Handling of Carson Wentz’s back fracture raises more questions about Eagles medical staff

The Eagles have had 24 players miss 137 games and counting to injury this season. They’ve placed 14 of those players on injured reserve, with an additional player on physically unable to perform reserve. Those numbers would be shocking alone, except that there have been an inordinate number of irregularities in recurrence, recovery, and diagnosis.

The mounting questions about the new medical staff’s handling of injuries didn’t reach code-red level, however, until quarterback Carson Wentz became the latest to suffer a setback under dubious circumstances.

Wentz has a fractured vertebra, Tuesday tests revealed. He is out for Sunday’s game at the Rams, questionable for the rest of the season, and, considering a recent spate of injuries, more problematic in the long term than he was just a week ago.

Of immediate concern: when did Wentz suffer the “stress injury” -- coach Doug Pederson’s semantic softening of the fracture -- without the Eagles knowing? And, how did the medical staff treat and test the back of the franchise’s most important player?

Pederson was evasive at a Friday news conference, two days after he announced that Wentz had “back soreness,” and a day after the fracture was first reported. When pressed for details, he essentially repeated the same answer: “He has a stress injury, evolved over time, and he requires no surgery.”

On Wednesday, the coach said it was an injury Wentz had “dealt with” for some time, presumably in mid-October, when his name first appeared on the practice report. Pederson declined to make any correlation, although it would be reasonable to connect the dots. Wentz also suffered a stress fracture in college, which the Eagles knew about before the 2016 draft, a source told the Inquirer.

Pederson was placed in a difficult position Friday. He has no medical training. The team’s collection of doctors and trainers don’t report to him; they report to senior executive Howie Roseman. And it’s a fluid situation, both in how the injury affects Wentz and in how it affects the game plan.

Wentz wants to play. He is as type-A as they come. In fact, type-A-plus might be a better way to describe the 25-year-old. Most players play through injury, and that is why there may be a disconnect between team and player.

“There’s a fine line with guys that can return to play that have an injury,” Pederson said, “and there’s a fine line of how far you want to push an athlete to test him to see where he’s at physically, through his protocol."

The team has become increasingly tight-lipped on injuries, dating to Chip Kelly’s arrival as head coach in 2013. Kelly seemed more interested in the sport of withholding information than anything having to do with protecting a player’s rights. At times, his downplaying of injuries didn’t reflect well on the players.

Pederson has taken a similar approach, perhaps for competitive advantages. But his awkwardness in setting timetables -- he has described players as “day to day” before they’ve gone on to miss weeks or never play again -- has only added to the overall ambiguity of how the Eagles have treated their injured:

“These athletes ... they want to get back out on the field,” Pederson said. “Sproles wants to get back out. Jalen wants to get back out. Tim wants to get back out. ... So, we’re going to put them through our own sort of internal test, right?

"And so there’s a fine line to how much we can push. And then, sometimes, within that pushing from whether it’s doctors, it could be the trainer, the player himself, there could be setbacks, because we’re trying to see where the athlete is, and that happens.”

The Eagles had their share of injuries last season, many to key players. But most of the injuries were cut-and-dried and of the season-ending kind. And yet, the numbers pale in comparison to this year, even with three games to go.

The Eagles had 23 players miss a total of 111 games last season, not including Jones, who missed 15 games after he ruptured his Achilles tendon during his college Pro Day before the 2017 draft. And they had only six players placed on IR.

Football Outsiders, which tracks the number of adjusted games lost to injury, ranked the Eagles 1, 5, 6, and 4 from 2013 to ’16. But, last year, the Eagles dropped to 13th, and they are 24th this season.

If the No. 1 reason the Eagles fail to repeat as champions is injuries -- and that has been part of the narrative from coaches and players in explaining a 6-7 record -- then the medical staff and the protocol for handling injuries must be scrutinized. Especially after the team unloaded its top two doctors and their head trainer in the months after winning the Super Bowl.

In February, Chris Peduzzi “stepped down” as head trainer, although sources have since he was forced out. In June, the Eagles announced that Peter DeLuca and Gary Dorshimer would no longer be their head physician and internist, respectively. All three worked with the organization for about 20 years.

