Will Carroll
Thursday September 22nd, 2011

There are two reasons I do an intro to my columns. First, my editors tell me to do it. Second, there are often interesting things that don't get associated with one player or team. This week, I could do a lot of that, but there simply are too many injuries to discuss. Injury stats aren't up significantly, though the perception is that they're up, especially with all the high profile ones. Don't get too wrapped up in it, especially with traumatic injuries like ACL sprains that are inherently random. Let's focus on what we can do something about and get right to it:

Vick's injury offers a lot of insight into how the NFL is dealing with the concussion policy. Initially, Vick was said to have a neck injury. He was shown walking off the field, spitting blood from his bitten tongue (he doesn't wear a mouthpiece), and pointing at people in the Atlanta stands. There was no evidence that his neck was anything more than sore at that stage and several observers say they didn't see any evaluation of his neck on the field. Given the restrictions on movement and manual testing caused by shoulder pads, the fact that Vick had them on as he walked off the field tells us that the alleged neck injury was likely not serious, but Eagles trainer Rick Burkholder has been consistent, saying as late as Wednesday that Vick has no concussion symptoms but still has some soreness in his neck. It could be argued that there is a competitive advantage to not saying anything about injuries in-game, but it's a poor message. After the game, though, Andy Reid quickly confirmed the concussion, which has required Vick to do all the testing and other requirements the NFL has in place for such a diagnosis.

This is a problem of perception, not treatment. There is no single test that will reveal a concussion, so the Eagles have to treat Vick based on the symptoms. The problem is how Vick's injury was presented, not how they handled it. Despite the mixed verbal signals coming from the Eagles camp, they appear to have treated him symptoms appropriately. It would help if Vick (and all other football players) wore a mouthpiece, but it's a personal choice, one that he's now experienced the downside of.

If Vick is unable to go against the Giants, it's unclear whether Vince Young will be physically ready as he continues to rehab a hamstring strain or whether he would be Reid's choice after nice play from Mike Kafka against the Falcons. Vick has not yet been cleared to play, though it is expected he will be. The Eagles will take this right up to game time if necessary, but all signs are that Vick will play normally in Week 3.

The important thing about the alleged stem cell procedure Manning had in Europe isn't the stem cells, the location, or even who had it. The key fact is that it didn't work. This was a "Hail Mary" pass done after his May surgery, once it became clear he wasn't healing as quickly and completely as had been hoped. Manning looked into everything, we assume, in a desperate attempt to avoid surgery and save his 2011 season.

Stem cell injections have been used by Kobe Bryant for his knees and Bartolo Colon for his elbow (and detailed in this SI article), so they're not new or controversial. Similar procedures can be done in the U.S., but due to governmental restrictions, Europe is often ahead of the U.S. equivalent in experience.

The timing of Manning's procedure is interesting, placing it somewhere in late July or early August and in close proximity to the end of the lockout. This procedure, we assume, wasn't hidden by Manning once the lockout ended. That means that he was signed to his extension anyway and that the Colts knew this was a likely outcome much earlier than previously believed. Manning is now two weeks post-fusion and is at a stage where his rehab is going to have to progress to throwing very soon if he's going to meet the original 8-to-12 week time frame. The Colts should know sooner than that if the nerve problems in his shoulder/arm were relieved by the surgery and if Manning will be able to return at all. For now, he's just "walking it off."

I'm surprised there's less outcry about how Charles actually tore his ACL. The video is clear. Charles made an awkward extended step and landed on the plastic first down marker laid on the field. It slid, forcing his knee into hyperextension and then caught, snapping the ligament in the process. Charles was already reaching for the knee as he was falling and well before he bumped into the Lions' mascot. There were a lot of tweets, many joking but taken seriously, that the mascot was what caused the injury. I'm curious why those plastic markers are necessary. I asked two NFL running backs if they looked for them and neither said he'd ever been able to spot them consistently. "I look for the sticks," one said. The other said he focused on looking before the play. "I'll look before the play and say to myself 'OK, 35 is the first.' I'll be honest though, once I start running, I'm never really sure where I'm at." The markers seem to be unnecessary and should be removed. Charles is headed for surgery once the swelling in his knee is down and he'll be a good value in drafts next season.

