Will Carroll
Wednesday November 24th, 2010

Some people wonder why I take injuries so seriously, why I believe that there's so much needless suffering and that doing more to prevent and reduce injuries isn't just something that would make the game better, but is our duty. Some people wonder why things like concussions, drug abuse and paralysis are things that I'll never stop telling you about, even when people say, "they know the risks and are well compensated for it." The reason is that it's the right thing to do and that life, real life, away from the pads, the fields, and the camera, is just as important as anything that happens between the lines.

I got my reminder this week. My grandmother, Lois, passed away. To say that she was my inspiration shortchanges everything she did. We often hear the stories about players' families -- the mother who signed them up for Pop Warner, the coach that believed in someone. I always feel like we're letting those people down when we allow something that we could fix to not be fixed. When an injury happens that could have been prevented or worse, a death, I wonder as much about the people surrounding the player as I do about the player. We have to commit to work hard, to do more, to commit the resources, and to acknowledge that while life is short, it's also important and meant to be full. We have work to do.

Let's get to the injuries:

The Giants are getting really thin at WR after yet another injury at the position. Losing Hakeem Nicks is more devastating than most of these, but the double whammy of losing him while Steve Smith is out leaves Eli Manning in much the same situation that Philip Rivers did for a few weeks. Like Rivers, he's got one guy -- Mario Manningham -- that he can trust and a whole bunch of other guys who have barely seen reps, or worse, are coming in off the street.

Nicks will miss at least three weeks with a condition called compartment syndrome. This is a pressure problem within the spaces we all have within our body. What happens is that one of the compartments is injured traumatically and the compartment fills with fluid, usually blood, and all the nerves and other structures are squeezed. In some cases, the pressure has to be relieved surgically, which is a simple procedure that opens up the compartment and allows it to drain. The usual cause in football is a helmet to the leg. It's very painful, but as long as it is treated before there is internal damage, the return path is pretty straightforward. It can't be shortened, however, due to the need to make sure that the area heals completely and properly. Once back, Nicks should have no real issues, but it will be Week 14 at the earliest and do not be surprised if it takes a couple weeks longer.

With Steve Smith targeting a Week 13 return from his pectoral strain, Manning and Manningham will have to find a way to step up. Smith's return is the key here, so he'll be watched very closely over the next 10 days. Remember that pectoral strains are usually at the thinner insertion, near the shoulder. In fact, while you instantly think "chest" when you hear this, people with pectoral strains would usually point near their shoulder if asked where it hurts. Like any muscle at it's weakest point and not fully healed, the recurrence risk is high, so the Giants will have to be sure that they're not pushing Smith out too quickly due to the absence of Nicks.

Gates was not able to go this week due to the plantar fascia tear that he's been dealing with for almost a month. There was a bit less of the "he's a warrior" talk, but that doesn't matter. Warriors who can't run are just cheerleaders anyway. The tear, a compensation injury resulting from trying to fight through the toe injury (which is being helped by the time off, which is kind of a reverse compensation), is still inflamed and painful, which makes this one a week-to-week injury that's going to require a lot of time and effort. The issue here is one of progression, and in the week since we last saw Gates as a game-time decision, there wasn't much that changed. The Chargers are hoping that the continued rest gets him back on the field, and just as important, keeps him on the field. With Vincent Jackson expected back this week, Philip Rivers has some targets back, leaving Gates a window of healing. He might not help get teams to the fantasy playoffs, but it seems like Norv Turner is determined to make sure he's back for those same weeks. That's a smart play.

Just after Tony Romo fractured his collarbone, a source told me that the Cowboys would wait until about Week 12 to make a decision on whether Romo would come back this season or be pushed to IR. It looks like that source was dead on, with Romo undergoing tests to check on the status of the fracture. There's still a discernible fracture, but there is progress. The question now is whether the progress on the field matches up and makes playing Romo make sense. That same source thinks that the Cowboys will wait at least one more week before making any decision, while Romo is rehabbing as if he expects to play. This will heat up more, especially if Jon Kitna continues to play well enough for the team to win, though there's almost no chance the team would hold Romo back due to Kitna's presence.

The Saints RB situation is so confusing, I have to invoke Vince Lombardi. With a short week heading into Thursday's game, it won't get any easier, for the Saints or for fantasy players trying to figure the situation out. The Saints had hoped that Reggie Bush would be ready to go, but Sean Payton had set up a high bar for Bush's return, saying that if he wasn't 100 percent, ready to take "full carries plus returning kicks," then the team would rather leave him inactive. That's exactly what happened, despite some disagreement on just how close Bush was at any point during the week. Bush was at Monday's practice, but only a limited participant on Tuesday. Despite that, there are signals from Payton and other sources that Bush is likely to play on Thursday.

