2015-07-09 12:45:25 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.
A pick-up game of basketball this past weekend left Rory Mcllroy on crutches with a lateral ankle sprain. He's officially out of next week's British Open, but I think there's an excellent chance he'll compete in next month's Bridgestone Invitational here in Akron.
He suffered a grade 3 sprain with a ruptured ligament. Luckily, the injury responds well to aggressive physical therapy and, in contrast to a high ankle sprain, the recovery time is relatively short.
This week, I spoke with 1590 WAKR morning show host Ray Horner about this injury and treatment. We also discussed New York Mets' David Wright's recent diagnosis of spinal stenosis and the future of his game.
Below is an audio file and transcript of our discussion.
HORNER: Our good friend, Dr. Joe Congeni, is live in our studio.
By the way, when Joe's live if you do have a question about sports medicine, maybe some injuries you've seen or maybe even in your son or daughter, grandson, granddaughter ... 330-370-1590 is the number to call.
Joe, I was just talking moments ago about Rory Mcllroy. Uh, Tony (Mazur) passed the word on to me yesterday right around this time. He said, 'Hey, Rory has a ruptured tendon, ankle playing basketball this weekend.'
They're saying, man, British Open looks definitely in jeopardy and they don't know about the Bridgestone Invitational. What do you know about this type of injury?
DR. CONGENI: You know, he's out of the Scottish Open this weekend, I think that's what they said, and the British is 10 days from yesterday, so they have 10 days to get him ready.
I chuckled a little bit at this one because they said a ruptured anterior talofibular ligament and that is the very, very fancy, common name for a bad ankle sprain. So, this is just a bad ankle sprain.
HORNER: Oh, okay.
DR. CONGENI: So, the ligaments that connect the lower leg bones to the foot and ankle are the ones that tear most frequently on the outside of the ankle. It's called a lateral ankle sprain. Grade 1 is a stretch, grade 2 is a partial tear, grade 3 is a complete tear or rupture.
I assume from what they're saying that ... he has a complete tear. You saw pictures of him in the boot and crutches and it doesn't look very good. My prediction is there's gonna be a heroic Rory siting at the Open next week. So, this is an injury that really responds very well and quickly to aggressive rehab.
Dr. Joe Congeni
DR. CONGENI: Now, I don't know his situation. Like we always say here, I haven't examined his ankle.
DR. CONGENI: But, even people with ruptures with complete tears, very frequently they respond very well to physical therapy. So, I'm sure in a guy like Rory they've got going on all the treatments that we do initially to get rid of that swelling.
They, uh, had him icing, stimming (stimulation), and getting massage treatments to get the swelling out of the ankle and then get the range of motion and strength and balance back in the ankle.
At the level of somebody like Rory with a brace, I think there's a very good chance he's still gonna be playing in the Open.
HORNER: So, this isn't like a high ankle sprain. This is the outside sprain that a lot of us get playing basketball ...
DR. CONGENI: The typical, typical sprain that they talk about.
HORNER: but a bad one.
DR. CONGENI: But a bad one because it tore all the way versus a partial tear, but they did not mention a high ankle sprain. High ankle sprain -- and you've learned through the years -- is about twice as much time to get back.
If he was playing in the NBA finals, I think he'd be ready in 10 days with a lateral ankle sprain. The one on the outside of the ankle, below the ankle, the typical ankle sprain most of the time with really aggressive physical therapy.
This is where the PTs get to shine. They do a really good job getting the blood out of there. This ligament is very vascular. That means it has a lot of blood vessels.
So, kids come in from the emergency room nowadays, this is par for the course in my office, they bring a picture on their cell phone, smart phone of what their ankle looked like. They say it looked like a golf ball or a softball, and there's all this swelling and bruising.
But, when you start therapy within the first 24 to 48 hours, you can get the blood out of there, get the ankle moving again, get the strength back in there, rehab, brace or tape them and get them back to sports often within 7, 10, 14 days.
HORNER: Dr. Joe Congeni with us, Sports Medicine Center at Akron Children's Hospital.
Joe, with a sport like basketball, this type of injury to me would take a long time to get back on the court, maybe as a football running back, . What about the game of golf? How much stress does that put on that particular area of the body?
DR. CONGENI: Yeah, that's unique because we're used to getting people back to soccer or basketball or football with this kind of injury, and not so frequently to that very high level of golf.
Because timing and all I hear about from the golf people is muscle memory and having to do the same thing over and over again, I would be a little bit concerned about Rory having that timing down.
But otherwise, I think that this would be an easier thing to do than the stop and start, and lateral motion of, uh, the other sports that we mentioned.
On the other hand, there is some rotation that comes across the ankle just like there is in the knee in golfers, so it'll be interesting to see how he plays because of the timing and the muscle memory.
But, I do think that there's a very good chance, even though we saw him on crutches with a boot just yesterday, I think there's a real chance he may still play in the British Open.
