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Friday, June 5, 2009
Reading between the lines of Westbrook's surgery


Eagles star running back and game-changer Brian Westbrook underwent surgery Friday to remove two bone spurs in his right ankle, along with some scar tissue. This is the same leg that endured a high ankle sprain in 2008, which caused Westbrook to miss one game and remained problematic throughout the season.

As reported by 950 ESPN Philadelphia, Westbrook will not be allowed to bear weight on his ankle for two weeks. Following this early protective phase, therapy will focus on regaining Westbrook's ankle range of motion, with progression to strengthening and functional activities as healing permits. Although the team has not offered a specific timetable, presuming there are no setbacks Westbrook should be able to participate in at least a portion of training camp and be ready to start the 2009 season.

Beyond the surgical procedure itself, the implications of what led to surgery might be the Eagles' biggest cause for concern, though.

The procedure, performed by foot and ankle specialist Dr. Mark Meyerson in Baltimore, was first described by the Eagles as a "debridement" (pronounced de-BREED-ment). This term is commonly used in medicine to describe the removal of damaged or diseased tissue. In the realm of orthopedic surgery, debridement can refer to the removal of damaged or infected soft tissue, as well as the removal of damaged cartilage or bone.

Brian Westbrook
Brian Westbrook's leg-injury risks are compounded by the fact that he turns 30 in September.
Bone spurs are a result of stress on the bone. Bone follows Wolff's law, which essentially states that bone will respond to the loads or stresses to which it is subjected. If stress is increased on bone, it responds by laying down more bone. This is one of the reasons that weight-bearing exercise is recommended to help maintain bone density. The problem arises when abnormal stresses are placed on bone; it might respond by laying down bone where it is not necessarily desired. Enter the spur. Spurs often develop as a result of abnormal shear forces and stresses within a joint.

These abnormal shear forces and stresses increase as a result of instability. Instability occurs most often within a joint after damage to the soft tissue in the area (especially ligaments and joint capsule). As those tissues become lax or stretched out, there is increased shearing of the bones that come together within a joint. This potentially results in damage to the cartilage (the smooth material that protects the bony ends) and bony spurring.

It takes time for these changes to occur, and the high ankle sprain he suffered in '08 certainly didn't help the overall joint health or stability and would likely accelerate any degenerative process already in place.

The precipitating factor for surgery now was Westbrook's recent aggravation of the ankle during a workout, according to a team source. The natural follow-up question is why Westbrook didn't have this ankle surgery in February while he was having his knee scoped.

Many reasons are possible. Westbrook's surgery was on his left knee; this is his right ankle. Limitations in weight bearing on both legs simultaneously may not have been desirable. Or maybe the ankle just wasn't bothering him much in February, and with a few months of rest awaiting Westbrook as his knee recovered from surgery, he thought the ankle would improve. And despite the prevalence of surgery in professional athletes, most surgeons will continue to reiterate that surgery becomes an option only when all conservative measures fail. Surgery is not the first choice, and it is not undertaken lightly. A combination of recently aggravating the ankle, along with diagnostic findings, might have been the turning point in the decision to operate on Westbrook.

Facing rehabilitation now, even if it ultimately means a slow start in training camp, is a better option than chronic problems during the season. Westbrook is a veteran who knows this offense, so he can be afforded some extra time in the preseason. The biggest concern might be advancing his conditioning to where it needs to be when the season opens.

Assuming everything went well, Westbrook should face a fairly straightforward rehabilitation process, one that might go even more smoothly now that his left knee has undergone a similar cleanup procedure.

That said, this ankle surgery (and the prior knee surgery) does not erase the wear and tear that Westbrook has placed on his body as a result of seven years in the league. Nor does it stop the clock from ticking, the one that will chime "30 years" for Westbrook in September.

Expect Westbrook to return next fall as a productive member of the Eagles' offense and an excellent tutor for LeSean McCoy. But bear in mind that his overall playing time might be affected, either in an effort to try and protect him or as a result of another injury, something Westbrook has not been able to avoid in his otherwise impressive career.