We all saw what happened to Ben Roethlisberger on Saturday, the sack from Bengals linebacker Vontaze Burfict that injured his throwing shoulder.
But what's happened since? What's Roethlisberger's day-to-day like right now, and what are the Steelers doing to get him ready to play Sunday in Denver, as he's expected to do?
First off, imagine waking up the next day. Your shoulder is throbbing. It's hard to even roll over, let alone push your way out of bed. You try to do the normal things you do on a daily basis, but everything is affected by the pain. The next day? Same thing.
That is what Roethlisberger is experiencing this week. That's what it's like to have an AC (acromioclavicular) joint sprain.
If you had this injury, you might consider it debilitating. You'd certainly avoid doing anything to aggravate it.
Roethlisberger, on the other hand, can't avoid aggravating it. He has to deal with it while preparing to play in an NFL playoff game.
As an orthopedic surgeon specializing in sports medicine who spent 17-plus years in the NFL, including time as a head team physician, I have treated dozens of AC sprains. I will try to give an inside look at how the Steelers medical staff might get their star quarterback ready to play.
Treating any injury starts with diagnosis. By video, Roethlisberger's injury was a classic AC joint sprain and not a clavicle fracture like Tony Romo suffered twice this season. Immediately after on-field evaluation, Big Ben was likely taken to get in-stadium X-rays to confirm the bone integrity and assess the degree of the AC joint injury.
An AC joint sprain is also called a shoulder separation. It has nothing to do with the "ball and socket" (glenohumeral) joint of the shoulder. The injury is to the junction of the outer (lateral) end of the collarbone (clavicle) as it meets the top of the shoulder (acromion). The coracoclavicular ligaments (conoid and trapezoid) that hold the end of the collarbone down in place are commonly part of the injury.
An AC joint injury is going to result in some general shoulder pain, loss of strength and motion and will cause a lot of discomfort when performing any activities that stress the AC joint (lifting, reaching). Imagine having to throw a football over and over again with this injury or even reaching to hand off the ball on a stretch play.
After diagnosis, treatment begins immediately. The Steelers medical staff focuses on ways to safely return their star quarterback to the game and make sure he is healthy for the next week. The key with mild AC joint injuries is pain and function, not stability.
Controlling the swelling is key. Several forms of oral or injectable medications could be used. Injections are often more powerful and act more quickly.
For the immediate, Toradol is a powerful injectable anti-inflammatory agent that also can help with pain. To help control swelling overnight and the first few days, a cortisone-type injection into the AC joint was likely also given. No brace is effective here, although a donut pad on top of the shoulder could help.
After the initial game, the days following involve rest, ice and modalities to continue with edema (swelling) control. Next, rehabilitation would consist of regaining range of motion and keeping the rotator cuff strong. Return to throwing comes later, after this initial rest period.
An MRI is routinely obtained after the game to confirm the diagnosis and rule out any additional injury. Although Roethlisberger spoke about ligament damage, that is really part of the original AC joint sprain. No additional damage was found. No repeat imaging is needed going forward.
What Changed for Tony Romo on Day 1 of NFL Free Agency?
What Will It Take for Tony Romo to Land in Denver?
Tony Romo Says Goodbye to Cowboys
Deal Alert: Grading Alshon Jeffery to Philadelphia Eagles Free Agent Signing
Deal Alert: Grading DeSean Jackson to Tampa Bay Buccaneers Free Agent Signing
Insider Buzz: Deep CB Draft Class Helped Patriots Outbid Teams for Gilmore
Matt Miller's Winners and Losers from the NFL Combine
Insider Buzz: AP May Return to Vikings as Other Teams Show Little Interest in FA
Insider Buzz: Desean Jackson Will Get Big Payday; Could Set Brandin Cooks Market
Deal Alert: Grading Brandon Marshall to New York Giants Free Agent Signing
Insider Buzz: Hue Jackson 'Loves' Mitch Trubisky; Chance to Be #1 Overall Pick
Top Performers from the 2017 NFL Combine
Rumor Alert: San Francisco 49ers Targeting Free Agent WR Kenny Britt?
