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NFL Injuries to Monitor This Offseason

Dave Siebert, M.D.Featured ColumnistFebruary 7, 2013

NFL Injuries to Monitor This Offseason

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    The 2012-2013 NFL season has come and gone, and teams are now turning to coaching changes, scouting and the 2013 NFL Draft. The Baltimore Ravens are your Super Bowl champions, and this season's headlines included Adderall, Michael Vick versus Nick Foles and the startling impacts of three rookie starting quarterbacks.

    Oh, and there were also injuries—a lot of them.

    While some players have already recovered, others suffered injuries that may influence not only their offseason, but next season, as well.

    The following players' injuries have the potential to affect their squad's plans, ranked in order from least to most potential impact and intrigue using criteria such as injury severity, injury timing, the importance of the individual player or the controversy surrounding the injury in question.

Honorable Mention: Chicago Bears Middle Linebacker Brian Urlacher's Hamstring

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    The playoff hopes of the Chicago Bears took a major hit when middle linebacker Brian Urlacher went down with a grade-two hamstring strain in December. As many—including myself—feared, the injury cost him the rest of the season.

    A grade-two strain implies that one or more of Urlacher's hamstring muscles—the semitendinosus, semimembranosus and biceps femoris—were partially torn. Since the hamstrings are used to bend the knee, they are used for every single step an athlete takes.

    For that reason, it is extremely easy to re-injure a torn hamstring weeks or even months following the initial injury. Just ask Green Bay Packers wide receiver Jordy Nelson.

    Urlacher will likely fully recover during the offseason, but whether or not he will be missing a step next year—wherever he ends up—remains to be seen.

Honorable Mention: Baltimore Ravens Defensive Tackle Haloti Ngata's Knee

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    The third-quarter shift in momentum during the Super Bowl included an injury to Baltimore Ravens defensive tackle Haloti Ngata. According to ESPN.com, Ngata left the game with a knee injury and did not return. He will undergo an MRI of his knee on Thursday.

    As soon as a diagnosis is available, he will be moved up or off this list as necessary.

     

    Update: Thursday, Feb 7, at 11:18 p.m. ET

    According to Ryan Mink of the official Ravens website, an MRI on Thursday confirmed that Ngata's knee injury is not serious. He is not expected to miss any action—in training camp or otherwise. 

    ---End of update---

Honorable Mention: San Francisco 49ers Defensive End Justin Smith's Triceps

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    San Fransico 49ers defensive end Justin Smith partially tore his triceps tendon in December, an injury whose impact was immediately felt when Smith sat out the 49ers' Week 16 42-13 dismantling at the hands of the Seattle Seahawks.

    Smith returned for the playoffs, and with the help of a protective brace, he played through pain and weakness all the way through to the Super Bowl.

    Immediately following the big game, Smith underwent surgical repair of his triceps tendon. He should fully recover before next season, but as I wrote on Tuesday, triceps injuries can be very fragile.

    Keep tabs on his rehab progress, though he can be expected to be ready the next time the ball is snapped.

10. Baltimore Ravens Linebacker Jameel McClain's Spinal Cord

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    Ray Lewis' looming retirement makes the Baltimore Ravens getting a healthy Jameel McClain back at the linebacker position for next season that much more important. McClain sustained a spinal cord contusion in December after landing on his head during a nasty fall.

    A spinal cord contusion occurs when a ligament sprain or other injury around the cord causes the injured tissue to swell and press on the cord itself. Pressure on a spinal cord can cause symptoms ranging from mild numbness to full-blown paralysis.

    McClain must rest until the swelling fully resolves, as another blow to the head or neck could result in further swelling and more severe—or even permanent—symptoms.

    He should fully recover, but given the fact that any setbacks could be extremely serious, the Ravens will surely take their time with their linebacker.

9. Houston Texans Running Back Arian Foster's Heart

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    Although not an "injury" in the purest sense of the word, Houston Texans running back Arian Foster gained attention this season when he had to leave the Texans' Week 16 contest against the Minnesota Vikings with an irregular heartbeat. As this has happened before, Foster's heart appears to be predisposed to episodes—or "paroxysms"—of irregular rhythms.

