November 2, 2014 10:30 a.m.
Tony Romo is questionable with a back injury that he suffered during a Monday Night loss vs. Washington, but now that we know he suffered 2 small fractures in his back and continued to play; Is Romo the toughest player in the NFL?
Tony Romo is reported to have 2 small fractures to his vertebrae. The fractures are said to be to his transverse process which are small processes that are on both sides of the vertebrae. Without the exact location of which vertebrae are fractured, it is difficult to predict how much this will affect his performance or game play status. However, his ability to practice and/or play in this week’s game will help us make some educated guesses.
First off we need to get this out-of-the-way: this injury is not likely to be related to the surgery that Romo had on his back last year. The two issues would be difficult to correlate with one another as these fractures appear to be a direct result of the hit that Romo took on Monday night. Now while I don’t think the fractures occurred because of his old injury, I do believe that getting hit with the force that it takes to fracture his vertebrae can not be good news for someone who had a herniated disc issue just last year. Herniated disc are generally irritated during forward bending activity and on Monday night the hit in question surely looked to violently bend Romo forward. It is a long season, we will have to wait and see if some of the same disc issues arise as the season progresses, but if Romo keeps getting hit like that, his chances are greater to suffer an exacerbation.
As for the injury at hand; much of Romo’s limitation depend on where the fracture is. There are different sections to our vertebrae. The neck or cervical region provides lots of motion and allows us to move our head. The upper back region is considered the thoracic region and provides very little movement. The low back or lumbar region can be considered the region which provides us with most of our trunk mobility as it allows us to bend and rotate. The Sacral region is in our pelvic region and is also involved with trunk movements and can be particularly important in females. The location of Romo’s injury is not listed, but the general term of “back” would imply that this is either his thoracic or lumbar spine is involved.
Basically, the key factors in this assessment are comparing the inflexible nature of the thoracic spine to the very flexible nature of the lumbar spine. If this is a thoracic region transverse process injury, there will be pain. However, the pain int the thoracic region would likely occur during contact and possibly during the rotation forces while throwing. If his injury is in the lumbar region, I believe the severity of pain, the occurrence of pain, and the risk for further injury are all increased based on the fact that the lumbar spine is always active and can be bent and rotated during the game both in a voluntary nature but also in an involuntary nature. Without getting into a full anatomy lesson, I will say that there are many structures around the transverse process such as the intertransverse ligament which connects adjacent transverse processes, in the thoracic spine the ribs attach very close to this area, the overlying musculature and soft tissue which will feel pain, and the remainder of the actual vertebrae which is now somewhat at risk.
If Romo plays, it is my guess that the fracture is in the thoracic region. In this case, he will likely get something for pain and have extra padding. If he doesn’t play my guess is that the fracture is in the lumbar region and Romo is unable to tolerate the pain during the throwing motion as well as the medical staff not wanting to take a chance at exacerbating the injury.
Ultimately, this will likely be an injury that will bother Tony Romo for a while as bone healing is generally 6-8 weeks. However, the fact that surgery has not been mentioned and these fractures are described as small tells us that these are likely simple fractures that are not at great risk. The treatment plan will likely include decreasing his trunk mobility by likely using a restrictive back brace; as well as utilizing pain modalities for Romo’s comfort. Furthermore, the NFL has long been on the cutting edge of having modalities that minimize healing time and I am sure the Dallas Cowboys are serving these up to Romo on a platter.
I do not expect Romo to play today and if he does I would not be surprised if he did not finish the game. With Brandon Weeden to fill in I would think he is the logical replacement on your roster. I would be careful though as the Dallas Cowboys are already a running team and this likely means more runs and less action for the back up. Arizona is the best run defense in the league though, so you may get a surprise outing from Weeden if Murray gets shut down for the first time this year. If Weeden is not your preference, then you may want to check if Brian Hoyer is available in your league. Although he is not someone who would usually be on my radar; my colleague Dr. Starks has convinced me that Hoyer is headed for a big day.
I expect Romo to return in week 12 . The Cowboys have the Jaguars in London for week 10 and my guess is they will try to treat this like an additional bye week as they have their actual bye in week 11. They likely believe they can beat Jacksonville without Romo but I already have my upset alert ringing.
As for whether Romo is the toughest player in the NFL, the answer is simply NO! I do think he is tough and old school in his ways. He always wants to get back on the field and is willing to play through pain, but there are far worst injuries to players who will endure far more contact and pain throughout the game. Romo’s injury will be sold as a broken back and him gutting it out, but in the end he is dealing with a fracture to a non-functional structure and if he plays he will likely have the miracle of medicine to mask most of his pain. In Romo’s case, I say don’t believe the hype!
Watch out for that DeMarco Murray injury I predicted (Dallas Cowboys Running Back DeMarco Murray will end up on the bench!). It is hard to imagine that they can lean on him any harder without him falling; this may just be the week he goes down too.