Monday Morning MD

Why the rash of Achilles, high sprains, Lisfrancs, turf toes, ankle and foot fractures? In Week 4, Vikings quarterback Teddy Bridgewater, Raiders quarterback Derek Carr and Panthers running back DeAngelo Williams all exited their respective games early with apparent high ankle sprains. Robert Griffin III, Matt Cassel, Danny Woodhead, Derrick Johnson and DeAngelo Hall are just some of the other recent foot/ankle victims. Knee injuries used to be the leading injury, but that trend seems to have changed.

My analysis of current NFL rosters indicates that the foot/ankle has overtaken the knee when it comes to serious injuries. Currently, 51 players are listed on injured reserve (including designated for return) due to foot/ankle issues versus 40 with known knee issues.

During my two decades caring for NFL players, I have slowly observed this developing shift. When I began, knee ligament (ACL, PCL, MCL), meniscus, patella and cartilage issues dominated the training room. Although the knee is still prominent, injury frequency has moved down to the foot/ankle.

As an example of the change, I stated that Achilles tears are the new ACL. Both lower extremity soft tissue ruptures are typically non-contact injuries that happen without warning and lead to surgery with a lost season. No team wants to hear the word “Achilles” or the letters “ACL.”

Teddy BridgewaterBridgewater threw for 317 yards before exiting Sunday's game with an ankle injury.

When I first looked at this issue halfway through the preseason, league-wide there were nine ACL tears and seven Achilles tears. Now, just under a quarter of the way through the regular season, I count 24 ACL tears and 16 Achilles ruptures. Hopefully, the total doesn’t rise with the Monday injury reports that could include Cowboys cornerback Morris Claiborne’s presumed ACL.

These two injuries are far and away the leading two categories for the 153 players on injured reserve with no other specific diagnosis reaching the double digits of frequency.

The Chiefs made news last week with their third season-ending Achilles tear. Many theories were thrown around as to the cause, but one can’t blame limited preseason practice (injuries happen later in the season, too), turf (all three injuries occurred on grass), certain antibiotics that weaken tendons (players not on Cipro), PEDs (would not be limited to Achilles) or even shoes/insoles.

I doubt this anomaly is related to the Kansas City strength coaches or their quality medical staff. Statistical variances do happen. For example, there are currently 13 Achilles ruptures in the AFC, but only three in the NFC and there is no common denominator to explain that conference discrepancy.

Why the increase in foot/ankle injuries? There is no doubt that the reason is multi-factorial and no one explanation can account for it all. My theory has always been related to the changing NFL landscape. As players continue to get bigger, faster and stronger, the foot/ankle essentially remain the same and, thus, becomes more vulnerable. If you continue to plant a bigger tree into the same size pot, problems are inevitable.

MMMD 1: Not all high ankle sprains lead to prolonged absence

Most knowledgeable NFL fans fear a high ankle sprain knowing it is typically more severe and takes longer to return than a traditional low ankle sprain. High sprains happen with external rotation while low sprains happen with inversion.

Severe high sprains can even lead to fracture and surgery (see Danny Woodhead). Although it is common for a player who suffers this injury to miss six weeks, there are milder varieties of high ankle sprains.

Kansas City running back Jamaal Charles was injured during Week 2 and missed last Sunday’s game at Miami, but is listed as ‘probable’ for his Week 4 Monday night game. Despite initial concerns about prolonged absence with his high ankle sprain, the Kansas City running back looks to meet my original 1-3 week estimate.

By mechanism, I am expecting the high ankle sprains sustained by both Teddy Bridgewater and Derek Carr to be relatively mild. They both might have an outside chance to return for the next game. I don’t expect a prolonged absence of over a month. Bridgewater’s prognosis may be better, however, Minnesota’s next game is on Thursday. Carr’s main issue is his ankle, but he also has a mild knee MCL injury.

Derek CarrMatt Schaub is likely to take over for Derek Carr, who was injured on this play.

Since Carr is likely to miss some time, history may repeat itself. Matt Schaub replaced brother David Carr in Houston and now Schaub might temporarily replace Derek in Oakland.

Panthers running back DeAngelo Williams may have the most severe of these three high ankle injuries. He was immobilized in a boot after the game, which is not uncommon, to reduce swelling over the first few days. With Jonathan Stewart and Mike Tolbert already out, this injury leaves the Panthers without any of their top three running backs what could amount to several weeks.

MMMD 2: Hope for RG3 ankle dislocation

Kirk Cousins’ four-interception second half performance last Thursday halted talk of permanently replacing Robert Griffin. However, will Griffin’s ankle every fully recover?

One only has to look at Philadelphia’s Darren Sproles, who early in his career dislocated his ankle with a fracture. He is now in his tenth season. The week RG3 was injured, Sproles racked up 178 yards from scrimmage and one touchdown. On Sunday he had an 82-yard punt return for a touchdown.

There is no reason RG3 shouldn’t fully recover despite the gruesome injury. Medically, ankle dislocations without cartilage damage return to full form.

MMMD 3: NFL players play through injuries we don’t know about

At some point, almost everyone gets injured and fans don’t always know the extent. The NFL only requires disclosing injuries when it might affect whether or not a player will suit up. Many smaller injuries go undisclosed to the public.

Tampa Bay wide receiver Vincent Jackson likely suffered a hairline fracture to his wrist during the second series of the team’s Week 3 loss at Atlanta, but finished the game before x-rays were even taken. On Sunday, Jackson played the entire game with the bad wrist but still managed to catch the game-winning touchdown.

49ers tight end Vernon Davis was hit in the lower back and x-rays were negative, but we don’t yet know the extent of his injury. Davis left the game due to back spasms, but joins the list of players who expect to play through his injury next weekend.

Almost all NFL players get hurt at some point during the season. What one does with the injury and how one safely plays through it determines true championship character. Most of us will never know what these athletes go through.

MMMD 4: Injuries have domino effects

Often times it is not just what a missing player isn’t able to do but how his absence affects the team downstream.

After Raiders quarterback Derek Carr was injured Sunday in London, backup Matt McGloin came in and botched a shotgun snap that lead to an easy six points for Miami.

Levine ToiloloLevine Toilolo (80, bottom) had to play right tackle for the Falcons on Sunday due to injuries.

Jaguars wide receiver Cecil Shorts injured his left hamstring at San Diego, causing him to not run his full route with vigor, which led to Blake Bortles’ first NFL interception.

The Falcons offensive line became so depleted in Minnesota that there were only four healthy linemen left suited up on Sunday. Tight end Levine Toilolo filled in as best he could at right tackle, but it essentially gave no chance for Matt Ryan to rally his team.

From a fantasy prospective, an in-game injury can’t be replaced. From a reality prospective, sometimes it can lead to even bigger problems.

MMMD 5: The bye weeks begin in Week 4

The bye week has been a positive addition for the NFL, as players and teams welcome the rest and chance to get healthy. With a plethora of games and the rise of fantasy football, few fail to notice that three fewer games were played this week.

The biggest complaint for some is that the bye week comes too early in Week 4. The Seahawks have complained that as Super Bowl champions, they shouldn’t have the bye this early, as they have a long 13-game stretch to go plus a potential trip to the postseason in order to repeat.

I feel the best solution is to add a second bye week. In the health and safety era, this would eliminate long stretches without rest and add revenue/television opportunities without increasing the number of games or injuries. This might be the best compromise in place of the proposed 18-game regular season.

MMMD 6: Medical matters when drafting

Although it is too early to give out draft grades, there is no doubt medical input is important.

The Texans placed rookie NT Louis Nix III on injured reserve last week due to his knee after being inactive for the first three games. He was listed as a “red light” grade for his knee in my top medical issues for the NFL draft column.

Third-round picks, like Nix, are counted on to contribute significantly. In the end, I hope he is a productive player. But so far, Nix’s knee injury has left him on the sidelines until next year.

MMMD 7: London calling

Sunday marked the first of three NFL games to be played overseas this season. It is part of the NFL push to get a London-based team within the next decade. Many further steps are needed including playing back-to-back games.

With coast-to-coast travel affecting visiting teams, how would a trans-Atlantic club fare? Medically, a team in London is feasible. The time change issues and travel are surmountable, as a Seattle at Miami game is almost equal to the travel required for New England to arrive in London.

Or course, games would need to be clustered and paired with byes. The bigger issues will be socialization of living in a foreign country when most players haven’t even traveled outside of the United States.

Follow David on Twitter: @profootballdoc

Dr. David Chao

Monday Morning MD: New formula to extend Tom Brady’s career

Despite being hated by Patriots fans, the commissioner may have actually helped New England win this and more future Super Bowls.

How did a 39 year-old quarterback outlast a young defense that in the first half was flying to the ball and applying pressure without blitzing? The Patriots had more than twice the offensive plays

Despite being hated by Patriots fans, the commissioner may have actually helped New England win this and more future Super Bowls.

How did a 39 year-old quarterback outlast a young defense that in the first half was flying to the ball and applying pressure without blitzing? The Patriots had more than twice the offensive plays as the Falcons. The lopsided time of possession difference was even worse than the stats indicated (40:31 vs 23:27) as New England’s 14 more incomplete passes added little clock time but substantial real time on the field. Atlanta defended for an unprecedented 93 plays. Brady passed more times than Matt Ryan even touched the ball. By the fourth quarter, the pass rush seemed to wear itself out and the tight coverage began to trail.

Don’t forget that the offense led by Brady was on the field the same number of plays as the “rise up” young defense. Why did the aging quarterback not seem tired? Brady is dedicated to his training regimen but there may be more to it.

The four-week forced hiatus where he not only missed games but had to be away from the facility and could not practice may have helped the veteran QB and his team in the long run. The Patriots with Brady only playing a 12 game season still ended up with the playoff bye and home field advantage.

The early rest and shortened season may have helped Brady during the playoffs and Super Bowl. He certainly doesn’t need the added reps. Perhaps it played a role in his strong 4th quarter as the Falcons defenders ran out of gas.

Bill Belichick used a boxing analogy at the MVP ceremony this AM saying “the mark of a true champion is winning after getting knocked down.” Staying in fight game analogies, this contest seemed like the famous rope-a-dope fight during the 1974 “Rumble in the Jungle”. The young George Foreman came out strong and punched himself out as Muhammad Ali conserved energy and stayed strong to finish the fight in the end.

During my time with the Chargers, LaDainian Tomlinson never played in preseason games. He didn’t suit up his rookie year due to a holdout. The newly announced Hall of Famer played so well his rookie season and became so valuable, the team decided to not mess with success. During his illustrious career, he always sat out preseason games. Perhaps this season will set the new precedent for the Patriots.

Father Time catches up to all of us. Perhaps the shortened season model is something Brady and the Patriots will adopt going forward to combat the effects of age. Inadvertently, the most hated man in New England may have helped the Patriots to their fifth Super Bowl and perhaps extended the career of Brady into winning more.

MMMD 1: Did injury play a role in who ultimately won?

By video, it was clear that Alex Mack would not be 100% even before the news of a broken/chipped fibula. He played surprisingly well but did give up the key sack to Trey Flowers that prevented the Falcons from icing the game with a late field goal.

Julio Jones was also still hampered by his turf toe injury. He made a spectacular catch but had a subpar performance for him with only four catches. Jones is reportedly still undecided on offseason surgery.

The lengthened pre-game and halftime made it harder on both Dwight Freeney and Chris Hogan who were playing through muscle injuries. Freeney recorded a sack but missed a short portion of the game with his calf and undoubtedly was not 100%. Hogan recorded 4 catches with his thigh issues but was not nearly as productive as during the AFC Championship Game.

Dont’a Hightower played through a likely left shoulder labral tear and has been using a harness/brace. He effectively used his left arm to make the pivotal strip sack resulting in the key Falcons fumble.

MMMD 2: Athletic trainers and doctors deserve rings too

The medical staff plays a vital role in not only health and safety, but also in a team’s winning. It is right that they too will be awarded with Super Bowl rings.

There is no better example of medical helping a team win than this year’s Super Bowl. The key play was Dont’a Hightower’s strip sack fumble. Despite a likely labral tear (which will need offseason surgery), he made the game-changing play with his injured arm. Doctors and athletic trainers had him safely on the field with a shoulder harness that provided stability yet did not restrict his motion to prevent reaching Matt Ryan to cause the turnover that launched the Patriots to victory.

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This is nothing new for the Patriots ATCs as they have enjoyed many Championships. The head team doctor is a rookie this year, as was the lead physician two years ago when New England last won it all. In my 17+ years in the NFL, my team never even made it to the big game. But trust me, I am very happy for them as I know how much work is put in and how special it is.

MMMD 3: NFLPA agenda

Each year at the union players press conference, there seems to be a main agenda push. This year, the call is for teams to follow the concussion protocols exactly. For years, the mantra has been changing and advancing the head injury rules. Now, the players seem happy with the rules and want them strictly enforced.

Recall only two years ago, there was controversy over a big hit on Julian Edelman. That was the genesis of the medical timeout rule. Last year a second concussion spotter was added. Sideline replay, neutral independent physicians, standardized testing, mandatory rules for going to the locker room are just some of the many changes.

It is noteworthy that no new rules are being requested. Last year the commissioner announced a structure for penalties to teams of fines and/or draft picks for violations. To date, no one has been penalized.

The Dolphins were recently warned over their handling of Matt Moore.. The Chiefs are being investigated now over their handling of Chris Conley. I know Kansas City has a quality medical staff and the head athletic trainer is the current President of the Pro Football Trainers Athletic Society. I do not know the specifics of their care during the Division Round game in question. However, don’t be surprised if penalties are assessed for the first time as that is the push of the NFLPA.

MMMD 4: Pain medication lawsuit

News broke during Super Bowl week that the Falcons were worried about their reliance on painkillers in 2010 and how the team spent nearly three times the league average on narcotics. I am not an attorney and I do not know details about the pending lawsuit but I don’t believe this story is not nearly as explosive as it sounds on the surface. In fact, it is my understanding that some teams, including the Falcons, have been dropped from the legal action (although they could be added back in).

To me, the emails show that Atlanta executives acted as soon as they realized their team used more pain medication than the rest of the league. Medical staff changes were made to make sure this problem didn’t go forward.

The Falcons should be applauded not criticized for their actions. In medicine, there is something called peer review. Any internal criticisms and actions to improve medical care are exempt from attorney discovery. The purpose is to encourage the process of improving patient care and to remove the fear of plaintiff attorney discovery. Here it seems like the Falcons found a problem and then acted to correct it.

MMMD 5: Medical Mike Pereira

As most of you realize, I am not a trained professional writer or full-time media member. I have a “day job” as an orthopedic surgeon. I hope this and my almost two decades of experience as an NFL team physician gives me the unique perspective that you enjoy. Hopefully, I can be as good at analyzing injures as Pereira is at breaking down the rules.

I have written a 1500 word article for over three straight years with a one main and seven subtopic format including through the offseason. Add in watching games, keeping up with news, speaking to other reporters, my SiriusXM sport medical analyst duties and my Real Football Network work. It is almost a 40 hour a week second job..

I enjoyed my time at Radio Row and the game. I especially enjoyed taking the media bus all week long. Every ride provided a nice opportunity to randomly meet a fellow media member that we have been mutually following. I was so surprised and flattered that a few fans recognized me and even asked to have their picture taken with me.

MMMD 6 Mrs. ProFootballDoc

I have to thank my wife as she has been so supportive. She takes the kids every Sunday so I can do football. This past week she was single parent for the week as I attended Radio Row and the Super Bowl. She is eight and a half months pregnant and still managed to take the kids to Disneyland for her birthday. There is NO ONE like her.

I also want to thank my co-stars on the Periscope broadcast, Davis and Dylan. My weekends are free again so more Daddy time on the way.

MMMD 7: ProFootballDoc scorecard

This marks the end of my tally of initial impression right/wrong for this season. There may be adjustments as new information is revealed but any subsequent injuries will not count to this total.

This year concludes with a 95.1% record (203-10) of correct injury predictions. Last year the final record was 94.3% (165-10) and the year before that was 137-11 (92.6%). The number of first impression assessments have gone up slightly as well as the percentage correct. With a three-year track record, I am not sure if I will track it again next year as the concept seems to be proven. Using video and insider medical knowledge is at least 90% accurate.

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Monday Morning MD: “Witch hunt” season is on

As the numbers of games dwindle, there is more time to deal with unfinished business. Thus the administrative “witch hunt” season is on.

The Dolphins were admonished (but not penalized) over their handling of Matt Moore during the Wild Card round. There was no criticism of the care he received. The Unaffiliated Neurotrauma Consultant participated

As the numbers of games dwindle, there is more time to deal with unfinished business. Thus the administrative “witch hunt” season is on.

The Dolphins were admonished (but not penalized) over their handling of Matt Moore during the Wild Card round. There was no criticism of the care he received. The Unaffiliated Neurotrauma Consultant participated and agreed with the treatment and return to play process. Bear in mind it was a road game where the UNC is local to the Pittsburgh area and probably a Steelers fan. The purpose of the UNC is to first hand witness and provide player protection. Despite the UNC not requiring a locker room evaluation and agreeing with care, the team medical staff was still criticized for not following the concussion protocol.

There was the perception of rushing Moore back into the game since he only missed one play. With the referee and TV delays, I timed that Moore was out for exactly five minutes before he returned, which is the equivalent of seven or eight plays of real time. A sideline screening exam takes two to three minutes. Blood in the mouth is considered by the league to be a sign of concussion requiring locker room evaluation. Apparently there was a trace amount on Moore, but not enough to concern the Dolphins or independent doctor. Of course the slight blood could have come on a different play but on this technicality the Dolphins were criticized and warned of future penalties.

Now attention is focused on the Chiefs for their handling of Chris Conley in the AFC Divisional Round. With last year’s announcements of potential team penalties/fines for medical staff transgressions, it seems the NFL and NFLPA are destined to find someone to punish. The Chiefs head ATC is the current president of the Pro Football Athletic Trainers Society, which makes him a high profile target. Add to that the fact that he has been in the news this season and previously related to head injury and sets the Chiefs up to be a prime candidate to become a scapegoat.

I do not know the details of what the Chiefs did or did not do in their evaluation of Conley. This is why I have advocated for transparency. Why not let the UNC describe what happened on the field, sideline and locker room? Referees talk to a pool reporter after the game to help explain what the officials were thinking. Allowing the UNC to do this might clear up the perception that players were not cared for and might even apply more pressure to do the right thing with the doctor knowing he/she will have to answer publicly for it.

Currently the NFL does not have a full-time medical officer. Normally that person would jointly conduct the investigation with the NFLPA physician. With only one physician involved, penalties become more likely as the NFLPA physician has no counter. It is like only one side having an attorney in court or only one side having an expert witness in trial. The outcomes potentially get skewed.

Protocols are guidelines not rules. The NFL and NFLPA should stop practicing medicine and allow the UNC and team physicians to operate. They should allow them to speak to clear up misperceptions. If the independent physician is complaining, that should be fully and aggressively investigated with full representation from both sides.

