Support Texans Talk as a Monthly Donor

Wish to make a one time donation? Make it here.

The New New JaDeveon Clowney Thread

Marshall

Not pretty, but ALIVE!
After yet another thread has spiraled out of control, let us try again.

For those who deal with Football injuries regularly, how far is being released for full non contact workouts from being released to play real football? What is the body doing in the healing process at at this point and what injuries can result if you try to short circuit this process?
 

thunderkyss

It's good to be me... again.
Staff member
After yet another thread has spiraled out of control, let us try again.

For those who deal with Football injuries regularly, how far is being released for full non contact workouts from being released to play real football? What is the body doing in the healing process at at this point and what injuries can result if you try to short circuit this process?

I'm not a doctor. I'm not a pimple on a doctor's ass. But the last I recall from CnnnD's posts was that JaDeveon shouldn't be doing anything now that would give you a clue as to how well his recovery is going. His activity should gradually increase, but CnD would not expect him to be participating in full contact stuff, even late into the preseason.

If you see him doing any "football stuff" before September, they're rushing him.

Any swelling or pain in the knee from Jd & it's pretty much over. You don't want to hear those words in the same sentence in reference to JaDeveon Clowney. Not now, not in September, not in December, not next off season. If (& this is my own non-smart person's opinion) we make it to next season without hearing about swelling/pain in JaDeveon's knee, then we can breathe.

Don't expect to hear too much "real" info about his recovery for the next three months. In this case, no news is good news.
 

CloakNNNdagger

Site Contributor
After yet another thread has spiraled out of control, let us try again.

For those who deal with Football injuries regularly, how far is being released for full non contact workouts from being released to play real football? What is the body doing in the healing process at at this point and what injuries can result if you try to short circuit this process?
Not really sure what full noncontact workouts are...........very cloudy description. But suspect true full contact is still a month or two away, since full contact requires great resistance and stress on the knee joint. At this point in time, strengthening the muscles of the legs and thighs secure stability of the knee joint will continue to be a major part of his rehab. Any instability will facilitate the grinding away of the newly formed pseudo cartilage. If brought back too soon to full contact, his long-term performance and career will be more unpredictable than his short-term performance.
 
Last edited:

JB

Old Curmudgeon
I'm not a doctor. I'm not a pimple on a doctor's ass.
I'm not either, but I would like to know about the meniscus. Does the micro-fracture surgery basically encourage it to regrow? If so, how long does it take for that to fully happen? And if he can do most stuff in the weight room he has progressed to the point that he can put force on it vertically but not laterally? I know from experience it takes a while for muscles to recover from atrophy of being in a cast, can he strengthen all the muscles in his knee and calf by this point?

opps, Doc answered most of my question.
 

thunderkyss

It's good to be me... again.
Staff member
I'm not a doctor. I'm not a pimple on a doctor's ass. But the last I recall from CnnnD's posts was that JaDeveon shouldn't be doing anything now that would give you a clue as to how well his recovery is going. His activity should gradually increase, but CnD would not expect him to be participating in full contact stuff, even late into the preseason.

If you see him doing any "football stuff" before September, they're rushing him.
Or maybe a month away.
 

CloakNNNdagger

Site Contributor
I'm not either, but I would like to know about the meniscus. Does the micro-fracture surgery basically encourage it to regrow? If so, how long does it take for that to fully happen? And if he can do most stuff in the weight room he has progressed to the point that he can put force on it vertically but not laterally? I know from experience it takes a while for muscles to recover from atrophy of being in a cast, can he strengthen all the muscles in his knee and calf by this point?

opps, Doc answered most of my question.
Menisci do not "grow back" with microfracture surgery. If anything, partial absence, depending of how much, may be contributory to a poorer prognosis in that it may empirically add to the instability factor.
 

Playoffs

Subscribed Contributor
Menisci do not "grow back" with microfracture surgery. If anything, partial absence, depending of how much, may be contributory to a poorer prognosis in that it may empirically add to the instability factor.
Even moreso the lateral meniscus...

CloakNNNdagger said:
The lateral meniscus carries 80% of the lateral load of the knee... Therefore any removal of the lateral meniscus presents significant concern as relates to the stability of the knee joint and the ultimate (especially longer term) outcome of a microfracture surgery.
 

