Are the latest virtual reality return-to-play performance measures the wave of the future?

2014-11-13 09:42:19 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the blog.

Kobe Bryant's return to the game too soon may have lead to the injury in his other knee. Kobe Bryant's return to the game too soon may have lead to the injury in his other knee.

Typically, return-to-play decisions are clinical guesswork. But as we enter the year 2014, there are some new virtual reality-type performance tools that can more precisely indicate an athlete's injury deficiency, as compared to his baseline measurement.

Yesterday, I had the chance to visit in studio and speak with WAKR morning show host Ray Horner about this topic. I think these performance testing measures are the wave of the future.

Below is an audio file and transcript of our discussion.

HORNER: In our studio right now is Dr. Joe Congeni from Sports Medicine Center at Akron Childrenís Hospital. Joe, thanks, by the way, for coming on yesterday and talking about exercising in the real cold weather. You want to talk a little bit this morning about injury recovery?

Dr. Joe Congeni Dr. Joe Congeni

DR. CONGENI: Yeah, about what we call return to play. I mean a big part of what we do in sports medicine is trying to make decisions on return to play and itís not easy.

Just recently over the holidays, you know, Kobe Bryant (L.A. Lakers) and his Achilles tendon. We all kinda know, hey, Achilles tendon surgery, that takes awhile before you return to play. But Kobe, you know, heís the mind-over-matter guy and he was gonna tough his way through and be back before anybody could be back.

And sure enough the first 2 or 3 weeks back playing, he ends up with an injury in the other knee ó a stress fracture, bone bruise-type problem, which Iím certain, no question about it, was related to the fact that he wasnít ready.

There are some tools on the horizon that might help give us data that a person is 72 percent of normal or 68 percent of normal. Itís pretty exciting for us in sports medicine.

Last year, we saw one of the best-known athletes, RG3 (Robert Griffin III of the Washington Redskins), return and everybody now looks back and says he shouldnít have been out there.

And a year ago, everybody was battling, you know, whatís the deal with Derrick Rose (Chicago Bulls) after his ACL?

So, these decisions arenít easy. Typically, we just make clinical decisions. We see them in the office, we talk to the therapists, we do some testing, but in the year 2013-14, there are some new tools that are out there.

These are virtual reality-type tools that actually give us measures of explosion, and vertical jump, and rotational movement patterns and side-to-side movement patterns. If you have a baseline on somebody, you can see exactly how theyíre doing when theyíre returning from an injury.

The way I liken it to athletes is itís kinda like a scoreboard up there. Instead of just kind of clinical guesswork about whether somebodyís ready, there are some tools on the horizon that might help us with giving us , that person is 72 percent of normal or 68 percent of normal. Itís pretty exciting for us in sports medicine.

HORNER: Joe, one thing we see a lot ó and we can turn back the clock to Grady Sizemore and move forward from there with the examples you had ó is when they have these devastating injuries, often the players will come back, but suffer an injury to another part of their body. Why is that?

DR. CONGENI: Yeah, thereís no question when you look at the mechanics of people returning to play, if thereís a significant deficit, theyíre gonna find a problem in another area.

The Grady Sizemore thing no question he was unraveling, having all sorts of different injuries. He got into that chronic change, the microfracture. Remember, microfracture is one of those code words for Ö that person is really struggling.

HORNER: Well, you were the first person who told me ó and I remember this distinctly ó when he suffered that injury Ö you said, heíll never be the same player again. You went on record of saying that and you were exactly right with that.

DR. CONGENI: Yeah, you know, as a lifetime Cleveland sports fan, it pained me to say that because it was such a wonderful thing to see him play.

But no question about it, in somebody like Kobe Bryant, again, itís another example of the fact that heís the kinda guy that , Iím gonna go out there and play and help my team and things, but he didnít really help his team.

Now, heís got a setback again, and now you question whether heís going to be useful heading into the play-offs or not. And are the Lakers really looking at just this whole season as kinda being a loss and trying to regroup for next year?

