Breaking down Tony Romo’s back injury… Star Trek style!

We have officially hit the halfway point of the season! Coming off of a record low number of injuries in week 7, I must have jinxed the NFL because we saw a record high this week. Sorry, guys… Week 8 by the numbers:

51 = Number of players who missed game time due to injury.

6 = Number of players placed on season-ending IR.

2 = Number of starting quarterbacks injured.

29.32 = Combined annual salary (in millions) of the two injured starting quarterbacks.

lamar-houston-injury-after-celebrating-sack-against-new-englandLet’s jog your memory for a second. Remember way back in week 3 when Stephen Tulloch tore his ACL celebrating a sack? I bet you thought that was a pretty rare mechanism of injury. So did I… Until it happened again this week! This time the victim was Lamarr Houston, starting defensive end on the Chicago Bears. With three minutes left to go in an absolute stomping of the Bears (they were losing 51-23), Houston broke through the Patriots offensive line, sacked their backup quarterback, and decided to celebrate with a jump. What’s that? They were down by 28 points?! And the Patriots already replaced their starter with their backup?! And Houston still celebrated that hard?! Yes to all of the above. Another ACL bites the dust. All you can do is sigh…

Quarterbacks are clearly important pieces to their team’s success. So when big names like Aaron Rodgers of the Green Bay Packers and Tony Romo of the Dallas Cowboys are hurt, it’s a big deal. Rodgers pulled his hamstring running for a first down while Romo was kneed in the back on a sack. Rodgers seemed to tough it through most of the game before his coach yanked him (and a slew of other starters) from a losing effort against the Saints. Romo’s story is a bit different. Let’s hit the rewind button and provide a bit of background info first.

“Captain’s log, stardate December 22, 2013. Our destination is Washington D.C., Maryland.” In a tight affair against the Washington Redskins, Romo engineers a game-winning touchdown drive with 1:08 left on the clock. It was a heck of a performance by Romo, who helped the Cowboys win and kept their playoff hopes alive. But in a sudden twist the following day, it was announced that Romo would require back surgery to repair a herniated disc. The surgery saw an end to both Romo’s season as well as his team’s season as the Cowboys lost the final game of the year without their starting quarterback.

lumbarOkay, get those brain cells working again because it’s anatomy lesson time! In fancy medical lingo, the bones in your low back are called lumbar vertebrae. Between each of the lumbar vertebrae are shock-absorbing pads known as intervertebral discs. These discs are composed of a water-filled nucleus that’s surrounded by layers of fibre. Feel free to name your next indie band “The Intervertebral Discs”; I will definitely attend your shows. The diagram on the left represents a completely normal back. The blue thing between each bone is a disc and the yellow thing by the disc is a nerve root. Discs are a guy’s best friend (after his dog, of course) until its fibers that encase the nucleus start tearing. If this happens, then that disc will push up against its neighbouring nerve root. Nerve roots supply your legs with strength and sensation. If a disc is pressing on a nerve root, it will cause severe pain along with weakness and numbness in your leg. So how does this all happen? To some extent, almost everyone will have some disc degeneration. As we age, so do our discs. They lose water content in their nucleus and elasticity in their fibers. It’s pretty natural to see some degeneration over time. But with an acute or repetitive overuse injury, it’s possible to wreck discs further. For example, pretend you’re lifting your couch off the ground to find the debut album of the Intervertebral Discs that you just dropped. Instead of keeping that back upright and core tight, you lift your couch with poor technique and feel a sudden, sharp pain in your back. This one bad lift might cause a disc injury! Or let’s say you are really klutzy and you keep dropping that album behind the couch. Sometimes when you lift the couch, it’s with good technique. But most times, it’s after a long day at work and all you do is want to listen to The Intervertebral Discs’ upbeat single “Lift Properly and Be Nice to Me” right away so you have sloppy form. All of those repeated bad lifts might cause a disc injury! Screen Shot 2014-10-28 at 11.28.03 PMThe four stages of disc herniation are shown on the right. Obviously, we want that nucleus of the disc to stay contained in its fibrous boundaries. If the nucleus begins to protrude through the fibres, things get a bit dicey.

