The “DL” Report: Week 4

By now you have already seen the gruesome video. Cincinnati Bengals’ Tight End has suffered a season-ending ankle injury against the Atlanta Falcons on Sunday afternoon.

He suffered a broken right ankle as he was being tackled to ground.

Tyler Eifert has a fairly extensive injury history since coming into the league since being drafted in the first round back in 2013 out of Notre Dame.

He would be considered injury-prone. There were several other major injuries around the league as well. New England Patriots Tight End Rob Gronkowski injured his ankle against the Miami Dolphins and did not return either.

---

Anatomy Review:

The ankle is formed through many different bones in the lower leg. The upper ankle joint is formed through the tibia, fibula, and talus. The talus is one of the tarsal bones of the foot. The lower ankle joint is formed through the calcaneus and talus bones, which are tarsal bones of the foot.

The tibia and fibula make up part of the ankle while the bones of foot (see below) also contribute to the ankle. The bones of foot are the Talus and the Calcaneus.

When the ankle breaks, especially with the type of injury he sustained, there are many components involved. It’s not just which bones he broke but it is also which ligaments and tendons are torn. With the type of fracture sustained and the way the ankle was “bent” the medial (inside) ligaments and muscles sustained the majority of the damage. The ligaments of the ankle attach:

• Fibula to Calcaneus
• Fibula to Talus
• Tibia to Talus
• Tibia to Calcaneus
• Fibula to Tibia

Generally speaking it is tougher to sustain medial ankle injuries because of how thick the medial ligaments are, compared to the lateral ankle ligaments. The musculature of the medial ankle are stronger compared to the lateral ankle as well. There are primarily two small(er) muscles that stabilize the lateral ankle compared to three-four muscles that stabilize the medial ankle.

There are several different types of ankle fractures because the type of fracture is dependent on the type of force that is used to cause the break and typically which way the foot turns.

There are two different joint types that are involved with ankle fractures. The tibia and fibula are a syndesmosis joint (meaning they are held together by a fibrous band) and the tibia, fibula, talus and talus/calcaneus are synovial joints.

Causes of Ankle Fractures:

• Rolling your ankle
• Direct blow to your ankle

Types of Fractures:

• Fibula Fractures (break the outside bone of your lower leg) – Lateral Malleolar Fracture
  • A force from the inside would cause a break of the fibula
• Tibia Fractures (break the inside bone of your lower leg) – Medial Malleolar Fracture
  • A force from the outside would cause a break of the tibia
• Fibula and Tibia Fractures – Bimalleolar Fracture
• Fibula and Tibia and Posterior Tibia Fractures – Trimalleolar Fracture
  • There’s a small portion on the posterior (back) side of the tibia that can fracture separate from the medial malleolus of the tibia
• Talus Fractures (break the bone of your foot)
  • A high-energy force (falling from a ladder or MVA) unlikely in this scenario

In Tyler Eifert’s situation, he could have just broken his tibia, there’s a potential he broke both his fibula and tibia on top of the ligament tears sustained.

---

Rehabilitation Outlook:

For this portion of Rehabilitation Outlook I am going to focus on Phase 1 of treatment. Phase 1 of treatment will last about six weeks, depending on what sort of protocol you may follow and as long as there are not any complications. Different speciality groups have devised different standards of treatment and can shift time frames for different portions of care. Phase 1 for Protocol X can have different parameters in their phases compared to Phase 1 for Protocol Y but eventually will get to the same end goal.

The initial portion of ankle rehabilitation is fairly uneventful but important. Very important. In Phase 1 of treatment he is going to do focus on how to move his foot and ankle again to begin to regain range of motion and strength in the simplest ways.

Another priority of the first few days is to reduce the amount of swelling in the ankle. While inflammation can be a good thing, in this instance it is not. You can reduce inflammation through compression, electrical stimulation modalities and devices, manual work.

Just don’t do the whole RICE protocol as your only means. We can be better than that. There has been countless recommendations that have been shown to do better than RICE. The end goal of this phase is to get him to be able to be weight-bearing and walk again.

Where I could help with my current training is, working primarily on the soft tissue to help prevent any sort of contractures that may have developed while he was in his boot and help improve the range of motion by working on the muscles of his lower leg and foot.

---

Season Outlook:

Tyler Eifert is out for the year and may miss part of next season depending on how rehabilitation goes following surgery. The challenging part of lower leg injuries of this severity is the portion of learning to walk again. Also it hasn’t been reported but you hope there is no nerve damage or vascular damage which could prolong his recovery.

Rob Gronkowski may miss a game or two and even down the road may miss a game because ankle injuries, similar to hamstring injuries, will linger throughout the entire year. With his size, defenders will continue to shoot low on him to bring him down thus increasing the likelihood he could suffer another ankle injury. I think Gronkowsi will play this weekend but expect him to be limited if he does play. Of course his ankle will be heavily taped but if the pain is severe enough it will absolutely effect him.

---

As always: I don’t own this stuff (pictures or photos). They belong to the NFL, NFL Franchises, Associated Press and thanks to Google and Twitter.