MMMD 1: “Witch hunt” part 2

There has been lots of conjecture on fines/penalties for the Seahawks not disclosing Richard Sherman’s MCL injury. I have explained why I feel Seattle will escape punishment. Sherman has now confirmed my thought that the MCL injury was minor. Thus, there was no requirement to list it on the report.

Now the Steelers are undergoing scrutiny for not listing Le’Veon Bell’s groin injury. Last year, the Colts were investigated for not listing Andrew Luck’s rib injuries, but no penalties resulted.

The reality is there are many more injuries on every NFL team than listed in the injury report. The speed limit is 55mph but everyone on the highway is going 65mph. Only the ones going 75mph will be ticketed. Or as Mike Garafalo tweeted at me, the “Ferarri’s” (star players) get all the attention from the cops but the “Kia’s” (average players) are ignored when it comes to getting pulled over.

MMMD 2: Everyone will play in SB51, but how well?

Everyone gets healthy in the two weeks before Super Bowl. Fortunately, both the Falcons and Patriots are relatively injury free.

The Falcons have no one listed on the game status injury report. Julio Jones is still dealing with his turf toe and is said to have two ligament injuries and a mid foot issue. This is the same foot that has had two previous 5th metatarsal fracture surgeries. I do not think the extra week will allow Jones a full recovery. Despite a monster Conference Championship game, don’t expect a repeat performance. Center Alex Mack, by video, suffered a high ankle sprain and finished the NFC title game but has now missed considerable practice. No doubt he will strap it up for the big game.

Of course the Patriots will miss Gronk (on IR for back surgery) but everyone else should play. Nate Ebner is on pace to be cleared from concussion and may accomplish an unprecedented feat. In the last six months he will have played in the Rio Olympics (for USA rugby) and now a Super Bowl. All of his many teammates listed as “questionable” should be available as well.

It is the Super Bowl. Everyone will be available.

MMMD 3: Teddy Bridgewater not back for 2017?

A small uproar was created when it was reported that the Vikings QB would miss next season. This is a case of don’t shoot the messenger. Jason Cole correctly quotes the typical recovery time from a knee dislocation, where multiple ligaments are torn, to be a year and a half. When NaVorro Bowman torn his ACL and MCL, he missed the following season and still struggled after that. There is optimism for Jaylon Smith after his multi-ligament knee injury but he is still wearing an AFO indicating a nerve problem. The point is that all knee dislocation/subluxation injuries are far harder to return from than the average ACL tear.

There is no guarantee for 2017 for Bridgewater. Typically there is always offseason injury optimism but head coach Mike Zimmer has said he does not have a timeline for return. After all, did the Vikings trade for Sam Bradford just for one season, or were they also buying insurance for the next year and beyond?

MMMD 4: League injury data

The annual NFL injury data was released early instead of at Super Bowl week. The league data showed concussions remained essentially the same over a five-year span with 244 total this past season. ACL tears remained constant over the last five years with just under two per team as the average. MCL tears also were similar, averaging just under five per club. With the new touchback rule, there was not a big statistical change on kick-off related injuries. If anything, knee injuries increased. Thursday games continue to have fewer injuries than Sunday games.

MMMD 5: Three unusual situations

Cyrus Kuoandjio had hip surgery after a fall at home. Details were not released but the implication is a potential hip fracture. That is not unusual for grandma, but extremely unusual for a young healthy NFL player. We will need to wait to hear more details on whether there is some underlying pathology or if this truly was a fluke. Dexter McCluster was signed by the Chargers and had a previous forearm fracture and re-broke it with an at home luggage incident.

Josh Doctson is still dealing with his Achilles tendonitis. I am sure the Redskins medical staff has tried all sorts of conservative care, modalities and likely PRP/stem cells. If he doesn’t turn the corner soon, surgery to debride the Achilles may become an option.

Ryan Tannenhill finally had surgery ruled out this week. He injured his ACL and MCL but only recently determined that no ACL reconstruction was needed. There are reports of him flying to Germany for treatment despite PRP and stem cells being legal and routinely used in the US. Players will literally go to the ends of the earth if there is a chance for something better.

MMMD 6: Hardest part of retirement

Steve Smith, Sr. on the “Know Them From Adam” podcast talked about one of the hardest adjustments to post-NFL life. He singled out medical care. Indeed now he will need a new set of doctors. All player’s (and sometimes family) needs are met by the team doctors. Most times, the physicians make “house calls” and come to the facility. There are even preferential appointment times for the dentist. Indeed, life after football involves getting to know what a doctor’s waiting room is for.

MMMD 7: ProFootballDoc

I did not watch the Pro Bowl and thankfully there are rarely injuries in that all-star game. Having covered two of these exhibitions, anyone with the slightest of medical conditions is pulled for safety. No injury analysis this week and thus the 95.1% accuracy rate stands.

I am in Houston this week for Super Bowl and the media activities. I hope there will not be a need, but will be at the big game to provide live injury analysis from NRG stadium.

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Monday Morning MD: History repeats itself

Another AFC Championship game in Foxboro. Another opposing star running back is injured early and sits dejected on the sidelines with an oversized jacket to stay warm. The Patriots advance to another Super Bowl.

When Le’Veon Bell left just after the start of the game with a groin injury, it reminded me of LaDainian Tomlinson’s

Another AFC Championship game in Foxboro. Another opposing star running back is injured early and sits dejected on the sidelines with an oversized jacket to stay warm. The Patriots advance to another Super Bowl.

When Le’Veon Bell left just after the start of the game with a groin injury, it reminded me of LaDainian Tomlinson’s early exit with MCL injury. Both came into the game with their injuries but could not continue. Both sat helplessly trying just to stay warm as their teams lost to the host Patriots. Both incidents just had the same look and feel.

Injuries are always a big part of the game. Would the Steelers been able to hang tight with the Patriots if Bell stayed healthy? Would the Chargers have prevailed in 2008 if LT would have been healthy?

A groin injury is debilitating for a running back. Not only does it make it hard to cut, it robs a player of his burst. The cold didn’t make it any easier. Bell could have limped through his game like LT could have hobbled through his, but clearly it was the better move in both circumstances to play their capable back-ups.

Is it just luck for the Patriots that their path to the Super Bowl was made easier by the opposing team’s key injury? Certainly, to some extent New England makes it’s own luck by having the best record in the NFL.

The only thing these Patriots have in common with the 2008 team is QB Tom Brady and K Stephen Gostkowski, plus of course the head coach. In fact, there are 30 new players out of the 53 since the last Super Bowl victory just two years ago. We shall see if it will yield the same results as the Falcons seem to be a formidable opponent.

I provided medical coverage for two Super Bowls but my team never made it to the big game in my almost two decades. The Patriots had a new team doctor when they won it all in 2015. Again they have a first time team doctor this year. Will history repeat itself?

MMMD 1: Everyone plays

When it comes to the Conference Championship games, no one wants to miss the chance to help their team get to the Super Bowl. After all, next comes an extra week of rest before the big game or an offseason of rest. This is what drove Philip Rivers to play fresh off a knee scope and with a torn ACL in 2008.

All three injured Packers wide receivers (Jordy Nelson, Davante Adams and Geronimo Allison) played. Also Morgan Burnett (quad) and Christine Michael (back) suited up as well.

It was obvious that James Harrison would play and so did his flu-ridden teammates. I doubt a 3am wake up had much effect for an evening kickoff. Besides, in my experience, players don’t get up to leave their rooms with a fire alarm without team security personally performing the evacuation.

MMMD 2: Everyone will be ready for SB51

Barring any surprises, it should be a healthy game in Houston. The additional week before the big game should allow all players to be near top form.

Julio Jones with his turf toe/foot issues will be a player to watch but I anticipate he will be fine. Alex Mack finished the game with his ankle spatted and should be in good shape in two weeks.

Martellus Bennett will need ankle surgery with his bone chips/fracture but that should be a minimal issue. Chris Hogan had a big game despite coming in with quad injury and then having hamstring issues where the two weeks will help here.

Here is hoping both squads remain at full strength and the better team wins.

MMMD 3: How did Jordy Nelson play with multiple broken ribs?

When it was reported that the Packers WR was on the second bus on Sunday, that confirmed to me he would play. Players that are game-time decisions, arrive early on the first bus to test the injury out. Ones that know they won’t play take the 3rd bus.

The much talked about Kevlar vest is not the main reason Nelson could play. Any protection doesn’t eliminate the pain of twisting, reaching, blocking or even deep breaths. Often rib blocks are utilized where the intercostal nerves are numbed with injections. This allows a player to move without pain and is an entirely legal form of medication in the NFL. Pain pills are used less frequently than people think, as a player’s mind needs to be clear to play this complex game.

MMMD 4: Seahawks won’t be penalized

Pete Carroll said Richard Sherman had a “significant” MCL but he was never on an injury report. This led many to expect a Seahawk penalty to come.

I don’t think it will happen. Teams are not required to report all injuries. Trust me that every team’s injury list is longer than the one that is published.

Only significant injuries are required to be reported. This is where the semantics come into play and Pete Carroll is obviously not a physician.

Medically, it is impossible for any CB to play with a significant MCL injury. Of course you can argue that any mild MCL is a significant issue for a defensive back. However, if the MCL was medically graded as mild (even though the coach described it as significant), that will be the loophole that allows the Seahawks to escape league penalties.

MMMD 5: Zach Orr gets lucky

Unfortunately the Ravens budding star linebacker was forced to medically retire from football. In reality, Orr is quite lucky. He has a dangerous congenital C1 condition that was discovered after a routine work up for a stinger.

He had unknowingly played his entire career with the potentially deadly problem. One wrong hit and a C1 problem could easily be fatal and there is no reason to take chances.

In the end, Orr is lucky to have discovered the issue and that he didn’t play one play too many. That is the bright side of this unfortunate situation.

MMMD 6: Pro Bowl replacement season

This is the annual ritual where players tap out due to injury. The Pro Bowl game is always a game of musical chairs to the point that it is hard to keep up.

Alex Smith and Dustin Colquitt are now in. Jadeveon Clowney, among others, is out. With the game now the week before the Super Bowl, Conference Championship winners will all be out, while many of the losers will choose not to attend.

Also this week, many offseason surgeries were announced. Andrew Luck had a clean up throwing shoulder procedure. Meanwhile, Sammy Watkins finally had his much anticipated second foot surgery.

MMMD 7: ProFootballDoc scorecard

Sammy Watkins finally had the second predicted foot surgery. Ladarius Green missed as expected. James Harrison, Jordy Nelson, Davante Adams, Morgan Burnett, Julio Jones, Chris Hogan and Martellus Bennett all played as expected. Le’Veon Bell did not return. Alex Mack did injury his left ankle.

I was wrong in too hastily opining on T.J. Lang’s injury with only one view.

This slightly lowers the 203-10 (95.3%) record to 214-11 (95.1%).

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Monday Morning MD: Who is healthy for the Championship Games?

Not all ACL surgeries go smoothly. Even ones done by renowned orthopedic surgeons can go wrong.

After tearing up his knee last year, Dion Lewis flew to seek out who he thought was the best to perform the procedure but still had a serious complication. After his initial surgery, his kneecap developed a fracture from

Not all ACL surgeries go smoothly. Even ones done by renowned orthopedic surgeons can go wrong.

After tearing up his knee last year, Dion Lewis flew to seek out who he thought was the best to perform the procedure but still had a serious complication. After his initial surgery, his kneecap developed a fracture from where the ACL graft was taken. He needed a second surgery with screws in his patella and missed a majority of this season.

The Divisional Round was his come back party. Lewis triumphantly scored three touchdowns in three different ways: receiving, rushing and special teams. He was a passing TD away from a historic cycle.

At the start of the season with Lewis missing, there were many questions why the Patriots could not get their star RB on the field. As I have always said, the truth comes out eventually. In fact, given the surgical complication, Lewis has made a tremendously quick recovery.

Medical staffs and especially team physicians are quick to get the blame. Their names are rarely mentioned when credit is due. When a second opinion doctor performs the surgery, their name is often announced with the obligatory proclamation that “surgery was successful”. When the team doctor does it, it is usually done in anonymity. In many ways the medical team is like offensive lineman or long snappers. Their names are often mentioned with blame but rarely with kudos.

I am glad this story has a happy ending but it serves a reminder that there is always risk in surgery and despite everyone thinking that return from ACL surgery is routine, there are definite pitfalls along the way.

Here are how the teams look from a health perspective headed into the Championship Games as well as the medical rundown.

MMMD 1: Packers injury outlook

The Jordy Nelson good news is that he has no organ damage, did travel to the game, and was on the sidelines. The bad news is he was moving very gingerly and I saw him clutching his ribs as he congratulated players on the first touchdown. Reports also said his current goal was to breathe normally again. With a week to go there is a chance, but far from a guarantee, that Nelson would play. If Green Bay gets to the Super Bowl, he would have an excellent chance of playing.

Morgan Burnett appeared to have a quad contusion. If the Packers can control swelling and maintain flexibility, he has a chance to play next week.

By video, David Bakhtiari suffered a mild right knee MCL sprain. He returned after being taped/braced. He should be fine moving straight ahead but likely will have some limitations side to side.

Slow motion showed DeVante Adams with a mild left high ankle sprain. He was taped and returned. Careful here with the swelling. I would expect a post-game boot and some missed practice but that he would try to go next week.

LaDarius Gunter appeared to have the wind knocked out of him and finished the game. I don’t seen any issues with him being 100%,

MMMD 2: Falcons injury outlook

Julio Jones left with a foot injury late in the game. The presumption is a re-aggravation of his turf toe. His coach said he could have continued but was pulled for the score. Jones will likely be limited in practice this week. This bears watching but the hope is Jones will be just fine.

Adrian Clayborn was reported to tear his biceps tendon at he elbow. Normally that is a season-ending injury that requires surgery. If Clayborn and the Falcons want to pull out all stops, he could try to play and have surgery after the season. It would be hard due to pain/swelling to play in the Championship game but he could play with some flexion and supination weakness in his elbow for the Super Bowl. Before you say this is far-fetched, ask Terrell Suggs. He played thru the second half of this season with a biceps tear.

MMMD 3: Patriots injury outlook

Chris Hogan appeared to have a thigh bruise and with good medical care should be good to go for the Championship Game.

Martellus Bennett survived a hyper-extension injury scare to finish the game and should be healthy.

Danny Ammendola continues his recovery from a high ankle sprain and another week should improve that.

MMMD 4: Steelers healthy

Big Ben is fine. The ankle scare when he was seen with a boot post-game last week is long behind us. As expected it was purely precautionary and he played and moved well.

Hope no injury news pops up as sometimes happens, but right now the big news in Pittsburgh is all about Antonio Brown’s social medial locker room post.

MMMD 5: Head coach younger than player

The Rams have a very young team but new head coach Sean McVay (age 30) is still younger than one player on his roster and the same age as two others. I am not sure what the NFL precedent is for this.

I don’t think this will be an issue. In my first eight years as a NFL team physician, there was at least one player on the team younger than me. That was an oddity but never an issue other than perhaps locker room banter.

MMMD 6: Will medical staff move with the Chargers?

Typically, the athletic training staff moves with the club. The doctors usually do not. NFL physicians all have full-time practices outside of the team that account for the majority of their income. With the move to Los Angeles, the UCSD medical sponsorship and the local team physicians will certainly change.

MMMD 7: Injury rundown

Chief WR Chris Conley took a vicious penalized hit to the head, yet returned to the game. Another example of how concussions cannot be judged by video. By the eye test, he certainly should have been removed from the game but the independent doctor allowed his return after examination.

Seattle CB DeShawn Shead likely tore his ACL. Unfortunately, that means surgery and starting next season on PUP.

Seahawk Germain Ifedi by video suffered a left high ankle sprain but will have plenty of time to recover for the offseason program

Jimmy Graham has made everyone forget about his patella tendon rupture playing very well at season end.

Mike Zimmer is just being honest on Bridgewater when he says “We don’t know when Teddy will be back”. Video posts show progress in rehab but he is a long way from a full return. A knee dislocation is among the severest of injuries.

MMMD extra: ProFootballDoc scorecard

I was on vacation with the family so I did not have my usual video capabilities in the hotel but thanks to the extra cameras and playoff coverage, many great replays were shown allowing me to still provide some input.

Davonte Adams returned from left high ankle sprain. David Bakhtiari returned from a mild MCL sprain. LaDarius Gunter avoided injury from a bad looking hit. DeShawn Shead appears to have torn his ACL.

C.J. Prosise did not play as expected and neither did Jordy Nelson. Big Ben’s foot/ankle was a non-issue. Blake Martinez was limited with his MCL.

This improves the 203-10 (95.3%) record to 211-10 (95.5%)

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Monday Morning MD: Who is healthy for the Divisional Round?

Will Big Ben or Jordy Nelson play this week? How will injuries play a role in who moves on to the Conference Championships?

Ben Roethlisberger made the collective hearts of Steelers Nation stop when he showed up at a post-game press conference in a boot. He injured his right ankle/foot on the final interception with

Will Big Ben or Jordy Nelson play this week? How will injuries play a role in who moves on to the Conference Championships?

Ben Roethlisberger made the collective hearts of Steelers Nation stop when he showed up at a post-game press conference in a boot. He injured his right ankle/foot on the final interception with 4:34 left to go in the fourth quarter up 18 points trying to extend a play. Big Ben was rolled up on with a plantar flexion sprain to his right ankle/foot. This is not a dreaded high ankle or Lisfranc sprain. Walking boots are commonly used as a precaution to help control swelling and will likely come off shortly. The Steelers QB may even skip a practice or two, adding to the drama. Recently, Roethlisberger has played through a meniscus tear, Lisfranc sprain and separated shoulder. I am expecting he is more hurt than injured here, thus Big Ben will undoubtedly be healthy and mobile when they face the Chiefs, but whether he has Ladarius Green as a target is up in the air due to concussion symptoms.

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Jordy Nelson took a helmet to the left lower postero-lateral ribs and did not return. Not only is there worry for rib fracture, there is some concern for internal organ injury. He left the field on a cart with a primary care physician (not orthopedist). If there is a fracture (and there may be more than one), it will be difficult to play in Dallas this week for not only the pain, but the risk of injury to his spleen/lung/kidney. Without a fracture, Nelson might have a chance to play with medication/rib block and a flak jacket.

In other Packer news, Ty Montgomery who had recent ankle issues and was twisted up awkwardly and limped off the field. He returned to finish the game. By video, LB Blake Martinez injured his MCL. He had a similar injury in November. He could play and run well but would have trouble cutting.

Tom Savage has a good chance to get cleared from his Week 17 concussion but would still be the back up as Brock Osweiler has already been named the Texans starter.

Danny Ammendola returned to practice for the first time since the Week 13 apparent high ankle sprain. I expect him to be near 100% given he has had six weeks to recover by the time the Patriots kickoff.

The Cowboys should be at full strength with Tyron Smith coming off a mild MCL sprain and Morris Claiborne finally returning to action after a groin avulsion injury in Week 8.

I expect both Justin Houston (knee) and Spencer Ware (ribs) to both give it a go this week for the Chiefs.

Russell Wilson shed his knee brace and looks to finally be himself after knee and ankle issues for most of the season.

Let’s hope we see all players at full strength and may the better team win.

MMMD 1: Should Matt Moore have been pulled?

