Pittsburgh Steelers quarterback Ben Roethlisberger has a sprained AC joint and torn ligaments in his throwing shoulder. That's trouble for anyone on the street, let alone a pro quarterback who has to sling the football around on the playoff stage this Sunday versus the Denver Broncos' top-tier defense. But for Roethlisberger and other injured players such as Kansas City Chiefs wide receiver Jeremy Maclin, going through the pain-management process is the key to survival at this point of the season.
In the NFL, no one is truly healthy by the end of October. That means reps are limited on the practice field and in the weight room. Players lose weight; their core strength drops and treatment schedules become a lifeline to Sundays. Now, just imagine the guys who are still playing, still competing in the postseason with bum shoulders, ankles, knees, etc. That stuff requires constant treatment throughout the week and an injection to mask the pain on game days.
Just get through three hours, right? That's it for these guys. Find a way to make it to Monday, when the process starts again. So, how does it work and what is the week like for NFL players who are battling an injury? Let's run through the steps that Big Ben, Maclin and plenty of others will follow this week to make sure they are back on the field.
Step 1: Identify the severity of the injury
Before teams can prep for game day, trainers and doctors have to diagnose the player's actual injury. That means X-rays, MRIs and the beginning stages of treatment. That can range from old-school tactics of ice buckets for an ankle injury to the new-school hyperbaric oxygen chambers that players will actually sleep in to promote healing. It could be as simple as "stim and ice" (muscle stimulator) Monday morning, which is used for everything in an NFL training room. Pull a hammy? Turn an ankle? Tear off a fingernail covering a kick? Well, get some "stim and ice."
Whatever the case, it's the start of a process that will entail three to four treatments per day. That's pretty standard. And necessary.
For Roethlisberger, the Pittsburgh trainers have to ask themselves: "What can we do to get him to throw a ball?" Think of the exercises and strengthening drills to develop the range of motion in the shoulder, stretching and basic joint mobilizations. It's on the trainers to start bringing that shoulder back to life. Some soft toss on the field? Not just yet, as Roethlisberger was visibly hurting Saturday night versus the Bengals when he came back into the game. Bubble screens, option routes and the shallow crosser aren't enough to beat Denver. This guy was just trying to push the ball forward.
With Maclin, the first thing the trainers have to find out is if he can walk straight. Yeah, it's that simple when looking at his gait and his ability to put weight on his injured ankle (diagnosed as a high-ankle sprain). That leads to some very light linear running and the questions about his ability to cut. Where is he at? Can he change directions? Does his position require him to lean on lateral movements? For example, are we talking about a slot receiver who has to run option routes all day or a split end whose main job is to run vertical routes? That all comes into play with the treatment process.
Like Roethlisberger, or any player who is beat up right now, there has to be a starting point. And that starting point often feels a long, long way from game day. But the injury can be managed if there is no true structural damage.
Step 2: Limit practice reps
Keeping an injured player on the shelf all week before throwing him into a game is a bad idea, in my opinion. You have to practice -- some. But it's a balancing act for teams, as they also have to be extremely smart and cautious about how they allow players to practice. Along with the continued treatment schedule (which doesn't end at the facility after quitting time), there has to be some field work to get reps while managing an injury.
I highly doubt Roethlisberger will throw deep fade routes to Martavis Bryant in today's practice. But he can still take some "dry snaps." What does that mean? Think about Roethlisberger going through his footwork drills, taking his drops, working his progressions -- without throwing the ball at game speed. And he can start some soft toss. But that's it.
While the training staff continues with soft-tissue treatments and manual work to increase the healing process, the Steelers will most likely wait to Sunday morning, in Denver, to test out Big Ben's arm. That gives him as much time to recover as possible.
But for the players and the training staff, they both know the injury isn't going to totally heal by the time that game day morning rolls around. Yes, the treatment works, it promotes documented healing and all that other good stuff talked about at medical conventions. I get it. But what's not taken into account is the pain the players have to deal with. That's no joke. That means the pain injection is the next and final step to getting back on the field.
Step 3: Pain injections and game-day management
There will be a line out the door in game day training rooms this weekend for pain injections. I took one of those shots, a Toradol injection, for every game during the final three years of my career. Drop your pants and wait for the needle. It only stings for a couple of seconds.
I'm sure Toradol has long-term (and negative) effects, just like the overuse of ibuprofen, but when you need that shot to get through three hours on game day, it is the final (and sometimes best) option. Unlike in the movies where players take a direct injection into a knee or ankle (which is all Hollywood fiction), this shot is administered the same way for every injury and is not some kind of "numbing agent." Yes, it will take the edge off and bring some relief to players, but it's not going to take away all the pain.
Players usually take the shot a couple of hours before kickoff and then go through a simulated warm-up. This is when Big Ben will throw -- and I mean really throw -- while Maclin works out for the trainers and coaches. It's final decision time for those coaching staffs with declaring players active or inactive, and it also allows the injured players to truly test their mobility.
However, even with that shot of "Vitamin T," as players call it, this is still about the player's ability to handle the pain of the injury. It's going to hurt. There's no way around it. For Roethlisberger, this will be a true case of pain management. He won't be close to 100 percent. But at 60-70 percent, does he give the Steelers a chance to win? No doubt.
The only negative to Toradol injections? When they wear off, the pain hits you hard. It's fierce -- and it can be worse than when the injury occurred. That leads to a brutal morning after you get out of bed and start yet another pain-management cycle to prepare for the coming week. But if that means getting another week to play ball, another opportunity to reach the Super Bowl stage, then, yeah, playing through the pain is more than worth it.
ESPN.com NFL analyst Matt Bowen played seven seasons as a defensive back in the NFL.