AFC North: Stephania Bell



Ravens linebacker Terrell Suggs says he expects to play in 2012, in about four to six months following this week's surgery that repaired his Achilles tendon.

The key isn't when Suggs can return to the field. It's when Suggs can return to his old self, the quarterback-harrassing NFL Defensive Player of the Year.

"Some guys will say it takes them a full year to feel like they did pre-injury, especially when it comes to power, speed, explosiveness," said ESPN injury expert Stephania Bell, a certified orthopedic clinical specialist. "Can they still come back and contribute before that? Absolutely, if everything proceeds according to plan and if they are medically cleared."

According to Bell, there is no difference in the recovery time for a partial or full tear. Once surgery takes place, the rehab is essentially the same.

"There are other factors involved in surgery which can slow rehab such as if the tendon was in very poor shape or if there was bone work involved near the attachment," Bell said. "Then there are always post-op possible complications, like infection, which can influence timeline. Not to mention the work the athlete puts in, within the parameters permitted based on the post-op guidelines. It is a lot of hard work to get back from this."

The likely scenario is the Ravens place Suggs on the Physically Unable to Perform (PUP) list at the start of training camp and gauge where he stands after the first six weeks of the season. There's a possibility that Baltimore will try to limit the wear and tear on Suggs by using him as a pass-rush specialist this season.

"So the bottom line is that Suggs could return midseason, if all goes well," Bell said, "but no one can set that timeline in stone right now."
Despite suffering a left high ankle sprain in the AFC title game, Pittsburgh Steelers rookie center Maurkice Pouncey seems extremely confident he will be ready for Super Bowl XLV on Feb. 6 against the Green Bay Packers. But in our experience -- most recently with the quarterbacks of the Cleveland Browns -- this injury has kept players sidelined for about a month.

So the AFC North blog checked in with ESPN medical expert Stephania Bell to get some insight on whether Pouncey recovering in half the time is possible or a pipedream for the Steelers.

Stephania, let's start with what exactly is a high ankle sprain and why it's more severe than regular ankle sprains?


Bell: It's really where the injury is located. The most common ankle sprain, for instance if you're playing pickup basketball, is when you roll your ankle. Someone goes up to the basket, shoots, lands usually on another player's foot and turns an ankle. The foot points in and all that stress goes to the outside of the ankle and that injures the ligaments down where the ankle attaches to the foot. With a high ankle sprain, the mechanism is different. It's often that the foot is planted and the player's leg gets twisted around. And what happens is it damages the ligaments that are basically at the top of the ankle joint. These are the ligaments that form the roof of the ankle joint where the two lower leg bones connect -- the tibia and the fibula. Those two bones are anchored by ligaments and it helps form the top of the ankle joint. So when those two ligaments are damaged, that's called a high ankle sprain.

Pouncey is confident he can come back in two weeks from this injury. What's been your experience?

Bell: Usually we give an estimate of four to six weeks for a high ankle sprain of the moderate variety. A severe one could take much longer. But you do have some evidence of guys coming back sooner. If you look at [Houston Texans receiver] Andre Johnson, he said he had a high ankle sprain. He later had problems because he tried to push through it, but Johnson was able to play sooner on a less than 100 percent ankle. I think when you look into the context of two weeks, it's the Super Bowl, and Pouncey doesn't have gross instability or a fracture based on what we know. So it will come down to whether the Steelers get the pain down enough and the swelling down enough that Pouncey can have normal motion in the joint and put pressure through the foot. One of the challenges of a high ankle sprain is every time you weight bear or put pressure over the foot, it puts stress right on those injured ligaments. The good news for Pouncey is he doesn't have to go running down the field. In his case, his position helps him. But perhaps the biggest risk is somebody could land on that ankle or twist it again.

Does Pouncey's age at 21 help at all in this recovery process?

Bell: Yes, in one sense we always feel you heal a little bit faster the younger you are. But also Pouncey hasn't had the same extensive career to have multiple injuries, which then often make it harder to heal. It's all of those variables that factor into it. It's the extent of the injury and how well he heals. We see just in terms of swelling after injury, some people will swell a lot and some don't swell so much. And Pouncey having the experience of having a similar injury [right high ankle sprain in college] and coming back quickly certainly helps.

So there you have it from ESPN medical expert Stephania Bell. Pouncey returning to the Steelers for Super Bowl XLV is not impossible but will certainly be a challenge. We will keep you posted on Pouncey's rehabilitation process until the Super Bowl.

