Here’s what could give Chiefs QB Patrick Mahomes the most trouble with his ankle injury

Here’s what could give Chiefs QB Patrick Mahomes the most trouble with his ankle injury

The quarterback soon to earn his second NFL MVP award operates outside the position’s intended residence more frequently than any other quarterback in the league.

By a wide margin.

He is also better than the others.

By a wide margin.

That’s all to say that the immediate, off-script, impulsive brilliance of the moment is a big part of what makes Chiefs quarterback Patrick Mahomes different from other guys.

And that’s the part we can’t be sure we’ll see on Sunday.

Look, it’s hard to imagine even the sprained ankle keeping Mahomes out of a playoff game, let alone an AFC Championship game, and in particular an AFC Championship game. AFC against this team.

The question, in this case, is not whether Mahomes is likely to play against the Bengals, but whether he is likely to play like, well, Mahomes.

And let’s eliminate that earlier:

“These ligaments that have been damaged,” said Dr. Kirk McCullough, an orthopedic sports medicine specialist and foot and ankle surgeon at the Kansas City Orthopedic Institute, “will not be healed by Sunday.”

In the days since Mahomes was injured in the AFC Divisional Round victory over the Jaguars, I spoke with a handful of medical professionals, including doctors who specialize in ailments of the ankle and a former NFL coach. Before we go any further here, the obvious must be pointed out – none of them personally treated Mahomes’ injured ankle, which Chiefs coach Andy Reid described as a sprained high ankle, and so they are not aware of his test results or grade. sprain.

But they can provide important education, even if it is generalized. These conversations have focused on the characteristics of ankle sprains in elite athletes, rather than diagnosing a patient they haven’t treated, but it allows the rest of us to connect the points to assess some answers to a few key questions:

What could Mahomes’ week look like as he tries to prepare to play?

And where could he be most limited on Sunday against the Bengals?

To answer this, it’s important to understand that a high ankle sprain is very different from the more common lateral ankle sprain, typically taking two or three times as long to heal if graded the same. way. These are estimates, of course. But there is a main reason for this timeline.

A lateral ankle sprain results from inversion of the ankle, while a high ankle sprain is a rotational injury. Simply put: there are more mechanisms at play with the high ankle injury, and it is affected by more movement.

“The problem with a rotational injury is that, while possible, it’s much more difficult to brace, to tap, to do those things that limit the movement that’s causing all the strain,” said McCullough, also a consultant to the NFL Musculoskeletal Committee. “Some people with chronic lateral ankle instability, by comparison, you can give them really good band jobs and put a splint on them, and they can still perform really well.

“With a high ankle sprain, a rotational injury, how do you keep the foot from rotating relative to the leg? It’s much, much harder to do.

The pain of such a sprain occurs when the ankle exerts a rotational movement, in other words. So with Mahomes’ right foot sprain, if he turns his right foot outward or bends his ankle, the pain will follow.

For the most part, this would make certain movements particularly difficult.

As …

“Guys can run straight hard with high ankle sprains. They just can’t stop very well and they can’t cut very well. Those are the two things that are the hardest when you’re talking about a high ankle,” said Aaron Borgmann, a former NFL physical therapist/athletic trainer for 12 years. “The deceleration is one of the worst parts of the injury, as is the cut. It’s either cutting the injured ankle or cutting the top of the injured side. It hurts like hell.


And cut.

Two things most quarterbacks do a lot. Two things this one does more than any of his peers.

Mahomes has left the pocket on 121 retirements this season, most in the NFL, according to Sports Info Solutions. He managed to dodge the bags on all but one. It also consistently turns them into big plays – 25.6% of them result in “boom” plays, like the SIS frame, or plays that add at least one expected full point to play. This also leads the league .

It does this with the greatest frequency. It does this with the highest success rate.

And that part of his game might be limited. Or let’s put it this way: this is what is most likely be limited, as it requires cutting.

It was notable, for example, that in Mahomes’ first practice in the second half on Saturday, he was able to rush in for a first down, but his ensuing slide was clunky. It’s typical. The stop was visibly difficult.

The changes to his throwing motion were equally evident. The sprain is to his back leg as he throws, which essentially knocked his base off balance. There were some very obvious errant throws on Saturday – even Mahomes admitted as much after the game.

“One of the great things about this injury and one of the (reasons) it’s hardest to recover is because it gets inflamed – your big toe tendon, the flexor hallucis longus, gets inflamed and irritated because of this injury,” McCullough said. “So the ability to tiptoe up is one of the last things people really feel comfortable doing. And it’s one of the hardest and last things to recover. .

How much can eight days change all that?

Well, that’s a rushed timeline with most ankle injuries, although we’re not privy to the details of this one. Most don’t finish the game. Even among those who do, a high percentage will still not play the following week. While most other types of injury recovery go in a somewhat linear progression – things like muscle strain or a standard ankle sprain – high ankle injuries can often be worse 48 hours after the incident in due to building ignition. Players can be helped by adrenaline during a match, adrenaline absent on the following days.

But the rehabilitation process begins immediately. Borgmann described the type of treatment he has implemented in the past.

The key mechanics of this process involve either an underwater treadmill or an AlterG, a version of an anti-gravity treadmill. These items remove weight-bearing, designed to get a player moving at rapid speed without weight before gradually lifting the treadmill and eventually bringing that work down to earth.

Simultaneously, athletes will progress through single-leg balance work, then exercises like squats and lunges and such, then mix up the angles and increase the difficulty of the movements.

It’s a brief summary. There are layers.

“When I worked with high ankles in the past, it was all done in overlapping Venn diagrams and all at the same time,” said Borgmann, who now has his own private practice, Borgmann Rehab Solutions. “So you’re constantly pulling levers and flipping switches to see what works and what doesn’t.”

Still, at the start of the week, the Chiefs will need to gather some kind of forecast as to where they expect Mahomes to be by Sunday – as it will greatly affect the kind of game plan they implement on Tuesday. , Wednesday and Thursday.

At press conferences, questions for Reid this week will focus on whether his quarterback will play. If he will practice.

Its internal matters will be different.

How much do we think he can do on Sunday? What games will need to be discarded?

“It’s the art of sports medicine,” McCullough said. “It’s an injury where you look at a player and (analyze) what he looks like today, what he looks like tomorrow, what he looks like the day after. How do you minimize the inflammation and irritation that might occur? From a medical perspective, yes, we have objective criteria, but there are a lot of structures at play that come into play in a dynamic assessment.

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