Dr. Blue's Health of the Franchise - Hart, Sanders

A funny thing happened in the days after Super Bowl XLIII... all players who were on Injured Reserve status were suddenly and unceremoniously taken off of it, regardless of when or how severely they were injured.  Those transactions simply marked the end of the 2008 season and the beginning of 2009, but for those of us who grew up playing video games (or who have children who did), the effect was something akin to starting a new game with all of your "lives" intact.  Or maybe it was more like a big "do-over."  The unintended consequence is that many fans may assume that players will be back at it next year, fully healthy and rehabilitated, ready to go.

The reality, however, is that many of the injuries sustained by NFL players severely limit or even end their careers.  They lead to weeks and months of frustrating attempts to return to the field, only to have a real hit knock them out again or "the next man up" out-perform them and take their job.

I was curious as to where my favorite injured players are in their current rehab progress, and what the realistic chances are for their return, and thought that might be a good topic for my first meaningful post on this blog.

Please note that although I labeled this "Dr. Blue," I am not a doctor, I do not play one on TV, and I did not stay at a Holiday Inn Express last night.  However, I have a little personal experience with sports injuries, have friends in the medical profession, and I can research the HECK out of the Internet (where you can believe everything you read).  With that... I submit my first entry in what I hope becomes a mini series... Mike Hart and Bob Sanders:

Mike Hart, RB
Date of Injury: Oct 12, 2008
Nature of Injury: Torn ACL in right knee
Typical Rehab Process/Duration: Remove the middle third of the patellar tendon and use that to replace the ACL.  Physical therapy can begin as soon as 2-3 days post-op, and recovery for non-athletes is ~9 months if things go smoothly.
Players who have suffered similar injuries:  Edgerrin James, Terrell Davis, Ronnie Brown, Deuce McAllister

via www.colts.com

In his own blog, Mike Hart reported just a few weeks after his injury that you wouldn't even know he was injured.  This is not atypical of an ACL tear.  Technically you can still walk - and even run - with a torn ACL.  But the ACL is the lateral stabilizer inside the knee joint; with that damaged, what you can't do is change direction quickly while running... something that NFL running backs obviously need to do.  Rehab focuses on ensuring that the patient's joint is mechanically repaired and that it remains flexible and strong, but the critical element here will be if his confidence is as high as it was during that bullrush run we saw against Baltimore.  This is not to say that he doesn't have confidence, but having had a severe knee injury myself, I know that I don't fully trust that knee any more to withstand certain moves.  Oh and I also have arthritis in it, it hurts all the time, and my IT band is constantly tight... but I digress.

Despite his own reports of being well ahead of schedule, and Bill Polian's confidence that he will be ready by the start of the regular season, I think we should temper our expectations given the typical recovery period.  We will also need to temper our expectations of his performance once he does return.

Dr. Blue's Prognosis - Likelihood of Game 1 Appearance: Medium

Bob Sanders, DB
Date of Injury: 2004, 2005, 2006, 2007, 2008...
Nature of Injury: Knee injury (exact nature unknown, but I'm guessing meniscus tear) and high ankle sprain (Sep 17, 2008)
Typical Rehab Process/Duration: Reportedly had arthroscopic surgery on his knee in Sep/Oct 2008.  Rehab process likely similar to ACL repair.  Rehab of ankle sprain depends on severity; could be a few weeks to several months.
Players who have suffered similar injuries: Kyle Orton, Sidney Crosby, Brian Westbrook

via www.colts.com

I do love me some Bobzilla, but I have to say I'm frustrated that he hasn't been able to put together a string of several games in a row where he takes the field as the starter.  Of course I'm sure he's MUCH more frustrated than I.

The nuance of Sanders' knee injury seems to be recurrent swelling that simply won't subside without several days' or weeks' rest, hence the reason he didn't play in many (or any?) consecutive games last year.  Swelling can be caused by a number of conditions, including arthritis and gout, but in Bob's case probably is a reaction to knee surgery and the years of playing a demanding contact sport.

As concerning as the knee swelling is, the high ankle sprain is much more concerning to me in terms of recovery.  A high ankle sprain injures the ligament above the ankle that joins together the tibia and fibula in the lower leg.  It occurs when that ligament is stretched or torn.  Recovery from this injury depends (naturally) on the severity of the damage.  If the damage is minimal, and the patient's lower leg bones are stable, the patient can wear a simple cast for a few weeks while the ligament repairs itself.  If the lower leg bones are found to be moving around more than they should, surgery may be indicated to essentially fasten the leg bones in proper place while the ligament heals.  If surgery is required, the patient may have to wait 3 months before starting rehab, and another several months of rehab thereafter, up to 6 months for the non-athlete.

Polian stated in February that Sanders will likely open training camp on the PUP list.  This could be just a continuation of the approach they took last year with Bob and a way to determine the right ratio of playing days to rest days that will allow him to be strong and healthy come game day.  However, I fear that this may be an indication of the severity of his sprain.  Here's to hoping I'm way off base.

Dr. Blue's Prognosis - Likelihood of Game 1 Appearance: Low