    There are a number of ways to treat these types of paroxsymal irregular heartbeats. One of those is a surgical procedure to destroy—or "ablate"—the area of the heart responsible for causing the abnormal rhythm. While the procedure would likely only destroy an area in Foster's heart of insignificant size, he is not interested—for now.

    The operation could theoretically serve as a complete cure of his condition. Without it, Foster's heart remains prone to switching into an irregular rhythm, causing the shortness of breath, weakness and other symptoms that come along with it.

    Though it occurs very infrequently—as is characteristic for paroxysmal rhythms in otherwise healthy athletes—should his heart again switch into an irregular rhythm during a game, we could see a repeat of Week 16 all over again.

8. Dallas Cowboys Defensive End DeMarcus Ware's Shoulder, Elbow

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    A torn shoulder labrum and hyperextended elbow greatly slowed down Dallas Cowboys defensive end DeMarcus Ware toward the end of the season, but they did not stop him. After playing through his injuries for some time, Ware underwent surgical repair of his labral tear in January.

    The shoulder labrum is a cup of cartilage that extends outward from the shoulder blade in which the bone of the upper arm—the humerus—sits. By providing a cartilage encasement, the labrum gives the shoulder stability while also allowing for ample range-of-motion at the joint. However, if the labrum is torn by a blow to the upper arm or following a shoulder dislocation, that stability is lost.

    As in Ware's case, an unstable shoulder is not only weaker but also very prone to further dislocations and injury.

    Ware's labral tear is similar to that of the NBA's Dwight Howard. Yet unlike Howard, Ware had the luxury of undergoing offseason surgery in hopes of obtaining definitive, final treatment. He also will undergo a minor procedure on his injured elbow.

    Reports project Ware being out up until training camp. He will need time to adjust to a new defensive scheme in Dallas, so that timely return is very important.

7. Houston Texans Linebacker Brian Cushing's Knee

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    The Houston Texans defense took a big hit in October when linebacker Brian Cushing suffered a torn ACL during a Week 5 victory over the New York Jets.

    ACL tear treatment and rehabilitation usually requires nine months of sustained effort before the idea of returning to the field can be entertained. Since the injury took place four months ago, Cushing is already well on the road to recovery. That timetable puts Cushing being ready for action somewhere around July or August.

    That said, nothing can be assumed. ACL injuries require extensive rehabilitation, and setbacks can occur at any time. The knee is incredibly unstable with a torn ACL, and until a repaired ACL graft fully cements itself into place, an athlete is nowhere near him or herself.

    If Cushing can stay on pace with his knee range of motion and strengthening exercises, he has an excellent chance to be ready for Week 1.

6. New York Jets Darrelle Revis' Knee

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    New York Jets star cornerback Darelle Revis vacated his post on Revis Island back in September when he, too, sustained an early-season ACL tear.

    Like Brian Cushing, Revis is likely finished with a large portion of his recovery and rehabilitation, and the expectation that he will be ready for the start of next season is a reasonable one.

    However, will he be the same suffocating defender that has terrorized opposing No. 1 receivers and fantasy football owners alike for years? As B/R's Will Carroll wrote last month, that remains unclear.

    Nevertheless, Revis remains the subject of trade rumors and speculation, making the tracking of his recovery all the more interesting.

5. Buffalo Bills Tight End Scott Chandler's Knee

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    Less certain will be the availability of Buffalo Bills tight end Scott Chandler for the start of next season.

    Chandler also went down with a torn ACL this year. However, his injury occurred in late December. He also did not go under the knife until January. Therefore, a projected nine-month recovery period makes his status for the preseason unknown, and if any setbacks occur, he could very easily miss regular-season time, as well.

    That said, recent history—specifically this year's still-incredible recovery and then performance of Adrian Peterson—suggests Chandler has a chance to be ready.

    The Bills certainly hope he is, as they definitely need him to continue to improve on the occasional flashes of brilliance they showed this season.

4. Seattle Seahawks Defensive End Chris Clemons' Knee

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    The late-season trend toward ACL tears continued into the new year when Seattle Seahawks defensive end Chris Clemons fell victim to the turf monster during the Wild Card Round of the playoffs. He also tore his meniscus on the play.

