The Philadelphia Eagles faced off against NFC rival Los Angeles Rams in a contest that many think could be a potential NFC Championship preview. The Eagles came out with a victory, winning 43-35 but suffered a more important loss. In the third quarter, the Eagles star quarterback Carson Wentz dived forward for what was initially thought was a touchdown but took a big hit to both of his legs. The touchdown was called back on a holding penalty but Wentz went on to complete the drive with several hand offs and a great throw in the pocket to receiver Alshon Jeffery for a touchdown. Wentz left the field on his own volition after the drive and walked back to the locker room amid the long faces of the Eagles support staff. It was reported later that Wentz had torn his left ACL which will end his potential MVP season. This is devastating for the Philadelphia Eagles who were super bowl favorites and currently own a 11-2 record, best in the NFC.
Anterior Cruciate Ligament injuries are a very common orthopedic injury in all sports but most notably in sports played on grass/turf due to the high level of cutting required. ACL injuries are frequently non-contact such as when pushing off or pivoting during which the distal aspect of the lower extremity is pushed laterally causing the knee to buckle inwards (known as a Valgus Stress) which places a large amount of stress on the ligaments of the knee most notably the ACL and the Medial Collateral Ligament. ACL injuries can also be from contact or blunt force trauma as in the case of Wentz. A blow to the lateral side of the knee can cause a large valgus force that can lead to an ACL tear.
The ACL is one of the key stabilizing ligaments of the knee along with the posterior cruciate ligament, medial collateral ligament and the lateral collateral ligament. The ACL’s primary function is to control anterior translation of the lower leg(Tibia) on the upper leg(Femur). When one or more of the knee ligaments are not intact, the knee becomes inherently unstable and can cause the knee to buckle or suffer additional soft tissue injuries. For athletes, this is especially problematic as they will not be able to confidently cut or pivot on their affected knee. When a high level professional athlete suffers a complete rupture of the ACL, reconstruction of the ligament is necessary if the athlete wishes to return to sport.
Rehabilitation for an athlete undergoing ACL reconstruction generally takes about 6-8 months to return to sport but can sometimes take over a year. It is important to make sure that the graft that is used to replace the deficient ACL is as strong as it needs to be to tolerate the extreme stresses at the knee of high level sports. It is also important for the athlete to regain as much knee/hip strength (most notably the hamstring which assists the ACL in preventing anterior translation of the tibias) as possible to regain stability at the knee. The athlete must also gain the confidence to compete at a high level on their affected knee which can often be the limiting factor in returning to sport. Early ACL rehab focuses on the athlete regaining full knee range of motion as well as volitional quadriceps strength to allow them to fully straighten the knee. Focus in the first few months is placed on strengthening all of the muscles of the knee/hip/ankle as well as working on balance and proprioception to help return the knee to its pre-injured state. Once the new graft has been given ample time to set (10-12 weeks) more high level strengthening and some sports specific training can begin.
Bears Tight End Zach Miller has Emergency Vascular Surgery Following Knee Dislocation by Sean Sullivan, PT DPT
While orthopedic injuries tend to dominate the headlines in professional sports leagues such as the NFL, neurological or vascular injuries can occur in conjunction and often can be limb/life threatening. Chicago Bears tight end Zach Miller caught a pass in the end zone during their game against the New Orleans Saints when he landed awkwardly on his left leg and came up lame in obvious pain/distress.
His injury was initially diagnosed as a fracture of his leg but was later diagnosed as a knee dislocation. A dislocation the bones that make up that joint are separated often times due to trauma. In Miller’s case, his Femur(thigh bone) and Tibia(shin bone) were separated. It is not known at this time whether Miller suffered any fractures along with this dislocation but it is likely that he will require surgery to repair any soft tissue(ligament) damage that occurred.
