Sports Medicine Doctor Weighs In on the Chiefs Guard

In the modern NFL, offensive skill players tend to steal the spotlight. That’s especially true when you’re talking about the Kansas City Chiefs. With the likes of Patrick Mahomes and Travis Kelce on the field, who else are you going to focus on?

Well, offensive line play might not be visually exciting, but it’s a key part of the club’s success. And guard Joe Thuney has been essential on the left side of the line.

But now, there could be a problem.

During KC’s divisional-round victory over the Buffalo Bills, the veteran guard suffered a chest injury. While it seems as if he avoided the worst possible outcome (a torn pectoral), he still missed Wednesday and Thursday’s practices with what the team is labeling a pectoral issue.

Based on reports from league insiders, it doesn’t seem he’s likely to play against the Baltimore Ravens in Sunday’s AFC Championship game. That will be a major blow for the Chiefs—Thuney shines in pass protection, but he also creates space for running back Isiah Pacheco—but it does make sense. Linemen have to push to create space, and pushing motions stem from your chest.

But wait, you might be saying, this is playoff football. Can’t Thuney tough it out? What’s the worst that can happen?

With that in mind, we spoke with Dr. Leon Popovitz, an orthopedic surgeon and co-founder of New York Bone & Joint Specialists, to learn a bit more about what the lineman could be facing.

We’re talking about Joe Thuney of the Chiefs, and there was an initial fear of a torn pec, but now it’s looking like it’s more of a pec strain. So, from a medical perspective, can you just explain what the actual difference is between a strain and a torn pec?

Sure. So the pectoralis muscle has two different layers. They originate from two different locations, and then you can…obviously see the pectoralis muscle. It’s kind of like the breast muscle there at the front of our chest. And they both kind of join together and attach to the humerus, which is the arm bone up on top.

And because of the unusual anatomy of that muscle, if there’s uneven or eccentric contraction and a sudden load on that muscle, it’s subject to or it’s prone to injury. The injury often, if it’s a tear, occurs where the fibers that are attached to the bone start ripping off the bone. So the attachment starts getting ripped. If it’s not fully torn, it could sometimes be a partial tear, where some of the fibers are ripped off, or it could just be a strain of the actual attachment.

But the key to the mechanism and why they often look similar is because of the eccentric load. More often than not, outside of [the] NFL, these injuries occur from weightlifting. So, when you’re weightlifting…you put very extreme and full tension on that shoulder as you’re bringing the arm down. And when that muscle is fully contracted unevenly…and then there’s sudden pressure on it or sudden tension on it, that muscle starts failing or ripping.

In football players, it’s a little less common to occur actually in weightlifting, and it’s more actually common to occur [with players] such as in defensive linemen or even the quarterback sometimes. Because what they do is they bring their arm in this position of 30-degree extension, and they have full or maximum contraction of the muscle. But during, you know, strenuous and unpredictable situations, that contraction might be in an awkward position, what’s called eccentric contraction, a contraction that’s not even throughout but it’s at maximum level.

And then, at the same time—for instance, if the lineman or the defensive back is holding their arm in that kind of contracted position to brace themselves for either a tackle or any kind of contact—excessive tension can occur while their muscle is unevenly contracted. That can cause rippage or partial tearing of the muscle.

Now this injury would have happened last weekend, and the AFC Championship is this weekend. So trying to play with a pec strain a week later, since we’re talking about an offensive lineman doing a lot of pushing, a lot of blocking, things like that, will that just be a pain tolerance issue? Or will it be more physically not being able to generate force while pushing?

So if the MRI does not show a full avulsion, a full tear off the bone, then much, much of the issue will be pain tolerance. If there’s some partial tearing or kind of interstitial tearing like in the belly of the muscle itself, then they’ll probably have some level of weakness or not have the same level of strength. But, again, if it’s not fully torn off, even if there is some partial tearing, it should heal in time.

Obviously, professional athletes are a different breed. So for professional athletes sometimes, because it’s their livelihood, because of the different level of strain they put their bodies in, they often have to return when other people would not return to play. So normally people would return to play after three to six weeks after an injury like that.

If there’s no full avulsion, if there’s no full tear off of the bone, the attachment is still intact, typically you can, theoretically, for a professional player, return to play. But they’ll definitely be feeling the pain and some level of weakness, even the pain in of itself can cause some weakness in the muscle.

Let’s say he does try to play with this strain. What’s the worst that could happen if he’s trying to play through it? A fully torn pec?

Depends upon the type of strain. They categorize the type of strains. The first type is just a contusion or like a blow to the muscle itself, which it doesn’t sound like it’s the case here, or just a simple sprain, where the muscle has been overloaded but it has not torn or even partially torn. That’s a relatively safe situation, and the likelihood of a full tear is small.

If it’s a type two, where there’s some partial tearing to the attachment, then there simply is a risk of it fully tearing.

And a type three is a full tear.

I know we touched on the recovery time a little bit, and you said a normal person is out for three to six weeks.

So do you think that it’s fair to say—obviously without knowing the full details—that if the Chiefs were to win this weekend and the Super Bowl is two weekends away, that he would be materially improved by then?

I would expect so.

Again, the real key is if there’s no avulsion, there’s no actual tearing, even partial tearing off of the bone. If there’s not any significant tearing or minimal tearing, then I would expect yes, that’d be the case.