Explaining Andrew Luck’s injury situation and the timetable to decide on a Week 1 starter

Andrew Luck has been through a lot in his short NFL career. He spent years leading the league in hits and sacks taken. The toll for that beating was finally paid in full when he had to undergo surgery to repair a torn labrum in his throwing shoulder. The recovery from that injury cost him all of the 2017 season.

What made matters worse was that the Colts organization struggled to deliver an appropriate message on the injury and Luck’s likely recovery. Team owner Jim Irsay espoused supreme confidence that Luck would be ready for training camp or at the very minimum the start of the regular season shortly after the surgery was completed. General Manager Chris Ballard and other members of the front office were unwilling to commit to any timetable for return and preferred to allow the healing process to play out before saying anything definitive.

Fans were left in limbo, hoping that Luck would return to play but without anything concrete indicating that was a reasonable likelihood. When Luck was finally shut down for the year, the strained trust between the fan base and organization reached a peak. Fans were as frustrated as the team was not to have their franchise quarterback on the field. They were frustrated that it would likely mean a lost season of football and that the lingering recovery might indicate longer-term implications — or possibly even the premature end to a promising career.

The good news is that Luck finally did recover. Another hazy off-season ahead of the 2018 season left the fans to worry again but Luck did return to the field and had one of the best statistical seasons of his career in a brand new offense. The shoulder looked great. After a few weeks getting back into the groove, Luck looked like his old self. Maybe even a better version of himself.

This off-season was supposed to be the first healthy off-season program for Luck in years. He was supposed to have a great opportunity to work on timing with his receivers and a full training camp in Frank Reich’s offense to build on last season. Instead, Luck was held out of spring/summer activities due to a reported calf strain. He attempted to make a come back in training camp but lasted only a couple of practices before being shut down again due to lingering pain.

How can this be happening again? It’s a fair question and fan frustrations are entirely reasonable given Luck’s history and the history of how the team has communicated about his injuries in the past.

Jim Ayello and Shari Rudavsky of the Indianapolis Star spoke with Dr. Jonathan Shook and Dr. Jan Szatkowski, both orthopedics specialists, to get their explanation as to how the player, team, and fans could find themselves in this situation.

As to why it would take doctors so long to diagnose this injury and how the situation may have developed, Dr. Shook discussed the process and likely effectiveness of an MRI:

Q: So what would an MRI show on an ankle like Andrew’s? Would the straining and stressing or tearing be pretty clear?

Shook: No. Not in the way you’d say for someone who gets an MRI for an ACL tear. That’s a pretty cut and dry reading. It’s either torn or it’s not most of the time. For this, because this syndesmosis or this set of tissue extends over a long distance between the two bones, you could have areas that might be fine and areas that are not fine. So you’d be looking throughout that to see if there’s a little bit of tearing here whereas in the other 90 percent of it, it looks fine. Or maybe it 50 percent looks bad and the other half looks good. It’s not an all or nothing proposition like it is for ACLs.

An explanation for why the Colts may have correctly reported a calf strain and then later report a high ankle injury is offered by Shook and Szatkowski:

Q: Can you explain how the calf or the back of the ankle is affected by this issue in the front?

Szatkowski: I think the calf strain could have been a distracting injury. When someone has an injury to the calf, their muscles are weaker and they are more predisposed to having an ankle injury.

Shook: I would look at it more like this: It’s not in the front. It’s not in the back. Syndesmosis are actually between these two bones, so it could present, ‘Oh it’s in the front, no it’s actually in the back,’ because that ligament is in the middle. It’s between the two bones. The calf is in the back, so you’ve actually got musculature in the ankle in the front, so it could present pain on both sides, front and back.

Here they offer an explanation for both why an injury like this might linger and what is typical in terms of a recovery time:

Q: Is it common for this type of injury to linger for as long as it has? And is it common for it to appear as only a calf injury and for it to develop into a high ankle sprain?

Shook: They certainly last a lot longer than your typical low ankle sprain. Some of these, it’s not uncommon for an athlete to battle these throughout an entire season, because they kind of keep aggravating it. I’d say some people could go six months with this being a problem. I’d tell you the fact that this course has taken longer than people thought it should, it does kind of play into the narrative of, yes, it’s getting more into this high ankle sprain, this thing we expect to take longer.

I don’t know if there was one injury that beget the other, but I wouldn’t say he had the calf injury and now all of a sudden he has a high ankle sprain. I don’t see a correlation between that. I think it was probably a common injury that kind of resulted in both things being aggravated. … I’m not sure if I’ve ever seen someone rehab from a calf injury all of a sudden get a high ankle sprain. It’s generally not the way it works.

The Colts have indicated they would like to make a determination about Luck’s status for week one following the 3rd preseason game with Frank Reich saying:

“Ideally, the more time you have the better, but by the end of the third preseason game I think you need to know something. You’ve got to be able to make the call and move from there. . . . You have 10 days for that first game and whether we’re full speed with Andrew after that third preseason game or at that point, are we going to go with Jacoby? We’ll make that decision when that time comes.’’

That tells us that the date to mark on the calendar will be that first practice following the week three preseason game, August 26th. How Andrew Luck is doing at that point will be largely indicative of whether he is able to prepare adequately to play against the Chargers in week one.