BSJ Injury Mailbag with Dr. Jessica Flynn: Gronk's thigh, Krug's jaw and Pedroia's knee

Hi everyone! Thanks for submitting excellent questions for my second 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 Gronk’s surprise thigh injury, recovery from rib fractures in the NFL, Torey Krug’s broken jaw, and performance after Tommy John surgery. Let’s start with a question that will help you get to know me a little bit better and understand why I spend my time talking about high-profile sports injuries…

Do you think it’s irresponsible to talk about a player’s injury w/out having examined him? (Steve DeBoer @WHS_Mr_DeBoer)

This is a very fair question and one I’ve thought a lot about. Believe it or not, I started my blog because I was pissed at Mike Felger. I heard him yammering on the radio about how Jimmy Garoppolo was weak because he didn’t “just take the shot” and return to play. My reason for commenting on sports injuries goes back to that day — I want fans to understand what these athletes are dealing with. They may look superhuman, but they're not. They're people — somebody's kid, somebody's patient — and they are trying to make a living in a few short years. They spent high school and (usually) college playing football with some studying on the side. They are fighting for a dream they've been working towards for years. They won't get another chance. They are part of a team that’s a lot like a family — during a season it's a huge part of their life. Leaving that team with an injury sucks. They don't want to be alone in a hospital having surgery, isolated in the training room getting treatment — they want to be out on a field with their brothers. Some fans are really interested in the physiology of high profile injuries, and often that’s in part due to the fact that they or someone they know has had a similar issue. I use pro athlete injuries and recoveries all of the time in my practice, often to re-assure young patients that their sports careers will not end with whatever injury they happen to be dealing with at the time.

I believe in an athlete's right to privacy. If I comment on an injury or an athlete then that means that I have never examined that athlete and have no inside information on their care. I believe in the sideline medical tent. I hate the darn thing because it gets in the way of me getting more clues to the injury, but it's there for good reason. Injured athletes deserve private examination and treatment. For the same reason, if I personally observe any injury information off of the field, I'm not going to comment on it. All of what I comment on is publicly available info — video replays are the most telling a majority of the time, team injury reports, and media reports.

I am never “diagnosing” the athletes I write or talk about. I’m making an educated guess based on what I see. I’m not very into fantasy sports (but my 8-year-old is, and he peppers me with questions every week). I hope this helps you to understand where I’m coming from.

Do u think Gronk will play in 10 days? What is the treatment for that?
(Shy Sullivan @CheyenneSulli14)

Yes, I think he will play in 10 days. Rob Gronkowski reportedly has a thigh contusion (bruise). The mystery is when the injury occurred. Typically, a thigh bruise occurs as a result of a direct hit during contact play. I did not see any specific hits that caused Gronk to look hobbled in Sunday’s game and after the game, reporters said that Gronk looked fine — no limp. They lifted on Monday and had mostly meetings and walk-throughs, so no real chance for a contact injury. In any case, Gronk was seen yesterday in a thigh sleeve — compression and warmth are typically used for muscle contusions and strains (I wouldn’t be surprised if there was some fancy TB12 ceramide coating on the inside of the sleeve, just like the recovery pajamas). The bad news was that he wasn’t deemed ready to play. The good news is that he was not on crutches or walking with a limp. Do you remember how gimpy Tom Brady was after his hit from Kam Chancellor? He could barely get up to the podium for his post-game presser. He had a thigh contusion. Limped for a couple of weeks. In my opinion, Gronk was most likely held out because of fear of worsening the injury. The damaged muscle can tear and, if the contusion is hit again, the tissue can re-bleed, which brings us to our next Gronk question….

I recall, wayyy back in the day, Peter Forsberg (Colorado Avs) requiring surgery on a thigh bruise that some how "calcified" (I think)...
(Big Wally @BostonWest80111)

This condition is called “myositis ossificans.” It occurs when badly bruised and sometimes torn muscle begins to heal. Some patients are thought to be genetically predisposed to this injury. When the body is trying to heal a bad muscle injury it will sometimes try too hard and instead of just increasing blood flow and making scar tissue, it also lays down calcium to heal the site. If an athlete has a personal history of myositis ossificans then we are very cautious with subsequent muscle bruises to prevent it from occurring. There also seems to be increased risk for myositis ossificans if an athlete sustains a second major trauma to a pre-existing muscle contusion. This may have played a role in the decision to rest Gronk last night.

