BSJ Injury Mailbag with Dr. Jessica Flynn: Rex Burkhead's ribs

Thank for visiting my first BSJ Injury Mailbag! Would love to hear from you for future editions, so make sure you check out the contact information at the bottom of the page.

Lots to get to this week, including how ACL and injury rehab differs for pro and amateur athletes, could we see the recovery times for ACLs cut even further, Nate Solder, and David Price's elbow, but let's first start with a timely subject: Rex Burkhead and rib injuries:

 

https://twitter.com/Grohman/status/913566761798311936

 

https://twitter.com/CheyenneSulli14/status/913525763600785408

 

Rex Burkhead was injured in the Saints game on Sept. 17. It’s being reported by the team as a “rib injury.” This is likely either a bruised or fractured rib. The fact that it has taken 12 days for Burkhead to be spotted at today's practice leads me to believe that it’s a significant one. Rib fractures can take 2-to-6 weeks to heal, depending on other soft tissue injuries. We’re past the two-week mark at this point. Now that's he's back at practice they’ll likely work him back in slowly so he doesn’t have any setbacks.  A return for this weekend might be pushing it since he hasn’t practiced with the team in a couple of weeks, but you never know what Bill has up his sleeve…

On broken ribs and Ty Montgomery

https://twitter.com/ClarkBar1414/status/913586425400053760

 

My 8-year-old son feels your pain, @ClarkBar1414! He woke me up this morning asking the exact same question. Speaking of pain, it’s pretty common knowledge rib injuries are incredibly painful. A rib fracture can take anywhere from two-to-six weeks to heal. It’s almost impossible to take a deep breath with a rib fracture, so pain is really what dictates this. Soft tissue injuries including rib cartilage injuries can take a little longer - closer to six weeks.

ACL questions...

https://twitter.com/MrQuindazzi/status/913598834470776832

This is an excellent question and the truth is we don’t really know. In general, we don’t look for degeneration in ligaments on MRIs. We don’t talk about ligament wear and tear in the knee as a diagnosis, but that could contribute to tears. Patients don’t complain about nagging symptoms and then — pop! — a tear. In general, tears to the ACL are acute events that occur because the strength of the ligament is overcome by the stress exerted on it. In pro athletes we see bigger, stronger muscles with harder and faster cuts on stickier turf surfaces which leads to acute overload on the ACL, causing it to give way. In Julian Edelman’s case, if I recall correctly, Brady threw him the ball three quick plays in a row. He just took one sightly over-reaching awkward step and the knee buckled. He knew immediately. Can’t help but comment that I feel terribly for him after dealing with that nagging Jones fracture and finally getting back to himself. Offense could sure use him this week!

ACL rehab for the common man or woman

https://twitter.com/csoandy/status/913570488810708992

 

 

https://twitter.com/daydaynew1999/status/913566051404800000

 

Thanks! Happy to be here! More great ACL questions.

A friend of mine has been asking me to write something about this for a while. The general principles of the rehab for professional and amateur athletes are the same. In the case of an ACL tear, for example, both a pro athlete and a weekend warrior would first wait until the swelling has improved and range of motion is optimized. This is done to shorten the recovery period after surgery. After the reconstruction is completed, the two main goals are healing of the graft and return to normal function. This is where the two rehab protocols can differ. Pro athletes have different goals and access to 24/7 rehabilitation. And, for the most part, recovery IS their full-time job. Most ACL reconstructions use a patellar tendon graft with bone plugs at both ends. It takes at least 6 weeks for those bone plugs to heal in. And it takes at least 18 months for the tendinous graft to transform itself into a functioning ligament. That’s a big part of why we say that athletes don’t tend to be back to their normal selves until about one and a half to two seasons after ACL reconstruction. Ever since Adrian Peterson returned 8 months after ACL surgery better than ever, NFL athletes have been racing to push the bar. The problem is that many of these athletes are having complications like patellar stress fractures (Dion Lewis dealt with one) and chronically swollen, stiff knees. The truth is, there’s a lot of benefit to having around-the-clock therapy like NFL athletes do. But the downside, and probably the biggest lesson we can learn from them, is that even the fittest, fastest, baddest bodies are still made up of the same cells as the rest of us and those cells need time to heal.

On bone bruises…

https://twitter.com/IronRooster606/status/913556547015516160

 

 

 

https://twitter.com/dannypsports/status/913481065637011463

 

A bone bruise occurs when something strikes the bone, just like a bruise on your skin. In the case of the knee, bone bruises usually occur when one of the knee bones hits into another one of the knee bones when the knee is stressed. The diagnosis is made by physical exam — athletes are tender — but confirmed by MRI. What we see is an area of the bone where there’s a lot of swelling and increased blood flow. Mild bruises are a pain tolerance issue — some athletes play right away while others can take a couple of weeks. But more significant bone bruises carry a risk of the bone fracturing or collapsing if athletes return too soon. Think of severely bruised bone as softer bone. If that softer bone is just under the surface of the knee joint (which is commonly the case), then if an athlete returns before the bone is healed, that part of the bone can collapse and take part of the joint surface with it. Collapse of the joint surface and the resultant injury to the shiny articular cartilage in the knee is a career-threatening injury, so it’s one that teams take very seriously. Moderate-to-severe bone bruises can take closer to 4-6 weeks to heal. (I wrote about this in-depth when Dez Bryant had a bone bruise last year so if you want more info check it out!)

Is there any way to determine from Nate Solder’s movement on the field whether or not he is injured? His play has deteriorated this year and I would assume that he is dealing with something. - Neil Gardner

Hi Neil! I agree that Solder doesn’t seem like himself this season. Unfortunately, I don’t see anything specific in the way that he’s moving to account for it. Sorry I can’t help more with this one.

Can you give us your opinion on David Price’s arm? Would you have suggested surgery? - Adam Lewis

Price’s elbow situation is certainly “unique,” just like his doctors reportedly said. I honestly don’t know what to make of it. The worst surgery an athlete can have is an unnecessary surgery. Because I don’t know everything about his elbow, have never examined him (and hence CAN comment on it) it’s hard for me to know if I would have suggested surgery. A lot will go into that decision, including how much longer he plans on playing. If he can’t keep that elbow feeling good enough to be on the mound more than he has this season, then clearly it’s time to start looking into other options.

Dr. Jessica Flynn is a sports medicine physician at Lahey Hospital and Medical Center in Burlington, MA. She writes about injuries in professional sports on her blog, DocFlynn.com. You can follow her on Twitter @jessdeede.

Have a question for a future Dr. Flynn Mailbag? You can send those to her at any time via email (docflynn@bostonsportsjournal.com), or you can Tweet them to her here.