After being sacked by Bengals linebacker Vontaze Burfict at the end of the third quarter on Saturday, Steelers quarterback Ben Roethlisberger left the wild-card playoff game, the fourth time this season he has been forced to the sideline to be evaluated for an injury. Despite an injury to his throwing shoulder, Roethlisberger returned to finish out the game, ultimately leading the Steelers to a win and a chance at a divisional-round matchup against the Denver Broncos.
His return to play last week after suffering the injury hints at an increased likelihood that he'll suit up this weekend. But even if Roethlisberger takes the field, there will be uncertainty as to just how effective he can be, particularly when it comes to throwing the ball downfield, something even he acknowledged was impossible when he re-entered last week's game.
Roethlisberger's injury was the result of landing hard on the point of his right shoulder, with Burfict's weight on top of him adding to the impact. The two most likely outcomes with that mechanism of injury, depending on the physics of the forces through the shoulder on contact, are either a broken collarbone (think: Tony Romo) or an AC (acromioclavicular) sprain; Roethlisberger's was described as the latter.
An AC sprain involves injury to the ligaments at the junction of the clavicle, or collarbone, and the tip of the shoulder blade (a bony projection called the acromion), a region that is considered part of the shoulder. This injury is sometimes referred to as a shoulder separation because if the ligament damage is significant, the clavicle will move -- or separate -- relative to the tip of the shoulder blade.
An AC sprain makes it particularly painful for an athlete to raise his arm overhead; movements across the body also can be difficult. For a throwing athlete, coming across the top of the arc of motion and advancing the throw can be affected. The grade of injury reflects the extent of ligament damage and the associated discomfort, but in the absence of a surgery (typically reserved for the most severe cases), the ability to play typically comes down to how well the athlete can function in the presence of the injury.
The primary questions facing Roethlisberger and the Steelers as they decide on his status for Sunday will be:
Can he get his arm overhead?
How much does it affect his normal throwing arc?
Can he still push the ball downfield?
During his radio appearance on 93.7 The Fan in Pittsburgh earlier this week, Roethlisberger referenced his specific limitations when he returned to last week's wild-card game late in the fourth quarter.
"It didn't hurt when I reached back to throw," Roethlisberger said. "But it was pushing forward to throw and then the end of the throw."
The adjustments he had to make from a physical standpoint definitely affected the types of plays they could run in that final drive.
"I definitely felt like I was kind of shortening my motion up a little bit," Roethlisberger said, "which is why we threw some screens and couldn't really get the ball down the field."
The first step will be establishing whether Roethlisberger can throw well enough to start the game. He has yet to test any throwing in practice but was expected to do so Friday. As the game progresses, his shoulder is likely to become sore, not only from repeated throwing but also from contact. The greatest risk would be going to the ground and landing directly on the shoulder, just as with the original injury.
Despite preparations to ensure Landry Jones' readiness, Roethlisberger's presence at practice, even on a limited basis, is consistent with the air of optimism surrounding the team that he will be able to take the field Sunday. But the Steelers' approach could be altered if deep throws are not a part of the package, and Roethlisberger is forced to scramble more than usual to avoid the risk of reinjury via sack. Not to mention the Steelers ruled out wide receiver Antonio Brown because of a concussion, and running back DeAngelo Williams is still nursing a foot injury.
If there's anything we've learned about Roethlisberger over the course of his career, it's never to count him out. Those three other times he exited a game early this season because of injury? Only once did he miss subsequent time. That stat is likely to remain unchanged this weekend.