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NOTE: This column is a living document. I'll be updating as needed after team press conferences, imaging reports, Monday Night Football injuries, etc. Major changes to the content will be noted in red. I'll also be retweeting any key pieces of news and my own reaction and analysis, so make sure you're following @JeneBramel and checking my timeline on Twitter throughout the week.
FOLLOW-UP APPOINTMENTS
This is another week is which the players with ongoing injury concerns are dramatically more interesting than the new injuries that occured yesterday. So, I'm opening with the follow-up appointments again and saving the list of new injuries for later.
As a quick aside, the evolving nature of these stories is fascinating to me. I do three injury columns a week at Footballguys -- Monday, Wednesday and Sunday. But injury news has become a 24 hour cycle. Imaging reports, specialist visits, coach press conferences, etc. happen at all hours throughout the week.
Most of the situations in this section include thoughts I tweeted in real-time. I won't be correct with every bit of early speculation -- as those who read my concerns on Jimmy Graham have often reminded me of late -- but make sure you're following me on Twitter (or checking my timeline daily) if you're interested in my analysis of major injuries on non-column days.
dez bryant | back | day-to-day
Fishy. There was no other way to describe the chain of reports on Bryant's back last week. Early in the week, Bryant was said to be dealing -- once again -- with back spasms. Though Bryant had struggled through back spasms multiple times over the past two seasons, he was allowed to talk with the media and had a history of playing through the spasms.
Midweek, however, there was a report that the Cowboys were concerned about a possible disc-related issue. Both Stephen Jones and Jason Garrett denied this, but their denial came way too quickly and it came through some of the less reliable beat writers. That had my spidey senses tingling on Friday. It wasn't surprising to learn from Ed Werder yesterday morning that Bryant had an epidural injection early last week for back pain.
You don't have an epidural injection for back spasms. An epidural injection will usually include both a local anesthetic and steroid and goes into an area between the spinal cord and vertebrae near where the discs and nerves exit the spinal cord. These injections are used to relieve pain associated with disc herniations and other conditions that put pressure on the nerves around the spinal cord.
I spoke with a neurosurgeon familiar with these injections yesterday. Relief from the first injection often happens quickly. In some cases, relief can be permanent with just one injection. But it's rare because injections don't treat the underlying anatomical problem causing the pain and spasms, they only relieve the symptom. More commonly, relief lasts between 4-6 weeks and most who have one injection get another in four weeks to continue treating the symptoms.
For some, that's enough. The inflammation heals, the herniation resolves and the pain and muscle spasm ends. But that's a big ask for a football player who is being hit and putting his body in unnatural positions many times a week. As we've seen many times -- see Rob Gronkowski, Jason Pierre-Paul and now Arian Foster as high profile cases -- in recent seasons, a second (and sometimes third and final) injection isn't enough and players are left with no option but to seek surgery.
It's possible that Bryant's MRI was negative and didn't show a herniated disc, though there's clearly reason to doubt the team's denial now. There are other causes of nerve-related pain treatable by epidural injection. That's not necessarily a good thing. Injections are more likely successful for disc herniations than inflammation due to bone spurs. For now, it's reassuring that Bryant got enough pain relief to practice and play last week.
But the clock is now ticking. Will Bryant's symptoms fully resolve with one injection? If he needs a second injection in 4-6 weeks, how effective might it be? Will Bryant need surgery after the season? There's no way to know the answer to those questions today. But given what we now know, it's less likely he finishes the season now than it was two weeks ago.
percy harvin | labral tear hip | day-to-day
Harvin moved back out of the rehab group and into practice last week. After full sprints in rehab, he had no recurrence of the soreness that set his recovery back two weeks ago. That's a reassuring sign that he experienced only the usual ebb and flow of rehab after hip surgery and not an indication that he'll still struggle with impingement symptoms or additional delays in his rehab. If his return to football-related activity in practice goes well, he'll return to play this week. I'll have more on his possible usage and gameday expectations after we see his practice participation and hear from Pete Carroll midweek.
aaron rodgers | fractured clavicle | week-to-week
There was a flurry of reporting on Rodgers in the days after his injury. After he went on his local radio show and confirmed that he did fracture his collarbone, the reports slowed to a trickle. The rush to break the story on his diagnosis was over. But there's been very little followup on the timetable for his return. That's likely because Rodgers said, essentially, it'll heal when it heals. And while that's true, the healing process is different for different types / locations of collarbone fractures.
I have the sense that the consensus return date on Rodgers is 3-6 weeks. That range is usually interpreted as 3 weeks is possible, 4 weeks very possible and 5-6 weeks more conservative than likely. I'm not so sure in this case. We've seen players recover from AC sprains involving collarbone injuries and midshaft collarbone fractures in 3-4 weeks. But without knowing the specifics of Rodgers' injury, the 5-6 week (and possibly 6-8) timetable is a reasonable expectation.
We'll know more on Rodgers in the next two weeks, but there's no guarantee he's back quickly.
ARIAN FOSTER | lumbar herniated disc / HAMSTRING | injured reserve
Last Monday, I wrote of my concerns on Foster's back injury and the likelihood that it was much more than simple back spasms caused by over-compensation while rehabbing his hamstring injury. The tea leaves were plainly evident. Foster had an epidural injection for what was called "disc irritation" in his lower back during the preseason. When it was reported mid-week that Foster was seeking multiple opinions from back specialists, that sealed my concerns and I tweeted on Friday that it was time to brace for a long-term absence.