If you’ve ever hurt your back, you can probably recall being out of commission and feeling like you can barely move. Not like when you’ve hurt your ankle and it’s sore but you can hobble around and function somewhat normally. When we hurt structures close to our spinal cord or brain, we shut down. This a protective mechanism. Our body is aware that damage to our nerves is serious and it wants to stop you from further harm. Remember that time you slept on your friend’s futon and you woke up with a kink in your neck? Even that little kink causes tons of pain and now you look and move like a robot when you try to shoulder check. So if you’ve wrecked your back and can barely walk, how are you supposed to play in the NFL?

Welcome to Tony Romo’s life in December 2013. He was officially diagnosed with a disc herniation in the lumbar spine and promptly under went surgery. I should add this disclaimer: not everyone who is diagnosed with a disc herniation requires surgery. It’s likely that Romo sustained the injury well before the game against Washington and was battling this problem for weeks. In other words, he was dealing with a chronic injury. He probably received conservative treatment such as physio and then perhaps cortisone injections before the team doctor decided to shut him down for the season. Surgery is always the last resort.

“Captain’s log, stardate December 27, 2013. Our destination is Dallas, Texas.” Romo has a successful microdiscectomy surgery. There are three different types of surgery designed to remove the portion of a disc pushing on a nerve root. Out of the three, microdiscectomy is the least invasive because it is performed using a surgical microscope, meaning the incision made on the low back is very small. It’s thought that this procedure reduces the amount of scarring around the nerves and joints which allows for shorter recovery. Now that the troublesome disc is all fixed up, it’s time for rehab!

Early stages of physio involves careful and gentle movement. Gradually, range of motion will return to normal. Once Romo is moving through his usual ranges without pain, then he starts some core strengthening. After six weeks of no bending, lifting, or twisting, these movement patterns are reintroduced. When these basic motions are working smoothly, we delve into fun football skills! Romo has to practice his drop backs, scrambles in the pocket, handoffs, throws, and other quarterback-specific activities!

“Captain’s log, stardate May 28, 2014. Our destination is Irving, Texas.” The first day of organized team activities (OTAs) signals the start of NFL preseason. At the Cowboys’ practice facility, Romo explains how gradual progression in rehab has allowed him to throwing with full velocity again.

“You start with a certain number of throws you’re going to do. A certain number of reps and then you take it a little bit more and a little bit more and you make sure your body keeps getting comfortable. Been going with that progression here for a while so it’s been good.”

Ah… It’s always nice to hear those words come from someone’s mouth. It’s like music to my ears! I’m pretty much shedding a tear of joy! Now that we’re all caught up, let’s press  fast forward and catch up to week 8.romohurt.0

“Captain’s log, stardate October 27, 2014. Our destination is Arlington, Texas.” Romo is the unlucky recipient of a knee to the back in the third quarter. He stays down on the field for a couple minutes and then gingerly walks off to the locker room to get examined by the medical staff. Because NFL facilities are incredible, Romo is x-rayed right there and then. Fortunately for him, the x-ray is clear (aka there are no broken bones or abnormalities) and he is diagnosed with a contusion – a fancy word for bruise. It sounds like the impact of the knee caused some acute swelling in his back muscles. The doctors inject him with a painkiller and Romo returns to the sideline. He is shown having a lengthy discussion with the head doctor, seemingly convincing him that he’s good to go. And as he jogs back on the field in the fourth quarter, Cowboys nation breathes a sigh of relief. The Cowboys ended up losing the game in overtime but I’m sure fans are happy that their franchise quarterback is healthy enough to play – for now.tonyromoIt will be interesting to see what develops out of this Romo injury. The latest news report indicates that Romo went for an MRI yesterday. What’s the difference between an x-ray and an MRI? X-rays show us pictures of bones and MRIs show us a pictures of tissue (discs, muscles, tendons, ligaments, etc). The training staff is hoping to rule out any serious soft tissue problem with the MRI. I’ll continue to follow this story and keep you guys updated. It’s a real life soap opera! Nothing is better than that, right? For now, you can send good vibes to Mr. Romo. Here’s to hoping he’s able to compete for the rest of the season!

– Chris (2-6, btw I am not a Trekkie although I appear to be in this post)

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