Seven-step drop: Carson Palmer concerns

October, 11, 2010
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Here are seven notes and observations from Week 5 in the AFC North:

    [+] EnlargeCarson Palmer
    AP Photo/David KohlCarson Palmer is currently on pace for 19 interceptions this season.
  • The biggest concern I have about Cincinnati Bengals quarterback Carson Palmer is not his health, it's his decision-making. Palmer suddenly and surprisingly doesn't see the field as well as he used to, and that's a huge issue that is difficult to correct. At times, Palmer is reading defenses like an inexperienced quarterback; his three interceptions in Sunday's loss to the Tampa Bay Buccaneers is further proof. Palmer has thrown six picks in five games and probably had an additional four or five that were easily dropped this season. Palmer is on pace to throw 19 interceptions this year, and his career high is 20 for a season.
  • Palmer naturally is going to take a beating for his trio of picks, but the Bengals' coaching staff put Palmer in a bad spot late in the game. Leading by seven with less than three minutes remaining, the Bengals (2-3) faced a third-and-13 at their 38-yard line and Tampa Bay had no timeouts. Cincinnati should have run the ball, punted and pinned Tampa deep in its own territory with two minutes left. Instead, Bengals coach Marvin Lewis was overly aggressive and called a pass that turned out to be an interception near midfield. It quickly led to Tampa's tying touchdown and the Bucs later won on a field goal. This was a time the Bengals needed to be conservative.
  • Peyton Hillis' thigh injury could be a lingering issue for the Cleveland Browns and fantasy football owners. Hillis has deep bruise in his right quad muscle, something that has plagued him before. I recently talked with ESPN's Stephania Bell, an expert on sports injuries. She told me this type of injury can be tough, because calcification can build underneath the bruise and cause lingering discomfort. Hillis recently had the hot hand but didn't look himself in Sunday's loss to the Atlanta Falcons, gaining just 28 yards on 10 carries. He has been Cleveland (1-4) best offensive player through five games.
  • Cleveland Pro Bowl left tackle Joe Thomas had a rare off game against Atlanta. Falcons defensive end John Abraham beat Thomas twice for sacks, including the one that injured Seneca Wallace's ankle and knocked him out of the game. Thomas has raised the standard so high that Browns fans have become accustomed to the blindside being protected every week. But Sunday's game provided a rare view of how Cleveland's offense struggles when Thomas isn't at the top of his game.
  • Keep an eye on the topic of pass protection this week with the Pittsburgh Steelers (3-1). Starting quarterback Ben Roethlisberger moves around in the pocket more and holds the ball longer than his backups, Charlie Batch and Dennis Dixon. That has led to plenty of big plays but also a lot of sacks. The Steelers' offensive line must hold blocks a little longer now that Roethlisberger is back. Cleveland sacked Roethlisberger eight times in the teams' most recent meeting last December.
  • It's not a coincidence that the Baltimore Ravens' offense is hitting its stride at the same time as the offensive line. Baltimore (4-1) has won most of the battles in the trenches the past two weeks against the Denver Broncos and Pittsburgh. The Ravens allowed only one sack in each of those two games. They didn't run well against Pittsburgh (who does?), but quarterback Joe Flacco was given time to put together a winning performance. On Sunday, the Ravens had no problem pounding the Broncos into submission, rushing for 233 yards, four touchdowns and averaging 5.0 yards per attempt.
  • Lastly, kickers rarely get any love in the Seven-step drop. But Baltimore's Billy Cundiff deserves kudos for his four touchbacks against Denver. Field position is such a big part of Baltimore's game, and Cundiff's kickoffs were booming Sunday. It's hard driving 80 yards against the Ravens' defense. So if Cundiff can keep this up, he could be a nice weapon for an already-stacked team.

Posted by ESPN.com’s James Walker


Here are the most interesting stories Thursday in the AFC North:
  • Sunday’s high-profile matchup between the Minnesota Vikings (5-0) and Baltimore Ravens (3-2) could come down to the play of quarterback Brett Favre and linebacker Ray Lewis.
Morning take: These two love and respect the game of football, and you can see it in the passion that’s never subsided after all of these years. We will have more on this matchup in the next blog entry (hint, hint).
Morning take: I’m not one to suggest how anyone should spend their money, especially in this struggling economy. But in my opinion, this year’s Bengals are worth the price of admission.
  • Scratch the Washington Redskins off the list of teams rumored to be interested in Cleveland Browns quarterback Brady Quinn.
Morning take: Although the timing of Quinn putting his home on the market is peculiar, I don’t expect the Browns to trade Quinn next week. But this offseason, anything is possible.
  • Pittsburgh Steelers (3-2) tailback Willie Parker is practicing but is still in wait-and-see mode for Sunday’s game against Cleveland (1-4).
Morning take: As Stephania Bell pointed out last week, turf toe is nothing to play with. With Rashard Mendenhall playing well, there is no need to rush Parker if it risks further damage.

