ACL Recovery Timeline: Treatment Breakdown

A common athletic injury that you’ve probably heard about might have to do with tearing the ACL. The ACL, or anterior cruciate ligament, joins the upper leg bone (femur) with the lower leg bone (tibia) and functions as the primary rotational stabilizer for the knee. When you’re moving forward, such as when you’re running, the ACL isn’t really involved. It only comes into play when you’re cutting around or changing directions to stabilize the knee joint area. An ACL injury commonly happens when you rotate too quickly or with too much force in that joint area, which causes your ACL to overstretch and tear. Depending on how badly torn the ligament is, you may be a candidate for surgery to repair the damage. Post-surgery, you will likely feel immobile. You may wonder how you’ll ever get back on your feet again. Although the timeline for ACL recovery varies depending on your specific injury, you should expect 4-6 months of one-on-one treatment with your physical therapist.

Therapydia ACL Injury Treatment

0 Weeks, Treatment Before You Even Have Surgery

Pre-rehabilitation physical therapy, or “prehab”, is a form of physical therapy that begins before you have scheduled surgery. Prehab focuses on increasing strength and flexibility of the muscles in your surgery area. Although the surgery will fix the tear, it will also cause the muscles in the knee area to become weak and stiff. You’ll want to strengthen all the muscles that will aid in keeping you balanced post-surgery. Undergoing prehab before surgery has been proven to improve knee function faster after surgery. One study in 2013 found that patients participating in prehab returned to sports almost 2 months faster. Prehab treatment might involve building up quadricep and core strength pre-surgery so you’ll see greater knee stability and faster recovery post-surgery. It could also involve teaching you how to use assistive devices (i.e. crutches) and tackling tricky movement barriers, such as stairs, so you know how to move around after surgery.

Therapydia ACL Injury Treatment

0-4 Weeks, Baby Steps

Many of the same goals you would want to achieve in prehab also apply here in the initial phases of physical therapy treatment. Some of these processes may vary depending on your doctor’s protocols. Main priorities will be to reduce inflammation, regain range of motion of the knee (i.e. bending and straightening the knee), and begin to slowly withstand bearing weight on your injured knee so you can start to walk. Making sure you have the proper flexibility includes immediate manual therapy, or hands-on techniques, that your physical therapist will perform on the surface of the knee joint and the muscles surrounding it. A common complication post-surgery is stiffness and loss of range of motion because of excess scar tissue formation. Your physical therapist will manually breakdown any scar tissue restrictions that may be developing in your knee. Manual therapy can also help decrease swelling around your knee. You’ll slowly wean off of your dependence on crutches as your knee tolerates. Important exercises in this phase of rehab (i.e. straight leg raises, half squats, partial lunges, etc.) will be targeted toward quadricep strength. By strengthening the muscles at the front of your thigh, walking will become that much easier and the knee will feel more stable.

Therapydia ACL Injury Treatment

4-10 Weeks, Getting Back To Walking

At this point, the goal is to start getting your natural walking pattern back. You want to be able to control your walking movements again, which means you may have to begin some balance training. Both the fact that your knee is injured and that you haven’t been using your injured knee very much will have thrown your body’s sense of balance off. Guiding you back into proper walking form involves a combination of continued manual therapy and personal exercise-based treatment. It’s key to start building up balance on your weaker leg by doing some one-legged activities. There will also be a focus on building up strength and full flexibility in the muscles around your hips as well as the muscles around your knee. With improved strength in your hips and quads, you’ll be putting less pressure on your healing ACL. You’ll be working your way from exercises such as single-leg squats to step-up and step-down techniques (using a step) as well as resistance training with a band.

Therapydia ACL Injury Treatment

12-16 Weeks, Starting Some Light Running

By about 3 months, any swelling you had will likely be gone. You also should have full range of motion in your knee, which means being able to extend and bend without restriction (135-145 degrees for bend, 0 degrees for extend). If you still have muscle stiffness, your physical therapist will apply more manual therapy to any specific muscles that are restricting your ability to extend or bend your knee. Depending on your unique recovery progress, your knee joint may still need to be manually mobilized in a certain way. Any basic aspects of leg movement should be back under control, such as naturally walking or being able to move around casually. Your personal ACL treatment program will continue building strength in your core and lower body muscles. You might be doing some endurance training on a stationary bike, elliptical, or treadmill. At this point, you will want to do some more advanced balance training on balance boards or bosu balls to ensure that your healing leg is stabilizing well. Your physical therapist will want to customize your treatment to make sure that you’re treating any balance issues that were caused by your ACL injury. At some point in this phase, you might begin lightly running, jumping, or getting back into any physical activities you used to do.

