Classic Lateral Ankle Sprain

Last Wednesday night, Kobe Bryant suffered a lateral ankle sprain.  You can see the video here.  Bryant went up for a shot and his left foot landed on the foot of the defender, forcing his ankle into inversion (bottom of the foot turning towards the mid-line) and plantar flexion (foot pointing down).  This type of mechanism of a lateral ankle sprain occurs commonly in sports like basketball and volleyball.  The players are in close proximity to each other which increases the likelihood of them landing from a jump onto the foot of another player.  The reports said Bryant suffered a severe ankle sprain, but since he was able to attempt to play on Friday, it was likely a Grade II (moderate) ankle sprain. 

You can see in the picture above that the mechanism of a lateral ankle sprain damages the lateral ankle ligaments, which include the anterior talofibular, the posterior talofibular, and the calcaneofibular ligament.  Bryant likely suffered damage to all 3 ligaments.  The best treatment of this injury is a period of rest, management of pain and swelling, followed by rehabilitation to restore range of motion, strength, proprioception, and functional movements.  Since the Lakers are trying to get into the NBA playoffs, rest is not really an option for Bryant (although he isn't playing tonight because of this injury and because he has the flu).  This injury will definitely affect him the rest of the season, although he is a great athlete and has shown the ability to play through pain in the past.

Trip to Greenville, SC for SEACSM conference

Early on the morning of February 14, I departed Starkville with 3 undergraduate students for the 2013 Southeast Chapter of the American College of Sports Medicine annual conference in Greenville, SC.  The three students were Alisan Abernathy, Murry Adams, and Anna Comer.  We had been working together on a research project since this past summer investigating the relationship between ankle joint laxity, balance, and landing kinetics.  Each of the students made their own presentation based off of the data we had collected so far.  They all did a wonderful job with their presentation and we received several compliments.  They also competed in the student quiz bowl and did very well.  Below are some picture from the trip.  We have a little more data to collect before we start working on a paper to submit for publication.

 Murray in action.

 Murry and his poster (the girls didn't want individual pictures with their posters.

 The students and me.

 Getting ready for the quiz bowl.

Taking in a little minor league hockey on Friday night.  We had great seats.

Career Ender

I have blogged previously about Chris Carpenter and the surgery he had last summer for thoracic outlet syndrome.  The surgeon has to remove Carpenter's first rib on his right side to take the pressure of the nerves than run from the neck down into the shoulder and the arm.  Carpenter had been experiencing weakness, numbness, and a loss of sensation in his right arm for a long period of time.  He was able to come back in a little over 3 months and pitch in 6 games at the end of the regular season and playoffs.  He pitched about like what you would expect someone to pitch only 3 months removed from major shoulder surgery.

Earlier this week it was announced that Carpenter was having a re-occurrence of the thoracic outlet symptoms that lead to the surgery, and that he would not be able to pitch in 2013, and likely not ever again.  Although this was not a complete surprise, given his injury history, it is still a disappointment.  Carpenter is one of the best pitchers in Cardinals' history and one of the greatest postseason pitchers ever.  However, he has had multiple shoulder and elbow surgeries over the course of his career, and these injuries and surgeries begin to take a toll on the body.  Hopefully once he stops pitching the symptoms will subside and he can have a normal life, although he will likely contain to experience some of the symptoms in his throwing arm.

Life Threatening Injury

I was reading the latest edition of the NATA (national athletic trainiers association) news and came across the story of Houston football player D.J. Hayden, and how the quick response of his athletic trainer, Mike O'Shea, likely saved his life.  If you are a member of the NATA, I encourage you to read the story.  If you are not a member, this ESPN.com article offers a pretty good summary of the injury. 

The injury that Hayden suffered was a torn inferior vena cava.  The inferior vena cava is the large vein that carries deoxygenated blood from the lower extremity into the right atrium of the heart.  A tear of this structure results in massive internal bleeding and is a serious medical injury.  According to the story in NATA news, Hayden went up to intercept a pass and another teammate's knee hit him just underneath the sternum, right below where the protection from his shoulder pads ended.  O'Shea examined Hayden on the field and again on the sidelines, and quickly decided to move him into the locker room.  Because Hayden's signs and symptoms were not adding up with a typical chest injury, O'Shea and the team physician went ahead and called the paramedics, who decided to take him to the nearest trauma center.  The doctors at the hospital suspected a ruptured spleen or liver, but soon discovered that it was his inferior vena cava that was ruptured.  According to the article, there have not been any documented cases of a torn vena cava occurring during athletic competition.  It more commonly results from a gunshot wound or car accident.