What is turf toe?

October, 9, 2009
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Posted by ESPN.com’s James Walker


Pittsburgh Steelers tailback Willie Parker is expected to miss his second straight game Sunday because of turf toe.
 Parker


The AFC North blog checked in with ESPN medical expert Stephania Bell for a description of the injury to get an idea of what Parker is going through.
Bell: "Turf toe usually results from hyperextension of the big toe and is an injury to the tissue surrounding the joint where the base of the big toe meets the ball of the foot. Ligaments around the joint can become overstretched or torn and that is what causes the pain and swelling. The more damage to the ligaments and joint capsule, the more severe the injury. It can be excruciatingly painful. Players often describe it like driving a nail through the toe when they try to push off and that is the problem. You need to extend your big toe in order to push off your foot properly when running, meaning all of your body weight is over that joint just before the foot leaves the ground. For a running back who has to cut, the toe has to pivot, adding stress to the joint. It's important to try to get it under control because chronic turf toe can become very disabling and in some cases has prematurely ended an athlete's career."

Stephania Bell on knee injuries

September, 21, 2009
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Posted by ESPN.com’s James Walker


With Pittsburgh Steelers Pro Bowl safety Troy Polamalu sidelined with a MCL sprain, a lot of AFC North fans are suddenly interested in how the knee heals.
  • Tim from Columbus, Ohio writes: Which is the more important knee ligament: ACL or MCL? And why does it take so long to heal when they are injured?

Because I didn’t go to medical school, I contacted ESPN medical expert Stephania Bell to answer this question.

Here was Bell’s response:
  • “Both ligaments are critical to the knee as they make up two of the four primary stabilizers of the joint. That being said, it’s almost impossible for most people to function when their ACL tears, and braces are not very effective in compensating for that injury, which results in front-to-back and rotational instability. So it tends to be the more devastating. An athlete with a torn MCL can function decently while it’s still healing with a brace, because the brace controls medial-lateral stability (MCL function) pretty well. A torn ACL won’t heal on its own, and it sits deep inside the joint and has to be reconstructed. The MCL, because it lies flat against the knee (it attaches the inner aspect of the thigh bone to the leg bone but sits OUTSIDE the actual knee joint), can repair itself by forming scar in the majority of cases. By keeping an athlete with an MCL tear in a brace initially, it helps the tissue to scar down. Ligaments in general don’t have the greatest blood supply which is why they often take a little longer to heal.”

Stephania Bell on Timmons and Smith

September, 3, 2009
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Posted by ESPN.com’s James Walker

When it comes to explaining sports injuries, no one does it better than physical therapist and ESPN’s own Stephania Bell.

Thursday the AFC North blog checked in with Bell to breakdown a pair of recent, key injuries within the division involving Lawrence Timmons of the Pittsburgh Steelers and Andre Smith of the Cincinnati Bengals.

Lawrence Timmons
Injury: High ankle sprain
Date suffered:
8/29

Bell’s analysis: Surgery obviously is not needed for Timmons but nonetheless the ankle ligaments need to heal enough to maintain stability in that joint, and he has to be able to move -- run, plant, pivot, cut -- without pain and at full speed. Timmons is ruled out for the last preseason game but appears questionable for Week 1. The first game would only be 12 days post-high ankle sprain which would be a pretty quick return for this type of injury. There are varying degrees of severity of sprains which better allows for prognosis. Without knowing the severity of Timmons' sprain, it makes it difficult to accurately assess. While nothing is impossible and having to assess the player's healing on a daily basis, the fact that he's in a boot now, which is designed to limit mobility and promote healing, makes next Thursday's return appear unlikely. I would more likely project him to Week 2 or even Week 3.

Andre Smith
Injury:
Foot fracture
Date suffered: 8/30

Bell’s analysis: Without knowing which bone, it's tough to provide any definitive guidelines. I will say that if the bone is healing well, he can return sooner. I believe [Bengals coach Marvin] Lewis said he'd miss a few weeks. But there may be some issues with his conditioning that they want to work on before throwing him back into the football mix. Even if he's in a protective phase now as far as weight-bearing, he can ride the bike, work out in a pool, and other cardio activities. And he can use the time to learn the system, playbook, etc. since he missed so much time in camp. Even if he heals quickly, I would expect that he'll need some additional time to get into 'football' shape both mentally and physically. Again, there is not enough information for me to give a really accurate prognosis. But it would not surprise me if we don't see him for a few weeks.

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