The Odell ankle saga all began when he caught his foot and ankle under a Chargers corner during the New York Giants October 8th matchup against the San Diego Chargers.
Here’s the sequence of events that led to the injury:
1 – The play started innocuously enough with Odell breaking inside on a quick slant. Eli got the ball out after a 3 step drop but it came out hot and high:
2 – This put Odell in the precarious situation of leaving his feet to attack the ball with the corner bearing down and making contact from behind. Odell got twisted in the air and landed on his left leg, all his body weight transferring to that leg:
3 – And finally, Odell’s left ankle got caught under the Chargers corner and on the turf – all his weight still on that left leg. The foot severely rotated to the left as Odell’s full body weight came down onto it. I’ve highlighted the rotation below, his ankle was pointing to 3 o’clock when it should have been pointing to 6 o’clock:
On the eye test alone, you know the body isn’t supposed to do that. Seeing Odell’s emotional reaction at the time made it that much more salient and puts some perspective on how fragile an athlete’s livelihood and goals can be – it can all be taken away on one play.
It’s easy to forget how much hard work these guys put in day-in and day-out just to be on the field and perform at high level.
The news came out that the Odell ankle injury consisted of a fibular fracture and a severe high ankle sprain (a sprain/tear of his tibia-fibula syndesmotic ligament), and he’d be out for the season. For reference, it’s not uncommon for both of these injuries to occur simultaneously when the ankle is severely rotated like it was in Odell’s case.
We’re now nearing 8 months since the Odell ankle injury and surgery. With Giants mandatory mini-camp starting on June 12th, I figured it’s good time to check-in and see how he’s doing on his road to recovery. He’s really active on social media so that gives us an unprecedented amount of access and insight.
The game plan is as follows:
- We’ll review the basic anatomy and function of the involved pieces
- Then take a look at Odell’s surgery
- Follow him on his rehab journey, from post surgery to the most recent updates
- Based on his current functionality, give a timeline for his return
- Lastly, discuss any short or long-term implications
So here we go…
I. Odell ankle anatomy, function, and injury
The ankle is a body region rich in anatomy – a smorgasboard of muscles, ligaments, bones. For this piece, we’ll take a look at the fibula and syndesmotic ligament. For a more detailed look at the ankle joint and ligaments, check out this piece on Cristiano Ronaldo’s inversion ankle sprain.
The fibula is a partial-weight bearing bone (about 15%, whereas the tibia, shinbone, bears 85%) on the lateral (outside) of your leg. It starts below the knee and ends by forming the lateral malleolus (the knobby thing on the outside of your ankle). If you trace up towards your knee from that knob, the next big bump you feel is the head of the fibula.
Here’s a picture of the fibula:
The lateral malleolus stabilizes the foot and ankle against excessive eversion (the foot/ankle turning outwards). However, when there’s a high level eversion force at the foot and rotation force at ankle (like the Odell ankle), it can fracture that lateral malleolus – known as a lateral malleolar fracture.
This fracture, when accompanied by a high ankle sprain, is usually higher up the fibula compared to other ankle-associated fibular fractures. Take a look at an x-ray:
In general, sports that involve cutting and contact/collision, have a higher prevalence of fibular fractures. Football certainly falls under that category.
So that’s the fibular fracture, now onto the….
B. Tibia-Fibula (Tib-Fib) Ankle Syndesmosis
The ankle joint is comprised of three bones – the fibula, tibia (shinbone), and talus. The tibia and fibula form the ceiling of the ankle joint and sit on top of the talus. Here’s a picture:
The tibia and fibula are adjoined by the tibiofibular syndesmosis – this is a series of 4 ligaments that connect the tibia and fibula.
Here’s a picture of them (note, the inferior transverse ligament is not pictured):
For reference: Anterior tib-fib ligament = ATiFL; Posterior tib-fib ligament = PTiFL; Interosseus ligament = IOM
And a great video of ankle anatomy – go to the 3:10 mark for the ankle syndesmosis:
These syndesmotic ligaments passively keep the tibia and fibula (and therefore the ankle) stable when the ankle is dorsiflexed and particularly when the foot is externally rotating (rotating outwards)
Think of ligaments like rubber bands that are tensioned and help the joint stay in place during movement.
