Injury analysis: Ankles take center stage

Published Nov. 20, 2009 11:29 p.m. ET

Sometimes the injury bug is more than just a bug, it's a plague. In Week 10, an ankle injury one swept the NFL, afflicting Denver's Kyle Orton, Miami's Ronnie Brown and Atlanta's Michael Turner.

Ankle sprains are one of the most common injuries in sports. They vary in severity based on the amount of damage sustained to the supportive ligaments and the surrounding tissue. A sprain is classified as a minor, or Grade I, sprain if the ankle ligaments are overstretched, but don't tear. In Grade II sprains, specific ligaments are torn while others are partially torn. The most severe and debilitating ones are Grade III sprains in which all the ligaments are torn, and damage to the joint capsule is sustained.

Furthermore, ankle injuries are classified by the manner in which they are incurred. Inversion ankle sprains are the most common and occur when the ankle is forced inward, applying excessive stress to the ligaments on the outside of the foot. An eversion sprain is more rare because of the structural design of the joint, but occur when the foot is pronated and forced outward. A syndesmotic or high ankle sprain occurs when the damage isn't isolated to the talocrural joint and extends up the leg to include the distal tibiofemoral joint and the interosseous that support the two lower leg bones.

The recovery time for an ankle injury is closely associated with the severity of the sprain. Grade I sprains generally heal faster while high ankle sprains can linger for an extended period of time. Athletic trainers will begin treatment by attempting to minimize excessive swelling and inflammation. Therapeutic modalities such as ultrasound and electrical stimulation are utilized to aid in the healing process. When the swelling subsides, treatment and rehab progresses, focusing on range of motion, then weight-bearing and strength. The athlete then will begin functional activity where he simulates activities the ankle must be able to perform in a football game.

Orton sustained an inversion sprain to his left ankle on a play in the second quarter of Denver's loss to Washington. He sat out the second half, and his status for Week 11 is unknown. Coach Josh McDaniels is following the lead of his mentor Bill Belichick and staying tight-lipped on the extent of the injury, but he wouldn't rule out his quarterback for their game against the Chargers. Orton sprained his right ankle last season while with Chicago as well. The injury forced him to miss one game and appeared to hamper him for the remainder of the season as he threw as many interceptions as he did touchdowns (eight) over the last seven games. Chris Simms would start if Orton remains shelved, but remains a fantasy liability after an uninspiring second half in which he went 3-13 with an interception.

Miami's Brown was on the sidelines for Week 11 after what was initially described as a sprained right ankle. The running back was injured in the third quarter of the Dolphins win over the Buccaneers. He appeared on Miami's injury report with a foot injury and was still using crutches this week. Ricky Williams becomes the starting running back with Lousaka Polite likely to get a few more reps as well.

The Falcons were getting an exceptional day out of Turner before a high ankle sprain forced him from the game. Results of further testing have yet to be released, but Turner's availability for Week 11 is a giant question mark. Coach Mike Smith said the injury isn't season-ending, but didn't reveal any specifics, saying he didn't want to give the Giants a "competitive advantage." Based on the pain and limitations associated with high ankle sprains, it's unlikely Turner will suit up. Jason Snelling and Jerious Norwood will split the carries in Turner's absence. Keep an eye on the running back situation throughout the week to see who's receiving the majority of reps in practice, but fantasy owners should be cautious with these two as well. Norwood's returning from a strained hip flexor that's kept him out for the past four weeks, and Snelling's been nursing a strained hamstring.

Cincinnati's Cedric Benson has been a pleasant surprise for fantasy owners this season, but a Week 10 injury left many disappointed. He left the Bengals' win over the Steelers in the first half with an injury initially called a hip flexor sprain. However, it's now officially being listed as an abductor strain. The gluteus medius and gluteus minimus are the abductor muscles of the hip and are responsible for pulling the leg inward and are essential in walking and running. Benson feels the injury isn't severe and is optimistic about playing against the Raiders. But the Bengals will be cautious with their star and have already signed former Chief Larry Johnson as insurance. Coach Marvin Lewis said the addition of Johnson shouldn't threaten Benson's standing as the starting running back, but fantasy owners will now have to closely monitor the situation.

I highlighted concussions last week, and, unfortunately, two NFC East running backs are still suffering from them. Washington's Clinton Portis is still experiencing blurred vision after sustaining a concussion in Week 9. Ladell Betts remains the safe play until Portis' concussion symptoms subside and he's able to practice. The situation's more serious for Eagles running back Brian Westbrook. The former Pro Bowler suffered his second concussion in three weeks, and his season may be over. The focus for Westbrook remains on his health, not on football, and the Eagles will take the necessary precautions to ensure their star isn't at any serious risk for permanent damage. LeSean McCoy will continue to start in his absence.

Julius Jones is unlikely to play in Week 11 after bruising his lung against the Cardinals. The Seahawks running back didn't fracture a rib, but was hit violently enough to cause bleeding in his lung. While it's encouraging he didn't break a rib, the injury is still significant. Justin Forsett starred in Jones' place, rushing for 123 yards on 17 carries and is a waiver wire pickup waiting to happen.

Article first appeared 11/17/09