The injury that keeps on taking
Aggressive diagnoses have seen rise in incidents of high ankle sprains
Hip injury will end Frank Gore's season but likely won't end career
Adrian Peterson's pain tolerance may allow quick return from ankle injury
Do fantasy players have triskadekaphobia? The calendar has flipped to December, and with Week 13 coming up, we're heading into the dark, desperate hours where a team makes or breaks a season. Most leagues have their playoffs in Weeks 15 and 16, but there are some that start in 14. Either way, time is running out at the same time that the injuries are piling up.
One of the injuries that has been putting players on the sideline all year long is the "high ankle sprain." It's technically a sprained syndesmosis, but the term is so ubiquitous now that we're stuck with it. Players such as Andre Johnson, Dez Bryant, and anyone playing QB for the Cleveland Browns has had one of these injuries. I asked Dr. Philip Kwong, one of the leading foot and ankle specialists in sports medicine, about the issue. I asked him why we're seeing more of this injury. "It's been more aggressively diagnosed," he said, pointing to high profile injuries to Grant Hill and Chuck Long in the 90s as the start of the trend. "It's usually an external force, having the foot planted and then being dragged down or rotated," he explained. The trend in the NFL to pull, spin and punch at the ball rather than relying on form tackling could be contributing as well. Another factor is that more athletes are recovering and continuing their careers after ankle and knee problems, which could be leading to a cascade type injury with a less stable holistic structure.
Is there anything we can do to prevent these? Dr. Kwong isn't sure. "Bracing and taping is better than nothing, but there's no controlled studies," he told me. Until then, Dr. Kwong will have more patients like the unlucky Kendry Morales. Let's get to the injuries:
Any time you hear "broken hip" in sports, the immediate thought is Bo Jackson. Frank Gore isn't Bo Jackson in any sense of the word, but is his injury, like Jackson's, a career-ending or even career-threatening injury? It could be. What we don't know at this point is the location of the fracture. "Hip" is not a precise medical term and the fracture could be in one of three major areas -- the femur, the "cup" of the hip, or the pelvis itself. While the Niners have not clarified where the injury is, several reports and sources state that the injury is not career threatening. It's important to remember that it was not the hip fracture that ended Jackson's football career, but the avascular necrosis that resulted. Necrosis is the death of tissue, in this case the head of his femur, and required replacement. No one's talking about that for Gore. He is done for the season and paired with his long-standing knee problems, his durability remains the only hole in his game. The Niners will attempt to put together a committee to replace him, but Brian Westbrook is likely to be the direct replacement.
It's one thing to have the top-ranked RB in the game go down. This is a crusher. Peterson was No. 1 overall, almost by acclimation, in most drafts, in part because of his durability since becoming a Viking. While he hasn't been a breakout guy, even when he leaves the game early, he put up decent numbers. The problem was that the ankle sprain seemed to get worse as he waited, which isn't uncommon. The ankle can swell once it's allowed to rest, which is more of an issue in basketball than platoon-style football. It's very difficult to keep the swelling down when the opposing team has the ball, though you'll see attempts to keep the player active or to limit the swelling through a taping or bracing. Peterson described the pain on Sunday as "unbearable," but given the Vikings' indications that they thought he could return to that game, we have to assume it's a low-grade sprain. Sources are very mixed on this, with everything from a solid Grade II down to a "he should have been out there." Peterson's never had issues with pain tolerance, so the evidence leans to a I/II sprain. We'll have to watch practice reports to see how it's progressing, but there are no indications yet that he won't be available on Sunday. Don't be surprised if you hear GTD all week.
Steve Smith said on Wednesday that he was "talked into" practicing. I'd love to know who did that. Was it the coaching staff? Fellow players? Someone on the medical staff with knowledge of his rehab and healing state? (indications are that it was a player, but I couldn't confirm it.) The convincing got Smith back on the field, but he wasn't taking contact or even catching passes. The Week 14 target is still in place, so be more excited if you see some progress later this week that Smith is on track for that rather than getting caught up in any "will he or won't he drama" in Week 13. The stress on his pectoral muscle, both in reaching for the ball and in holding it, might be enough for a setback, so he's risky even if he plays. The Giants are encouraged about the progress from Hakeem Nicks after procedures to correct his compartment syndrome but he is not yet running. They're expecting that over the next week and there's some chance he could be ready for Week 14. He should have no deficit once he returns, so don't be too scared at slotting him in for a playoff game.
Vincent Jackson's return lasted a couple plays, but the rumors dragged on to mid-week. Many were wondering aloud whether or not Jackson's unhappiness with the Chargers would lead him to return in order to become a UFA, but not play. A calf strain would do that and who could say, but there are some extra facts here. The Chargers medical staff checked Jackson on Sunday night and an MRI confirmed the diagnosis of strain. The strain, said to be a Grade II, had a palpable defect. The injury quickly ruled him out of playing in Week 13, though no one yet is saying how long he'll be out. Normally, similar injuries will go two to four weeks, so seeing him back in Week 14 or 15 is realistic and may even be necessary if the team is going to have any confidence in him for their likely playoff run.