The doctors were able to repair the rupture in his vena cava, and Hayden is expected to make a full recovery.  The doctors stated that the fact Hayden also broke his diaphragm during the injury likely helped save his life, because it allowed the blood from the ruptured vena cava to pool in his adbomen instead of around his heart.  The doctors also stated that if he had arrived at the hospital 5 minutes later he likely would have died.  This was a remarkable job by the entire medical staff, beginning with the athletic trainer.  The typical survival rate for a torn vena cava is around 5%.  You never know what may happen when you step out onto the field or court to cover a practice or game, and the actions of this athletic trainer helped save a life. 

Robert Griffin III latest knee injury

I hope that everyone had a great holiday season and a happy new year.  As we wrap up the first week of classes at Mississippi State, I thought I would talk some about the latest Robert Griffin III knee injury.  A few weeks ago, Griffin sustained a sprain of his right LCL.  He missed one week of action, but then came back and played in the final two regular season games.  This past Sunday, Griffin sustained a tear of his right ACL, likely on the play in the picture above.  There has been much debate about rather or not he should have been playing, and if the coaching and/or medical staff is to blame for this injury.

There are a number of factors that can cause an injury, and it is impossible to isolate just one factor and say it is the primary cause.  One would have to believe that the Redskins medical staff, led by Dr. Andrews, would not allow Griffin to play if they believed he was at serious risk of injury.  Due to his recent LCL injury, his knee was probably not quite as stable as it originally was, but there is no way to know if that caused the injury.  He could have sustained the ACL tear even if he was playing on a completely healthy knee with no history of injury.  A number of factors likely lead to this injury, including his previous LCL sprain, his previous ACL reconstruction of the same knee, fatigue (end of game and season), the condition of the field, and the awkward position he is in trying to field the snap.  One could argue that if the snap had been better, this injury would have never occurred.  The point is that it is impossible to pinpoint the exact cause of the injury.

The other thing I have heard several times is that Griffin can be back by the start of the 2013 NFL season because Adrian Peterson did so this year.  I'm not saying that he can't, but it is impossible to make direct comparisons.  While both players are world class athletes, this is Griffin's 2nd reconstruction of this right ACL.  Everyone also heals and rehabilitates at different rates.  It typically takes anywhere from about 8-12 months to come back after ACL reconstruction.  He has a good chance to play next year, but nobody knows for sure at this point what level he will be at.

Final Post of 2012

This will likely be the last blog post of 2012.  I'm planning on staying off the computer the next few days and enjoying the holidays with my family.  As I look back in 2012, many amazing things happened in the world of sports, too many to name.  One of the most remarkable and quickest recoveries from ACL reconstruction is Adrian Peterson.  Peterson tore the ACL and MCL in his left knee on December 24, 2011.  He underwent reconstruction for both ligaments only six days later in Birmingham.  The procedure was performed by Dr. Andrews.

Now, the typical rehabilitation time after an ACL reconstruction for an athlete is around 8-12 months, although this can vary, depending on the athlete, sports, and position.  While most athletes can return to competition within a year of the injury, the majority of them take around 2 years to return to their pre injury performance level.  Probably due to a combination of Peterson's athletic ability, motivation to return to play, and great work by the Vikings' sports medicine staff, he was able to return for the season opener on September 9th, a little over 8 months after his surgery.  This was remarkable considering the stress placed on the knee of a running back.  Peterson is on pace to rush for over 2,000 yards this year, a feat that has only been accomplished 6 other times in NFL history.  Peterson also has a chance to break the all time single season rushing record.  This is truly a remarkable accomplishment, and most of the credit has to go to Peterson.  The rehabilitation following ACL reconstruction is long, tough, and demanding, and for him to do what he has done less than a year after the surgery is very impressive. 

LCL sprain

Last Sunday, Robert Griffin III suffered a fairly uncommon knee injury, the lateral collateral ligament (LCL) sprain.  The lateral collateral ligament connects the femur to the fibula on the lateral (outside) part of the knee.  It is smaller and thinner than the medial collateral ligament, and it feels like a small pencil.

Most of the time in football, players are hit on the lateral side of their knee, which places a lot of tension on the medial side of the knee and can cause a MCL sprain (think about breaking a pencil, the side that is getting longer is normally the side that breaks).  The lateral side of the knee is much more exposed which increases the number of MCL sprains.  In order to sustain a LCL sprain, a person would likely have to be hit on the medial side of the knee.  That's what happened during Griffin's injury.  As he was falling to the ground, the defender hit him directly on the medial side of the knee, causing the LCL sprain.  The LCL isn't as critical to knee stability as the other 3 knee ligaments, but for a running quarterback like Griffin, it is a bad injury.  He missed this past Sunday's game and could be out a few more weeks as the ligament heals and he goes through rehabilitation.