The Doctor Is In: Bone Bruise Shouldn’t Sideline JuJu Smith-Schuster For Long

As anyone following the Pittsburgh Steelers training camp updates knows, JuJu Smith-Schuster has been a welcome addition to the wide receiver corps.  The rookie second-round draft pick appears to be everything he was advertised to be.  The only probably is that he keeps missing time due to injury.  Fortunately, none of them have been significant to date.

There was concern yesterday when the young wide receiver left the field with an apparent knee injury.  Given that he wasn’t rushed immediately for an MRI, structural damage seemed unlikely.  Today, head coach Mike Tomlin reported that JuJu had sustained a bone bruise.  Earlier in the day, Gerry Dulac commented that JuJu was wearing an “electro-stim” on his knee.

So what exactly is a bone bruise?  The name itself doesn’t paint the full picture.  A bone bruise is a microfracture of the inside of the bone which results in bleeding.

Here is a quick rundown (courtesy of www.md-health.com):

• Subperiosteal hematoma– A bone has a thin covering called the periosteum, and a direct force can cause an injury with bleeding beneath this covering, resulting in a subperiosteal hematoma.
• Interosseous bruise– On the other hand, high compressive forces that are repetitively inflicted on a bone can cause bleeding inside the bone where the marrow is located, causing a bone bruise called interosseous bruising. This commonly occurs in the knees and ankles of professional basketball or football players.
• Subchondral bruise – Finally, there is the subchondral bruise which occurs between a cartilage and the bone beneath it, causing the cartilage to separate from the bone with bleeding in between.

Bone bruises can only be seen on MRI, not plain Xray.  Here’s a schematic image of the bone of the distal femur, or the lower end of the thigh bone:

Here’s an MRI image of a bone bruise:

Obviously, I don’t have access to Smith-Schuster’s MRI report, so it’s not clear which type of bone bruise the wide receiver sustained.

The treatment for all of these is essentially the same – ice, anti-inflammatory medications (like ibuprofen or Toradol, which has gotten so many NFL players through games and is commonly used for post-op pain as well) and light activity to keep the knee loose and prevent the stiffness that follows swelling.  A stationary bike is the perfect therapy because it doesn’t require him to bear weight, which is clearly painful, but allows him to work on range of motion and minimize tightening of his quadriceps muscle.

And then there is the “electro-stim” thing Dulac tweeted about.  This is a device used by physical therapists to treat pain, particularly by reducing muscle spasm.  There are also medical studies that suggest that electrical stimulation can accelerate the time for fractures to heal.  If you want to totally geek out, here is a review.

As far as recovery time, there is a fairly broad spectrum.  A bone bruise does not cause knee instability, so it is primarily a pain issue.  In his rookie year, Cincinnati Bengals wide receiver A.J. Green sustained a bone bruise playing against the Steelers on the only catch they allowed him.  He missed the next game against the Baltimore Ravens but was able to return against the Cleveland Browns two weeks after the injury, catching 3 passes for 110 yards with a long of 51 yards.  He was diagnosed with his second bone bruise after landing awkwardly on the first day of training camp in 2013 and missed two weeks of practice, including the first two preseason games.  He went on to play the second two preseason games and the entire regular season.

Both Le’Veon Bell and Ben Roethlisberger have suffered bone bruise injuries as well.  The running back was injured in the final game of the 2014 season and worked hard to recover in time for the playoff game against the Ravens the final week but never got a helmet.  The Steelers season ended, so we will never know if Bell could have returned later in a theoretical playoff run.  The quarterback sustained both an MCL sprain and a bone bruise against the St. Louis Rams in week 3 of the 2015 season.  He missed four games, but the MCL sprain was probably the bigger issue there.

It sounds like JuJu’s injury is not too severe.  And if pain is the determining factor expect to see him back on the field soon.  This young man seems very focused, and with the current depth at WR the Steelers have, he will want to make sure he gets his share of snaps.  I would guess Smith-Schuster will be back in time for the 3^rd pre-season game against the Indianapolis Colts.