What happened in conjunction with Miller’s dislocation turned out to be the more pressing concern for the NFL veteran. Miller also suffered a rupture of his popliteal artery. Miller’s leg was stabilized by on field medical personnel and was rushed to the University Medical Center of New Orleans where he underwent emergency vascular surgery to repair the damaged blood vessel. He is currently being monitored to ensure proper healing/blood flow following his surgery.
The popliteal artery originates from the femoral artery which runs from our groin down the front/inside of our thigh. The Popliteal artery can be found on the posterior aspect of our knee and branches into its various divisions below the knee where it supplies blood flow to our entire lower leg. It is not difficult to see why a rupture of this artery( or any for that matter) is an emergency medical condition. When an artery is damaged, the blood flow to the areas of the body that are supplied by that vessel is impaired which leads to tissue ischemia. Prolonged ischemia of 6-8 hours can lead to irreversible tissue death and can result in amputation being the only means of preserving a limb.
While Miller’s injury is a very rare case, it is important for all medical personnel (on or off the field) to properly evaluate neurovascular integrity of a patient’s limbs following trauma. This means checking all pulses distal to the injury sight and assessing sensation to rule out any nerve or blood vessel damage. Making sure to not forget this crucial step can ensure that patients do not endure long term health ramifications due to late detection of neurovascular damage.
The 2017-18 NBA season tipped off last night with a rematch of last years Eastern Conference Finals pitting the Cleveland Cavaliers against the Boston Celtics. Just minutes into the first quarter Celtic small Forward Gordon Hayward went up for an alley-oop dunk from guard Kyrie Irving when came down awkwardly on his left ankle. The photo below shows Hayward in the air before landing on his left leg. The next photo shows Hayward sitting on the court in visible pain and gives a great view of how his ankle looked after the fall. Those who are squeamish, scroll down with caution.
While further details are still to come on the specifics of Hayward’s injury, what we do know is that he sustained a fracture of his left Tibia(Shin Bone) and a dislocation of his ankle joint. He is set to have surgery on that ankle Wednesday back in Boston. He will likely require a plate/screw/nail fixation(Open reduction with internal fixation) to keep his ankle joint stable and possibly a repair of the ligaments that work to stabilize his ankle. Luckily the Celtics medical staff were able to reduce/relocate his ankle on the court before placing it in an air cast which helped to reduce his pain. He also likely avoided any nerve/blood vessel damage that can occur with this type of injury as this would require immediate surgery.
Rehab for this type of surgery is likely to be at least 3-4 months but possibly longer depending on the degree of soft tissue damage that Hayward sustained. This is important because when a joint is dislocated, often times the surrounding ligaments become compromised, as they work passively to stabilize the joint. As discussed in my post on high ankle sprains, soft tissue such as ligaments do not heal as quickly as bone due to their poor blood supply. If the damage to the surrounding ligaments of Hayward’s ankle is severe, this will likely add months to his recovery and will make his return this season very unlikely.
The NFL suffered another painful blow to their star power when Aaron Rodgers left during the 1st quarter of the Green Bay Packers game against the Minnesota Vikings after suffering a fracture of his right clavicle. Rodgers was tackled by Vikings linebacker Anthony Barr and was drilled into the ground. Barr was not penalized for the hit and while deemed legal by NFL rules many felt the roughness of the tackle was unnecessary. Rodgers will have surgery to repair the fracture which will likely end his regular season.
The mechanism of injury for Rodgers is typically how a clavicle fracture occurs which is a direct blow or fall onto the lateral shoulder. The most common area of the clavicle to be fractured is the middle third of the clavicle and these types of fractures typically heal well without surgery if the fracture is not complex or displaced. These type of fractures can heal with a period of immobilization in a sling. If the fracture is at the distal end of the clavicle or is a complex fracture, this will almost always require surgical treatment.
