training before returning to competition.

Wishing a full and straightforward recovery to Amano, Hunter and Brown…

Follow Abby on Twitter @abcsims

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Patellar Tendon Ruptures in the NFL

ets’ safety, Jim Leonhard, is the newest member of the NFL’s ruptured patellar tendon club, after suffering the injury in last Sunday’s victory over Kansas City. As expected, surgery will end Leonhard’s season, the second consecutive year that injury has shut him down early. Last year he fractured his right tibia (leg), the same side injured this week.

Arizona Cardinals’ rookie, and second round draft pick, Ryan Williams, has been sitting out the entire 2011 season with a right patellar tendon rupture that he sustained during a pre-season game. Only 20 years old at the time of his injury, Williams is missed on a Cardinals team that has been rebounding from a rough start and might be playoff bound if he’d been out there.

Last year’s victims of a torn right patellar tendon included Nate Allen, a rookie safety on the Eagles who was injured in December of 2010, and Clint Sintim, NY Giants linebacker, who was sidelined during a pre-season game.

Interesting that all the injuries were on the right side…

The patellar

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tendon is a part of the extensor mechanism of the knee and it serves to connect the patella (kneecap) to the tibia (larger bone of the lower leg). The extensor mechanism acts to straighten (extend) the knee, and is also comprised of the four quadriceps muscles of the front of the thigh, the quadriceps tendon (which attaches the quads to the patella), the ligaments that help to stabilize the patella (by providing a connection to the femur (thigh bone) above and to the tibia below), and also by other soft tissues on either side that help stabilize the patella and other structures of the knee.

Patellar tendon ruptures are relatively rare and they occur most often in people younger than 40 (most are in their teens or twenties). Ruptures can either be partial or complete. Complete ruptures should be surgically repaired quickly in order to enable the tendon to be sutured end-to-end. This also optimizes outcome. Waiting would result in retraction of the tissue and make a repair more difficult. The upper (proximal) portion of the patellar tendon ruptures more often than the lower. Some of these proximal ruptures pull a piece of bone away from the lower part of the patella; this type of injury is called an avulsion of the patella. It has been noted that African Americans have a greater predominance of patellar avulsions than other groups.

A complete rupture of the patellar tendon renders the quadriceps helpless, making it impossible to straighten the knee. A partial rupture makes extension difficult and is likely to make it impossible to straighten the knee through the end-range of motion.

Post-operative rehab is (as coaches say about almost everything), a process. Controlling pain and swelling in the initial phase, while also addressing mobility of the scar and surrounding soft tissue is crucial. Care must be taken to protect the repair and avoid stretching the sutured tendon too quickly, while ultimately restoring full range of motion – thereby enabling the knee to bend. Weight bearing is gradually resumed and assistive devices (crutches and canes) are eliminated once the extensor mechanism is strengthened sufficiently to fully support ambulation without significant gait abnormalities. Muscle strengthening, flexibility and endurance, as well as overall mobility and agility are all a part of rehabilitation.

A study on the recovery of NFL players who suffered patellar tendon ruptures concluded that the injury occurs most often with eccentric overload* of the extensor mechanism. It also noted that anterior cruciate ligament (ACL) tears occasionally accompany patellar tendon ruptures in the NFL, and that players without complications from other injuries generally return to play the following season. The study also found that players who’d been chosen earlier in the draft were more successful in returning to play.

• An eccentric muscle contraction is one when the muscle is actually lengthening while it is working. An example would be the second phase of a biceps curl when the elbow is straightening, thereby lengthening the biceps while the muscle works against gravity (and added weight) to slowly return the arm to its resting position.

Follow Abby on Twitter @abcsims

Quarterback Questions – The Walking Wounded

Fantasy teams are as difficult to manage as the real ones this NFL season. Of the 32 teams, 12 of them have injured quarterbacks, three of whom are likely out for the season. The only odds that seem pretty good are that each week at least two quarterbacks will stagger or fall.

Peyton Manning (Colts) should probably consider shutting it down permanently after his third neck surgery, and Matt Cassel (Chiefs) just had surgery to address a “serious injury” to his throwing hand, suffered last week Though many reports have team management hoping Cassel will make a miraculous recovery and return this season, it isn’t likely. The specific nature of his injury remains a mystery to me,

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as reports are vague.

With a bye in week 11, the Texans are simply listing Matt Schaub as out for week 12. Schaub was diagnosed with a Lisfranc Injury and, though surgery seems probable, even if it is avoided, Schaub clearly won’t be back this year.

Other starting QBs not practicing this week include: Michael Vick (Eagles), resting the cracked ribs he played with for most of last Sunday’s contest, and Jason Campbell (Raiders), out since leaving the game on 10/16 with a fractured clavicle (collarbone).

Those who participated in limited practice and are listed as questionable for this weekend include: Tarvaris Jackson (Seahawks) who’s been out since exiting a

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game on 10/9 with a torn pectoral muscle, and Kevin Kolb (Cardinals), who hasn’t played since sustaining a turf toe injury on October 30th.