Therapydia ACL Injury Treatment

4 Months+, Getting Back In The Game

There’s a range of what patients with a healing ACL injury might begin to do around 4 months. Everyone has different preferred physical activities and you’ll begin to get back into your favorite activities at this point. If you played basketball, you might begin some shooting drills. If you’re a runner, you might begin getting back into some longer jogging. It all depends on what your activity takes to get back into. You don’t want to halt any progress you made by overly exerting your knee, but certain sports-based drills will be okay to practice. Your treatment program post-injury should focus on not only reducing pain, but building up your body’s strength and flexibility in a way that prevents a future ACL tear. Beyond that, you’ll be given the tools you need to have better endurance, balance, and coordination with your healing knee. You may feel totally thrown off balance and mobility-wise after your ACL injury, but one-on-one treatment is meant to steadily get you back to 100%.

Top 5 Game Changing NBA Playoff Injuries in Last 5 Years

top nba injuries

During the NBA Playoffs every fan has a love-hate relationship with any injuries that happen—depending on the team you want to win. Losing star players to injury during the post-season might greatly affect a team’s chance at winning a championship title. Currently, the 2016 season has been no exception to its fair share of injuries. Ankles issues were prominent from Steph Curry in the Western Conference to Nicolas Batum and Isaiah Thomas in the Eastern Conference. Sudden injuries were also mixed in, with Chris Paul’s hand fracture being one of the worst. Here’s a look at some of the most devastating injuries that have shaken up the Playoffs in the last 5 years.

2016: Western Conference First Round, Clippers vs. Trail Blazers

Looking at the 2016 post-season, the Clippers take the award for the worst (double) injury so far during the Playoffs. Core players Blake Griffin and Chris Paul were both taken out of the Western Conference during Game 4 of their 1st round playoff series. The Clippers were deprived of their 2 All-Stars at the worst possible time. Paul ended up with a fractured bone in his third metacarpal in his right hand while Griffin agitated his left quadricep injury (i.e. muscles around the thigh)—he had partially torn a tendon in his thigh earlier in the season. Both Paul and Griffin were unable to continue through the rest of the Playoffs. With a depleted roster, it was a serious setback for the Clippers as it considerably derailed their advancement through the Playoffs. The Clippers continue to be plagued with bad luck as they head into the 3rd straight post-season without advancing past the second round after losing against the Trail Blazers during Games 5 and 6.

2015: NBA Finals, Cavaliers vs. Warriors

The Cavs moved onto the Second Round and eventually made it to the Final Round against the Golden State Warriors, sound familiar? The Cavs ended the first game of The Finals with Kyrie Irving suffering a terrible accident during overtime. Kevin Love, another part of Cleveland’s Big 3 (including LeBron James), was taken out of the post-season during the First Round after suffering a shoulder dislocation. Irving had already missed two earlier games during the Eastern Conference because of knee tendinitis and had recently returned to play in The Finals. Irving was driving down the court during Game 1 and while attempting to stop, felt his knee give out. Irving limped off of the court and was eventually diagnosed with a fracture of the kneecap. It was the longest he’d actively played on the court in a month, which may have contributed to the stress behind his fracture. Irving was out for the rest of the Playoffs, which was an unfortunate end to his dynamic overall season (averaged 22 points). The Cavs were down 2 All-Stars with Irving and Love no longer able to play. LeBron James pushed forward through the series for the remaining games. The Warriors accomplished what the the Cavaliers could not—staying injury-free. The Warriors eventually defeated the Cavs during Game 6. There’s no way to tell what impact Kyrie and Love would have had on these games, but they are tremendous players and their impact would certainly have been positive. Here’s to another year of seeing the Warriors vs. Cavaliers in The Finals.

