It goes without saying that Joe Flacco is the best quarterback the Baltimore Ravens have ever had. In the words of DJ Khaled, Flacco is the Ravens’ "key to success". Flacco had never missed a start for the Ravens until last season where he tore his ACL and MCL in the Ravens win over the then St. Louis Rams. He had surgery in the days following the game and was thus out for the remainder of the season.
This injury could be career ending for running backs, but Flacco is obviously not as mobile as backs. Carson Palmer has suffered this injury twice in his career but is now one of the top quarterbacks in the NFL. That aside, this injury is nothing to take lightly, and there is no way to know if Flacco will be able to be the same player as he has been up to this point in his career.
Flacco’s health coming into this season is the storyline for the Ravens. His performance in training camp may not show how Flacco will react to pressure. However, most fans don’t fully understand the work that it takes to come back from the injury, and get back to an elite, yes elite, level of play. So, to get more information, I spoke to Christopher Gnip, PT, DPT of Select Medical in their Aurora/Thornton, CO clinics, an expert in sports injury rehabilitation.
MC: Describe what an MCL and ACL tear would mean for an average person?
CG: "The average patient would go to physical therapy for an ACL/MCL tear due to the instability that results from the injury. Both the MCL and ACL help keep the knee in its place with cutting activities, and if they are no longer intact, a lot of people will have difficulty performing anything more challenging than the most basic of activities. A typical PT progression would be anywhere from six months to a year."
MC: What routines would you put someone who suffered the injury through?
CG: "The patient would begin therapy anywhere from a few days to a few weeks after the surgery. Initially, the focus would be on regaining any lost [range of motion], and then when appropriate and instructed by the surgeon, beginning strengthening exercises. Once enough stability is noted by the PT and MD, the patient can then progress to higher level sport activities, which doesn't usually begin until 6 months at it's earliest."
MC: Is the process any different for an average person compared to an NFL quarterback
CG: "The major difference is going to be the strength and stability of an NFL'er such as Joe Flacco going into the surgery as opposed to the average person. the more strength and stability you have in the surrounding muscles, particularly your quads and hamstrings, the quicker you'd be able to progress through the initial strengthening phases of PT. However, despite how quick the initial phase can go, the latter phases of being stable enough to return to activities are typically longer for higher level athletes due to the complex movements needed for their sports as compared to the typical patient, who's only goal might be to just return to jogging or biking."
MC: Is there a risk that the injury could hamper Flacco's play?
CG: "Any time you have a ligament injury and subsequent repair, there is an increased risk of injury. Putting in a graft is never as strong or stable as the natural ACL. These risks can be increased dependent on the stresses placed through the knee. Someone who needs to cut more, like say Jamaal Charles or RGIII, would have a higher risk of re-tear as opposed to more stationary players, such as Tom Brady or Joe Flacco."
(speaking of Brady, am I the only one who is thrilled that he might finally serve his suspension?)
MC: What are the biggest obstacles he would have to overcome?
CG: "I think the biggest obstacle is going to be the mental approach he takes to the field. His MD and trainers/PTs wouldn't allow him to return to the field until he is physically ready and stable enough. However, how confident is Joe going to be to step back and pivot off of his knee? How willing is he going to be to run out of the pocket and sprint down the field and expose himself to a hit? What's been shown is that patients who try to protect themselves too much and start messing with the way they naturally move can actually expose them to a higher risk of re-injury. If Joe can mentally recover from this injury and be confident that the surgery was successful, he'll be real close to how he was last season."
MC: What is the re-injury risk?
CG: "There are various reports out there, but what I found was 2-13% chance of re-injury. The higher study, 13%, involved handball players, which is a sport that involves a lot of twisting/torquing of the knee."
MC: Overall, should Ravens fans worry about Flacco?
CG: "Flacco may take some time to get back to full speed (mid to late season), but long term, I don't see any reason why a quarterback like Flacco would have any concerns long term in getting back to his previous form."
Based on my conversation with Christopher Gnip, I would find it hard to believe that Flacco doesn’t return to full strength. Flacco just needs to avoid following in Palmer’s footsteps in terms of injuring himself again. But as long as Flacco can regain his comfort in and outside of the pocket, he should be fine. At the end of the day, the fans, as well as Flacco, just want to see #5 on the field.