JB

Old Curmudgeon
Menisci do not "grow back" with microfracture surgery. If anything, partial absence, depending of how much, may be contributory to a poorer prognosis in that it may empirically add to the instability factor.

Then it is cartilage regrowing? Trying to understand the "newly formed pseudo cartilage"
 

thunderkyss

It's good to be me... again.
Staff member
Sorry, that doesn't compute... blood clots kill ya
If they are inside a vein & move... yes. Blood clots on your elbow don't. They allow the tissue beneath to heal, which is what the blood clot on Jd's bone is doing.
 

Number19

Hall of Fame
Here are the Texans news releases on Clowney as reported by Rotoworld:

The Texans remain confident Clowney will be ready to contribute Week 1. May 19 - 12:39 PM

Clowney is not expected to be ready for the beginning of training camp, but Week 1 is realistic. Apr 28 - 1:59 PM

The Texans are targeting the "end of training camp" for OLB Jadeveon Clowney (microfracture surgery) to return to
the football field. Apr 3 - 2:53 PM

Clowney is expected to miss Houston's entire offseason program recovering from microfracture surgery. He should
be ready at some point in training camp, but remains questionable for Week 1. Mar 28 - 3:37 PM

Clowney will miss Houston's entire offseason program. Clowney needs to avoid setbacks to be ready for Week 1. Mar 25 - 7:08 PM
 
Last edited:

Playoffs

Subscribed Contributor
Then it is cartilage regrowing? Trying to understand the "newly formed pseudo cartilage"
Dr CND is without a very serviceable computer at the moment so replies are challenging for him, at best.

And with the old Clowney thread locked -- didn't realize that -- we can't quote his old posts.

But to really simplify it, think of your natural cartilage -- the think layer of white you see on a chicken leg -- think of that as ice: hard like an ice cube and very slippery, but thin.

What is created in microfracture surgery would be, in comparison to ice, like a layer of straw.

The "ice" wears down in all of us over much time(in high level athletes much faster), rubbing down to bone-on-bone that creates pain = arthritic.

The "straw", in comparison, wears away much faster.

That's as good as I can do until Dr. CND returns to correct/refine it.
 

CloakNNNdagger

Site Contributor
Here are the Texans news releases on Clowney as reported by Rotoworld:

The Texans remain confident Clowney will be ready to contribute Week 1. May 19 - 12:39 PM

Clowney is not expected to be ready for the beginning of training camp, but Week 1 is realistic. Apr 28 - 1:59 PM

The Texans are targeting the "end of training camp" for OLB Jadeveon Clowney (microfracture surgery) to return to
the football field. Apr 3 - 2:53 PM

Clowney is expected to miss Houston's entire offseason program recovering from microfracture surgery. He should
be ready at some point in training camp, but remains questionable for Week 1. Mar 28 - 3:37 PM

Clowney will miss Houston's entire offseason program. Clowney needs to avoid setbacks to be ready for Week 1. Mar 25 - 7:08 PM



Well, it's good to see that they don't plan to push him back too early like they did before.


 

Marshall

Not pretty, but ALIVE!
Not really sure what full noncontact workouts are...........very cloudy description. But suspect true full contact is still a month or two away, since full contact requires great resistance and stress on the knee joint. At this point in time, strengthening the muscles of the legs and thighs secure stability of the knee joint will continue to be a major part of his rehab. Any instability will facilitate the grinding away of the newly formed pseudo cartilage. If brought back too soon to full contact, his long-term performance and career will be more unpredictable than his short-term performance.
I guess that was how I as a layman characterized the running, lifting and shifting in drills. Basically all the moves without the outside forces from contact. But I'm sure that is foreign from the proper terminology of the medical profession.

But I'm learning more all the time.
 

CloakNNNdagger

Site Contributor
Dr CND is without a very serviceable computer at the moment so replies are challenging for him, at best.

And with the old Clowney thread locked -- didn't realize that -- we can't quote his old posts.

But to really simplify it, think of your natural cartilage -- the think layer of white you see on a chicken leg -- think of that as ice: hard like an ice cube and very slippery, but thin.

What is created in microfracture surgery would be, in comparison to ice, like a layer of straw.

