Dr. Liao's Week 12 Injury Report
Dr. Liao takes a peak at the long term prognosis for Alex Anzalone and Aiden Hutchenson. He also takes jabs at the Mike Tyson Jake Paul "fight" that occurred last weekend. If you're looking for a deep dive into athletic bone and tendon injuries and their treatment this is the video for you.
Doc also looks at the Lions next opponent, the Indianapolis colts and diagnoses their chances on Sunday against the Detroit Lions. Spoiler alert, this case might be terminal.
Detroit Lions Podcast Brings You Key Detroit Lions Coverage
The Detroit Lions Podcast will continue to bring you the latest info on the Lions as the team marches through opponents in the 2023 NFL season. Stay tuned as we continue to bring you more great Detroit Lions content every day.
https://youtu.be/26SwoW9V4NY
Let us know what you think about the show by commenting in the podcast thread in the subreddit, or by leaving us a voice mail message via Skype at: Detroit Lions Podcast Your input will help make the show better, and if you leave us a message on Skype, you just might be featured in an upcoming podcast! You can also give us a call at (929) 33-Lions.
Get yourself a Classic Detroit t-shirt here! http://shirt.detroitlionspodcast.com
Don't miss our great merch selection in the Detroit Lions Podcast store.
Looking for the relief that CBD products can bring? Click here: https://bit.ly/2XzawlG
Get your Lions Gear at: https://bit.ly/2Ooo5Px
As an Amazon Associate we earn from qualifying purchases made here: https://amzn.to/36e2ZfD
Donate Direct at: https://bit.ly/2qnEtFj
Join the Patreon Crew at: https://bit.ly/2bgQgyj
#lions #detroitlions #detroitlionspodcast #onepride #allgrit #sanfrancisco #49ers #purdy #mccaffery #goff
Learn more about your ad choices. Visit megaphone.fm/adchoices
Hey it's me Tyler, both open earbuds are stylish, the color that looks almost like an earring. I feel like it could go with anything. The music I'm making right now feels like a holiday. I want to look like it soon. Check out boas.com for more. This is the energy of electrification. Available type test high performance variant with nearly 500 horsepower and 278 mile EPA range range. Choose from our complimentary charging packages so you can charge how you want the all-electric Acura ZDX. This is the energy of innovation, Acura, precision crafted performance. This is your local Acura dealer to lease the all-electric ZDX for $389 a month. Lions fans. It's time for the podcast you've been waiting for. The show where Kool-Aid runs blue. Faces turn red. And rose-colored glasses never go out of style. This is the Detroit Lions podcast. Welcome fellow Lions fans. What a historic weekend. A total domination against an outmatched opponent. Just a pummeling. Somebody needed to invoke the mercy rule. For me it was actually too much. I started feeling bad for the other guys. It was painful to watch really. That's right. I'm talking about the Jake Paul versus Mike Tyson fight, which was certainly historic. Be terrible. Where everybody old enough to remember Tyson in this prime. And everybody young enough to know who the hell Jake Paul is. And everybody in between who accidentally tuned in and felt as confused as a Barrett said coach at the end of a game. We knew Tyson was in trouble when he came out in a need race, walking worse than Aiden Hutchinson, a pool with a fractured leg. The big winner of the night, spoiler alert here for anybody who's yet to watch the travesty. The big winner was Charlie Steron who's sitting ringside and looking fucking fantastic. At age 49 she's aging well. Unlike Mike Tyson who is well aging. I would have rather watched an alternate feed focusing on Charlie's the whole night, but Netflix could barely get one feed working. So instead of watching Cougars on Friday, we got to watch Jaguar's on Sunday. And that was historic. Lee, great. We're not nine in one, best starts since 1934. We out gained the jags by 475 yards, most in the NFL in 45 years. We totaled 644 yards of offense, which is the most in Lions history. We've rushed now for a touchdown in 24 straight games, most in NFL history. First time ever were favorites for the Super Bowl at plus 420. We have the third best DVOA through 10 games in NFL history. And now we've won three games this year by at least 38 points which is tied for the most in NFL history. There is some bad news though, which is we are out of the running for the number one pick in the draft. Long time Lions fans like me are still in the habit of looking at our draft position in mid-November. I'm Jimmy Leal, University of Michigan Medical School grad, board surviving family medicine. This is the Detroit Lions