DeMarcus Ware injury: Physician provides insight into ailment

Denver Broncos pass rusher DeMarcus Ware has struggled with back injuries this season, and it’s a condition that likely will sideline him up to a month. We were offered the pleasure of seeking some medical clarity on Ware’s situation from Dr. Harvinder Sandhu, orthopedic spine surgeon at Hospital for Special Surgery.

Dr. Sandhu did not and has not treated Ware, but he offered his expertise on the matter for us. Since this is the second time Ware has gone down with a back issue this season, we wanted to know what exactly he’s dealing with.

“DeMarcus Ware had to leave the game on Sunday with a report of back spasms,” Dr. Sandhu said via an e-mail conversation. “This was the second such incident this season.  Based upon publicly available information, a prior MRI did not indicate a disc injury.  We can presume then that he had a significant myofascial (muscle and ligament) injury to his back.  The problem with this diagnosis is that the severity of the injury can vary considerably among players and is not so easily measured on imaging studies such as an MRI.  The severity is largely measured on clinical examination and follow-up examinations over days and weeks.  Essentially, he likely damaged (tore) the fibers of his back muscles and they will need time to heal but also must be rehabilitated to allow him to perform at his extremely high level.  This requires a careful balance of rest and reconditioning exercise by very experienced sports physiotherapists.”

Because of the severity of the injury, is it possible Ware won’t fully ‘heal’ from it?

“It is unlikely that he will “fully heal” during the season after a likely high-grade myofacial injury.  The question is:  will he heal enough?  Typically, doctors will have a good idea of the extent of recovery within the first two weeks.  Again, there is a delicate balance of allowing the muscle fibers to heal but also reconditioning them to withstand the enormous stresses they will have to face when he is back on the field and making contact.  The area of injury is vulnerable to repeat injury if the reconditioning wasn’t satisfactory or if high impact stress is applied to the same area of injury.  This is probably the reason for his re-injury this past week so soon after the injury in the game against the Raiders earlier.

Typically, football players will play through a reasonable amount of pain.  There is an additional psychological problem, though.  Even if a player rehabilitates adequately to get back on the field, if he already has experienced a re-injury before, he is more prone to be physically cautious.  This may also limit performance.”

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This isn’t what Broncos fans will want to hear, but it’s important to know because of how critical a piece Ware has been to the Broncos’ defensive resurgence this season. There are players who can pick up the slack, but to be as consistently great? That will be tough.

Another question that needs to be answered is whether or not this could affect him beyond this season, since the Broncos have $10 million committed to him for the 2016 season.

“A myofacial injury never fully recovers back to the original uninjured state.  There is always some propensity for re-injury in the future.  This can be managed with very diligent rehabilitation.  The problem with DeMarcus Ware, though, is that he is at an age (33) where muscle injuries are far more common in general and rehabilitation is slower and more difficult.  Finally, although his prior MRI showed that his discs were ok, it may not be that way in the future given his repetitive injuries.”

For the more immediate future, what kind of treatments will he receive in order to get back on the field?

“There will probably be quite a bit of “soft-tissue” work like massage, gentle manipulation, heat, ultrasound, and electrical stimulation.  All of these therapies are designed to bring blood flow to the area of damage to promote healing.  After this, there should be a graduated program of strengthening starting with isometrics and then more aggressive strength training.  In my practice I also push cardio starting with low impact exercises.  The point is get the heart rate up for a sustained period to drive blood flow to the areas of injury.”

Does the nature of his position make him more susceptible to such injuries?

“There is no question that a linebacker/pass rusher is at higher risk for repetitive back injury.  Generally, these players have to generate significant speed and make contact on practically every play.  Linemen make contact but not at high speed and backs have speed but don’t always make contact.  The pass rusher has to be quick, maneuverable (constant twisting/turning) and make hits against opposing lineman and their targets.  They are among the most frequent athlete visitors to spine specialists.”

We hope DeMarcus Ware is able to get back out on the field as soon as possible and continue his phenomenal season, but this prognosis doesn’t sound very great. The Broncos certainly are a better team with him on the field, and Ware is one of the team’s top leaders. The road back onto the field might be rough, but he is one of the hardest workers in the league and if anyone can get this done, he can.