2014: Western Conference Semifinals, Thunder vs. Clippers

The Oklahoma City Thunder didn’t begin their Final Round during the Western Conference at fighting strength. Serge Ibaka, a power forward, had to be subbed out of the game after suffering an injury to his leg in the 3rd quarter. He left the series clinching semifinals against The Clippers with a left calf injury. After attempting to block Chris Paul’s shot, he tangled legs with him and both fell to the ground. Up to that point, Ibaka had been a strong asset for the Thunder, shooting no worse than 40 percent from the field in any game. Many considered Ibaka to be a part of the Thunder’s “Big 3” at the time, alongside Russell Westbrook and Kevin Durant. A fully healthy OKC would have been a favorite in the series, especially if Ibaka had been able to return in full capacity. He did return from his injury in a limited role (29 minutes of play time) after the Thunder fell behind 0-2 against the Spurs during Game 3, a game which they ended up winning. In the end, the Spurs ended up winning the semifinals in Game 6 and advancing forward.

2013: Western Conference First Round, Thunder vs. Rockets

The Thunder’s bad luck also plagued them the previous post-season as well. All-Star Russell Westbrook was injured midway through the 2nd quarter of Game 2 against the Rockets. After a collision with Rocket’s player Patrick Beverley, Westbrook fell to the floor after banging legs with Beverley. He limped off the court in visible pain and was eventually diagnosed with a torn lateral meniscus (i.e. cartilage around the knee). It was the first time Westbrook had missed an NBA game in his career. On the other hand, it also meant that the Thunder’s lineup had never played without Westbrook. In general, the Thunder had avoided major injuries to their core players as they built themselves up to being Playoff contenders. Westbrook eventually ended up missing the remainder of the 2013 Playoffs after undergoing surgery to repair the tear. The Thunder had been the Western Conference’s number 1 seed (i.e. ranking) leading the series 2-0. A series that looked like a sweep became shaky with Westbrook gone for the rest of the season. Although the Thunder ended up advancing to the Western Conference semifinals, the Grizzlies ended up winning and advancing to the final round against the Spurs.

2012: Eastern Conference First Round, Bulls vs. 76ers

In a postgame report, TNT’s Cheryl Miller said that the packed arena went silent when reigning MVP Derrick Rose went down with an injury in Game 1. He suffered a torn ACL (i.e. anterior cruciate ligament) in his knee with 1 minute left in the game after coming down hard on his left leg after going for a layup. Rose seemed to have been back to himself after dealing with a variety of injuries (a sprained toe, sprained ankle, strained groin, and back issues) for 27 games during the 2nd half of the season. The Bulls finished the 2011-12 lockout season with an NBA best of 50 wins and 16 losses. They had captured the top overall seed in the Playoffs for the 2nd year in a row. Rose was unable to play for the rest of the post-season after undergoing knee surgery. Uncertainty formed over the Bulls’ chances of a championship title since Rose led all scorers—the Bulls were 18-9 without him that season. The Bulls had managed relatively fine when Rose was out during the season, but playing against the NBA’s top teams during the Playoffs was another challenge altogether. As a Playoff series extends into 6 or 7 games, that’s when a player like Rose could make a huge difference. The Bulls eventually ended up losing closely to the 76ers during Game 6.

NBA Playoffs: How To Come Back From An Ankle Injury

Ankle Injury Steph Curry Warriors

If you keep up with the NBA Playoffs, it’s clear that these seasoned athletes perform with incredible agility and endurance. Unfortunately, during the heat of the Playoffs, these athletes also have to deal with recurring injuries flaring back up. Steph Curry’s sprained ankle gave Warrior’s fans cause for concern earlier in the Western Conference Playoffs. What is the best way to treat an ankle injury? It comes down to two concepts: strength and balance.

Breaking Down Steph Curry’s Right Ankle

Stephen Curry sat out 2 games during the Western Conference Playoffs when the Warriors were matched up with the Rockets. Although Curry returned from his ankle “tweak”, Curry has had a 5 year history of issues with his right ankle. In basketball, ankles are one of the most commonly injured body parts . With sprain after sprain, his season in 2011 ended with surgery to repair a tendon in his damaged right ankle. This season, he played 80 games compared to just 26 games in 2011. It’s clear Curry has put his nagging ankle pain behind him. Yet, as seen by his sprain earlier this season, ankle injuries do have the potential to happen again.

Ending The Cycle Of Spraining

The chances of re-spraining your ankle are at least 30% and sometimes as high as 80% if the ligaments of your ankle are severely stretched and unstable. Basketball players are especially prone to ankle injuries because of the movements they engage in. Unexpected changes in direction and potential contact with other players leads to a risky environment for the ankles. There’s a lot of side-to-side movement with players cutting around other players at quick speeds. Player’s take an opening when they have the chance, which means a lot of high impact jumping and landing can occur in awkward positions. Landing on another player’s foot is also another common way to sprain the ankle.