The "ice" wears down in all of us over much time(in high level athletes much faster), rubbing down to bone-on-bone that creates pain = arthritic.

The "straw", in comparison, wears away much faster.

That's as good as I can do until Dr. CND returns to correct/refine it.
Pretty good analogy, Playoffs.
(thanks for explaining my temporary handicap!)
 

Marcus

Ruthless pragmatist
IMO, They should PUP him the day before the Hard Knocks insanity arrives. Take away any semblance, or any inclination to "hurry up" anything.

What would really make me happy, (and I know it wouldn't make anyone else) is if he doesn't even set foot on the field this year. I'm not Cloak, and I'm not a 'pimple on his ass', but given his type of injury/surgery, it would be hurrying up 'something' if he did.

And another thing that would make me happy is if O'Brien imposed a gag order on himself regarding anything to do with Clowney.
 

Playoffs

Subscribed Contributor
IMO, They should PUP him the day before the Hard Knocks insanity arrives. Take away any semblance, or any inclination to "hurry up" anything...
I'm down with that, especially with Texans doctors proclivity for bringing players back too soon. I think HKHT is a no-win situation for JD. He'll be hammered no matter what, imo.
And another thing that would make me happy is if O'Brien imposed a gag order on himself regarding anything to do with Clowney.
Except his son asks him how Clowney's doing every... single... day. :truck:
 

GNTLEWOLF

All Pro
IMO, They should PUP him the day before the Hard Knocks insanity arrives. Take away any semblance, or any inclination to "hurry up" anything.

What would really make me happy, (and I know it wouldn't make anyone else) is if he doesn't even set foot on the field this year. I'm not Cloak, and I'm not a 'pimple on his ass', but given his type of injury/surgery, it would be hurrying up 'something' if he did.

And another thing that would make me happy is if O'Brien imposed a gag order on himself regarding anything to do with Clowney.
I can't believe that I actually agree with Marcus on something, but I'm all for this as well.
 

thunderkyss

It's good to be me... again.
Staff member
If he's ready to play, he should play.
The trick is how do you determine if he's ready. It's not like you can look at the scar & say, "Whelp, it's as healed as it's going to get."

The only thing you can do is increase the load at regular intervals & look for side effects... pain, swelling. However, at the onset of pain & swelling, you've set yourself back as the body will have to recover from the more recent trauma before getting back on track for the original trauma.
 

Marshall

Not pretty, but ALIVE!
The trick is how do you determine if he's ready. It's not like you can look at the scar & say, "Whelp, it's as healed as it's going to get."

The only thing you can do is increase the load at regular intervals & look for side effects... pain, swelling. However, at the onset of pain & swelling, you've set yourself back as the body will have to recover from the more recent trauma before getting back on track for the original trauma.
I do hate it when the warning only comes after further injury.
 

HOU-TEX

Ah, Football!
The trick is how do you determine if he's ready. It's not like you can look at the scar & say, "Whelp, it's as healed as it's going to get."

The only thing you can do is increase the load at regular intervals & look for side effects... pain, swelling. However, at the onset of pain & swelling, you've set yourself back as the body will have to recover from the more recent trauma before getting back on track for the original trauma.
I don't. It ain't my job. I know the Texans medical staff isn't very highly regarded around here, but along with his Dr., it's their call. If they think he's ready to play then he should play
 

WolverineFan

Hall of Fame
I don't believe that he'll contribute in any major way this year as he is coming back from major surgery. Hopefully they PUP him and maybe even IR him. I just don't trust the Texans doctors to not screw this up and bring him back too early.
 

Double Barrel

Moderator
Staff member
Dr CND is without a very serviceable computer at the moment so replies are challenging for him, at best.

And with the old Clowney thread locked -- didn't realize that -- we can't quote his old posts.
PM me links to any CND posts you want in this thread and I'll be glad to quote them for ya'. Here are some from that thread:

If it is an isolated lateral meniscus tear, I would expect the spectrum closer to 6-8 weeks for full recovery from this surgery. The problem is that a lateral meniscus can be associated with MCL and/or ACL injuries. Neither of these injuries would surprise me as a finding at surgery.......especially an MCL. If this would be the case, recovery could be expected to be significantly longer.