If the ankle joint dorsiflexes and/or the foot externally rotates outside its normal range of motion, these ligaments stretch, tear (sprain), and in severe cases, rupture (full tear):
The foot goes outwards while the ankle joint rotates which pulls the tibia and fibula apart. This stretches and damages the tib-fib syndesmosis ligaments.
This is known as a high ankle sprain and medically termed a “syndesmotic ankle sprain”. They’re much less common than the typical ankle sprain (like when your ankle turns inwards), accounting for only about 6% of all ankle sprains.
During the Odell ankle injury, his ankle experienced a high dorsiflexion moment with all his body-weight coming down onto that ankle and then his foot severely rotated to the outside. Take a look (again, not for the faint of heart):
This combined dorsiflexion and external rotation trauma is the most common cause of a high ankle sprain. High ankle sprains are classified as a grade 1, 2 or 3 – each corresponding to a higher level of severity.
Here are the key defining features of each:
- Grade 1
- Partial tear of the ATiFL, with no separation of the tibia-fibula on x-ray.
- This is considered a stable injury
- Grade 2
- Complete tear of the ATiFL and partial tear of IOM, with no separation of the tibia-fibula on x-ray.
- This is considered a potentially unstable injury
- Usually involves partial tearing of ligaments on the medial (inner)aspect of the ankle and possible simultaneous fractures
- Surgery is usually indicated
- Grade 3
- Complete tear of the ATiFL and IOM plus partial or complete tear of PTiFL, with separation of the tibia-fibula on x-ray
- This is considered an unstable injury
- Usually involves full tearing of ligaments on the medial (inner) aspect of the ankle and likely simultaneous fractures
A picture of the 3 grades:
Although the Giants haven’t released any details on the severity of the high ankle sprain (sports teams rarely do, keeping all medical info close to the chest), it’s likely that the Odell ankle suffered either a grade 2 or grade 3 high ankle sprain based on the severe mechanism of injury and accompanying fibular fracture.
Here’s what a grade 3 high ankle sprain and fibula fracture looks like on an X-ray (note the separation between the bones, indicating rupture of the syndesmosis and instability of the ankle joint):
Now that we’ve learned the anatomy and general function of the fibula and ankle syndesmosis, let’s take a look at how they’re involved in football-specific functions…
II. Sport-specific & position-specific function
As I’m sure you know, ankle stability and function is critical for movement. It’s loaded to some degree during any upright movement.
Football places a high load on the ankle with constant movement, starting/stopping in different directions, high-leverage contact with opponents, and the constant threat of collisions with other players.
Those loads are ratcheted even higher for the wide-out position:
- High speed, precise cutting and acceleration/deceleration
- Leveraged contact such as blocking, beating press coverage, and hand-fighting all along the route
- Jumping and landing
To top it all, they’re often putting themselves or being placed into vulnerable and dangerous positions:
Odell puts even more stress on his ankles and lower body due to his elite level of burst, change of pace, footwork, and leveraged physicality. Take a look (I could watch technique film all day):
In addition, he’s often matched up against the opposition’s #1 corner, with coverage tilted towards him, and a target on his back. This increases the level of intensity, contact, high-risk situations, and emotion.
Odell vs Xavier Rhodes in week 4 (the best job I’ve seen a corner do on Odell without completely tilting the safeties toward him)
In each of these cases, ankle integrity and stability is critical. For the Odell ankle, the first step to regaining this integrity and stability was undergoing surgery…
III. The Surgery
The goal for Odell’s surgery was two-fold:
1 – Fixate (keep it in place) the lateral malleolar fracture
2 – Align and reduce the separation between the tibia and fibula (this is called a “reduction”) and then fixate them.
