AUBURN — For the last 11 days, the biggest story of Super Bowl XLVI has been New England Patriot Rob Gronkowski’s left ankle.
As an orthopaedic surgeon, Dr. Paul Cain has some insight into how the tight end’s high ankle sprain has been treated since he suffered the injury while being tackled during the AFC Championship game against the Baltimore Ravens.
As head of the the sports medicine program at Central Maine Orthopaedics and team physician for the Bates College athletic program for the last 20 years, Cain has an idea what Gronkowski’s prospects are for playing and playing well this Sunday.
As a Patriots fan, Cain has been hanging on every morsel of news he can get about the most famous foot injury New England has seen in, oh, nearly eight years.
“It’s getting a lot of attention. It’s right up there with (Curt) Schilling’s sock,” Cain said, referring to the Red Sox pitcher’s infamous bloody sock during the 2004 postseason.
The Patriots announced on Thursday that Gronkowski was able to practice for the first time since suffering the injury. His participation was listed as “limited” on the team’s injury report.
“We’ll take that as a positive sign,” Cain said. “It’s a tough injury.”
Most people who suffer an ankle sprain suffer an “inversion” injury, where the ankle turns out and the ligaments on the outside part of the ankle are torn, Cain said. Gronkowski suffered an “eversion” injury, coming down on the inside of his foot, causing a separation between the fibula and tibia bones. The ligaments there are very thick and have a lot of force applied to them.
“It’s a more forceful injury,” Cain said. “It’s actually the most common way that people fracture their ankles. Luckily, he didn’t have a fracture, but he had enough of a force so the fibula separated enough to tear the ligaments between the tibia and the fibula.”
It it what it is
Gronkowski went down in obvious pain and hobbled to the locker room to have the ankle checked. He returned a short time later for a few plays in the fourth quarter, “which is pretty impressive,” Cain said. “But those ligaments will take a long time to heal, but he’s still going to have a hard time pushing off and pivoting.”
“It’s a load-bearing articulation around the ankle, so if it’s not working right, then it’s painful to push off or to have any sort of compressive load. So you can’t just tape it up and try to stabilize it that way, because people still have to push off,” Cain said.
Someone with a high ankle sprain can feel fine with normal activity, he said, “but when they get back to high-level activities, they still have symptoms because of that compressive load.” That means Gronkowski may not feel the full affects of the sprain until he tries to run and make cuts on a pass route or tries to block a New York Giants pass rusher.
Gronkowski was photographed wearing a walking boot immediately after the AFC Championship game and reportedly continued to wear it until Super Bowl media day this past Tuesday.
The boot immobilizes the ankle, thus allowing the ligaments to heal.
“It speeds up the healing. If the ankle is still moving a lot, the ligaments never have enough time to knit to one another and it would take longer that way to heal,” Cain said. “A lot of it was for pain control, I’m sure, but some of it is to facilitate the healing.”
Cain believes the Patriots treatment of Gronkowski included the well-known RICE technique — rest, ice, compression and elevation — for the first 48 hours. That may have been followed by some ultrasound therapy and potentially having Gronkowski spend time in a hyperbaric chamber, which some believe accelerates the healing process for soft-tissue injuries.
The last few days likely would have included strengthening exercises for the ankle. But Patriot fans shouldn’t expect Gronkowski to be at 100 percent by kickoff, Cain cautioned.
“The healing process is what it is,” Cain said, paraphrasing a favorite saying of Patriot coach Bill Belichick. “You can only speed it up so much.”
Recovery time for the injury Gronkowski suffered on Jan. 22 is typically three to six weeks, Cain said, “and it can be longer. It can be a lot longer. It can be a severe injury that really limits people, and sometimes it needs to have surgery.”
Patriots medical staff will likely tape and brace the ankle before the game, and pain killers are also likely. There have been reports that Gronkowski could be outfitted with a special cleat which, Cain believes, will provide additional support and stability for the ankle.
“I’m not sure exactly what that’s going to do, but I would imagine it’s going to be a high cleat,” he said. “They’re going to try to eliminate external rotation, which puts a lot of stress on the syndesmosis.”
Surgery in Gronk’s future?
One concern for Patriots fans is that Gronkowski’s ankle could stiffen up during halftime, which is typically extended to about a half-hour for the Super Bowl. Cain said a compressive wrap and ice will likely be placed on the ankle during the break, but just because the injury isn’t bothering Gronk at the start of the game doesn’t mean it won’t flare up later on.
“They can re-tape him many times (during the first half), but the tape actually stretches out pretty quickly,” he said. “Let’s say he has a good first half but he takes those hits and those loads, during halftime it’s going to swell up on him. He could potentially come back feeling stiffer and not be as effective in the second half.”
He said it’s likely Patriots medical staff have put Gronkowski’s ankle through a stress test, taking X-rays of the foot in a number of positions to see if the tibia and fibula separate. If they separate, that is what is known as a syndesmotic disruption, which means the ligaments have not healed and are not going to heal without surgery.
There have been reports that Gronkowski’s injury will require surgery after the Super Bowl. If he does have a syndesmotic disruption, Gronkowski would have to have screws inserted across the fibula and into the tibia to hold everything in place securely. The screws would be removed once the ligaments have healed in 8-to-12 weeks.
Cain said it is possible Gronkowski would only need arthroscopic surgery to get into the ankle and remove any bone fragments or adhesions that are there.
“That would be a quick recovery. That would be probably best case scenario,” Cain said. “But if he has the open procedure on top of that or instead of that and he’s got the screws in the ankle for at least eight weeks, he’ll be on protective weight bearing for at least eight weeks and recovery time would be three to six months.”
Nevertheless, Cain said Gronkowski isn’t risking further injury by playing Sunday.
“I don’t think he could really make it a lot worse by playing on Sunday. He may just not be effective. He may not even make it through the game (because of pain and stiffness),” he said.
Speaking as a fan again, Cain said losing Gronkowski shouldn’t cause Patriot Nation to lose all hope.
“He does have backup out there. Some guy named Hernandez,” he added, referring to the other half of New England’s dynamic duo at tight end, Aaron Hernandez.