Physical rehabilitation for any ankle injury involves manual therapy to improve the ankle’s range of motion, prevent scar tissue buildup, and reduce any swelling in the joint. Combatting future sprains involves taking a full-body approach to treating your ankle. What makes rehabilitation unique to basketball players is teaching them how to control their bodies during unnatural movements when they jump or land. Players work on extending their range of motion within their body so they won’t be injured if they jump at weird angles.

How NBA Players Train Their Glutes

Preventing an ankle injury involves strengthening the whole body so players aren’t as dependant on their ankles when they move. Emphasis is placed on strengthening the hips, gluteal, and abdominal muscles to give a player more control when they move. Basketball players have to focus on controlling their bodies during unnatural movements when they jump or land so they don’t injure their knees or ankles. For that, it’s not only the ankle that needs stability—the knee, hips, and core need strengthening as well. Your glutes provide stability throughout the lower half of your body. The Warriors prefer exercises such as the trapbar deadlift to build up strength. It involves stepping into a diamond shaped bar and lifting the weight straight up around your body. One of the primary muscles groups that this exercise strengthens are the glutes.

Sacramento Kings shooting guard Seth Curry also practices the single-leg deadlift to continue to improve his strength and balance. You start off by standing up straight and keeping your arms by your side while holding a single weight in one of your hands. Then, you lower your torso as far as you can go while balancing on the opposite leg as the hand that’s holding the weight. As you do this, you lower the dumbbell slowly down while keeping your arm straight.

If you practice this exercise while balancing on the sprained ankle, you balance train and strengthen the glutes at the same time. With weak glutes, your hips can drop out, and your knees can turn inward as you move. Once that happens, there’s more pressure put on your ankle to compensate for the imbalance—which increases the chances of a resprain.

Keeping Balanced On The Court

Balance retraining is another key component to treatment to help your ankle stay stable as you move around. For basketball players, they need to have exceptional balance control for the lower half of their bodies. They battle against the forces of gravity while on the court by constantly jumping and landing. An ankle injury disrupts your body’s sense of balance and puts you at risk for re-spraining it. Your ankle has small muscles surrounding it that help keep it in place. Those small muscles are constantly activating and sending signals to your brain to help keep you balanced.

One of the primary goals of physical therapy is to re-educate your ankle’s sense of balance that was damaged during the injury. Special receptors in your ankles send information to your brain about how your ankle is positioned when you’re walking or moving. After an injury, communication between these receptors in your ankle and your brain is disrupted. Since the receptors are damaged, they can’t tell your body how your ankle is positioned. Your ankle may lose its sense of where it’s positioned relative to your movements (i.e. proprioception). This may leave your already injured ankle prone to instability since your body can’t balance it correctly. Ankle stability training involves dynamic activities such as balancing while throwing a ball or moving on a balance board.

Kevin Durant incorporated this type of balance training into a lunging exercise. Watch it here. He would lunge forward and place his foot onto a wobbly balance board in order to improve the stability of his ankle on an unstable surface. By doing this, he prepared himself for the unstable footing he might have to deal with on the court. As you get better at balancing, you’ll lose the feeling of instability or wobbliness in your injured ankle. Your body will get better at controlling the positioning of your ankle without having to consciously think about it.

Staying In The Game

Without properly treating your initial ankle injury in the first place, future ankle instability may lead to future sprains. It doesn’t come down to simply strengthening the ankle muscles. Steph Curry began rehabilitating his ankle by not only strengthening his ankles, but his hips and glutes as well. Your sense of balance and ankle stability go hand-in-hand. Retraining the way your balance system communicates with your brain is a key part of the physical rehabilitation process.

