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There is no way Kwon Alexander should be able to return this season. Physiologically, it leans more towards the impossible than improbable side. Yet, less than three months after tearing his left pectoral, Alexander might be returning for the 49ers in the Divisional Round of the playoffs next Saturday.
According to Adam Schefter of ESPN, Alexander, like J.J. Watt (tore his pectoral three days before Alexander, on October 28) of the Houston Texans did on Saturday in the Wild Card Round, is not just “on track to play,” next Saturday, but the 49ers, “believe he has a good chance of returning.” Alexander said he talked to Watt and took inspiration and advice from his rapid recovery.
Sources: 49ers’ LB LB Kwon Alexander is pulling his own J.J. Watt and is on track to play in Saturday in divisional round.https://t.co/a8NKU8ozEu
— Adam Schefter (@AdamSchefter) January 5, 2020
As explained here, in an interview with a pectoral tear specialist, this should not be possible. Here is the nitty gritty of it.
Dr. Bashir A. Zikria, MD, MSc, is Johns Hopkins University’s Director of Sports Medicine Arthroscopy Education and is an expert in dealing with tears of the pectoralis major, which is what happened to Alexander.
In a conversation with KNBR, Zikria said there are three main types of tears of the pectoral muscle, which is attached to a pair of heads: the sternal head (attached to the sternum) and the clavicular head (attached to the clavicle), both of which are attached to the humerus, the large arm bone which is next to the bicep.
The first, and most commonly seen type of tear, is where the muscle tears off the bone, usually off of the sternal head, in what’s called an “eccentric contraction.” The muscle is still attached at the other end to the humerus. This can happen often in bench presses as the barbell comes down, and is normally treated with surgery.
The second type of tear is at the musculotendinous junction, connecting muscle and tendon. The third type of tear is when the muscle itself tears (i.e. attached to both heads, but tears in the middle). These latter two are normally treated without surgery.
Because Alexander underwent surgery, it indicates he likely suffered the first type of tear and it likely tore off his sternal head. Zikria says that on average, the recovery time from this type of injury is nine months, with the absolute earliest being around the sixth-month mark. That would put Alexander’s earliest recovery in late April.
Zikria was correct in predicting the type of tear Alexander suffered. As Alexander told KNBR on Thursday, after his second day of practice (in a blue non-contact jersey), he did in fact suffer that first type of tear, where the pectoral tore off his sternum, requiring surgical repair.
I asked Alexander, how, when the timeline for recovery was so dire, that he expected to return, and seemingly turned that expectation into reality.
“Just my mindset really. I don’t really put a limit on me, so always, as long as I’m working and I have my mind clear and thinking positive, doing positive things and just grinding with my head down, I’m gonna get wherever I want to go.”
He said he’s had that mindset since he was a kid and his ACL injury coming into this season made the recovery from his pectoral tear much easier, given that his lower body was unaffected.
“Yeah, I’ve been had that [mindset],” Alexander said. “I’ve been through way worse injuries too, like ACL injuries, and in those those tough times you have to clear your mind and get your mind right and that trained me for this injury too. So once I got the injury, it didn’t hurt, or nothing like that, my mind was clear. I was just down to it and ready to go.”
The toughest, or lengthiest part of the recovery, Zikria said, is building back strength:
“One, you’ve got to get the tendon to heal to bone, and then you’ve got to build that strength back up, to prevent re-injury,” Zikria said. “Essentially, what happens is that the muscle gives out and that’s when the tendon comes off. It depends on what sport you’re playing and if you’re playing a non-contact sport you can probably go back, maybe at six months, but football, on average, is about nine months.
“At three, four months, you can probably start doing light lifting. Slowly work the muscles, so the muscle is not atrophying… Three months you’ve got a decent amount of biological healing. It’s not completely healing, but you’ve got a decent amount of biological healing. But as far as strength and everything else to prevent the injury and all that, you’re not close.”
Alexander said his strength is back and there was no benchmark he has to pass other than getting back to contact.
“I mean, strength already back,” Alexander said. “Mainly it’s just the contact and stuff like that. I’ve got everything else, so once they let me know what’s up and I’ll be ready for sure… If there was a benchmark, I probably already done past it. So probably what it is just the contact and stuff like that, which I’m ready to knock that out. So just waiting on them, whatever they want to do I’m ready for it.”
He said Wednesday that he wasn’t thinking about the risks of returning too soon.
“I’m not even trying to think about no risk right now, I’m staying positive,” Alexander said. “Once you go to that negative state, it stays in your mind, so just looking forward, moving on day by day.”
If Alexander does return next Saturday, it’s not immediately clear whether rookie Dre Greenlaw would remain at the starting weak side, WILL linebacker spot where Alexander was earlier this season. There is a possibility that Alexander could be moved to Greenlaw’s old spot at the strong side, SAM linebacker spot to limit his snaps to 4-3 sets.