It has not come out what type of fracture Aaron Rodgers suffered but what we do know is that he will require surgical treatment which likely will involve an open reduction internal fixation. This means that the surgeon will need to perform an open surgery to allow them to put the fracture back in place and then use some type of fixation(Screw, nail, plate) to hold the fracture in place while it heals. Since the clavicle does move slightly with shoulder elevation, it is important to limit overhead activity for the first few weeks. Rodgers will likely be in a sling for the first 4-6 weeks and will not be able to start throwing until at least 3 months.
Week 4 of the NFL season just concluded on Monday night following the Kansas City Chiefs last second win over the Washington Redskins. As with just about every week of NFL games comes a host of injuries to key players on contending teams, often times of the season ending variety.
Rookie running back Chris Carson of the Seattle Seahawks suffered a season ending left leg injury during the Seahawks win over the Colts on Sunday night. What was originally diagnosed as a fracture of his left lower leg turned out to be more severe. In addition to the fracture that he suffered in his fibula, Carson suffered a severe syndesmosis tear otherwise known as a “High Ankle Sprain”.
The syndesmosis is a series of ligaments that connect the ends of the two lower leg bones, the tibia and the fibula. A tear of one of these ligaments is a common injury in American football and is generally caused when the athlete’s foot/ankle is pushed into extreme external rotation. It can also be caused by a blow to the lateral aspect of the knee/lower leg with the foot planted which causes the syndesmosis to be over stretched which is what happened in Carson’s case as seen in the picture below.
The words “High ankle sprain” are words an athlete never wants to hear. Unlike a typical lateral ankle sprain which is a tear of one of the lateral ankle ligaments, a syndesmosis tear takes more time to heal. If there is a disruption of the any of the syndesmosis ligaments, these ligaments are stressed any time the athlete tries to bear weight on that limb as the athlete’s body weight and gravity put stress through the lower leg and tries to separate the tibia and fibula. This is the primary reason why recovery from a high ankle sprain can take longer to heal and are prone to reoccurrence.
MRIs are the gold standard for diagnosing a high ankle sprain. Depending on the grade of the tear, a patient may or may not be instructed to bear weight following the injury. Upon imaging, if there is no widening of the space between the tibia/fibula, the fracture is considered stable and are treated conservatively with rest/rehab and can weight bear as tolerated. If there is mild widening of less than 4cm, then the athlete is generally immobilized in a walking boot. If there is significant widening of the mortise of greater than 4cm, this will require surgical treatment which unfortunately is what will end Carson’s season. Following surgery, Carson will likely be immobilized in a plaster cast for 2 weeks and transferred to a cast boot for another 4-6 weeks during which he will be non weight bearing to avoid stress to the healing fracture/ligaments.
Kevin Durant reportedly suffered a hyperextended knee less than a minute into last night’s contest against the Wizards in D.C. and exited the court shortly thereafter. An MRI is scheduled. The injury occurred when Washington Center, Marcin Gortat made contact with Golden State’s Zaza Pachulia who then stumbled, landing on Durant’s left leg.
Though the MRI may not reveal any significant injury beyond a mild sprain, there is a range of diagnoses possible in this situation.
What is the significance of a hyperextended knee?
Ligaments – which attach bone to bone – provide stability by restraining excessive movement in our joints. When a joint goes beyond its normal range of motion, the integrity of certain ligaments becomes compromised, resulting in a sprain. In the case of the knee, forceful or traumatic hyperextension into a bowed position stresses the anterior cruciate ligament (ACL) – which is the primary stabilizer of the joint – and may also impact other secondary stabilizers. Worst-case scenario for Durant would have been a Grade 3 sprain, otherwise known as an ACL tear. A Grade 3 sprain is actually a complete rupture. Best case would be a Grade 1 sprain, with only mild tweaking of the ligament.
When the knee hyperextends, the tibia (the larger bone in the lower leg) glides forward excessively on the femur (the thigh bone) at the knee joint. This abnormal movement, whether caused by trauma or a non-contact situation, can also result in a bone bruise, or contusion. As with a sprain, the extent of the contusion would be proportional to the degree of hyperextension that occurred and whether trauma played a role. Another factor is the athlete’s baseline – or normal – range of motion.