Shadowing A Physical Therapist

therapydia denver physical therapy clinic

At Therapydia Denver, we enjoy having PT students shadow us to see what life is like in an outpatient physical therapy clinic. Last month, Taylor, a prospective PTA student, was at our clinic to shadow both Casey and Josh and here’s what her experience was like:

“I’ve always wanted to have a job in the healthcare field. My senior year of high I decided that my career path came down to two options, nursing or physical therapy assisting. After volunteering at a nursing home I realized that I could not do bodily fluids on a regular basis and decided to pursue a career in physical therapy. Over my spring break I shadowed Casey and Josh at Therapydia Denver. While they both had slightly different approaches to physical therapy, what amazed me the most was their knowledge of the human body. They knew exactly what was wrong when a patient described their pain and how to help. It was astounding. Out of the three shadowing opportunities I have done this was the most interactive by far. Both Casey and Josh explained what the patient was coming in for, their techniques for treatment and how this treatment will help the patient. This deepened my knowledge of the human body and also the world of physical therapy. I am definitely grateful for Casey and Josh taking the time to teach me and give me the most hands on experience. I will be applying for the PTA program at ACC this spring for the fall program, with an even greater desire to work in this field. I want to get my life started and have a real job for a while and maybe later on go back to school to further my career in this field.”

If you’re a medical student or medical professional who is interested is seeing what physical therapy is like at Therapydia Denver, contact us at hello@therapydiadenver.com.

What’s In a Sit-Up? Follow Wade’s Journey To Doing His First Sit-Up

Wade’s newest fitness goal comes down to doing 1 sit-up. In his words, do a sit-up, unassisted, no cheating—for the first time. Wade’s “The Sit-Up Movie” wittily chronicles his fitness journey towards his #NoMoreNevers goals as well as his battle with dermatomyositis. Throughout his short video he challenges the viewer to consider what goals they thought they could never achieve.

When Wade was 5, he was diagnosed with a rare form of arthritis called dermatomyositis. Dermatomyositis is a neuromuscular condition that causes inflammation and weakness of the muscles and skin. Growing up, Wade experienced major flexibility losses as his muscles atrophied, tightened, and shortened. Wade has been highly committed to his fitness journey over the past few years. He started exercising his upper body and core which he hadn’t really ever done before. He joined his first gym, Vital Strength and Fitness, began training for a marathon, and began preparing to do 37 burpees on his 37th birthday. Wade’s goal is to improve his functional strength and eventually begin to try out new sports for the first time.

The Ultimate Triple Threat

After a snowboarding accident, Wade began to see his physical therapist, Casey, at Therapydia Denver. His rheumatologist, Jason, his Vital personal trainer, Todd, and Casey, came together to assess what some of Wade’s barriers to his goals might be to create a holistic wellness plan. Wade needed to strengthen his core—and one way to do that would be to do a sit-up. In Wade’s case, it’s more than just increasing his muscle size in his core area (i.e. hypertrophy). It’s having all of his muscles in his core area to coordinate one major movement without any joint restrictions (i.e limited lumbar flexion). It also has a day-to-day significance—sitting up, getting out of bed, or reaching over to get some favorite snacks.

#NoMoreNevers

To get this goal, Wade and his team developed a weekly fitness program. It included going to personal training three times a week, physical therapy once a week, an intensive cardio regimen, and daily stretches. Unfortunately, no major effort comes with its setbacks. Wade’s dermatomyositis came out of remission for the time in 20 years. With doubled recovery times and buckets of daily medication, Wade hardly lets it slow him down from completing his prodigal sit-up. According to Wade, it’s not about some sappy monologue, he’s going to do a sit-up.

What’s your #NoMoreNevers?

Thank you Wade for sharing your dynamic fitness journey with us!

FEEL BETTER FASTER: QUICK LINKS TO COMMONLY SUGGESTED ITEMS

 

At Therapydia Denver we strive to help our patients feel better as quickly as possible.  In some cases, regular treatment sessions and a solid home exercise program are not all that is necessary for a speedy recovery.

Here is a list of items the Therapydia PTs often suggest for patients to purchase for home use:

KT Tape

KTtape

KT tape is a specific brand of tape that is used to promote healing, manage swelling and enhance your body’s control of muscles and joints while not limiting range of motion.  It can be worn for 3-4 days at a time and rarely causes skin issues.  With instruction from a Therapydia PT, most people are able to apply the tape in a safe and effective manner.

We like KT Tape specifically because the strips are pre-cut and rounded, ready for application right out of the box.

KT Tape is most commonly suggested for patients with: shoulder pain, golfers elbow, tennis elbow, knee pain, plantar fasciitis

Lumbar Support

lumbarsupport

Many low back, neck and even shoulder issues can be exacerbated by poor Lumbar Support during prolonged sitting.  If the curve in your low back is allowed to flatten out, it essentially starts a chain reaction which can adversely affect structures above and below your spine.