The Dolphins QB took a ferocious and penalized hit to the jaw. The internet was abuzz with outrage that he was returned to the game after missing just one play and thought that he could not have been properly checked for concussion.

I took a stopwatch to the sequence of events. With the prolonged time tending to Moore on the field and the adjudication of the multiple penalties, there was exactly five minutes of elapsed time between the hit and his next snap. If play had resumed immediately, Moore would have missed a handful of plays or more. He only missed one play due to the protracted stoppage.

Typically a sideline concussion screen only takes about two minutes. If positive, a full locker room evaluation takes approximately 10 minutes. The league appointed Unaffiliated Neurotrauma Consultant (UNC) was seen taking an active role. Remember, this is a local Pittsburgh area physician (who is likely a Steelers fan) and I would find it hard to believe he was influenced by the Dolphins’ desires to keep Moore in the game.

A hit to the jaw can cause a concussion. After all, that is why mouthpieces can decrease head injury risk. However, Moore was hit with more of a rotational force to the jaw torquing his neck and thus may have escaped concussion symptoms.

I don’t know the details of how the medical decisions were made but here is another reason for transparency. Referees are questioned by a pool reporter after the game. Why not let the UNC speak as to what he saw and what the medical thinking was? This would not be a patient privacy violation as the UNC is the league observer and is not there to treat the player and thus HIPAA would not apply.

MMMD 2: Changing of the guard?

Some are proclaiming Jadeveon Clowney as the new Texans defensive leader. Certainly he played well and with a skinny J.J. Watt in street clothes on the sideline, that was an easy narrative as we are prisoners of the moment.

Don’t count Watt out yet. First, the team is just being cautious after the second disc surgery. Second, I expect a full recovery, as disc surgery does not typically end careers. Third, it is easy for a workout warrior to lose muscle mass quickly but it is also relatively easy to regain weight with the start of lifting, if you have been that big before.

Expect a double-headed monster for the Texans defense next year, not a passing of the torch.

MMMD 3: Tyrod Taylor contractual controversy?

The Buffalo QB underwent sports hernia surgery as expected. The Bills announced Taylor “elected” to have the procedure. Is that wording posturing for the looming $27.5 million March contract guarantee?

Typically core muscle surgery takes 6-8 weeks to return to play but three months to be 100%. The March date comes in between this timeline.

By contract, the team physician will be the one to determine if Taylor is healthy. This does present a potential conflict. When I was a team doctor, I avoided these situations by asking the team to never inform me about the business side. It was my job to get all players healthy as soon as possible. The best player needed to be healthy to get on the field and the worst player on the team needed to be healthy to get released to make room for roster improvement. I did not want to be influenced by factors other than my medical judgment.

I hope the Bills ownership and Taylor can get on the same page

MMMD 4: Injury rundown

Dominique Rodgers-Cromartie suffered a thigh bruise early against the Packers. With a quad contusion and stiffness, it is hard to run and play cornerback. The challenge to get and stay loose was made harder in the cold and he was thus ineffective.

Jason Pierre-Paul will return to be 100% from his sports hernia surgery but there is no rush anymore as the Giants were eliminated.

Donald Penn reportedly has a small fracture in his knee but will not need surgery.

Ryan Tannenhill did not return from his ACL/MCL sprains. The MCL heals with conservative care but do not be surprised if surgery is announced for his ACL.

Jay Cutler’s shoulder labral surgery is recovering well. Whether the Bears will keep, cut or trade their QB, they need him healthy as soon as possible for all three potential reasons.

Trevor Siemian had left shoulder surgery. He finished the season but it is not unusual to have clean up procedures. This is why the end of the season is the busiest medical time of the year.

Terrelle Pryor had finger ligament surgery and is expected to have a full recovery.

Sammy Watkins finally is having his much anticipated second Jones fracture surgery. This time, likely bone graft and a larger screw will be used. Dez Bryant and Julian Edelman had similar second surgeries last offseason and recovered well.

Matthew Stafford will not need surgery on his mallet finger. The extensor tendon heals well with immobilization.

MMMD 5: Coaches union?

Brandon Marshall said, “It’s time for our coaches to unionize. We’ve had four coaches in the hospital this year. If people understood how many hours, and what it takes to be a head coach, how many hours they put in, it would be an issue.”

Perhaps instead of a union, it could be a competition committee issue. Even if hours were limited, coaches would take work home. However, that is still better for their health than long hours at the office.

MMMD 6: Jaylon Smith back in the news

The Cowboys high second round pick says he is still recovering and wearing his ankle foot orthosis (AFO) but can run a 4.5 40-yard dash.

I appreciate Smith’s optimism but I have never seen anyone in the NFL play with an AFO. Mike Ryan, a long-time NFL athletic trainer and now sports medical analyst for NBC, concurred.

A tendon transfer is not the answer either as those procedures are done to help everyday people to walk, not get around the corner to rush a QB.

I wish Smith the best and hope he can make history.

MMMD 7: ProFootballDoc scorecard

Matt McGloin was available but the Raiders played Connor Cook. Tom Savage was not cleared. Ryan Tannenhill was not ready to go. There was no way for Derek Carr to even travel to the game. Matt Forte did have a knee scope. C.J. Mosely had a calf strain and no surgery needed. JPP did not return. Tyrod Taylor and Sammy Watkins did have surgery as predicted. Jordy Nelson injured his ribs. Ty Montgomery is OK and returned. DRC had a quad contusion.

The previous 191-10 (95.0%) record is now 203-10 (95.3%).

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Monday Morning MD: Smart to sit?

To play or not to play was the theme of the week for both college football and the NFL. Leonard Fournette and Christian McCaffrey ignited debate when they decided to skip their college bowl games to prepare for the draft. Meanwhile the Cowboys and Steelers rested their stars in meaningless games as other teams played

To play or not to play was the theme of the week for both college football and the NFL. Leonard Fournette and Christian McCaffrey ignited debate when they decided to skip their college bowl games to prepare for the draft. Meanwhile the Cowboys and Steelers rested their stars in meaningless games as other teams played their starters.

Medically speaking, it is certainly smart to sit as it is the only way to avoid injury. McCaffrey’s teammate, Stanford QB Keller Chryst appeared to tear his ACL. Michigan’s high draft prospect TE Jake Butt tore his ACL which will affect his draft stock as there is no guarantee he will be ready for the start of the next season.

The key is what do the 32 NFL general managers think of the decision to miss bowl games. The natural question is: are they “me” guys more than “team” guys?

Sometimes the decision to miss the bowl game is clearly smart. Michigan’s Jabril Peppers was better off not playing for risk of making his hamstring injury worse and effecting his Combine as well as potentially being downgraded for not playing up to par.

On the other hand, not playing sometimes hurts. Florida State’s Dalvin Cook had a spectacular bowl game performance, which may have catapulted him to the top of the RB draft board. Meanwhile, Fournette could not respond to reclaim his top status as he had elected to sit.

NFL decisions to sit are made by the team not the individual player like in college. Weighing the potential of injury versus momentum/continuity is the playoff team’s dilemma. The Raiders clearly needed Matt McGloin to play to get more snaps but unfortunately he was injured.

If the argument is to always sit for meaningless games then the majority of the NFL would not play as most Week 17 contests had no postseason implications. In retrospect, the Cardinals probably wish they had sat David Johnson (details below).

There is precedent for NFL players to choose to skip meaningless “bowl” games. It is common for professionals to pull the injury card to skip out of the Pro Bowl. Tyler Eifert injured his ankle during the all-star game last year and needed surgery. He now says even if selected, he is never going back.

The bottom line is many things factor into a “play or sit” decision for the individual and teams. I certainly can’t argue with a player’s right to decide or a team’s necessity to strategize.

MMMD 1: Another QB concussion controversy?

Questions arose after Tom Savage was returned to play and then pulled due to concussion. It certainly looks fishy when the Texans QB is cleared and the head coach says at halftime he will play but he is re-evaluated and pulled from the game.

In reality, it is common to be fine and develop later concussion symptoms. It is routine for doctors to perform serial exams. Likely Savage had a routine re-check at halftime and doctors decided to pull him.

This is another reason that I have lobbied for more transparency. Why not let the doctors speak or at least issue a statement? Even referees are interviewed by a reporter post game. Understanding what happened would help clarify these situations and help dispel the distrust the public and media have for the NFL when it comes to concussions.

MMMD 2: Playoff QB injuries

With Savage in the concussion protocol, Brock Osweiler will be the likely Texans starter for the Wild Card round. The majority of head injuries are not cleared in one week. This will be a short week with the game on Saturday. Even if Savage was cleared late in the week, he would still miss practice snaps important for a first time starter.

Matt McGloin left the Raiders game with an apparent left AC joint sprain and later reports of trap muscle issues. It appeared that McGloin was not happy he was replaced and he was in uniform on the sidelines for the second half. It will be interesting to see if Connor Cook gets the playoff start and how much of this is coaching decision versus purely injury.

Matthew Stafford’s injury appears to be a mallet finger. I have suspected this by the type of splint but media had only reported dislocation with torn ligaments. A mallet finger is a tear to the extensor tendon at the tip of the finger and requires full-time immobilization in extension for six weeks or there is risk for surgery. Stafford can play through without long-term implications but a mallet finger injury is significantly harder to deal with than a finger dislocation as it affects his grip since he is not allowed to bend the tip of his middle finger. This could explain his declined performance post injury.

David Carr reports that brother Derek’s ankle ligament was not torn and the fracture was already healing. That may be a lay person’s interpretation but no way a bone starts to heal in three days. Also when your knee points “north” and your toes point “east”, the syndesmotic ligament is torn even before the fracture happens. Derek Carr will be back at 100%, but no way it will be in time for a potential Super Bowl appearance.

Ryan Tannenhill seems to be getting closer to playing but I think it will be beating the odds for him to be the Dolphins Wild Card round starting QB. Even if it is just a grade 2 MCL, it is a stretch to go from a cast and a crutch to playing NFL football in three weeks.

Aaron Rodgers seems to have put any worries about his calf strain and hamstring injury behind him. He moved and ran well during the Packers win to seize the NFC North crown.

Tony Romo played in a real game for the first time in over a year. He is completely healed and at no further risk for injury. What a luxury for the Cowboys to have an experienced back up like Romo.

MMMD 3: David Johnson escapes horrific injury

By video, many feared the worst for the Cardinals star RB. Fortunately, it seems to be the best-case scenario for Johnson with only a significant MCL injury with his ACL spared. He is unlikely to need surgery and should be healthy for the offseason program.

MMMD 4: Jets medical staff blamed

Muhammad Wilkerson appeared to criticize his team’s training staff for not having a plan as he returned from ankle surgery. He did acknowledge his responsibility in the process as well.

There is no question that hindsight is 20/20 and that medical staffs can look back and wish they had approached an injury differently. However, it is unusual to call out a teammate and indeed the athletic trainers are looked upon as teammates.

Undoubtedly the medical staff was consulted before Wilkerson was offered an $86 million contract while he was injured this offseason. If anything, he should thank the trainers and doctors for vouching for his ability to recover.

MMMD 5: Decreased injuries with more touchbacks?

The rule change to place the ball on the 25-yard line has decreased kick-off returns but has it reduced injuries? Bill Belichick cited the Broncos Kayvon Webster’s concussion as an example of how the new rule has not worked. Sometimes injuries can happen when covering teams ease up as they see the runner kneeling down, but blockers don’t know the play is over. Full speed versus half speed will result in injury.

I am eager to see the season long statistics on this rule change. The NFL usually releases this type of injury data during the Super Bowl week health and safety press conference..

MMMD 6: Non QB Injury rundown

Vic Beasley left shoulder “popped out” but he returned to finish the game with a brace. Don’t be surprised if he needs offseason surgery similar to what he had on the right side last year.

Zaire Anderson was placed on a spine board after a head down hit. Fortunately he was released from the hospital.

Donald Penn left the game with a knee injury but returned. He will likely play against the Texans on Saturday.

C.J. Mosely was carted to the locker room but I do not expect a serious left leg injury.

Sammy Watkins injured his hip that he had surgery on in 2015. The hip does not appear to be severe but he will need to address his 5th metatarsal lingering fracture which may need a second surgery to heal properly.

Quinten Rollins was placed on a spine board for head/neck injury but early reports indicate that he will be OK.

DeMarco Murray played with a plantar plate injury this season to become the leading AFC rusher. This is essentially a turf toe injury. He will avoid surgery unless the plantar plate is retracted.

Ryan Kerrigan exited with left hand/finger injury

Ty Montgomery left the game briefly with and ankle issue but returned to be effective.

Tyrod Taylor has a groin injury and don’t be surprised if he elects to have a sports hernia surgery.

Tyler Eifert had back surgery. It has been a rough year after his ankle surgery from the Pro Bowl injury.

Tyron Smith sat out with a mild MCL from last week where the knee brace may have saved him form more severe injury.

MMMD 7: ProFootballDoc scorecard

Only a few injury first takes this week as I was on vacation with the family in the mountains and did not have my usual set up and access to all videos. David Johnson fortunately with only MCL sprain. McGloin has an AC joint sprain and trap spasm. Quinten Rollins neck was OK. Tyron Smith did have a mild MCL.

Last week’s 187-10 (94.9%) is now 191-10 (95.0%).

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Monday Morning MD: Derek Carr and Marcus Mariota with similar season-ending injuries

The leader of the Raiders and Titans both were announced to have suffered broken fibulas. Unfortunately by video, the injury is more than just to the bone. Both were felled by the severest form of high ankle sprain where the syndesmotic ligament (holds the fibula and tibia together) is torn before the fracture even happens.

The leader of the Raiders and Titans both were announced to have suffered broken fibulas. Unfortunately by video, the injury is more than just to the bone. Both were felled by the severest form of high ankle sprain where the syndesmotic ligament (holds the fibula and tibia together) is torn before the fracture even happens.

Essentially both injuries are considered ankle fracture-dislocations where the talus (ankle bone) shifts out of place. The need for surgery is not for the fibula fracture as much as to reposition the bones due to the ligament tear.

Derek Carr was reported to be having surgery on Christmas Day, but was delayed due to holiday staffing issues and he is now reported to travel to Los Angeles for the procedure. Marcus Mariota was set to have surgery in the next few days after injury. The procedure is not an emergency and can be done in the first week or two.

The initial urgency for Carr’s surgery may have been born out of a desire to keep any slim hopes of a Super Bowl 51 return alive. Assuming the Raiders make it to the big game six weeks away, it would still be a considerable stretch to think that Carr would perform anywhere near his MVP candidate level. This is not just an issue of bone healing but one of the ligament and associated structures as well. Typically, this injury carries a six-month recovery, thus reports of earlier return seem optimistic to me. To cite the Charles Woodson or Terrell Owens early Super Bowl return from ankle fracture would be unfair comparisons as there is a dislocation component here for Carr.

The good news is that this is not a career-ending injury and both should return to essentially 100%. A good example is Darren Sproles who had a similar injury/surgery 10 years ago and continues to perform at a high level and is still known for his quick cuts as a running back. Both quarterbacks should be ready for the start of the 2017 season.

MMMD 1: Another broken leg

Tyler Lockett suffered a gruesome tibia and fibula fracture (graphic video here). Teammate Earl Thomas broke only his tibia and did not need surgery. Lockett broke both bones and likely has an open fracture with the description of blood immediately on the field.

This fracture is very unstable and requires early surgery. Fortunately the Seahawks were in Seattle, otherwise Lockett would have needed surgery before flying home.

Despite how horrific the injury seems, this is not a career-ending injury. Many others, including Patriots fullback James Develin last season, have made full recoveries. This is a similar injury to NBA’s Paul George and UFC’s Anderson Silva who both have returned to their sport. Lockett may not be ready for the start of the season as there is typically a 6-9 month recovery.

MMMD 2: Earl Thomas returning

Thomas likely suffered a non-displaced isolated tibia fracture and thus did not need surgery. He contemplated retirement at the time.

Medically, this was not an injury that ends careers. I would not begrudge any athlete who chooses to retire as I agree one needs to be “all in” to play effectively.

Fortunately for us as fans, Thomas has decided to return next season. Since he tweeted retirement thoughts on his twitter account immediately after the injury, it was appropriate that he used twitter to announce his return.

MMMD 3: Play or sit?

Christian McCaffrey and Leonard Fournette started much discussion with their decision to skip bowl games to prepare for the draft. Skipping games is a precedent that already exists in the NFL. Many players choose to miss the Pro Bowl. Tyler Eifert hurt his ankle there last year and needed surgery, which affected his season. He would not go back if asked.

Now the discussion of play or sit turns to the teams that have clinched post-season spots. For example, should the Cowboys sit their stars for rest and/or injury protection or keep momentum going? Does the season-ending injuries to Carr and Mariota make it more likely we see Tony Romo over Dak Prescott to finish the regular season?

MMMD 4: Return to play decisions

A.J. Green is unhappy he was not allowed to play. He made the trip to Houston for the Christmas Eve game with the expectation to suit up, while other injured players stayed behind.

Green was pulled from a team meeting and informed of the ownerships decision to not risk further injury and he subsequently flew home. The decision was based on fear that the tendon portion of the hamstring injury had not fully healed and further damage might mean surgery.

Return to play is always decided by a unanimous vote between the player, medical staff and the team. It is clearly within the ownerships rights to withhold the player, but perhaps communication of that intent prior to travelling to the game would prevent any hard feelings.

MMMD 5: Team doctors care for more than players

Todd Bowles was treated for kidney stones and gall bladder issues. With Gary Kubiak (complex migraine) and Mike Zimmer (retinal detachment), that marks the third head coach to be hospitalized this season which is a higher rate than for players.

Line Judge Sarah Thomas was knocked down and taken to the locker room. She did return to finish the Vikings at Packers game.

Head coaches and all team staff are cared for by team physicians. In fact, coaches’ physicals is a big part of a team doctor’s job. On game days, the home team medical staff is responsible for providing care to the game officials.

MMMD 6: Injury rundown

Aaron Rodgers left the game briefly with a stinger. This should not be a major deal if the Packers protection holds up. The calf injury seems to have progressed nicely.

Ryan Tannehill came out of his cast which is certainly good news. Still with the partial ACL/MCL injury, he may not be ready to go for the wildcard round.

Jay Ajayi fell on his left shoulder in overtime suffering a likely AC joint sprain that is hopefully mild and won’t have him missing time.

Carlos Hyde injured his knee and will be done for the season. MCL sprains do not typically need surgery and he will be healthy for the off-season program.

Justin Houston sat out, proving again that even though players return well from ACL surgery, the second season back is the fully healthy one.

Robert Griffin III left with a concussion but the Browns notched their first victory.

Jordan Reed did not play with his grade 3 AC separation which is usually a six week injury.

Ryan Matthews is reported to have a herniated disc in his neck. Even if he needs surgery, return from single level cervical discectomy/fusion is reliable in the NFL.

Derek Wolfe left with a neck injury that has plagued him in second half of this season.

Kayvon Webster was blind-sided, but riding off in the passenger seat of the cart is a great sign that his spine was OK. Of course his head injury will need evaluation.

