Concussion Probe; Why Tua’s Fingers Froze

The biggest NFL injury news of the week is the unaffiliated neurotrauma consultant involved in clearing Dolphins QB Tua Tagovailoa during his Week 3 game against the Bills has been fired. According to reports, that specialist made “several mistakes” in his evaluation.

The league and players’ union are also exploring new concussion protocols, including immediately ruling a player out if he demonstrates any instability. That rule could go into effect as early as Week 5. 

I’ll break down exactly what happened Thursday night with Tua when his fingers locked up, and we’ll give proper context to other key injuries around the league.

Will Carroll has covered NFL injury news and injuries in sports for more than 20 years and has written four books, including the newly published “The Science of Football”. He also consults with several pro teams. Will is currently the Director of Bioanalytics for Northstarr, a sports science startup company.

Editor’s Note

MAC JONES, QB PATRIOTS (sprained high ankle)

For my initial thoughts, I did this video on Monday. Follow @TheLinesUS on Twitter for NFL injury news and the latest betting information.

Since then, I’ve learned a bit more about the significant high ankle sprain suffered by Mac Jones. While Jones continues to call it day to day, this is one that’s headed to surgery. Jones and the Pats are considering options, but the most likely is that he’ll head back to Alabama to have a procedure called a Tightrope. This is the same sort of procedure done recently on Trey Lance, and on both ankles of Tua Tagovailoa. 

Dr. Lyle Cain in Birmingham, Alabama’s team doctor, has done several of these, including Tagavailoa’s, with very positive results. The expectation is that Jones will have the procedure and while there’s theoretically a 10-12 week return, teams tend to be very conservative with these types of surgeries. These have been around better than a decade, starting with ankle surgeries in Scotland, so there’s plenty of results. We’re starting to see more of them in knees, ankles, high ankles, and even elbows, across sports.

Jones has every chance to come back, but the normally conservative timelines and the struggles of the Patriots likely end Jones’ season and draw into question how the Pats will deal with the rest of the season. They’re likely to become a slower team, reliant on the run, and even that depends on Brian Hoyer’s ability to at least threaten somewhat with the pass. The lack of an offensive coordinator would suggest adjustment will be tougher, so the team becomes an under play until proven otherwise, with both points and yardage across the board.

  • Betting Angle: QB Brian Hoyer passing yards O/U / ()

TUA TAGOVAILOA, QB DOLPHINS (back spasms)

So why did Tua’s fingers freeze in such an awkward, scary position after suffering a concussion Thursday night? It’s called a fencing response. The brain and the spinal cord get short-circuited. What they do is protect the body by shooting out. The benefit, basically, is that you don’t fall on your face.  

What you saw with his fingers was just the electrical signals going nuts. When it gets hit that hard, when the spinal column gets a shock, the spinal cord just shuts down for a little bit and, kind of, reboots. 

The fencing response is a normal thing. We’ve seen it before, as scary as it may have looked for those that have never seen it before. 

For more on Tua’s upcoming recovery from this (second?) concussion, watch TheLines Injury Podcast on YouTube:

JUSTIN HERBERT, QB CHARGERS (fractured rib cartilage)

Brandon Staley said that Justin Herbert didn’t want to “quit on the game”, so he left him in, down 28 points and the pain-blocking injection wearing off. Coaches and the medical staff are there to keep players like Herbert, trained to always want to play, from doing things against their own and the team’s best interests. They let him down, but Herbert became the starter because someone couldn’t go, which is powerful training. 

Herbert showed no issues with his rib injury, making all the throws, including one spectacular off-balance deep ball where he was twisted. He took some hits, some falls, and seemed to be moving normally despite the injury and the necessary injections. Essentially, Herbert should be in the same spot next week, with a bit more certainty. He’s still at risk of re-injuring those ribs and will be for a few more weeks.

If there’s room for microbetting by play or by quarter on your betting card, Herbert’s play was clearly influenced by the painkiller. He took one just before the game and at halftime. The further from it, the more he struggled. I need to see more next-gen, but he clearly had mobility and arm strength, but missed Keenan Allen, who could be back next week after missing time with his hamstring strain.

