Playing with pain a way of life for Eagles and other NFL players

Jason Kelce ruptured the bursa sac in his left knee. Lane Johnson had a herniated disc that sent shock waves down his leg. He still does. Connor Barwin hyperextended his elbow.

Their injuries, however minor, never popped up on the Eagles' injury report this season. The players spoke of their various injuries as if they were bankers talking about the occasional dip in the stock market - an occupational hazard.

"It's not really anything structural, and it really doesn't hurt during the game," Kelce said last month. "But the next few weeks, your knee is swollen and [stuff]. Now it's fine. I hit it again in a game last week. It hurts. It's like a bruise."

It's unlikely the Eagles, in this most disappointing of seasons, were trying to keep the injuries secret. Every player is hurt, or there's a difference between being hurt and being injured, as they like to say in the NFL. But the dividing line is thin, and since Chip Kelly became the Eagles' head coach, it's become a fuzzy one.

"I'm not a medical doctor," Kelly said when asked recently why he seemingly takes a hands-off approach to his players' injuries. "So I think it would be very foolish of me to say,'Yeah, I don't think he has a concussion. Go back on the field.' That's kind of preposterous, I think."

Kelly may be one of the worst offenders when it comes to withholding information, but almost every coach is guilty of handling injuries as if they were top-secret. The league mandates practice and injury reports, but the only information offered is a basic description ("ankle"), the level of participation ("limited"), and game status ("questionable").

Every team is looking for an edge and there is no benefit to disclosing details.

"I think most coaches, especially in season," Kelce said, "want injuries not to be talked about at all."

Only after the season does the extent of some injuries become known. Eagles tight end Brent Celek once played an entire 16 games with a torn labrum and half of another season with double groin tears. The concealment, in some ways, does the players a disservice, but they are often partners in the operation.

It's football, and Rule No. 1 in football is you don't talk about injuries - or at the least publicize them. There's too much at stake. Playing through the pain is all part of the job. Coaches ingrain that in the players from almost the very start.

"Even when you're a little kid - you get the wind knocked out of you, you get hit, you break your arm, whatever," Eagles quarterback Mark Sanchez said. He then referred to his former coach at Southern Cal: "I remember Coach [Pete] Carroll would say, 'Have you ever seen a three-legged dog? Besides not having the leg, what's the difference? They still run around with all the four-legged dogs.'

"And he would give that speech just about every year when guys would get nicked up. It was a reminder that either you're hurt or you're injured. If you're hurt, get your ass out there and play."

For Sanchez, the worst injury he said he played through in the NFL was a torn posterior cruciate ligament in his left knee his rookie season with the New York Jets. Kelce broke three bones and tore capsules in his foot in the season finale of his rookie season. The center finished the game and had surgery a week later.

Johnson, like many of the Eagles interviewed for this story, said he played through a high ankle sprain. They typically require two to four weeks of recovery. Barwin said he soldiered through more severe elbow hyperextensions in 2011 and 2013.

Brad Jones, whom the Eagles released two weeks ago, said he played eight games with a broken shoulder in 2010 - not a separated shoulder. He said his shoulder would dislocate three to four times a game. He finally went to see the Packers trainer.

"He did one test," Jones said. "Just touched it a little and it completely popped out."

He was promptly placed on season-ending injured reserve.

Celek said his shoulder popped out every game of his rookie season. He actually tore his labrum in college, but delayed surgery because of the draft and then throughout 2007 because he knew it would hinder his chances of staying with the Eagles.

"As a fifth-round pick, you have nothing guaranteed," Celek said. "You're either on the field or you're out of their mind. That's just life. And I just knew there's no way. If I wanted to play, if I want to do what I wanted to do, I just had to play through it."

Veterans, particularly Pro Bowl tackles such as Jason Peters, have more leeway. That isn't to say he has nursed injuries longer. But teams are certainly more patient. Peters suffered a quadriceps injury in October. He said then that it was the worst injury he had played through in his 12 NFL years.

Was it his decision or the Eagles'?

"It's Chip's decision," Peters said then. "He took care of me and I went out there and did what I had to do. He told me he was going to take care of me. And I just went out there and played on Sunday."

