Joint Dysfunction: A Limiting Constraint on (Re)-Injury Risk and Career Longevity
The Case of Taylor Lewan.
At Absolute, we utilize the careers of real-life athletes as feedback for us as performance practitioners to learn from. In doing so, we continue to establish new, never before discussed, linkages between physical capacity and career longevity. For example, this article established a primary link between absolute strength and career length.
Tragically, this article will establish a linkage between a lack of joint function and health (i.e., joint dysfunction) as a limiting constraint on career length using one of the NFL’s best offensive linemen, Taylor Lewan. Lewan’s career is on the brink of being over, and the tragedy is that it is not by his choice or his lack of hard work.
Taylor Lewan
Taylor Lewan is a current NFL offensive lineman who is in his 8th year. He was the Tennessee Titan’s first-round pick in 2014, selected 11th overall, and has been selected to three consecutive Pro Bowls (2016 - 2018). Following his third consecutive Pro Bowl after the 2018 season, the Titans rewarded Lewan’s physical dominance at the Level of Competition by rightfully making him the highest-paid offensive lineman in NFL history.
In 2019, the Tennessee Titans and Lewan were absolutely physically dominant. Titans running back Derek Henry would win the NFL rushing yards title, averaging almost 200 yards against the toughest competition in the playoffs. The Titans would lose to the eventual Super Bowl champion Kanas City Chiefs. The 2020 Titans had Super Bowl aspirations and started the season off 5-0, but in week 5, Lewan tore his ACL, and the Titans finished the season 9-7, making the playoffs but losing in the first round to the Baltimore Ravens.
Lewan underwent subsequent ACL reconstruction surgery and completed his rehabilitation. Sadly, in 2022 Lewan re-injured his ACL, and now his potential hall-of-fame career has been put on pause due to his inability to recover from this injury and get back to Point B. Having worked extensively for years now with NFL athletes, specifically NFL linemen, it is our belief at Absolute from experience that Lewan’s inability to get “healthy” is not on him. We believe that blindspots in his treatment and training process have put his career on the brink of being over.
In the video below, Lewan discusses his injury and re-injury on his and Will Compton’s podcast: Bussin with the Boys.
Lewan’s ACL Rehabilitation: Complete Failure
Firstly, understand: we do not have the specifics on Lewan’s rehabilitation. But we do not need to have the specifics of his rehabilitation to classify it as a total failure, as the sad but true reality is Lewan suffered the same injury he suffered in 2020. Even though Lewan’s rehabilitation was a total and complete failure, and as a professional, he bears some responsibility for that, the overwhelming blame should be on the performance practitioners who were organizing, programming, and managing Lewan’s rehabilitation training work and Lewan’s physical state.
Let’s use this scenario as a learning experience to explore a highly probable blindspot in Lewan’s rehabilitation that led him back to re-injury, joint dysfunction.
Joint Function & Joint Dysfunction
We conceptually understand a joint as the space (i.e., joint space) between adjacent bones or bone and cartilage that come together (i.e., articulate with each other) to form a moveable connection. Joint space is a dynamic physical capacity that is either: expanding, contracting, or being sustained and therefore is a trainable quality of the human biological system. As such, joint space is a critical determinant of joint function, which is a physical determinant of movement ability. Recall that at Absolute joint function is a fundamental capacity of Point B.
The words function and its opposite, dysfunction, are paramount to understanding for performance practitioners.
Functional joints, ones that display no capsular barriers on movement potential, act like system amplifiers in that they allow for the athlete’s nervous system to organize its internal space to efficiently and effectively move and navigate through space externally. Functional joints are the central biological enablers of the athlete’s ability to move and navigate.
When joints transform into a state of dysfunction, the nervous system's ability to efficiently and effectively move and navigate through external space at the Level of Competition is disrupted, and compensation is an inevitable consequence.
Functional joints are the central biological enablers of the athlete’s ability to efficiently and effectively move and navigate through external space at the level of competition.