MMMD 7: ProFootballDoc scorecard

Unfortunately the significant injuries to Derek Carr, Marcus Mariota and Tyler Lockett were easily seen on video. Will Gholston did dislocate his elbow missing this week. Kayvon Webster suffered a concussion but was spared neck or back injury. Earl Thomas will play in 2017 as expected.

The previous 181-10 (94.8%) record now improves slightly to 187-10, a 94.9% accuracy rate.

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Monday Morning MD: Injury decisions not made in a vacuum

How long before a grade 2 MCL sprain to return to play? The answer depends on many circumstances and the medical status is not the only factor in the decision. Obviously the sport, position, type of player, associated injury, time of season and many other factors come into play. At this point of the year,

How long before a grade 2 MCL sprain to return to play? The answer depends on many circumstances and the medical status is not the only factor in the decision. Obviously the sport, position, type of player, associated injury, time of season and many other factors come into play. At this point of the year, a team’s record and playoff position factors into return to play.

If the Dolphins were out of the playoff race, surely there would not be talk of Ryan Tannehill returning with an ACL/MCL sprain. Adrian Peterson accelerated his meniscus repair rehab to try to bolster the Vikings fading division chances. The Packers rested Aaron Rodgers during the week but they roll the dice on his calf and hamstring come game time to chase down the Lions. Sammy Watkins continues to suit up with a reported broken foot with the Bills still having a small glimmer of post-season hope.

Now that the Bengals are officially out of the playoffs, will A.J. Green still push to return from his hamstring injury? The eliminated Chargers likely will continue to play it safe with Melvin Gordon even though he is only three yards shy of a 1000-yard season.

On the other hand, the Patriots in control of a first round bye, can give Danny Ammendola all the time he needs on his presumed high ankle sprain. The division leading Falcons also take it slow on Julio Jones’ toe sprain.

Of course there are always the old school guys like Matt Forte. His Jets are long eliminated, yet he continues to play through a documented meniscus tear which will likely require surgery at season end.

The bottom line is that decisions on return from injury are never made in a vacuum. This time of year, the team’s standing usually factors into a player’s and team’s mindset and risk tolerance.

MMMD 1: Double good news for Packers

Green Bay continued its resurrection winning their fourth straight game and Aaron Rodgers came through without aggravating the recent calf or previous hamstring injury in the bitter cold of Chicago. His strong arm took over, often throwing off the back foot.

Rodgers looked better than he did with his December 2014 calf strain that lingered into the playoffs. He actually ran on some plays, something he refused to do with a similar injury two years ago. Hope his calf can hold up.

MMMD 2: Doubt the Dolphins can get their QB back

Miami got initial good news of ACL and MCL sprain on Ryan Tannehill but a sprain is a tear. Grade 3 sprains are complete tears. The hope is for lower grade sprains meaning partial tears.

Tannehill is reported to be in a cast with a slight ACL tear. http://profootballtalk.nbcsports.com/2016/12/17/ryan-tannehill-is-in-a-leg-cast-has-slight-acl-tear/ He was seen using a crutch and walking with his left knee immobilized. Unfortunately, this is not the look of someone who will make it back before the end of the regular season.

I hope Tannehill can return. The Dolphins have said no surgery is needed now, but there still may remain the possibility of a procedure after the season. Only on rare occasions does a partial ACL ultimately not need surgery.

MMMD 3: Quick meniscus repair return

Kudos to Adrian Peterson and the Vikings medical staff for a fast three-month return after his meniscus was sutured. He played with a knee brace and was not particularly effective (6 carries for 22 yards) but neither was his team. This is not a knock on Peterson. It is very hard to miss three months of football, practice for three days and play well.

Hopefully he can help salvage the minimal Vikings playoff chances and stay healthy.

MMMD 4: Finger dislocation a regular occurrence

Derek Carr and Matthew Stafford have much discussed finger dislocations since they happened on their throwing hands. Both played reasonably well despite the injury.

When fingers are dislocated, by definition, ligaments are torn. Fortunately they heal and scar in without surgery in most cases.

Finger dislocations happen routinely. Michael Crabtree and Chris Hogan appeared to dislocate fingers recently and finished their games with key receptions. Often players reduce their own finger dislocations or have teammates help out with the reduction without coming off the field.

In my NFL experience, there is probably a finger dislocation every game that we don’t hear about. When it happens to a quarterback, then comes all the attention.

MMMD 5: Ravens with only DOUBTFUL players to play

We covered the ACTIVE rates of QUESTIONABLE players previously. DOUBTFUL players are essentially always inactive. The only three exceptions this season were all from the Ravens: Terrell Suggs, Steve Smith, Sr. and Alex Lewis. If your favorite player is listed as DOUBTFUL, count on him to be out, unless he plays for Baltimore.

MMMD 6: Injury rundown

Fortunately Week 15 seems to be one of the better injury weeks, but there will be the typical late injury announcements to follow.

Janoris Jennkins exited after a teammate’s knee to his back. It was announced there was worry for organ injury, which based on location would be either lung or liver. Hope he is OK.

Will Gholston dislocated his right elbow, but his season is not necessarily over. He is likely to return if the Buccaneers make the playoffs and could play in Week 17 in a brace.

Stephon Tuitt left the game early with a knee injury. By video, there is some worry for a meniscus tear.

Darius Slay left with a hamstring injury and will obtain a MRI.

Lamar Miller hopes to be fine after a late game ankle injury.

Austin Hooper is hoping for the best but fearing the worst on his knee injury.

Matt Forte saw limited action but played with a MRI documented meniscus tear that is likely to need an offseason scope.

Bryce Petty suffered a chest bruise but should be fine going forward.

Melvin Gordon is likely to return from hip/knee injury but not until completely healthy.

A.J. Green’s hamstring is nearly healthy but his team’s playoff chances are done.

Julio Jones initial turf toe diagnosis is now called a toe sprain. He missed his second game but should be back next week.

Danny Ammendola was seen in a boot still, likely meaning his high ankle sprain is still several weeks away, but he should return for the Patriots first playoff game.

MMMD 7: ProFootballDoc scorecard

Here is a quick review of some of this week’s calls. Matt Stafford played with a modified glove and minimal obvious effects from a finger sprain. Jared Cook is OK after a hard fall to ground and played this week despite possible lung contusion. Duron Harmon was not injured but momentarily short of breath. Jimmy Smith left with a high ankle and may be out for a few weeks. Haloti Ngata was not seriously injured and returned after a thigh contusion. Janoris Jenkins took a knee to the back. Will Gholston did dislocate his right elbow.

This slightly improves the 174-10 (94.6%) record to 181-10 (94.8%)

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Monday Morning MD: Tannehill ACL tear preventable?

The Dolphins were victorious staying in playoff contention, yet they lost big when their starting quarterback suffered a serious knee injury. Ryan Tannehill routinely stepped into a throw when Calais Campbell, who may have been pushed from behind, hit the QB’s lead leg.

Miami fears an ACL tear for their star signal caller. By video,

The Dolphins were victorious staying in playoff contention, yet they lost big when their starting quarterback suffered a serious knee injury. Ryan Tannehill routinely stepped into a throw when Calais Campbell, who may have been pushed from behind, hit the QB’s lead leg.

Miami fears an ACL tear for their star signal caller. By video, it was a classic lead leg hyperextension injury, the kind that has ended many quarterbacks’ seasons. Opposing QB Carson Palmer, back in 2006 when he was a Bengal, tore his ACL the same way on a long completion. Tom Brady had a near identical mechanism with his 2008 ACL. I was on the opposing team sideline in 1999 when Trent Green tore his knee ligament in similar fashion, after which Kurt Warner led the “greatest show on turf” to Super Bowl victory.

All of these examples were routine completions where the QB steps into the throw and transfers weight to the front leg on follow through. None of them were broken plays or excessively violent hits, although intentional contact to a quarterback’s legs in the pocket is now illegal for just this reason.

Would a knee brace have prevented these injuries? No one can be sure, but in college prophylactic bracing is largely mandatory on offensive lineman and often the lead leg for the quarterback. Some NFL players use it routinely as well, including Brady after he learned his lesson after his ACL tear.

Studies have shown some ability to prevent ACL tears with knee bracing. However, due to small sample size, there are no definitive statistics on how effective lead leg bracing is on NFL quarterbacks.

I am not definitively saying Tannehill would still be playing had he wore a prophylactic brace. The point is with known injury risk on such a routine play, wouldn’t it make sense to take the precaution? It might even give a QB more confidence to step into throws and keep his eyes up the field. Many quarterbacks, like Joe Flacco, routinely use a lead leg brace after their reconstructive knee surgery, but why not before to prevent the first injury?

The team knows before the MRI. The Dolphins will get the results of imaging to assess associated damage and confirm the tear before the formal announcement is made today. Obviously, Tannehill’s season is over, but there is a likelihood to be ready for Week 1 of 2017. The question is would a brace on the lead leg have saved the rest of this season for the Dolphins QB.

MMMD 1: Lions fans should not panic with QB finger injury

Finger dislocations are common. In my experience, on average, there is one or more a game. However, when it happens on the throwing hand of the star QB, everyone is understandably worried.

By video and reports, Matthew Stafford dislocated his middle finger PIP (proximal interphalangeal) joint. There should be no fracture or tendon injury. With every finger dislocation ligaments are torn, but once reduced, heal well with tape/support and do not need surgery.

This injury should not have a big effect on Stafford. In fact, he stoically never missed a play, but did don a glove afterward to improve grip. Derek Carr recently dislocated his pinky finger and has continued to play effectively (outside of a poor team performance in the cold this past Thursday). Even if a description of mallet finger with tendon injury is true (which does not fit the video), expect him to play through effectively.

Stafford played thru a 2011 broken index finger. If he can play through a fracture, which can be unstable on the 2nd finger, surely he can play effectively on a stable reduced dislocation on a less important for throwing 3rd finger.

MMMD 2: Aaron Rodgers déjà vu?

In December 2014, the Packers QB suffered what seemed at the time an innocuous left calf strain. The injury lingered and bothered Rodgers running ability throughout the playoffs.

Sunday on the third play, Rodgers suffered a right calf injury and although he noticeably limped, led his team to a dominant win. The injury likely was due to compensation for the left hamstring.

Calf injuries tend to linger so this one bears watching. Expect to see Rodgers throw well with his arm strength. He should be able to move in the pocket, but don’t expect Rodgers to take off and run anytime soon, including potentially during the playoffs if the Packers get there. This may be a repeat of the 2014 injury.

MMMD 3: Melvin Gordon hip

A star running back being carted off is always a scary sight. When the injury is to the hip of a young talented recent first-round pick, fears of a Bo Jackson career altering injury flash to mind.

By video, Gordon’s injury has no similarity to Jackson’s other than both were hip injuries. The Chargers RB was injured with extreme flexion, adduction and internal rotational twisting. The end of Jackson’s career was a result of significant axial load trauma instead.

With playoffs out of reach, the Chargers were smart to hold Gordon out pending a confirmatory MRI. I expect a posterior capsular sprain and it will be good to rule out any small avulsion fracture or labral tear.

My guess is that Gordon will return without surgery to get his 1000 yards rushing (he is 3 yards shy), but also expect the team to stop making him the work horse to save him for next year.

MMMD 4: JPP groin surgery

Jason Pierre-Paul was having a resurgent season after his 2015 fireworks injury. Now he is out for an extended period of time. Nowadays, traveling to Philadelphia is a harbinger of core muscle surgery and indeed JPP has a sports hernia fixed.

It would be optimistic to think JPP could come back and be effective unless the Giants made a deep playoff run. The recovery takes 6-8 weeks to return to play but several months to get to 100%. Don’t expect JPP back unless the Giants make a Conference Championship appearance.

MMMD 5: Jamaal Charles return?

Despite the disappointing ACL comeback earlier this season and now two knee surgeries, the Chiefs could get their star RB back for the playoffs. Charles is eligible to return off IR in Week 17.

This is not far-fetched. Both knee procedures were arthroscopic clean ups and the eight week short term IR timeline would fit nicely. Look for Kansas City to have a playoff boost from Charles.

MMMD 6: Injury rundown

Matt Forte left the Jets game early with lateral popping/crunching. His ligaments are OK but a MRI is pending. Don’t be surprised if this veteran has a knee scope when his season ends.

Jared Cook left with a chest injury after a hard fall to the ground. Hopefully there is no pneumothorax and he can return soon.

Chris Harris Jr was chop blocked on his right knee and suffered a MCL sprain. Thankfully his foot was not trapped and the injury appears minor as he returned to play.

Marcus Gilchrist collapsed onto his right knee. Unfortunately, he tore his patella tendon which is harder recovery than even ACL tear.

Su’a Cravens was reported to have a biceps partial tear. If the distal tendon is torn, that could mean season-ending surgery.

By video, Jack Mewhort left the Colts game with a MCL injury and I hope his ACL was spared.

Joey Bosa was evaluated for concussion and later neck injury. I hope this to be a temporary setback for the potential rookie of the year.

Derrick Johnson had Achilles surgery. Medically, this should not end his long and illustrious career.

Brian Cushing is reported to be playing through two spine fractures, which are likely to the transverse process.

MMMD 2: ProFootballDoc scorecard

Cecil Shorts unfortunately did tear multiple ligaments in his knee. Braxton Miller did injure his AC joint. Julio Jones did miss with his turf toe. Trevor Siemian did play with his foot injury. Sammy Watkins and Robert Woods were far from themselves. Derrick Johnson did rupture his Achilles. Charles Johnson did miss time with a hamstring injury.

Melvin Gordon hurt his left hip but it did not appear to serious. Joey Bosa appears to avoid serious injury. Randall Cobb has a mild high ankle sprain and returned. Ty Montgomery appeared to have a stinger. Chirs Harris Jr left temporarily with a mild MCL sprain.

I am documenting an error on Marcus Gilchrist. His season is over but with patella tendon rupture, not ACL tear. I probably should not have opined off only one replay angle.

The previous 161-9 (94.75) record for 2016 is now 174-10 (94.6%).

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Monday Morning MD: Earl Thomas season over

Three weeks ago two stars collided when Earl Thomas tackled Rob Gronkowski in one of the most talked about hits of the year. Now both headline players are done for the year.

Gronk was placed on IR on Friday (details in Item #1 below). Thomas, a leader of the Seahawks “legion of boom”, will soon

Three weeks ago two stars collided when Earl Thomas tackled Rob Gronkowski in one of the most talked about hits of the year. Now both headline players are done for the year.

Gronk was placed on IR on Friday (details in Item #1 below). Thomas, a leader of the Seahawks “legion of boom”, will soon follow suit after his lower leg injury last night.

This time the collision was between star teammates, when Kam Chancellor’s leg inadvertently “karate chopped” Thomas’ tibia bone. He tried to stand on it momentarily but couldn’t, yet refused to be carted off the playing field.

Pete Carroll indicated a “cracked tibia” and mentioned six weeks in his timeline, but Chancellor said it was a fibula but season ending. By video, the truth is somewhere in between: a season ending nightstick tibia fracture (with fibula intact).

The tibia is the much larger weight bearing bone in the lower leg. The fibula is the smaller bone. The recovery for an isolated fibula fracture is non-surgical and approximately six weeks (see Thomas Rawls). The healing for an isolated tibia fracture is about six months and usually means rodding surgery. Because the fibula was intact, the lower leg did not need an immediate fracture splint, yet it is still a serious injury.

Unfortunately, I don’t see a scenario where Thomas could return this season, even if the Seahawks make it to the Super Bowl two months away. Fortunately, he has an excellent chance at full recovery for the 2017 season. Famously, UFC fighter Anderson Silva and NBA star Paul George fractured both tibia and fibula and both made full returns. Other recent NFL players to come back after tibia fracture include Khiry Robinson and James Develin.

Thomas tweeted about possible retirement immediately after the injury. I would never blame a player who makes the decision to hang up his cleats, but the best safety in the league will be back next year, if he chooses to do so.

MMMD 1: Gronk career not over

With his eighth surgery consisting of a low back procedure, some are saying Rob Gronkowski may be done or on serious decline. No question a third disc surgery is concerning, but all were not at the same level (one L4-5 and now a second at L5-S1). Three at one level would beg the need for lumbar fusion, which would end an NFL player’s career. This does not seem to be the case.

The Patriots and Gronk/family are rightfully taking the cautious course. Gronk could return to play at 6-8 weeks post discectomy in time for the conference championship game or Super Bowl, but would not be at 100% until at least 3-4 months. Just like J.J. Watt could come back now after his second surgery on his same disc; however, the Texans are being cautious and looking at the long-term picture.

One can argue any player starts to decline as he approaches the age of 30, but I do not see this as a career ending deal for the 27 year-old superstar. Yes, Gronk will need to be careful and perform lifelong back stabilization exercises and he does risk back pain and degenerative changes long term; however, it would be premature to say his career is over or in decline.

MMMD 2: Hockey injury descriptions?

Julio Jones was described by his head coach as having a “lower body injury”. Normally such descriptions are reserved for the NHL, where a team indication of upper or lower body injury are all that is routinely given.

Although the NFL reports are far from complete, at least it requires a body part and is far superior to the NHL. With the NFL getting rid of “probable” designations, I hope this is not a sign of moving towards even less information.

MMMD 3: Sideline tent

During last week’s Monday night game, there was much intrigue over the Packers structure behind the bench. Cameras followed Aaron Rodgers entering the mysterious canopy causing fans to wonder.

This is simply a medical tent for potential evaluation and treatment. Rodgers entered for privacy to drop his pants to get a hamstring pressure pad wrap.

Several colleges have even bigger versions. I personally wanted to have one when I was a NFL team doctor. Ironically now, I would rather teams not have them as I would rather see what is going on.

Often it saves a trip to the locker room or provides a place to quickly relieve one’s self without running inside.

MMMD 4: Vikings get head coach back

Mike Zimmer had emergency eye surgery and missed his team’s game. This third procedure for a detached retina was likely more than a simple laser and may be his last chance to regain all of his vision. Opthomologists have quoted to me a 25% chance of permanent visual impairment if this surgery doesn’t go well.

Position, stress, airplane restrictions and temporary visual impairment are common. It has been reported that if Zimmer can now fly to Jacksonville for the next game and has resumed coaching duties. Even with the good news, there is no question he will be limited this week in terms of watching film and installing the game plan.

Zimmer and the Vikings should be smart and do whatever it takes to restore his vision as a priority.

MMMD 5: Medical marijuana in NFL?

Seantrel Henderson was suspended for marijuana use that he claimed was used to treat his known Crohn’s disease. The 10 game suspension was confirmed despite the medical reason for usage.

Although recreational and medical marijuana are becoming increasingly legal in various states, it is still strictly prohibited in the NFL. Currently there are no medical use exemptions. If players want this to change, it needs to be a topic for the next collective bargaining agreement (CBA). Don’t be surprised if that happens.

MMMD 6: Injury rundown

Let’s start with positive medical news. Eric Berry beat cancer just over a year ago and now his pick-6 and pick-2 literally won the game for his Chiefs.

Aaron Rodgers was limited but survived without re-aggravating his hamstring, which is tough given the cold weather and poor footing with the snow. If the Packers can continue a playoff push, this injury should be behind Rodgers if they make it to the post-season.

