Dr. Flynn's Mailbag: Who has best shot to come off IR? Are smaller players prone to more injuries? And more

Happy holidays, everyone!

I want to thank you all for making my job so easy this year with fantastic questions for my mailbag. I’ve enjoyed the back-and-forth that formats like this allow for. I hope you’ve learned some from me, as I definitely have from all of you. If you didn’t contribute a question this year, don’t panic — you have one more week! If you’re busy with last-minute wrapping or picking which movie to see on Christmas Day, I completely understand. 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.

This week I’ll get out my crystal ball (it’s actually plexiglass, hope it still works) and try to guess who the Pats could activate off of IR. We’ll talk about meniscus tears, muscle tears, and Christmas cookies. Do small guys have it worse when it comes to injuries and could a preseason imaging study help to warn of impending ACL injury? You’ll have to read on to find out!

Sort of a general Q: looking at the Patriots IR players, do you see any possibilities of someone being activated off the list for the playoffs? Mitchell, Hightower, Valentine? I know it requires a crystal ball, but based on the injuries that put them on the list…
(Big Wally, @BostonWest80111)

I think the athlete with the best shot of coming off of IR is Malcolm Mitchell. It’s too soon for Hightower, who had surgery for what has been reported as an acute-on-chronic pec tear in October. Recovery from that surgery takes about 4-to-66 months. Vincent Valentine is on IR for an undisclosed knee injury. While reports are that he is progressing, the sense from beat writers is that Mitchell has been progressing more quickly. Mitchell is also dealing with a knee injury. Video from his initial injury was concerning for a meniscus injury, but it is unknown if the wide receiver had surgery early in the season to address it. In any case, time is running out for the Patriots to activate anyone from IR. I would expect to see Mitchell back at practice within the next week if he is going to make a return for the post-season.

1) What is the difference between a tear and a partial tear when it comes to muscle injuries?

2) Alan Branch has a meniscus injury, is this a ticking time bomb? and even with rest won't he need surgery to eventually correct it?

3) what's your favorite Christmas cookie ?

(Murph, @TMurph207)

A partial tear involves tearing of a portion of the muscle fibers, whereas a full-thickness tear means that the entire muscle is torn. They can be treated differently. In the case of a calf tear, for example. a full-thickness distal (close to the heel) tear is problematic. Muscles are under tension and if the entire muscle tears, the ends will retract away from each other leaving a big gap. If the muscles ends are not in the same area code it’s tough to get them to heal together. In some cases, surgery is required but it can be difficult - sort of like sewing two clumps of ground meat together, nothing to hold a stitch (I’M SORRY, YOU ASKED!!!!).

A meniscus tear that’s causing pain or swelling and impacting play often needs to be dealt with surgically at some point but can wait until the season is over. At times the type of tear can cause locking in the knee (eg. a “bucket handle” tear) and needs to be addressed surgically immediately. If there is any articular cartilage damage around the tear that can be a complicating factor…let’s hope not.

Chocolate sugar cookies. Definitely, nothing with raisins in it because that’s grosser than sewing two pieces of ground meat together.

Hi Dr. Flynn. Is technology getting closer where they can take pictures of athlete's knees in, for instance, preseason physicals to detect weaknesses that turn into injuries, or is something like Edelman's knee injury undetectable inside the knee beforehand? Long sentence, huh.
Thanks,
Bob Robblee

Hi Bob! MRIs are often used at the NFL Combine to screen players with suspected injury concerns. However, as far as using imaging to evaluate risk for impending injuries and, more specifically ACL injuries… I’m not sure that that would help. Most often, ACL injuries like Edelman’s are non-contact injuries and not the result of a ligament ‘hanging on by a thread” and finally rupturing. The forces across the ligament in that one awkward step is too much for the tissue to handle and it tears. Strength testing IS something that can be helpful in the pre-season to assess how well balanced an athlete’s strength is. If, for example, the quadriceps strength is greatly disproportionate to the hamstring strength that can be a risk factor for ACL tear. At this point, physical exam, injury history, and style of play are probably the most predictive tests for future injury.

You might not be the right person to ask, but maybe you have some thoughts. Successful smaller guys like Dion Lewis and IT always draw out the convention wisdom/worry that "they're great, but ... can they take the punishment? They're gonna get hurt again." How much truth do you think there is to the idea that little guys are somehow inherently less durable, more prone to injury? I'm sort of agnostic. On the one hand, physics says the body with less mass will be the "loser" in a collision, meaning they'll bounce more etc. But is there any real reason to think when all other things are equal, smaller athletes are going to get injured more easily, say, per unit of force?

That part I don't really buy. But people point at again, IT and DL and their injuries, and think they're right. And yet, as we agreed previously, knee injuries are not usually directly due to contact. Did DL blow out 2 ACLs cuz he's little? Is IT's hip injury from being small? I say more no than yes. Whaddaya think?

I think the style of play and position are bigger factors than size. In the case of Dion Lewis, he’s a jittery, quick-footed running back. In the case of Julian Edelman, he’s often receiving in the slot. Does size play some role? I’m sure. Honestly, in some sports, I worry more about the bigger guys — all of that weight and tension on their joints. That type of wear and tear can shorten careers just as easily. IT’s injury is a bit different. Part of his issue could be the way that his hip joint is shaped, a condition called femoracetabular impingement (FAI). This type of hip issue puts the joint at risk for labrum tears. His hip issue isn’t because he’s less vertically gifted. I know that you want a simple answer, but unfortunately, I don’t think you can pare this down to a nice, clean physics equation - there are way too many variables.

I’m pretty short and when I played lacrosse at Amherst my Dad always told me “remember, Jess, the bigger they are, the harder they fall.”

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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