So, they get into mechanical patterns and they have deficits that cause them to have other types of injuries. Itís a very common pattern.

We try to avoid that in the high-school setting, the kids that are in our office. But thereís no question thereís a very fine line: people want to be back, the seasons are short.

I have these discussions in my office. They put a lot of money and emotional input and everything to be ready for those 22 basketball games or 10 high school football games. And if you miss 3 or 5 or 7 games in a sophomore year, junior year, worst of all, a senior year, itís a big deal.

HORNER: We saw Michael Crabtree with the (San Francisco) 49ers has come back. It was late May he had an Achilles tear, complete surgery. This guy looks like he never had an injury.

DR. CONGENI: Yeah. I think with Michael Crabtree, though, they did a really good job. Remember all the pressure early in the season with the 49ers about no receivers, they donít have anybody out there?

But they hung on, they waited with him, they rehabbed him well, they brought him back at a real key time of the season, and now he looks like heís giving that team a boost.

HORNER: Is that a normal time of recovery for an Achilles tear? I remember, and maybe things have changed medically, with Achilles tears youíd be down at least a year, maybe more. Heís back in five, six months.

DR. CONGENI: Itís a little bit difficult to say. So many professional athletes now are doing so many of these experimental-type treatments.

PRP (Platelet-Rich Plasma) is not experimental anymore. Thatís where you take out the personís own growth factors in their bloodstream and re-inject them into these injured areas.

But Kobe ó and now a lot of other athletes have followed him over to Germany ó is doing some of the genetic-type treatments that they have. So, there are a lot of things that can push that envelope of getting people to heal faster, especially in the pro setting that we donít have available to our high-school kids.

But still, thereís a certain time that the body takes to get better and with an Achilles tendon, youíre looking at a minimum of 6 months.

HORNER: Dr. Joe Congeni with us from Sports Medicine Center at Childrenís Hospital.

You were talking about these deficiencies, Joe. Do you think that is something that will be put into testing for athletes when theyíre going in, for example, to an NBA or NFL draft, or for high-school kids coming in? If an organization, Iím talking down the road, wants to select these kids, can they put them through those tests to test for injury deficiency?

DR. CONGENI: Yeah, thereís absolutely no question. A couple of the people that have come up with these devices, the first people they sold them to before the sports medicine people that develop the performance-training centers that develop the athletes.

So, you know, right now all these guys that every day now are saying, this guy declared, and this guy declared, and Johnny Manziel (Texas A&M) Ö Theyíre all declaring right now.

Where are they heading off to in the next week or two? Theyíre going to these performance centers all over the country now ó thereís one at the Mayo Clinic in Minnesota.

And, exactly, no question, these people are going to be tested before, and then theyíre gonna work out for three or four months, tested after.

These same tools are going to be useful at places like the combine, and then we hone it down to the high school kids that are looking to get into college. This is the way theyíre gonna be tested, and the future is looking at these performance testing measures.

HORNER: Yes, so Iím thinking when they go to these combines, the 40-yard dash and the is going to be just as important as the deficiency score. Donít you think?

DR. CONGENI: Less important. I think itís gonna pass these tests up. A lot of people have looked back in our realm of performance training and say really, the shuttle, the 40, a lot of things weíve hung our hat on for a long time . Weíve known this because theyíre drafting people on the numbers who never get out on the field or help anybody.

So, weíre looking more at performance numbers and this is going to be a big wave of the future. You hit the nail directly on the head as usual, Ray. This is whatís cool about some of this testing is I think itís going to change how we evaluate athletes.

HORNER: Thereís no doubt about it. I can see this happening. Itís gonna be up there on the screen. He has that deficiency score, do you draft him or not? Itís kind of exciting and very interesting.

Joe, as always, thanks for coming in. We appreciate it.

DR. CONGENI: Thanks, Ray.

HORNER: Dr. Joe Congeni from Sports Medicine Center at Akron Childrenís Hospital joining us in studio.

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