Able to rest his newly fractured thumb with a bye this week, Ben Roethlisberger (Steelers), is probable for week 12 after taking part in practice. Also likely suffering, though taking part in full practices and listed as probable for week 11, is Sam Bradford (Rams), out since suffering a high ankle sprain on 10/16.

Mathew Stafford (Lions) played last week with a fractured index finger in his throwing hand, an injury sustained in the game the week prior. The injury clearly limited Stafford’s effectiveness, yet he too is probable for week 11.

Rookie Christian Ponder (Vikings), took a beating in a big Monday night loss this week and, despite the need for x-rays of his left hand, is also reportedly likely to start.

Finally, Josh Freeman (Bucs), who like Stafford, played with an injury (thumb) is again likely to play in week 11. Both Ponders and Freeman threw a lot of interceptions last week, so for all the macho of the league, playing hurt doesn’t seem to be paying big dividends – for the injured players, the teams or for fantasy enthusiasts.

Many QBs on the current injury report made earlier appearances on the list this season with other ailments, as did some of their back-ups. It is likely that these injuries remain somewhat of an issue, though to a lesser extent (Stafford’s ankle, Schaub’s hip, Romo’s rib, Vicks other fractured ribs, Bradford’s finger amongst them).

Exposed in the quarterback shuffle and in the push for starters to play through significant injury is the thinness of the rank at the QB position. How effective will the walking wounded be on Sunday?

Follow Abby on Twitter @abcsims

NFL ACL Recount

Re-reviewing the updated NfL injury reports, 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. 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. Other October ACL injuries include those to Indianapolis Colts rookie Tight-end Ben Ijalana, who was hurt in week 4, and Green Bay Packers RB , Alex Green, who succumbed to his ACL in week 7.

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. Sims-Walker is slated to undergo a new knee surgery, the details of which have not been reported. He 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!

Follow Abby on Twitter @abcsims

Season-Ending ACL Injuries in the NFL

There have been so many season-ending injuries in the NFL this season,and complete ACL tears seem to lead this category. By my count, there are already 10 players who are looking on from the sidelines after having ACL surgery.

When watching replays on TV or at the stadium, I’m actually amazed there aren’t even more ACL tears. Feet are planted while the

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body rotates, a tackle forces a knee to hyperextend, pushing it beyond the straight or locked out position, or most commonly, a players legs are grabbed in a tackle while his body keeps moving (generally with the knee bent), forcing his knee to move in a manner that is simply not possible with the ligaments intact. It is so easy to wind up injured.

NFLers currently nursing post-operative ACL’s include:
Running Backs Ernest Graham (Tampa Bay), Tim Hightower (Redskins) and Jamaal Charles (Chiefs)
Wide Receivers Kenny Brit (Titans) and Domenik Hixon (Giants)
Tight End Tony Moeaki (Chiefs)
Safety Eric Berry (Chiefs)
Cornerback Bradley Fletcher
Linebacker Thomas Davis (Panthers)
And even kicker, Nate Kaeding (Chargers)

Hixon is on his second ACL surgery in just two seasons, Fletcher tore his in a practice collision and Moeaki was injured in the final game of the rushed pre-season. Taking the trophy in this unwanted competition, Davis is on ACL surgery number three in less than two years. I hope he’s been saving his money and has a plan B.

The Anterior Cruciate Ligament is the primary stabilizer of the knee. It is located between (and attaches) the rear outer base of the femur (thigh bone) and the top of the front inner tibia (the larger of the two bones in the lower leg). It is called the anterior (front) cruciate because it crosses another ligament (the posterior cruciate) that is located behind it, with the two ligaments essentially forming an “X”.

The ACL is comprised of two distinct bundles which serve complementary functions. The posterolateral (outer/rear) bundle restricts or checks the motions of hyperextension and excessive forward gliding of the upper tibia with the knee straight. It also limits internal rotation in the knee. When the knee is forced into hyperextension or inward rotation, this larger band risks injury.

The smaller anteromedial (front/innermost) band is taut in flexion (when the knee is bent) and is therefore most likely to be injured with force to the knee in a bent position.

The anatomy of the ACL explains why it can sometimes suffer only a partial tear, and why in these cases, it may be possible for an athlete to avoid surgery.

Follow Abby on Twitter @abcsims

Injuries Force Transition in the NFL

FL quarterbacks are padding the injury reports, and their injuries are not only impacting game outcomes but resulting in unanticipated trades. Some injuries, like the clavicle (collarbone) fracture suffered by Raiders QB, Jason Campbell, are obvious game changers. With the team possibly playoff bound, and with a field leader definitively unable to go, it was abandon hope or find a replacement to preserve the possibilities. Hence the arrival of Carson Palmer.

Other QBs, playing injured because that’s what football players do, are struggling to play to their healthy potentials and squeaking by or taking the losses as a result. Tony Romo is a case in point. With a winable game on the line, even his coach, Jason Garrett, lacked confidence in Romo’s ability to throw for distance in the final series. Game, set, match.

