Andrew Luck’s calf and high ankle injury assessment from a Holistic – Sports Medicine Physical Therapist’s perspective.

Danh Ngo"Staying Active" Division, Ankle Pain, Shoulder Pain

Andrew Luck is having a rough time starting the NFL 2019 season. This season can define his status as an elite quarterback in the NFL or not.

He has physically gone through a lot of events that could have been prevented. This article goes over the timeline of his injuries. Everything happens for a reason, and Andrew Luck’s sequences of injuries show this.

We will breakdown why his body is doing what it is doing and how to rehabilitate from a combined Holistic, Sports Medicine, and Orthopedic specialist perspective. Click Below on the picture of HERE to watch the video of Dr Ngo’s explanation.

Here is the order of his injury.

Week 4 to 6 of 2015 season: Andrew Luck missed 2 in-season game due to a “sore” Right shoulder. Later found out that he suffered 2 broken ribs to the Right shoulder complex. (click HERE to read)

Oct 2015 season: Diagnosed with “sustained torn cartilage on two of his ribs and was still coping with significant pain”.

Game 9 of 2015 season: Andrew Luck reported ankle injury.

November 2015: Andrew Luck suffered an abdominal injury and lacerated kidney late in Sunday’s 27-24 win over the Denver Broncos (click HERE to read on this past injury).

Offseason 2015: Andrew Luck had an Acromionclavicular Joint injury while snowboarding. (Click HERE to read).

January 2017 + Rehab the entire 2017: Right shoulder labrum surgery

2018: Andrew Luck got the COMEBACK Player of the YEAR award!!!

March 2019: LEFT Calf strain to “high ankish” injury with talks of it being an Os Trigonum problem. (Click HERE to read.)

Aug 2019: Realize it is front ankle situation, even if the pain is near the Achilles Tendon region as Andrew Luck is having trouble rolling out of the pocket (lateral and rotational movement). (Click HERE to read).

Andrew Luck has admitted that the injuries have affected his confidence and mind at times as a result of these injuries.


We would like to start by saying that the body works together, heals together. There is no one injury that does not impact the entire functionality of the human body’s ability to move well. The good news, and the reason in writing this article is to demonstrate how Andrew Luck’s situation makes perfect sense.

Although it is easier to talk about it after the fact. You cannot predict who will get hurt, but the odds are stacked against Andrew Luck.

We will start from a biomechanical perspective first.

This is just a fancy word that implies the influence of your bone, joint, and muscles in helping you to move.

Bones connect to form a joint. The joint is surrounding by connective tissues and ligaments. We call these tissues as a passive restraint. They limit bones from moving too much.

A dislocation is where your bones moved too much and it stretched the joint capsule and ligaments.

Muscles move bones and impacts joint health. If you have weak muscles, then your joints suffer from excessive compressive and/or shear forces. Elders know this as arthritis.

There are two types of muscles. Phasic muscles, or fancy for muscles that stabilize the joint. Lastly, tonic muscles, or fancy for muscles that produces big movements. If you have more tonic than phasic muscle activity, you will have a movement that puts more pressure on your joints. We like to say that this particular movement option is similar to driving with your parking brakes on. It is possible but comes at a cost.

Where are we going with this?

With Andrew Luck’s recent calf strain, os trigonum, or front ankle situation, you have to understand that all three of these situations become problematic when you have an imbalance of phasic and tonic preferences.

If you do not own the ability to move well, it will come at the cost of your muscles, joints, or both.

A calf complex is a group of 2 muscles. They are designed to give you explosive power. Your deeper shin and arch muscles are necessary for making sure you get the most out of your calves. This list of muscles includes your Fibularis Longus, Posterior Tibialis, Posterior Anterior, and Toe intrinsics group. They function in making sure your joints are positioned in the proper setup to leverage the power of your calves.

Imagine a trampoline. The ankle and foot stabilizers are the stilts, while the calves are the springs and “jumpy material”. Sorry for the advance vocabulary skills.

As Andrew Luck is demonstrating a high activity, and thus complaint of discomfort, when using his calves complex, we can safely assume that he does not have a sufficient ratio balance of tonic and phasic muscles.

Now, we run into the chicken-or-the-egg dilemma.

Why is Andrew Luck’s body choosing to use a high-pressure strategy to play quarterback?

If the joint is not stable, your tonic muscles have no choice but to be over-active. This is the reason for the subsequent reports of a high ankle sprain, os trigonum, or front ankle problem.

There is a bone in the middle of the ankle joint called the talus. The talus is a floating bone and impacts your rearfoot, called the calcaneus. Your Achilles tendon and calf complex attach to the calcaneus bone. Your calcaneus impacts whether you have a well-supported foot or not.

We commonly find that the talus is too mobile, or hypermobile, in many people after a low ankle sprain. When the talus shifts too much, it blocks the mechanics of your ankle and foot to leverage optimal use of your muscles.

If you force jam your ankle and limit the amount of movement that occurs at the low ankle complex, you get a rarer high ankle sprain. This is a much longer rehab. We have not concluded whether Andrew Luck has this or not, but a high ankle sprain makes it difficult to move out of the pocket or laterally.

As for the os trigonum bone, we believe the high activity of the calf muscles can cause an overuse tension point at his os trigonum. The os trigonum bone is the victim of improper use of Andrew Luck’s ankle, foot, and leg complex.

If every muscle in his leg is seen as an instrument in an orchestra. Andrew Luck’s song sounds very off-tune.