    The meniscus is the cartilage cushion between the femur—the thigh bone—and the bones of the lower leg—the tibia and fibula. Similar to the MCL and LCL, the meniscus can tear when the knee is forcefully bent inward, toward the midline of the body, or outward, away from the midline of the body.

    ACL, MCL and medial (inner) meniscus injuries occur simultaneously very frequently, so frequently that the medical community sometimes refers to them as the "unhappy triad." All three structures can be damaged when the knee of a planted leg is forced inward.

    Clemons' injury occurred in early January. If a nine-month recovery timetable is assumed—a very big assumption—Clemons is in serious danger of missing multiple regular-season games next season.

3. Pittsburgh Steelers Tight End Heath Miller's Knee

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    Week 16 was not a good week for the Pittsburgh Steelers.

    First, they were eliminated from playoff contention by the Cincinnati Bengals. Shortly thereafter, physicians diagnosed tight end and team MVP Heath Miller with a torn ACL, torn MCL and possibly torn PCL following a brutal hit during the loss. Miller eventually needed surgery to reconstruct his ACL and MCL.

    As mentioned, the ACL and MCL are frequently torn together. An MCL tear results when a hit overwhelms the MCL's ability to prevent inward knee motion, and an ACL tear occurs when the hit twists the lower leg inwards in relation to the thigh.

    The addition of an MCL tear does not necessarily lengthen the recovery time. It does, however, complicate the rehabilitation process. Additionally, Miller sustained his injury very late in the season. Similar to Scott Chandler and Chris Clemons, he is not necessarily a sure bet to be active for kickoff in September.

2. Detroit Lions Running Back Jahvid Best's Concussion

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    Detroit Lions running back Jahvid Best's career is the story out of a nightmare.

    Concussions have plagued Best's career, and his 2010 concussion as a member of the Cal Bears remains one of the scariest sights one can see on the football field. When his head hit the ground on the play in question, he lost consciousness and assumed the "fencing response"—a phenomenon of reflexive arm extension and flexion seen when a concussion affects the brain stem.

    That marked only the beginning of his story.

    Fast forward to 2013. An inability to recover from his most recent, fourth concussion—suffered all the way back in 2011—threatens Best's career. He cannot find a physician who will clear him to return to the field.

    The hesitance to medically clear Best stems from the fact that repeat concussions can make future concussions more severe and also last longer. Additionally, each successive concussion may lower an athlete's "concussion threshold"—how easy it is for an individual player to suffer the brain injury.

    In a way, Best epitomizes the seemingly still-present disconnect between players, their coaches and a team's medical staff with regards to concussions. His career seems to already have its days numbered, and no doctor wants to be the one responsible for what could happen to him if he returns to football.

    Yet he still wants to play.

    Can you blame him? Of course not. He is an athlete, and he defines himself by his sport. If he feels he can play, he will want to.

    Unfortunately, the problem extends much deeper—far beyond will and determination. For now, it also lacks a solution.

1. Washington Redskins Quarterback Robert Griffin III's Knee

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    The collective gasp of the entire nation could practically be felt when a clearly hobbled Robert Griffin III collapsed for the final time during the Washington Redskins' Wild Card Round loss to the Seattle Seahawks.

    Should or shouldn't he have been playing? Was it the turf's fault?

    Those and other questions were asked again and again after RGIII received his final diagnosis—complete tears of the ACL and LCL in his right knee.

    At this point, the answers to the questions surrounding the injury are moot. All that matters now is how RGIII responds. Like the other athletes who underwent surgical reconstruction of knee ligaments this season, RGIII's recovery time will likely be somewhere in the neighborhood of nine months. The addition of a torn LCL will complicate his rehabilitation but will not likely extend his missed time.

    RGIII rose to stardom this season at an incredible rate. He became an immediate star in Washington and broke his team's long streak of ineptitude when he led the Redskins to a playoff berth this season. Perhaps more refreshing in today's modern era of performance-enhancing drugs and criminal arrests is his conduct off the field.

    After undergoing surgery in January, it is very possible that RGIII can return in time for next season, though it is certainly no guarantee.

    Yet one thing is certain—the NFL looks nowhere near the same with him on the sidelines.

     

     

     

    Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will graduate from medical school in June. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Injury information discussed in this slideshow is based on his own knowledge.

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