Why Seahawks RB Chris Carson may fare better in his return than Thomas Rawls

As the Seattle Seahawks look to get back to being a punishing rushing team in 2018, one of the biggest question marks is regarding who will be the running back or running backs that lead the way? The running back position for the Hawks has basically been a waiting room where backs share the injury bug with one another while awaiting their turn on the field. In recent seasons the team has been forced to turn to street free agents like DuJuan Harris and Terrance Magee simply to make it through the year, and one of the biggest question marks regarding the position for 2018 will be the return from injury of Chris Carson.

Carson, of course, was lost for the season when he suffered a severe ankle injury in Week 4 against the Indianapolis Colts. For many fans this was highly reminiscent of the 2015 injury Thomas Rawls suffered against the Baltimore Ravens, and from which Rawls has seemingly never recovered. While the Carson injury was similar to Rawls, the two were not identical so as I have done in the past, I once again reached out to retired orthopedic surgeon Dr. John Gilbert to tap into his four decades of medical knowledge to address this matter. (Author’s note: As you may have guessed based on the name, Dr. Gilbert and I are relatives.)

Obviously Dr. Gilbert has never met or medically evaluated either player, but that is irrelevant for the purposes of this analysis. All I was looking for here was a basic understanding of what we as fans should be able to expect from a player who had suffered the type of injury Carson suffered in comparison to the type of injury Rawls suffered. Were the injuries sufficiently different that it is reasonable to have high expectations for Carson going forward? Or was the difference between the injuries immaterial when it comes to the long term outlook of either player?

Without getting too deep into either injury, this is the question I posed:

I’m looking for a summary of what one would expect of the differences in recovery between the following two ankle injuries (both patients are approximately the same age and build: early 20s, 5’9-5’10, 215 lbs and neither has a history of ankle injuries):

Injury A: high fracture, non-displaced with a full tear of the syndesmotic ligament. Ligament was repaired surgically and the fracture healed without surgery. Patient was ambulatory and able to run at ten weeks post op.

Injury B: high fracture, displaced which was originally treated conservatively, but required surgery and plating approximately four months post-injury (I’d assume due to the fracture not setting properly, but do not have the specifics). Patient was unable to pass a physical to play professional football at 7.5 months post injury (~3 months post op), but did pass a physical at 8 months post injury.

Nothing too specific needed, just what your basic impressions would be in each situation regarding what to look for, what longer term concerns a medical professional would have regarding each and what the likelihood that either injury would impact the player’s ability to play in the future.

For those of you who do not recognize the medical terminology or who may simply be unfamiliar with the details of the injuries suffered by Carson and Rawls, Injury A refers to Carson and Injury B is Rawls. Without wasting any more time with my non-medical expertise, the response I received was as follows (bolding is mine):

Injury A: Undisplaced fracture probably indicates the complete tear was of the anterior syndesmotic ligament* only, with fibular length being largely maintained by the posterior syndesmotic ligament. Primary repair of the ligament probably facilitated anatomic restoration of the ankle anatomy and probably has a better prognosis for return to play. Running at 10 weeks is probably not ready to pass pre participation physical.

Injury B: Displaced fracture indicates a much higher energy injury, likely disrupting both syndesmotic ligaments. These will always allow some shortening at the fracture site and concomitant mechanical compromise of the ankle anatomy and mechanics. Secondary repair will be much more difficult. It’s hard to regain length on the soft tissues late. If a good restoration of the ankle anatomy was accomplished prognosis for return to play is more guarded. 8 months sounds about right for rehab. I’d guess 6 - 12 is normal. If not ready at 12 probably needs to find other work

Neither ankle will be like brand new; they are both likely to have “lost a step” and be at risk for late degenerative disease.

* Speculating based on hearsay, that’s my best guess. Hope it helps.

So there we have it. There may in fact be reason to believe that Carson has a higher probability of performing at a high level in the future in comparsion to Rawls. However, as pointed out, he is likely to have “lost a step”. What losing a step means for Carson going forward remains to be seen, but with his style of play based less on explosive speed, him losing a step may not be as meaningful as Rawls having lost a step.

Of course, for someone who only possessed 4.58 speed prior to the ankle injury losing a step could be disastrous. Seahawks fans may have witnessed just such a scenario in 2017 with Eddie Lacy. Coming out of Alabama in 2013 Lacy had 4.64 speed, but had ankle surgery during the 2016 season for an injury that was described as “more than sprained”, which leads me to believe there was likely some kind of ligament or tendon tear in the ankle. In any case, Hawks fans saw firsthand in 2017 what it looks like when an already slow back loses a step following ankle surgery.

Additionally, the information about Rawls’ injury and the fact that the type of injury he suffered is eye opening. The fact that there were likely physical changes to the ankle as a result of the injury is significant and could help explain a lot of his struggles over the past couple of seasons. It could easily be that the flashes Rawls displayed in 2015 are the highlights of his career, and that following the injury he may never be the same running back again. With two years of evidence in support of this, it definitely appears this may be the case.

Regardless, going forward with the knowledge that Carson may have indeed lost a step, the team should have a better understanding of their needs at the running back position through free agency and the draft than they had following the 2015 campaign. That is at least one benefit to Carson having been injured significantly earlier in the season than Rawls was injured, but fans won’t know how much Carson may have lost until training camp or the preseason. So, regardless of the probabilities, there is still likely to be six more months of speculation regarding Carson and his ankle until he shows how the ankle has recovered during preseason.