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Breshad Perriman's Knee Injury: The Mystery Continues

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Tommy Gilligan-USA TODAY Sports

The Ravens organization was particularly quiet concerning Breshad Perriman's injury back during training camp. As most of us remember, initial reports claimed that his injury was merely a bruise and he would return to practice in a matter of days. However, days turned into weeks and eventually the entire pre-season had passed. Fans were understandably frustrated by this point, particularly with the Ravens for not providing details about his injury. Still, many took some comfort in the fact that NFL rules require teams to begin disclosing injuries the week before the start of the regular season. Certainly answers were about to come, right?

Well, we are now approaching Week 4 of the season and know little more than we did 8+ weeks ago. Other than Jamison Hensley's report that Perriman is recovering from a sprained PCL, nothing else has been said out of Ravens camp and no one from the Ravens has confirmed that report.

Perriman has returned to practice recently, only to suffer an apparent set-back during warm-ups of last Sunday's game. When questioned on the matter John Harbaugh channeled his inner-Belichick, denying any knowledge of the incident and ultimately added more fuel to the fire in the process.

There is so much secrecy surrounding Perriman's injury and, for that reason, speculation amongst the fan-base has spread like crazy. I, like everyone else, can only continue to speculate at this point. However, I'll do my best to try and provide some insight about what may be causing the delay in his recovery.

MY CURRENT TAKE ON PERRIMAN'S INJURY

Perriman’s reported mechanism of injury (falling onto a bent knee) certainly supports the notion that he suffered a sprained PCL. However it’s important to realize that knee sprains actually involve tearing of the involved ligament. The more severe the sprain, the more tearing involved. Based on the way the Ravens handled his injury initially (suggesting it was merely a bruised knee and he’d be "day-to-day"), it seemed likely that he suffered a Grade I sprain at the most. However, if that were the case, he would certainly be back by now. My best guess is that Perriman either suffered a Grade II PCL sprain or is battling a bone bruise in addition to the PCL sprain that Hensley reported. Bone bruises can be nagging and fairly unpredictable in terms of healing time, so I wouldn’t be surprised if that’s the hold-up in his recovery.

(You can read more about PCL injuries HERE)

WHAT EXACTLY IS A BONE BRUISE?

Bone bruises are actually much more debilitating than their name suggests. There are two types of bone tissue: cortical (also know as compact) and cancellous (also known as spongy or trabecular). Cortical bone serves as the outermost shell and is extremely strong, dense, and hard. Cancellous bone is the innermost layer and is much softer and far less dense and strong.

A knee bone bruise typically occurs when there is a sudden and forceful impact to the knee. Rather than being a black and blue surface mark like most associate with bruising, a bone bruise actually involves microscopic fractures and bleeding to the cancellous bone. Essentially what happens is the forces aren't strong enough to fracture the outer bone, but are strong enough to fracture the inner layer of bone. This results in both significant pain and swelling.

HOW LONG DOES IT TAKE TO RECOVER FROM A BONE BRUISE?

As I mentioned earlier, bone bruises can be nagging and fairly unpredictable in terms of healing time. They are notoriously slow to heal and can take anywhere from a few weeks to several months before a full recovery is made. It really just depends on the severity of the injury.

It's important to realize that it is not a condition where you can simply take pain medications and ignore the symptoms. The bone must be given the necessary time it needs to heal. If not, any further trauma to the injured area can cause greater injury and/or prolong the recovery time.

- Bobby Esbrandt, PT, DPT, PES