Michael Vick leads parade of Week 4 injuries

Michael Vick leads parade of Week 4 injuries

Michael Vick, QB, Philadelphia Eagles: By now, everyone is aware that Vick suffered a chest injury in Sunday's game; the big question on everyone's collective mind is: How much time will he miss? Undoubtedly, that question is followed by others, such as, "How effective can he be when he returns?" or "What are the chances of reinjury?" These are all valid questions but, sadly, there is very little to offer in the way of definitive information. Rib cartilage injury, which is what Vick is dealing with now, is by its very nature unpredictable.

So what can we say about the injury? Starting with the way the injury happened, we can say it looked perhaps more like a hockey injury than anything else. Vick was, as he put it in his interview on Bruce Smith's radio show in Virginia Beach, Va., "sandwiched" between two defenders, absorbing a hard hit from both sides. It looked like the shot a hockey player takes when driven into the boards, which usually results in a shoulder separation, a rib injury or a cartilage injury. The force from the simultaneous hits on Vick was transmitted through the shoulders, through the ribs, and ultimately the failure occurred at the weak point, the cartilage junction between the ribs and the sternum (breastbone). According to The Philadelphia Inquirer, an MRI taken of Vick's chest revealed no broken bones but rather damage to "the cartilage that connects his second and third ribs to his sternum."

A natural immediate reaction would be relief that it was cartilage damage as opposed to a broken bone. But, in fact, a rib fracture would be desirable over a cartilage injury of this type. I posed the question to several colleagues (orthopedic surgeons and physical therapists/athletic trainers who treat NFL players) as to which injury, in their opinion, would be more problematic, and they all agreed that this type of cartilage injury is more difficult to manage than a broken rib.

Part of the challenge has to do with the fact that cartilage just doesn't heal as quickly or predictably as bone. Additionally, part of the role of cartilage in the chest wall is to allow some elasticity in the thoracic cage (essentially the 12 vertebrae that make up the middle portion of the spine, the ribs that attach to them and the sternum in the front). There has to be some elasticity to permit motion during breathing and to make the entire cage less brittle. Once a portion of that cartilage is cracked, however, it is difficult to keep it "still" enough to heal. Every breath, every reach, every twist, yawn, cough or sneeze presents an opportunity to move that damaged cartilage, resulting in pain, usually sharp, along with the potential for slowing down the healing.

There is no magic fix. The best treatment is rest and avoiding movement of the injured area. Vick's ability to return will be largely pain-dependent; there is no great concern about making this injury worse. The sharp pain should subside over the first week or two, but the problem might come when Vick tries to increase his activity. As he begins to throw (yes, even though he throws with his left arm, it causes movement on the right side of his body), or, for that matter, even run hard (making him breathe more forcefully, which could be painful), he might experience pain again. Every time he takes a big hit or lands on his shoulder, chest or back, it has the potential to aggravate the symptoms. Vick ultimately should recover fully from the injury; the question will be how long the pain makes its presence felt this season.

This injury has the potential to sideline Vick anywhere from two weeks to five or even six weeks. The broad range of time reflects how variable the symptoms can be from one athlete to the next. It's worth keeping in mind that much of Vick's success as a quarterback is the running threat he provides. If he can't run effectively, it's hard to imagine him being dangerous at his position. The more running, the more rib motion and the more uncomfortable it will be, at least in the early phases of healing. And although a lower rib injury sometimes can be aided by extra padding or a wrap to splint the area, it's much more difficult to add any kind of protection for the upper ribs because they are so close to the shoulder.

Expect Kevin Kolb to start at least two weeks, if not more, to try to re-establish his role in the quarterback position. Fantasy owners who were just getting used to having Vick in their lineup now need to prepare for his extended absence.