We like this particular lumbar support because it is affordable, portable and durable.

Lumbar Support is most commonly suggested for patients with: low back pain, sciatica, shoulder pain, neck pain, headaches

Stabilizer

stabilizer

Numerous studies show that low back pain is accompanied by absent, poor or incorrect activation of important core muscles.  The Stabilizer  gives the patient immediate and accurate feedback, letting them know if they are doing their prescribed exercises properly.  It essentially increases the quality of core exercises at home.

A standard blood pressure cuff can be used for the same purpose, but they are often too sensitive to give useful feedback.  We like this particular stabilizer because it is durable and just sensitive enough to give the patient only the information they need.

A Stabilizer is most commonly suggested for patients with: low back pain, sciatica, sacroiliac joint (SI joint) pain, hip pain

Foam Roller

foamroller

The Foam Roller has been suggested by healthcare professionals for years and for good reason.  They are extremely helpful for loosening up tight muscles and fascia between sessions with your Therapydia PT.  After careful instruction, they are also effective at loosening up tight spinal joints that make achieving proper posture difficult.

We prefer the 36 inch round roller as it can be used for the widest variety of exercises and activities.  This particular roller is affordable, extremely durable and more dense than others on the market.

A Foam Roller is most commonly suggested for patients with: knee pain, hip pain, upper back pain, shoulder pain, neck pain

Roller Stick

rollerstick

The Roller Stick is essentially used for the same purpose as a foam roller.  The main difference is that this hand-held tool allows the patient to control the amount of pressure, whereas a foam roller usually incorporates body weight.

We like this roller stick because it is much more portable than a foam roller and allows the patient to reach some areas that may be tough to address with a foam roller.

The Roller Stick is most commonly suggested for patients that travel frequently and suffer from: knee pain, hip pain, calf pain, achilles tendon pain, plantar fasciitis

Metatarsal Pad

metpad

A number of aches and pains in the foot may arise from a fallen transverse (or forefoot) arch. A Metatarsal Pad is used to brace this portion of the foot, thus restoring the natural shape of the forefoot and dissipating compressive forces.

We like these particular metatarsal pads because they are affordable, durable and self adhesive.  When applied between the insole and the shoe they tend to stay in position during most activities.

Metatarsal Pads are most commonly suggested for patients with: metatarsalgia, morton’s neuroma, forefoot callus

Heel Lift

heellift

A Heel Lift can be used to treat a leg length discrepancy as well as a variety of achilles tendon issues.  When properly applied, a heel lift can essentially level out a patient’s pelvis which can provide rapid alleviation of hip, knee and lumbar spine pain.  A heel lift can also alter the amount of tension on the achilles tendon to allow for proper healing after an injury.  

We like this particular heel lift because it is affordable and adjustable.  This allows for proper fit and progressive increases in tension to the achilles tendon as healing continues.

A Heel Lift is most commonly suggested for patients with: leg length discrepancy, hip pain, sacroiliac joint (SI joint) pain, achilles tendonitis, achilles tendon rupture

 

Peyton Manning’s Plantar Fascia Tear…Is this the End?

Fantasy Football Injury of the Week:  Peyton Manning and his Plantar Fascia

Yesterday we learned that Peyton Manning has a tear in his plantar fascia and will miss at least this week’s game against Chicago.  The fantasy implications of Manning missing time might be minimal (Manning is ranked 30th in my leagues this year for QBs), but as a Denver resident and Broncos fan, this is some serious news.

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This week I want to focus on what exactly is a tear of the plantar fascia, what can be done to treat it, and will Manning play again this season or ever again?

What is the plantar fascia and why is a tear career threatening?

The plantar fascia is a thick band of connective tissue that supports the arch of the foot. In the physical therapy clinic, we most commonly see an acute inflammation or micro-tearing of the fascia near the heel bone, known as plantar fasciitis.  We also see very chronic cases in which there is a buildup of scar tissue at the same location from repetitive micro-tearing followed by healing.  Plantar fascia injuries are one of the more common diagnoses that we see in PT but also one of the hardest to treat, especially the chronic cases.  Even though this band is thick and tough, it’s job is to maintain your arch while supporting all of your body weight.  When the plantar fascia becomes irritated, inflamed or weakened by chronic injury, every step can be painfully perpetuating the injury.