Podcast Medical Edition. The big story this week is Alex Anzolone. Let me start with an interesting comment by Jalen Hertz, Cordrek of the Eagles. The best game he hit his head on the ground hard a couple times and got up slow. He passed the sideline concussion evaluation, and after the game he said, "I beat the concussion protocol." That suggests he knows he may have had a concussion but was able to avoid the official diagnosis. To me, this highlights what a difficult job the sideline doctor, aka the neurotrauma specialist has. They may care about concussions, but they don't want an official diagnosis on their public chart if they can help it. Each concussion affects so many things for the player. It affects their current contract and their status with the team. Players can get cut, or the team might draft the replacement in the future. If Jalen Hertz is having too many concussions and the team is worried about his reliability going forward, they might spend a first or second round or all Cordrek back. It also affects future contract negotiations. Teams rightfully are going to structure a contract differently. There's a chance the player is going to miss a bunch of games, like Toa or retire early, like Calvin Johnson. Less guarantee money, less years on future contracts. These are all things that can happen. It also affects the player's ability to control if they want a player or not. Not just in the short term for that game, but also long term if they get cut and nobody wants them anymore. You guys might remember Travis Swanson, our center from a few years ago, who was missing multiple games for each concussion. After he left us, he only played one more year in the NFL for a total of six years. No team wants a player who's going to miss multiple weeks for each concussion. So back to the doctor-patient relationship here, it can create an adversarial relationship to those minor concussions that are blatantly obvious. You're dealing with players who often are there against their will and withholding or lying about their symptoms to avoid a diagnosis. And may be very upset if you give them a diagnosis that they don't want. We saw this most publicly with Jamal Adams last year who got into fights two different times with the doctor on the sideline. I'm sure privately there's been a lot of conflict frequently as well. They offered when he was with us in 2020 somehow weaseled his way out of an obvious concussion diagnosis when he played the Vikings, who was visibly dazed on the field and sent to the locker room. He missed the rest of the game with it, and somehow was never officially diagnosed with a concussion. Unless there's an obvious something on the video like fencing, inability to walk, or even snoring, I've had teammates who got concussions who were snoring on the field, or if there's an obvious confusion on exam, the doctor can't just slap a concussion diagnosis on a player. Yes, the NFL does do baseline mental testing, but it's unclear how useful that actually is. If there's an extreme difference, then sure, that could be a very high signal for a concussion. But if there's only a minor difference, like say 10% or 20% below baseline, we don't really know what to do with that information. Is that a sign of a concussion or not? We really don't know. And famously, Peyton Manning said he would purposely do poorly on the initial baseline mental test, so that would be easier for him to match that score with future tests. The other issue with the test is players are just coming out of a game totally exhausted both mentally and physically, so it would be natural for that testing to be slightly decreased from baseline when they're arrested and in an office setting. The bottom line for most mild concussions is, it requires self-reporting of the symptoms, and if the player takes the fifth and refuses to testify against himself, there's nothing the doctor can do. It's like your Miranda writes, you have the right-terming, silent, anything you say can and will be used against you. This is in contrast to the real world of medicine, where a patient is going to voluntarily come to me wanting accuracy about a concussion diagnosis. They're going to be more forthright, they're going to tell me honestly what's going on. So I'm working together with the patient to try to figure out what the diagnosis is. In the NFL, it's the opposite, which makes it a completely different doctor-patient relationship. Now let's get to Alex Anseloni, left forearm fracture last game against the Jaguars. The forearm has two bones, the radius and ulna, either or both could have been broken. If both are broken, potentially a slightly longer timeline, which