Arian Foster, Achilles Tendon Rupture

Arian Foster, Houston Texans Running Back

Arian Foster is reported to have sustained an achilles tendon rupture in the Texans’ 44 to 26 loss to the Miami Dolphins on Sunday (video of injury here).  It has already been announced that Foster will miss the remainder of the season.  The real questions is if he will ever return to playing in the NFL and if so, at what level.  When healthy, Foster is a fantasy football team owner’s dream.  If you are playing in a keeper league,  given his past numbers and high fantasy draft stock, it is quite possible that he is on you our your opponent’s team for years to come.  

How severe is Arian Foster’s injury?

Achilles tendon injuries are classified from Grade I to Grade III.  Foster is reported to have sustained a grade III strain, also known as a complete rupture.  More information about the grading system below:

AchilleTendon-Injury-LG

Grade I: Mild strain, disruption of a few fibers. Mild to moderate pain, tenderness, swelling, stiffness. Expected to heal normally with conservative management.

Grade II: Moderate strain, disruption of several fibers. Moderate pain, swelling, difficulty walking normally. Expected to heal normally with conservative management.

Grade III: Complete rupture, often characterized by a “pop,” immediate pain, inability to bear weight. Typically requires surgery to repair.

©http://www.moveforwardpt.com/

What is next for Foster?

Foster will likely undergo a surgical procedure to repair his achilles tendon within the next week or so.  Immediately following the surgery he will be in a cast and using crutches to avoid putting any weight on the operative limb for 2-4 weeks.  After that he will be wearing a walking boot and slowly increasing the amount of weight he is putting through his leg during walking activities.  He will likely go through a therapy protocol lasting roughly 6 months before he is able to resume athletic activities (sample rehab protocol here).  

His rehab will include pain and swelling management using modalities such as the Gameready ice machine.  He will also likely undergo hands-on therapy including joint mobilization and trigger point dry needling to decrease pain and increase mobility.  His exercise program will be geared towards strengthening and stabilization of his core and entire lower extremity to decrease the likelihood that he will suffer another season-ending injury.  Proprioceptive training is extremely important in recovering from and protecting against injury.  Here’s an example of a proprioceptive training progression:

 

Will Arian Foster ever be the same?

Possibly.  A study published in 2009 investigated achilles tendon ruptures in the NFL and their impact on player performance.  The researchers found that on average, players experienced a greater than 50% decrease in power ratings following an achilles tendon rupture.  Furthermore, roughly 32% of players that sustained an achilles tendon rupture never returned to play in the NFL.  

Given recent data on achilles tendon ruptures and Foster’s explosive style of play, The Therapydia PTs feel that if Foster was your first pick in a keeper league, it may be time to look for a different league.  
Prediction: Arian Foster returns next season as a much less productive back, if he returns at all.  

Injury Revisited: Dez Bryant, Jones Fracture

With no high-profile injuries to players at skilled positions this week, we bring you an update on the status and likely return to play for Dallas Cowboys wide receiver Dez Bryant.  Dez suffered a right 5th metatarsal fracture, commonly referred to as a Jones fracture, during the Cowboys’ week 1 win over the New York Giants (video and more information here).

jones-fracture

Jones fracture (not Dez Bryant’s)

The base of the 5th metatarsal can be a particularly difficult bone to heal.  This is due to the area’s poor blood supply as well as the huge amount of force transmitted through the area, especially with running, jumping and cutting.  The day after the injury he underwent a surgical procedure that was reported to include internal fixation with hardware as well as a bone graft.  Given current surgical procedures, the graft was most likely a marrow aspirate with demineralized bone matrix injected at the fracture site.  This is essentially used to speed up healing and increase the likelihood that the fracture with heal completely.  In most cases, a bone graft is used when a fracture has been recurrent or chronic in nature.  However, it is very likely that they are treating this as aggressively as possible to allow for the quickest return to play possible. 

 

jonesrepair

Jones Fracture Repair (Not Dez Bryant’s)

A recently published study followed 25 NFL players from their surgery through return to play.  The study found that 100% of players returned to full participation and 12% of them ultimately refractured their 5th metatarsal and required a revision surgery.  The time from surgery to return to play was between 6 and 14 weeks, with the average being 8.7 weeks.  

Dez is undoubtedly receiving excellent care as he rehabilitates this injury.  He is likely undergoing joint mobilization, stretching, strengthening, stability and balance training and quite possibly trigger point dry needling in an effort to regain range of motion and full function.  

Given recent data on Jones fractures amongst NFL players, along with the demands put on the foot of a wide receiver such as Dez Bryant,  The Therapydia PTs believe this will be a fairly lengthy recovery.  

