Dr. Flynn's Mailbag: On 'body men' and medical staffs, Hightower and ACLs

Hi everyone, hope you enjoyed the first snow and are ready for what I hope will be a great Patriots-Steelers match-up this weekend! Thanks so much for the great questions this week. If you didn’t get to contribute this week, no worries! I’d love to hear from you for future editions, so make sure you check out the contact information at the bottom of the page.

Your questions were focused on the Patriots this week - Alex Guerrero’s relationship with the Patriots, Dont'a Hightower is “ahead of schedule,” and how will Julian Edelman look when he returns next season. Here we go…

Doc, How does med community view interference from personal trainers (ie Alex Guerrero)? Do you feel the benefits of such relationships are more psychological than physical?
— (Rich Coveney, @coves121)

Way to start me off with a simple question, Rich….geesh! That’s okay because the hard ones to answer are usually the best. This week we’ve heard murmurings suggesting that all may not be so tight between the Patriots and Tom Brady’s body guy, Alex Guerrero. Some have reported that he has been banned from the facility and cannot travel with the team. Others have suggested that the tension between Tom Brady’s two coaches, mind/body and football could be affecting his game in a negative way.

I can’t speak for the entire medical community on this topic, so I will just speak for myself. I’m a professional and can work with anyone. I don’t provide any medical services in a bubble and a whole team of people (including the patients themselves) help me to do my job every day. So a team approach isn’t foreign to me. I work with acupuncturists, massage therapists, physical therapists, personal trainers and chiropractors. Many patients come to see me after they already have established relationships with these providers and it’s my job to integrate what I do, with their treatments when appropriate. I enjoy the teamwork, but the relationship needs to remain just that: a team.

There was an article about Guerrero in Mens Journal last year that detailed an athlete’s recovery from calcaneus surgery. The athlete went to TB12 for advice on his recovery. The surgeon prescribed a period of keeping all weight off of the foot and Guerrero dismissed the recommendation, saying that the surgeon “didn’t care if (he) ever runs again” because his only concern was the surgical site. The disrespect in that statement was so disappointing that even reading it again now, I feel a sting. How could I recommend TB12 to my patients with soft tissue injuries now that I read something like that? I would find it difficult to work with someone who I was worried was disregarding my medical recommendations and questioning my concern for my patients’ well-being.

I don’t think that Guerrero’s work is simply “interference,” nor do I think it is fully “psychological.”  I’ve written a bit about my feelings on the TB12 method and, at least from the outside, some of what he is doing makes sense. I think he is a very talented man, especially with soft-tissue work, but he is NOT a personal trainer and he is NOT a doctor. You need a specific level of certification for both. The work that Guerrero does is not based on science and many of his recommendations (like weight-bearing early after calcaneus fractures) go against the results of medical studies and the observations of tens of thousands of surgeons. His methods are well-publicized because of the success of his No. 1 client, however, and that’s what makes his case more complicated.

At the end of the day, athletes get the best results when they are treated by a team. I’m really lucky to work with a great team of providers in my practice and the Patriots have an incredible staff of doctors, therapists, trainers, strength coaches, the list goes on. Bill Belichick has shown over the years that he will always do what he thinks is in the best interest of his football team. For now, it seems that having Alex Guerrero on the sidelines is not on that list.

Odds that Hightower comes back to play this season?
— (CapSpace=$3,396,748,@patscap)

Very close to zero, Miguel. Dont'a Hightower suffered an acute-on-chronic pec tear in late October and underwent season-ending surgery. While he is technically still able to be activated off of IR, his injury will not be healed in time. Pec repairs generally take 4-to-6 months to heal, putting him at February at the earliest. Given his history, I would suspect the team would be more cautious with his return even at that point. Hightower reported last week that he is doing great and “ahead of schedule.” He also added that he’s looking forward to NEXT season.

Thinking about recovery from ACL injuries and Dion Lewis. Is he an example of it really taking two years to get the same burst back? Is thinking Edelman could return at about 90 percent sound right for next year?  I'm sure it varies a ton just wondering about any trends
— (Stephen Oleski, @stephenoleski)

Yes, Lewis is a perfect example of athletes returning to their normal selves about 18-to-24 months after ACL repair. In an ACL reconstruction, a tendon graft is used to replace the torn ligament. Even once the graft is healed in, the tendon is still undergoing slow transformation into tissue that more closely resembles a ligament. That process takes around 1 1/2-to-2 years. The athlete is also getting used to running, cutting, and jumping on a “new” knee. That process also takes time, both physically and psychologically. Some athletes, Adrian Peterson for example, don’t fit that mold. He was somehow able to return quickly for a record-setting season. Chances are that Edelman will take a year to return to his prior level of play. Returning at 90 percent is a bit high for expectations, but time is on his side in that his injury was very early in the season. We’ll have to wait and see.

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.

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