Poor Sam Bradford, of the St. Louis Rams, has had one setback after another. In September he played with a finger injury, and now he is likely out with a high ankle sprain. This after a college career that saw the 2008 Heisman winner through at least two shoulder injuries that resulted in surgery during his senior season. Though in a walking boot this week, Bradford is still not officially counted out for this Sunday. So what that it’s his left ankle and he throws off his right? He’d still have to be able to move out there, yes? A high ankle sprain is a big deal, especially if severe. Bradford can’t possibly be effective if he plays hurt, particularly while still in the acute post-injury period. (For more on the

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nature of high ankle sprains read an earlier post on Maurice Pouncey).

Matt Schaub of the Texans is another QB with a new injury. His sore hip isn’t expected to keep him on the sidelines, but may impair his mobility and make him vulnerable.

Michael Vick finally pulled one out for the Eagles on Sunday, in spite of an early scare (again?), when it seemed like he’d suffered another concussion. This year’s self proclaimed “dream team” is a major disappointment, but Vick has been a warrior and is like one of those inflatable punching bag dolls who just keeps taking hits and bouncing back for more.

I think the quarterbacks featured in the NFL injury report would vote unanimously to

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beef up their offensive lines. These guys are taking a beating.

The most dramatic quarterback injury story this season is that of Peyton Manning. After three neck surgeries, and despite his insistence otherwise, it seems likely that Manning’s Hall of Fame career is over. The Colts’ recovery has been as tortuous as Manning’s. Here is another team with a huge disparity between it’s starting QB and his back-ups. Injuries are certainly altering the destiny of many teams this season. The impact has been felt at many positions, though quarterbacks may get the most attention.

Though not losing their starting spots because of injury, still other starting quarterbacks are looking at sitting down the rest of the way. Whether you call it age or fading ability, Donovan McNabb and Kyle Orton have been replaced by their next in line. It appears their careers are soon to be history. For McNabb, it’s been a spiral downward that has deflated a legacy that might have led to the Hall of Fame. Though they say he hasn’t been the same since leaving Philly, to me, McNabb failed to live up to expectations while an Eagle. He somehow always came close but fell short.

As my husband, sportscaster Dave Sims, always says about the expected and unexpected things that happen in baseball, “That’s baseball”. You can sum up this quarterback situation by saying, “That’s the NFL”.

 

Follow Abby on Twitter @abcsims

To Play Or Not To Play

ichael Vick has said he’ll be on the field for Sunday’s contest at home against the 49ers, despite having suffered a significant contusion to his right (non-throwing) hand in last week’s loss to the Giants. Reports say his hand remains swollen, sore to the touch and in a protective cast. That means its function is also impaired because of pain with use. Though he backed down from his initial take on typically not getting calls from the officials, Vick smartly has not, at least publicly, ever indicted his offensive line. However, with that line being what it is, and with Vick a moving target who is more difficult to protect, should he play? Remember, as it was, in the Eagles-Giants game, Vick was playing only one week after leaving the field in the third quarter of his homecoming versus Atlanta having been dealt a mild concussion. Michael Vick is certainly a warrior. He is one of those guys who wants to be out there, but at what cost?

Dallas’ Tony Romo is another one of those guys.– a selfless leader. He completed the game in week two against the 49ers, returning in the third quarter having knowingly suffered a rib fracture in the first half. Romo painfully, but heroically, went on to make a 77 yard pass to set up a win in OT. It was only later that he was also diagnosed with a small lung puncture along

with the isolated rib fracture.

Romo also played last Monday night in a boring squeaker against the Redskins. His performance was clearly hampered by his injury and the offense sputtered. It would be surprising if Romo did not taken pain meds or have an injection to combat the pain associated with his issues. His breathing was likely still painful and throwing, especially for distance, had to have heightened his symptoms. Should he have played?

Jay Cutler went to fan and media purgatory after taking himself out of the NFC title game with a knee injury last January. Cutler even came under fire from some fellow players. Turned out, to everyone but Cutler’s surprise, the injury was real and it was significant. He’d suffered a Grade 2 MCL (medial collateral ligament) sprain/tear. Though he’d been known more as the warrior type prior to this incident, that didn’t shield Cutler from the abuse. I wrote about it then, but Vick and Romo bring the dilemma of the injured player back to the headlines.

I’m not of the mind that players should simply tough it out when doing so is likely to contribute to an exacerbation of their injuries. Not allowing for a proper healing response delays recovery, often causing an injury to become an even bigger issue both on and off the field. Such situations can also result in chronic conditions. Not only can this potentially impact performance, it can, and often does, impact life. Just look at the struggles of many NFL veterans.

Football being football, there is the unwritten rule to target an opposing team’s weaknesses. We all know that doesn’t just mean a hole in the defense or a size mismatch on coverage. Football puts a target on each players back under the best of circumstances. The already vulnerable become even more so.

The Cowboys were fortunate to come away from the Redskins game with a win. They didn’t win because of Tony Romo, and, if you ask me, Tony Romo didn’t win at all. He lost a week to help him recover.

Your thoughts?

Follow Abby on Twitter @abcsims