Insider Buzz: Dolphins May Pay Big Money for Stills; Parker's Future in Question
Rumor Alert: Bears Will Make 'Major Push' for Free Agent QB Mike Glennon?
NFL Free Agency 2017: Where Will Former Redskins WR DeSean Jackson Land?
NFL Free Agency 2017: Why Teams Should Be Targeting WR Terrelle Pryor
Myles Garrett, Top Edge Rushers Absolutely Owned the 2017 NFL Combine
Insider Buzz: 49ers Targeting Mike Glennon If Cousins Deal Doesn't Develop
NFL Free Agency 2017: Why Teams Should Be Targeting RB LeGarrette Blount
Insider Buzz: Romo to Denver 'Gaining Momentum', Lack of Other Options
NFL Free Agency 2017: Where Will Former Chicago Bears WR Alshon Jeffery Land?
The Explosive, West Coast Kid: Meet the Ultimate Deep Threat John Ross
NFL Free Agency 2017: Where Will Former Vikings RB Adrian Peterson Land?
Insider Buzz: Glennon Offered Top Backup QB Money by Bucs, CHI & NYJ Interested
Insider Buzz: Raiders Will Wait to See Murray's Market Before Targeting Peterson
Insider Buzz: JPP Not Expected to Agree to Long-Term Deal, NYG Could Draft DE
Rumor Alert: Titans Most Likely to Trade for Saints WR Brandin Cooks?
Rumor Alert: Philadelphia Eagles Will Evaluate Signing RB Jamaal Charles?
NFL Free Agency 2017: Where Will Tony Romo Land If Cut by Dallas Cowboys?
Matt Miller's Rapid-Fire Predictions for 2017 NFL Combine
Insider Buzz: Kirk Cousins Open to Being Traded to Cleveland Browns
Insider Buzz: Adrian Peterson, Vikings to Determine Future at NFL Combine
Meet the Biggest Sleeper DB Ready to Tear Up the NFL Combine
Insider Buzz: Cutler Won't Accept Any Trade by Bears, Could Threaten to Retire
Insider Buzz: NFL Won't Rush to Interfere in Revis, Jets Contract Situation
Top Landing Spots for Tony Romo If Released or Traded by Dallas Cowboys
Top Landing Spots for Former New York Giants WR Victor Cruz
Insider Buzz: Redskins Interested in Tony Romo; Could Trade Kirk Cousins
Insider Buzz: Jets Can Get Out of Revis Contract Due to Incident in Pittsburgh
Insider Buzz: Jets Can Get Out of Revis Contract Due to Incident in Pittsburgh
Insider Buzz: QB Mitch Trubisky Is a 'Lock for the Top 5' in 2017 NFL Draft
Insider Buzz: Salary Cap Increase Could Lead to Uptick in Franchise Tag Use
Tim Tebow Gave 75,000 Kids with Special Needs a Night They'll Never Forget
Insider Buzz: Tony Romo Could Retire from NFL to Pursue TV Career
Insider Buzz: Aldon Smith Reinstatement in Jeopardy with Latest Controversy
Insider Buzz: 49ers Open to Keeping Kaepernick but Not at Current Salary
History Will Never Forget New England Patriots 5th Championship in Super Bowl LI
Simms: Blame Falcons' Conservative D, Not Aggressive Offense, for SB LI Collapse
A7FL No-Pads, Full-Contact Football League Claims It's Safer Than the NFL
Gridiron Heights: Patriots Win Super Bowl LI
NFL Comeback Player of the Year Jordy Nelson
Top 5 NFL Interception Leaders of 2016
Insider Buzz: Rams Could Let Trumaine Johnson Walk in Free Agency
Insider Buzz: NFL Being Urged to Decrease TNF Games; Goodell Not Budging
Insider Buzz: Las Vegas Deal Dead, but Raiders Haven't Contacted City of Oakland
Insider Buzz: Belichick Could Pull Out Old Trick to Slow Down Julio Jones in SB
Tale of the Tape: Do Patriots or Falcons Have Advantage in Super Bowl LI?