Peduzzi’s replacement -- Jerome Reid -- wasn’t hired until June. And Christopher Dodson and Stephen Stache weren’t announced as the Eagles’ new head orthopedic doctor and head physician, respectively, until August. Normally, the orthopedic doctor is the head physician, but Dodson doesn’t have that title.

He does, however, with the 76ers.

Roseman has yet to comment on the medical-staff turnover and won’t likely be available to reporters until after the season.

“I’m not even going to comment on that either,” Pederson said.

DeLuca, Dorshimer, and Peduzzi have declined to comment. DeLuca and Dorshimer were never made available to reporters while with the team, but former coach Andy Reid would routinely have trainer Rick Burkholder answer questions and explain injuries.

Pederson has been the sole spokesman, but he said that he had a “high level” of trust with the medical staff because “of the communication that we have, myself, Howie, our docs, Jerome, [director of rehabilitation] Shireen [Mansoori], everybody involved.

“We’ve had a lot of really good conversations, a lot of really good protocols put in place for every injured athlete we’ve had this season.”

Of the players who have dealt with abnormalities, most have declined to comment or been unavailable. Sproles, when he finally returned, said that the medical staff had been doing the best it could. Jones also has not been critical.

The Eagles didn’t make Wentz available last week. He spent most of his offseason rehabbing after he tore two ligaments in his left knee just over a year ago. He was aggressive in his approach and surprised many observers when he was a full participant during one of the first practices of training camp.

But the Eagles dialed Wentz back the next day -- he made it clear that he felt otherwise -- and he was limited for the next four weeks. Wentz set the regular-season opener as his goal, but he fell short and missed the first two games.

When he returned against the Colts, Wentz came out guns a blazing and looked as mobile as he did before his injury. He sustained a high number of hits over the next several games, though. On Oct. 10, the day before the Eagles traveled to face the New York Giants, Wentz didn’t practice, the official explanation being, “Not injury related -- rest.”

His name returned to the practice report the following Wednesday, when he was limited with a “back” injury. An Eagles spokesman said there was nothing serious and that Wentz would return to practice and play that Sunday against the Panthers. The same sequence occurred the following week, before the Jaguars game.

Pederson said Friday that Wentz was tested during the season, although he didn’t say when. Asked why the stress fracture hadn’t been identified earlier, Pederson said, “Because, at the time, probably it wasn’t identified.”

A small fracture can be difficult to detect with a CT scan.

But players such as receiver Jordan Matthews said they had known Wentz was playing through pain. He suddenly stopped running as much, wasn’t connecting on as many deep passes, and was missing on throws he typically makes.

“We saw the missed throws,” Pederson said, “but we’re not linking the two together.”

Pederson also said that Wentz didn’t fracture his vertebra because he was compensating for his surgically repaired knee, although it would be difficult to prove either way.

On Friday, Wentz met with his own doctors. Seeking second opinions isn’t unusual, and the Eagles have had players who sought treatment away from the NovaCare Complex. Some still see Dorshimer.

The previous medical staff endured its share of complaints. Matthews said that he received the wrong diagnosis on two occasions. Former Eagles linebacker Emmanuel Acho has been openly critical of his treatment. The DeLuca-Dorshimer staff failed to detect an aortic aneurysm that could have killed former Eagles long-snapper Jon Dorenbos.

Medicine isn’t an exact science. The same could be said of injuries, which affect each player differently. A veteran Eagles player recently said that there hasn’t been a game when he’s played without some issue. Injuries are often the cost of doing business at the highest level of the sport.

“A lot of injuries occur because of the nature of the sport, the violent hits of this sport,” Pederson said. “Guys know exactly what they are getting into, even at a young age, and Carson is no different.”

But how much Wentz knew about his fractured vertebra remains an unanswered question.

The Eagles have had 24 players miss 137 games and counting to injury this season. Three more players (Jordan Mailata, Josh Sweat and Isaac Seumalo) and a least 17 more games lost will be added to those numbers after Sunday’s game at the Los Angeles Rams. Here’s a complete list of the injured:

Name, Position, Games Missed, Injuries, Designation

*Ruled out for Sunday’s game at the Rams.