Derek Carr didn’t have any issues with his finger dislocation. He did not use a glove or buddy tape the pinky and lead the Raiders to a decisive comeback win.

Dennis Pitta had a career threatening injury when he dislocated his hip the second time. It took surgery and two years but he is finally back, as he had nine catches for 90 yards and two TDs, his first since the injury.

Clay Matthews and Justin Houston both played through AC joint sprains on Sunday.

Michael Bennett returned to play four and half weeks after his knee scope.

The worst injury of the day belongs to WR Cecil Shorts. By video, he suffered a multi-ligament knee injury which likely involves his ACL and MCL.

The Patriots likely will loose Danny Amendola for some time with a right high ankle sprain, but the hope is to be 100% for the playoffs.

Jason Pierre-Paul by video has a groin strain, which was confirmed.

Sammy Watkins played through his Jones fracture, which has still not completely healed. The Bills targeted him nine times but he only had three catches for 28 yards. At some point, one has to shut him down and have surgery again to get right for next season.

A.J. Green seems to be improving and on course for a late season return from a grade 2 hamstring injury.

Doug Martin limped off with an injury to the left side where the injury was obscured by a pile of bodies, but hoping/expecting that it is minor.

Trevor Siemian did not practice with his left foot injury and missed the start but I think he has a good chance for this week.

Charles Johnson injured his left hamstring and may miss some time.

An abdominal injury is trouble for any kicker and the Steelers replaced Chris Boswell with Randy Bullock temporarily.

MMMD 7: ProFootballDoc scorecard

There were three mistakes this week. They were not bad ones and I could argue that I was at least partially correct but I will take my lumps. There may have been more to Gronk’s injury than the innocuous Jets fall but he is done for the year with a disc injury. Despite the fact the Jordan Reed should return soon from his grade 3 AC sprain, he did miss this week. The Danny Trevathan injury turned out to be an ACL tear.

Jay Cutler’s season is over with labral tear surgery. Ryan Kalil is suffering the same fate. A.J. Green has a multi-week proximal hamstring strain. Daryl Williams has a left high ankle sprain. Steeler’s kicker Chris Boswell abdomen did keep him out. Derek Carr played well despite last week’s finger dislocation. Sammy Watkins does still have a fracture in his foot.

Dont’a Hightower avoided serious injury from a chop block as his feet were not planted. Andrew Whitworth suffered a mild MCL sprain and later returned. Luke Stocker appears to have a left high ankle sprain. Bucs WR Adam Humphries left due to a concussion. JPP had a groin strain confirmed. Michael Crabtree avoided serious injury. Charles Johnson exited with a left hamstring injury. Justin Houston played through his apparent mild AC joint sprain. Michael Bennett took longer than the original 2-3 week return as expected. Danny Amendola was confirmed with a high ankle sprain.

These new additions to the scorecard lower the previous 145-6 (96.0%) record to 161-9 (94.7%).

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Monday Morning MD: Solution for Thursday Night Games

Coming off the biggest Thursday with three Thanksgiving games there seems to be a renewed call to get rid of some midweek contests. Even John Madden is critical saying “it just doesn’t work”. The league is reportedly revisiting the subject to consider ending or limiting Thursday Night Football.

My suggestion that I first

Coming off the biggest Thursday with three Thanksgiving games there seems to be a renewed call to get rid of some midweek contests. Even John Madden is critical saying “it just doesn’t work”. The league is reportedly revisiting the subject to consider ending or limiting Thursday Night Football.

My suggestion that I first wrote about in 2014 is simple. Add a second bye week and pair all teams playing on a Thursday with a bye. This way, there would be 11 days before and still 10 days after.

Playing on four days rest and all of its problems would be eliminated. There would be no more health and safety concerns. Players like Andrew Luck who missed the Thanksgiving game with concussion could then play and improve the competitiveness of the game. There would be no need to schedule only regional matchups to avoid long flights and thus provide more compelling matchups. Teams would be able to install normal game plans and the quality of the product would improve.

Teams look forward to the bye week and there are often complaints that the singular break comes too early or too late. Byes are universally acknowledged to be good for player health and recovery so why not have one in the first half of the season and another in the second?

To alleviate the CBA and scheduling concerns of adding a week to the season, the league could get rid of one preseason game. The money lost doing that would be more than made up for by the TV revenue of an extra Sunday, Monday and Thursday game as well as an extra slate of games in the regular Sunday slots. Currently, it is impossible to follow all the nine or ten early games or the three to four later games and spreading 16 weeks of football over 18 weeks would barely be noticed.

A second bye week was tried in 1993 but that was over two decades ago and the league only had 28 teams at the time instead of 32, so it was like four teams were on a perpetual bye already in terms of scheduling.

Heck, if this happened, the league could even add a Wednesday night game and there would be no short week issues.

The bottom line is, I believe players would be in favor of adding a second bye and pairing Thursday games as long as it didn’t lengthen the season. Owners will be for it as there would be more dollars to be had. Fans would get one more week of meaningful football. In the end, this is a rare opportunity for the NFL to improve safety and increase revenue at the same time.

MMMD 1: Derek Carr finger dislocation

Finger dislocations are commonplace in the NFL. Often players will put their own fingers back into place without even running to the sidelines to seek medical help. Most linemen tape their fingers to help prevent dislocation. Most of us have seen the gnarled finger joints of ex-players.

Derek Carr’s right fifth finger dislocation brought lots of attention as it was publicly visible, resulted in a turnover, he ran off the field with pain, everyone always notices the quarterback and it was on his throwing hand.

By video, it was a pinky finger dislocation without associated fracture. The PIP joint is the most common one dislocated and once reduced is stable. Carr did go to the locker room for likely X-rays, tape/splint support, medication/treatment and returned with a glove to lead the Raiders to victory.

Although he will be more sore and swollen after the game, Carr will play next week against the Bills. There may be some practice time and game modification but he should still perform well. Note that Carr lined up in victory formation from the pistol, likely to avoid the pain from a direct under center snap on his top dominant hand.

MMMD 2: Brady and Gronk

Both Tom Brady and Rob Gronkowski started the game as expected and the Patriots were lucky to escape the Jets with a win.

Gronk chest issue and presumed pneumothorax was not a problem but he did leave the game early due to a back issue after a diving attempt at a pass. He did not return and was seen after the game walking stiffly and needing to use handrails on steps. By video, this is not a recurrence of disc herniation that has necessitated previous surgery. Back spasms can be tricky and this hopefully remains a short-term setback.

Brady seemed to be off his normal game throwing high several times. He was clearly bothered as the Patriots QB even supported and favored his right knee as he sat down on the bench. I don’t think this is related to the Kam Chancellor hit to the thigh from two weeks ago. In any case, I expect this to be a relatively minor issue going forward.

MMMD 3: Jordan Reed plays through severe AC injury

The Redskins TE returned from a grade 3 acromial clavicular joint sprain to accumulate 10 catches and two touchdowns. After going down hard on his left shoulder, Reed was seen with a sling on. However, with some treatment and medication, he returned for a big second half.

The bad news is that multiple ligaments around the end of the collarbone are torn causing significant pain, presence of an obvious deformity with a visible bump and he will miss significant practice time. The good news is Reed is unlikely to miss games, although he will have to play through pain despite the help of medication. The next game is the hardest as swelling sets in post-game. Ironically once the swelling subsides, a more severe grade 3 injury looks worse but is less painful than a less severe grade 2 sprain as the end of the clavicle is riding so high it no longer rubs against the acromion to cause pain.

MMMD 4: Both Justin Houston and Von Miller dominate after ACL

The Sunday Night Game featured two great pass rushers recovered from ACL surgery. Von Miller had a 2014 ACL surgery and Justin Houston is only 10 months out from reconstruction. Miller had 10 tackles (9 solo) with three sacks and four tackles for loss. Houston matched those numbers with 10 tackles (10 solo) with three sacks and five tackles for loss. Miller is the NFL season sack leader and Houston might be challenging for the lead if surgery on his November knee injury wasn’t delayed until February.

MMMD 5: Harvard player health study

The NFLPA has funded a Harvard study on NFL player health. The report was released last week including the top 10 recommendations.

The best recommendation is for the NFL and NFLPA to stop using health issues as bargaining chips in the CBA negotiations. The most obvious are that all involved should follow a code of ethics and continue to collect/study injury data. The least game-changing is the suggestion that players be supported in their right to a second opinion as that is already the case and second opinions are very routine.

The most controversial recommendation is the use of “player’s medical staff” not hired or reporting to the team. I see the potential ethical concerns but in reality they are not there. Just like this study has potential bias because it was funded by the NFLPA, doesn’t mean it is biased. If Dr. James Andrews can serve as a Redskins team physician and yet be considered ethical and above reproach, so can other team doctors. Besides a system of independent doctors would be very cumbersome and result in many delays. For example, I don’t see how Derek Carr or Jordan Reed return to play with their injuries this week under such a system. Of course you can make the argument they shouldn’t have, but I think both Reed and Carr would object to that.

MMMD 6: Injury rundown

LeSean McCoy played well as expected despite having surgery to relocate his thumb six days ago and rushed for 103 yards with 2 touchdowns and two catches for 31 yards. https://twitter.com/ProFootballDoc/status/802987411143725056

Justin Houston, by video, suffered a mild left AC sprain when he caused the safety, but returned quickly to the game.

Odell Beckham Jr. had a thumb injury that did not seem to slow him down much.

Luke Willson was said to have a mild knee sprain, which was not the same side as earlier this year.

18 months ago, some feared Jason Pierre-Paul’s career was over due to the fireworks injury. Instead, on Sunday he had 3 sacks and fumble return over 40 yards for a touchdown, a first in the NFL in over four decades.

By video, Jordan Richards, Patriots safety, had a mild MCL. Luckily his knee was flexed and he avoided more severe injury and returned to play.

The mechanism for Danny Trevathan’s knee injury is likely to result in a right ACL tear.

Martellus Bennett seemed to re-aggravated right high ankle sprain that has bothered him since Week 5 but continued to play.

Derek Wolfe returned in three weeks with a brace and avoided elbow surgery for a fractured coronoid process.

MMMD 7: ProFootballDoc scorecard

LeSean McCoy played well despite his thumb. He performed better than Sammy Watkins who was also active. Tom Brady and Rob Gronkowski played as expected. Jordan Reed’s injury was more than just a mild AC and was announced as Grade 3 sprain. Jamison Crowder was OK with low ankle sprain and continued to play.
Josh Forrest was confirmed to tear a ligament in his knee. Robert Woods does have a significant MCL and missed the game. Andrew Luck was not cleared for the Thursday game. Marshall Newhouse did have a MCL sprain. Halapoulivaati Vaitai does have a MCL sprain. Demetri Goodson unfortunately is confirmed with a multi-ligament injury with ACL tear. Derek Wolfe did avoid surgery and returned in just under a month with an elbow brace. Blake Martinez missed with a confirmed MCL strain. Kelvin Benjamin returned to the game and caught a touchdown.

This slightly improves the 130-6 (95.6%) record to 145-6 (96.0%).

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Monday Morning MD: NFL players show incredible toughness every week

Few doubt how tough you have to be to play in the NFL. This week has many examples of how players react and play through injury.

LeSean McCoy got up and casually walked to the Bills sideline as if almost nothing happened. He missed the second half with a dislocated thumb, which could not be

Few doubt how tough you have to be to play in the NFL. This week has many examples of how players react and play through injury.

LeSean McCoy got up and casually walked to the Bills sideline as if almost nothing happened. He missed the second half with a dislocated thumb, which could not be reduced and now needs surgery. Yet, he is likely to play next week. The crazy part is this actually makes sense as by video, he dislocated his small (IP) joint without fracture. Once reduced with surgery today (as the flexor tendon blocks reduction). The thumb should be stable and relatively pain free.

No one even knew Giovani Bernard was injured but he reportedly tore his ACL on his final catch. Since the Bengals were down by four with under a minute to go and no timeouts, he hopped up to avoid a 10 second runoff then went right back to line up for the next play and even attempted to throw a block before the play was called dead. With the stoppage, Bernard then subbed himself out. Now he will need major surgery and will have to race to return for Week 1 of 2017.

A.J. Green’s season is likely over with a significant hamstring tear, yet his body language indicated a routine play with a minor issue. The injury appears to be high up and proximal hamstring tears take longer to recover.

Safety Eric Reid acted like nothing happened when by video, he tore his distal biceps tendon. He almost continued to play until stopped by a delayed timeout. Typically, this injury ends one’s season and requires surgery.

Terrell Suggs is delaying surgery and playing with just such a distal biceps rupture. Sunday he had a sure sack, but due to weakness to flexion/supination on his injured left arm, Dak Prescott stepped through the tackle.

Even long snappers got in the tough guy act. Clark Harris limped badly with a foot/ankle injury and was about to be driven off. He hopped off the injury cart to play, even though he could no longer even jog to cover punts.

In a bad injury week, there were plenty of examples of how the NFL is a real man’s game.

MMMD 1: Emotional Luke Kuechly

The former defensive player of the year was not showing weakness when he appeared to reveal vulnerability. Certainly he was red-faced and sweating from the game; however, Kuechly’s body was heaving to try and catch his breath, not blubbering in tears.

By video, he took a blow to the chest/sternum and was gasping for air from having the wind knocked out of him. He also hit his head and it is a known medical fact that a concussion can cause mood alterations. Combine the fear of not being able to breathe and the loss of emotional control from head injury and you get Kuechly’s reaction to injury.

MMMD 2: Seahawks RB carousel

Seattle leads the NFC West but will start its third running back in three weeks. Christine Michael was released after a mild hamstring issue. Now C. J. Prosise is injured.

By video, the worry was a scapula fracture for Prosise who did not return in the second half. Typically, a scapula body fracture does not need surgery but is very painful and leads to a 4-6 week recovery. A report surfaced that Prosise will not return until the playoffs.

Fortunately for the Seahawks, Thomas Rawls is finally healthy after an early season fibula fracture. This truly has been “next man up” after Marshawn Lynch retired.

MMMD 3 Accuracy of team reports

Two weeks ago, I documented the differences in teams’ use of the “questionable” designation. “Questionable” also seems to be the tag whenever a player initially exits for injury, but is it accurate?

Demetri Goodson suffered a horrific multi-ligament knee injury. (Video here but warning: graphic) The Packers officially classified him initially as questionable to return to the game. In reality, what is questionable is whether Goodson can return to a productive career as a cornerback. Best wishes to him.

MMMD 4: Who is ready to return?

Three quarters of teams have yet to use the single “designated for return” spot to bring a player off injured reserve. With six weeks left in the regular season, watch for more teams to start bringing players back.

Ameer Abdullah is seeking a second opinion and may be the Lions player to return off IR.

Sammy Watkins is slated to have a CT scan to assess fifth metatarsal bone healing and might be able to come off IR to help with Robert Woods’ absence.

Everyone has forgotten about J.J. Watt after his second back surgery. I know the club wants to be cautious but he is eligible to come off IR after today. I expect Watt to be medically healthy now and lobbying to help his team to the playoffs. The Texans lead the AFC South and if they beat the Raiders tonight, they would be in position for a possible playoff bye.

Branden Albert missed this week after surgery on a dislocated wrist and could be back next week.

Rob Gronkowski was not allowed to fly to California this week with a pneumothorax, but I fully expect him to travel and play against the Jets next week.

Mo Claiborne having torn “some bone off the pelvis” sounds ominous but it simply is a groin avulsion, which usually heals without surgery. A 6-8 week timeline from injury puts him back at Week 14-16. Hope his follow up MRI confirms this expected healing.

Look for lots of late season roster moves.

MMMD 5: Harvard health study

A comprehensive report with medical recommendations for the NFL and NFLPA was released this week. I promised to analyze the top ten recommendations but there were just too many injury issues this week to find the space in this column.

I will agree with one finding. Stop using player health as a bargaining chip in the collective bargaining agreement. My full thoughts are to follow in the coming weeks.

MMMD 6: Injury rundown

Zach Miller has a broken left foot and needs surgery.

By video, Robert Woods has a MCL sprain and is on crutches. He is likely will miss several weeks.

Cody Kessler is out with his second concussion of this season. Don’t be surprised if an extended absence is coming.

Fortunately, Leonard Floyd seems to have escaped significant neck injury. He took a head down hit and was sent off on a spine board.

Seattle FS Earl Thomas and CB DeShawn Shead both have hamstring injuries.

Dee Ford has a hamstring issue as well. Justin Houston has returned from February ACL surgery to help the Chiefs linebackers.

Ryan Matthews is reported to have a MCL sprain and Darren Sproles has a rib injury.

Laremy Tunsil left with a shoulder injury and did not return for the second half.

Rams LB Josh Forrest by video has a major knee ligament tear, which is likely the ACL.

Matthew Slater was knocked out with a left foot injury and seen post-game in a walking boot.

By video, Halapoulivaati Vaitai suffered a MCL sprain. Hopefully he can return in a week or two with a brace.

MMMD 7: ProFootballDoc scorecard

Even though Branden Albert finished last week’s game, he did have wrist surgery and missing this week but has a chance for next week. Tom Brady had no issues despite a scare. Rob Gronkowski was not allowed to travel with his pneumothorax. Jordan Howard avoided Achilles tear or other significant injury to play well. Kyle Long does have a high ankle injury requiring surgery. Kelvin Benjamin overcame mild AC sprain and returned in the same game.

Cody Kessler does have a concussion. The Leonard Floyd news is encouraging. Jake Ryan and T.J. Lang missed this week after being rolled up on last week. C.J. Prosise has a presumed scapula fracture. Eric Reid does have a left distal biceps tear. Nick Perry’s mild ankle sprain is OK and he returned to play.

This improves last week’s 117-6 (95.1%) scorecard to 130-6 (95.6%) through Week 11.

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Monday Morning MD: Offensive line injures aplenty

Fans may think of this week as a relatively healthy one. In reality there were plenty of injuries. A plethora of offensive players were hurt, just not the ones most fantasy owners and fans are interested in.

Offensive line injuries lead the way in Week 10. The trend began on Thursday when the Ravens left

Fans may think of this week as a relatively healthy one. In reality there were plenty of injuries. A plethora of offensive players were hurt, just not the ones most fantasy owners and fans are interested in.

Offensive line injuries lead the way in Week 10. The trend began on Thursday when the Ravens left guard was carted off and their center limped off. Alex Lewis’ right leg was placed in a vacuum splint after being rolled up on. Though early reports indicated no fracture, by video, Lewis has a significant high ankle injury that will result in an extended absence and may still need surgery. Teammate Jeremy Zuttah was much luckier with a standard basketball type low ankle sprain.

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The trend continued Sunday when two linemen with the last name Long (no relation) suffered apparent season ending injuries. Kyle Long of the Bears was carted off in an air splint. By video, he suffered a significant high ankle injury with possible fibula fracture and likely needs surgery. Jake Long’s twice torn left ACL was spared but video evidence of a left Achilles rupture was later confirmed by his head coach. The Vikings have now lost their third offensive tackle and their fourth consecutive game after five victories to open the season.

