To gain some perspective on Carson Wentz’s back injury, we spoke with an expert.
Here’s our Q&A with Dr. James Sanfilippo, chief of the spine section and medical director at Virtua Brain and Spine Institute in Mount Holly, New Jersey, and an orthopedic spine surgeon with Reconstructive Orthopedics in Moorestown.
Sanfilippo is not treating Wentz but is a leading expert on the specific injury he suffered, a vertebral fracture.
Q: Can you give us some background on the injury Carson suffered and just some basics on how serious it is?
A: “There are non-operative vertebral, primary bones that stack in the back, separated by the discs. If they’re saying it’s a fracture, one of those blocks is compressed down a little bit. Which is very difficult to diagnose. Sometimes you don’t see it until the bone starts to heal, which could have been the delay in the CAT Scan (revealing a fracture). Picture a Rubik’s cube and the top is sort of compressed down a little bit. Sometimes you won’t see that or notice that on a CAT Scan or on other imaging until it starts to heal and you see other bone starts to develop around it. It’s either that or there are little projections of bone that come off to the sides or off to the back that help support some of the muscles.
If it’s one of those, you might also not see it until the same type of healing process (begins) or if the bone moves a little bit you can see it. Any of those are A) non-operative and B) are extremely irritating to the muscles in the back. So (you get) the muscle spasms, soreness, tightness, however you want to describe it. And all of them heal with time and none of them should be a permanent problem moving forward as far as A) re-injury or B) coming across difficulty moving forward. It’s just symptom management and time to heal.”
Q: What’s the treatment for an injury like this?
A: “Rest and gentle stretching to begin with and then going through the physical therapy and really getting back that full range of motion. But the first thing you need to do is let that inflammation subside and that’s the rest portion. And only he and the trainers and doctors treating him are going to know when he’s symptom-free to then begin to put him back through normal range of motion and normal workouts and eventually back into play.”
Q: What causes an injury like this?
A: “Usually, these type of injuries are impact related. They’re not related to repetitive motion or repetitive stress. When you think of the healthy professional athlete and non-operative, it’s usually one of these types of injuries. Impact or trauma.”
Q: Could Carson play right now?
A: “I think the biggest risk is continually irritating it and having pain and muscle spasms and soreness and then the question is, does that pain and soreness affect his play on the field? And then how long do you prolong those symptoms and prolong the recovery afterwards by playing through it?”
Q: How long a recovery time are we looking at?
A: “You’re looking at (a few) weeks type of range. The biggest problem right now is how long is the Eagles’ season? If there’s a playoffs involved and they make a deep run in the playoffs, can he come back? I don’t see a reason why not if he’s symptom-free. If it’s just regular season, is he able to be symptom-free and get back on the field and do everything he wants to do at 100 percent in a couple weeks after this (Rams) game? That becomes a question.”
Q: How long does it take for the actual fracture to heal?
A: “To fully heal, a fracture can be anywhere from six to nine months, so you’re not really waiting for the fracture itself to heal solid. What you’re waiting for is the symptoms (to stop). You’re waiting for the body to stabilize it so there’s no motion of the bone. That means no inflammation. No inflammation means no muscle spasms and you can get back into motion.”
Q: Carson initially had symptoms in October. Why wouldn’t the fracture appear on a scan back then?
A: “Some of these fractures are slight enough that you don’t see them until they start to heal and start to form more bone around them. Then all of a sudden you start to see on repeat scans, ‘Oh wait a second, there might have been something here, because now we’re seeing healing.’ Not being privy to the studies that were done, it’s speculation, but it wouldn’t surprise me if it showed nothing six weeks ago and now it shows a fracture.”
Q: So what you see on the scan isn’t the fracture?
A: “Exactly. We call it bony callous. That’s where bone starts to form around the fracture to stabilize it. Often, that’s what we’re seeing.”
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