NFL Draft Injury Impact: Wake Forest LB Justin Strnad

04/20/2020
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Wake Forest linebacker Justin Strnad was the epitome of a team player during his time in Winston-Salem. Team captain, durable with 20 consecutive starts, leading the team in tackles and getting the Demon Deacons into the AP Top 25. He was also instrumental in helping the team to reach four straight bowl games — a first in school history. 

Unfortunately, Strnad was unable to finish the season in the Pinstripe Bowl having suffered a distal right biceps tear in a win over Florida State midway through the season. While this is the only recorded injury that Strnad suffered at Wake Forest, it was certainly a costly one that may affect where he gets taken in the draft. Up to that point, Strnad had been incredibly healthy, not missing a game due to injury dating back to his redshirt freshman from what could be found. 

Biceps anatomy

The biceps brachii is a powerful muscle that overlies the humerus in the upper arm. This muscle crosses two joints, the shoulder and elbow, performing multiple functions. The biceps has two connections on the proximal portion or origin: a short and long head. The long head connects from the labrum in the shoulder and the short head connects to the coracoid process on the scapula. The distal attachment or insertion connects to the radial tuberosity and aponerosis. This muscle allows for elbow flexion, supination of the forearm (turning the palm upward) along with assisting with shoulder flexion and is essential for everyday activities. 

Due to the shape of the ulna with the olecranon process, the elbow has a terminal endpoint as it goes into full extension. As a result, the biceps cannot be overstretched through elbow extension and as a result, the biceps can’t tear. Typically, the way that the distal biceps tendon tears is the result of an eccentric contraction or abruptly loaded. This is where the biceps are under active contraction into flexion and the elbow is forcefully extended. This can also happen as the result of forceful supination in which the hand turns over palm up. 

Distal biceps tendon tear

In Strnad’s case, he attempted to tackle Florida State running back Cam Akers on a routine play midway through the third quarter. He tried to attack Akers out of position, catching him with his right arm. Akers got away forward and Strnad’s body weight had him going backward. Strnad was actively contracting his biceps and his body weight was actively lengthening the muscle, leading to the tear. To see the injury itself, go to the third quarter with 9:13 left in the game, specifically at the 1:33:30 mark.

There was a brief thought that he tore either the long head of the biceps, but considering Strnad was able to return to the sideline with his elbow wrapped indicates that he tore the distal portion. Prior to getting the wrap, he was observed on the sideline motioning to his arm and appearing to bend it slightly. Immediately after the injury, he would have had significant loss of function in the arm, bruising, and a possible bulging of the bicep muscle as it retracts upward towards the shoulder due to the tendon rupture. There are other muscles in the arm that assist with flexion of the elbow including the brachialis and brachioradialis which is why he could have still had some function despite the tear or suffering a partial tear.

 

Credit: Rehabmypatient.com

As a result of the injury, he required surgery to repair the area which is usually a three to four-month recovery. Bracing for immobility is indicated for four to six weeks to allow the tendon to re-heal to the bone. After that, rehab consists of progressive strengthening along with furthering range of motion until full function is reached. 

Strnad was cleared medically at the NFL Scouting Combine in late February and participated with all activities with the exception of the bench press. Considering that he had the surgery on Oct. 22, that would put him at the four-month mark exactly. Could he have bench pressed? Absolutely. Would it have been a wise idea? Absolutely not. While the Combine is designed to show off athletic feats, it is also not the place to sustain an injury or re-injure an area. 

NFL injury impact

Cover 1’s Christian Page slates Strnad as a fourth to fifith round selection, in the 115-150 pick range. That would put him squarely into Day 3 and allow some teams to work their draft boards for other guys and let Strnad fall to them. The Day 3 grade may be more of an indictment on his talent than injury concerns. 

According to the research available, distal bicep tendon ruptures are rare with 1.2 events occurring per 100,000 persons per year. Thankfully, the resulting repairs are highly successful. Most research studies indicate that patient satisfaction rates are excellent up to 90% regardless of the type of procedure. Looking at other objective measures, strength is relatively the same when compared to the non-involved side with slight differences based on the procedure. The ability to supinate the forearm also was at 10-15% less than of the non-involved side strength wise for up to two years following surgery. Finally, range of motion differences between the involved and non-involved sides was not statistically significant. 

Complications that could occur include nerve palsy which could result in altered sensation in the local area due to injury to the nerve during surgery. There are others such as heterotrophic ossification, pain, or infection, but Strnad is well beyond any of those possible complications at this time. Re-rupture rates are between one and two percent which indicate the effectiveness of the surgery but also how rare the injury is as a whole. Most re-ruptures happened within several weeks following surgery if the patient did not follow post-operative protocols. 

This injury should have little to no impact on his ability to play in the NFL. One source I found of Strnad during his draft analysis at CBS Sports is concerned about his arm tackle attempts. This is ultimately what contributed to the injury but the injury itself was simply bad luck.

While there are not a lot of players that suffer this injury, the only comparable player that I can come up with is former Bills linebacker Brandon Spoon. The Bills middle linebacker in 2002 suffered a right biceps tendon tear and before that at UNC, suffered a left biceps tendon tear. He also suffered several other lesser injuries during his brief career, but never had the longevity that he could have had if he was healthy. 

This is not to say that Strand will be Spoon. But the draft grade, position and injuries all have similarities. Ideally, Strnad plays much longer. Strnad’s playing style could open him up to further injuries as he begins to play in the NFL, but this is far from a guarantee. A team looking at him may want him to work on his tackling form and have him square up more rather than trying to grab guys one-handed as he flies down the field. 

If he doesn’t suffer another biceps tendon tear in the opposite arm, there would be concerns for a pectoral tear or an overall inability to hit his target as he will frequently be out of position. This should be a skill that can be effectively taught for the next level and will allow Strnad to rely on his other skills such as lateral movement to contain a player rather than trying to cover up mistakes through his athletic ability. 

Looking at Strnad, I don’t believe that any team should be scared off by the biceps injury in itself. His style of play and his abilities that translate to the next level will be ultimately what get him drafted. The shortcomings of Strnad from what I see are teachable and should allow him to play a slightly more contained style which could further reduce his injury risk. With the right team, he should be able to fit in nicely as a depth piece towards potential starter, slowly adapting his game to the NFL as he grows as a player and person.

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