2015-01-09 12:43:18 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.
Overuse injuries are a big part of sports medicine. In fact, 70 percent of the injuries we treat in our office are overuse or overload injuries, with the other 30 percent being trauma injuries.
Overuse injuries occur from just that, repeating the same activity/motion over and over again, whether it’s lifting in the gym or during play. Even the greatest athlete of our time, LeBron James, is suffering from an overuse injury and may need to sit out a few games.
Today, I had the chance to speak with WAKR morning show host Ray Horner about this topic. For overload injuries, rest and rehab are key to treatment. However, unlike trauma injuries, it’s not clear-cut as to how much rest an athlete will need to fully recover.
Below is an audio file and transcript of our discussion.
Horner: Dr. Joe Congeni with us, Sports Medicine Center at Akron Children’s Hospital. What’s on your list for us today, Joe?
Dr. Congeni: Well, I mean, of course what we get asked about a lot — and it’s a real good opportunity for me to use this, and I’ll be using it a lot in the next few weeks here — are the types of injuries we see a lot in sports medicine.
Seventy percent, 7 out of 10 patients in an office like ours are overuse injuries. Thirty percent are trauma injuries, if you really break injuries into those two types.
So, trauma injuries are like torn ligaments, like an MCL or an ankle sprain and things like that, versus overuse injuries are where you’re just doing too much — 70 percent of what we see.
So, even in the greatest athlete of our times, right in our backyard, oh my gosh, you mean that LeBron James is gonna have to take time off for an overuse injury? I mean, it’s a real head-scratcher, Ray. People saw the game before he took time off. He dunked. He was running up and down the court. He was playing well.
Dr. Joe Congeni
You know, you can play through these overuse injuries, but they’re just actually getting worse instead of better. Rest is part of getting them better, but it’s not always really easy to say how long to rest, either. You know, as I talk to patients in my office, geez, we need a crystal ball. Is it 2 weeks? Is it 4 weeks? You know, what’s gonna be enough to treat people.
For instance, is called jumper’s knee, and jumper’s knee is an overload injury to the tendon below the knee. So, they said a week or so ago, they did a full workup of MRIs and other things. There’s nothing torn, and there’s no structural damage, and there’s no bad arthritis or anything like that, what the report in the paper said.
This appears to be an overuse injury and this is what we deal with literally 7 out of 10 patients that we see in the office.
If they’re at a point in the season where, hey, we have to play through for a few weeks, just so they understand, it might begin to affect their performance. They’re not playing at their best with, uh, jumper’s knee, plantar fasciitis, rotator cuff overuse, stress fractures. Those are all overuse injuries and they definitely are improved significantly by some period of rest.
Horner: Dr. Joe Congeni with us, Sports Medicine Center at Akron Children’s Hospital.
Back issues we hear with the Cavaliers, as well. Both LeBron and now Kyrie Irving having some back issues. I mean, everything that I’m hearing, Joe, this is more of a rest thing, right?
Dr. Congeni: Exactly. So, actually, you can throw Kevin Love in that group. He finished the day with a back sprain the other day.
There’s no question rest, but it’s really hard to say. So if the calendar said June 1st right now or May 15th, you think these guys probably would be playing through these games? Yeah, they may, but these things do better with some degree of rest. So, you have to be wise about using rest as a tool to help people get better and remember rehab.
I mean, they’re literally saying Kyrie stayed home and had, you know, 24 hours of rehab, 2 or 3 different things. He stayed home from the trip to, uh, Philadelphia this week to get his rehab. Kevin Love had rehab, uh, and LeBron is getting 2 weeks of physical therapy and rehab here to get better for his back, as well.
So, rest and rehab is what gets people better, but it’s not always clear-cut as to how long. So for instance, if you tear an MCL, we know, we tell you 4 to 6 weeks. If you have a fractured bone, 6-week injury. It’s not as clear-cut with an overuse injury or a back injury how long you have to hold somebody out.
We do some testing to see functionally how well these athletes are doing, and I’m sure Kyrie’s going through that right now as they try to decide how much he’ll be able to play on that road trip.
But, a big part of sports medicine are these overload injuries and having to use rest occasionally to take a couple steps forward, instead of continuing to get worse.
Horner: You know, an interesting thing, and it’s almost like a laughter type of thing, Joe, is Johnny Manziel. He missed that last game with “a very severe hamstring injury.” Uh, didn’t even play that last game. Now we see him out and about in some clubs in Houston and such. He’s gotta take care of this thing. A hamstring really can linger a long time.
I remember years ago, a baseball player by the name of Edgar Martinez had a bad hamstring in April, ended up missing basically the whole baseball season. You take the rehab seriously.
Dr. Congeni: Yeah, you know, I mean there are many stories like that. Uh, the hamstring is one of the biggest, thickest, strongest muscles in the body. It depends a little bit again on the grading of how severe that injury is.
A grade 1 is just kind of an overstretch to the ligament, I mean to the muscle tendon of the hamstring. A grade 2 is actually some partial tearing and a grade 3 can be a complete tear.
And so, they do take a long time . Remember, because the body does such a good job trying to heal, that’s where rest really helps. With a period of time without playing, the body does a good job in healing itself.
But in the hamstring, Ray, just like you said, a lot of times that healing lays down a lot of scar tissue in that thick, fleshy muscle and people will kinda have a stiff look when they run.
There’s thickened and gritty scar tissue in the muscle and tendon and you don’t play as well when that very important sports muscle, the hamstring, that, you know, goes from the buttocks to the back of the knee, . When there’s a lot of scar tissue in that muscle and tendon and it isn’t fully healed, you’re not gonna be reaching your full potential as an athlete.
Horner: I heard yesterday, uh, quarterback Aaron Rodgers for the Packers, he said, numerous injuries to his right leg this year. He’s getting ready for a big play-off game on Saturday against the Cowboys. Right now he’s got a calf injury.
Dr. Congeni: Right.
Horner: And with a right-handed quarterback, I was trying to picture myself, that’s the front leg as he’s throwing. Do you often see injuries to right legs? I should say the left leg is the one in front. The right leg is behind. That’s the push-off leg for a right-handed quarterback, Joe. Do you see a lot of injuries for quarterbacks in that area?
Dr. Congeni: Um, sure. And again, trying to sort out whether it’s something traumatically, you know, that he did one time. Everything was perfectly fine and then one time he pushed off, or one time one of his good friends, like Ndamukong Suh, steps on him or stretches him, you know, that muscle.
Dr. Congeni: That’s a trauma injury versus an overload injury from over and over throwing a lot in practice, lifting a lot to try and get ready. Whether it’s an overload, overuse injury versus a trauma injury, I’m not all together sure in Aaron Rodgers, but this is one of those situations where that week off, apparently from what I’m reading, was fantastic for him.
He didn’t even practice or do anything for the first week that they had the bye week in Green Bay and they’re saying that that calf muscle injury was much better. But if you saw him in the last few weeks, he was having trouble pushing off. He was definitely not moving around as much in the pocket and I think it really was beginning to affect performance.
And a big part of sports medicine is determining at what point of affecting performance do you pull an athlete out. Again, coming back to even the best athlete in our own backyard, when was that back injury and that jumper’s knee for LeBron getting bad enough that is was affecting his performance and we need to take a break?
Horner: Good insight, Joe. Thanks for the time, always appreciate it.
Dr. Congeni: Alright. Have a great week, Ray.
Horner: You too. Dr. Joe Congeni, Sports Medicine Center, Akron Children’s Hospital.
Originally aired on 1590 WAKR-AM on Jan. 7, 2015
(8 a.m.-4:30 p.m.)
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