Prediction: Dez Bryant misses just over 10 weeks and returns to face the Carolina Panthers on Thursday, November 26th.  

 

Rotator Cuff Strain for Drew Brees (9-21-15 Fantasy Football Injury of the Week)

Stated Injury: Rotator Cuff Injury

New Orleans Saints quarterback Drew Brees suffered a shoulder injury in the second half of their loss to the Tampa Bay Buccaneers.  The injury appears to have happened as Brees was going through his throwing motion as an opponent’s attempt to swat the ball abruptly stopped the forward motion of his arm (video and more information here).  

Preliminary reports have referred to the injury as a “rotator cuff injury” or a “rotator cuff bruise”.  The rotator cuff is a collection of 4 muscles that run from the shoulder blade to the upper arm.  These muscles are instrumental in most movements of the arm, especially rapid overhead movements (like throwing a football).

The severety of the injury depends on what tissues have been injured (torn or bruised) and how much.  A rotator cuff strain (mild tearing of muscles or tendons) can usually be rehabilitated using stretching, strengthening and trigger point dry needling.  A full-thickness rotator cuff tear (most commonly occurring at the supraspinatus tendon) usually requires surgery and extensive rehabilitation lasting from 8-12 months prior to return to sport.  Furthermore, professional overhead athletes rarely return to previous form after a full-thickness tear that required surgery.  

Luckily, Brees was able to finish the game.  This suggests that his injury is less-serious than the one he returned from in 2006.  

Given the information at hand, the Therapydia Denver PTs believe that Drew Brees will miss one game due to a rotator cuff strain.  After a few weeks of treatment including Physical Therapy, he will return to full participation against The Dallas Cowboys on Sunday, October 4th.  

Fantasy Football Injury Of The Week

New for the 2015-2016 NFL season:  

Each week, the Therapydia Denver PTs will analyze and discuss the NFL injury with the most serious implications for your fantasy football team.  In this analysis and discussion, we will include a description of the injury, the most likely treatment options for the injury and a prediction as to when the injured player will be back on the field.  

We will explore all available information outlets, then employ our extensive training and experience in orthopedic and sports physical therapy to give you an informative yet concise evaluation of the injury of the week.  

We will give you all the information you need to make an informed decision.  The rest is up to you.  Start, bench, trade or hop on the waiver wire.  

 

Summer Knee Pain? Trigger Point Dry Needling May Be The Solution.

run assessment denver

Summer in Colorado brings warmer temperatures, longer days and inevitably more time spent outdoors. Many Coloradans choose to take advantage of summer by hiking or running on our vast network of urban and mountain trails. Oftentimes, this increase in miles traveled on our feet can lead to pain in and around the knee, specifically the kneecap. This pain is technically termed patellofemoral pain syndrome, but is commonly referred to as hiker’s or runner’s knee.

How Do I Know If I Have Hiker’s Or Runner’s Knee?

Another sign that you may be at risk for developing hiker’s or runner’s knee is a knock kneed (valgus) position during activities like squatting or walking up or down stairs. This position makes it more likely that your knee will become irritated or painful. The hallmark sign of hiker’s or runner’s knee is pain around or under the kneecap. This pain is usually worsened with squatting and walking up or down stairs or hills.

runner knee signs

 

Image credit: http://what-when-how.com/

What Is Patellofemoral Pain Syndrome?

Patellofemoral pain refers to pain arising from excessive or faulty contact between the kneecap (patella) and the bottom portion of the thigh bone (femur). The patella lies in a groove between two rounded portions of the bottom of the femur.  It is essentially like the patella is sitting in a valley between two hills.patella pain running

During weight bearing activity where the knee is bending and straightening (such as walking, hiking or running), the patella glides up and down in the valley between the hills. If the patella does not glide perfectly in the valley, it may grind awkwardly on one or both of the hills.  This grinding causes irritation, popping, pain and sometimes swelling.

What Causes Patellofemoral Pain Syndrome?

The patella is a sesamoid bone, meaning that it is suspended between two tendons rather than being attached to another bone by a ligament. The top portion of the patella is connected to the quadriceps tendon, which then attaches to the quadriceps muscle group. The bottom portion of the patella is connected to the patellar tendon, which then attaches to the shin bone (tibia).  This unique arrangement allows the patella to be pulled one way or another based on variability in muscle strength and flexibility.

patellofemoral dry needling

Image credit: http://physioworks.com.au/

The most common strength/flexibility issue leading to patellofemoral pain involves weakness in muscles on the inside of the thigh (vastus medialis obliquus) coupled with tightness in the muscles and tendons on the outside of the thigh (vastus lateralis, iliotibial band).  This weakness on the inside and tightness on the outside pulls the patella to the outside, causing it to grind up on the lateral hill rather than gliding perfectly in the valley.