One of the worst things for any medical staff is a recurrence. One of the hardest things for a medical staff to do is understand how a player feels. Those two things came together with Foster, who pushed to get back for Week 2 and seems to have pushed too hard. In his first few runs, it's easy to see why they let him go. He ran well and showed some burst, but the hamstring didn't hold and tightened back up. It's not considered a complete recurrence of the strain, but it's clear that it's not completely healed either.

One of the reasons Foster was pushing so hard is that he saw how well Ben Tate played in his absence. The disagreement between Foster and Gary Kubiak about who pulled Foster from the game is laughable and irrelevant for getting any handle on how long Foster will be out. Again, it appears Foster is trying to rush back this week, while the Texans seem more comfortable giving him at least another week off.

Romo now has his "bloody sock" game, after playing with a broken rib and a pneumothorax. That latter diagnosis, commonly referred to as a "collapsed lung," is the confusing part for most. The lungs are not like a balloon, where one small hole causes a complete collapse. In Romo's case, there was a small pocket of air in the chest cavity. The leak was bad and painful, but there's really no way for a medical staff to diagnose this. X-rays can show it, and Romo did have X-rays on the rib during the game, but radiologists I spoke with say that small pneumothoraxes require specific and multiple views, and even then they can be tough to see on images. Romo's difficulty breathing is common with fractured ribs but is focused on pain; breathing hurts the ribs, not vice versa. Romo was able to not only speak during the game, but to call out signals over the noise of a crowd while he played, so this idea "he could barely talk after the game" is a bit overplayed. Saying "the painkiller wore off" is much more understandable.

In total, it appears this was a situation in which the medical staff did all they could to make sure Romo wasn't going to injure himself further, but the player himself made the final choice to put himself back in the game. He'll be watched closely over the next week, but it's likely he'll be able to play, just as he was last week. This is due, in part, to a protective vest made by a company called Unequal, which appears to have an intriguing system. In a sport where mythology is strong, Romo's decision is one many fans will remember as much as any late game interception.

Romo isn't the only Cowboy with some problems. Witten actually has the same issue -- a rib injury -- and like Romo, he's expected to play. The Redskins know that both players are hurting and will test them early, so factor that risk into any decision you make. Jones is a bit more mysterious. His separated shoulder is definitely problematic -- and intriguing. Many thought that the team tried to work through Jones' shoulder issue with a change to his equipment, as the team was seen working on him and his shoulder pads on the sidelines. The team either put on a harness to protect his shoulder or worked it on underneath the pads. I asked an an NFL equipment manager about this and he told me that while it's possible, there's no time savings or reason to do so. The other major question is whether Jones had the harness put on him or whether they were adjusting a harness already in place. If it's the latter, it indicates a previous problem that was exacerbated in game, rather than a new injury.

It's going to be a close call for Week 3. Jones can play if he can handle the pain and if he's not going to create more issues. Since, by definition, there is some laxity in the shoulder, it's dangerous, though Jones is obviously strong and in condition.

Austin's situation is easier. His recurrence of a moderate hamstring strain is going to keep him out for at least a couple games, with some pegging his return after the team's bye week (Week 5). We'll have to watch to see if he's running well ahead of Week 6, but take him off your active roster until then.

The Rams escaped Week 2 a bit healthier than in Week 1, when we learned the true meaning of the term "decimate." (Go ahead, look it up.) They believe that Jackson will be back this Sunday after taking a week off due to his quad strain. This is a Grade I strain -- or "I+" in the more modern parlance -- that to Jackson feels like "stiffness." That stiffness is inflammation and the body's protection function that can manifest as a hard contraction to prevent movement. The worry is that this can lead to a cascade, putting other muscles or the opposing muscles (in this case, the hamstring) at risk. Jackson won't be overtasked and will likely split carries to some extent with Cadillac Williams. Of course, Williams is dealing with a mild hamstring strain and an ineffective start against the Giants, so at best, the split is going to lean to Jackson.

