2015-03-02 16:39:08 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the inside.akronchildrens.org blog.
Chris Bosh is sidelined for the season with blood clots on his lungs.
Sports medicine is taking the spotlight in basketball and baseball these days. The leagues are plagued by multiple injuries — from minor to major, life-threatening scares.
Just to name a few:
Last week, I had the chance to visit in studio and speak with WAKR morning show host Ray Horner about these injuries and treatments. Below is an audio file and transcript of our discussion.
HORNER: Joins us in studio once a month, good to see him come in, and that's Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital. And, boy, a lot going on when you're talking sports medicine these days. So, let's get into some things you've got I'll also throw some things your way.
DR. CONGENI: Yeah.
HORNER: Bad news, first of all, in regards to Chris Bosh (Miami Heat), one of the better players in the NBA. I guess he has shutdown blood clots.
DR. CONGENI: Yeah, I mean, but this is a teaching point. I mean, we need to talk about that a little bit because there aren't many things in sports medicine, certainly, that are life threatening. This is life threatening.
And for whatever reason, Ray, you know, a lot of people think this couldn't happen to young athletes, but how many examples do we need of it? I mean, we've had a couple college athletes it recently. ...
DR. CONGENI: We had Jason Pinkston (Cleveland Browns). We had Anderson Verejao (Cleveland Cavs). This happens to young people, and now with Chris Bosh.
And of course, coming on the heels of, Jerome Kersey, uh, people remember him with the Portland Trail Blazers and later on he won a championship with San Antonio. He passed away at 52 ... from a blood clot that went to his lungs.
He had had a surgery in the week prior, so maybe his was more related to surgery because what everybody's asking is how do these come about?
Dr. Joe Congeni
DR. CONGENI: And, we need to really look for these things if young people do get them.
HORNER: Big guys sitting down.
DR. CONGENI: Big guys sitting down, I didn't see that. There was a study that if you're greater than 6 ft 3, the leg room issues in airlines, on planes, .
I always recommend that people get up. ... You know, I just got back, I always get up and walk once or twice up and down the aisle on any sort of long flight ... to try and get that blood moving, but you have to be aware that these things can occur in young athletes.
HORNER: Are there any, like, warning signs that you have a blood clot, Joe, I mean?
DR. CONGENI: Well, the warning signs start out in the calf, you know. The calf classically is crampy pain, not just pain when you play. So, a lot of people say they have pain when they play, but these people have pain and redness and warmth in the calf.
HORNER: I see.
DR. CONGENI: We do a squeeze test. The thought used to be it's only on one side, but you know I've seen a few in young people lately they've had this calf problem on both sides. Then, when they start having the lung symptoms ... .
You know, Bosh thought maybe that he had a rib injury, and other people are coughing a lot. Pinkston couldn't get over a cold. He was supposedly pneumonia because he had so much chest pain and shortness of breath.
When you put those constellation of symptoms ... together, that's a person . You gotta figure it out because this is life threatening.
HORNER: So, medically, what do you do? For example, Chris Bosh, he is shut down for the year. Do you go in medically, do they take the clot out?
DR. CONGENI: No, no they can't take ...
HORNER: What do they do?
DR. CONGENI: They can't take the clot out, but what they do is they put him on powerful blood thinners, first of all. They have you hospitalized on IV blood thinners and then later on you go home and remain on these blood thinners for, it's up to the docs, 4 months, 6 months.
Obviously then what would be the risk if you go out and you're banging people ...
DR. CONGENI: ... playing in a contact sport for bleeding, particularly bleeding in the head, so that's why you're out for a prolonged period of time, 6 months or more.
Remember, Pinkston never did make it back and so, that's a pretty big deal, but definitely out for the year on blood thinners.
Kevin Durant has missed 28 games this season due to a foot fracture and its lingering effects, and was recently ruled out for another week following a procedure to have a screw in the foot replaced.
HORNER: Okay, let's go also in the NBA, one of the maybe top 4 or 5 players in the league is Kevin Durant (Oklahoma City Thunder) and he's got what another foot injury?
DR. CONGENI: Yeah, remember the Jones fracture we talked about earlier this year?
The Jones fracture happens a lot in sports. Out on the fifth metatarsal, way on the outside edge of the foot, they get these stress fractures that just don't heal very well.
So instead of trying to put 'em in a boot and rest, we know they don't heal well, so in athletes we put a screw in 'em to fix 'em.
Well, in this case, in Kevin Durant, where they put the screw in, uh, it actually is rubbing against a bone more towards the middle of the foot, called the cuboid, causing irritation.
You saw him play maybe recently against the Cavs or in the All-Star game, he was limping around and not playing well and not explosively pushing off that foot, and he finally had to have something done about it.
So, what do you do? I mean, gosh, a handy man like you, you go in your garage and look for another screw, and they had to replace the screw.
But, honestly, there are some people that are at risk that I kinda wanna just mention for these kinds of injuries. And not to oversimplify it, but we look at the feet in athletes a lot to try and take the stress off the shin, the foot, the knee. sometimes make orthotics or inserts for the shoe.
... I heard one of the talking heads on ESPN saying, I haven't seen Kevin Durant, but that his foot type is called a rigid foot type.
There are basically, in simple terms, two types of foot types. A flat foot that that arch is not very tight. It's very loose and when you step down, it's a flat foot and not a very good shock absorber and prone to certain types of injuries.
But even more at risk are people with a real high tight arch. That arch on the bottom of the foot is like a little mini trampoline to absorb shock forces from the ground, and what happens if you have a very tight or rigid arch, you put a lot of pressure on the outside part of your foot.
