ProFootballDoc: Justin Herbert Rib Injection is Biggest Question of the Day

Rib cartilage injuries are painful. A flak jacket or padding is never enough. If it hurts to cough, sneeze and laugh, imagine playing in a NFL game with all the twisting and turning to avoid tackles and throw the football.

This is why intercostal nerve rib block have been done for decades routinely in the NFL. The numbing injection takes away the pain for the rib and the when the attached oblique, intercostal and abdominal muscles pull on the area.

As a NFL head team physician, I have performed about two dozen of these injections on quarterbacks and nearly 100 times on all positions across almost two decades. Philip Rivers had a 240 game consecutive played streak with the aid of these injections at least 20 times (and his underlying toughness). Over his career, he played through several rib issues and each time would get these blocks pregame in the training room for several weeks until pain free. (Permission granted from Rivers so there is no HIPAA violation here)

Ask any head team physician across the league. This is part of the job. No question there is risk to the lung as happened two years ago with Tyrod Taylor but there are ways to do it safely. In fact, ultrasound is routinely available in locker rooms now to assist to know exactly where the tip of the needle is.

Of course it is a players choice whether to take the injection. Based on recent circumstances, James Conner said publicly that he was reticent to inject his ribs last season and that is his absolute right.

The injection itself is painful but with the rib area numb it allows for full normal performance, until the medicine wears off. Indeed it can be more painful after as one won’t know if the injury was aggravated during play. Either way, this injury will affect practice time next week and in the coming weeks.

Information from Chris Mortenson provided some clarification but also begged more questions.

This explains the line shift from Chargers -7 to -3 and Chase Daniels taking all first team snaps on Friday. He does confirm ultrasound would be used if injected. But the question remains why the injection had mixed results. In my time in the league we didn’t routinely do mid week injections to reduce risk as we had confidence the rib blocks would be 100% effective. No doubt a Toradol injection will be given too but that is has systemic, not local affect.

If Herbert or the Chargers decide not to do a rib block or can’t play this week, he still will not be full go until well into October. In the end, this is not a one-week dilemma, but of course it improves each week.

Written by Dr. David Chao

David Chao, MD -- known digitally as Pro Football Doc -- is an expert contributor for Outkick. Chao spent 17 seasons as the team doctor for the San Diego Chargers (1997-2013) and is part of the medical team at OASIS in San Diego where he treats and specializes in orthopedic sports injuries, working with high-profile professional athletes from the NFL, NBA, and MLB.

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