Rob Gronkowski, the lively tight end originally drafted in the second round of the 2010 NFL draft by the New England Patriots, suffered a significant back injury on November 13, 2016 after absorbing a large hit from Seattle Seahawks safety Earl Thomas. This caused him to be able to only play 8 games during the 2016 season. In those 8 games Gronkowski was able to manage 25 receptions for 540 yards, including 3-100+ yard games and 3 touchdowns. The previous year Gronkowski posted a monstrous line of 72 receptions, good for 1176 yards, 5-100+ yard games and 11 touchdowns. This was the 5th time in 6 years that Gronkowski scored more than 10 TDs, which is an impressive feat. If you drafted him last year, these are very disappointing results. He likely cost you a top-30 pick, depending on your league size and settings. For the past several years he has the consensus #1 tight end in Fantasy Football, and for all but 2 years of his career he has been a top 5 tight end. Of course those 2 years that he did not finish in the top 5, both ended in injuries. The purpose of this article is to discuss not only the recurrent injury that continues to plague him, as well as project whether or not he should be the #1 drafted tight end this year.

Back injuries have plagued Gronkowski’s career for many years. During his time in college at the University of Arizona, Gronkowski suffered a disc herniation that led to pain, numbness and weakness in his legs which then caused him to miss the 2009 season following a microdiscectomy procedure. Then, during the 2013 season Gronk suffered a complicated forearm fracture which caused him to miss half of the season. During that interval he decided to undergo a second microdiscectomy, however this was on a different vertebral disc than the original operation.

It is the nature of back injuries unfortunately that these rarely completely heal 100% to preinjury, but instead the pain, numbness, and tingling become more manageable. However, when an athlete continues to take such vicious hits as Gronkowski does, catching a perfectly-placed ball over the middle of the field thrown by Tom Brady, those very tender bulging disks in his back unfortunately can worsen very easily. One major hit can cause a previously stable back condition to become unstable. Which in turn causes a sometimes unbearable amount of pain in the legs, secondary to nerve compression. It was this hit by Earl Thomas, presumably, that led Gronkowski to get an MRI. This revealed that he had another disc herniation, and nerve compression, that was likely too unstable to continue to play with. It was at this point, that the Patriot’s medical staff and Gronkowski himself decided to fly to Los Angeles and have him undergo a third spine surgery, another microdiscectomy. Let’s talk about the injury that has so many Fantasy Football enthusiasts too concerned to consider drafting him at his current ADP.

How does a disc herniation occur?

Disc herniation occurs in the lumbar spine in athletes from a mechanism of axial loading and rotation of the flexed lumbar spine. Lumbar disc herniations happen to be more common in obese athletes because of their increased risk for premature degeneration of the disc. Any time an athlete experiences acute back pain, there is a concern for disc herniation; as opposed to subacute or slowly developing pain which is more likely musculoskeletal in nature. Radiculopathy may develop secondary to inflammation of the nerve roots.

Anytime you’re dealing with the spine, vertebrae, and spinal cord there is always a major concern for paralyzation, as well as subsequent less-severe sequela. There is a condition called cauda equina syndrome, which is very severe and potentially life-threatening, and requires emergent intervention. These patients typically present with bilateral leg pain, sometimes accompanied by bowel or bladder dysfunction. Anytime there is a major back injury, questions about loss of bowel or bladder function should always be addressed.

How are disc herniations diagnosed?

First the physical exam by an appropriately-trained medical staff can help to narrow down the potential causes of the injury. Then, if imaging studies are needed, X-rays are usually the first test of choice. These may show loss of disc height, but are typically negative. MRI is the best imaging of choice, as it may be helped to identify any acute traumatic herniations.

How are disc herniations treated?

Management of disc herniations often consists of conservative measures, which include rest, anti-inflammatories, appropriate rehabilitation, and sometimes the use of epidural steroid injections for refractory pain. In the case of Rob Gronkowski, surgical intervention was called upon in all 3 instances since the non-operative management was ineffective.