In summary, the key to Andrew Luck’s biomechanical and orthopedic rehab is to make sure we get his small ankle muscles to move well at all time. We will support his ankle joint with sports tape to ensure proper joint movement and not too much mobility. Lastly, proper calf muscle integration to his leg, pelvis, and spine.

Next, we will add a Sports Movement perspective.

Our body produces power and athletic movement through a whole-body kinetic sequence. This is a fancy way to say that the body transfer energy from your leg’s impact into the ground, and the ground back into your leg, pelvis, spine, and up to the arms.

Your spine and core muscles function to be a bridge between your upper and lower body. We can get into more details and the nuances of kinetic movement, but for the sake of this article, we will keep it short. Your ability to use your spine and the joint health impacts whether you will have a dispersed or connected kinetic force transfer.

In the case of Andrew Luck, he had 2 broken ribs. Broken ribs are like train tracks that are imperfectly lined up and impacts your ability to move well. This does not mean you cannot perform at a high level, as many professional athletes have strong careers after broken ribs. We are saying that there are “behind the scenes” consequences and compensations that occur after having a broken rib.

If the new habits are impactful to your sport or functional goal, then you will have recurrent injuries that are hard to shake off.

The shoulder is an area that requires a well oiled (healthy) scapula and torso to work at a high demand and fast pace situation, consistently. The keyword is consistent.

As he sprained his AC joint and broke his ribs, he destabilized his shoulder tremendously. He cannot harness the power of his legs, as the highway that connects his arms and legs, had suffered an abdominal injury and kidney laceration.

After 2015, his upper body went from efficient to inefficient. It went from low pressure to high-pressure strategy. You tend to become more front shoulder dominant. This includes more biceps and pectoralis minor activity.

If you go back to the biomechanical perspective, the high force strategy of being front shoulder dominant, destabilized his shoulder joint. One key shoulder stabilizer is your labrum. This is what Andrew Luck had surgery on.

In summary, Andrew Luck had a nagging shoulder problem because he could not harness the training of his legs due to the injury to his torso. This resulted in a high-pressure way of shoulder use, which amplified any possible shoulder instability.

Lastly, our Holistic Medicine perspective.

This is new to many reading. There are 4 concepts.

  1. Every organ stays healthy and is shown by its mobility and motility.
  2. Every organ has ligaments and fascial connection to it’s surrounding muscles and joints.
  3. Your organ is more important for survival reasons. Your circulation and nutrients favor your organ over your neighboring muscles.
  4. Your neighboring muscles will develop a high-pressure movement strategy to prevent yourss from jarring more to the visceral organ that is in need of protection.

The lacerated kidney is what is the thorn that no one is possibly addressing. From our specialty in Visceral Manipulation, we understand that trauma can stunt the natural rhythm that every organs needs to have.

Your kidneys move up to 4 inches vertically. As your muscles stay healthy with a flexing and relaxing movement pattern, your kidney stays healthy as it moves too. This is called visceral mobility.

There is a visceral motility. This is where every organ has a natural beat that it goes through. Andrew Luck’s kidney may possibly still be in a state of shock or stiff as a result of being lacerated.

As our muscles get injured, it develops tension and stiffness that is felt within the fascial connective tissues. Your kidney is no different.

Your kidneys have renal fascial connection to your pelvis and sacrum. Your kidneys are near your lumbar spinal nerves. The connection to your bladder has an influence on the sacral spinal nerves.

So far, Andrew Luck has a less mobile kidney. This kidney impacts him from possibly having supple lower back muscles. The nerves gets impacted as being indirectly associated with the kidney.

When a neighboring spinal nerve does not get adequate movement to maintain optimal health, the ability of the nerve to communicate to the muscles become slow and delayed.

The ankle region is impacted by the sacral spinal nerves. A slow nerve talk causes the joint to move too much and/or the muscle to underperform. Add high reps and force strategy, then you have an overworked calf complex, aggravated os trigonum and subsequent front ankle situation.

We would like to believe that Andrew Luck needs TLC (tender, love, and care) to his kidneys and associated fascial connections to his lumbopelvic complex.

BONUS: If we incorporated our clinical neurology and cranium manipulation perspective, we have no doubt that Andrew Luck will be at the top of his game. We can safely assume that concussion and brain health could be improved as a Football player.

There are numerous research that demonstrated the impact of an athlete’s ability to move well to dampened after having a concussion. The vestibular and visual impact on movement and performance is undeniable.

As a quarterback in the NFL, he needs an accurate eye-hand, eye-body balance, and brain-body coordination to do well. With is trouble in coming out of the pocket, we can suspect that there maybe some eye-body disconnection.

Imagine yourself riding a bike. You see something to the side of your eye. You turn your head, and you feel your bike steering in that direction. Your body follows your eyes. There is a strong influence of the vestibular system on your ankle stability.

As there are numerous nerves that comes out of your skull to connect nearby your shoulder, heart, and gut, we can theorize that his shoulder mechanics could be influenced by the anatomical nerve connection. In the game where 1% performance improvement can set you apart from your competitor, Andrew Luck game can be enhanced and rid of injuries by having treatment from a clinical neurology perspective too.

As a mind-body medical provider, we will educate him on fear beliefs, and address any subconscious PTSD movement tendencies. We will encourage him that he has many reasons to believe that he can still be one of the great quarterbacks of his time.

The reasons are that there are sensible gaps in his care that indicate an opportunity for him to only improve.