Another common flexibility issue leading to patellofemoral pain involves tightness in the muscles on the back side of the thigh, also known as the hamstrings. Tightness in the hamstring group pulls the shin bone backwards, thus increasing the amount of force with which the patella is sitting in the valley. This increased force can lead to grinding and irritation between the patella and the femur, even if it is gliding in the correct portion of the valley.

How Can Trigger Point Dry Needling help?

Trigger Point Dry Needling (also known as functional dry needling or intramuscular manual therapy) involves inserting a tiny filiform needle into a taut band of muscle tissue, also known as a trigger point.  This causes the muscle to momentarily cramp and eventually release.  This treatment option is extremely effective in releasing muscle tension and restoring normal flexibility and function rapidly.

When addressing patellofemoral pain, releasing muscle tension and restoring normal muscle flexibility can decrease the likelihood that the patella will be pulled out of the valley and cause grinding, irritation and pain.  Releasing tension in the hamstring group can help decrease the amount of force with which the patella is pushing into the valley.  Coupled with specific strengthening and stretching exercise as prescribed by your Physical Therapist at Therapydia, Trigger Point Dry Needling is an effective tool in combating knee pain in hikers and runners.

Performing At Your Highest Level Starts With a Good Night’s Sleep

good nights sleep morning run

Whether you are a high level athlete, weekend warrior, or simply trying to make it through the work day, sleeping is an integral part of being a highly functioning individual. For many, the challenging part of sleeping well is simply finding and staying in a comfortable position. Difficulty sleeping due to pain or discomfort may stem from underlying musculoskeletal issues. If the problem is due to positioning, changing your preferred sleeping position can be extremely difficult, as most people have been in the habit of sleeping a certain way for years. Here are some easy tips to modify your preferred sleeping position in hopes of getting a better night of rest and performing at your optimal capacity during waking hours.

Side Sleepers:

When sleeping on your side, major pain generators are often related to lower or upper spinal rotation. If your top knee slides forward coming to rest on the mattress you may experience discomfort stemming from lower back rotation. This can be easily remedied by placing a pillow between your knees, shins and feet. This will help decreased rotation of your low back, while relieving potential pressure points between your knees and ankles.

side-sleeping-position-pain

Side sleepers may also suffer from pain associated with upper spinal rotation. This may occur if your top arm and shoulder slide forward. This can be corrected by sleeping with a pillow just in front of your chest, with your top arm resting on it.

side-sleeping-pain-management

Another problem with side sleeping can be related to your mattress. Soft or worn mattresses and box springs can allow sagging of your torso between your hips and your shoulders, thus putting your back in a side-bent position (a). This can be remedied by actively bringing your down-side hip and shoulder closer to one another (b), and then relaxing (c). The active arch in your back (think of making a space between your side and the mattress), followed by relaxing your core will allow your spine to rest in a more neutral position.

a)side-sleeping-posture b)side-sleeping-good-posture c)side-sleeping-posture-pain-relief

Back Sleepers:

When sleeping on your back, the most likely pain generator is prolonged excessive low back extension. Resting with both legs straight slightly tilts your pelvis forward, causing an increased bend in your low back. This can be relieved by placing a pillow underneath your knees. This minor elevation of your lower extremity will place your pelvis in a slight backward tilt, thus flattening out your low back and easing tension due to prolonged excessive extension.

back-sleeper-pain-relief

Stomach Sleepers:

When sleeping on your stomach, the most likely contributor to pain is rotation of your neck. In order to breathe effectively, a stomach sleeper must turn their head one way or another. This prolonged rotation can cause skeletal or muscular restrictions to take hold. An easy way to decrease the amount of neck rotation is to place pillows under the side of your body that your head is turned towards. This elevation of half of the torso and shoulders results in a relative decrease in rotation of you neck.

stomach-sleeper-pain-relief

Still having trouble getting comfortable?

Give these slight alterations to your preferred sleeping positions a try. If you are still experiencing difficulty getting comfortable you may need further musculoskeletal evaluation. Physical Therapists at Therapydia have undergone extensive training and possess the skills to evaluate and treat what may be causing your neck or back pain. If you are not getting quality sleep due to discomfort in your muscles and joints, don’t hesitate to contact Therapydia. We’ll help you get back to sleep so that you can tackle the day, able to perform at your highest level.