One of the top WR prospects in the 2019 NFL Draft is WR DK Metcalf from Ole Miss. Much is known about his abilities on the football field, but little is known about the neck injury that prematurely ended his 2018 season. As a result of the neck injury, he missed the final five games of his college career but still declared for the NFL draft as a redshirt sophomore. Today’s article will attempt to identify the specific injury that he suffered in the October 13th win over the Arkansas Razorbacks.

While there is little known about the neck injury, there are several clues that allow us to narrow down the possible diagnosis. We know roughly when he suffered the neck injury; this occurred during the first offensive series of the Ole Miss-Arkansas game. Looking at game film, he was targeted on one pass, which he caught for 49 yards, and after which he was able to play several more snaps before exiting the game after an Ole Miss field goal. During the 49-yard catch, Metcalf fell backward and hit the base of his neck, though he was able to get back up and finish the series. He was initially diagnosed with a neck strain, but following an MRI it was determined that he suffered a more serious injury, thereby ending his season.

There are reports that indicate that he had surgery on October 22nd. According to the reports, the injury did not involve his spine; it was all vertebrae, and he will be cleared for football activities on January 22nd. This sentence is loaded in that it effectively rules out many possibilities of the injury. As a result of what we know, we can rule out injuries to the upper cervical area above the C4-5 level, which could involve disc herniations, radiculopathies, cord compression, fracture/dislocation resulting in decompression/fusion surgery, or burst/compression fractures. The C4-5 level is key, as this is the level that controls breathing down in the diaphragm along with upper body movement required for self-care and general mobility. This is important because if he did have an injury here, there would be questions as to whether it would be appropriate to continue playing football as in the case of retired Bills C Eric Wood.

As a result of eliminating the upper cervical vertebrae as cause for concern, this leaves us with C5-T1, which is typically the lower cervical vertebrae. We can further eliminate possible injuries to the area due to the timeline that Metcalf gave. He had stated that January 22nd he would be cleared for return to football activities. According to this article, that date would place him 12 weeks from his initial surgery date of October 22nd. There are not many surgical interventions to the neck region that would allow for full football activities after 12 weeks, which rules out cervical fusion. This is a procedure that is done when there is pain/instability in the region; the disc is removed and the vertebrae are linked together permanently in order to reduce motion at that level to reduce/eliminate the symptoms. Consequently, most cervical fusions take between 6-12 months to fully heal.

While most of the fusion protocols that I have viewed do state that running is allowed at earliest 12 weeks, this means that only running is allowed. The article above states that Metcalf will be cleared for full football activities, which I infer to be full contact, after 12 weeks. Lower-contact sports such as skiing, golf, and basketball are allowable at 4-6 months, according to most research, for fusions. Finally, if a fusion were to occur, Metcalf would have been observed wearing some type of neck brace to keep the head in neutral to avoid placing stress on the healing vertebrae. According to this picture from Metcalf’s Twitter page, he was standing on the field not even two weeks after his surgery without any sort of bracing or obvious discomfort.

There is the possibility that he had a laminectomy, microdiscectomy, or foraminotomy, but those are usually reserved for more chronic issues, such as what Peyton Manning dealt with prior to his cervical fusion surgery. In addition, the timelines would be really tight or unrealistic based on what we know. Overall, this appears to be an unlikely intervention, based on procedure and mechanism of injury.

Credit: physio-pedia.com

With all that we now understand about his injury, I can state with relative confidence that Metcalf suffered a spinous process fracture, also known as a clay-shoveler’s fracture. In the picture above, the bones in red are the cervical vertebrae to which we have been referring during today’s article. I believe that he fractured off a piece of the spinous process or the tail-like structure during his fall back in October. The spinous process acts as an attachment point for muscles and supraspinous ligaments on the vertebrae to assist in keeping everything stable and in their rightful places. A spinous process fracture typically occurs as the result of an avulsion, which is where a piece of bone pulls away with the connecting tissue as the result of sudden forceful muscle contraction and pulling on the supraspinous ligaments, leading to pain at the base of the neck or between the shoulder blades, in the case of the clay-shoveler’s fracture. These ligaments connect the spinous process from C7 to the sacrum and provide stability to the spine. However, I believe the mechanism of injury for Metcalf was direct trauma as a result of the fall.

Credit: http://radiologyinthai.blogspot.com

My observation is that he suffered the injury, was not feeling great, was removed from the game, and had resulting pain with reduced neck motion that was not subsiding with conservative means shortly thereafter. An MRI was performed and found that the fracture was present. Seen above from an X-ray is a spinous process fracture where the arrow is pointing. In most cases, these injuries are treated conservatively with rest along with a hard collar to allow healing to occur. With Metcalf being the special talent that he is and the need to ensure his health for football, the consulting doctors most likely excised or removed the offending structure to reduce the risk of chronic pain. Despite this sounding like a simple surgery, he still needed time to recover, as skin, muscle, and ligaments were cut into, which at minimum requires several weeks to heal. This is in addition to regaining motion and strength while not irritating the healing area. It is reasonable to assume that he would take 12 weeks to fully heal and return to prior level of function before the injury.

As he is a highly-touted prospect. Doctors wanted to ensure that he was fully healthy and having no complications afterward to make sure that he is ready for the combine and NFL Draft. As for long term impact, there is none. While the spinous process does assist with structural stability for muscles and ligaments, missing one won’t cause any long term issues. Knowing all of this, the neck injury becomes a non-issue and would make any fan feel good about their team’s choice to select him in the draft. The only other known injury that Metcalf sustained in college was a broken foot freshman year, but considering how well he was performing prior to his neck injury, there is little cause for concern moving forward for both injuries.

Whether he is the right pick is up for NFL teams to decide, but his health appears to be a minor issue and should not impact his production in the NFL.

Thank you to Cover 1 for allowing me to provide injury analysis on upcoming draft prospects prior to the draft. If you like what you read, make sure to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit at u/BangedUpBills, and online at www.bangedupbills.com. Thank you for reading and GO BILLS!

*Mandatory Photo Credit: Matt Bush-USA TODAY Sports