NFL Award Predictions: Who Will Take Home Hardware at 'Honors' Ceremony?
Why Dion Lewis Will Be Patriots Good Luck Charm in Super Bowl LI
Which Group of Road Graders Will Win Offensive Line of the Year at NFL Honors?
Deflategate to Lady Gaga: Prop Bets That Will Keep You Hooked on Super Bowl LI
Insider Buzz: Patriots Will Move Fast on Garoppolo Trade This Offseason
Insider Buzz: Romo Wants to Face Cowboys in 2017 Season
Can Super Bowl LI Patriots Cement Legacy as Top Team of New England Dynasty Era?
Fake Brady Makes Appearance at Super Bowl 51 Media Day
Insider Buzz: John Elway, Rich McKay Endorsed John Lynch for 49ers GM Job
Insider Buzz: Raiders to Vegas Hits a Snag, Lease Proposal Seen as 'Insulting'
Why One of College Football's Worst Teams Will Be a Winner in Super Bowl LI
Atlanta Falcons X-Factors to Disrupt Patriots Offense in Super Bowl LI
Insider Buzz: 'Unconventional' John Lynch Hire Won't Impact Shanahan to 49ers
Insider Buzz: Teams Take 'Precautions' Before Facing Patriots, Shred Game Plans
NCAA Lacrosse to Super Bowl LI: Patriots WR Chris Hogan's Rise to the Top
Simms in 60: Falcons and Patriots Have Most Creative Offenses, Take Notice NFL
Alabama QB Tua Tagovailoa Is Much More Than "The Next Marcus Mariota"
Who Had the Best Attendance in the NFL in 2016?
Insider Buzz: Former Bills Coaches Angry at 'Lazy' Dareus' Criticism of Rex Ryan
Insider Buzz: Spanos Denies Wanting to Move Chargers Back to SD, Won't Sell Team
Insider Buzz: Outgoing Rams Coaching Staff Blames Todd Gurley's Struggles on Him
From College Lacrosse to Super Bowl 51: Chris Hogan's Journey
Insider Buzz: Stanford's Solomon Thomas Looking Like Top-10 Talent
Jackson vs. Garcon: Redskins Are Facing Difficult 2017 Free Agent Decision
Simms' Hidden Truth: Falcons Use of Julio Jones Too Dynamic for NE to Shut Down
Insider Buzz: Chiefs' Chris Ballard Emerging as Favorite for Colts' GM Job
Insider Buzz: 3 Teams Eyeing Free Agent DeSean Jackson If Let Go by Washington
Simms' Hidden Truth: X-Factors for Patriots to Slow Down Explosive Falcons in SB
Insider Buzz: Collins Deal Will Be Baseline for Patriots to Ink Dont'a Hightower
Insider Buzz: Raiders Hope Carr Contract Won't Reset QB Market, No Rush on Deal
Gridiron Heights Episode 20: Roger Goodell Hosts the Griddies
How Tom Brady, Bill Belichick and the Patriots Rewrote the History Books
Chris Hogan Lived Up to His "7/11" Nickname in Patriots AFC Title Victory
Insider Buzz: CLE & SF Both Landing Spots for Kirk Cousins in Offseason
Simms in 60: Brady's Brilliance Has Made NE Unstoppable Force Heading into SB51
AFC CHAMPIONSHIP PREVIEW: TOM BRADY POISED TO MAKE HISTORY WITH PATRIOTS WIN
The Key Player in the AFC Championship Game
Tom Brady Poised to Make History with Victory Over Pittsburgh Steelers
Insider Buzz: Shanahan May Cede Control of Roster to GM; 2 Lead Candidates Emerge
Insider Buzz: Raiders Face Hurdles in Vegas Move; Owners Want Them in Oakland
New England Patriots Have NFL's Ultimate Postseason Home-Field Advantage
Can Home-Field Advantage Help Falcons Close Georgia Dome with NFC Championship?