Dolphins left tackle Brandon Albert was reported to have dislocated his wrist but finished the game in a cast. A wrist (lunate) dislocation means ligaments are torn, thus surgery is likely. Miami is on an 11-day west coast trip (played Chargers on Sunday and Rams up next) creating logistical difficulties but I hope the injury is not truly a medical dislocation.

Knee injuries knocked out the Packers David Bakhtiari and Buccaneers Evan Smith. Also Packers guard T.J. Lang, by video, left with a high ankle sprain. Meanwhile, Bears Bobby Massie left with a concussion.

This may seem like a good week of injures as the offensive stars stayed healthy. However, their protectors took their share of injuries.

MMMD 1: Injuries to stars narrowly avoided

Near miss was the theme of the day. Tom Brady avoided a hit to the knee, instead took a blow to the thigh just above. He avoided serious injury but instead will deal with a quad muscle contusion. Teammate Rob Gronkowski took one of his hardest hits ever but since Earl Thomas stayed away from the head delivering the blow, Gronk avoided concussion.

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Larry Fitzgerald and Lamar Miller returned for the second half after brief absences. Jordan Howard’s coach said he hurt his ankle or Achilles. By video, Howard does not have a tendon tear. I am always happy to be reporting good news.

MMMD 2: Running back news

Christine Michael was active but limited with his late week hamstring issue. Doug Martin finally returned from his Week 2 hamstring injury and re-aggravation.

Dion Lewis was activated off PUP with his post-ACL patella stress fracture but was not dressed this week. DeAngelo Williams had midweek knee scope and is likely out longer than the initial three-week estimate.

MMMD 3: Tony Romo not active

The Cowboys QB is almost three months out from his L1 back compression fracture. He has been medically cleared.

No one is arguing that Dak Prescott should relinquish the starting job as the Cowboys now have the best record in the NFL. However, it was interesting that Romo was not even dressed as the back up. Even if Romo has not practiced with the first team, isn’t a rusty Romo better than Mark Sanchez who has yet to take a live snap as a Cowboy?

After the game, Jerry Jones said indeed Romo would be the backup next week. After all, every 2nd stringer is one play away from being the starter..

MMMD 4: Maurkice Pouncey heroic

The Steelers center tried to return last week after dislocating his thumb but lasted only one series. After thumb surgery, he is to be congratulated for not missing more time.

A snapping hand injury is like a throwing hand injury for a QB. With a cast and likely pins/screws to stabilize the thumb, Pouncey played with what could have been a 4-6 week injury. There were a couple of low snaps, but that could be forgiven. Kudos to the Steelers medical staff.

MMMD 5: NFL can go further for safety

As the league has begun its public relations campaign, I hope it continues to go further for safety. Commercials with Dean Blandino touting 42 rules changes including the elimination of the three-man wedge ran last week. This week featured a second ad pointing out sideline video, radio communication, hand held tablets with medical records and X-ray access.

These are all good advances. I remember getting multiple memos from the league saying cell phones are illegal on the sidelines. I argued they were necessary for communication to other medical personnel that may be in the locker room or with a hospital. The league now supplies all medical personnel with earpiece and radio.

A simple additional change is to not have mandatory charged timeouts when checking on player health. This would have prevented the Case Keenum situation from last year. It also would have helped with the Bills at Seahawks debacle Monday night at the end of the half. When medical came onto the field to check on the down kicker, the Bills were out of timeouts, meaning he had to leave for one play. Allowing medical checks without penalty of timeout would improve safety by removing the inhibition to check a player. Of course, the league would have to police for injury faking but if medical is a priority, this change should be done.

MMMD 6: Injury rundown

DeSean Jackson’s rotator cuff injury kept him out even with the bye week to recover. The hope is that there is no tear. Remember, a partial tear led to surgery and injured reserve for Eric Decker earlier this season.

Last week, people took note that Jimmy Graham was finally healthy after patella tendon repair. Now it seems his QB is fully healthy. Russell Wilson looks like his same old self while leading the Seahawks to a big win over the Patriots. His high ankle, knee MCL and pectoral muscle injuries seem to have finally improved.

The Steelers big free agent tight end signing finally played. Ladarius Green is off PUP and had three catches. It is unusual for a free agent to end up on PUP like he did since teams perform full physicals before inking deals, but that is all behind the team now.

MMMD 7: ProFootballDoc scorecard

Ryan Fitzpatrick did have a mild MCL sprain. Mike Evans did return from concussion in one week as expected. Eric Wood did suffer a high ankle fracture and need surgery. Justin Pugh did have a MCL sprain. Derek Wolfe will return soon from a hairline elbow fracture. Doug Martin did beat Jacquizz Rodgers back. Jake Long does have an Achilles rupture. Kyle Long does have a high ankle injury/fracture. Alex Lewis has a significant high ankle injury. Jeremy Zuttah’s low ankle sprain is not severe.

Credit Maurkice Pouncey and the Steelers medical staff for having him ready to play against the odds. Although the point of my tweets were correct about a snapping side injury for a center, he beat the odds and returned early so it will count as a mistake.

This makes the previous 107-5 (95.5%) record update to 117-6 (95.1%).

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Monday Morning MD: Teams take different approaches to injury reporting

This season, the “probable” category for pregame injury reporting was removed. Now players need to be either eliminated entirely from the report and deemed ready to play, or placed in the “questionable” category.

With the help of followers, I have gathered new injury reporting statistics. This season, approximately three out of every four (~75%) players

This season, the “probable” category for pregame injury reporting was removed. Now players need to be either eliminated entirely from the report and deemed ready to play, or placed in the “questionable” category.

With the help of followers, I have gathered new injury reporting statistics. This season, approximately three out of every four (~75%) players listed as “questionable” are active league-wide, compared to just over half (~55%) in the previous year.

At the halfway mark, it has become clear that teams take different approaches to injury reporting. I am not accusing any teams of manipulation or cheating; however, the numbers lead to stark contrasts. Over 90% of the “questionables” suit up for the Bengals, Panthers and Redskins. In contrast, under 50% of the same category are active for teams like the Titans, Jaguars and Seahawks.

Here is a full list of teams and the percentage of “questionable” players that are ultimately activated each week through the first half of this season.

RANK   TEAM   PERCENTAGE

  1. Bengals         100%
  2. Panthers         95%
  3. Redskins         91%
  4. Chargers         90%
  5. Bears               86%
  6. Buccaneers    84%
  7. Colts                84%
  8. Dolphins        80%
  9. Lions               79%
  10. Texans            79%
  11. Rams               77%
  12. Cardinals       76%
  13. Bills                 76%
  14. Jets                  75%
  15. Steelers           75%
  16. Raiders           72%
  17. Giants              71%
  18. Patriots           70%
  19. Cowboys         69%
  20. Ravens            66%
  21. Saints              65%
  22. Packers           64%
  23. Chiefs              64%
  24. Eagles              64%
  25. Falcons            60%
  26. Browns            59%
  27. 49ers                58%
  28. Broncos           54%
  29. Vikings            50%
  30. Seahawks        47%
  31. Jaguars            41%
  32. Titans               38%

Microanalysis will show many reasons for the differences. For example, the Bengals average only one player listed as “questionable” weekly but every player (a league low total of eight thru eight weeks) has been active. Some teams use the “doubtful” and “out” categories more liberally and thus have a higher percentage of “questionable” suit up.

I am an injury expert, not a fantasy expert. Thus I will leave it to the fantasy gurus to interpret the significance of the mid-season findings. However, there is clearly a big difference between how the Bengals who have activated 100% of their “questionable” players and the Titans who have only suited up 38% of theirs.

MMMD 1: Veteran leaders play through injury

Ben Roethlisberger, Terrell Suggs and Steve Smith, Sr. all played Sunday for the AFC North lead in the Steelers at Ravens clash. None of the three were at 100%, but most players are not at this juncture of the season.

All three have a history of toughness and early return from injury. Big Ben coming off knee scope and Smith dealing with a high ankle sprain will improve each week. Suggs who is putting off biceps tendon repair surgery will have to deal with elbow weakness for the rest of the year. Players will tell you that as the season marches on, 80% healthy is considered a good week.

MMMD 2: Joe Flacco breaks knee brace not knee

The Ravens QB scared fans when he came up hopping on one leg after an awkward slide. Fears of re-injury to his ACL or visual of a bone sticking out flashed through minds, but Flacco was fine. As he slid, his knee brace caught the turf and was mangled.

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Teams have spare knee braces, although they may not be the exact custom model for each player. The Ravens were at home but even on the road, athletic trainers pride themselves as “boy scouts” who are ready for anything.

MMMD 3: More knee braces and Patriots health

Even on their bye week, the Patriots made health news. Bill Belichick explained why he has the offensive line wear knee braces. Essentially every major college mandates it but it is rarely required at the professional level. A few teams like the Patriots and Cowboys insist, but players resist due to the perception restricting knee fluidity. A brace cannot prevent all injuries, but could lessen the degree of injury.

Belichick also noted how his staff tries to prevent the avoidable non-contact injuries. Part of New England’s success this season may be having only three players on injured reserve versus the 19 from last season. The league average is approximately 10 IR players per season.

MMMD 4: Marijuana use in NFL

An ESPN survey of 226 players indicates 71% support legalization and 61% say fewer painkillers would be used if pot could be used. 22% claim they know a teammate who smoked before a game. 67% indicate the NFL testing for recreational drugs is not hard to beat.

Overall, players feel marijuana is better for recovery and pain control than pills. If players are committed to this, look for the next CBA to change the rules on marijuana usage.

MMMD 5: Medical sideline reporting improved

With the change in the Thursday night broadcast from CBS to NBC, the medical updates are much more precise. The difference from one week to the next was noticeable.

This is not a slight at the CBS sideline reporter, rather it is a compliment to the NBC sideline team that has a secret weapon. Longtime former Jaguars head athletic trainer, Mike Ryan, is on site behind the scenes providing his expertise. This is why reports now talk about specific tests and the anatomic references are all on point. Kudos to the NBC team for improving medical accuracy and the broadcast experience. The future is medical experts on broadcasts, like every network has a referee to help explain calls.

MMMD 6: Injury rundown

Maurkice Pouncey dislocated his right thumb and valiantly returned for one series. Look for surgery to be announced as dislocation is often associated with fracture. Unless he can move to guard or snap with his off hand, expect a 4-6 week absence.

Darrius Heyward-Bey suffered a midfoot sprain. His absence will be determined by severity but will likely be weeks.

By video, Allen Hurns had a left high ankle sprain but returned. His availability will depend on swelling.

Victor Cruz had a low ankle sprain that should not keep him out for long if at all.

Ryan Fitzpatrick injured his left knee and will get an MRI. By video, I am hoping for a minimal injury that could show a mild MCL sprain.

Cody Kessler had X-rays on his right leg that were negative and should not miss time.

Derek Wolfe hyperextended his right elbow and had a non-displaced coronoid process fracture. If the piece is small, he can avoid surgery and return in 4-6 weeks and possibly sooner with a brace.

Justin Pugh, by video, exited with a MCL sprain. His return with a brace will depend on severity and swelling.

Derrick Henry injured his calf in warm ups. Careful here, as medially, gastrocnemius muscle strains tend to linger.

Sammy Watkins is out of his boot but that doesn’t meant he is ready. Being placed on IR means he is out for at least another month anyways.

Mike Evans was initially cleared for concussion and later removed from the game. Hope he can return next week.

Jameis Winston’s knee injury is not expected to be significant.

Jamaal Charles’ menisectomy lends to a quicker recovery than the meniscus repair for C.J. Anderson. Charles has to now overcome swelling of the other knee, his IR status, age approaching 30 and a high salary cap number.

Doug Martin (hamstring) should be able to beat Jacquizz Rodgers (Lisfranc midfoot sprain) back for the Buccaneers.

Carlos Hyde missed another week with, by video, what seems to be an AC joint sprain.

MMMD 7: ProFootballDoc scorecard

Big Ben played in three weeks as expected. Terrell Suggs and Steve Smith, Sr also played. Sean Smith missed the game with left shoulder subluxation. It was time to worry on Jamaal Charles who had surgery and was placed on IR. Jameis Winston’s knee seems OK. Kwon Alexander had a stinger. Ty Montgomery sickle cell issue was only a one-week ordeal. Tyrann Mathieu did dislocate his shoulder. Barry Church is out 4-6 weeks with a forearm fracture. Corey Coleman missed six weeks with a broken hand. Referee Ed Walker tore his quad and Wade Phillips is OK but neither of these will count as this scorecard is for player predictions.

The previous 96-5 (95.0%) record improves to 107-5 (95.5%).

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Monday Morning MD: Time for transparency

Transparency is long overdue. Why not let the doctors speak or provide rationale for return to play decisions?

Once again we have another concussion controversy involving a quarterback. Last season we had Case Keenum. In the NFL opener, Cam Newton became the national focus. Now we have the Alex Smith situation.

The Chiefs QB’s

Transparency is long overdue. Why not let the doctors speak or provide rationale for return to play decisions?

Once again we have another concussion controversy involving a quarterback. Last season we had Case Keenum. In the NFL opener, Cam Newton became the national focus. Now we have the Alex Smith situation.

The Chiefs QB’s head hit the turf, lacerating his ear, and had to be helped up by Spencer Ware (who ironically later suffered his own concussion) and a referee. Smith passed a concussion test and was returned to the game. The QB later suffered a second blow to the head on the turf and was then deemed to have a concussion.

I am not suggesting that the Chiefs or any doctor did anything wrong here. I am saying the optics of the situation are not good when a wobbly QB is allowed to stay in the game.

The latest concussion controversy deserves explanation. Credit head coach Andy Reid for trying to address it post game (even though he erroneously said Smith passed both concussion tests). However, when pressed, coaches always use the “I am not a doctor” line and say I just followed the doctor recommendations.

Why not let the medical staff speak or at least release a statement? Of course the player would have to grant permission, but perhaps that would clear up the misperceptions. Maybe the physician, knowing he would have to publicly defend his decision, causes a further pause before a player is cleared.

I don’t believe in conspiracy theories. Certainly the unaffiliated neurotrauma consultant (UNC) who lives in Indianapolis was not incentivized to keep Smith in the game to help the Chiefs beat his hometown Colts. I believe the doctors are doing their best with an inexact science of diagnosing concussions. I have been there and know what a difficult job it is. It is impossible to get every “play/no play” decision correct, like it is impossible to expect a referee to get every call right. My point is why not let the public know about the process and what the doctor’s thinking was? Even the referee has to answer a pool reporter’s questions post game.

I am curious as to what the referees were thinking on this first hit. The umpire was one of two people there to help hold Smith up and referees are also charged with player health. I would also love to hear the UNC’s side of the story. Did the UNC see a wobbly Smith? Was he provided with the video replays? What lead him to clear the player? Even if a player passes concussion tests, visual evidence of a balance issue is enough to rule a player out.

The NFL has been accused of conspiracy and denial in the concussion crisis. Why not shed that image and allow some transparency in the current head injury decisions? Not allowing for comment just makes the situation look worse.

MMMD 1: Good injury week

Overall Week 8 seemed to be the least injuries for 2016, yet there were still plenty. The year to date has seen a slightly higher rate than average with 40 ACL tears and 32 Achilles ruptures.

Lets hope we don’t get Monday morning bad news. Or as seems to be the pattern this year, Wednesday bad news like we did for Adrian Peterson, Dez Bryant, C.J. Anderson and others.

MMMD 2: Two stars trying to return

Ben Roethlisberger and Terrell Suggs are both coming off injury and a bye week to face off in a big divisional game. Big Ben will be three weeks after a knee scope. Suggs suffered a biceps tendon tear.

There are varying reports of stitches and whether Roethlisberger will be ready. Medically, expect him to play. The sutures are in the skin, not the meniscus; therefore, will be removed and is a non-issue. Suggs is forgoing surgical repair to play through what may be his final season in the NFL.

MMMD 3: All meniscus tears not the same

Earlier this season we covered the difference between the Adrian Peterson and Big Ben meniscus tears. Now we have additional examples.

C.J. Anderson had his meniscus repaired, which means six weeks of rest and minimum three months of recovery. Michael Bennett’s return timeline after his cartilage trim procedure is set at 2-3 weeks. Trimming meniscus is like mowing the lawn where you can play football immediately after, while repairing is like laying down new sod where you need to keep of the grass to let the roots grow in.

MMMD 4: Time to worry for Jamaal Charles

Swelling when increasing activity after an ACL surgery is not unusual. When it does not go away for several weeks, the effusion becomes a concern.

Charles is now seeking a second opinion. Hopefully, rest, time, compression, medication and draining the knee will be enough. I hope there is no need for a post-ACL knee scope.

MMMD 5: Worst injury of the season

Texans right tackle Derek Newton ruptured both of his patella tendons last Monday. Even though there was a report of successful surgery to repair both tendons, he has a long path to return to the NFL. Three players have torn both patella tendons at the same time: Wendell Davis, Gary Baxter and Greg Childs. None of the three returned to their pre-injury levels of play. Hopefully, Newton can be the first.

The road game presented several difficulties. First, Newton did not have access to pain medicine immediately as the visiting team is not allowed to bring narcotic medication per federal laws and the home team medication supply is limited. Second, the 300+ pound lineman was essentially wheelchair bound and could not fly home with the team but instead needed special medical transport.

MMMD 6: Injury rundown

Broncos defensive coordinator Wade Phillips was knocked over on the sidelines and rushed to the hospital. Fortunately rumors of a broken leg were inaccurate and he passed all tests and was released.

Four players were concussed during the Chiefs at Colts game: Alex Smith, Spencer Ware, Joe Reitz and Vontae Davis. Statistically expect at least two of the four to miss next week’s game.

Jacquizz Rodgers injured his left foot but video was not clear as he was in a pile and the mechanism or severity could not be seen.

Ty Montgomery has a kidney-related ailment. It is unclear what type or how long he might miss.

Martellus Bennett continues to deal with a high ankle sprain. He injured it in Week 5 and still caught three touchdown catches. Here is hoping the bye week gives him a chance to fully heal.

Barry Church fractured his right forearm, the same side that he broke causing him to miss the last game of 2015. He likely will undergo plating surgery and return in 4-6 weeks.

Morris Claiborne has a significant groin injury. Sometimes one can play through or the Cowboys could make the decision to fix it now to be back by the end of season/playoffs.

By video, Charles Clay suffered a left shoulder AC joint sprain but returned to the game.

Sean Smith appeared to subluxation/dislocate his left shoulder. If he torn his labrum, that could mean surgery or trying to play with a brace as Charles Woodson did last year for the Raiders.

Duke Ihenacho suffered a scary hit in London. After a substantial time on the ground, was able to walk off under his own power.

Vontaze Burfict’s knee injury does not appear to be serious. By video, he suffered a contusion to the muscles in back of his left knee and he did return to the game. Meanwhile, Burfict inadvertently hit Rey Maualuga’s left arm but there was no fracture and he ultimately continued as well.

Russell Wilson was able to play through his pec, knee and ankle injury but not well enough to come away with victory.

Tyran Mathieu left the game with an unspecified shoulder injury. Hopefully the follow up news will be good.