shouldn't be too much of a difference. The way he got hurt was his forearm got trapped between two players. The grand branch came in hard, hit the wide receiver or actually was the running back, and trapped Anseloni's arm. It created a leverage point which caused his bone to break. Prognosis going forward, he's going to have surgery with a plate and screws to fix the bone. Dan Campbell mentioned a six to eight-week timeline, which is appropriate. Bones in the forearm typically are fully healed in about six to eight weeks, very reliably healed as well. Long-term outlook here is unlikely to be any issues long-term. Based on the video, it looks like a mid-shaft fracture, so unlikely to have any damage to the elbow or wrist joints, which is important. There is a small chance that metal hardware can cause chronic pain and may need to be removed. Usually this is done in the off-season. Overall, really no long-term concerns, once he comes back or going forward in the future. So when can we expect him back? He's almost certainly going to be back for the playoffs, and a good chance of being back for longer two of the last regular season games. If he comes back in six weeks, that means he'll be back Monday night football against the 49ers on December 30th. The next game after that is the Vikings game, the last game of the regular season. He could come back even earlier than that. Last year, Dallas Goddard had a very similar-looking forearm fracture, he returned in five weeks with a very slim protective brace on his walk. An extreme example is Thomas Davis in 2016, who returned in two weeks for the Super Bowl, also with a fairly slim 3D-printed brace on his arm. That's a good example of players who are going to push things to return for the Super Bowl like we'll see later with Aiden Hutchinson. With Lulu Lemon, the real gift happens when they're living in it. When you give them the softest loungewear set, the real gift is this. And this. And this. This holiday, Lulu Lemon makes it easy to give a gift that goes beyond. Open the moment. Shop now at lululemon.com. Want to shop Walmart Black Friday deals first? Walmart Plus members get early access to our hottest deals. Join now and give 50% off a one-year annual membership. Shop Black Friday deals first with Walmart Plus. See terms at walmartplus.com Whole Foods Market has Thanksgiving gatherings covered. First things first. Reserve your no antibiotics ever fresh whole turkey today. Starting at $2.99 a pound. Or go with their organic spiral cup bone and ham, full of seared in flavor. For sides, choose Whole Foods Market grab and go platters. Go even further and get your whole meal catered. Just order online by November 26th. Get Thanksgiving ready at Whole Foods Market. Terms apply. There is a chance of increased risk of a refractor if he comes back earlier before the bone was fully healed. This may have happened with Rob Gronkowski in 2013. He returned in six weeks from a forearm fracture only to fracture it again two weeks later. Because our priority at this point is playoff performance. I'm expecting the Alliance to wait until Anseloni is fully healthy, which is going to be around that six to eight week mark. A good target might be the last regular season game against the Vikings. Get him a game to knock off any rust before the playoffs start. What's the impact on the team going forward? Anseloni is certainly a key member of the front seven. He's probably the fastest guy in the front seven. James Houston is the only guy who might have the kind of speed and burst like Anseloni. So we're going to miss him on the field over the next few weeks. We're going to see Jack Campbell and Malcolm Rodriguez get a lot of playing time. Both of those guys got over 90% of snap skins. Jaguars after Anseloni went out. But a silver lining here is that he may actually be stronger when he comes back. And I think he will be. That'll actually improve our playoff performance. Arm injury is not going to affect his legs. He can still stay in shape. He can still keep his legs strong. He tweeted this afterwards saying, "I'll be back in no time fresh legs in awe." So he's going to come back stronger, faster, healthier, quicker than he is now. It's going to actually improve our playoff performance. His injury was very similar to Hutchinson. Both knew they had a fracture right away. Both had a simple mid shaft fracture. Both injuries didn't involve the joint switches key. The big difference is Anseloni is his arm injury, which allows him to stay in shape, stay strong. While his hutches is out leg injury. So he's going to have leg atrophy. He's going to have cardiovascular deficiencies. He's going to come