We looked at the back injuries that had affected Tony Romo, Dez Bryant, DeMarcus Lawrence, Chaz Green, Dan Bailey, Tyron Smith, Charles Tapper, and Tyron Crawford. Along the way, we found out that the Cowboys had a very odd terminology when it came to back issues.
Case in point, Tyron Smith missed two games for the first time in his career in 2016 with what was initially described as “muscle spasms.”
“I hope Tyron is ready to go, we’ll just have to see, we thought he would play Sunday and that was a little surprise for us,” Jerry Jones said during an interview with CBS Radio’s 105.3. “It was more back spasm than structure,” adding, “I’m going on the basis he’ll play.”
Two weeks later, it was revealed that Smith was actually suffering from a bulging disc.
”Tyron has something that probably a huge percent of this league has,” Jones said. “It is not something that we would directly list on our report, and so it’s very common. It’s very common. It’s very common. And it’s more now like a muscle spasm. I would couch it as a muscle spasm. Treatment is more like that than it is anything to do with what I would consider traditional looks at bulging discs and things like that.”
If a back spasm equals a bulging disc in the Cowboys’ medical terminology, what other seemingly innocuous injuries could be far worse in the Cowboys’ convoluted circumlocutory? Could a “sore back” mean anything from back spasms to bulging discs through herniated discs?
And what about a “stinger”? A stinger is catch-all term that sounds harmless enough and is a common injury designation in the NFL - if it is reported at all. E-Orthopod.com describes a stinger as follows:
Injury to the nerves of the neck and shoulder that cause a burning or stinging feeling are called burners or stingers. Another name for this type of nerve injury is brachial plexus injury. Football players are affected most often.
Burners or stingers are the result of traction or compressive forces on the brachial plexus or cervical nerve roots. The usual mechanism of injury occurs when a direct blow or hard hit to the top of your shoulder pushes it down at the same time your head is forced to the opposite side.
In the process, the brachial plexus between the neck and shoulder gets stretched. The same injury can happen if a downward force hits the collarbone directly. In football, burners or stingers occur most often when you tackle or block another player. This motion overstretches the nerves of the brachial plexus.
So, when I first heard about Travis Frederick sitting out practice in Oxnard due to a stinger, I wasn’t overly concerned. After all, this is a common enough traction injury in football.
But when the Cowboys sent him to see Dr. Robert Watkins in Los Angeles, all sorts of alarms went off. After all, why would Frederick be seeing a neck specialist if it was just a minor stinger? Also, Dr. Watkins is a SURGEON, and not just any surgeon. He is the specialist Peyton Manning saw for his neck issues a while back. In Manning’s case, Dr. Watkins removed a problem disc, inserted a bone graft, and fused the neck vertebrae on either side.
At the same time, reports emerged that Frederick was experiencing “strength loss” in his arm, and I immediately went to DEFCON 1 and quickly contacted a friend of mine who’s also a Cowboys fan, and is a medical professional in real life.
And since NFL reporters regularly pass off their friends, colleagues, and acquaintances as “sources,” I’ll follow suit and call my friend (who prefers to remain anonymous) a source, first name Medical, last name Source. Here’s an edited version of the thoughts and information Medical Source provided me with.
Q: What was your initial reaction to Frederick’s visit with Dr. Watkins?
Medical Source: When reports surfaced of Travis Frederick seeking the opinion of the noted orthopedic surgeon that operated on Peyton Manning’s neck, I immediately thought he had a similar issue, a herniated cervical disc. The reports of neck soreness, abnormal sensation, and “strength loss” in the upper extremity correspond to the symptoms associated with a herniated cervical disc pressing against a nerve.
Why would I doubt that Frederick was suffering from stingers? He may have a brachial plexus traction injury (a stinger), but why would anyone seek the opinion of an orthopedic surgeon for a non-surgical issue? Furthermore, why would a player travel almost 90 minutes to visit a surgeon that specializes in operating on spinal derangements, when the brachial plexus is in the axilla (armpit) and is a non-surgical problem?
Q: So, what initially was a simple stinger morphs into a bulging disc or perhaps even a herniated disc?
Medical Source: I believe that the evidence points to a disc issue, but it could be my fandom hoping for a disc derangement. Brachial plexus injuries are difficult to treat, and frequently do not improve significantly if the player does not rest.
It is safe to assume that Dr. Robert Watkins examined a cervical MRI of Frederick. Judging from the post examination details, Frederick’s MRI did not show a degree of disc involvement that would necessitate immediate surgical intervention. That does not mean that Frederick will not elect to have surgery later this year or in 2019.