Peters said that Kelly "took care" of him by limiting his participation in practice. He played the following game, but was injured again the next week against the Panthers. He had to be carted off the field. The Eagles said he suffered back spasms. Kelly suggested that he would be back after the bye.

But Peters didn't play in the next two games. He said he had a pinched nerve in his back that was causing the pain in his quad. On the Wednesday before the Dolphins game on Nov. 15, Peters said that if the game were played that day he would have been able to go.

Peters was deemed "questionable" on the injury list that Kelly said the medical staff handles. He tested the quad two hours or so before kickoff, but was ultimately held out. Johnson, who had to move from right tackle, said he didn't know he was starting at left tackle until the inactive list was released 90 minutes before kickoff.

"Ultimately, I make the final decision on who the inactives and actives are," Kelly said.

The Eagles lost to the Dolphins. The next week Peters again went back and forth between practicing and not practicing. Before that Thursday's session Kelly said the tackle wouldn't go. However, when practice opened Peters had his full uniform on and was participating.

Johnson said he didn't know of Peters' availability for the Buccaneers game again until the inactives were released. Peters was active this time. He played until the fourth quarter after the Bucs took a 38-17 lead. He said he pulled himself.

Kelly said it was a mutual decision.

"I get input from him on how he feels," Kelly said after the Bucs game. "So we have a discussion on how he feels, but I'm not going to make a player go play if he tells me he's hurting."

But what if the player is hurting and he says nothing or if he's obviously injured and wants to play? Kelly allowed Todd Herremans to play through a torn biceps last year against the Texans until it was clear he wasn't helping the team.

"I don't have any rules on playing through pain," Kelly said. "I defer to our doctors and medical staff on every injury."

Rookie receiver Nelson Agholor told reporters days before the Cowboys game earlier this month that he was playing even though he had missed the previous two games with a high ankle sprain. But he ended up not being active. Kelly said Agholor wanted to play, but he stepped in and held him out.

"I just felt that he needed a little bit more time," Kelly said then, "and I wasn't going to rush him back from it."

Most coaches are evasive when asked about their players' injuries, but Kelly is purposely vague and has increasingly become indignant when pressed for answers. Early in his tenure, when he was asked about an injury, Kelly brushed off the questioner by saying he would provide Eagles athletic trainer Chris Peduzzi to give details.

Peduzzi has yet to meet with reporters in Kelly's three seasons. There aren't many teams that make their medical staff readily available, though. Andy Reid, Kelly's predecessor, was an anomaly. He gave out injuries at the start of every news conference and would often have trainer Rick Burkholder explain the intricacies of more complex injuries.

The day linebacker Kiko Alonso had arthroscopic knee surgery, Kelly declined to give details when asked to confirm.

"If a player wants to talk about what goes on with him, that's entirely up to the player," Kelly said on Oct. 1. "I'll give you an update on when he's in, when he's out, and when he's back. It's going to make my life a lot easier."

Last Monday, Kelly was asked whether Sam Bradford, who had missed the Bucs game with a concussion and a shoulder injury, would be at the practice that followed his news conference.

"I'm done with the updates," Kelly said. "You guys will see him on the field. You guys can get it then. I gave you an update last week [about Peters] and I was wrong, so I don't want to be wrong again."

With gambling and fantasy sports, tracking NFL injuries has become a cottage industry on the Internet. Fans eagerly await the latest news and do so by following reporters via Twitter. But few really know what goes on behind the curtain.

There are all kinds of pressures - self-applied pressure, peer pressure, and pressure from coaches. Brandon Graham suffered a high ankle sprain in his first season. Some players will try to finish, most don't. Then-Eagles defensive line coach Rory Seigrest made it clear Graham must finish, according to the linebacker.

"As a rookie, coach wasn't having it - 'We paid you, you're a first rounder, you're going to play,'" Graham said recently. "That's what I went through. They didn't take me out. It was a high ankle sprain. That [stuff] is serious."

Graham kept practicing even though he said he was clearly limping. The Eagles dressed him for the next few games, but he didn't play.

