Designated To Return: Tua Tagovailoa

Week 2 of the NFL week will wrap-up with the Green Bay Packers taking on the Detroit Lions but of the many notable injuries on Sunday, we’re going to talk about Miami Dolphins second year quarterback Tua Tagovailoa, who left the game due to a rib injury.

Video Credit: FoxSports NFL

Initially seeing this video, especially in slow motion footage, I thought he broke several ribs. But reporting was out fast and it turned out he “only” suffered bruised ribs.

Anatomy Review.

The rib cage is formed by the twelve thoracic vertebrae and twelve pairs of ribs. The first seven pairs of ribs are known as “true ribs.” True ribs are described as ribs that directly attach to the sternum via costal cartilage. The next five pairs of ribs are known as “false ribs.” False ribs have no direct attachment to the sternum but attach directly to the sternum via the seventh costal cartilage. In that set of false ribs, you have rib pairs 11 and 12 which are known as “floating ribs,” which means they do not attach at all to the sternum. The floating ribs, like the other ribs serve as attachment sites for muscles.

Between each pair of ribs, you have several different lays of muscles that attach the ribs. You have the external intercostal muscles, internal intercostal muscles, and innermost intercostal muscles. The primary job of the rib cage is to protect the heart, lungs, and the rest of the internal cardiopulmonary system, and some of our other visceral organs (stomach, liver, gallbladder, etc).

The purpose of the intercostal muscles are to stabilize the rib cage and assist with breathing. They help assist other accessory muscles that help with inspiration and expiration.

  • External Intercostals: assist with inspiration (breathing in)
  • Internal Intercostals: assist with expiration (breathing out)
  • Innermost Intercostals: assist with expiration and blends with diaphragm (primary muscle of inspiration)

The intercostal muscles assist with accessory muscles and breathing, they are not the primary muscles of breathing. The primary muscle for inspiration is the diaphragm muscle and the expiration occurs passively through recoil of the diaphragm.

How do you bruised ribs or fractured ribs occur? Blunt trauma, direct blow to the ribs, compression of the rib cage. Pain generally occurs with quiet breathing, laughing, coughing, and sneezing. Much of treatment is about pain mitigation. For many other injuries, you treat actively with stretching, strengthening, mobilizing. With ribs, you let the the body just heal itself. You do some breathing exercises, but you do not want to cause too much pain.

Designated To Return.

If Tua had fractured one or multiple ribs, he could have been out anywhere from four to six weeks (there is always a chance to come back sooner or be out longer). Given that further testing revealed there were no fractures sustained, he could theoretically return this week. When damaging the ribs, the biggest challenge is being able to breathe without pain. Unfortunately bruised ribs and returning to play is all about pain tolerance.

He’s going to play again this season for reasons other than just being medically cleared. I do think he misses this upcoming game against the Las Vegas Raiders and returns the following week.

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