What makes this injury an issue is that it involves Roethlisberger's throwing shoulder. A left-side AC sprain would have much less effect on his play. So far, Big Ben is on track to play. Having played the previous Saturday with the next game on Sunday gives him the advantage of an extra day's rest.
The Steelers will monitor Roethlisberger's swelling, range of motion and shoulder strength. They will know his status well ahead of the game. He is likely to have pain on follow-through, as that is when the AC joint is stressed. This may affect his ability to throw deep. A side benefit to playing in Denver is that the ball travels up to 10 percent further at altitude, which will help to counteract his weakness going long.
Come game day, Big Ben will likely be offered another Toradol intramuscular injection to help with inflammation and, to a smaller extent, lessen the pain.
Continuous use of Toradol four times a day for greater than five days is not recommended. However, despite its stigma, using it once a week throughout the season has proved to be safe, according to a study presented a decade ago at the NFL Physicians Society meeting.
It is also possible, safe and legal to receive an AC joint injection to numb the joint. Normally, it is a medical "no-no" to deaden a joint for fear of damage to the cartilage surface. In this case, the AC joint is not a weight-bearing joint.
Also, the treatment for an arthritic AC joint is resection (removal) of the joint, so there are no long-term consequences. A relief pad can be used to lessen direct contact, but there is no good way to brace the joint.
In-game aggravation can be a risk, but outside of another similar fall onto the shoulder, re-injury is not a significant issue. There is no threat to nerves or other vital structures. This injury should not have any negative impact on Roethlisberger for the 2016 season or beyond. It really is a pain and function issue.
All of the treatment will be performed with full explanation and consent of the player. Since there is minimal future risk, the ethical issues of short-term gain versus long-term benefit do not really exist here. Of course, an informed consent discussion is always necessary before any treatment.
This will certainly be a long, painful week for Roethlisberger. Although he finished the Wild Card Game and is likely to play in the divisional round, he can only rely on more traditional anti-inflammatories and oral pain medicines during the week.
Simple tasks like pushing himself up out of bed or brushing his teeth are likely to irritate the AC joint and cause pain. This would create a frustrating week for any individual. Yet, as a NFL athlete, Roethlisberger is expected to be out there Sunday.
Big Ben is not being rushed back because it is the playoffs, however. The treatment regimen outlined is routine in the NFL, and quarterbacks I have treated have played through AC joint sprains with success.
In fact, this season, Tyrod Taylor played through such an injury in Week 11 and came back the following week to have a passer rating of 106.4.
Joe Buscaglia @JoeBuscaglia
Tyrod Taylor still holding his shoulder pad down after the game much like he did during the final two drives #Bills https://t.co/TWYHc88zA511/24/2015, 5:08:58 AM
Quarterbacks actually tolerate AC joint sprains better than many other positions, namely linemen, linebackers and running backs where players take constant contact to their shoulders.
As we look forward to the divisional showdown in Denver, it will be the battle of two starting quarterbacks with throwing-arm issues: Big Ben with the acute AC joint injury and Peyton Manning with his chronic arm weakness resulting from neck surgeries.
With the appropriate medical support, I expect Roethlisberger to have the stronger arm Sunday.
David J. Chao, MD is a board-certified Orthopaedic Surgeon with a Subspecialty Certification in Sports Medicine, who has been engaged in an active San Diego practice since 1995. He is a member of the international ACL Study Group, the NFL Physicians Society, American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons and is an Assistant Clinical Instructor at UCSD.
Dr. Chao is a former NFL head team physician with over 17 years of sideline experience.
Like the new article format? Send us feedback!