The average return to play after conservative management of lumbar disc herniation is about 6-8 weeks, but one study has shown that the average return to play at 100% is closer to 5 months. A single-level lumbar disc surgery did not appear to limit or compromise any sporting activities in one particular study. Mind you that there is a huge difference between returning to a ‘regular’ job, like working on a computer or seeing patients throughout the day, after back surgery and one that requires full sprinting and colliding with men who generate massive amounts of force with 200-300 pound-frames is a completely different story. So the return to play estimation always has to be taken with a grain of salt.

What is a microdiscectomy?

A microdiscectomy is a minimally invasive procedure where the surgeon identifies the small disc herniation causing the issues, and then removes part of this disc that is compressing the nerves. This then results in alleviation of the pain and restoration of the weakness being caused by the disc compressing on the nerve. While the name of the surgery is quite scary, that’s basically the extent of it.

In light of this surgery, what should we expect for Gronkowski’s 2017 season?

At only 27, Gronkowski has already undergone 3 microdiscectomies, so this is very concerning. Now consider the fact that he is a very physical tight end playing in the NFL with loads of talent, and you have yourself a predicament. In light of his injury history, Gronkowski will not be able to last in the NFL for too many more years, so the time he does play he has to make count. How long that is, that’s anybody’s guess. I would not recommending drafting him in a Dynasty league, as even though he is a beast when he is on the field, his potential to get hurt is simply too high.

Gronkowski is simply running out of lumbar vertebrae to damage, and with each surgery the axial load and force is shifted on to one of the other nearby vertebrae. The most common site for disc herniation is at the bottom to lumbar vertebrae, which are L4/5 and L5/S1. Gronkowski has to learn to protect himself when he is running over the middle of the field, as he cannot sustain too many more major hits simply because his lumbar spine cannot tolerate it. If he were to sustain another severe lower back injury to any of these lumbar vertebrae, he would likely require what is known as a spinal fusion surgery, which would essentially end his NFL career.

Gronkowski is currently being drafted as the top overall tight end in a 12-team standard league with the ninth pick in the second round (2.09). In a 12-team PPR league, Gronk is being drafted about the same exact location, still the top tight end, averaging the 22nd pick of the drafted. This puts him in the same region as Marshawn Lynch, Todd Gurley, Leonard Fournette, Doug Baldwin, Brandon Cooks, and DeAndre Hopkins. Travis Kelce, the current #2 tight end being drafted, is being taken in the end of the third round (3.11) of 12-team PPR drafts. Currently, the top 5 tight ends (ADP wise) are Gronkowski, Kelce, Jordan Reed, Greg Olson and Jimmy Graham.

If you want Gronkowski, you’re going to have to pay for him. This isn’t like a couple of years ago when he was falling into the later rounds of the draft after he suffered that major forearm and he was returning from his second back surgery in the previous season, where he became a potential steal. Despite his massive injury risk, Gronk is still being respected for his on-the-field work, his significant role in the New England Patriots offense, and perceived superiority over the other tight ends in the league. Personally, despite being a devout Patriots fan, I will not be drafting him because he is simply too risky for me and I would rather draft a player in the second round with much less risk. I will likely be settling for either Jordan Reed, a wild card guide like Martellus Bennett, or sleeper picks like Delanie Walker or Hunter Henry. As much as I love Gronk, and his off-the-field antics, I cannot justify spending a pick on him with that much risk that early in the draft. Fantasy aside, I hope Gronkowski has another healthy and productive year in 2017.

This was written for the @TheFantasyDRS by Dr. Jesse Morse. I am a Board-Certified Family Medicine physician, and I am currently completing a Sports Medicine Fellowship at the University of South Florida in Tampa. If you have any questions or comments, you can contact me directly at @DrJesseMorse or visit my website at: www.DrJesseMorse.com. Keep an eye out for my next article!