Foster's return could come earlier than expected

The preseasons have not always been kind to Houston Texans running back Arian Foster. He has missed portions of camp in the past due to various soft-tissue injuries, and 2015 is no different.

On Friday, Foster underwent surgery in Philadelphia with Dr. William Meyers to repair a groin injury suffered in the Texans’ first full-padded practice earlier in the week. With the NFL season set to kick off in just over a month, the question now becomes when Foster will be able to return to football. While the answer is yet to be determined, there is reason to believe it could be quicker than what the injured reserve/designated for return slot would require.

When Foster left Monday’s practice with a groin injury, it was deemed serious enough at the outset to warrant surgical consideration. The implication (based on the apparent severity of the injury and proposed surgery) was that Foster had suffered an acute, traumatic tear of one of the adductor muscles (muscles of the inner thigh), typically referred to as a groin injury or groin strain. Groin injuries can encompass a wide range of presentations, but the role of the inner thigh muscles is significant.

The adductors have an attachment at the most central point on the front of the pelvis, specifically the bone that sits directly beneath the belly button. It is from this anchor that the adductors move the thigh inward, toward the midline of the body, when the leg is in the air (imagine a soccer player passing a ball across the body; this would engage the adductor). The adductors also contribute to other hip motions to a lesser degree, particularly as the athlete drives the legs forward (for a running back, think power running or cutting) and to global stability at the pelvis.

The adductors are stretched when the leg is pulled outward from the midline. If movement in this direction exceeds normal range of motion, especially if the movement is quick or sudden, the muscle will tear. For athletes, the injury often occurs when they slip on an unstable surface and their legs get stretched apart.

Broncos running back Montee Ball suffered what would ultimately become a season-ending groin injury last year in just this fashion. “My left leg caught [the defensive end’s] left leg and I tried to catch myself with my right foot and I slipped. So I kind of did the splits,” Ball said. “And my body’s not used to doing the splits. I knew immediately it felt like a tear.”

Athletes often describe a burning or tearing sensation and instinctively reach for the groin area, a reflexive attempt to protect the injured part. Unfortunately, the pain they experience indicates the damage has already been done but the degree of injury can vary greatly. There can be partial tearing of the muscle fibers somewhere along the length of the muscle. The adductor (or a portion of it) can tear away from its bony attachment. Sometimes as the soft tissue tears from its attachment, it can damage the underlying cartilage layer.

While some groin injuries can heal independently, Meyers believes surgery is often the best option for more substantial tears. In past conversations with Meyers regarding his general rationale for surgeries of this type, he has said he believes recovery for an elite athlete is more complex than simply getting the area to heal. He has stressed the importance of “balance” among the muscle groups that converge on the pelvis, including the adductors, which contribute to overall stability of the lower half of the body.

Consider this. The center of the pelvis serves as the anchor for not only the right and left adductor muscles, but also for abdominal muscles converging from both sides and from above. Consequently, in a healthy situation there are significant muscular forces exerted on the pelvis which help direct movement of the leg on the body and vice versa. Movement on one side is balanced by muscular stability on the opposite side. In the case of a substantial tear or muscular defect, balance can be disrupted leaving open the possibility of subsequent injury, either to the same area or elsewhere. For Meyers, surgical repair of a significant adductor tear can be critical in restoring that balance, at least structurally.

Equally important to a successful outcome following this type of procedure is the post-operative rehabilitation to restore functionality. Although it might appear logical to rest what would seem to be such a delicate area, the goal is to initiate movement right away. That early movement may be basic (for example, going from lying to standing or simply active walking) but is critical for keeping muscles in the area active and preventing the buildup of excess scar tissue.

The first two weeks following this type of surgery are typically spent focusing on strengthening and flexibility along with gradually increasing endurance. If all continues well and there are no setbacks, athletes can often resume running within a month and progress to higher level movements, such as cutting or pivoting within five to six weeks. Naturally, the individual’s own pain response and ability to heal will influence the rate of progression, but there is every reason to expect a return to peak performance.

Since recovery timetables aren’t set in stone, it is impossible to lock down a return date for Foster. One scenario has the Texans using their lone IR/designated for return slot on Foster. In that case Foster could resume practicing with the team after six weeks and could be eligible to play after eight. Given the Texans’ bye in Week 9, the soonest Foster could return to competition in this scenario would be Week 10, making him eligible for just half of the team’s 2015 regular-season games.

But what if he were physically able to return sooner? It would be a shame to have a healthy Foster, a key cog in the Texans’ offense, relegated to independent workouts through early October, unable to contribute in a game situation until November.

On the other hand, no one wants to make the mistake of returning Foster to competition too soon, risking a setback. After all, this is an athlete who has a history of lower body soft-tissue injuries -- groin, hamstring, calf -- which suggest a higher risk going forward, not to mention he is less than two years removed from lower back surgery. While Foster proved powerful in his return from a microdiscectomy to deliver a whopping 4.8 yards per carry, given the intimate relationship between the core muscles and the spine, ensuring he is at full strength before taking the field after this latest injury becomes increasingly important.

The Texans will have plenty to mull over as the clock ticks toward the start of the NFL season. Considering the timetable for Foster’s return could range from September to November, they are not likely to rush to make a decision, nor should they. Better to observe how he progresses and evaluate further when there is more information.

Assuming his progress is solid, it seems reasonable Foster could avoid the IR designation altogether. But when he is able to take the field for the first time may not matter as much as staying on it week in and week out. Foster has his work cut out for him over the next few months to prove not only that he can come back to full health, but that he can maintain it.