New York Jets head coach Rex Ryan finds himself in a quarterback controversy again. Was making back up Tim Tebow available for the team’s Thanksgiving night game against the New England Patriots, while having two broken ribs, a good decision?

According to Rich Cimini of ESPNNewYork.com, Ryan defended his decision to make Tebow active despite the revelation that the controversial quarterback had two fractured ribs. “He absolutely, 100 percent could’ve played in that game,” Ryan said.

Interestingly the embattled coach pointed out that the Jets’ team doctors only made the diagnosis of rib fractures Wednesday, the day before the game, even though Tebow was injured against Seattle 10 days earlier.

Shoulder x-ray
In this shoulder x-ray (not of Tebow), one can see how the heart, lungs, and other structures could complicate the diagnosis of a nondisplaced rib fracture.
In The New York Daily News, Manish Mehta outlined the team’s clarification of the injury. The team initially believed Tebow had sore ribs, as x-rays after the Seattle game did not reveal the extent of the injury. A CT scan and MRI performed Tuesday night revealed the fractures.

While that delay might surprise many football fans, it is a common scenario. Chest x-rays often do not show rib fractures. The fractures are often barely visible hairline-type fractures. The lungs, heart, and blood vessels in the area often obscure the x-ray findings.

CT scans more reliably visualize them. Since treatment usually only consists of rest and avoiding activities that cause pain, we often treat athletes as if rib fractures are present even without the confirmatory tests.

The bigger question in my mind is whether Tebow really could have played effectively with two broken ribs. Ryan pointed out that Jets’ doctors cleared Tebow to play and that Tebow reportedly told his coach he could play.

Rib fracture
This CT scan (not of Tebow) shows a rib fracture (white arrow) on the patient’s left side (right side of the image).
Had starter Mark Sanchez been knocked out of the game, Tebow would have been forced into action despite Ryan’s insistence that he would play only if necessary. In fact, the Jets’ third-string quarterback, Greg McElroy, was never activated for the game.

Mehta noted that Ryan believed Tebow could have played. “When you factor those things in, it’s like, hey, if we absolutely 100% had to have him, then I would have played him,” Ryan said. “I’m not a doctor but I’m a human. And that’s why I felt for him, but it was to the point where when the doctors are telling you he can play, the young man’s telling you he can play and knowing he was going to be in the role he was as the backup quarterback … that was why I had him active.”

While Ryan is correct that Tebow could have played if necessary, I doubt he would have fared well. Rib fractures are extremely painful. A blow from a Patriots defender would have been excruciating. And tape or pads would have barely limited the impact of those blows.

Furthermore, the muscles of the shoulder, chest, and upper back attach to the rib cage. Any twisting motions, like those involved in throwing, would be very difficult. I wonder how effectively Tebow could have thrown down the field. Cimini observed that Tebow was playing catch with a young fan after the game by throwing with his opposite arm.

Ryan did state that Tebow refused a pregame painkilling injection. While not identifying it by name, Ryan is likely describing a Toradol injection. Toradol is an anti-inflammatory medication injected intramuscularly to decrease pain. Despite concerns raised in recent months, the use of these injections by NFL players to decrease or prevent pain before games is fairly common.

Tebow’s rib fractures should heal in the coming weeks. I expect his pain to decrease to the point he can throw, run, and even take hits in the next week or two. I think the fans will be questioning Ryan, the Jets, and the handling of the situation for much longer.

Note: A modified version of this post appears as an article I wrote for Bleacher Report.