Sammy Watkins is out of his boot. That certainly is a good sign but only a first step to return and there is no medical certainty that he can come off IR when eligible in a month.

MMMD 7: ProFootballDoc scorecard

By video, I did not expect Geno Smith to tear his ACL. Demarcus Ware did return after ulna plating surgery and even had a strip sack fumble with his right arm that was reversed. Lamar Miller played with what has been confirmed as a deltoid contusion. Antonio Brown’s hip contusion is confirmed to be progressing well for this Sunday and will not miss time. Duke Ihenacho, Vontaze Burfict and Rey Maualuga injuries are all less significant than originally feared. Derek Newton was confirmed with bilateral patella tendon ruptures.

Counting the missed ACL tear lowers the previous 89-4 (94.7%) record to 96-5 (95.0%).

Happy Halloween to everyone!

 

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Monday Morning MD: Easy to just blame the coach

When a player returns early and is re-injured, it is too simplistic to blame the coach for pushing a player to hurt. Bills head coach Rex Ryan faced that criticism when LeSean McCoy played through and aggravated a hamstring strain in a Dolphins loss on Sunday.

Mid-week, McCoy was originally declared with only muscle

When a player returns early and is re-injured, it is too simplistic to blame the coach for pushing a player to hurt. Bills head coach Rex Ryan faced that criticism when LeSean McCoy played through and aggravated a hamstring strain in a Dolphins loss on Sunday.

Mid-week, McCoy was originally declared with only muscle tightness that turned out to be “coach speak” for a mild to moderate strain per media reports. It would be easy for me to say “I told you so” after the Bills star RB left the game in the second half feeling pain after 8 carries for 11 yards. I did warn of ineffectiveness and aggravation but that is nothing the Bills medical staff would not be aware of and had considered. The offensive coordinator even said earlier this week, “I don’t want to do what we did last year. I don’t want him playing 85% re-injuring the hamstring and this thing lingering all year.”

Return-to-play decisions are not solely made by the team doctor or the head coach. Typically it needs to be a unanimous group decision between three parties: the medical staff, the team and the player. Any of the three has “veto power” and must share in the responsibility of all return-to-play scenarios.

The medical staff input is a combination of the doctors and athletic trainers. The team decision requires varying input from coaching (head coach, coordinators and position coaches) and management (general manager and sometimes owner). The player component includes the athlete, agent and often family. (Certainly agents have stepped up and prevented their guys from playing before.) All three combined parties must agree, otherwise a player doesn’t step on the field. Decisions like these are always joint discussions and are never made in a vacuum.

Ryan acknowledged, “We never play a guy our doctor and trainers don’t clear”. I am sure the medical staff was aware of and discussed risks of re-injury and ineffectiveness. McCoy accepted his role in the decision to play as well, saying “I felt good…I wouldn’t play, if I wasn’t 100%”.

Given this situation plus the Sammy Watkins, Aaron Williams and Shaq Lawson decisions to play through injury, it is inevitable critics will blame the Bills for allowing these players to push the envelope and get back to action prematurely, causing a bigger risk for re-injury down the line; however, that would not be telling the whole story. At least in this case McCoy himself acknowledges his role in pushing to play and admitted it might have been better to hold off.

MMMD 1: Geno Smith injury “not too significant”

The Jets Sunday starter exited with a left knee injury. By video, there was no major ligament injury but there is some worry for a meniscus tear (similar to Roethlisberger’s injury last week) that will be cleared up by a MRI. Smith himself indicated it wouldn’t be “anything too significant”; however, he spent the second half in street clothes on the sidelines. Unlike Big Ben who was cleared to play the 2nd half, doctors didn’t clear Smith to return as a precaution. The thought is Smith will avoid a knee scope and it doesn’t appear to be serious, even though he may not be the starter anymore.

MMMD 2: Steelers hope to get healthy with bye week

Antonio Brown took a knee to the quad and was hampered the rest of the game. Fortunately muscle contusions heal quickly and the week off comes at a perfect time for the Steelers star WR. With rehab, expect Brown to be 100% for the next game.

It would also help if Ben Roethlisberger would be throwing him the ball. Despite some doom and gloom reports of missing up to six weeks, I have never waivered (and a new CBS report agrees) http://www.cbssports.com/nfl/news/big-ben-unlikely-to-miss-more-than-two-games-could-return-after-bye/ from my feeling that Big Ben is most likely to return for the post-bye divisional games versus the Ravens.

MMMD 3: Giants injury designation faux pas

Odell Beckham Jr. and five other players were listed as “probable”, a designation that doesn’t exist anymore on the Friday injury report. Perhaps, the Giants share in the thoughts of fantasy players in wanting that category reinstated.

All six players were subsequently removed completely from the injury report, as downgrading to “questionable” would have proven the fallacy of the new system. Beckham did play as expected with a hip pointer, but he was seen working with trainers pregame and perhaps was not 100%. With the post overseas game bye, OBJ should not be hobbled for his next game.

MMMD 4: No Reggie Bush touchdown

It didn’t matter in the outcome of the game but it could matter for future safety. A play is dead when the ball carrier’s helmet comes off. Reggie Bush’s helmet was completely off just before he crossed the goal line yet he was still awarded the score.

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Officiating guru Mike Pereira agreed. The NFL and NCAA rule are similar here except that the professional player is not required to leave the field for a play after his helmet comes off like the collegiate players. I would lobby that non ball carriers deserve the same protection. If the helmet comes off, any player should be deemed a non-participant meaning he can’t tackle, be hit, block or be blocked.

MMMD 5: 2016 Health and Safety Report

The annual medical update was released this week. The NFL has been far from perfect in dealing with head injury over the years but before anyone criticizes the league’s current action, they should read this comprehensive 39 page report of all of the health initiatives.

One piece of unfinished business is the NFL has yet to announce it’s new Chief Medical Officer.  The often maligned previous medical adviser was forced to retire in July but the new full-time position has yet to be filled.

MMMD 6: Injury rundown

Jay Ajayi was cramping and not injured. Who can blame him after two consecutive 200+ yard performances in Miami.

Russell Wilson still seems to be hampered by the knee and ankle injury, which I expected to be behind him after the bye.

Jamaal Charles was limited by knee swelling and only had 1 carry for 0 yards. Knee effusion is common after ACL surgery but the swelling usually goes away quickly. Only if it persists, is it time to worry.

Tevin Coleman left with a hamstring strain but it is difficult to discern severity off video so his absence is yet to be determined.

Brian Hoyer’s doctors were working Sunday despite the Thursday game this week. The Bears QB underwent surgery with plate and screws into his radius (forearm) bone. Contrary to popular belief, team doctor’s have “day jobs” outside of the NFL and likely the regular weekly workload made the off day schedule more convenient.

Ron Brooks of the Eagles ruptured his quad tendon and will need surgery. This injury is similar to patellar tendon tear and will require a minimum of 6-9 months recovery.

Aaron Williams left the Dolphins game in an ambulance for a precautionary MRI that was negative and flew home to Buffalo with his team. Jarvis Landry apologized for the penalized hit that may still draw a fine.

Jeremy Hill seemed to aggravate again what by video seems to be a left AC joint sprain.

Jerick McKinnon by video suffered a high ankle sprain but had a limited return for the Bears.

Josh Norman and Cody Kessler suffered concussions.

Jordan Reed was out again and admitted to hiding his concussion.

John Brown missed the game as his sickle cell trait work up continued. Expect a full return as most teams have at least one player with the trait that play without issue.

Saints special teams ace, Jake Lampman is hoping to avoid major knee ACL and/or MCL injury.

Josh Doctson was placed IR for recalcitrant Achilles tendonitis.

Dez Bryant cut his fingers making soup, but his knee and digits should be fine after the Cowboys bye this past week.

MMMD 7: ProFootballDoc scorecard
Please be clear that I take the time to chronicle the correct/incorrect video and injury analysis to publicly vet my stats. This allows readers and twitter followers the chance for a public audit of my numbers.

This week, Russell Wilson does not seem to be over the knee and ankle injury as I expected, thus will count as a mistake. Unfortunately LeSean McCoy did aggravate his hamstring. Carson Palmer played with his as expected. Jerick McKinnon had a mild high ankle sprain confirmed. Brian Hoyer did have an isolated radius and needed surgery, Dwayne Allen missed the Colts game with a high ankle sprain. Michael Bennett did avoid serious knee injury and played.

Add these into last week’s 83-3 (96.5%) drops the numbers to 89-4 (95.7%).

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Monday Morning MD: All meniscus tears are not the same

Ben Roethlisberger will need surgery but his season will not be over. Big Ben has a meniscus tear like Adrian Peterson; however, the Steelers quarterback will return in short order.

Not all meniscus tears are the same. A locked bucket-handle displaced meniscus tear like the Vikings running back had requires repair to prevent long-term problems.

Ben Roethlisberger will need surgery but his season will not be over. Big Ben has a meniscus tear like Adrian Peterson; however, the Steelers quarterback will return in short order.

Not all meniscus tears are the same. A locked bucket-handle displaced meniscus tear like the Vikings running back had requires repair to prevent long-term problems. Sutures require healing time measured in months. By video, Roethlisberger has a simple smaller meniscus tear that likely will be trimmed without the option for repair and his return will be measured in weeks. When laying down new sod, one must “keep off the grass”; however, after mowing the lawn, one can play football on the grass immediately.

The worst fears of injury were avoided. Roethlisberger described what he thought was a hyperextension injury but fortunately there was no serious ligament tear.

Big Ben will have had knee arthroscopy surgery by the time this article posts. Expect confirmation of a trimming procedure and a definite return this season.

With menisectomy (trimming) surgery, there is no wait for healing, thus, return is measured in weeks. Typically recovery is 2-4 weeks but given that Roethlisberger is not a position player and his recovery prowess is legendary, it is not impossible to return next week to play the Patriots. After all, Philip Rivers played New England in the 2008 AFC Championship game six days after a knee scope (and with a torn ACL).

However, the most likely return is after the Steelers bye the following week. I fully expect to see Roethlisberger play the division rival Ravens in Week 9.

There are many reasons to have immediate surgery. First, the tear can get worse. Second, playing on a meniscus tear can accelerate arthritis. Third, a cartilage injury limits playing effectiveness. Finally, with the quick recovery and the bye coming, there is no time like the present and Steelers doctors are acting quickly to make it happen.

Big Ben returned to play in the second half but there is no way he should continue to chance further injury without surgery first. I am sure if Roethlisberger had clinical signs of meniscus tear or mechanical symptoms, he would not have been allowed to return to play. Now that the meniscus tear is diagnosed, there can be no thought of playing through the injury.

Roethlisberger will return to 100% in terms of football. He will have some increased chance of long-term arthritis as a result of loosing some of the meniscus as cushioning, but less than without surgery.

An operation is never good news, but this type of meniscus procedure is really a positive scenario for Roethlisberger and Steelers fans. With a trim, Big Ben will have a chance to return very quickly.

MMMD 1: LeSean McCoy avoids serious injury

Like Big Ben, McCoy had a scare and clutched his right knee. By video, the Bills RB averted disaster and only had a mild MCL sprain. The key is that his foot was not fully planted or trapped. Indeed, McCoy returned for the second half and I don’t expect issues going forward.

MMMD 2: Odell Beckham, Jr. injures hip

The Giants star WR was injured within minutes of Roethlisberger and McCoy. Fortunately he too avoided major injury and returned for a big game.

By video, Beckham suffered a left hip pointer. The key is how swollen and sore he is this AM. Just because Beckham came back to play is no guarantee for next week. I expect the Giants to be aggressive treating this injury and thus a good chance to see Beckham in action next week in London. I do not expect the long flight to be a factor as teams fly on a chartered 747 and it’s like spending six hours in your living room. In fact, the Giants medical staff can set up a mini-training room on the plane as well.

MMMD 3: Terrell Suggs injured again

The 34 year-old pass rusher recovered from his second Achilles rupture, now he will have to deal with his second biceps injury. By video, Suggs ruptured his left distal biceps tendon at the elbow and Jay Glazer has confirmed the injury.

In 2012, he played through the month of December and into the Super Bowl with a right biceps tear. I suspect he will want to try to delay surgery and do the same now. Most players end up with surgery to re-attach the tendon to restore full flexion and supination (palm up rotation) strength.

Suggs has proven to be a quick healer and still can be an effective pass rusher. His ability to wrap and tackle may be hindered by this injury, but given his experience compensating and playing hurt on the other elbow gives him hope that he can do the same now.
MMMD 4: DeMeco Ryans sues over Achilles tear

The former Eagles linebacker ruptured his Achilles tendon in 2014 at NRG stadium and is now suing the Texans, NFL and stadium operators.

Originally the field was made up of natural grass pallets that were rotated into the sun for growth but the seams generated complaints. Subsequently the surface has now been switched to artificial grass.

Reggie Bush sued the St. Louis Rams stadium over his knee injury slipping on concrete and the case is still pending. Ryans returned to play during a subpar 2015 campaign but is no longer playing and seeks over $10 million in damages.

MMMD 5: Active does not always mean playing time

A big pregame topic is who will and won’t be on the inactive list. This week there was much discussion of to play or not to play for Arian Foster and Will Fuller.

Foster was called a game-time decision. The Dolphins RB was active but had minimal contribution with only 3 rushes for 3 yards.

Fuller was reported by Adam Schefter to be out. The Texans instead activated the wide receiver but he essentially did not play. Seems the Texans had no healthy scratches so Fuller was activated even though his effectiveness from hamstring injury was limited. In the end, the ESPN report was not wrong even though Fuller was technically active.

These are prime examples of where active does not equal effective.

MMMD 6: Injury rundown

Browns S Jordan Poyer was taken to the hospital with a concussion and diagnosed with a lacerated kidney. Expect a minimum one-month absence that could extend to season long.

Seahawks DL Michael Bennett suffered a scary looking knee hyperextension injury.

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The hope is his ligaments were spared despite the gruesome appearance and only minor anterior bone bruise or posterior capsular stretch injuries.

By video, Colts TE Dwayne Allen left with a right high ankle sprain. His status for next week is in doubt.

Redskins TE Jordan Reed did not play as expected after his recent head injury. With his sixth reported concussion, it will be smart to take great care and consideration before return. The bigger concern is not when he will return but potentially if he will return. There is no absolute number of concussions when one has to retire but I hope Reed makes the right decision.

Today, Chiefs LB Justin Houston can come off PUP from his ACL. He has been cleared for football activities. If he is activated, he has two weeks to practice before potentially playing in Week 9.

Packers RB James Starks underwent an unusual Sunday AM knee scope surgery. The timing may have been necessitated by a family emergency last week. Usually in season arthroscopy are done early week to maximize return, as is the case for Roethlisberger (detailed above).

MMMD 7: ProFootballDoc scorecard

I am glad that this section generated some interest this week. A follower thought I should count Dez Bryant as a mistake as initially I only said MCL. His bone bruise is indeed related to the MCL but I will follow his advice and call that a mistake. It was correct that Big Ben did not have a major injury and returned to play; however, I will not count it as correct as he now has what I consider to be a minor meniscus tear.

Despite three touchdowns last week, Martellus Bennett did show up on injury report with an ankle as expected. Eddie Lacy did play through his high ankle injury while Steve Smith was inactive as no player listed as doubtful has been activated in 2016. Trevor Siemian and Terrance Williams played with AC injuries. Jordan Reed was out with concussion and although limited, Sammie Coates was active with index finger fracture and laceration.

There were three correct pure video impressions. Odell Beckham, Jr. was confirmed with a hip pointer. LeSean McCoy did avoid major knee injury. Terrell Suggs does have a biceps tear.

This takes last week’s 73-2 (97.3%) mark to 83-3 (96.5%).

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Monday Morning MD: High ankle is not always dreaded injury

The average fan knows and fears the high ankle sprain. We have come to know this injury can knock players out for extended periods of time. However, does every high ankle sprain lead to a player missing multiple weeks?

Like any injury, there is wide variety in high ankle severity. Yes, players can perform thru

The average fan knows and fears the high ankle sprain. We have come to know this injury can knock players out for extended periods of time. However, does every high ankle sprain lead to a player missing multiple weeks?

Like any injury, there is wide variety in high ankle severity. Yes, players can perform thru mild sprains while severe sprains can even lead to surgery.

Early in the game by video, TE Martellus Bennett suffered a high ankle sprain and was in obvious pain. He channeled his inner superhero and returned to play, catching three touchdown passes for the Patriots. How sore and how much swelling he has this am, will determine if he can also play next week.

Steve Smith Sr. also appeared to suffer a high ankle sprain.

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He continued to play for awhile but ultimately limped off the field.

By video, Eddie Lacy also suffered a high ankle sprain. The Packers RB left the game but hopefully that has as much to do with the score at the time as the severity of the injury.

Meanwhile, high ankle injury can be very severe. Last week, Kevin White limped off under his own power but has been reported with a severe high ankle sprain with an associated fibula fracture. The injury to the Bears receiver has nothing to do with his tibia stress fracture from last year but he has been placed on injured reserve and likely needs surgery.

By video the worry is Trumaine Johnson may have suffered the same fate as White. The best case scenario is a severe high ankle sprain with a prolonged absence. The worst case for the Rams cornerback is season ending surgery if an associated fibula fracture is found. Neither possibility is good for someone playing on a franchise tag without a long-term deal.

We have chronicled both ends of the high ankle injury spectrum. Of course there are plenty of scenarios in the middle as well. Bottom line is the high ankle sprain is not always the dreaded injury it is made out to be in the media.

MMMD 1: Early stats for new injury categories

With PROBABLE being removed, what does QUESTIONABLE now mean? It used to mean a 55% chance of playing in 2015. Now with the two combined, the early returns show about a 75% chance to be active. It makes sense that when combining a 50/50 and 95% category that the results are somewhere in between. The challenge now is to figure out which players are truly questionable to play and which ones were always very likely to make it.

Of note, zero DOUBTFUL players have been active in 2016. Jay Cutler, Stefon Diggs, Dwayne Washington and others continued the no-go trend here. Seems like this should have been the better category to remove for the league.

MMMD 2: Browns can’t get started

Every offensive play starts with the snap. Cleveland can’t keep their centers or quarterbacks on the field. With the Cody Kessler injury to his chest/ribs, the Browns have now used eight players at these two positions. Kessler’s X-rays were negative so he has a chance to return next week.

Meanwhile, recently acquired backup QB Charlie Whitehurst was the fourth Browns QB injured when he hyperextended his left knee but hopefully escaped serious injury. Both Robert Griffin and Josh McCown suffered shoulder fractures previously.

MMMD 3: Trevor Siemian could return for Thursday

The Broncos starter was reported by Jay Glazer to have a grade 3 AC sprain and was inactive Sunday but that doesn’t rule him out for the midweek division clash versus the Chargers. The injury is to his non-throwing shoulder and contrary to some speculation, will not need surgery. With aggressive treatment and medication, I think Siemian has a good chance to play despite the high grade AC injury. Jimmy Garoppolo had a reported grade 2 injury to his throwing shoulder and missed 2 weeks but was healthy enough to back up Tom Brady and play in mop up duty this week.

MMMD 4: Gary Kubiak hospitalized after game.