From the picture below, imagine the lateral meniscus being crushed (coming down wobbly and hard from his jump). Such a crush would bend the knee joint to that side (creating a closed angle). The resulting bend on that side would cause the other side of the joint (the MCL side) to be forced into an open angle.....stretching/tearing the MCL which is there as a check ligament to prevent this type of movement.



This is actually a diagram of a congenital condition mimicking essentially the same type relationship of the knee position I am speaking of above.



Lateral meniscus tears can be caused by disruption of hip mechanics, especially if chronic. As any of you that have followed my medical posts on Clowney would know, sports hernias in most cases have been found to be associated with hip problems (especially femoral acetabular impingment). Most of the time, if the hip problem is not addressed, it lends itself to continued faulty core and hip mechanics which in turn encourage compromised performance and/or significantly increase the subsequent risk for future lower limb injuries (not to mention recurrent sports hernia problems). And let's not forget the chronic bone spur problems which encourages hip mechanical problems to begin with.

(You can also see from the skeleton diagram above how faulty alignment starting with the hips extending down to the knees and ankles can create an ongoing mechanical joint stress nightmare.)
I feel that the very least that should be addressed are the component(s) of the this acute injury and his bone spurs. Ideally, any hip malady would also be addressed, but this would be about a 6 month recovery.....and many surgeons would try to avoid combining major hip surgery with major knee surgery (we don't yet really know the extent of the knee injury). If this latter hip element is indeed a problem, and the team/Clowney makes the choice to try to return and make it through the remaining season until the offseason, it will continue to be a risk for further injuries in the interim.

Let's first see what they tell us about this most recent injury beyond "He will require no autopsy............yet"
The acute knee injury MUST be addressed now. This previous post of mine should explain the hip concern. And poor hip mechanics are also a perfect set up for lower limb injuries.
http://www.texanstalk.com/forums/showpost.php?p=2352737&postcount=709
With the estimate of 4-6 weeks given by the Texans, they have to be talking about a very small lateral meniscus tear in which they intend to be "removing" a small portion of the meniscus (removal of any portion of a meniscus is referred to as a "meniscectomy"). If they go in there and decide to perform a "repair" of the meniscus or if they have to remove a significant section of the meniscus, I would not expect him to return this season. (I explained the "excision" vs. "repair" implications in a Louis Nix thread a while back.......Nix underwent the latter.) Keep in mind that lateral meniscus tears when compared to comparable tears in the medial meniscus carry a greater degree of concern as far as return to play and the level at which the performance may be affected upon return.

I'd like to share with you the abstract of a very recent and very-appropriate-to-this-discussion study that came out in the American Journal of Sports Medicine just a couple of months ago.......co-authored by Dr. James Andrew the "orthopedic guru."


For those interested in additional details of the study: http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=19&cad=rja&uact=8&ved=0CFsQFjAIOAo&url=http://www.researchgate.net/profile/Kyle_Aune/publication/262978076_Return_to_Play_After_Partial_Lateral_Meniscectomy_in_National_Football_League_Athletes/links/0a85e53a98fe68b6a8000000&ei=MuQNVOfHOrHo8AHhvIG4Dw&usg=AFQjCNHm826wFnRUHq7h3YQKvN6SD8d32A&bvm=bv.74649129,d.b2U
This is not a MEDIAL meniscus.........this is a LATERAL meniscus injury/excision......a much worse animal that NEEDS much more rehab time.......whether he ends up being given it or not.
Because the Texans put out such a short return to play prediction, I had to assume that the excision was a VERY small area. And yet I stated in an early post that I felt that rehab if all went well would legitimately require at least 6-8 weeks.......if all went well........and the injury was very minor (without additional "withheld" injury).

The reason that rehab is so much longer and harder than for the medial meniscus is that the lateral meniscus
has been shown to be responsible for about 70% of load transmission across the joint.

Here is my previous post shortly after the surgery announcement.





Keep the following in mind re. this study.


Among those who returned, the average length of time until return was 8.5 months, although 4 players returned during the same season. Regarding those 4 procedures, 2 surgeries occurred in October, with an average return time of 29 days, and the other 2 occurred in December, with return after 19 days in each case. However, 1 of these early returners required a subsequent partial lateral meniscectomy immediately after the season in
which he underwent the original surgery.