  • Betting angle: Chargers 1Q spread

JOEY BOSA, EDGE CHARGERS (strained groin)

There are seldom any injuries with as immediate a diagnosis as Joey Bosa and his most recent groin strain. Bosa took an awkward step, dropped to the turf, and grabbed his groin. After a quick trip to the tent, he hobbled up the tunnel, again holding his upper leg. 

It’s almost as simple as that. Bosa’s a speed rusher, but needs to be able to make those turns, spins, and bulls, all of which involve the groin. Bosa is powerfully, but tightly wound and muscular, making the worry for a significant strain more worrisome. Bosa is unlikely to play this week and the Chargers may have to go without their star edge rusher for several more after that, depending on how the muscle responds to treatment.

With a game against the Texans upcoming, it’s less of a challenge for Kyle Van Noy and Khalil Mack to have less of a rotation. I love the points under here – the Chargers are banged up and the Texans are just bad. The bigger issue will be fatigue and making sure that doesn’t lead to more injury issues for the Chargers over the next few weeks.

D’ANDRE SWIFT, RB LIONS (sprained ankle/sprained shoulder)

When Dan Campbell suggested at his press conference that he was considering sitting D’Andre Swift for two weeks, ahead of the Lions’ upcoming bye, you could almost hear the betting lines move. Swift’s talent has shown even with a mild ankle sprain, but a shoulder sprain added to that has the running back potentially out in Week 4 and perhaps beyond.

The ankle is the same mild sprain, though it was a bit exacerbated in the game, showing the risk of trying to play through it despite the best efforts of what looked like about six rolls of tape on his ankle. (Kudos for the clean work, whoever did that tape job!) The shoulder is actually more concerning and could be the reason Campbell’s more willing to play without him. An AC sprain would hurt him in blocking and the pass game, not to mention make it harder for him to take and initiate contact. A mild sprain should heal in two weeks.

Two weeks of treatment and rest would be a positive, but it would certainly be an adjustment for any model that’s picking up on the dynamic Lions so far this season. This week, the Lions are without three key weapons (WRs Amon-Ra St. Brown and D.J. Chark are also out). So I’m watching unders on points and on Jared Goff’s yardage. 

  • Betting angle: Goff passing yards O/U / ()

DALVIN COOK, RB VIKINGS (inflamed shoulder)

It wasn’t quite a butt fumble, but question about the collision’s severity were answered when Dalvin Cook was determined to have a shoulder subluxation. Cook has a long history of shoulder problems and this appears to be related. A subluxation is when the ball of the shoulder joint moves more than it is supposed to, but is less than a dislocation, where the joint comes out and stays out. Lesser is still painful and still very problematic for soft tissue, like the labrum and the ligaments and capsule designed to hold it in place.

Cook declined surgery on the shoulder, electing to rehab it. (If you’re a baseball fan and this reminds you of Fernando Tatis Jr, it should.) While that can work, word that Cook hasn’t been wearing his protective harness this season seem short-sighted. This is exactly what can happen and I’d imagine that harness will be back.

The subluxation in and of itself isn’t the issue. It’s how the shoulder responded to it. There’s usually pain and swelling, but if it’s minor or responds well to treatment, it can be very minimal. 

Cook returned to full practice Thursday, and he’ll play in London. Figuring out the recurrence risk, or whether the Vikings will dial down his touches is one for you to decide, but is an unknown at this stage and I hate unknowns. I’m staying away from Cook and all offensive Vikings this week because of that uncertainty, though I’m willing to re-visit it if Cook looks good late in the week.

DAVID MONTGOMERY, RB BEARS (sprained ankle/knee)

As the old song goes, the knee bone is connected to the ankle bone. That’s why David Montgomery was listed as out last week with both knee and ankle. The mechanism was a player falling on his leg. Both his ankle and knee gave some, minimizing the strain put on either. Had the leverage been on one or the other, it could have been more significant. If it’s an MCL sprain or a high ankle sprain, or both, at least they are low grade. 

Instead, the body’s redundant protection mechanisms helped Montgomery escape the worst case scenario. While each will have to heal up, those tend to be concurrent. Montgomery runs low to the ground, so knee stability and ankle mobility go hand in hand. Not only will he not be able to cut and jump laterally, he’s not going to have much push if he’s trying to run north and south. 