The Rams made a curious decision last week with Amendola, listing him as "doubtful" early in the week despite almost no chance he would play. Well, that's the definition of doubtful, and the Rams think that Amendola could be back much quicker than expected. There's still swelling in the elbow, but the internal damage is minimal. He could be back in a few weeks, but definitely not Week 3.

Dustin Fink, ATC, from The Concussion Blog will be checking in every couple weeks with stats on this year's concussions. With a renewed focus and some rule changes, we'll see if the facts match up with the intent. So far, there have been 51 concussions this year. Thirty-four of those came in the preseason, including training camp. There were nine in Week 1 and eight in Week 2, with DBs being the leading positional group with four. There has been only one concussion during kickoffs, so it appears the new rules are working so far. To compare, there were 24 concussions through two weeks last year. The league is on pace for a six percent reduction in concussions.

Ben Roethlisberger got very lucky when he got rolled up. He was seen clearly limping, but it appears his size and strength helped hold him together. One doctor I speak with regularly texted me on Sunday and said that he was worried about a meniscus tear. Why Roethlisberger isn't wearing knee braces to prevent just this kind of situation is beyond me. He's expected to play normally on Sunday night in Indy ... Braylon Edwards had his knee scoped to clean things out and check on the structural integrity of the sprained ligaments. (Yes, plural.) He'll miss a minimum of two weeks and likely closer to a month. Michael Crabtree should see more targets, but Vernon Davis might be the better fantasy bet ... Eddie Royal has a pretty serious groin strain and could miss as much as a month. Eric Decker appears ready to step into the WR2 role in terms of targets, but he's not the same kind of receiver ... Domenik Hixon is done for the season after another knee injury. Torn ligaments end his season early again ... Mario Manningham is undergoing further tests after his concussion. It doesn't look like he's going to go this week, sending the bottom end of the Giants receiving corps into play in deeper leagues. Victor Cruz is the best play here, though only in the deepest leagues ... Sidney Rice's injured shoulder has him questionable not only for Week 3, but going forward. The WR's injury has plateaued, making the Seahawks wonder if they can play him and get any sort of production. Surgery is possible, but it's more likely that they try new therapies first ... The Cowboys seem confident that Dez Bryant will be back this week, but watch the practice reports for more guidance. Bryant slid late last week and there's some grumbling there ... Jordan Shipley tore his ACL and is done for the season. It appears to have pushed Andy Dalton to throw to A.J. Green even more, though the rookie QB continues to overfocus on short routes ... Nick Mangold is "day to day" with his ankle sprain, but all that matters is Sunday. He'll be a GTD, but things are leaning toward him not playing, which hurts the Jets offense a bit ... Nick Collins is done for the season, but the Packers are not giving any details on the specifics of his injury. One physician I spoke with said that it could be many things, including a spinal concussion (which is not like the head injury of similar name). Without more information, any discussion of Collins' return is speculation ... Cam Newton left Week 2 in a walking boot. He had a sore ankle than began to swell a bit after the game, so the medical staff decided to be safe. He'll play normally this week ... Knowshon Moreno was back at practice on Wednesday, but he seems to have slipped behind Willis McGahee for now ... Brent Celek's back issue is just muscular, which makes him a GTD. Watch to see how much he practices this week ... Thomas Davis tore his ACL and is done for the season. He's the second Panthers LB to have that injury, so it's not just the Chiefs ... Myron Pryor and Dan Koppen were pushed to the IR by the Patriots, ending hopes that either could come back this season ... The Pats might be without Zoltan Mesko this weekend. He injured his knee last week and the team is looking at options. This decision is likely to come earlier rather than later ... As always, I'll have my chat on Friday and again on Sunday, taking you right up to game time for Week 3.

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