Making Sense of the Jamaal Charles Reports

Photo: Ron Chenoy, USA Today Sports

August 13 Update:

I still the progression of reports on Jamaal Charles and his foot injury yesterday were fascinating. So I've kept my thoughts intact below. But we were lucky to get very detailed information from Kansas City trainer Rick Burkholder on Tuesday via beat writer Adam Teicher. It's enough to break the diagnostic code on Charles' injury.

From Teicher's article:

Burkholder said tests showed Charles’ ankle ligaments to be OK, but Charles had pain in the outside bone of the foot. X-rays were negative.

“There’s a tendon that attaches right at that spot,’’ Burkholder said. “That’s what’s sore right now. That’s why we call it a strain. Today, he’s sore up his leg, and that’s natural. We expected to see that.’’

That's specific enough to rule out midfoot injuries, including those to the Lisfranc complex , which involve a different part of the foot. It also makes more sense that the Chiefs were reassured by a simple x-ray. The most important nearby structure is the bone where that tendon attaches -- the fifth metatarsal. That's the same bone that Hakeem Nicks, Ahmad Bradshaw and others have injured in recent years.

It's a very good sign that the team is comfortable allowing Charles to walk without a boot and crutches. However, with the tendon strain so near the bone, expect the Chiefs to ease Charles back very slowly. They won't want to risk a rupture of that tendon or that a small avulsion fracture of the metatarsal.

Since Burkholder is calling the strain mild, it's reasonable to assume it's a low grade injury that should take less than four weeks to rehab. Barring an aggravation or cascade injury upon his return to football-related activity, it's likely that Charles will be ready for Week 1.

Jamaal Charles injured his foot in practice early this afternoon. Unfortunately, that's where the clarity ends.

What followed over the next few hours highlights the difficulty in getting accurate injury information -- from even the most reliable sources -- in today's fast paced world of Twitter and competing media outlets. It's frustrating to fans and fantasy owners who want a clear answer as soon as possible. But it's fascinating to me.

We had two ESPN insiders giving radically different "sourced" reports. Both reported that Charles suffered a foot strain and negative x-rays, but Adam Schefter had sources telling him the team was "bracing for the worst" while Ed Werder had sources telling him that the team didn't feel the injury was serious. Mike Florio had sources telling him that the Chiefs privately felt the injury was a sprain (implying a ligament injury) though Andy Reid told reporters it was a strain (implying muscle injury) after practice. Adam Caplan tweeted a transcript of Andy Reid's comments that suggested the team wasn't yet sure how Charles would respond, shortly after Chiefs GM John Dorsey told Sirius XM that Charles' treatment had been "more precautionary than anything else."

Later in the day, Schefter casually and respectfully acknowledged Werder's report but didn't back down at all from his earlier report. Then, Chris Mortensen casually tweeted that Charles would have an MRI in response to a follower. Strangely, that tweet is no longer in his timeline. It's still on my feed because I retweeted it. (Edit: A reader pointed out that I had the "no replies" setting marked. Mortensen's tweet is still there.)

Is it possible to make sense of all this? Probably not. If you're looking for a definitive answer, you'll have to wait for the MRI result. Even then, it's possible we won't get the whole story.

To be absolutely clear, a positive outcome with a short absence is still possible for Charles. But there are reasons for concern.

• The most trustworthy injury sources in the above paragraph -- Schefter, Florio, Caplan and Mortensen -- all have varying levels of concern. All of them are hearing that there's more going on than what the Chiefs are saying publically. Notably, Schefter didn't back down from his report after Werder's.
• A negative x-ray is reassuring. But only that Charles doesn't have a broken bone or obvious dislocation. An x-ray cannot accurately diagnosis or grade a muscle strain or ligament injury. It cannot rule out all foot conditions, including some Lisfranc and other midfoot sprains. The negative x-ray does not mean Charles does not have a severe injury.
• Florio's strain vs sprain distinction is relevant. Those two terms are often used interchangeably and incorrectly. If Charles' injury is in fact a strain, it's likely a muscle injury. If it's a sprain, it means the Lisfranc ligament or other more concerning midfoot structures are on the list of possible diagnoses.
• There's no reason for Andy Reid or John Dorsey to report concerning information until they have it. Under Reid, the Eagles deflected concerns about a Michael Vick concussion by saying he had dirt in his eye. They're the least trustworthy public sources currently commenting.

If you're looking for optimistic signs, you'll want to hear that the Chiefs have decided the injury is so minor that an MRI isn't necessary. Though Mortenson's tweet is no longer on his timeline, it would be shocking if Charles didn't have an MRI to better define his injury. You'll also want to hear that Charles is allowed to bear weight immediately and does not need a walking boot and crutches. The best news, obviously, would be a quick return to light work on the sideline this week.

What you don't want to hear is that Charles' MRI is concerning, that his actual diagnosis is in fact a sprain, or that he needs to see a foot specialist, specifically Dr. Robert Anderson in Charlotte.

As frustrating as it may seem, however, it's time to exercise a little patience. It's too early to assign a percentage chance that Charles has a serious injury like a Lisfranc sprain or guess at a timetable. We'll know when we know. If you're a Chiefs fan, it's nail biting time. If you're forced to a decision on Charles tonight, drop him a tier (or more) based on your risk tolerance and draft him only if you're comfortable with an extended absence.

I'll have more on Twitter as the story unfolds. Follow @JeneBramel for the breaking injury news updates, commentary and analysis.