2020 NFL Draft | Alabama defender Terrell Lewis looks to overcome injury background

02/05/2020
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Alabama linebacker Terrell Lewis has battled again and again with injuries that would derail most promising prospects college careers and outright dreams of the NFL. However, despite all the adversity, Lewis continues to battle back by setting himself up for a prime position in the 2020 NFL Draft. The big question mark will be whether his past injuries will let him see his name in lights Thursday on Day 1 or if he will get the special treatment Friday on Day 2 — potentially a steal for a contender.

The redshirt junior from Alabama made a name for himself during his four years in Tuscaloosa, though two of them marred by injury. During his time, he was able to appear in 26 games, registering 58 total tackles. He also notched 14.5 tackles for loss with eight sacks. While those aren’t eye-popping stats, he totaled most of those numbers in his 2019 season earning him All-SEC honors.

Right elbow UCL injury

As mentioned above, Lewis has had several injuries that would have ended most collegiate careers. Going in order, Lewis suffered a torn right elbow ligament as the result of a play in the backfield against Florida State in the 2017 opener. This injury occurred in the third quarter with 5:10 left when he attempted to tackle QB Deondre Francois, grabbing at him with his right arm as he went to tackle. He was able to get a hold of Francois, but Alabama teammate DT Da’Ron Payne got to Francois first from the other side, pushing him back as Lewis was coming forward. As a result of the forceful pushing back of Francois while Lewis was moving in the opposite direction, this caused an elbow UCL injury which ended his night

Elbow anatomy

Reviewing anatomy in the elbow, it is held together by the ulnar (medial) collateral ligament, radial (lateral) collateral ligament and annular ligament. These all create stability at the ulnohumeral and radiohumeral joints to ensure that the elbow acts as a hinge joint. The annular ligament allows the radius to rotate in order to perform supine/pronation movements.

Credit: Physio-pedia.com

When researching the Lewis arm injury, all reports indicate that he required surgery and missed 10 games. However, none of the articles stated which ligament it was. Based on video review, Lewis appears to injure his ulnar (medial) collateral ligament. The three branches to the ligament include the anterior, posterior and transverse bundles. The anterior band supports the elbow during extension, the posterior band during flexion and the transverse band that connects the two. 

A UCL injury is far more common in overhead throwing athletes and usually occurs as the result of heavy lifting, direct blow to the area or performing a throwing motion with a sudden pop noted. Falling on an outstretched arm or twisting of the arm can injure the UCL. This can also occur with the arm accelerating forward before releasing the ball. In Lewis’ case, his arm was accelerating forward along with his body weight when Francois got pushed back into his arm, overloading the ligament and causing the injury. 

UCL repair

The anterior bundle is the most injured band and the posterior band is only injured if the anterior fails. It is likely that Lewis suffered an anterior band injury. As a result of the injury, Lewis was initially thought to miss the 2017 season. He had surgery to correct the injury which required a UCL repair.

When most people see UCL injury, they do some research and see the words Tommy John. That makes them sweat a little. But new techniques have evolved over the past few years that have taken the concepts of the Tommy John surgery by changing the approach and materials used. Instead of totally reconstructing the ligament and taking 18 months to heal, the surgeon is able to take what healthy tissue there is and take super-strong tape and attach it to the UCL. It is coated in collagen which helps the ligament heal and research has been promising for its effectiveness.

Most UCL repairs are done in overhead throwing athletes and the average time for those returning to the sport was six months. Some opt for taking a year, but both are still better than the 18-month timelines from the reconstruction. Fortunately, Lewis is not a throwing athlete and looking at the UCL repair rehab protocols, it appears he was able to progress through his rehab faster and return with bracing on his elbow for the remainder of the season. UCL repairs have been around for decades but the reconstruction approach was favored due to the overall successful outcomes as opposed to repair. Fortunately, advancements in science and materials have allowed the repair method to be reincorporated back into a possible intervention when dealing with this injury. 

Lewis in 2018

2018 // Michael Wade/Icon Sportswire, 247Sports

I am not certain that he had a UCL injury or the UCL repair, but it is quite plausible considering the circumstances. All this would explain why he was able to return in 11 weeks and only miss 10 games as opposed to the entire season. His chance for re-tear of the area is small — specifically, 2.5% when looking at reconstruction rates. Factor in that these are overhead throwing athletes that are being studied compared to the non-throwing athletes. One added bonus is that he did not have to wear bracing on the area during 2019 (second picture). Compare this to the end of the 2018 season in the first picture. This further supports that the elbow is fully healed. 

2019 // Timesfreepress.com

Right torn ACL

As incredible as that recovery was from the torn elbow ligament, Lewis suffered yet another setback. During summer training, Lewis suffered a torn right anterior cruciate ligament in July 2018, forcing him to miss the entire season. Regrettably, ACL tears are all too common at the collegiate and NFL levels. We have observed time and time again that a torn ACL is not a death sentence for a pro career and multiple tears do not lead to a career ending.  

The ACL is a thin band of ligament that runs lateral to medial and prevents anterior translation of the femur over the tibia. This ligament also helps with rotational stability by preventing the knee from rotating at the tibia, ensuring that the knee acts as a hinge joint. The ACL contains mechanoreceptors that assist with detecting changes in direction, speed and tension. It is the most commonly torn ligament in the knee during sporting activities.

Credit: aquaphysicaltherapy.com

Causes for injury include a sudden change of direction, jumping and poor landing, deceleration or direct blows to the area. There is usually, but not always, associated damage to the area during an ACL tear including damage to the meniscus, articular cartilage and MCL. Damage to the PCL and LCL is also possible along with nerve and vascular damage in severe knee injuries. 

It is not known whether there was associated damage in the knee following Lewis’ ACL tear. What we do know is that Lewis was able to return and play in 2019 without any missed time or any steps lost. He still has several risk factors that weigh against him with regards to re-tearing the knee. He is still under 25 years old (21); he is not quite two years removed from the original ACL tear (July 2018); and he is still at risk to tear the other ACL due to the original injury with about a 15-30% increased risk.

As with any injury, there is always a concern for arthritis down the line. As mentioned above, we do not know and likely won’t know the extent of damage in the knee. He will certainly be at a higher risk to suffer arthritic degeneration as his career progresses, but it is hard to say whether it will affect him early. 

Overall 

Despite the serious injuries that Lewis sustained during his time in Tuscaloosa, I do not see where he gets dinged on draft day. Had he suffered either injury during the 2019 campaign, I believe it would sink his draft stock. All NFL teams will certainly be looking at the medicals, applying valgus stress through the elbow, tugging on the knee to ensure that both are healthy along with any other injuries that are not publicly known. 

Both injuries should not limit his mobility in any way whether he plays in a more traditional linebacker role or if he gets his hand in the dirt as a defensive end. Any concerns regarding his mobility will be evident on film, more likely with the knee than elbow and any potential deficits should rectify themselves as he gets further out from the original injuries and begins training at a professional level. The only thing that holds him back is when being compared to his contemporaries with someone having more upside with less injury risk. These injuries are to be taken into consideration, but I don’t see how they make him fall. 

Lewis looks good on film. His injuries look good with regards to research outcomes and he has stellar play to back up the overall concerns. I expect to see him go to a team that values his versatility and plug him into the starting lineup. Despite the injuries, how his body holds up will be a question. But many that have suffered similar injuries have gone on to have productive careers in the NFL.

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