Many of you are wondering what is going on with Tua’s hip. The media does a great job of giving you just enough information to get you interested, but doesn’t give you enough information on the extent of the injury and what his prognosis looks like as well. Today, I want to dive into the mechanism of this injury and explain in depth what is going on with his hip. We will also take a dive into what his return looks like and if he will ever be able to step back on the football field as a premiere QB.

Defining the Hip Joint

First, I think it’s important to understand what the hip joint looks like and why this is a pretty rare injury to happen to someone. The hip joint is made up of a long bone called the femur inserting into an area on the pelvis called the acetabulum. As you can see above, the end of the femur almost looks like a ball that inserts into the pelvis. This is important because it allows athletes to move the hip in 3 planes of motion. This is an EXTREMELY IMPORTANT joint for quarterbacks. The acetabulum where the head of the femur inserts into is very deep. With this said, this makes the femoroacetabular joint the most stable joint in the body.

Mechanism of Injury

As you can see in the clip, as Tua’s coming to the ground his right hip goes into flexion (hip bent) with the knee on course to be directly driven into the ground. You can also see that he has two defenders chasing him down behind him. The combination of the force from him running away from the defenders, as well as the weight from the defenders falling on top of him put a great deal of force through the knee. Once the knee hit the ground, it pushed his femur through the backside of the acetabulum causing a fracture in the back portion (posterior) of the socket. This caused a fracture in the “wall” of the pelvis, but also caused a dislocation of the head of the femur, which is extremely rare for adult athletes.

Ligament Damage

One issue that came to my mind right away when hearing about this injury is the damaged ligamentous structures to the hip when it was dislocated. The head of the femur is surrounded by a joint capsule that is made up of 3 very strong ligaments that blend together to help stabilize the hip joint. These 3 ligaments are the iliofemoral ligament, ischiofemoral ligament, and pubofemoral ligament. Since there was so much force into the femur for it to dislocate, there was absolutely damage to both the ischiofemoral ligament and the pubofemoral ligament as well. This will absolutely lengthen the extent of his recovery as they will have to find a way to reclaim the structural integrity of the ligaments to make sure that the joint is very stable again.

Arterial Damage

Another big issue that hasn’t been talked a lot about is the blood supply around the hip that nourishes all the structures within that area. These arteries are called the medial and lateral circumflex arteries and without these the head of the femur will die. This event is called avascular necrosis and happens over a long period of time without blood supply to the joint. This is the mechanism of injury for Bo Jackson when he had his hip subluxation. When the head of the femur came out of place, it actually sheered this arteries. Over time, the blood supply was lost and Bo’s hip joint became necrotic. This is why he needed a hip replacement while he was still playing because the joint was essentially rotting away from no blood supply.

The good news for Tua is that they were able to “reduce” or replace the head of the femur back in place at the stadium. This is important because studies show that if the hip joint can be reduced in less than 6 hours, then the likelihood of arterial complications goes down tremendously. Often times, it takes time to see the extent of the damage in relation to vasculature structures around the hip. With him being rushed to the hospital for MRI and CT scan right away, his outcomes look promising thus far.

Damage to Labrum

The last big issue that hasn’t been talked about in depth is if he has had any labral damage to the inside part of the joint. The labrum is essentially the cushion between the head of the femur and the acetabulum. It lines the inside of the joint and acts as a shock absorber when walking, jumping, running, etc. When the femur blew out the backside of the joint, I wonder if the labrum was damaged as well. If so, this could be bad for Tua in that he won’t have as much cushion in the joint which could lead to arthritic changes in the hip joint faster. Fingers crossed that this isn’t the case for him, but it most likely is with the extent of the injury being what it is.


There will be several stages that Tua will need to go through in order to repair this damaged hip. First, there will be an extended period of time where he won’t be able to bear weight through the right side of his pelvis because of the ligamentous damage, as well as the fracture to the pelvis. This could be anywhere from 10-14 weeks based on how they plan on fixing the fracture and then also fixing the ligamentous structures to hold the femur in place again. During this time, they might work on some isometric based exercises and exercises that didn’t involve the femur moving into the backside portion of the joint.

After this he will then start to claim back a lot of the range of motion in the hip joint in all planes, as well as starting to bear weight through the leg. He will also start performing low levels of exercise in all ranges. Progressions and regressions of these exercises will be given as needed based on contraindications and parameters given by the team docs.

Return to Play

The great thing for Tua is that this injury has happened in the right hip and not the left hip. The reason being is that his drive leg is his left leg since he’s a left handed quarterback. This would be challenging for a right handed quarterback because there’s a lot of compression force into the drive leg when trying to create ground reaction force. This is definitely on his side. The only drawback would be that in order to claim a proper follow through and to decelerate well, that quarterbacks need high ranges of motion through hip internal rotation on the plant leg. With him not bearing weight through the joint and then also moving the joint minimally over the next several months, this joint is obviously going to get stiff. This is what the doctors want in order to reclaim the stability of the joint, but this might cause problems in performance if not addressed once he steps back on the field. There will have to be a perfect relationship between enough stability to support the function of the joint and enough range of motion for him to perform the movement.

We love watching this guy play and think he’s a very special player. He seems like an even better human being so we are praying for a fast recovery for him. We hope this clears up some of the questions that y’all have regarding his injury and also his return to play as time goes on. Let us know if you have any questions by reaching me by email at [email protected]m or by phone at 812-343-4226.

-Drew Kiel PT, DPT, CSCS