Foster's MRI not the complete picture

As the dust settles in the aftermath of the Twitterstorm generated by Arian Foster's recent social media activities, the question for many fantasy football owners simply remains: What is Foster's status for Week 1 and beyond?

Although Foster has undoubtedly provided more fodder for discussion, we are not necessarily closer to a definitive answer to the aforementioned question than we were before we saw a snapshot of Foster's thigh. In essence, his status is questionable and likely will remain that way for at least the next 10 days.

As much as those involved in the medical care of athletes and non-athletes alike would welcome black-and-white scenarios for injury diagnosis, prognostication and treatment, the fact is such things remain complex and based on many factors. The reason that ranges of recovery times are issued for any given injury (four to six weeks, six to eight weeks, day-to-day) is simply because there is a range in the time it takes for people to heal from even two seemingly identical injuries. Factors such as age, health, body type, genetics, prior injury history, response to treatment, compliance with recommended treatment and nutrition are among the variables that can influence the rate of healing. Hence the reason one individual with a Grade 1 (minor) muscle strain can return to a sport within days with no recurrence of injury going forward, while another sits out four weeks only to re-injure the muscle within days of returning. It is precisely this imprecision of injury management and recovery that makes the process incredibly frustrating for both the athlete and the medical personnel responsible for the athlete's care.

In order to arrive at a course of treatment and a projected range of recovery time, the first order of business is to attempt to identify the problem. In the world of professional athletics, imaging tests such as X-rays and MRIs are so routine, it leads to the common perception that those tests alone neatly define the problem and outline the projected course of action. In truth, the images are just part of the evaluation process. Ideally in sports, the process begins with observation of the injury, followed perhaps most importantly by a detailed interview of the athlete (describe what happened, what was felt at the time, where the pain or other symptom is located and much more), and then followed by a thorough physical examination. The decision as to which tests will be obtained comes out of this evaluative process in the hope that such tests (X-rays, MRI, CT scan, diagnostic ultrasound, blood or other lab work) will serve to shed further light on the detail of the athlete's condition. The idea is to put all of the findings together to determine the problem and the best course of treatment.

The MRI has become one of the most frequently relied upon tests in the world of sports medicine because it is the single best tool for imaging of soft tissues (like muscles and ligaments). While it is typically very sensitive (meaning it does an excellent job of identifying positive findings when an injury is present), it does not necessarily define the full scope of the injury on its own and thus must be considered as only a part of the entire picture. For those who have never had the pleasure of undergoing an MRI (which requires lying very still for a period of time as one is moved, at least partially, through a narrow tube while enduring intermittent loud banging noises), the result is not one picture but many different images, or slices, of the injured part. The goal is to capture images at varying layers of depth and from different directions in order to best visualize the desired area. The quality of the images can vary greatly depending on, amongst other things, the sophistication of the machine itself, the operator, the positioning of the patient and how still the patient remains during the test. The best images are then compared with the symptoms the patient is complaining of and the physical findings to arrive at some sort of conclusion.

In the case of Foster, we do not have the complete picture of his pictures, so to speak. Even if we did, they would not tell the whole story. Other aspects of the story need to be considered. Foster injured his left hamstring on the first day of practice (Aug. 5), sat out practice for 11 days, then saw his (uneventful) first preseason action Aug. 20 and looked to be back on track. One week later, he suffered a setback, aggravating the hamstring in the first quarter of a preseason game against the San Francisco 49ers and then, well, we know the rest.

Of note, Foster jogged lightly in practice Monday and Tuesday. While this is not terribly revealing, if Foster were limping dramatically after the setback or there was significant concern about his latest injury, he likely would not have been jogging at all. John McClain of the Houston Chronicle, who covers the Houston Texans regularly, is able to make daily observations from a closer vantage point and noted that when Foster first hurt his thigh in early August, he watched him "limp around the facility." McClain added that since the setback in San Francisco, Foster has not been limping. While not earth shattering, those types of observations -- how Foster is moving, what he is able to do in practice -- may go further in hinting at how his injury is affecting him functionally than an isolated image.

At the end of the day, we are really no closer to "knowing" whether Foster will be ready for the season opener. He expresses optimism, as does the team, but we know from experience (and the research supports it) that athletes with a history of a hamstring strain are more likely to suffer another one. Unfortunately there are no perfect indicators for readiness for return to play; once all the rehab parameters have been met, the only way to truly test the hamstring is in-game play. The fact he has suffered a setback in the preseason is concerning, but if it is indeed a setback of less severity, perhaps it is not overly worrisome for the remainder of the season.

For fantasy owners it becomes, as is usually the case, a matter of risk versus reward. All running backs carry some level of risk because of the nature of their position but very few have actually delivered Foster-type rewards. At the end of the year, very few running backs will have played in all 16 games. The question for all to consider is who will have done the most with the time allotted. Foster is still worthy of being part of that discussion.