Monday Morning M.D.

My friend Gabe was watching the preseason football game between the Washington Redskins and the New York Jets the other night. Gabe is a Redskins fan, so I asked him about the injury to their star running back, Clinton Portis. A shoulder problem is it? “It’s subluxation,” Gabe replied. Ah, subluxation! I thought. That’s serious. It’ll probably keep him out 3-4 weeks. Of course, I don’t know what subluxation is. But that’s what preseason is for: boning up on your medical jargon.

There are a lot of well-documented problems with the NFL’s extended summer preamble. It’s too long. The tickets are too expensive. The games are boring and pointless. So many players get needlessly injured. But the long preseason has its perversely beneficial side-effects. It’s a boon to the sports medicine industry and to diagnosis lovers everywhere. Each year, it seems, there are new names for new injuries, and training camp provides essential practice time for anxious fans to codify the pain they feel when their favorite players feel pain.

Subluxation, if you haven’t been following the Portis case, is not a new sleeping pill. It is a partial dislocation of any bone in a joint. It could effect the hip or the elbow, or any moving part. In some contexts, subluxation describes an eye problem or a spinal condition. For Portis and for many athletes, it’s the shoulder. The term subluxation, Latin for “minor luxation,” has been around a long time. It has made occasional appearances in NFL talk, dating back (at least) to Jim McMahon’s 1987 shoulder surgery, but it’s never really hit the mainstream. Depending on Portis’s recovery and the state of the media machine, this may be subluxation’s breakout year. Injury descriptions seem to have gotten more clinical-sounding of late—we don’t talk about feet but tarsals and metatarsals – and there is something comforting about the Latinity of subluxation. It’s also vague enough to feed our need to guess and to hope. An upper-body subluxation? He’ll be back next week. Or is he out for the year?

The injury d’jour of the last few seasons had a similar appeal: the “sports hernia.” Its popularity is due in part to Philadelphia Eagles quarterback Donovan McNabb, whose groin problems and subsequent surgery were carefully chronicled by the media. What’s great about the sports hernia is that it isn’t really a hernia, nor does it have anything intrinsically to do with sports. It didn’t exist until the early 90s when doctors invented the term to explain lower abdominal pain in hockey players. It’s sometimes called Gilmore’s groin, although I’m not sure who Gilmore is or why his groin is so famous. (Maybe someone just liked the alliteration, and now this Gilmore fellow is stuck with an embarrassing legacy.) It’s also known as athletic pubalgia. It is characterized by torn or weakened muscles in the lower abdomen. There is no protruding organ like there is in a regular hernia, and there is little you can do about it. There’s just a lot of hurt down in the nether regions. A sports hernia? That could knock you out from 2 to 16 weeks.

Another injury invented by sportsmen is “turf toe,” a tear in the joint capsule around the base of the big toe. It got its start in the 70s and was named after artificial turf. It’s not clear, though, that playing on grass makes you less likely to suffer from it. For me, “turf toe” lacks the seriousness that “subluxation” connotes. Maybe it’s a mater of context. I first heard of turf toe when former cornerback Deion Sanders came down with a wicked case. It seemed absurd. Cowboy clown neon Deion sidelined with turf toe? Give me a break. Slap some mud on it and get back in the game. But Sanders was forced out of football. Turf toe is not to be messed with.

One of my favorite newfangled diagnoses actually has a long and storied history. The “Lisfranc injury” is a damaged tarsometatarsal in the foot. It’s named after Jacques Lisfranc, a field surgeon in Napoleon’s army. Back then, members of the cavalry often badly mangled their feet when they were caught in their stirrups. Gangrene set in, and off with your foot! Lisfranc figured out how to amputate through a particular joint, which now bears his name. It sounds a little silly, “Lisfranc,” a French equestrian injury. But after it knocked out Brian Westbrook, I took heed. Lisfranc injury? If it’s not the end of your foot, it could be the end of your season.

I’m on the lookout for hot new diagnoses as the season approaches. One never knows what epidemic will plague the NFL. Plantar fasciitis? Kris Mangum of the Panthers has it. Chronic blisters? They’re keeping the Cowboys Terry Glenn on the sidelines. Achilles heel? Everybody’s got one.

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