back probably for the Super Bowl much weaker than he left. Unlike Anseloni, he's going to come back actually stronger than before. Speaking of Hutchinson, let's do an update on him. He posted a video of him walking in a pool, which is great to see. He's five weeks post fracture at this point. Partial weight bearing is expected, so he's on schedule, not ahead of schedule. It's part of the rehab. Some weight bearing helps with the bone healing and recovery. He might have been partial weight bearing as early as two or three weeks. I would expect full weight bearing around six to eight weeks. The bone should be fully healed around nine to ten weeks. So let me get to some questions you guys had on X. Robert Gonzalez, my buddy who I met at the 49ers game last year, asked, "What's a reasonable timetable to be on the field?" I still expect him to be in the Super Bowl, but not himself, limited capacity, limited ability. He won't be back to himself until next season. Jarnell asked, "Still don't think they risk his future by rushing him back, even if we make the Super Bowl." I think the bone's going to be fully healed by the Super Bowl. Not much question about that. I don't think there's much if any added risk to play limited snaps in that one game. There's already a very high baseline risk in the NFL playing. A small added risk is not going to move the needle that much. And for the Super Bowl, for the player, it's going to be worth it. It's going to make Hutch happy to play, and that carries a lot of value in itself from a team building standpoint going long-term. He's critical to the team. Keeping him happy going forward is important. Let him play. Chad Reeb asks, "What's the risk of a tendon or muscle tear if not fully in shape?" No one knows for sure, but the risk might actually be less. Tendons generally tear when the muscle is too strong and overpowers it. So his leg being a little bit weaker, he's going to be a little bit slower, less quick, less burst. So he's probably got less risk of a tendon injury when he comes back. Same thing with a muscle strength. Moving slower, moving with less burst, there's probably a less risk on those kind of injuries. Max Reebel asks, "No, it has really been able to clarify if this injury will be or will never be the same as before kind of injury." Residuals to any kind of injury are always possible. The intramedullary rod, which is that big metal pull stuck into the middle of his bone, it can cause chronic knee pain, being served that rod through the anterior part of the knee. Right there, you can have some chronic knee pain. Also, that healed bone could be slightly rotated off the normal. It can affect his physiology and the way he moves his foot and his leg going forward. But the joints are unaffected, which is the key part. Most likely, he's going to be fought. And most likely, he's going to be the elite Agent Hutchinson we've been seeing before. Maximilian Martin asked, "How often do you suspect athletes like this are using hyperbaric oxygen for treatment?" Hyperbaric O2 would be off-label for a fracture. That means it's not on the indications list for the reasons you might use it. Players, patients, and doctors do do things off-label all the time, though. Pro-athletes certainly do off-label stuff because they have the money and time for it. Since fractures heal generally very well on their own, though, it's probably not worth any possible risk. There are some risks to hyperbaric oxygen, like lung issues, seizures, pretty serious issues, so might not be worth it for something that can heal very well like a bone fracture. Aclios asked, "Would something like a shin guard have reduced the severity of the injury? Or, with bone injuries, is it much better to have a clean break?" A shin guard would not have helped here with Aiden, because he was hit on the side of the leg. And a clean break is good, meaning a transverse fracture, mid-shaft, bones heal really well, and again, joints being spared as key here. James Sanders asked, "Has the team acknowledged yet the multiple injuries caused by Aleem and Hutch colliding?" All right, what he's referring to here is the injury last year that caused Aleem's MCL spring, looked exactly like what caused Aiden Hutchinson's TIBF fracture. I have this posted on my ex-highlights, if you guys want to check it out there. The video looks exactly the same. There's a concern going forward of Hutch swinging that leg around, which is causing an injury to himself or to other people. So, it's something worth reviewing on film to see how often this might be happening, and if he might want to change his technique. I have not heard the team, Dan Campbell, or anybody