With elite athletes who suffer a combination syndesmotic tear (high ankle sprain) and fibular fracture like the Odell ankle , a technique called “suture-button fixation” is commonly used because it doesn’t require hardware removal, unlike fractures that are repaired with screws. Take a look:
Fixating the fibula allows the fracture to heal, and reducing + fixating the tib-fib allows the syndesmosis to heal.
Once surgery is complete, Odell started the next phase of his recovery – rehab and getting back to the field.
As I mentioned in the intro, Odell’s social media gives unprecedented access into his rehab and return. I’ve traced his physical & mental recovery using his social media as the foundation and then adding in rationale and explanations.
Immediately following surgery, the Odell ankle was completely immobilized in a controlled ankle movement (CAM) boot for about 6 weeks (that’s about standard to allow for the bones to heal).
He slowly progressed from crutches:
To weight-bearing in a less restrictive boot:
To finally out of the boot at around 9 weeks:
An important note: throughout this process in the boot, Odell was still working on maintaining the range of motion in his ankle (any joint that’s “stuck” in one position for too long will end up losing range of motion) and using gentle low-load exercises to maintain strength in his left ankle and lower leg.
However, once the fibula and syndesmosis were fully healed and he was cleared for full weight-bearing, the Odell ankle rehab process really picked up steam as main focus shifted from healing to active rehab.
The first priority was to normalize Odell’s walking patterns (known as “gait”) in order to load the lower body appropriately and avoid any compensations.
Once that was complete, he began to progressively load the ankle. Here he is running underwater:
And starting to load his lower body and ankle with compound movements (an assisted squat in this case):
Progressing to higher-intensity loaded training for his lower and upper body:
— Odell Beckham Jr (@OBJ_3) January 16, 2018
Then adding single-leg, ballistic, and agility training (notice he’s not wearing shoes – this tells me he was getting more comfortable with that ankle and the rehab team was focusing on balance work to train his sensory feedback – proprioception and vestibular – systems):
Finally, he got back to running under his own weight:
I just wannna take this moment to thank God, as I sit back and reflect, knowing that we’ve came a long way. I remember not being able to put my foot on the ground, hopping up stairs, fallin over, gettin frustrated. I just wanted to be able to walk again, shoot hoops, play wit my dogs, just wanted to do some of the smaller everyday things that we often take for granted. Now we’re back on the right path. And we’re comin for it all! BeluhhhhDat!
Then he added another layer of complexity by completing agility and reaction drills in the sand. Sand is an unstable surface that forces your lower body and ankle/foot musculature to really work hard to activate and stabilize.
About 4 months after surgery, Odell was back on the field to do football specific activities, like agility and hands drills, route running, and blocking:
That progressed to longer and higher intensity routes with single-leg jumping and landing:
Most recently, Odell began running mock routes off the line of scrimmage, with press coverage thrown-in:
So that’s the physical aspect, how has Odell been dealing with the injury from a mental and psychological perspective?
Before we go into the specifics, lets start with a quote from Kobe Bryant (originally written to Gordon Hayward after his ankle dislocation) that encapsulates the mental approach required to unlock recovery and come back even better:
And now onto the Odell specifics…
1 – Support
Rehabbing from a long-term injury can be a lonely place, especially as a professional athlete. Most of your time is spent with the medical staff (usually it’s just one person) and you’re separated from the team.
In these situations, support from friends and family and staying connected with the team provides a mental reprieve and bolsters the healing environment.
Odell seems to have this support in spades. Here are some examples:
Started in the hospital and now we’re here….
Got more love and support from his Mom while in the hospital:
Kicked it with his dogs (the therapeutic benefits of pets are real):
Madden with the boys (this video killed me, had to include it):
Trained with Joe Haden:
Was part of a wedding party with friends:
Spent time with his family:
And spent time with his Mom:
2 – Resiliency and Perspective
A resilient attitude and long-term perspective can completely shift the course of rehab and recovery – I can’t emphasize this enough. Viewing an injury as a transient challenge rather than a permanent setback has a positive domino effect on every mental aspect – motivation, anxiety, stress, and so on.
