Gronk hurts his back and people are losing their minds

What the heck is going on? Rob Gronkowski tweaks his back and Tom E Curran says it may be time for the Patriots to re-evaluate their relationship with him? I was planning on writing about spine injuries but now I’m a little bit fired up. You know what, I think I need to talk to him directly….Mr. Curran, please listen, we’re sorry we didn’t send you enough good mailbag questions. We were hung over from too much turkey, college football, and black Friday shopping. But why on earth would you suggest that the Pats get rid of their cornerstone offensive player, one who draws double and triple coverage to open up the offense every time he’s on the field?  This one stings.

It’s time for all of us to take a moment and remember one thing. Rob Gronkowski would not be playing for the Patriots if he had a clean injury record. In fact, I would argue that Gronk is on the Patriots because of his injury history. The tight end first injured his back after his sophomore season at the University of Arizona. He tried to rehab it but eventually required microdiscectomy surgery to repair a ruptured disc and missed his entire junior season. Because of this injury and loss in playing time, Gronk’s draft value suffered. His NFL draft profile reflected injury concerns. “Gronkowski made an immediate impact when he arrived at the University of Arizona and has been a standout tight end when he has been healthy enough to stay on the field. Unfortunately he has missed a total of 16 games over the past two years due to injuries or illness.” Gronk’s durability issues are the only reason that he was available when the Patriots’ number 42 pick was called. The Patriots knew, from the moment they signed him, that Rob Gronkowski would not be on the field 16 games per season.

Gronk is a 6’6″, 270 lb tight end who runs a 4.68 forty. His signature play is a run up the seam with 3 defenders in tow. His body is not meant to move quickly, yet somehow it does. Gronk’s style of play and the size of his body both work against him on the injury front.

Gronk’s back issues started in college. In his book (and I use the term “his” very loosely), It’s Good to be Gronk, he opens up about his back injury. In the Spring of his junior year he was doing deadlifts with a trainer. He had never done them before as part of his training program. “On the last set, I felt something pop in my back and it didn’t feel right, but I continued lifting through the pain.” His pain increased over time and started to radiate down both legs. It got to a point where “the nerves in my legs didn’t work. My legs felt like they were 500 pounds each and I couldn’t jump or run.”

Gronk is describing a medical condition called lumbar radiculopathy. The spine is made up of building blocks of bone called vertebrae stacked on top of each other (in yellow on the drawing below). The vertebrae are separated by discs (in pink/purple). You can think of a disc as being a lot like a jelly donut – they are more firm on the outside but filled with softer material inside. When large forces are applied to the spine, these discs can bulge and, in some cases, the jelly can squirt out of the disc (herniate).

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In the picture above you can see many of the different variations of back injuries. The most common injury to the back is a muscle strain (not depicted), where the muscles overlying the spine get overworked and overstretched and go into spasm. Muscle strain is treated with stretching, massage, strengthening, rest, ice and anti-inflammatories. Another type of injury to the spine is an injury to the disc. Disc bulges and disc herniations (see depiction above) can cause pain. typically in the midline of the back. When the disc material bulges or herniates into the place where nerves exit the spine and run down the legs it can compress that nerve and irritate it. This causes pain down the leg, often referred to as “sciatica.” Sciatica is a specific group of nerves that are inflamed, so that term is often used incorrectly. The correct term is lumbar radiculopathy, where the disc is pushing on a nerve in the low back (lumbar spine) and causing pain down the leg. Depending on the particular disc and nerve involved, the athlete will feel pain in different areas in their leg. Gronk’s pain was in both legs, which means there was likely a large bulging disc that compressed nerves exiting on both the right and left sides.

Gronk tried to treat his disc injury with physical therapy but in the end it did not help. He eventually had a surgery to remove the part of the disc that was bulging and irritating his nerve. This is called a microdiscectomy. Rehabilitation after a spine surgery is often painful and frustrating. Gronk was not able to return to the field until the following season. In a football player of Gronk’s size and ability it is not uncommon for a back injury like his to become chronic. This is a major reason why other NFL teams were reluctant to take him in the draft (there were minor concerns about other things like blocking ability and…you’re going to laugh…yards after the catch). He likely continued preventative rehab for his back for years after. Unfortunately, his back continued to be an issue for him and, in 2013 while he was on IR for a complicated forearm fracture, he decided to have another surgical procedure on his spine. His agent and surgeon reported that this was another microdiscectomy, this time on a different disc.  He returned for the 2014-15 season. However, his back has likely continued to be painful, becoming a chronic injury that he and the medical staff manage with treatment and preventative exercise. Many professional athletes have chronic knee, hip, back, shoulder injuries that they manage successfully throughout their careers.

In an athlete with a history of 2 back surgeries, even a 27 year-old, there is likely some component of accompanying arthritis in the spine. Because of this and because the discs are damaged, back pain becomes a chronic nagging injury that needs upkeep. When Gronk layed out to grab a slightly overthrown ball on Sunday, he stood up very slowly and I said out loud to the crowd at my house, “Oh no, he hurt his back.” It was that clear. I don’t think we need to play detective trying to figure out if this is really a back injury or some odd complication from his lung issue. Laying out like that is a very vulnerable position for the spine. Jarring against the ground and another player can aggravate things even further. He looked okay walking off of the field and into the locker room. My hope is that his injury was more of a muscle strain. The mechanism of his injury is not one that usually leads to a new disc issue. However, it could aggravate any old injuries that Gronk has.

The Patriots always play it cautiously with Gronk. I suspect that if it was another player, for example Chris Hogan who has no history of spine surgery (that I can find), things may have played out differently. Hogan may have gotten a dose of anti-inflammatories and some treatment and gotten back out there. With a back muscle strain it’s usually easiest to play right away, before things tighten up. However, with Gronk they have to be more careful. Yes, it is strange that they have joint press releases with his family. Yes, it was painful to watch him sit out 2 regular season games and be limited in 3 more with a hamstring tear. But this is what the Patriots signed up for. The Patriots knew what they were getting into with their #42 pick in the 2010 NFL draft. For now, it appears that the Patriots understand that and are very focused on keeping him as healthy as possible. It remains to be seen if they will continue to show their appreciation for the tight end as he nears free agency in 2020.

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