It would seem that the 4 short rehab outliers had very minimal meniscus damage in order to return so much sooner than the 8.5 month average. We can only hope that Clowney is one of those with minimal damage. However, we must always remember that short return to play period forced early due to inadequate rehab tends to carry bad outcomes.
Dr CND is without a very serviceable computer at the moment so replies are challenging for him, at best.

And with the old Clowney thread locked -- didn't realize that -- we can't quote his old posts.

But to really simplify it, think of your natural cartilage -- the think layer of white you see on a chicken leg -- think of that as ice: hard like an ice cube and very slippery, but thin.

What is created in microfracture surgery would be, in comparison to ice, like a layer of straw.

The "ice" wears down in all of us over much time(in high level athletes much faster), rubbing down to bone-on-bone that creates pain = arthritic.

The "straw", in comparison, wears away much faster.

That's as good as I can do until Dr. CND returns to correct/refine it.
 

Mr teX

Hall of Fame
Don't understand the hatred of the Texans team docs around here. I mean it'd be 1 thing if the players themselves were repeatedly saying they weren't ready to come back & the training staff pushed them out there anyway, but that's not the case. The players want to play and ultimately the docs are just relying on the players and how they say they feel. Sure there's somewhat of a timetable out there of when its safest for these guys to return, but it is just a timetable and different for everyone. Some guys come back faster and excel (Adrian Peterson, Terrell Suggs) and some guys never quite return to form, (Penny Hardaway,Greg Oden). In that regard, all the docs can do is take the player at their word and hope for the best.
 

dalemurphy

Hall of Fame
Don't understand the hatred of the Texans team docs around here. I mean it'd be 1 thing if the players themselves were repeatedly saying they weren't ready to come back & the training staff pushed them out there anyway, but that's not the case. The players want to play and ultimately the docs are just relying on the players and how they say they feel. Sure there's somewhat of a timetable out there of when its safest for these guys to return, but it is just a timetable and different for everyone. Some guys come back faster and excel (Adrian Peterson, Terrell Suggs) and some guys never quite return to form, (Penny Hardaway,Greg Oden). In that regard, all the docs can do is take the player at their word and hope for the best.
The best example... Most obvious example of their incompetence was their handling of Ben Tate's broken ankle coming off the field in his rookie year. First, they attempted to have him walk off the field. Then, after loading him on the cart, they administered significant downward pressure on his knee and lower leg with his leg extended in a way that focused the force directly on that ankle.
 

Double Barrel

Moderator
Staff member
Don't understand the hatred of the Texans team docs around here. I mean it'd be 1 thing if the players themselves were repeatedly saying they weren't ready to come back & the training staff pushed them out there anyway, but that's not the case. The players want to play and ultimately the docs are just relying on the players and how they say they feel. Sure there's somewhat of a timetable out there of when its safest for these guys to return, but it is just a timetable and different for everyone. Some guys come back faster and excel (Adrian Peterson, Terrell Suggs) and some guys never quite return to form, (Penny Hardaway,Greg Oden). In that regard, all the docs can do is take the player at their word and hope for the best.
I think the team doctors take the public blame for the feeling of deception and misdirection that is perpetuated by the Texans front office.
 

paycheck71

Hall of Fame
Don't understand the hatred of the Texans team docs around here. I mean it'd be 1 thing if the players themselves were repeatedly saying they weren't ready to come back & the training staff pushed them out there anyway, but that's not the case. The players want to play and ultimately the docs are just relying on the players and how they say they feel. Sure there's somewhat of a timetable out there of when its safest for these guys to return, but it is just a timetable and different for everyone. Some guys come back faster and excel (Adrian Peterson, Terrell Suggs) and some guys never quite return to form, (Penny Hardaway,Greg Oden). In that regard, all the docs can do is take the player at their word and hope for the best.
My view on this is kind of two-fold. The Texans doctors work for the Texans and, intentionally or not, will tell the Texans what the FO wants to hear to a certain degree.

At the same time, what usually happens when you go to a doctor and get a diagnosis? He'll give you options and basically make it up to you to decide what to do. If you go and get a second/third opinion, it will probably reinforce one or two of those options. Eventually you'll pick the one you're most comfortable with. In the ultra competitive world of pro sports, where tomorrow is not guaranteed for 90% of the players, they will most likely be willing to push it and risk greater injury.
 