A prior history of ligament sprain that results in persistent joint laxity predisposes an athlete to excessive joint mobility. This may set the stage for a non-contact injury. Many people – particularly ballet dancers and gymnasts – have hypermobile knees, enabling extension beyond a level plane and into a hyperextended position. This expanded range of motion is their “normal”. For a hyperextension injury to occur in these populations, the tibia would have to glide that much further forward, still stressing its restraints.
It is important for an athlete or dancer to have exceptional muscle strength, particularly in those muscles surrounding a less than stable joint. It is also vital that strength is optimized at the end-ranges of motion. The hamstrings become particularly vital in the case of the knee, for in their role as knee flexors. In addition to bending the knee, the hamstrings also act to extend the hip. However, as knee flexors they provide a degree of dynamic restraint to limit hyperextension of the joint.
In recent years it has become more apparent that any impact to the human body, whether a fall or a bicycle accident, can have more lasting effects than previously thought. Concussions are among the many injuries resulting from trauma that are not physically apparent and are not easily recognized by victims and those around them. Concussion recognition during football, from the little leagues to the professional level, has gained media attention in the past decade. However concussions can also result from accidents, falls, and other types of impact sports. Soccer, hockey, volleyball, and basketball are just a few sports where aggressive play and bodily contact can lead to biomechanical brain injury. Coaches and health practitioners have the ability to help preserve athletic participation and future brain function by recognizing symptoms and by taking the appropriate action to help with healing.
Concussions are often difficult to diagnose without the proper tools and individuals may be reluctant to voice their symptoms. Competitive conditions make players fearful of being sidelined while workers or students may not want to delay projects at hand. Many others underreport or fail to report their symptoms because they lack the knowledge to recognize a true concussion. Players, coaches, and caregivers need to be educated in concussion symptom recognition and how to support these individuals.
Doctors of Physical Therapy are musculoskeletal specialists who can guide individuals and athletes recovering from concussion in a safe transition to daily activities, exercise, and sports. Besides increased risk of a second more severe concussion, there exist other post-concussive risks that can be detrimental to a person’s well-being. Recent studies by Herman et al. (2016) and Gilbert et al (2016), have demonstrated a relationship between concussion history and lower extremity injuries in athletes. One concussion can disrupt a person’s balance and equilibrium as well as their strength and mobility. When this is paired with subsequent lower extremity injury, a repeating cycle is created where rest, muscle atrophy, and decreased mobility contribute to re-injury and further physical decline. Physical Therapy eliminates this cycle by targeting strength, endurance, and balance deficits in the core, hips, knees, and ankles that persist after concussion. With an individualized rehabilitation program provided by a trained Physical Therapist, a patient recovering from concussion can return to function and return to their sport with confidence and decreased risk of future injury.
Elizabeth Lamontagne PT, DPT, SCS, CKTP
Staff Physical Therapist at Recovery Physical Therapy
Herman, D.C. Jones, D. Harrison, A., Moser, M., Tillman, S., Farmer, K., …Chmielewski, T. L. (2016). Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes. Sports Medicine. Doi: 10.1007/s40279-016-0607-9.
Gilbert, F.C., Burdette, G.T., Joyner, A.B., Llewellyn, T.A., Buckley, T.A. Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes. Sports Health: A Multidisciplinary Approach. 2016;8(6):561-567. Doi: 10.1177/1941738116666509.
Myofascial Release is a highly effective technique developed by John Barnes, an icon in the physical therapy world. The technique emphasizes gentle prolonged sustained stretching of the fascial system and myofascial elements to release restrictions that may be causing symptoms throughout the body. Fascia is continuous throughout the human body, so a restriction in one location may cause symptoms elsewhere. Fascial restrictions do not show up on MRIs or other diagnostic imaging, so the therapist performs a comprehensive evaluation, starting with posture to determine where fascial restrictions may lie.