And so, that's right where this bone is and the word is he and other NBA players are ones that have a rigid foot, a high arch -- we use a fancy medical word, cavus foot -- and the word is that he may be one of those.
So, this may be one thing that even with trying orthotics and other things, they're gonna have to try and take pressure off the outside part of the foot, make him comfortable again and get 'em back to play.
But the process of just taking the screw out and replacing it, that's not as big a deal. And if that's all he's got and not a refracture, he should be back fairly quickly.
HORNER: That's what I was gonna say, what's the recovery time for something like this?
DR. CONGENI: Oh my gosh, yeah, just weeks.
DR. CONGENI: So, he should be back in weeks if that's all he's got. If that fracture didn't heal very well, if he's still having some issues with that high rigid arch, .
So, that's what a lot of people face. ... That's what some of the people are saying and then that might take him a little bit longer and it may be awhile until he's comfortably playing.
HORNER: In the long run, does that shorten his NBA career?
DR. CONGENI: Usually not. This is an injury that's thought of as not one of those ... not like Z's (Zydrunas IIgauskas) foot problem. That foot problem is a little bit different.
DR. CONGENI: This is one that traditionally people get better and from what we read, his just seems the irritation of where the screw was between 2 bones and once they get it out, it should be short term.
The Oakland A's traded Brandon Moss to the Cleveland Indians. CC/Flick Keith Allison
HORNER: Dr. Joe Congeni with us, Sports Medicine Center at Akron Children's Hospital.
Let me go your way with Brandon Moss (Oakland A's) here. We're seeing more and more of hip injuries in Major League Baseball. You know, I don't think of hip injuries in baseball, but I guess if you look at the torque and everything, .
He's recovering; he's on a running regiment. He didn't have hip replacement; he had hip surgery. Joe, we're seeing a lot more of these hip injuries in baseball. Go down that road for me.
DR. CONGENI: Yes, and we've talked about that a little bit, even as it comes to younger athletes in a clinic like ours because of the fact that, you said it, torque is the word you used, or rotation is the word.
There's a lot of rotation in the sport of baseball; a lot of rotation on the hip. And remember, the hip is a ball-and-socket joint and when there's a lot of rotation, Ray, what happens the 2 bones start to rub against each other quite a bit. And, when the bones rub together against each other, we have a word for that, it's called impingement.
If the hip starts to wear out prematurely, all these people had hip replacements later, now we have a newer tool where we can do arthroscopic surgery to try and get rid of these bumps in the bone from rubbing.
The other thing we've learned is there's a shock-absorbing cartilage pad called a labrum. I think I read that Moss also had some work on the labrum.
So, the labrum helps keep that ball in the socket and what happens the labrum gets torn, the bones are rubbing together, and arthroscopically they go in and smooth off the bone, they go in and trim up the labrum. This is well before a hip replacement or we wouldn't be talking about him helping the Indians this year at the stage he's at.
DR. CONGENI: Now, we see variable success to this. But you know, the surgery with the arthroscopic has really improved things a lot. I think that's why you're hearing so much of it is it's being done sooner and arthroscopically, and the results are supposedly a lot better. Then you see someone like A-Rod (Alex Rodriguez) had that and he struggled through getting back.
But you're right, there's a lot of rotation in the sport of baseball. There's a lot of strain on the hip and in the old days, guys just played as long as they could and then they'd have old, worn out hips and 10 years later, they'd have hip replacement.
Nowadays, with another tool of arthroscopically going in there to smooth it off, we're seeing that a little bit more and it'll be interesting to see.
HORNER: Yeah, I know you haven't looked at the X-rays, for example, on Brandon Moss ...
DR. CONGENI: Sure, sure.
HORNER: So I know it's a case-by-case thing, but in the off-season, the A's kinda backed off him a little bit because of the injury. As you look at the Indians' situation here, is this a type of surgery procedure that guys recover from A-Okay or not?
DR. CONGENI: Yeah, Ray, you know, I don't want to elevate sports medicine people to higher levels than they should be, but that's what things like the Combine are all about. You and I talked about it last year. You're making decisions on teams from the standpoint of talent guys have, but also on what kind of baggage they have injury wise.
So the Indians, you know, low risk. They didn't have to pay him a lot of money, from what I understand. Uh, this is the kind of thing it's somewhat variable, and if they did a good job with this hip, if arthroscopically his hip was amendable to and not too badly beat up ... yeah, there's a real chance that he could come back and help the team.
Now, would I be totally shocked if the fact of the matter is he gets back out there and he continues to struggle with rotational things, no. But, it doesn't look like they paid him, you know, an exorbitant 10-year, no-cut contract or anything like that.
And in fact, a lot of those sports-medicine issues become what a lot of teams are having to face, might be some of the more important decisions that NFL teams make, that Major League Baseball teams make. And in a case like his, it certainly seemed like the A's wanted to back off. They didn't want to take a chance and give him anything longer.
DR. CONGENI: And maybe the Indians get fortunate in this newer surgery technique, the arthroscopic, to take care of his hip problems, and he's out there by mid-summer really knocking the ball around.
HORNER: Alright, Joe. Thanks for the visit. Thanks for coming in.
DR. CONGENI: Okay. Thanks, Ray. Good seeing you.
HORNER: Always great insight with ... Dr. Joe Congeni from Sports Medicine Center at Akron Children's Hospital.
(8 a.m.-4:30 p.m.)
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