Playoffs

Subscribed Contributor
Don't understand the hatred of the Texans team docs around here...
Having had very many in depth discussions with Dr CND, who is highly qualified to not only comment but also sort through the many bullisht studies to ferret out the qualified ones that apply to the NFL population/procedure in question, I'll take the other side.

First, there's no hatred. Period. Just a question of how a team physician attempts to maximize player minutes versus maximizing quality player minutes. Easiest recent example was 2013 Derek Newton. Had a knee procedure in offseason, was brought back too soon as noted by Dr CND, and was awful for most of the season. And they quietly had to re-do same procedure after the 2013 season. The Newton we saw in 2014 was a much different player. Asked, he shakes his head with a 'no comment'.

Coaches want players back a.s.a.p. Players wants to comply, even through pain. S.O.P. in NFL. Only the physician is responsible for qualified, independent intervention to hold a player back to maximize quality player minutes vs just getting him back on the field quickly...player minutes. Would it have been worth it for Newt to miss 3 extra weeks and return to play at 2014 levels?

Dr CND has documented many instances of this what I call wrong-headed process with other Texans right here on TTalk. It's the tail wagging the dog. And it costs us, in my opinion.

Again, no hatred. I just want my team to make decisions that maximize their chances to win.
 

Mr teX

Hall of Fame
Having had very many in depth discussions with Dr CND, who is highly qualified to not only comment but also sort through the many bullisht studies to ferret out the qualified ones that apply to the NFL population/procedure in question, I'll take the other side.

First, there's no hatred. Period. Just a question of how a team physician attempts to maximize player minutes versus maximizing quality player minutes. Easiest recent example was 2013 Derek Newton. Had a knee procedure in offseason, was brought back too soon as noted by Dr CND, and was awful for most of the season. And they quietly had to re-do same procedure after the 2013 season. The Newton we saw in 2014 was a much different player. Asked, he shakes his head with a 'no comment'.

Coaches want players back a.s.a.p. Players wants to comply, even through pain. S.O.P. in NFL. Only the physician is responsible for qualified, independent intervention to hold a player back to maximize quality player minutes vs just getting him back on the field quickly...player minutes. Would it have been worth it for Newt to miss 3 extra weeks and return to play at 2014 levels?

Dr CND has documented many instances of this what I call wrong-headed process with other Texans right here on TTalk. It's the tail wagging the dog. And it costs us, in my opinion.

Again, no hatred. I just want my team to make decisions that maximize their chances to win.
This isn't trying to take anything away from CND, his comments have been spot on, but these decisions aren't being made in a vacuum. The player has just as much if not more responsibility for how diligent he is with his rehab, how honest he is with docs about pain and everything else. Doctors get paid to practice medicine..& practice they do.

Supposedly players can't lose their positions due to an injuryin the NFL....but the players know that's a load crap so they push it to get back out there. So i wouldn't so much call it "complying" with coaches as much but rather these guys realizing they've got a small window to get out there, play and potentially make enough money to set themselves up for life before its all over. The last thing any of them want is to be told to sit out longer than they feel they have to or be labeled injury prone or soft....that kind of stuff comes back to bite them during contract negotiation time. Furthermore, having them sit out the expected time they probably should isn't a guarantee that they won't have lingering issues that require sitting out more time and/or more surgery after they do come back. Again, every player is different. It'd be nice if these decisions were made like you want , but it isn't up to the docs, its up to the player since its his career and to a greater extent the HC since he is the one who ultimately makes the decision on whether or not the player practices/plays. All the docs can do is give the player and the HC their professional opinion. And since we don't know whether or not this is actually happening, or whether the HC/player is actually listening to the doc, they can't really be blamed.
 

Playoffs

Subscribed Contributor
...it isn't up to the docs, its up to the player...
Your assumption is incorrect.

Dr CND has actual knowledge of how it was, how it is done in the Texans org, and how it should be done. He is an expert.

You're creating assumptions to fit your narrative.
 

badboy

Site Contributor
Clowney in minimal 2014 exposure looked really good before injury with little prep time. My 2 cents is to hold him out until game one and then pick his spots to play for first few games .
 


Top