Montgomery is out again, and the Bears offense doesn’t seem to change. Khalil Herbert produced given the opportunity and gives the Bears cover for being conservative with Montgomery’s return as well. Their reliance on the run means that Herbert could get overused or overexposed, with only Trestan Ebner behind him. Ebner was used for seven touches and a target, so the Bears aren’t afraid to use him, easing some concern. My expectation is that Montgomery will miss a week, maybe two, so his seasonal projections come back into the negatives even with his early usage. 

STERLING SHEPARD, WR GIANTS (sprained knee)

  • Betting angle: Giants WR Richie James receiving yards prop O/U / ()

Odell Beckham Jr and many others questioned why MetLife Stadium has turf after watching Sterling Shepherd carted off near the end of Monday’s game. The reasons are more about the use of the building outside of football. It’s easy to roll up the turf for the next big concert

There was lots of initial speculation about Shepard’s injury being focused on the patellar tendon. Instead, the team released on Tuesday that Shepard suffered an ACL rupture and will miss the remainder of the season. There was no word on whether there was any other damage, such as to other ligaments, the meniscus, or the patellar tendon. It would be standard for Shepard to have surgery over the next few weeks, with the six to nine month recovery time putting the start of camp for next year in reach. 

This is a tough break for Shepard, just back from last year’s late season Achilles rupture and repair, but the ACL is relatively better and easier to come back from than a patellar tendon injury. Regardless, it leaves Daniel Jones and the Giants offense without a proven receiver. With Shepard and Kedarius Toney seemingly injury prone, depth is an issue. This could prove a boon for Saquon Barkley, who is playing as if a full, normal off-season and a new offense has rejuvenated him.

TEE HIGGINS, WR BENGALS (sprained toe)

A second concussion for Tee Higgins would be problematic for him and for the Bengals offense. After recovering from his first just weeks ago, Higgins took a particularly nasty helmet to helmet hit and stayed down, but he was cleared to return in Week 3. In a week where Tagovailoa took all the heat for a surprising return, this one was every bit as problematic to me, given how quickly he was back in and that recent concussion.

He performed fantastically Thursday night with more than 100 yards and a touchdown, but this is again about the protocols.

He went through the protocol normally after Week 1, with a source telling me he had no issues or symptoms the day after his concussion besides a mild headache. While we know very little about the long term consequences of concussion — and research has slowed on this, post-settlement — recovery in the short term has a high degree of success if best practices are involved.

Higgins also played through a toe injury I was told it’s a mild sprain, but not something the team thinks will linger like turf toe or cause problems with speed and cuts. 

Higgins remains a solid WR2 with a top-tier QB. If the line gels with time, as is often the case, we may be underestimating the Bengals or overestimating the hangover. 

MORE NFL INJURY NEWS: QUICK HITS

Dak Prescott had the stitches removed from his thumb on Monday. Now it comes down to grip strength. A source tells me the team remains positive and he could start throwing this week … The Jets think Zach Wilson will make his debut after minor knee surgery cost him the first three weeks. We should see how he’s moving in practice. Key on his stops for the best sig … Tests on Amon-Ra St. Brown were positive, but the question was whether the ankle sprain would respond to treatment quickly enough to get back this weekend. It did not … It was a clean hit, shoulder to ribs, on Garrett Wilson, which is why he went down in such pain. He likely had the wind knocked out of him and was lucky to just have bruised ribs … The Saints believe Michael Thomas’ toe sprain is minor and on the opposite foot of his offseason surgery, but compensation injuries happen. Gait is bilateral, people … The Cowboys had hoped Michael Gallup would be ready for previous games, but they expect he’ll be ready to make his post-ACL return in Week 4 … Julio Jones’ mild PCL sprain shouldn’t keep him out more than last week, but I’ve been watching to see how he moves in practice. He got in two limited practices before a rest day Friday … Jalen Guyton suffered an ACL rupture and is done for the season, though would you believe me if I told you it didn’t have to be? … Same for Taylor Lewan, who will need an ACL revision on his left knee and will miss the season … Shaquille Leonard is, I’m told, physically cleared to play. He needs confidence in his legs after back surgery. He’s questionable again after a full week of practice … DJ Reader will miss a month with a knee sprain. No details, but that timeline matches with an MCL sprain … Myles Garrett was involved in an auto accident. First of all, grateful he was not more seriously injured after the Porche flipped multiple times. He’s a game-time decision.

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