Arian Foster, Achilles Tendon Rupture

Arian Foster, Houston Texans Running Back

Arian Foster is reported to have sustained an achilles tendon rupture in the Texans’ 44 to 26 loss to the Miami Dolphins on Sunday (video of injury here).  It has already been announced that Foster will miss the remainder of the season.  The real questions is if he will ever return to playing in the NFL and if so, at what level.  When healthy, Foster is a fantasy football team owner’s dream.  If you are playing in a keeper league,  given his past numbers and high fantasy draft stock, it is quite possible that he is on you our your opponent’s team for years to come.  

How severe is Arian Foster’s injury?

Achilles tendon injuries are classified from Grade I to Grade III.  Foster is reported to have sustained a grade III strain, also known as a complete rupture.  More information about the grading system below:

AchilleTendon-Injury-LG

Grade I: Mild strain, disruption of a few fibers. Mild to moderate pain, tenderness, swelling, stiffness. Expected to heal normally with conservative management.

Grade II: Moderate strain, disruption of several fibers. Moderate pain, swelling, difficulty walking normally. Expected to heal normally with conservative management.

Grade III: Complete rupture, often characterized by a “pop,” immediate pain, inability to bear weight. Typically requires surgery to repair.

©http://www.moveforwardpt.com/

What is next for Foster?

Foster will likely undergo a surgical procedure to repair his achilles tendon within the next week or so.  Immediately following the surgery he will be in a cast and using crutches to avoid putting any weight on the operative limb for 2-4 weeks.  After that he will be wearing a walking boot and slowly increasing the amount of weight he is putting through his leg during walking activities.  He will likely go through a therapy protocol lasting roughly 6 months before he is able to resume athletic activities (sample rehab protocol here).  

His rehab will include pain and swelling management using modalities such as the Gameready ice machine.  He will also likely undergo hands-on therapy including joint mobilization and trigger point dry needling to decrease pain and increase mobility.  His exercise program will be geared towards strengthening and stabilization of his core and entire lower extremity to decrease the likelihood that he will suffer another season-ending injury.  Proprioceptive training is extremely important in recovering from and protecting against injury.  Here’s an example of a proprioceptive training progression:

 

Will Arian Foster ever be the same?

Possibly.  A study published in 2009 investigated achilles tendon ruptures in the NFL and their impact on player performance.  The researchers found that on average, players experienced a greater than 50% decrease in power ratings following an achilles tendon rupture.  Furthermore, roughly 32% of players that sustained an achilles tendon rupture never returned to play in the NFL.  

Given recent data on achilles tendon ruptures and Foster’s explosive style of play, The Therapydia PTs feel that if Foster was your first pick in a keeper league, it may be time to look for a different league.  
Prediction: Arian Foster returns next season as a much less productive back, if he returns at all.  

Will Blake Bortles miss Week 6 with an AC Sprain?

Fantasy Football Injury of the Week:  How bad is Blake Bortles Grade I AC Sprain?

Blake Bortles has not typically been on the radar of many fantasy players since he joined the league in 2014.  However in 2015 he has had a sneaky good start to the season despite Jacksonville’s 1-4 record.  In my Yahoo league, he is currently the 7th best QB.  He has better numbers this year than our very own Peyton Manning (by a longshot) and fantasy studs like Drew Brees and Matt Ryan.

Unfortunately, Bortles may suffer a bit of a setback if he is forced to miss Week 6 against Houston.  Bortles suffered a Grade/Type 1 acromioclavicular (AC) joint sprain of his throwing shoulder at some point during Jacksonville’s week 5 loss to the Buccaneers.  Anytime a quarterback sustains an injury to the throwing shoulder it can be a scary situation.  Fortunately for Bortles, a grade one AC sprain leaves us optimistic that he will be able to play this week and here’s why.

What’s the difference between Grade 1, 2, and 3 AC Sprains?

An AC sprain is typically graded in its severity from a one to a three.  It easy to visualize the severity of an AC sprain in the graphic below:

ACJointSeperation-pic2©

A grade/type 1 sprain is mild or partial injury to the joint ligaments or capsule.  In this grade there is a slight tear or sprain of the acromioclavicular ligament.  This ligament helps to stabilize the AC joint and ultimately the shoulder itself.  Bortles likely will rest the shoulder this week and participate in physical therapy everyday to retain his range of motion, strength, and help control the pain with modalities like the Gameready ice machine:

File_000(note: this is not Blake Bortles)

A grade/type 2 sprain is a more significant tear of the acromioclavicular ligament as well the ligament below the clavicle called the coracoclavicular ligament.  

A grade/type 3 sprain is a severe injury to the shoulder.  In this situation, both acromioclavicular and coracoclavicular ligaments are completely torn.  The shoulder is very unstable and an athlete will often choose to have surgery to stabilize the joint by placing a screw or looped suture into the collar bone to anchor it back down.  This grade of injury will mean the player misses weeks or months of their sport.

So What’s the Prognosis?

Fortunately for Bortles he has been diagnosed with the most mild form of an AC sprain, a grade one.  Early in the week his shoulder probably felt sore and a little weak or unstable  He may have had some difficulty reaching overhead or across his body and lifting activities might have been uncomfortable.  Kinesiotaping can be helpful in giving stability and pain relief during this phase of recovery.

 

With daily physical therapy rehab, Bortles’ symptoms will likely improve significantly or resolve completely by Sunday.  

Prediction: Blake Bortles is able to play in Week 6 against Houston

 

Injury Revisited: Dez Bryant, Jones Fracture

With no high-profile injuries to players at skilled positions this week, we bring you an update on the status and likely return to play for Dallas Cowboys wide receiver Dez Bryant.  Dez suffered a right 5th metatarsal fracture, commonly referred to as a Jones fracture, during the Cowboys’ week 1 win over the New York Giants (video and more information here).

jones-fracture

Jones fracture (not Dez Bryant’s)

The base of the 5th metatarsal can be a particularly difficult bone to heal.  This is due to the area’s poor blood supply as well as the huge amount of force transmitted through the area, especially with running, jumping and cutting.  The day after the injury he underwent a surgical procedure that was reported to include internal fixation with hardware as well as a bone graft.  Given current surgical procedures, the graft was most likely a marrow aspirate with demineralized bone matrix injected at the fracture site.  This is essentially used to speed up healing and increase the likelihood that the fracture with heal completely.  In most cases, a bone graft is used when a fracture has been recurrent or chronic in nature.  However, it is very likely that they are treating this as aggressively as possible to allow for the quickest return to play possible. 

 

jonesrepair

Jones Fracture Repair (Not Dez Bryant’s)

A recently published study followed 25 NFL players from their surgery through return to play.  The study found that 100% of players returned to full participation and 12% of them ultimately refractured their 5th metatarsal and required a revision surgery.  The time from surgery to return to play was between 6 and 14 weeks, with the average being 8.7 weeks.  

Dez is undoubtedly receiving excellent care as he rehabilitates this injury.  He is likely undergoing joint mobilization, stretching, strengthening, stability and balance training and quite possibly trigger point dry needling in an effort to regain range of motion and full function.  

Given recent data on Jones fractures amongst NFL players, along with the demands put on the foot of a wide receiver such as Dez Bryant,  The Therapydia PTs believe this will be a fairly lengthy recovery.  

Prediction: Dez Bryant misses just over 10 weeks and returns to face the Carolina Panthers on Thursday, November 26th.