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Tuesday, October 6, 2009
Eli could be game-time decision for Week 5

By Stephania Bell



Week 4 gave us our first bye week, allowing some injured players to get additional rest. Looking to return this week are Philadelphia Eagles quarterback Donovan McNabb (rib) and running back Brian Westbrook (ankle). Arizona Cardinals quarterback Kurt Warner has been nursing a sore shoulder since suffering a stinger early in the season. He was practicing with the team during the bye week, but the additional rest (read: lack of hits from the opponent) also should have helped his shoulder. Atlanta Falcons running back Jerious Norwood, recovering from his second concussion in the past few months (the first concussion actually happened during the preseason), was medically cleared and returned to practice last Wednesday. As for the Carolina Panthers, well, the whole team had a chance to put the start of the season behind it and look ahead. Running back Jonathan Stewart was able to rest his troublesome Achilles and there is hope that the Panthers' running game improves overall as the season goes forward.

Naturally, there are new names to add to the list from the teams who did suit up in Week 4. Here's what we have so far ...

Eli Manning
Eli Manning got sacked here, but wasn't actually touched when he suffered his heel injury on Sunday.
Eli Manning, QB, New York Giants: It was a scary moment when Manning went to his knees shortly after releasing a pass in the direction of wide receiver Steve Smith. Upon closer look at the video replay, Manning was coming off a play fake to the left, then spun back around and set himself to throw, placing his right leg behind him in a lunge position. In that pre-weight transfer position, Manning's right leg was extended with the heel off the ground and the ball of the foot firmly planted, a position which places a strong stretch on the arch. Manning clearly felt a jolt of pain at that instant as he instinctively pulled his right foot up off the ground and hopped forward. He managed to release the ball, albeit a bit awkwardly (and Manning admits the ball was slightly underthrown to Smith as a result), then almost immediately went to his knees. Manning came up limping and exited the game shortly afterward.

The Giants are indicating that Manning has a plantar fascia injury and as is often the case, he has soreness and swelling in the heel and arch area of his right foot. His official status is day-to-day. In an interview with ESPN 1050 in New York, Manning said that Giants team physician Dr. Russell Warren has told him, "There is no time frame; it's just how fast you can heal and see how you feel these next couple of days." According to The Newark Star-Ledger, Manning had been suffering from plantar fasciitis (inflammation of the plantar fascia) but then suffered a subsequent injury to the same region on Sunday.

The plantar fascia is a thick fibrous tissue on the undersurface of the foot that provides stability through the foot during propulsion, or when the body transfers weight forward. It runs from the heel to the base of the toes and is placed under tension when the toes are extended (as happens during walking when the heel lifts off the ground). This tension in the plantar fascia essentially directs force through the arch that then stabilizes the midfoot. This stability is critical in order for the foot to function effectively as a rigid lever for pushing off. When the plantar fascia is injured or inflamed, tension on it can result in significant heel pain, often described by athletes as stepping on broken glass. In more severe cases, the pain can spread into the arch and progressively toward the base of the toes. The pain is usually the worst in the morning when the individual takes the first few steps of the day, or during long standing. Naturally as the symptoms worsen, they tend to be brought on more easily and linger longer.



There is no magic cure for plantar fasciitis; typically resting, icing and stretching make up a significant portion of the rehab program. Occasionally taping or shoe inserts will be used to decrease the stress through the arch. In Manning's case, this is not likely to be a condition that disappears anytime soon and may, in fact, linger to some degree until the season is over and he can truly rest for an extended period. In the meantime, as is the case with so many injuries, it becomes a matter of managing symptoms in an effort to allow him to function effectively. It would not be surprising to see his practice time get cut back in an effort to allow him to play on Sundays. After this latest setback, it is unclear whether Manning will be able to go this week, but he has certainly demonstrated a willingness to play through pain before. The question will be whether the pain is so severe that it impairs his ability to plant and throw effectively. Fantasy owners should know that this may well come down to a game-time decision.

Matthew Stafford, QB, Detroit Lions: Multiple reports indicate that Stafford suffered a patellar subluxation during Sunday's game but the team is not confirming this diagnosis. During a patellar subluxation, the patella (kneecap) slips briefly out of the groove in the femur (thighbone) where it normally rests, but pops quickly back into place. The primary factor in determining how quickly an athlete can return from such an episode is how much tissue damage is associated with the injury.



When the kneecap slips, there is often associated tearing of the soft tissue in the area, which results in some potential bleeding, swelling and pain. The less damage to the soft tissue, the more quickly the athlete can recover and return to play. As the kneecap gets knocked out of the groove, there is also the potential for cartilage damage on the undersurface of the patella as it bumps against the edge of the groove on the femur. Those cases are more complicated and if problems persist, may require surgery to address the cartilage damage. When an athlete has a history of multiple subluxation episodes, it may be reflective of general instability around the kneecap, which can result from a variety of factors. Repeat episodes are problematic in that they may signal the potential for increased frequency of subluxations, but they may also be associated with less damage per episode to the surrounding tissue.



As of now, the Detroit Free Press is reporting that the Lions are indicating that Stafford is day-to-day and he has not been ruled out for Sunday's game. His ability to function, particularly his mobility out of the pocket, will be assessed as the week goes on to help determine his status.

Darren McFadden
For the second straight season, Darren McFadden is going to miss a few games with an injury.
Darren McFadden, RB, Oakland Raiders: McFadden suffered a torn meniscus in his right knee and is expected to undergo surgery Tuesday. The Raiders said he'll return in two to four weeks. It's worth noting that rarely does an athlete return following this surgery in two weeks. The timetable to reduce post-surgical pain and swelling as well as regain adequate strength to play typically falls closer to four weeks, presuming no setbacks along the way. Running backs put exceptional stress on their knees with their frequent deceleration and directional moves so fantasy owners should plan on four weeks, maybe even a little longer, for McFadden to return to form.

Roy E. Williams, WR, Dallas Cowboys: Williams took a big hit to the ribs on Sunday and apparently it left him with some cartilage damage. The Cowboys indicate that Williams bruised three ribs and injured cartilage in the area. Cartilage injuries in the rib area can be as painful as broken ribs and sometimes take longer to heal. The Fort Worth Star-Telegram is reporting that Williams' status is currently listed as questionable. I would not be surprised if Williams is unable to go this week.

Other quick hits:

• Also in Detroit, wide receiver Calvin Johnson (quadriceps strain) and running back Kevin Smith (shoulder) are day-to-day.

Denver Broncos running back Correll Buckhalter injured his ankle and was on crutches after Sunday's game. His status for this week is not yet known, reports The Denver Post.

Seattle Seahawks quarterback Matt Hasselbeck hopes to return to practice Wednesday after missing the past two weeks with a broken rib.

• Dallas Cowboys running back Marion Barber was back in action this week, but played sparingly in the second half after his strained quad tightened up on him. He is trying to balance playing and healing. Seven more days without a setback should have him in better shape leading up to Week 5.

See you at the injury chats (Tuesday 11:00 a.m.-noon, Friday 11 a.m.-noon and Sunday pregame 10-10:30 a.m.) and we'll have the latest injury updates affecting Week 5 in the Saturday morning blog!