Houston Texans DE: JJ Watt Injury Discussion

I’m sure everyone knows by now that JJ Watt, all-world defensive end for the Houston Texans, is out for the remainder of the season. He got injured against the Chiefs on Sunday night.

When I first saw the injury, I was thinking soft tissue injury with MCL, ACL, medial meniscus. But it has been officially reported he fractured the Tibial plateau. A tibial plateau fracture is a break in the bone near the knee joint. What makes the injury significant is that the meniscus sits on the plateau. In his case, it was a lateral tibial fracture (at least). And many of you know how significant the menisci are to knee joint health.

The treatment and recovery process will depend on the severity and degree of the fracture, which can be divided into 6 different classifications:

Type 1: Lateral tibial plateau fracture without depression
Type 2: Lateral tibial plateau fracture with depression
Type 3: Lateral tibial plateau pure depression (sans fracture) can involve central portion of tibial plateau
Type 4: Medial tibial plateau fracture with or without depression
Type 5: Bilateral tibial plateau fracture
Type 6: Bilateral tibial plateau fracture with associated metaphysis involvement
Tibial Plateau fractures
Rehabilitation Phase: Since there are different classifications of fracture involvements. For most standard of care will start with 6-8 weeks before they can even bare weight and then at least another 6-8 weeks of weight bearing rehabilitation before they start their associated sports-related rehabilitation and training.

I am not a surgeon. I am not a physical therapist (I hope to get into school). I’m a chiropractor and strength coach. So where I would fall into the line of rehabilitation care wouldn’t be until the individual starts their weight bearing rehabilitation care and sports-related rehabilitation care and training.

What could I do?
 – Soft Tissue: In terms of the soft tissue damage that potentially occurred, I work the quadriceps, hamstrings, gastrocnemius, IT band, gluteus muscles, and ligamentous tissue around the knee. We need to make sure the tissue is pliable and not starting to become contractile and stiff that can occur from being in a brace and non-weightbearing for several weeks. Focusing on tissue health is important to making sure the athlete doesn’t develop movement compensations.
 – Exercises: If we’re talking JJ Watt specifically, the team of athletic trainers, physical therapists, chiropractors, and strength coaches will work diligently to make sure he comes back even better. But, talking at the high school level and non-professional athlete level, what I’d be able to bring is to make sure that the athlete doesn’t develop compensation mechanisms, especially through the hips and ankles.
 – Since general physical therapy doesn’t necessarily focus on the sports-related exercises treatment (mainly due to health insurance), this is where I can slide in and help. As the coach, we’ll train the athlete through movement competencies with squats, deadlifts, pulls, and pushes. It is all tailored to the athlete and their specific sports needs, but before we can even start sports specific we go with general athletic movement preparation.
     – We first would start with basic movements that work the sagittal plane, which for many is the flexion and extension pattern of the hips, knees, and ankles.
          – Squats: bodyweight to goblet squats to front squats to back squats
          – Deadlifts: hip hinge to rack pulls to traditional deadlifts (adding variations such as trapbar, kettlebells, and dumbbells)
          – Carries: being able to bear the load through the hip, knee, and ankle are important. So a lot of varied loaded carries will be integrated into the rehabilitation process.
          – Pushing and Pull the Sled
     – Second, we’ll work the frontal plane, which is going to lateral flexion and lateral transitional movements and some of the exercise selection we have to consider (Eric Cressey wrote a great article on exercise selection outside of the sagittal plane):
          – Weight shifts: being able to accept load and transition from side to side is important to continue development athletic movement.
          – Lateral squats and Lateral lunges
          – Lateral sled drags
     – Finally, let’s put the two planes together to work the transverse plane, which is where we develop the rotational power of the core and hips. As an athlete being able to develop the transverse plane allows to further enhance your athleticism.
          – Med Ball Rotational slams
          – Pallof Presses and it’s variations
That’s just the basics and some exercises I think when getting your athletes back to the field. It’s general movement preparation. There are many roads back to the sport and these are just a few to quickly highlight! First get the athlete back to moving and training athletically before you just jump back into training for your specific sport. I’ve seen many just jumping back to their sport before considering restructuring their athlete base and foundation. With being a CSCS, for me, getting athletes back on the field is more than just adjusting the spine, the knee, and ankle, it’s creating the movement competencies and those are just some of the exercises running through my mind. Happy [athletic] Rehabbing.

Get Strong JJ Watt!

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