HORNER: Which means a month from now with the Bridgestone probably an excellent chance?
DR. CONGENI: Oh, I think an excellent chance we'll see him in Bridgestone.
HORNER: Awesome. That's the best news of the day.
Now, you were also telling me you've been connecting with some people in New York about what David Wright (New York Mets)?
DR. CONGENI: Yeah, I get these calls sometimes now. They were trying in the New York Daily News to get a little bit more information. Everybody's really frustrated with David Wright. I gather that it's a little bit like we were with Grady a few years ago, that they just can't keep the guy on the field and healthy.
David Wright must show that he can run without pain before he can be cleared for baseball activity.
And so, when he came up he was, you know, an All-Star to be. He was the anchor. Baseball's very funny. One day an anchor, the next day you're sunk. I mean, you're gone. ... Baseball's really funny, and David Wright's had trouble staying on the field and what they've identified most recently in the last month is a diagnosis called spinal stenosis.
So again, just like the confusion on this ankle sprain, when Rory threw out the big name of a ruptured ligament in his ankle, well that's an ankle sprain. There's a lot of confusion about spinal stenosis.
So, there's the variety where in football and wrestlers ... up in the neck they're born with narrowing of the spinal canal that can put you at risk for being paralyzed, and they tell you, you can't play anymore.
There was a kid just recently, I believe, from the University of Florida -- Remember, an offensive lineman this year? -- where they told him after they worked him up with a neck injury, his neck canal was too narrow and he would run the risk and his career is over. That's a really tough thing to have to tell a very good prospect.
It's exactly the opposite in David Wright. It's down at the lower back, and this is what so many of us get when we get to be the weekend warriors at 40 or 50 or 60. Unfortunately, he's getting it prematurely.
The area around the spinal canal narrows ... that's the name stenosis, but it narrows down because of arthritis and disc disease, and all the wear and tear of playing sports all that time. And, when it narrows down it starts to pinch on the nerves coming out in the back.
So, a lot of times the way it manifests itself is recurrent hamstring strains or weakness in the legs and numbness in the legs and other things like that. And you say, geez, what's wrong with this guy? He's had so many hamstring strains.
We mentioned it in the book that I talked about. We signed a guy by the name of Keith Hernandez many years ago. He had hamstring sprain after hamstring . Finally, they looked at his back and they saw he had very bad spinal stenosis.
Uh, they tried surgery, but it doesn't work as well. They try injections. It doesn't work as well. When somebody gets to the point of wear and tear to spinal stenosis, it's a little like when you and I talk about microfracture surgery, it's not a good sign that the athlete has very long to be playing anymore.
HORNER: Wow, and he's relatively young and just signed a gigantic contract, too.
DR. CONGENI: Yeah, right. That's the kind of thing that can happen in baseball. You know, it happened to us a few years ago when we signed that core in '07, '08, '09, and all 3 of those guys broke down: Hafner, Sizemore, Westbrook. We talked about that.
This is the way baseball goes sometimes. One day you're on top of the world and the next day you're at the bottom of the heap.
HORNER: So, speaking of the bottom, when this is at the bottom again, that's more wear and tear not a blunt blow to the back?
DR. CONGENI: It's not the way you're born, yeah. So, people get confused. People are born with narrowing of that canal. That's up in the neck. That's career threatening.
In the lower canal, it's usually arthritis, wear and tear ... and stuff like that ... and it can begin to pinch on the nerves in the low back.
HORNER: Oh right.
DR. CONGENI: I wanted to give one quick shout-out also, the, uh, Astros are in town. You know, they're a very good team and they are the, uh, surprise team and doing great. And one of my old, uh, fullback and football players from Hoban is the strength coach, Jake Beiting.
HORNER: Oh sure, Jake.
DR. CONGENI: And so, we got a chance to connect with Jake Beiting this week. Jake, you know, very well known in this area. He's the head strength coach. He's with the Astros in town this week.
They're on top of the baseball world right now as they have a lot of good young players ... and so, he's overseeing the strength of the Astros and it's good to see our young people do well.
HORNER: No doubt about it. Hey, Tony picked up your book, by the way.
DR. CONGENI: Hey. That's fantastic. Thank you, Tony.
MAZUR: I'm looking forward to, uh, cracking it open today.
DR. CONGENI: I'd like to get a chance to sign it. You said you got it for your dad?
DR. CONGENI: I'd love to personalize it. It's been a real fun thing for me.
...Thanks for the, uh, news on the book. Anybody ... if you get one of those, I'd love to get a chance to sign it. It's really for those of us , you know I call it, the fraternity of misery.
DR. CONGENI: Those of us who love sports in Cleveland. The passion, the resilience of our fan base is unbelievable, unmatched.
HORNER: Alright, Joe. Good seeing you again.
DR. CONGENI: Thanks, Ray.
HORNER: Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital, joins us Wednesdays here on the Ray Horner morning shows.
(8 a.m.-4:30 p.m.)
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