'It's not a great place to be': Why Ravens QB Joe Flacco's hip injury is worrisome

Ravens quarterback Joe Flacco practiced on a limited basis for the second straight day Friday, and coach John Harbaugh did not rule him out for Sunday’s road game against the Atlanta Falcons.

Flacco has missed the past two games with a right hip injury, ceding his starting job to rookie Lamar Jackson. Given that the 11-year veteran was off the field for almost a month and was listed as doubtful Friday, Jackson still seems likely to start against the Falcons (4-7).

But Harbaugh praised Flacco’s rapid progress, even from Thursday to Friday.

“He’s coming along well,” Harbaugh said. “We had talked about anticipating some progress this week, and he made quite bit of progress. … The biggest thing was he didn’t have a setback from yesterday.”

Flacco was not in the locker room after practice and has yet to speak publicly about his injury or recovery.

Though the exact type of injury he suffered has not been revealed — other than Harbaugh saying there was a fear of dislocation if he rushed back — doctors and former players who’ve dealt with hip injuries said there are a variety of concerns involved.

There are two main reasons not to play before fully recovering, said Dr. Danyal Nawabi, a sports medicine surgeon at the Hospital for Special Surgery in New York.

“Category No. 1 is that they don't have any lingering discomfort,” Nawabi said. “If you get them back to 80, 90 percent, they're playing at 80, 90 percent the whole season with a little bit of a nick, which then predisposes you to further injury because you're not activating all your muscles and using your joint as it should be used. That's in the short term.

“Category No. 2 is longer-term damage. Depending on how many years the player’s left ahead of him, and obviously he has a productive life after, you're potentially taking the risk of causing long-term damage to the tip if you've got certain anatomical issues that are kind of just being taped over by giving painkillers or anti-inflammatory injections and just getting the player to play. And the key thing with the hip joint is degenerative joint disease, subjecting that hip to becoming arthritic, which unfortunately we see more and more now in younger patients.”

Hip injuries can also be difficult to diagnose, said Dr. Kenneth Tepper, director of hip preservation and arthroscopy at MedStar Union Memorial Hospital in Baltimore.

“I think hip injuries make up, at most, 10 percent of athletic injuries, and the vast number of hip injuries are sprains and bruises, contusions, things that get better pretty quickly,” Tepper said. “But you can have a more serious injury where, first of all, it may take a bit more time to properly diagnose, because oftentimes people are just told that they have a sprain, and there's a lot of structures around the hip, and it’s a deeper joint than the knee or the shoulder. … Having the large mass of muscle that's around the joint and the amount of nerves that run through the joint can make it a challenging diagnosis.”

A full dislocation, such as the ones former Ravens tight end Dennis Pitta suffered, is the greatest concern for athletes.

“It's worrisome, because when your hip joint dislocates, you could also disrupt the blood supply to the hip, and the hip itself could be destroyed over a short period of time,” Tepper said. “Which is like what happened to Bo Jackson, and then require hip replacement.”

ESPN analyst Matt Hasselbeck faced two hip injuries during his long career as a quarterback — one a subluxation, or partial dislocation, when he was playing at Boston College and the other a case of severe bruising and inflammation from repeated collisions with the ground during his 2010 season with the Seattle Seahawks.

“It’s not a great place to be,” he said. “I don’t know that it’s going to crush Joe. If he’s able to play and able to play safely, I don’t think it’s going to be crushing to his style of play, because he’s not much of a runner anyway. He’s your classic pocket passer. If Lamar Jackson had this injury, it would put him on the shelf.”

He said he’d be more worried about Flacco struggling to evade defenders than about him struggling to throw off his injured leg.

Hasselbeck compared the frustration associated with a subluxation to burning the roof of your mouth. “It just stays burnt until it’s not,” he said. “It’s slow to calm down, and until it calms down, everything’s inflamed, it’s painful, it feels like nothing works. You can’t just muscle through it.”

That said, he was encouraged to see Flacco throwing in practice.

Hasselbeck can identify with the Ravens veteran in another way. He was the incumbent starter for the Tennessee Titans in 2012 but watched former first-round draft pick Jake Locker usurp his role.

He said he rushed back from offseason injuries because he was worried about the competition.

“That was really the wrong thing to do,” Hasselbeck recalled. “I don’t get the sense Joe Flacco is in that same boat. I don’t get the sense that he’s like, ‘I’ve got to get out there, even if I’m on my deathbed.’ It doesn’t feel like that. I feel like the people outside the building, on the national scene, are more ready to hand this team to Lamar Jackson than the actual people who have the authority.”

He’s a Jackson fan.

“But I think there’s more work to be done there,” Hasselbeck said. “The people on the national scene who see ‘SportsCenter’ highlights and read headlines and have NFL Game Pass, I don’t think they see it the same way as the people who are living it every single day in that building.”

Flacco returned to practice as a limited participant Thursday, the first time he’d seen the field since the team’s 23-16 loss to the Pittsburgh Steelers on Nov. 4. Flacco suffered his hip injury early in that game, when he collapsed awkwardly on a hit from Steelers defensive end Stephon Tuitt.

He played the rest of the way against Pittsburgh, but when the Ravens (6-5) returned to action Nov. 18, he was inactive and Jackson was the starting quarterback. The rookie has led the Ravens to a pair of victories and kept them in contention for the AFC’s second wild-card berth.

Harbaugh said it’s still tricky to know when Flacco will be ready for game action, though he called him an option for Sunday.

“There are still doctors involved at this point,” he said. “It’s not simple. … There’s a formula involved here, and the biggest thing with situations like this, the two biggest factors, are time and circumstances. And those are things we just don’t know — time in terms of the medical aspect of it, circumstances in terms of our team and where we’re at, how guys are playing, including the players involved.”

Harbaugh said he did not know how the injury might be bothering Flacco on the field.

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