Sunday morning, John McClain tweeted that Foster will have surgery to repair his herniated disk this week. Depending on the extent of the procedure Foster undergoes (microdiscectomy alone or an added spinal fusion), Foster will likely spend the next 3-4 months in rehab. Many players have returned successfully from these procedures -- Rob Gronkowski is the most recent positive example -- but spinal surgery isn't a guaranteed cure.
It's only one unknown for Foster and the Texans this offseason. There are already rumors that Houston could choose to move on from Foster while trying to decide whether to re-sign Ben Tate.
DAVID WILSON | cervical spinal stenosis / herniated disc | injured reserve
Sunday brought more clarity on the specifics of Wilson's neck injury, but his prognosis is as muddy as ever. Wilson's recent MRI showed improvement in the herniated disc in his neck, but his care team would not clear him to return this season. We now know why. Adam Schefter reported that doctors told Wilson he has an increased risk of another neck injury if he plays. That means that at least one of his specialists believes his degree of spinal stenosis puts him at risk of a long term spinal condition (i.e. weakness, numbness, paralysis). Schefter also reports that the decision may be left up to Wilson and that he wants to return next season.
Seems straightforward enough. Why do I consider that progress to be muddy?
There's some controversy on what degree of spinal stenosis is suggestive of a high risk of injury. One study showed that many college players have some degree of spinal stenosis and disc herniation but have no symptoms. Some players -- most recently Jarvis Jones -- have not been cleared by one set of specialists but allowed to play by another. In Wilson's case, the cause and degree of the stenosis isn't known. It's also not known whether he'll fully recover from his disc herniation without surgery. And, though Wilson now says he's planning to play in 2014, he may change his mind even if his current symptoms improve. He's also clearly at risk of sustaining a similar or worse injury at any point in his future.
His next set of imaging studies will happen in 4-6 weeks. We may get more information then, but expect Wilson's evaluations and decision-making process to continue throughout the offseason.
INJURY ROUNDS
peyton manning | ankle | day-to-day
Manning won't give any specifics about his injury, but television replays suggest that he may have aggravated a right ankle sprain. Prior to the bye week, Manning was reported to have sprained both ankles, including a high right ankle sprain according to Chris Mortensen. Given the mechanism of yesterday's injury and the way in which Manning grabbed his right lower leg, I think his MRI today is to re-evaluate the high ankle sprain. I don't expect Manning to miss time. The Broncos will find ways to work around his injury with shorter throws, shotgun formations, less stretch runs, etc.
tony gonzalez | toe | day-to-day
Gonzalez left yesterday's game briefly with a left toe injury and was reportedly hobbling in the locker room afterwards. He wasn't more specific than that, but implied that he was nervous about how he'd feel today and whether he'd need additional testing to define his diagnosis. I'll update this afternoon with any new information.
jay cutler | ankle / groin | day-to-day
Cutler said he sprained his ankle late in the first half yesterday and it was that injury, not his groin, that limited him as the game progressed. There wasn't a clear television replay of the ankle injury, but he was moving more slowly after being taken down by Ndamukong Suh near the end of the second quarter. But I think the groin injury was clearly bothering him as well. That's no surprise. One week of light football-related activity just three weeks after a serious groin injury was pushing the envelope of recovery. I think it'll be another 1-2 weeks before we see Cutler finish a game as healthy as he started it.
vernon davis | concussion | day-to-day
Repeat after me: No two concussions are alike, no concussion can be immediately graded and a player must complete the return to play protocol before being cleared for contact. Though we'll see cases like Darren Sproles last week, don't expect Davis' status to be updated until Thursday afternoon or Friday.
terrelle pryor | mcl sprain | day-to-day
Pryor admitted yesterday that his knee injury was an MCL sprain and that he actually felt worse as the week progressed. An MCL sprain may not be an issue for a pocket quarterback, but it's a bigger deal for a mobile player like Pryor. It's also the right knee that's sprained. Pryor will feel some looseness at the top of his drop and when he transfers weight to his front foot. He'll also struggle to push off that back foot to start a scramble and in zone-read situations. It's likely a low grade sprain, but those can take anywhere from 1-4 weeks to fully heal.
stevie johnson | groin | day-to-day
I have Johnson listed day to day here, but only because he makes every effort to play through soft tissue injuries and strains. However, this latest groin injury is to his other leg, giving him three separate strains over the past six weeks. It's a cascade that will prove very difficult for him to recover from this week. Consider him a game-time decision at best for Week 11.
jake locker | foot | IR expected
Unless it occurred just after he came out from under center or on an earlier play, Locker's mechanism of injury wasn't consistent with how Lisfranc injuries usually happen. And Lisfranc injuries are often hard to diagnose with an x-ray only. But multiple sources had Locker's injury as a season-ender very early yesterday -- well before any MRI or additional imaging could have been done. That's never a reassuring sign and it's evidence that the reports that Locker's injury will end his season are accurate. Matt Schaub successfully returned from a Lisfranc injury in the past, but Locker has a long rehab ahead of him if the diagnosis is confirmed and is severe enough to require surgery.
I'll be updating this feature throughout the day. Footballguys Insiders will get a full update with additional fantasy perspectives on Wednesday, with analysis of the week's game-time decisions early Sunday morning. Follow me on Twitter @JeneBramel for breaking injury news and analysis throughout the week.