Photo: USA Today Sports

Another confusing injury for Andrew luck

Trying to parse the quickly evolving media reports, educated speculation, interviews, and press conferences about Andrew Luck's injury over the past 24 hours has been like playing a game of telephone with preschoolers. There's very likely a word or phrase in each iteration that's accurate. But it's nearly impossible to divine what's accurate and what may have been lost in translation without knowing what the first preschooler was told.

Whenever a story doesn't come together smoothly, I like to summarize the timeline of events and highlight what doesn't make sense.

In this case, the timeline is long and the questions are many.

Here's the executive summary before we get deep into the weeds and discuss the details:

• Andrew Luck has not practiced on consecutive days since late May.
• Despite varied reports and speculation, the Colts are not yet certain about Luck's diagnosis.
• Chris Ballard wouldn't confirm Luck's availability for Week 1.
• It's impossible to project a timetable for Luck's effective return until he returns to practice.
• Consider Luck questionable at best for Week 1 and beyond.

A Timeline of Events: march thru July

• March: Luck diagnosed with a calf strain by MRI (per Chris Ballard on Aug 13)
• Late May: Luck misses the Colts' second set of OTA workouts with continued pain around the calf
• Mid-June: Luck does not participate in minicamp while still rehabbing calf soreness
• July 25: Luck starts training camp on the active roster and begins practice
• July 29: Luck practices, struggles, appears visibly frustrated, tells reporters he has ankle pain, still feels limited
• July 30: Luck and the Colts elect to shut Luck down until his calf injury heals

From May through early August, Luck tells a handful of different reporters he's not concerned about his in-season availability and he believes he could play immediately if needed. After the Colts shut Luck down on July 30, Tom Pelissero reports there are no specialist visits planned, no additional scans scheduled, and no concern a surgical procedure is necessary.

At this point, there are some unanswered questions -- March is an odd time to be diagnosing calf strains, it's unclear why Luck was still having symptoms 2-3 months later during OTAs and minicamp, and it's curious to hear Luck describe ankle pain as a complication of a calf strain -- but Luck himself doesn't seem overly concerned and there's still six weeks until the opening weekend of the regular season.

A Timeline of Events: August

• August 3: Colts say Luck still not ready to practice
• August 10: Colts say Luck progressing but still not ready to practice
• August 12: Owner Jim Irsay tells Sirius XM hosts Luck has a "little bone issue"
• August 13: General manager Chris Ballard comments extensively about Luck's injury and status

Now the questions further escalate.

Irsay says Luck's soreness is not related to the calf but rather "a small little bone." He says trainers have told him Luck's condition is similar to what other Colts -- specifically Ryan Diem and Raheem Brock -- once dealt with.

While it's not clear what the bone issue may be, both Dr. David Chao and Will Carroll speculated Luck may have a condition called myositis ossificans, in which a small area of bone develops within the muscle in response to injury. Chao's experience and Carroll's sources in Indianapolis are strong. It's a diagnosis that makes sense. However, it's not clear whether that would cause ankle pain and it's likely something that would have shown up on follow up MRI scans -- which Luck and the Colts have said were negative.

Later, a local beat writer describes Diem's injury as os trigonum syndrome, which occurs when an extra bone causes pain around the ankle joint with certain movements. It's not clear how this relates to Luck's calf strain and it's also something that imaging studies would likely find.

Chris Ballard: A Detailed but Confusing Press Conference

With rampant speculation fueled by their owner and escalating nervousness in the fan base about Luck's readiness for Week 1, Ballard addressed the media Tuesday night. While he provided some helpful detail, I'm not sure we're any closer to knowing what Luck is dealing with or when he'll be ready to play.

Ballard told reporters:

• Luck had a calf strain that did not improve
• In the course of dealing with the calf injury, Luck developed an ankle issue
• The ankle issue is believed to be cumulative over the years
• An injection at the bottom of the calf did not resolve Luck's pain
• Specialists have explored an area near the bone; it's not believed to be the issue
• Specialist evaluation raised suspicion for an area in front of the ankle
• Luck will continue to rehab and no surgical interventions are planned
• It's too early to determine whether Luck will be ready for Week 1
• The team is optimistic they've found the cause of Luck's pain but cannot guarantee yet

Ballard's comments suggest the team has ruled out possibilities like os trigonum syndrome and myositis ossificans. But his description of their current concern is confusing. He describes the condition as involving the "front of the ankle" but "up by the calf." Those are two different locations. Ballard's understanding of a "high ankle - ish" injury is also hard to define. That seems to imply a syndesmosis injury -- the ligament injured in a high ankle sprain -- but that's hard to reconcile with a calf strain and cumulative injury.

In short, if you've stuck with me this long, we may not be any closer to understanding Luck's condition than we were before.

An Evolving Situation

Unfortunately, sometimes a diagnosis isn't clear. Injuries evolve and cascade, what was once felt to be likely to respond to rehab can later require more investigation. That's what's happened here.

Without knowing the precise nature of Luck's condition, it's difficult to speculate on Luck's future. But there are three factors concern me.

First, Ballard told reporters Tuesday night the Colts aren't 100% confident they have Luck's condition diagnosed. That means it's difficult to trust that the current prescribed course of action -- rehab without surgery -- will be successful.

Second, the last time Luck attempted to practice he was visibly frustrated with his mobility and accuracy. If his condition doesn't improve with rehab, Luck's performance is in doubt.

Third, Luck hasn't spoken since August 5, when he told Peter King he believed he'd be ready for Week 1. Luck talks to the media about his injuries only when he's comfortable with his progress and feels confident about his future. It's possible Ballard's press conference on Tuesday was in response to Irsay's Monday comments and Luck will address the media soon. And Luck has been seen observing practice from the sideline in recent days. If Luck disappears from the sideline and goes media silent, you should grow even more nervous.

When Will Luck Return?

I was much more confident about Luck's Week 1 readiness prior to Irsay and Ballard addressing the media. Luck had been steadfast in telling reporters he could play if needed. While many players can't be trusted when they project their own availability, Luck's track record has been good.

Unfortunately, Luck hasn't been able to practice on consecutive days for over three months. He's still seeing specialists and actively seeking solutions for his condition. We're now three weeks from the Colts' practice preparation for Week 1 and there's been no positive movement on Luck's status since camp opened.

Consider Luck questionable -- at best -- for Week 1. While I don't believe we're seeing a reprise of 2017, when Luck went quiet and eventually missed an entire year while rehabbing a shoulder injury, it will be difficult to confidently project a timetable for his return until we see him return to practice or hear him clarify his own status.

Follow me on Twitter @JeneBramel for breaking injury news and analysis throughout the off-season.