Ben Roethlisberger does one thing really well: heal. Sure, he has some other skills, but he truly mends quickly. His most recent injury, reported as a mid-foot sprain, didn't keep him off the field last week and hasn't kept him from practice. He's in a walking boot to protect the foot off the field and is wearing some sort of device inside his shoe to protect and stabilize the problem while on the field. The Steelers are most worried about someone stepping on the foot. Many of the facts point to a fracture more than a sprain, but the treatment isn't significantly different either way. Thinking about this like the foot/ankle issues that Brett Favre dealt with earlier this season is a good comp. Roethlisberger will play against the Ravens, but the Ravens defense is going to find ways to test that foot, including allowing him a lane to run at times.
I'm not sure what it is about Shaun Hill and fractures this year. He missed time with a fractured forearm that had to be plated. Now, he's fractured the index finger on his throwing hand, a much tougher injury for a QB. Word is that this could end his season, but it's largely going to be a function of what the Lions feel their need will be over the next few weeks. Matthew Stafford is making some progress, but the Lions don't seem to be willing to let Drew Stanton take the reins for an extended period of time. If Stafford could safely be back by Week 14 or 15, they might ride it out with Stanton, but they'll need some kind of addition. Hill is unlikely to be back before Stafford returns, which closes the window on him more than the injury itself forces him out. It's the type of roster situation that drives GMs to early retirement, but aside from Hill being out this week, there's not much clarity here and certainly none of these QBs -- even a returning Stafford -- will be good fantasy options.
The Dolphins like seeing Brandon Marshall back at practice. While they're still not sure about his availability for Sunday and will likely be tagged "questionable," getting him back on the field on Wednesday is key. It's also very important that he not have setbacks, so look out for any limitations at later practices. Marshall's not reliant on his speed, so he can play at less than 100 percent, but at that level there's an increased risk of recurrence. Marshall's presence would help Chad Henne, who seemed to lack a short target he could trust, leaving him checking to runs on blitz reads. We've seen in recent weeks how gameplanning and role-sharing can help protect a player who is coming back from injury. It's a bit tougher with something like this, since there's always the chance a six-yard slant could become a 60-yard footrace to the end zone, something where any instructions to go easy will go away. Odds are, though, that Marshall's looks will be short, they could be worth some solid fantasy points. numberFire already has him at six points this week and I have a feeling playing time estimates will go up as Marshall practices more this week.
The Colts' injury list is getting shorter, but it's still the defining point of this team. No one questions the talent on the team, but their inability to put the talent on the field has the franchise worrying about being in the playoffs for the first time in a decade. The injury stacks and key injuries were up this year over past years, though a look at numbers collected by Bill Barnwell show that perceptions about the Colts as a healthy team are illusory. It's No. 18 that's healthy, while everyone around him has been more or less replaceable. The 2010 season has shown that's only true up to a point. The Colts will be without Joseph Addai again this week. The brachial plexus injury is still causing problems for him in his hand. While he has more strength and range of motion in his shoulder, he still has some weakness in the middle, ring and pinky fingers, so holding the ball would be a real issue. Until that gets back to normal, the Colts will go with Donald Brown. Austin Collie is back at practice, as he was at the end of last week, but the Colts aren't making any indication as to whether Collie might play this week. We have to assume he's been cleared at this stage, but after his immediate setback last time, the Colts are going to have to be even more conservative with a return than they were previously. At best, he's a GTD this week.
Tony Romo is throwing again, lightly, but there are no signs yet about a return date ... Colt McCoy is going to be a GTD for the Browns on Sunday, but if he can go, he will go ... Bruce Gradkowski severely sprained his shoulder and will be out indefinitely ... The Saints had some positive statements on Pierre Thomas on Wednesday. He'll be a GTD this week, which is a major improvement ... Jahvid Best is back at practice, but there's still no clarity on how many touches he'll get, due both to the toes and to seasonal fatigue ... Ryan Mathews is back at practice, so if he can do that a couple more times without a setback, he should mix into the RB situation for the Chargers this week ... Marion Barber is out at least two weeks with his calf strain. Tashard Choice should see more touches ... Indications are that Ryan Torain will be out this week with his chronic hamstring strain ... The Bills expect to have C.J. Spiller back this week, after he missed two games with a hamstring strain. He'll be used as a change-of-pace back, getting 20-30 percent of the touches at best ... Kenny Britt is back at practice, but a start this week is still a longshot. His return would likely mean the end of the Randy Moss experiment ... Greg Jennings got the day off on Wednesday, but was back Thursday. He'll play and should have no issues with the foot ... All signs point to Mike Williams missing his second straight game for the Seahawks. The bigger worry is that he doesn't appear to have made any progress ... The long week has given Jerricho Cotchery plenty of time to heal up from his groin strain. He'll play his normal role on Monday... Dexter McCluster was completely off the OIR this week, an indication that the Chiefs think he's a lock to play this week. It's unclear what his role will be, even if healthy ... Antonio Gates fought through things for the big game against the Colts, but reports that he "felt better than expected" on Monday are relative. If he doesn't practice by Friday, he won't play against the Raiders and even so, might be held out ... Gary Kubiak says it's 50-50 that Owen Daniels plays. Sources tell me it's a bit less than that, but that Daniels is pushing to get on the field even in a limited role ... Jeremy Shockey's return doesn't mean he's a good start this week. Jimmy Graham has earned a split for at least another week while Shockey gets the rust off ... Michael Oher looked like he could be facing a brutal knee injury, but came out of an MRI with nothing more than a low grade sprain. He's expected to play this week. We can only hope that he'll consider wearing a brace to prevent a future issue ... Bob Sanders could be back at practice soon, but he won't be back for the Dallas game as previously suggested. I'm still not convinced he'll be ready at any point.