Joint Dysfunction-Compensation Cycle
Dysfunctional joints then are the central biological limiters of any athlete’s ability to efficiently and effectively move and navigate through external space at the Level of Competition. As evidenced by the neurophysiological profile of an articulation as well as its anatomical location, we can be certain that an articulation or a linkage of articulations during movement is a primary feedback mechanism to the CNS regarding many important information properties that are interpreted and adjusted for both on an ongoing and subsequent movement basis. This information flow is highly dependent upon the quality of the joint and its requisite movement dynamics. When either of these things becomes compromised, the CNS is unable to accurately interpret the information. As a result, the outflow of the system becomes compressed. It is for this reason that dysfunctional joints are the generators and drivers of compensation. Ultimately this compensation can result in injury or, in Lewan’s case, re-injury, which has significantly stalled his playing career.
In our history of working with athletes from various sports, this is a common occurrence post ACLR. In fact, just recently, in assessing another NFL athlete with a previous history of the reconstruction of his right ACL, he described a feeling of his right leg not “feeling” like his left, with a perception of weakness, heaviness, and a lack of control. As a practitioner, this is a clue to a change in the neurophysiological profile of that knee, affecting the flow of information to the CNS. The information the CNS receives is more noisy, and it becomes more difficult to access the signal as to how the athlete’s movement dynamics and force production must emerge to meet demands. Sure enough, in the assessment of his knee joint, there was a lack of full flexion (limited to 120 degrees) as well as very limited internal rotation of the tibia (minimal amount). This is the definition of joint dysfunction.
The image below demonstrates a simple feedback loop on how joint dysfunction leads to compensation. If the opposite of function is dysfunction, the opposite of capacity is compensation - and it is the aim of the physical training of any athlete to utilize training to cultivate and compound physical capacity.
Major Blind Spots in ACL Return to Sport
It is well documented in the literature that ACL re-injury rates are much higher than we would like them to be. Despite increased knowledge of injury mechanisms, improved surgical techniques, improved understanding of ACL biomechanics, and enhanced knowledge in rehabilitation practice, return-to-sport rates and subsequent second ACL re-injury rates after previous reconstruction are not optimal. Although we know of no specific re-injury data in NFL athletes, there is evidence to support that 1 in 5 athletes (younger than 20 years) will sustain a re-injury to their ACL upon returning to sport.
Although there are many potential factors related to this high re-injury rate, one of the more significant ones is that of the return to sport rehabilitation in the latter stages of the program and the criteria used to return to sport. Often, in current standardized rehabilitation programs, many of what Absolute terms, the “four fundamental capacities,” are not included or are included but at the wrong prescriptive levels. This leaves the athlete ill-prepared for returning to the Level of Competition.
This is a significant blind spot. Too often, the training efforts post-surgery focus on following the protocol irrespective of the athlete, rather than actually preparing the athlete to adapt to a surgically reconstructed knee. This must occur firstly by achieving movement-specific outcomes, secondly by tissue-specific training and preparation, thirdly integrating the two, and lastly, by performance-specific.
Further, the testing of athletes at the end of their rehabilitation is very limited in its scope of applicability within the external environment. Broadly these tests are non-specific, and again the focus is on meeting the objective of the protocol rather than the necessary outcomes required for the athlete.
Unfortunately, there is a paucity of literature on what we may deem highly relevant rehabilitation and return to sport testing after ACLR. Recall, the fundamental capacities that all athletes must possess are a level of necessary absolute strength, articulations that allow for a large and controlled dynamic workspace, tissue-specific reactive strength, and speed strength that allows the athlete to be explosive.
This paper contains important information for practitioners and researchers to support optimized late-stage rehabilitation and return to sport programs and testing with a view to enhancing patient outcomes after ACL reconstruction. It aligns well with the view of Absolute.
The Dreaded Black Swan
Black Swan events are those that come with unpredictability as they escape contemporary modeling and analysis yet have devastating impacts.
It is our belief that Taylor Lewan was mismanaged and, unfortunately, now is suffering the consequences, the most significant of which is the potential loss of his playing career.
This could have easily been prevented by simply viewing the knee joint as a dynamic environment that has specific demands internally, as well as training the knee with the external demands in mind.
At Absolute, we believe that joint function and health play a primary role in the athletes' career length, even though this has yet to be addressed, identified, or even openly discussed among strength practitioners. Our belief is that joint function is either: a primary enabling or limiting constraint on the athlete’s career length is a major reason for joint function and health being one of the fundamental physical capacities of Point B.
The linkage is quite simple: when joint function is possessed by the athlete, we believe, they are enabled to play at a higher level and for sustained periods of time thus, having longer careers.