"They were acting like I wasn't hurt. People were like,'Why are you limping?' And I'm like, 'Coach, you know I'm hurt. I got my foot wrapped up. My other foot is good,'" Graham said. "It was just mind games. They didn't want me to have that baby mentality."

Malcolm Jenkins played through a high ankle sprain as a rookie, because, he said, "I was young and dumb." The safety played through a concussion in the Cowboys game earlier this month. He said it was his call. He said he wouldn't do it again.

"I think it's pressure from everybody, or perceived pressure," Jenkins said. "Obviously, the team - you think they want you to play. So the coaches ask you, monitor you every day - 'How are you doing?' So in your mind you feel like you have to rush it back, even though they may not be pressuring you."

Managing pain can be subjective. One player's threshold may be different from another's. One soft-tissue injury may be different from another.

"Some guys have a high tolerance for pain. Discomfort is not a really big deal. Those types of guys you have to really figure out what the injury is and hold him back," Jones said. "And then there are the guys you have to push forward. A guy might have a little ding and he's like, 'Woe is me, the world is over.' You have to push guys like that."

Linebacker Mychal Kendricks missed three games with a hamstring strain. When DeMeco Ryans suffered the same injury, Eagles defensive coordinator Bill Davis called the linebacker a "warrior" and predicted he would be back the next game. Ryans ended up missing two games.

"You never know how much pain somebody's going through," Barwin said. "Some people get a bruise and they can't play. If you get a deep bone bruise - it doesn't sound that bad - but that can be [extremely] painful. If you get a torn meniscus - sounds awful, but a lot of people can play through that."

A leg injury for a receiver is also a lot different from a leg injury for some other positions. Offensive linemen seem to play through some of the most significant injuries. Former Eagles tackle Jon Runyan once played through a broken tailbone. Johnson and Kelce spoke about it with awe.

The players sometimes have to go to extremes to make it through games. Toradol is the most commonly used painkiller. It is usually taken orally. Johnson said he takes it only on game days "for the health of my liver." Linebacker Najee Goode said he doesn't take anything stronger than Advil.

In some cases, players can have Toradol injected into their bloodstream.

"Usually, you can get it in your butt, but I choose to do a pregame IV," Johnson said. "I'll do the hydrate. So I'll just have an IV rather than get that long needle stuck in my butt."

But there's a delicate balance between helping and hurting the team. And there is also the likelihood of exacerbating the injury or creating a domino effect. Cornerback Byron Maxwell played through a high ankle sprain as a rookie. He said that led to a stress fracture and then a hamstring injury that limited him in his second season.

"I was like, 'I'm on my way out,' " Maxwell said. "Availability is key."

Kelce's bursa sac injury has reemerged. He was questionable for the Lions game on Thursday, but played and clearly at less than 100 percent. When he spoke to reporters after the game, much of his left leg was purple from bruises.

"It's football. I mean . . . you work your whole life to do it and if you can play, you play," Jones said. "You're clawing and scratching every year you play, no matter how good of a year you had, how bad of a year you had, you're just fighting tooth and nail for everything you have.

"Honestly, it seems messed up, but in the moment, you don't even think about it. You're like, 'Whatever.'"

Kelly's sports science program is partly designed to keep the players healthy and to provide long-term benefits post-football. Players are provided with a team of trainers, nutritionists, and masseuses.

But the game is violent.

"It's worse than a car wreck," Kendricks said. "And all the pads do and the helmets do is allow you to hit harder. Rugby? They hit hard, but it's body on body. Body and bones give. Plastic and metal don't."

The players say they know what they signed up for. Kelce said he's more concerned about the constant pounding his head and cartilage take than he is about his ligaments and bones. Celek, who has missed only one game in his nine-year career, said that he feels prepared for life after football.

"I'm just taking it day-by-day," Celek said. "I know that I'm going to have to do a lot to take care of my body, but I know how to make my body feel good when it comes to stretching, massages.

"If I don't do that stuff I feel like garbage. I can't even walk."

jmclane@phillynews.com

@Jeff_McLane