Michael Vick leads parade of Week 4 injuries

One might say it's been a busy week in the world of NFL injuries. Running backs continue to take the biggest hits, with a couple of notable exceptions in the quarterback department.

Here's where we are coming out of Week 4.

Michael Vick, QB, Philadelphia Eagles: By now, everyone is aware that Vick suffered a chest injury in Sunday's game; the big question on everyone's collective mind is: How much time will he miss? Undoubtedly, that question is followed by others, such as, "How effective can he be when he returns?" or "What are the chances of reinjury?" These are all valid questions but, sadly, there is very little to offer in the way of definitive information. Rib cartilage injury, which is what Vick is dealing with now, is by its very nature unpredictable.

So what can we say about the injury? Starting with the way the injury happened, we can say it looked perhaps more like a hockey injury than anything else. Vick was, as he put it in his interview on Bruce Smith's radio show in Virginia Beach, Va., "sandwiched" between two defenders, absorbing a hard hit from both sides. It looked like the shot a hockey player takes when driven into the boards, which usually results in a shoulder separation, a rib injury or a cartilage injury. The force from the simultaneous hits on Vick was transmitted through the shoulders, through the ribs, and ultimately the failure occurred at the weak point, the cartilage junction between the ribs and the sternum (breastbone). According to The Philadelphia Inquirer, an MRI taken of Vick's chest revealed no broken bones but rather damage to "the cartilage that connects his second and third ribs to his sternum."

A natural immediate reaction would be relief that it was cartilage damage as opposed to a broken bone. But, in fact, a rib fracture would be desirable over a cartilage injury of this type. I posed the question to several colleagues (orthopedic surgeons and physical therapists/athletic trainers who treat NFL players) as to which injury, in their opinion, would be more problematic, and they all agreed that this type of cartilage injury is more difficult to manage than a broken rib.

Part of the challenge has to do with the fact that cartilage just doesn't heal as quickly or predictably as bone. Additionally, part of the role of cartilage in the chest wall is to allow some elasticity in the thoracic cage (essentially the 12 vertebrae that make up the middle portion of the spine, the ribs that attach to them and the sternum in the front). There has to be some elasticity to permit motion during breathing and to make the entire cage less brittle. Once a portion of that cartilage is cracked, however, it is difficult to keep it "still" enough to heal. Every breath, every reach, every twist, yawn, cough or sneeze presents an opportunity to move that damaged cartilage, resulting in pain, usually sharp, along with the potential for slowing down the healing.

There is no magic fix. The best treatment is rest and avoiding movement of the injured area. Vick's ability to return will be largely pain-dependent; there is no great concern about making this injury worse. The sharp pain should subside over the first week or two, but the problem might come when Vick tries to increase his activity. As he begins to throw (yes, even though he throws with his left arm, it causes movement on the right side of his body), or, for that matter, even run hard (making him breathe more forcefully, which could be painful), he might experience pain again. Every time he takes a big hit or lands on his shoulder, chest or back, it has the potential to aggravate the symptoms. Vick ultimately should recover fully from the injury; the question will be how long the pain makes its presence felt this season.

This injury has the potential to sideline Vick anywhere from two weeks to five or even six weeks. The broad range of time reflects how variable the symptoms can be from one athlete to the next. It's worth keeping in mind that much of Vick's success as a quarterback is the running threat he provides. If he can't run effectively, it's hard to imagine him being dangerous at his position. The more running, the more rib motion and the more uncomfortable it will be, at least in the early phases of healing. And although a lower rib injury sometimes can be aided by extra padding or a wrap to splint the area, it's much more difficult to add any kind of protection for the upper ribs because they are so close to the shoulder.

Expect Kevin Kolb to start at least two weeks, if not more, to try to re-establish his role in the quarterback position. Fantasy owners who were just getting used to having Vick in their lineup now need to prepare for his extended absence.

Steve Smith, WR, Carolina Panthers: Smith's twice-fractured forearm is holding up well so far this season. Unfortunately, he now has to contend with an injury to his ankle. Smith, known for his speed and athleticism, won't be running anytime soon after suffering a high ankle sprain in Week 4.

Smith is sporting the customary protective walking boot on his injured left ankle and is expected to miss at least this week. Although Panthers coach John Fox has referred to Smith's condition as day-to-day, Smith's agent stated that he "most likely" would sit out the game Sunday against the Chicago Bears. Knowing the slow resolution of high ankle injuries, Smith's absence in Week 5 would appear to be a foregone conclusion. The Panthers have a bye in Week 6, so the question becomes how likely would Smith's return be in Week 7?

Naturally, it's too soon to say with any degree of certainty because much depends on the severity of the injury and Smith's healing rate. The law of averages when it comes to these injuries would suggest that Smith's absence could be longer. Fantasy owners should secure a backup with that in mind.