Odell’s a very emotional and passionate player who gets a lot of his identity from being a top player in the league and being one of the best at his craft. This type of emotion and passion can lend itself to reacting in extreme ways (as we’ve seen on the sidelines), for good or for bad.
In the case of his injury, that passion has manifested for the good. Before I started writing this piece, I didn’t know much about Odell (still don’t really, what the public sees is just a very small slice of that person) but from what I’veseen and read, I’ve been really impressed with how he’s taken to the challenge of rehab and understood that there is a next chapter.
Here are some examples that highlight this mental resiliency and perspective….
Starting with a positive perspective and mentality from the jump:
Continued resiliency and the mentality of “back better than ever”:
Openly acknowledging the mental aspect and challenge of the injury and rehab (this is HUGE):
And lastly, moving on from the past and flipping the page to the next chapter:
3 – Fun
Fun? Rehab ain’t fun…well yeh, that’s why it’s important to get away sometimes. Being pent up with anger and frustration while isolating yourself and fixating/obsessing on the injury frankly kills the healing environment. It ratchets up stress levels, pain sensitivity, and catastrophic thoughts.
Breaking up the rehab routine and getting your mind off things is CRITICAL – you have to get out, have some fun, and give yourself a break from the entire process. Odell certainly knows how to do that (some might say too much but that’s a different conversation):
He went back to his alma mater, LSU, for a football game:
Got his salt bae on with Nusret:
Spent the weekend in LA for the NBA All-Star game:
And traveled abroad, taking a requisite tourist photo:
So that’s a snapshot into his physical and emotional state and recovery, but what’s his timeline to be back at 100%?
IV. Odell’s timeline for return
Based on what we’ve seen from the Odell ankle rehab process thus far, he’s on the verge of being cleared for mini-camp and nearing 100% physically.
This sentiment was echoed by Giants coach, Pat Shurmur:
he is pretty close to being fully medically cleared to participate.
If he’s at camp, I fully expect for the Giants to play it conservative and ease him back into drills. No amount of mock drills or training can mimic the intensity of actually lining up against a NFL level cornerback.
V. Short and long-term consequences
Ankle fractures and high ankle sprains, isolated or in combination, have relatively low complication rates and excellent outcomes when managed appropriately.
If there are short-term complications – like nerve or blood vessel damage – they are readily identified in most cases. Long-term complications are usually due to something being missed by the medical provider or the patient not adhering to rehab.
I’m pretty confident this isn’t the case with Odell or the Giants medical staff.
In terms of return to play implications – there’s always the chance of another ankle injury because the NFL is so physical, but that’s inherent for any player, not just Odell.
Generally, I’ll say the same thing for the Odell ankle that I say with any person coming off a serious, long-term injury: give him the luxury of time to ramp back up to 100%, both physically and mentally.
He’s going to have to manage swelling and pain in his ankle, leg, and body as they re-acclimate to the rigors of being an NFL wide-receiver. With Odell and how passionate he is about the game and performing, he’ll likely have to deal with and manage some frustration, anxiety, and stress as he incrementally progresses and tests his abilities. However, these are all natural parts of coming back after a major injury.
You gotta trust the process.
VI. All in all
All in all – the Odell ankle injury was very serious but by all accounts his surgery went well, his physical rehab has continued to progress incrementally, and he’s been bolstered by his resilient mindset, support from teammates, friends, family, fans, and his ability to decompress and take his mind off things.
I expect him to participate fully in mini-camp and that will be another step in his incremental progression as he makes his way back to the field. Odell ankle is getting stronger and he continues to re-gain confidence in his movements.
Barring any setbacks, Odell should be at or near 100% physically as we get to the pre-season. However, I wouldn’t be surprised if it takes him at least a couple games in the regular season to fully get over any lingering mental hurdles and short-comings he may have. Nothing can substitute for the intensity and stress of actual games, especially after returning from a long lay-off.
Thanks for reading and until next time.
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