Myofascial Release is used to treat all types of diagnoses ranging from low back pain, neck pain, TMJ, patella-femoral issues, tennis elbow, headaches, to name a few. It is estimated that the fascial system can create pressures up to 2000 lbs of pressure per square inch, thus causing pain, numbness, tingling, edema, and decreased strength. Myofascial release is a safe, gentle treatment which consistently produces lasting results.
Dr. Robert Kotraba, PT, DPT, OCS utilizes Myofascial Release at our Rockefeller Center location. For more information, please call 646-562-0617.
TAPING FOR NYC MARATHON RUNNERS
When: Saturday, November 5th, 2016
Where: Recovery Physical Therapy Upper East Side Location
157 East 86th street 2nd floor, New York, NY 10028
(Entrance next to Steve Madden Shoe store)
What: 30-minute kinesio taping by a licensed Physical Therapist to enhance performance and decrease pain for those running the NYC marathon.
Who: If you have neck, shoulder, back, hip, knee, foot, or ankle pain, there are taping techniques that can help with pain and enhance performance.
Cost: The cost includes a 30-minute session where the therapist will evaluate taping needs and administer the tape (tape will be provided by Recovery Physical Therapy.) $50 self-pay fee.
There will be no massage, stretching, joint mobilizations or manipulations, or any other modalities/treatments. If you feel you do need any of these services before or after the marathon, please contact us at (212) 831-3315 to schedule an appointment.
Contact: Please feel free to contact us at (212)831-3315 or come in to make an appointment!
Though water is still the best, this antioxidant-rich liquid has been an answer to pain, inflammation, swelling, and sleeplessness. Tart cherry not only has important nutrients but also contains many antioxidants and anti-inflammatory agents. It aids in cancer prevention, heart health, and as an anti-inflammatory, which can help alleviate a variety of ailments like asthma symptoms, arthritis pain, and regulate metabolism.
Cherry juice concentrate:
- Soothes pain, prevents muscle damage and fastens recovery
Runners, here is something useful for you. Cherries could be the solution to post-run muscle soreness. It is naturally high in potassium, which conducts electrical impulses throughout the body. This mineral also helps maintain blood pressure, hydration, muscle recovery, nerve impulses, digestion, heart rate, and pH balance. Cherries contain about 330 mg of potassium per cup, which is almost 10 percent of how much you need each day.
- Treats insomnia.
Let this juice help you get a good night sleep. A lot of healing takes place when you sleep .The fruit is naturally rich in melatonin which is responsible for sleepiness and regulates your body’s internal clock and tryptophan, an amino acid the body uses to create even more melatonin. Also, a class of pigments called anthocyanins found in the fruit is able to slow the breakdown of tryptophan, thereby lengthening its sleep-inducing effects.
- Prevents gout, fight inflammation and arthritis
Research shows that the antioxidants in tart cherry juice can reduce pain and inflammation from osteoarthritis- gout. The fruit lowers the levels of uric acid—the chemical that causes gout in high concentrations—and c-reactive protein, a biomarker of inflammation. Researchers give credit again to anthocyanins, which also give the fruit its dark red hue.
- Boosts Immunity
Cherry concentrate and cherries pack a powerful antioxidant and anti-viral punch. Flavonoids, a type of antioxidant in cherry juice, are made by plants to fight infection and have a significant impact on immune system function.
But wait, the potential side-effects of tart cherry juice include abdominal discomfort and diarrhea. While studies show that anthocyanins act against the development of obesity and can help reduce abdominal fat, and lower the risk of metabolic syndrome, the 140-calorie per 8-ounce serving juice may also affect your weight. If you’re looking to lose some fat, stick to eating the fruit rather than drinking the juice.
Ekta Lund, PT, MSPT, CSCS, CKTP – Co-Director, Upper East Side location