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Neck Stinger: A Look at the Injury Keeping Chris Samuels Out Against the Chiefs

Published: October 13, 2009

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If you were trenched up in your football cave this weekend and saw clips from the Redskins-Panthers game, you watched the pressure the Panthers’ defensive line was able to apply to Redskins quarterback Jason Campbell, ultimately resulting in five sacks for the game. 

The Panthers’ defense was aided by the loss of Redskins six-time Pro Bowl left tackle Chris Samuels, who left the game at the conclusion of the second play from scrimmage after suffering a neck stinger.

As a result, Samuels will be held out next week against the Kansas City Chiefs.

A stinger is a painful condition which usually is result of a direct blow to the head, neck, or shoulder; however, it is possible in any sport or activity.

In this case, the injury was suffered after Samuels went to block Panthers defensive end Tyler Brayton, which caused a forceful stretch of the nerves.

According to the Washington Post article, Redskins center Casey Rabach, who has had the injury in the past, said “That’s a scary injury.”

The name comes as a result of the sudden and intense stinging pain that shoots down your arm or in your hand. 

The feeling is similar in nature to that of a limb that has “fallen asleep”; however, in the case of a “stinger,” the onset is sudden, and the intensity greatly increases. A mild case can last for just a few seconds; in a more severe or chronic case, symptoms may persist over longer periods of time and result in decreased coordination, strength, and sensation in the affected arm.

The injury should be immediately reported to coaches, trainers, or a team physician; ignoring them and continuing to participate could lead to more significant injury. 

The application of ice to the neck and shoulders will help the discomfort initially; however, going forward the individual should seek out treatment from a skilled physical therapist to prevent further complications.  Treatment may consist of moist heat, soft tissue massage, thermal ultrasound, treatment with the FDA approved ML 830 cold laser and passive stretching may be used to decrease any muscle spasm that may have resulted in continued symptoms.

Muscle spasm is often overlooked as a cause for delayed recovery. When one voluntarily contracts a muscle, they have the ability to voluntarily relax that muscle. 

When one is hit, the body goes into a protective, involuntary protective contraction, and it is more difficult to release. When a person has larger, more powerful muscles, the resulting muscle spasm can be more powerful as well and take longer to release. 

Even when the symptoms are relieved, the muscle spasm must still be addressed to prevent future or lingering complications.

Be wary of treatment programs that just use passive modalities and do not address the resulting muscle spasm. Doing so can delay your recovery time and delay the return to your activity.

Once the symptoms have dissipated, treatment should focus on strengthening the muscles of the cervical spine and improving the range of motion as well, particularly in the front of the neck. 

Additionally improving one’s sports-specific technique can decrease the chances of re-injury.

If symptoms persist, an X-ray, MRI, EMG, or CT scan may be indicated to rule out disc herniation or nerve damage.

Christopher Stulginsky, PT, is a 2003 graduate of the physical therapy program at the Rangos School of Health Sciences at Duquesne University in Pittsburgh. He has worked at The Johns Hopkins Hospital in Baltimore and in various sports medicine clinics around the country. Currently, he is the managing partner or Ayrsley Town Rehabilitation, a physical therapy clinic in Charlotte, N.C.

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New York Giants QB Eli Manning Day to Day with Plantar Fasciitis

Published: October 8, 2009

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Last weekend, in what looked like a pretty mundane play, New York Giants quarterback, Eli Manning suffered an injury to the bottom of his right foot.  It was enough to sideline him for the rest of the game and to keep him out of practice on Wednesday, according to the injury report at

Plantar Fasciitis is inflammation of the plantar fascia, a dense connective tissue structure that runs along the bottom of the foot from the heel to the area around the ball of the foot.

Though referred to as one unit, it is actually comprised of many thin layers that have to work together and glide over each other in order for it to work together as one unit. When that area gets inflamed, the layers do not properly glide and as a result cause pain in the bottom of the foot. 

The severity ranges, a relatively mild case can be isolated to one area of the foot, where a severe case can be felt from the heel to the ball of the foot.

Based on reports, it seems that the injury is located on just one area of the foot. Nevertheless, plantar fasciitis can be unbelievably painful, it effects nearly 2 million Americans each year and may affect 10 percent of the American population in their lifetime.  

It is a condition that has sidelined Tim Duncan of the San Antonio Spurs and Shaquille O’Neil of the Cleveland Cavaliers. The patient’s that I see with this diagnosis report that basic tasks, like walking, are unbelievably painful let alone high performance task like throwing a football.

The foot is foundation of the body and, as a result it is the foundation for proper biomechanics of the football throw. The injury is located in Manning’s right foot, which he uses to the plant before he passes the football. 

The condition could affect his ability to plant and drive off of his right foot, which could affect his accuracy; it could increase time the ball is in the air, and give the defense more time to react.

Additionally, it can affect his ability to generate power on down field throws and will limit he mobility in the pocket in attempts to avoid the defensive pass rush. Typically the goal of treatment is to decrease the initial inflammation associated with acute injuries by resting and icing the structure.

Going forward, the goal needs to be to continue to address the residual inflammation in the area as well as improve the range of motion.  Electric stimulation, ultrasound, iontophoresis or phonophoresis with 0.4 percent dexamethasone are indicated along with use of cold laser and stretching the gastrocnemius and soleus, which make up the “calf muscle.”

On game day, the medical staff can use injection therapy and give extra support to the area with taping techniques. Additionally they can modify Manning’s footwear to decrease the symptoms in an attempt to decrease the effect of the injury on his performance.

In Manning’s situation, because he is a professional athlete, other biomechanical factors such as tightness and strength deficits of the hip and knee may not need to be addressed.

However, if you have or are experiencing these symptoms, be wary of a treatment program that is isolated to the bottom of the foot. In most situations, plantar fasciitis is caused and is, therefore a symptom of biomechanical issues elsewhere in the body.

These muscle imbalances cause the plantar fascia to be overloaded with forces it is not able to withstand causing injury.  Addressing just the plantar fascia and without addressing additional factors increase the chances of the recurrence and could make the situation chronic.

Christopher Stulginsky, PT is a 2003 graduate of the physical therapy program at the Rangos School of health Sciences at Duquesne University in Pittsburgh, PA.  He has worked at The Johns Hopkins Hospital in Baltimore, MD and in various Sports Medicine clinics around the country. Currently, he is the managing partner or Ayrsley town Rehabilitation, a physical therapy clinic in Charlotte, NC.

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