A medical view on the injury suffered by Ben Roethlisberger

Jason Bridge-USA TODAY Sports

Much has been written about Ben and his injury this year. His performance after returning has been much scrutinized by members of our site and by many in the media. One popular conclusion is that Ben's shoddy play and performance after his injury is due to friction with our feisty new offensive coordinator, Todd Haley. But what if there was an underlying medical explanation for Ben's sudden bout of unclutch-itis? Read further if you're willing to join me in an exploration and discussion of the medical issues Ben may still be dealing with as a result of his SC sprain.

As a former student athlete for a Division I school and a current medical student (and a future medical professional hopefully), the intersection of sports and medicine is particularly fascinating to me. I've personally had the pleasure of badly spraining my ankle and working with a medical professional to rehab back to 100 percent. In my experience getting back to the field is only the beginning of rehabbing a sprain. Getting back to the field means that the joint is stable enough and strong enough to handle the rigors of sport. But what of the fine motor control? What of all the little finesse movements that must be made to balance and control the body as its in motion? The ability to finely control movement tends to return much more slowly, and they certainly did for me. This is due to the loss of "proprioception" that often accompanies a joint sprain.

What is proprioception?

In doctor speak, "Proprioception can be defined as a specialized variation of the sensory modality of touch that encompasses the sensation of joint movement (kinesthesia) and joint position (joint position sense)" (Lephart, 1997).

In normal speak, it's being able to feel the manner in which your joints are moving and the positioning of those joints. In even simpler speak, it's your coordination.

What does this have to do with a sprain?

Basically, when you sprain a joint it is stretched or moved it in a way that stresses and damages the soft tissue; meaning ligaments, tendons, and most importantly for the topic of this post your nerves. Specifically, the loss of proprioception is due to the damage of your peripheral afferent nerves and peripheral afferent is just a fancy way of saying they convey information from your periphery towards your brain. Damaging these specific nerves doesn't affect your ability to move directly, but rather robs your brain of important feedback that helps to coordinate your movements.

What does this have to do with Ben?

Knowing all this, it is entirely possible and in fact biologically reasonable to imagine a situation in which an athlete is rehabbing an injury and all of the structural damage has healed. The muscles are working and back to strength. The ligaments are strong and the joint is stable. The joint can be moved without pain. But those darn peripheral afferent nerves (they're tricky customers and heal slowly if at all) aren't working the same way they did before the injury. Thus, the brain is receiving different feedback for the same motion after the injury when compared to before the injury.

This is what I believe we are seeing with Ben. He can throw the 60 yard bomb and his throws have plenty of velocity, but he can't throw a little touch pass over a DE to a RB on a screen. All of the sudden, open men who are usually hit in stride and then getting YAC's are diving and stopping and changing direction to get to the ball. Most notably, He throws a ball maybe a foot and a half behind where it should be to Mike Wallace on an out pattern in Dallas. Interception, end of game. He can't fit a pass to MW while on the run into the gap between the corner and the safety against the Bengals. Interception, end of season. These are throws we know he can make, that we've seen him make and I'm here to tell you, don't worry.

Can they fix this proprio-a-thingy?

Fortunately, your brain is one smart cookie and given enough time and enough practice you can essentially re-learn the proprioception of the sprained joint. I don't know the specifics of rehabbing for an SC joint sprain, but there are all sorts of smart people who focus on stuff like this, and those are the people who I'm sure are working with Ben. So really, don't worry. We'll see those throws again on a consistent basis. Give Ben's proprioception a chance to get right, and we'll see the confident, accurate, MVP candidate that we saw at the start of the season. His brain just has to figure out how to use his shoulder again, and that takes time.

The following articles were consulted in research for this post:

Lephart SM. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med. 1997 January; 25(1): 130-7

Laskowski ER. Proprioception. Phys Med Rehabil Clin N Am. 2000 May;11(2):323-40, vi. Review.

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