address this publicly. I have not heard anybody ask about this to them. It would be a great question, I think, for one of the beat reporters to ask, though. Now, let's do an update on a Fatu Melafangwoo. Unfortunately, this is not a positive update. Let's do his whole timeline. August 17th in the pre-season. Suspected Achilles tendonitis, although he's been listed as an ankle throughout. Achilles tendonitis can cause a prolonged uncertain recovery. September 28th placed on IR, so it was a delayed placement on IR. They thought he would be back earlier, but then realized he's not coming back any time soon. November 6th, the practice window opened, so positive news there. Then November 19th, after being activated off IR, he was put back on IR. The reason for that was the week before he presumably had a finger injury that caused this issue. Dan Campbell had mentioned that he's not going to be back for a little while, which is why they needed to take him off IR and put him back on, so he would have another four weeks to recover, and he wouldn't be using up a roster spot in the meantime. First time he could be eligible to return will be December 22nd against the Bara season. Unger restricted free agent after this season, so he may never be back with us. What's going on with this finger? A lot of finger injuries can be played through. We saw this with Carlton Davis, who broke his thumb, and didn't miss a game. We saw him with a splint on it, this last game against the Jaguars. Alex Anseloni also had surgery for a thumb issue last year. He missed one game, but that may have been due to him having a new baby, and not actually needing to miss a game. So a lot of finger issues can be played through. Some finger tendon ruptures do require the finger to be placed in a splint in a very specific position for it to heal properly, even if they've had surgery. Whether it's in a fully extended position or slightly flexed, maybe if he was just not comfortable playing through this kind of a splint. It's also possible he heard multiple fingers at the same time, which could make things much more complicated. Alright, now let's get to the Wednesday injury report. Thank you Colts for not listing half the team on the report. Really appreciate that. The Lions also had a pretty short report. This might be in total the shortest report on the year. So starting with Sam Laporta listed with a shoulder FP, which is great news. He missed one game with the left AC joint spring. Today Dan Campbell stated that Laporta was questionable to above and it's trending the right way, but with the FP it strongly suggests he's playing on Sunday. This episode is brought to you by NFL Sunday Ticket on YouTube TV. There's plenty to be thankful for. Your friends, family, and the fact that you can now get NFL Sunday Ticket for only $89. So thank yourself this holiday season and watch every game every Sunday when you bundle NFL Sunday Ticket and YouTube TV. Sign up now at YouTube.com/SundayTicket. Offer ends December 2nd, local and national games on YouTube TV. NFL Sunday Ticket for Out-of-Market Games excludes digital-only games terms in embargo supply. This episode is brought to you by LinkedIn. Struggling to close deals? Cold outreach can be a waste of time. Especially when using outdated data. That's why you need to be using LinkedIn Sales Navigator. The first deep sales platform that will help you sell like a superstar in no time. And right now, you can try LinkedIn Sales Navigator and get a 60-day free trial. Visit LinkedIn.com/Solutions today. Carlton Davis with his thumb FP, which is great news. Remember, he broke his thumb last week in practice. Played the entire first half versus the Jaguars and a thumb splint. It was pulled in the second half, presumably as a precaution. But there was a concern that there was some kind of aggravation. The FP confirms no significant aggravation and he'll be ready to go. Alan Robinson has a new designation I haven't seen before, which is a game-day concussion protocol evaluation with the FP. He hit his head late in the Jags game, was slowing getting up, but did pass the concussion evaluation during the game. Since it was an estimated practice, I'm presuming that's why they had to put this kind of protocol evaluation designation on him. But the FP means he was not diagnosed with a concussion. Otherwise, he'd have an NP or an LP at best. That means he should be available on Sunday. Shane Zilstra, late in the game, went out with a neck issue. He had an FP today, which is great news. With a neck, you're always worried about a spinal issue. But with the FP, that means not a spinal issue, probably just a soft tissue strain. Off