It's less likely that Pierre Thomas will make it back in time. His ankle sprain -- and my sources insist that it is a sprain, not a strain, though that distinction is irrelevant in terms of recovery timelines with serious injuries like this -- has not allowed him to make any sort of lateral moves and is still showing a significant limp. The longer week heading into Week 13 makes that more likely, though Thomas will have to prove he's ready. The guys who've been playing in Bush and Thomas' absence are also banged up. Chris Ivory has both shoulder and knee soreness, though his oft-repaired knee is the bigger concern, both short and long-term. Ladell Betts looks like he'll be out for this week after suffering a concussion.

Any rookie is going to have a real test about this time of the year. College football teams play 11 or 12 games, plus a bowl game, but it's about this time where the season is over. Once in the pros, there's six more weeks to go. Some compare it to "the wall" in a marathon, but it's simply taking the body to a place it hasn't been before after being hit more and harder than it has prior. Every rookie is in that unknown territory now, including Jahvid Best. Best has the additional issue of his lingering turf toe, making it tougher to say that the fatigue or the injury is what's reducing his effectiveness. Now that Kevin Smith is out for the season and the playoffs are out of the picture, expect the team to dial Best's touches back to avoid fatigue-based injuries, but keep him in the plan so that he "feels" the full schedule and is better prepared, they hope, for what's likely to be an 18-game season next time out.

The indications were as bad as they could be just a couple weeks ago for Chad Henne. A dislocated kneecap, a strained knee -- that usually equals a season-ender, something almost all reports indicated. Something changed, or at least our information did. Henne's low-grade sprain is problematic, but not a season-ender. When his patella dislocated, it was painful, but the underlying damage was "minor" according to my sources. "Minor" is a very relative term, but it's obvious that it could have been much, much worse. The knee is not stable, nor is the patella, which is the major concern now. Henne was able to suit up as the emergency third QB last week, but sources say that it would have had to be a real emergency. "[The Dolphins] would have had to lose both QBs and the Wildcat before Chad would have played," I was told on Tuesday. It's not likely that he's back this week, but Henne is back at practice and a return in the next couple weeks is possible. One big factor in whether he returns is going to be the line play. Jake Long's shoulder might force him out and there's problems at center as well. If the Dolphins can't count on protection for a significantly less mobile Henne, they simply won't play him.

There's a huge difference between Austin Collie having a setback from a concussion and having a second concussion. I'll stay away from the concussion soapbox here and just try to focus on what those two scenarios mean in a football sense. The Colts and NFL were quick to point out that Collie passed all the appropriate post-concussion screening. That's not a dispute, but with the pressure the entire Colts team was under heading to Gillette Stadium, it's quite possible that Collie didn't disclose residual symptoms. After the first series, CBS gave us a shot of Collie standing on the sidelines talking to three members of the Colts medical staff. He went back out, but just a few series and one hit of his head on the ground later, Collie was out of his pads. If Collie was suffering residual symptoms and played, then the system designed to protect him was either circumvented or gamed. If it was, in fact, a separate concussion, the worry is that second impact syndrome can lead to more severe, lingering issues. The Colts have given no information regarding Collie since he left the game, so this early, it's impossible to tell what his availability is going to be, this week or this season. One other note on this: Collie hasn't spoken to the press at all since the incident. This would appear to be a violation of NFL policy. Collie did speak at a charity event prior to the Pats game, even taking some questions about the hit. Sources say that Collie said he doesn't remember a significant period of time prior to the original concussion and that he was "improving slowly."

Vince Young will have surgery to repair a torn tendon in his thumb. He's done for the season ... The Chargers don't seem optimistic that Ryan Mathews will be back to face the Colts. His ankle is still tender, though he will try to practice this week ... Clinton Portis has been put on injured reserve with a groin injury. We'll also have to watch to see if Ryan Torain sees any improvement this week with his hamstring. Keiland Williams seems to have Mike Shanahan's confidence for now ... While the Seahawks won't confirm anything about Mike Williams' foot injury, reports are that it is a plantar fascia strain, not unlike what Antonio Gates has been dealing with ... Don't expect to see Mike Sims-Walker this week. He's made little progress with his high ankle sprain ... The short week makes it tougher for Jerricho Cotchery to make it back this week, but signs are positive. He's a GTD ... Patrick Crayton dislocated his wrist in Monday's game. No word yet on how much time he'll miss, but the return of Vincent Jackson makes this less of a factor for the Chargers ... No Friday chat this week due to the holiday. I hope everyone enjoys it and comes back to check out the Med Check on Sunday. I will try to give some updates for the Thursday games over on Twitter, so follow me @injuryexpert for those.

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