Clinton Portis, RB, Washington Redskins: Portis already has been struggling with one injury (wrist) this season, opening the door for Ryan Torain, recently signed from the Redskins' practice squad, to step up. And Torain did step up Sunday, delivering 70 yards and a touchdown. Portis is now facing another more significant injury that might thrust Torain into the starting position this week. Portis, who injured his left groin Sunday, is still waiting to hear the results of an MRI taken Monday but has already told 106.7 The Fan in Washington that he does not expect to play Sunday. According to The Washington Post, Portis heard a "pop" in the groin at the time he injured it, often a sign of a relatively significant injury. The groin (adductor or inner thigh) muscles are critical not only for lateral movement but for straight-ahead explosiveness, as well. These also are injuries that are easy to aggravate. Fantasy owners should heed Portis' advice and make alternate plans for at least this week and perhaps longer.

Darren McFadden, RB, Oakland Raiders: Run DMC has been living up to his nickname so far this season until, well, another injury slowed him down. McFadden pulled up on a big fourth-quarter play, his hand grabbing the back of his thigh, signaling a pulled hamstring. The severity of the injury has not been reported, although Jerry McDonald of the Oakland Tribune described McFadden as "moving rather stiffly" in the locker room Monday. This is not the same hamstring McFadden injured in training camp (that was the left; this is the right), but that doesn't exactly provide any comfort to fantasy owners. McFadden says he is taking it "day-to-day," but no one should be surprised if he is forced to sit out Week 5. The good news for the Raiders is that Michael Bush continues to progress in his recovery from a thumb fracture and should be able to step up and shoulder the load.

Jay Cutler, QB, Chicago Bears: After being harassed in the time he was on the field Sunday night, Cutler finally was forced out of the game entirely after suffering a concussion. Cutler was sacked nine times in the first half, but it was not entirely clear when the injury occurred. Nonetheless, once it was established that he had indeed suffered a concussion, Cutler was not returning to the game.

It is worth noting that Cutler was at the Bears' practice facility Monday, although it is not clear exactly how he was feeling. As all teams are required to do, the Bears will have to proceed through the necessary steps to clear Cutler to return to practice once his symptoms permit. At this point, it is not known whether Cutler will miss any time.

Other quick hits

• As if the injury to Vick weren't enough, the Eagles also saw running back LeSean McCoy suffer a broken rib in Week 4. Although the team has not indicated definitively whether McCoy will sit out Week 5, it certainly would not be a surprise. McCoy's rib injury will come down to pain management, as well, but it's possible he will return before Vick does.

Baltimore Ravens running back Ray Rice emerged from Week 4 no worse for wear. Rice told the Baltimore Sun, "I definitely felt good." It's not surprising that the Ravens ultimately chose to let Willis McGahee start the game, working Rice into the mix gradually. It's worth noting that McGahee took a hit to the head in this game that forced him out for a period of time. According to the Sun, McGahee says he could have returned to the game but did not because Rice and Le'Ron McClain were performing well.

Detroit Lions running back Jahvid Best insists that his Week 4 performance had nothing to do with his toe, but that's a hard sell. Best appeared to struggle with his footing throughout the game. At one point, he slipped on a passing play, which resulted in an interception. He also gave up a fumble. Even if Best wasn't in great pain, he wasn't in great form, either. It will be worth watching his practice activity this week to see how he shapes up for Week 5.

New York Giants running back Ahmad Bradshaw injured his ankle Sunday night, with coach Tom Coughlin referring to it as a "little ankle" injury, according to the Newark Star-Ledger. Bradshaw is scheduled to undergo more tests to determine the extent of the injury.

Houston Texans wide receiver Andre Johnson reportedly is feeling somewhat better after sitting out Week 4 to rest his sprained ankle. Coach Gary Kubiak said he hopes to have him in Week 5, but Johnson is not expected to return to practice until Thursday. Teammate Jacoby Jones left the game in the second quarter Sunday with a calf strain, and the team hopes to know more about his status Wednesday. Stay tuned.

• Raiders wide receiver Louis Murphy was neither looking good nor feeling good after aggravating his collarbone injury in Week 4. Murphy, who bruised the clavicle (collarbone) in Week 3, had been limited in practice last week as a result. He attempted to play despite the limitations, but it didn't take long for it to flare up. Murphy struggled, including a key drop in the fourth quarter that ended up being intercepted, so it will be interesting to see what he is able to do this week.

Dallas Cowboys tight end Jason Witten sat out practices in the bye week to rest his sprained MCL. Witten was back on the field Monday doing side work with the athletic training staff, according to the Fort Worth Star-Telegram. It looks as if Witten will return to practice Wednesday, which would bode well for his return in Week 5.

Minnesota Vikings tight end Visanthe Shiancoe appeared to injure his right hamstring in Week 3, but the Vikings have not offered any details. On Monday, Shiancoe was not at practice, but according to the St. Paul Pioneer Press, he was working with the medical staff doing some hill running. He has clearly become a favorite target for Brett Favre, who would love to have him available Monday night. We should learn more as the week progresses.

• The safety position is anything but safe for the Indianapolis Colts. First, it was Bob Sanders who went down with a biceps tendon rupture. He underwent surgery and remains on the Colts' active roster in the hope that he can return late in the season or in the postseason. Now, it's Sanders' replacement, Melvin Bullitt, who has suffered a major injury, one that is definitively season-ending. According to ESPN reports, Bullitt suffered a fracture in his right shoulder and is scheduled to undergo surgery in the near future. The Colts are expected to place Bullitt on injured reserve.

We will continue to update these injuries and others as the week progresses.