I hope it is just illness and nothing more as flu-like symptoms sent the Broncos head coach off in an ambulance post game. In 2013, he collapsed at halftime as the Texans head coach and suffered a mini stroke. Hopefully this is all precautionary and Kubiak will be fine.

MMMD 5: Injuries no excuse

All teams have injuries and need to make adjustments. The Vikings head into their bye as the only undefeated team at 5-0. They lost their franchise QB, star RB, starting left tackle and others, yet still remain undefeated. Kudos to the GM, coaches and players for their success.

Versatility often helps a team as well. There is no better example than Texans LB Brian Peters. He had kick off duties Sunday and has even stepped in as long snapper. As they say in the NFL: the more you can do.

MMMD 6: Injury rundown.

Tevin Coleman had no issues with sickle cell in Denver. He tied the Falcons record for most receiving yards (132) for a running back as he helped hand the Super Bowl Champions their first loss.

A.J. Green was rolled up on late in the game but returned after six plays.

Jeremy Hill left with a shoulder injury after his previous chest injury but should not miss significant time.

Josh Norman injured his right hand/wrist and finished the game with a splint and tape.

By video, Terrance Williams had a mild left AC sprain, which he confirmed. He should not miss any games.

Cam Heyward will have a MRI on his hamstring to determine severity.

Letroy Guion said he had a complete tear of MCL from week 2 but returned this Sunday with a brace and will not need surgery.

WRs Randall Cobb and Chris Hogan had ugly looking hits but neither suffered significant injury, but likely both will be sore.

Tony Romo will have a repeat MRI Monday. Expect good news as compression fracture heals reliably. Despite a long list of injuries there is no medical reason for Romo to retire. With his replacement playing well, expect Romo back after the week 7 bye.

Dez Bryant was inactive Sunday but will beat Romo back as he does not have a true fracture.

Latavious Murray was out with a turf toe and his return is undetermined.

Senquez Golson was placed on IR as Lisfranc injuries are hard for defensive backs to play through.

Zach Ertz was active after his early season first rib dislocation. No surgery was needed and he should do well going forward.

Tyler Eifert has yet to play after a Pro Bowl ankle injury and surgery. His return is now delayed by a back issue.

Jacoby Brissett needed thumb surgery. Likely his ulnar collateral ligament injury kept the Patriots from having a full offense last week. Kudos for toughing it out and delaying surgery until Brady returned.

Josh Doctson’s Achilles tendonitis continues to linger. I am sure the Redskins are doing what they can but this is just one of those frustrating issues.

Eric Decker is still out. Optimists will say it is good news the team has not put him on IR for his partial rotator cuff tear. Pessimists will say he is done and needs surgery. The truth will depend on the extent of the tear, where greater than 50% thickness spells trouble.

MMMD 7: ProFootballDoc scorecard

Lee Smith was confirmed with an ankle fracture. Kevin White had a severe high ankle sprain with fracture. Randall Telfer did miss the game with a high ankle injury. Zach Ertz returned to play without surgery on his dislocated first rib. Sickle cell indeed was a non-issue for Tevin Coleman. Senquez Golson was placed on IR for long standing Lisfranc injury. Randall Cobb and Chris Hogan were ok despite nasty looking hits. Charlie Whitehurst knee hyperextension seems mild as expected. Martellus Bennett had a mild high ankle sprain. Josh Doctson Achilles tendonitis is lingering. Cody Kessler seems ok with no fracture.

This makes the previous 61-2 mark, now 73-2 (97.3%), but one or two misses will bring it right back to the 95% target.

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Monday Morning MD: Ultimately things make sense

Dez Bryant’s injury was called a “hairline fracture” by his head coach. With his team saying their star wide receiver was day to day, that just didn’t make medical sense.

Were the Cowboys that desperate that they would jeopardize a playmaker’s health? Was Dallas just sending out false information to make the opposition do extra

Dez Bryant’s injury was called a “hairline fracture” by his head coach. With his team saying their star wide receiver was day to day, that just didn’t make medical sense.

Were the Cowboys that desperate that they would jeopardize a playmaker’s health? Was Dallas just sending out false information to make the opposition do extra homework in game planning?

The truth seems to be neither, but rather that Bryant seems to have a bone bruise rather than a fracture. This new diagnosis indeed jives with how the team has been handling the injury.

The first thing that seemed weird is that the team didn’t release Bryant’s MRI results. Fans feared that they were hiding something. Then it came out that there was no Monday MRI. This led me and others to think the injury wasn’t significant enough to warrant an MRI. The truth was the Cowboys were initially just protecting their star player, as Dez missed his MRI appointment while going temporarily AWOL.

The next unusual thing was that Jason Garrett broke the news of a “hairline fracture” to the 49ers media rather than his hometown beat reporters. Now it seems clear that it wasn’t an intentional slight but simply being forthcoming with the next media opportunity after the Wednesday MRI results.

When the injury was confirmed to be in the lateral tibial plateau, medically that meant a minimum 4-6 week absence. However, the Cowboys continued to insist it was a day-to-day injury. A hairline fracture implies injury to the cortex (hard outer surface) and indicates damage to the structural integrity of the bone. Playing on it would risk displacing the fracture and needing surgery.

Now it all makes sense. A bone bruise can be described as microscopic fracture of the trabecular (soft inner) bone. This is not structural and one can see how Garrett could have unintentionally mistermed it a “hairline fracture”. Indeed the team is not putting Bryant at risk with its “pain tolerance only” stance expecting return in 1-3 weeks. A bone bruise was always a worry and made sense combined with the MCL sprain based on video.

I have always said that teams aren’t stupid. If a decision made on the inside looks silly to the outside, that just means we don’t have all the facts. The Bryant/Cowboys situation is another example of how there is usually a logical explanation for everything.

MMMD 1: Another major NaVorro Bowman injury

By video, the star 49ers linebacker unfortunately suffered a left Achilles rupture.cty9ysrumaax_wc

The team ruled him out immediately with a lower leg injury. Media has confirmed worry of Achilles tear. I hope my film analysis to be wrong but this was a classic change of direction, non-contact, eccentric load type mechanism.

Bowman missed the entire next season after his 2014 combined ACL and MCL tear needed surgery. Now he will miss all of this season with surgery again. The only good news is he medically should be on track for Week 1 2017 and chances are good to be 100%. The injury is on the same side but there is no definite linkage of the two.

MMMD 2: Concussions for Cam and Carson

Cam Newton needed to keep his head on a swivel but a momentary relaxation lead to a goal line concussion. Carson Palmer’s head slammed to the turf before entering the concussion protocol.

The Panthers play next Monday, while the Cardinals are scheduled for this Thursday night. Newton has twice as long to recover before the next game. Although concussions are unpredictable, Palmer seems very unlikely to play while recent data would have Newton 50/50 on getting cleared.

Safety of Thursday games comes into play again. Adding a bye week and pairing up midweek games with the bye would eliminate this problem. With the Packers and Eagles having their bye this past week they likely would welcome a second bye in the late season.

MMMDS 3: Broncos win with another rookie QB

Trevor Siemian has now been confirmed with an AC joint sprain (separated shoulder). By video, it was never a clavicle fracture as some feared.

Siemian could have returned to play but instead was confirmed as the emergency QB. Likely the Broncos decided a healthy rookie Paxton Lynch was a better option than an injured QB. Siemian’s injury is very similar to that of Jimmy Garoppolo except it is on the non-throwing shoulder and thus should be available next week. If Siemian doesn’t start/play next week, it will mean a coaching decision regarding limited practice and a QB not being 100% rather than an inability to play through the injury.

MMMD 4: Rookie quarterbacks fairing well

This year seems like a Seinfeld episode with a “George Costanza opposite” season for signal callers. The Broncos, Eagles, Patriots & Cowboys all have first time starters at QB and are a combined 13-2 so far. Meanwhile, established Pro Bowl QBs Drew Brees, Cam Newton, Philip Rivers and Carson Palmer are a combined 4-12.

In a quarterback league, it is certainly a “bizzaro world” to see rookies with all this success and star players struggling.

MMMD 5: Harbinger of a London based team

The Jaguars played overseas for the fourth straight year but that is not what signals to me the growing likelihood of a British team. To me the significance is that both clubs voluntarily choose to fly to London on Thursday. The days of the early travel and week-long stays in England seem to be over. This signals the growing feasibility of travel.

In fact, the Colts do not even follow London with a bye, which had been the league norm. These subtle but important changes are paving the way for a global NFL.

MMMD 6: Injury rundown

As feared, Sammy Watkins does seem to have a bone issue with surgery with a larger screw and bone graft coming. He was placed on injured reserve and will not return. This is not uncommon for Jones fractures, but when healed, he will be 100% again for 2017.

J.J. Watt had a second discectomy surgery on the same L5-S1 level. There was no fusion and thus no fear of career implications.

Eric Decker has a partial rotator cuff tear. The extent of the tear and his response to rehab will determine whether he needs surgery.

Russell Wilson lead his team to victory and the good news is with the bye, he should be 95% healthy by his next game with the MCL and high ankle essentially behind him.

Tony Romo is likely to practice fully and is getting close to a return. With Dak Prescott performing well, it gives the Cowboys luxury to wait until after the Week 7 bye.

Lee Smith suffered a gruesome ankle fracture yet still limped off the field under his own power.ctygyiousaafwzw

The Raiders TE will likely need surgery and is done for the year.

Kevin White appeared to have an third quarter mild high ankle sprain but there was only one limited view.

Darelle Revis left with a hamstring strain and his return is uncertain.

Chris Johnson was announced on TV as his left knee giving out, but by video to me he had a groin strain, which was confirmed.

Dewayne Washington was announced as an ankle, which may be good news as there was initial worry for turf toe or Lisfranc injury.

Eric Ebron, Brandon Bolden and DeForest Buckner were rolled up upon in similar fashion. All three may have the combo MCL and/or high-ankle sprain with recovery based on severity.

Dont’a Hightower played with partially torn meniscus. He seems to be trying to finish the season but a scope may be in his future.

Gerald McCoy left with a calf injury. This may be something that lingers for the Buccaneers.

Tyler Lockett is reported to be playing through a PCL sprain. Kudos for toughness but the worst is likely behind him and he is unlikely to need surgery for what seems to be a mild sprain.

Tyron Smith of the Cowboys has a bulging disc, which usually does not need surgery but return to play depends on symptoms.

Randall Telfer had a Browns friendly fire high ankle sprain.

The Steelers suffered a host of injuries including Marcus Gilbert with a likely mild high ankle sprain.

MMMD 7: ProFootballDoc Scorecard

Russell Wilson played through injury. Sammy Watkins did indeed have a bigger issue. Brian Cushing played at three weeks, sooner than the six week projection as expected. Josh Doctson’s Achilles tendonitis is lingering. Charles Tapper is now on IR with pars defect. Dez Bryant does have a MCL with bone bruise. Jay Cutler missed while Jacoby Brissett played.

NaVorro Bowman does seem to have an Achilles rupture. Trevor Siemian has an AC sprain and was available to play. Chris Johnson has a groin strain, not knee. Martellus Bennett’s injury was mild. Dez/Scandrick/Tyron Smith all were inactive as expected.

The previous 48-2 record is now 61-2 (96.8%).

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Monday Morning MD: MCL and high ankle combo

What do the injuries to Russell Wilson, Dez Bryant & Brandon Marshall have in common? They all have a similar mechanism of being pulled to the ground in a “horse collar” type fashion.

Wilson’s tackle was flagged as a penalty. Bryant was pulled to the ground legally by the jersey. Marshall was illegally yanked down

What do the injuries to Russell Wilson, Dez Bryant & Brandon Marshall have in common? They all have a similar mechanism of being pulled to the ground in a “horse collar” type fashion.

Wilson’s tackle was flagged as a penalty. Bryant was pulled to the ground legally by the jersey. Marshall was illegally yanked down by his facemask last week. All three tackles are dangerous and have the same injury patterns. They all are at high risk for knee MCL injury and same side high ankle sprains as the tackler’s body pins the ankle while the knee is rolled up upon.

Fortunately all three only had mild MCL sprains. Wilson continued to play before being removed for a coaching decision based on the lopsided score. Bryant was injured the second play of the game and returned to catch a touchdown pass. Marshall surprised people when he finished the game last week and proved doubters wrong by starting this week.

When the defender’s body traps the leg as the ball carrier is pulled to the ground, either the medial collateral ligament (MCL) and/or the syndesmotic ligaments (high ankle sprain) are injured. Sometimes it is both. In these cases, there may have been some ankle symptoms but all three were primarily knee injuries.

The good news of all three are that by video, they appear to be mild. Marshall’s injury is known. Wilson and Bryant will have the prerequisite MRI that will confirm the mild MCL sprain. Contrary to some internet fears, I am sure there is no additional ACL tear or bigger injury looming for either player.

Pulling a player to the ground by the collar, facemask or jersey is dangerous as the tackler’s body often pins the leg. Fortunately, Wilson, Bryant and Marshall escaped with minor injuries; however, this can cause ankle fractures or more rarely tibial plateau fractures as well. Players need to take care of each other. Football is dangerous enough and no one should suffer a preventable injury.

MMMD 1: The dreaded non-contact injuries beginning with “A”

Everyone knows anterior cruciate ligament (ACL) tears end seasons. Achilles tendon tears are second only to that in landing players on injured reserve. As players get bigger, faster & stronger, the ACL and Achilles do not get larger, thicker or stronger, thus a weak point exists.

By video, DeAngelo Hall tore his right knee ACL. The Redskins officially called it a “knee sprain” during the game, which is technically not inaccurate; however, an ACL tear is a severe form of a knee sprain. Ironically, Hall tore his Achilles in 2014.

Manti Te’o was announced to be out with an Achilles. There was no official mention of tear yet but the bad news is expected with the formal announcement of tendon rupture, surgery and IR. This marks the 3rd Achilles tear for the Chargers (RB Brandon Oliver & TE Jeff Cumberland). This is also the 3rd week in a row that San Diego has lost a key player for the year. Keenan Allen and Danny Woodhead tore their ACLs in Week 1 and Week 2.

MMMD 2: Walk-through injuries

Injuries in games, practice and preseason are bound to happen, but injuries during walk-through practices? The Browns kicker injured his knee during the lightest of practices and was later placed on injured reserve.

Sammy Watkins had his foot stepped on in walk-through and missed Sunday’s game. His pain predated the stomping injury and my hope is that he won’t need a second Jones fracture surgery as happens up to 20% of the time with this problem fracture.

MMMD 3: Weather delay in Tampa

A thunderstorm delayed the end of the Rams at Buccaneers game by just over an hour. The delay was not just about player safety but fan safety too. Lightning is dangerous for both fans and players.

Reports of danger in football are usually in high school fields without large structures like stadiums; however it pays to be smart when the chance of a potentially deadly injury is preventable.

MMMD 4: Several medical timeouts

It seems that referees have gotten the message after the season opening Cam Newton potential head injury incident. A medical timeout was not called and the league underwent criticism.

This week, several medical timeouts were called by referees. Cardinals WR Michael Floyd was sent off for a play. So was Browns QB Cody Kessler. Both were not diagnosed with concussion.

This is a good step forward. Now let’s hope the system works this well the next time a big star QB in the final two minutes takes a significant head blow.

MMMD 5: UNC needs to watch the action

I feel bad for the elderly gentleman on the Cowboys sideline that got run over. He was clearly mesmerized by the video boards and not watching the action as it came towards him. I hope he wasn’t hurt.

This does bring up a different question. The gentleman was on the sidelines working as the official unaffiliated neurotrauma consultant (UNC). His job is to watch the action and protect players. It is the spotter’s job to watch video and sideline personnel’s job to watch the field. Certainly it would be appropriate for the UNC to watch the video boards after the whistle for replays but not to miss the live action.

Lesson number one on the sidelines is to watch the action. With this incident, I wonder about the experience of UNC doctors. Last week, I was told by a NFL doctor that the assigned UNC had never worked a football game in his/her life and had no specific football training. Recently, Jenny Vrentas was allowed access to observe a sideline neuro doc in action and he admitted to only having 10 games experience in 3 years. In contrast, up to half of team doctors have 10 plus years of experience.

Since the UNC plays an important role, perhaps there should be some formal training mandated before stepping onto the sidelines to help give players more protection.

MMMD 6: Injury rundown

The Steelers had multiple players leave the game. LB Lawrence Timmons (shin – hospitalized and quickly released), G Ramon Foster (chest), S Rob Golden (hamstring), WR Eli Rogers (toe) and LB Ryan Shazier (leg) were all nicked. Their status will be determined this week.

Redskins WR Josh Doctson was a surprise late scratch with Achilles tendonitis. This injury has lingered from preseason and hopefully will not hamper him all year. Teammate CB Bashaud Breeland suffered a high ankle sprain.

Bears RB Jeremy Langford left with an ankle injury. Contrary to some reports of Achilles injury, by video, his tendon is not torn. His return to play is yet to be determined but fears of his season being over are premature.

Packer TE Jared Cook left with an ankle injury. Video was not clear as to diagnosis or when he might return.

Giants CB Eli Apple left with a hamstring injury and his return is to be determined.

49ers CB Jimmie Ward strained his quad/thigh muscle and left the game.

DeSean Jackson and Morris Claiborne both suffered different contusions and were able to return to play.

Tony Romo helped warm up Cowboys with throws during pregame. At five weeks after L1 compression fracture, I expect to see him at practice at any time now in a red jersey. Romo is not ready to take a hit but he is ready to practice with a red jersey.

Jay Cutler did not play with his UCL thumb injury as expected. Even though he doesn’t need surgery, expect his absence to continue as his ability to grip and spin the ball is affected.

Patriots QB Jacoby Brissett’s thumb sprain has not been confirmed as an UCL and thus still has a chance to play next week. Either he or Jimmy Garoppolo (AC) is likely to be available for Week 4 before Tom Brady returns.

Browns QB Josh McCown was announced with a hairline clavicle fracture in addition to AC sprain. His estimate to return is pegged at 2-4 weeks. WR Corey Coleman broke his hand in practice and will not need surgery but will miss 4-6 weeks.

Jimmy Graham appears to be rounding into form after his patellar tendon tear last year.

Titans G Chance Warmack’s season is over after finger tendon surgery. The reason for IR is the post-op recovery protocol is extensive, thus making it impossible to play through, even thought it is just a finger.

MMMD 7: ProFootballDoc scorecard

Josh Mcown does have an AC sprain but he also has an unanticipated hairline clavicle fracture, so even though video was right, it was also wrong, so it will be counted as a mistake.

Adrian Peterson did have a locked knee with bucket handle meniscus tear. He did end up with repair, which is better long term but longer recovery. There was much misleading info but scope and repair were always the likely outcome.

DeMarcus Ware did have surgery for an ulna fracture and returns in a month. DeAngelo Hall confirmed ACL tear. Manti Teo will have Achilles tear announced soon. Jay Cutler did miss due to his thumb. Mo Claiborne and DeSean Jackson continued through contusions. Eddie Goldman was confirmed with high ankle sprain. Chance Warmack will miss the season with flexor tendon finger injury.

The 39-1 record moves to 48-2 for a 96% average.

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