When Tony Romo fractured a vertebra in his back in the preseason game against the Seahawks on August 25th, it was widely reported that he'd be out for 6-10 weeks.
Tomorrow, it will be exactly nine weeks since the injury, and Tony Romo hasn't even practiced yet. The Vegas oddsmakers currently see a return against the Browns in Week 9 as the most likely scenario for Romo, but they are also offering 2-1 odds that Romo won't start at all this year.
So is there something going on with Romo's back that the Cowboys are not telling us?
When mulling Cowboys-related medical issues I like to exchange thoughts with a friend of mine who's also a Cowboys fan and is a medical professional in real life. And while he prefers to remain anonymous, he has no objections to having his thoughts and speculations published. Given that NFL reporters regularly pass off their friends and acquaintances as "sources," I'll follow suit and call my friend a source, first name Medical, last name Source. Here's an edited version of the thoughts and information Medical Source provided me with.
Q: The bard once wrote that something is rotten in the state of Denmark. Do you get a similar feeling out of Dallas regarding Romo's recovery?
Medical Source: The Cowboys thought about placing Romo on IR to begin the season, but felt that he would be available before the game against Cleveland. I felt that he would be available well before week 7. Now rumors are circulating that he may not play at all, and he definitely is not playing when he was originally projected to return when the decision to keep him off of IR was made in September.
I have also noticed that the comments once made by [Jason] Witten regarding how Romo would come back sooner than anyone expects have not been repeated since September. Jerry Jones has changed his tune, now hedging on when his quarterback will return.
Assuming that Jerry Jones was truthful when reporting that Romo’s fractured vertebrae has healed as per the MRI results, and that the quarterback is throwing with good velocity, there must be something that is being left unsaid. Otherwise, why would Romo not at least be cleared to practice?
Q: From a medical perspective, what could be a likely explanation?
Medical source: Something has changed since the Cowboys decided not to put him on IR. Romo may not be physically able to play due to complications that may have arisen as a result of his compression fracture, and considering Romo’s medical history and the sparse information provided by Jerry Jones, signs point to at least one of Romo’s lumbar discs once again being an issue.
Tyron Smith had a disc problem earlier this season and the Cowboys kept it mum, mislabeling it as back spasms for quite some time. There was no mention of Demarcus Lawrence having back issues until it was reported in the summer that he had undergone back surgery. Dan Bailey has reportedly "slept funny", but his symptoms (that have lasted for weeks) suggest something mechanical, like a facet joint issue, or a disc problem.
While the Cowboys have not been forthright with injuries, it appears that those in charge of disseminating information are especially surreptitious when back issues arise. It would stand to reason that such a stance would also be used when dealing with one of the faces of the organization.
Q: What, to you, suggests Romo is dealing with a lumbar disc issue?
Medical Source: I have heard both Jerry and Stephen mention that the medical staff prefers that Romo continue to strengthen his core. Core strengthening does not prevent future fractures to the vertebral bodies. Core strengthening is mainly done to minimize issues pertaining to the lumbar intervertebral discs and/or dysfunctions associated with the zygapophyseal (or facet) joints in the lumbar spine. Those exercises are also performed if the individual has an instability such as a pars defect, like Charles Tapper, or in cases where the person underwent a decompression that resulted in excessive motion at that joint - decompressions are frequently performed with discectomies, which is the surgery Romo had at the end of the 2013 season.
The cyst that Romo had removed in 2013 was likely formed due to poor biomechanics at the facet joints in the low back. The disc herniation suffered against the Redskins at the end of that season led to surgery and subsequent core strengthening exercises. If Romo needs to spend more time completing exercises designed to strengthen the lower abdominal and lumbar muscles charged with stabilizing the spine, perhaps his lumbar disc issues have resurfaced.
Tyron Smith, Dan Bailey, Demarcus Lawrence and Tyrone Crawford have all had low back symptoms that suggest lumbar disc involvement. A study conducted by the University of Washington some years ago concluded that certain exercises performed by the football players at UW (e.g., squats) were contributing to lumbar disc problems.
If Romo is once again feeling the effects of a lumbar disc herniation, the medical staff would certainly want him to strengthen his core before permitting him to play. If the symptoms he is experiencing are similar to those that he had prior to his surgery at the conclusion of the 2013 NFL season, Romo may need another surgery, most likely a fusion, and he may not be able to play another down. That is obviously the near worst case scenario.
Question: So is this potentially an old issue popping up or could it be directly related to the vertebra fracture?
Medical Source: If the vertebra that sustained the fracture assumed a wedge shape, more force would be transferred to the posterior portion of the discs in the low back, facilitating the herniation of another disc, or the re-herniation of the same disc. A study conducted a few years ago recorded an incidence of disc re-herniation two years post-op at 23.1%. Over 10% of the patients in the study developed leg symptoms again within that two-year window. I feel safe in assuming that none of the subjects played professional football in the NFL following their discectomy, which would likely increase the percentage of re-herniations.
Question: Couldn't Romo just be working on recovering his core strength as part of getting back into playing shape?
Medical Source: Perhaps, but Tony has been working on his core strength for years and reported to training camp in great shape as per numerous reports. While he could not play football immediately following his compression fracture, he could still complete some level of lumbar stabilization exercises. The original prognosis from the Jones’ included time for strengthening the lower abdominal muscles. The time Tony is spending on core strengthening is more than what was expected.
Question: Could there be something else that is keeping Romo off the field?
Medical Source: As I mentioned a little earlier, a spinal instability may also be the reason Tony is needing more core strengthening. If the discectomy (Tony's operation in 2013) also included a decompression, Tony may have developed a spondylolisthesis. That is a condition where the vertebral body moves excessively, and may lead to nerve impingement that is similar to the nerve involvement suffered with a herniated disc
Charles Tapper woke up in training camp one morning with numbness in his legs. After several weeks, the Cowboys admitted that he had a pars defect that led to excessive motion (a spondylolisthesis) through the lumbar spine. As with most re-herniations, if stabilization exercises do not provide satisfactory results with the spondylolisthesis, the cure is surgery.
This is just an educated guess, but if Tony stays on the bench beyond Thanksgiving, I would not be surprised if he undergoes surgery and announces his retirement from football shortly thereafter. For me, and countless other Cowboys fans, that would be a sad day.
Question: That's a rather harsh assessment. Could there be an alternative, and more benign, reason why Romo isn't practicing yet?
Medical Source: One alternative has been discussed ad nauseam on social media, on sports talk shows, and in a flood of opinion pieces: While it is difficult to believe that Garrett, who has spent the last decade working with Tony Romo, would choose a promising rookie over an established veteran quarterback that is among the best passers in the NFL, it is possible. But a medical issue seems more likely to me.
Question: Our readers are probably wondering why they're reading this on a blog and not from one of the regulars at Cowboys press conferences.
Medical Source: I wish somebody would ask better questions during those press conferences. I listen to Bryan Broaddus of Dallascowboys.com when I can, and even he laments the quality of the questions the Dallas media hurls at Garrett. Instead of asking general questions like, "How is Romo progressing?", they should ask something more to the point:
"Has Romo been experiencing symptoms that would suggest the involvement of a lumbar disc?"
If Garrett does not answer it by stating that he does not want to discuss the progress of rehab programs, I would interpret that as a non-denial. Entire NFL media careers have been built on much less confirmation than that … I am looking at you, Florio.
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