video, nothing serious showed up, but you don't always see something serious with a spinal issue. Emmanuel Mosley, with his PEC FP that's expected, he opened his 21-day practice window November the 6th, expecting to continue to be out this weekend, but moved to the active roster early next week before Thanksgiving. That means he could possibly play on Thanksgiving. Notably absent from the report, Broderick Martin, who was as expected, activated to the roster yesterday, Tuesday, from his IR practice window. He had his right knee hyper-extension injury on August 24th, has not played yet this year, just because he's on the roster active doesn't mean he's going to be active on game day though. He's only a second year player, he's missed this entire year, so overall his physical and mental readiness may not be quite there yet, and he might not be that high on the depth chart either. So it wouldn't surprise me if he's still inactive on game days. Now let's move to the Indianapolis Colts practice report. They have some serious issues along the offensive line. They already have their starting center, Ryan Kelly on IR, who's missed the last two games, Will Fries or Fries, not exactly sure there, is the starting offensive guard, he's on IR and has missed the last six games. Their left tackle, Bernard Raymond missed last game with an unspecified knee injury. He's got an NP today, Wednesday. That does not bode well for the weekend for him. You have to get to at least an LP tomorrow, to hopefully have a chance this weekend I would presume. The other new issue for the Colts is Braden Smith, their starting right tackle, a new foot listing. He's played in every game this year, has not had this foot listing yet, so this is a new issue. We'll have to keep a close eye on this, and see if he downgrades or upgrades over the course of the week. The other two guys on the Colts report, Ty Quang Lewis, defensive end with an elbow, an FP. The FP does not mean he's playing this weekend, he's probably not. He's been along IR for the last seven games, he just had his 21 day practice window open today. So that means it's very unlikely he'll play this weekend. The last guy on the report is Michael Pittman, wide receiver, with the back listing with the FP. FP means he's going to play. He's been dealing with a back issue for a few weeks, and he's been playing through it. He should be playing against us, no problems. He has 35 catches for 412 yards on the year. All right, looking forward to the game on Sunday. We're favored by seven and a half points, a lot less than the Jaguars game. It's on the road, which is not a concern for me as we are road warriors this year having not yet lost the game. Enjoy the game. Thanks for listening, talk to you next time. Let's bring it here together. Let's go up, baby. Land's on three, one, two, three! Pass! You've had enough of that shit.
Dr. Liao's Week 12 Injury Report
Dr. Liao takes a peak at the long term prognosis for Alex Anzalone and Aiden Hutchenson. He also takes jabs at the Mike Tyson Jake Paul "fight" that occurred last weekend. If you're looking for a deep dive into athletic bone and tendon injuries and their treatment this is the video for you.
Doc also looks at the Lions next opponent, the Indianapolis colts and diagnoses their chances on Sunday against the Detroit Lions. Spoiler alert, this case might be terminal.
Detroit Lions Podcast Brings You Key Detroit Lions Coverage
The Detroit Lions Podcast will continue to bring you the latest info on the Lions as the team marches through opponents in the 2023 NFL season. Stay tuned as we continue to bring you more great Detroit Lions content every day.
https://youtu.be/26SwoW9V4NY
Let us know what you think about the show by commenting in the podcast thread in the subreddit, or by leaving us a voice mail message via Skype at: Detroit Lions Podcast Your input will help make the show better, and if you leave us a message on Skype, you just might be featured in an upcoming podcast! You can also give us a call at (929) 33-Lions.
Get yourself a Classic Detroit t-shirt here! http://shirt.detroitlionspodcast.com
Don't miss our great merch selection in the Detroit Lions Podcast store.
Looking for the relief that CBD products can bring? Click here: https://bit.ly/2XzawlG
Get your Lions Gear at: https://bit.ly/2Ooo5Px
As an Amazon Associate we earn from qualifying purchases made here: https://amzn.to/36e2ZfD
Donate Direct at: https://bit.ly/2qnEtFj
Join the Patreon Crew at: https://bit.ly/2bgQgyj
#lions #detroitlions #detroitlionspodcast #onepride #allgrit #sanfrancisco #49ers #purdy #mccaffery #goff
Learn more about your ad choices. Visit megaphone.fm/adchoices