Q: Surgery, please no! But if it is necessary, can it really be delayed to 2019?
Medical Source: Another Cowboys player had disc issues that did not require immediate surgery, Tony Romo. After the exacerbation of his lumbar disc in Washington during the Week 16 game of the 2013 NFL season, he noted that his back had been sore for quite some time. He took steroid injections to play, something that Frederick will now likely do.
The injections may deaden the abnormal sensation and make it easier to play, but I do not believe that tingling and discomfort prompted his visit to the surgeon. Frederick noted the strength loss in his arm after his visit to Dr. Watson. A herniated disc can cause weakness throughout the affected innervated area, just as a brachial plexus injury can result in similar weakness.
When patients experience weakness due to a disc derangement, the clock starts running on when to schedule surgery. According to the research, patients will have the greatest chance for a full recovery of strength if the surgery is performed within three months from the time weakness is first detected. In other words, if Frederick does not significantly improve with rest and conservative treatment (physical therapy) before Thanksgiving, he may miss the final five or six games to go under the knife.
Q: How soon before we know that a conservative treatment like physical therapy is working?
Medical Source: Directional preference has been studied and found to be effective in the conservative treatment of acute disc derangements. That type of physical therapy would yield results within 4-6 weeks. If Frederick does have a brachial plexus injury, no type of physical therapy has been found to be effective, and he could only recover function with rest, which precludes any type of football related physical activity.
Q: Any reaction to reports that Frederick has sought a 2nd and 3rd opinion?
Medical Source: Patients frequently shop for diagnoses and treatments when they are not satisfied with the recommendations of their physician. It is not uncommon for six different orthopedic surgeons to have six radically different treatment options to the same problem, but that discussion best be reserved for another forum on a different day.
Frederick’s continued visits to specialists indicate that everything did not “check-out,” and is far from being “not a larger issue,” as he related following his visit to the LA orthopedic surgeon. His symptoms, which likely include a degree of weakness, continue to limit him.
Indeed, today we were treated to two vastly different reports about Frederick’s status.
First, Jerry Jones made an appearance on 105.3 The Fan and announced Frederick received good news on Saturday from the second opinion he got on his neck. Jones went on to say that he expects Frederick to be ready to play in Week 1.
Apparently, that second opinion came from another orthopedic surgeon, Dr. Andrew Dossett, a spine consultant for the Cowboys, Texas Rangers and Dallas Stars, who saw Frederick on Saturday evening at AT&T Stadium before the Bengals game.
But then earlier today The Dallas Morning News noted that Frederick is still getting more information on the stinger issue, so all options are still on the table.
But several sources said the club continues to gather information and awaits results from the latest round of testing before a final determination is made on the best course of action.
That means surgery can’t be ruled out at the moment.
While it’s true that “surgery can’t be ruled out” until at least a third opinion has been obtained, there’s also no medical opinion from the first two doctors consulted that suggests surgery is required. At least that we’ve been told of.
Perhaps it’s all just a matter of timing, as Medical Source pointed out above. If Frederick’s issue is indeed a disc derangement, physical therapy would likely be the first course of action. And only if that fails would surgery be required, perhaps as early as Thanksgiving. Back to Medical Source:
Q: Any chance Frederick could simply tough it out until the offseason, perhaps by rubbing some dirt on it (or with the help of copious amounts of painkillers)?
Medical Source: Frederick could try and put off the surgery until the offseason, but remember how Demarcus Lawrence looked when he tried to play through his low back disc issue, or how Tyron Smith played when his lumbar disc was affected?
My best guess is that Frederick has a herniated cervical disc. The doctors will try to manage it conservatively with therapy and steroids injections.
But if the arm weakness does not improve in two months, Frederick will undergo surgery. Research supports that weakness from a compressed nerve in the cervical spine has a greater chance to become a permanent disability if not surgically repaired within three months (13 weeks). If the Cowboys wait until the offseason to address this, Travis may never be the same center.
Q: What’s your take on the DMN report that surgery hasn’t been ruled out yet?
Medical Source: There are no surgical procedures for a true stinger, which is a brachial plexus traction injury. If surgery is being discussed in any form, even if it’s being ruled out (for now) that means Travis Frederick likely has a cervical condition causing his upper extremity symptoms. Most likely, he has a disc issue.
On that sobering note, let’s hope that everything checks out for Frederick, and that he is indeed simply suffering from an everyday stinger, or brachial plexus injury, and not some form of disc injury that would add to the epidemic of back injuries that has been plaguing the Cowboys.