What was Stephon Gilmore’s issue? Looked like he was moving good all game.
(Tony C @tonyc3896)

He was listed on the Patriots’ injury report as limited with an ankle injury. He worked out for the medical staff prior to the game last night. I agree with you — looked like he was moving well.

Hi Dr. Flynn. Great first mailbag! Loved it! I'm asking about football players' broken ribs. I've broken mine several times and they've taken much longer than 6 weeks to heal. Swinging a golf club once 4 months after resulted in excruciating pain. How can football players recover so quickly while I still feel pain after a year and a half? Thanks!

Hi and thank you! I’m sorry that you’ve broken ribs several times, it’s such a painful injury. Partly it depends on the type of rib injury. You’re right — a single rib fracture can heal enough for an athlete to play in 2 weeks, but sometimes it can take 4-6 weeks. Often those athletes are treated with numbing injections called “rib blocks” which help to numb the pain. Unfortunately for the athlete, that injection wears off after the game. If the rib is injured where it inserts into cartilage, however, that injury can take much longer to heal. Flak jackets can also be worn to aid in protecting a healing rib fracture.

I just was wondering about your thoughts on Torey Krug’s fractured jaw injury. What type of fracture do you think occurred with his month recovery time?  Do you think that he would be allowed to play with a face guard (football style)? (Nathaniel Donovan)

The Bruins announced on Sept. 21 that Krug had a non-displaced jaw fracture and would likely be out for around 3 weeks. Non-displaced jaw fractures can often be treated non-operatively and athletes can return to play at around 3-5 weeks, once healing occurs. And I agree, he’ll likely return with a full-face cage.

I find it odd that in baseball pitchers come back from Tommy John surgery throwing faster and better than they did with their original parts. It almost seems as if some pitchers *want* to have the surgery so they can be better. Is there something about replacing a ligament with a tendon that could make the pitching motion more effective? And is there similar research in replacing knee or ankle ligaments with tendons? (Eric Ogren)

This is a great question. I remember reading a really great Q&A with Dr. James Andrews, a true leader in the field. It’s from MLB.com and here are the 2 answers I would point you to.

Does Tommy John surgery improve performance?

No. 35 percent of parents incorrectly believe that overall pitching performance would be enhanced following surgery (Ahmad et al.). While there are notable instances of players improving following surgery, the most optimistic expectation for a pitcher undergoing Tommy John surgery is that the procedure allows the player to return to his previous level of performance. In fact, two recent studies have shown that players returning from Tommy John surgery tend to follow the typical aging pattern for players without surgery.

Does Tommy John surgery improve pitching speed?

No. 53 percent of college athletes incorrectly believe that pitching speed would improve following Tommy John surgery (Ahmad et al.). Similar to overall performance, players do not throw harder after Tommy John surgery than they did before the procedure. Most doctors have concluded that in cases where pitchers who have thrown harder post-surgery, it was predominantly due to the quality of their rehabilitation and improved strength and conditioning.

While many pitchers do improve their performance after surgery, I suspect that it is because of their rehab program and period of forced rest. I am not aware of any tendon/ligament studies in the knee, but in the case of ACL reconstruction surgery where patellar or hamstring tendon is used to reconstruct ACL ligament, the tendon graft undergoes cellular changes in the first 2 years post-surgery. Under a microscope, it starts to look more and more like a ligament.

This year Dustin Pedroia has been a physical wreck most of the year due to his knee.  Nobody is coming clean on how severely injured he is, but it would seem like surgery is happening a week or so after the Red Sox season ends.  Given his age (34), and previous knee injuries, what is the likelihood Pedroia is going to recover and be effective the remaining 4 years of his contract?  He seems like a DH in the making. (Erik Hindley)

Last October, the Red Sox announced that Pedroia underwent a left knee surgery. The procedure was said to be a “left knee arthroscopic meniscectomy and chondroplasty.” This means that Pedroia has thinning of the articular cartilage in his knee. I hate to use this word, but thinning of articular cartilage is arthritis. That’s kind of a dirty word in professional sports because it implies shortened careers, but you’d be surprised how many professional athletes have arthritis at a young age. Pedroia’s knee is certainly a long-term issue that will need to be managed and that will likely include periods of rest during the season. Without a crystal ball it’s pretty hard for me to know how he’ll hold up over the next 4 years, but in general, injuries like this don’t tend to get better as time goes on. Of course, I’m a huge fan and hoping for the best for him.

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.