Dr. Flynn's Mailbag: Checking in on Chris Hogan, Eric Rowe, David Backes and Drew Pomeranz

Hi everyone! I really appreciate all of the great questions you submitted this week. Would love to hear from you for future editions, so make sure you check out the contact information at the bottom of the page.

We'll get into why hamstrings are so much trouble, Eric Rowe's return, David Backes' surgery, and Drew Pomeranz's platelet treatment, but we'll start with the one player every Patriots fan is worried about this bye week, Chris Hogan.

What do u think is wrong with Hogan? (Shy Sullivan, @CheyenneSulli14)
Hey Doc, any word on Chris Hogan since his MRI? Have a great weekend! (jhhhealy)

Lots of Hogan questions this week! Chris Hogan left last weekend’s game with a shoulder injury. He appeared to fall hard - directly onto the tip of his shoulder. He reportedly had an MRI the next morning that showed no structural damage requiring surgery and his condition was to be re-evaluated after the bye week. I suspect that he has either a strain of his rotator cuff or an AC joint injury. I’m deducing this from both the injury video and the team’s response to the injury. I have no inside knowledge. If it is an AC injury or cuff inflammation picture, then I would expect him to work his way back over the next 2-4 weeks.

David Backes reportedly had a portion of his colon removed as part of his treatment for diverticulitis. Often when a portion of colon is removed a colostomy is required. Do you have any insight as to whether this will be the case with Backes, and if so, is there any implication for playing hockey (a high contact sport) with a colostomy bag? (Bruce Lauterwasser)

Diverticulitis is a condition where tiny outpouchings in the colon get inflamed and infected. It sounds like Backes has had two major bouts of diverticulitis and the most recent one was complicated by an abscess formation. An abscess is a walled-off infection that’s very difficult to treat because getting antibiotics through the wall of the abscess through the bloodstream is nearly impossible. Often these have to be drained.

Given Backes’ young age and the fact that he had two episodes with a complication, his risk was high for recurrence and the decision was made to have surgery to remove the part of the colon with pouches that keep getting infected. This can be either a one or two-step procedure. In a two-step procedure, a portion of the colon is removed and the end is connected to a hole in the abdominal wall which is fitted with a colostomy bag. At a later time, once the colon is healed, that end is reconnected with the part attached to the rectum and the ostomy hole is closed. In certain cases (I’m not a colorectal surgeon so don’t ask me when!), once the diseased colon is removed, the two ends are able to be re-attached immediately, skipping the need for the colostomy bag. I suspect that’s the case for Backes. His reported return to play is around eight weeks - if it was planned as a two-step procedure, return to play would be closer to three months. This is assuming that all has gone as planned which I am, of course, hoping for!

Hi Doc, had a question regarding injuries. Why is it that hamstring injuries take so long to heal? (Nick @SportsTalk_Plus)

Thanks for the question, Nick. It really is true - hamstring injuries, and groin injuries for that matter, can take a very long time to heal. The hamstring muscles are located on the back of the thigh and their primary role is to flex the knee, a movement that’s quite important for running. Hamstring injuries can be of varying degrees, from a mild strain of the muscle fibers to full-thickness ruptures of the muscle or its attachment in the lower buttock. Hamstring injuries are very common in the NFL, especially in athletes who have to cover a lot of ground quickly. Matthew Slater went down with a hamstring injury early in camp this season. We all knew it was a significant injury because Bill Belichick left the practice field to go check on him in the medical tent. Slater was away from the field for over eight weeks. That’s on the longer end of typical hamstring recover, which is usually around 2-6 weeks. I suspect that he had a large hamstring tear, similar to what Rob Gronkowski dealt with early last season.

Treatment of hamstring injuries involves allowing the muscle to heal without allowing too much scar tissue to form. It’s a delicate balance. The first part of rehab is allowing the muscle injury to heal. The second step of the recovery process involves allowing athletes to slowly progress back into activity with team training staff, before they return to the practice field. Many athletes have small setbacks during this time. The muscle tear can become re-aggravated if it’s not completely healed. In some cases, if “too much” scar tissue has formed, athletes can tear the scar tissue and this can set them back.

I know that you didn’t ask about groin injuries, but a groin pull is really just a strain of the hip adductor (groin) muscles and is very similar to hamstring injuries. I would keep a close eye on Eric Rowe’s progress next week. He’s coming back from a groin strain that occurred at the beginning of the season and was re-aggravated a few weeks ago. He had a hearty limp a week after the re-injury which indicates that it was probably a significant one. I hope that the Patriots take their time in working Rowe back into practice so that he does not suffer another setback. Unfortunately, I don’t anticipate that he will be on the field in Denver next weekend.

Last fall, the Red Sox pitcher Drew Pomeranz had one of those platelet injections in his left elbow, that “appeared to work” for the 2017 season once Drew was able to start throwing regularly at the end of spring training. Is this a situation where the injection “cured the problem” so it does not occur again, or is the injection more of a one-time short-term fix that potentially will eventually require future injections and or surgical procedures to fix the underlying problem? Given that Pomeranz is now moving to a point in his service time where a big free-agent contract in on the horizon, are there any long-term physical issues with his left elbow that the platelet injection may foreshadow? (Erik Hindley)

Great questions. Pomeranz reported that he had “stem cell” injections in his elbow last winter. Stem cells are all-powerful cells in the body that can help tissue to heal by signaling loads of healing chemicals in the body to enter injured tissue. The cells are often removed from the pelvic bones, concentrated, and injected directly into the injury site. This treatment is not proven to work but Pomeranz did seem to respond in time for spring training. The drama around “withheld” medical information and the fact that the pitcher required experimental injections together send up a red flag about the long-term health of his elbow. Injections can be an intermediate step before eventual surgery for things like a stretched or torn ulnar collateral ligament (i.e. Tommy John Surgery). Stem cell injections for issues like this are rarely considered curative. I don’t know the exact injury Pomeranz is dealing with, but certainly, it will be an issue to consider as he hits free agency.

Thanks everyone for the great questions this week!

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.