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Manning’s situation is much more severe than the common plantar fasciitis diagnosis we see at Therapydia.  In his case, he has sustained a partial rupture or larger tearing of the plantar fascia.  For any of you who have experienced the pain of plantar fasciitis yourself, that pain is magnified significantly with a partial rupture.  Imagine having a cut on the knuckle of your finger.  Every time you use or bend that finger, the cut painfully reopens and the healing has to start over.  The finger is easy to keep from moving, just buddy tape it or use a splint from the drugstore to keep it from bending.  The foot on the other hand is very difficult to immobilize so the time it takes to heal can be painfully long…..and therein lies the major problem with Peyton Manning’s foot issue.  Will there be enough time for him to return and be effective this year or will this be the end of Manning’s illustrious career?

When will Manning be back and is there anything that can be done to speed up his return?  

Unfortunately, I am not privy to all the details about Manning’s injury.  I can only speculate on what I’ve read or seen on Sportscenter.  The typical time frame for a non-operative recovery of a partial tear of most soft tissue injuries is 12 weeks or more.  This is when we often consider the injured tissue to be back to or near full strength.  However, at 4-6 weeks, the injury could be 80% healed which may be sufficient enough to allow an athlete to return to their sport.  Returning too early though can increase the likelihood of reinjury or lead to another serious problem.  See Arian Foster.

Manning has a few options that may get him back on the field quickly.  Platelet rich plasma (PRP) injections are being used more often these days to speed up the healing process.  Injecting the injured tissue with PRP provides an instant proliferation of growth factors that can quickly stimulate healing.  Tenex is a minimally invasive procedure that removes the damaged or injured tissue, allowing the healthy tissue to regenerate and thrive.  Finally, Manning and his doctors may decide to do a plantar fascia release or surgical cutting of the the partially torn fascia.  By fully releasing the partially torn section of the plantar fascia, tension is released and inflamed nerve endings are no longer sending painful signals to the brain.  However, the long term risk factors of this procedure are much greater than other options including nerve damage, instability in the joint of the feet, loss of normal biomechanics of foot and ankle.  The expected recovery from these procedures is 3-6 weeks versus the 8-12 weeks or more of conservative treatment.

Again, I have very limited information on the severity of Manning’s plantar fascia injury.  He is also dealing with injuries to his throwing shoulder and ribs.  As the Denver Post points out, there are also a number of scenarios that could occur in the next several weeks that impact Manning’s return.  Nonetheless, we are here to predict when or if Manning returns from his plantar fascia tear, so here it is….

Prediction: Peyton Manning misses 4 games.  The tear is either mild enough to return in four weeks or he undergoes a minimally invasive treatment that allows him to return for an important Week 15 matchup against the Pittsburgh Steelers.  

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.  

Will Blake Bortles miss Week 6 with an AC Sprain?

Fantasy Football Injury of the Week:  How bad is Blake Bortles Grade I AC Sprain?

Blake Bortles has not typically been on the radar of many fantasy players since he joined the league in 2014.  However in 2015 he has had a sneaky good start to the season despite Jacksonville’s 1-4 record.  In my Yahoo league, he is currently the 7th best QB.  He has better numbers this year than our very own Peyton Manning (by a longshot) and fantasy studs like Drew Brees and Matt Ryan.

Unfortunately, Bortles may suffer a bit of a setback if he is forced to miss Week 6 against Houston.  Bortles suffered a Grade/Type 1 acromioclavicular (AC) joint sprain of his throwing shoulder at some point during Jacksonville’s week 5 loss to the Buccaneers.  Anytime a quarterback sustains an injury to the throwing shoulder it can be a scary situation.  Fortunately for Bortles, a grade one AC sprain leaves us optimistic that he will be able to play this week and here’s why.

What’s the difference between Grade 1, 2, and 3 AC Sprains?

An AC sprain is typically graded in its severity from a one to a three.  It easy to visualize the severity of an AC sprain in the graphic below:

ACJointSeperation-pic2© http://kneeandshoulderclinic.com.au/shoulders/surgical-conditions/ac-joint-seperation/

A grade/type 1 sprain is mild or partial injury to the joint ligaments or capsule.  In this grade there is a slight tear or sprain of the acromioclavicular ligament.  This ligament helps to stabilize the AC joint and ultimately the shoulder itself.  Bortles likely will rest the shoulder this week and participate in physical therapy everyday to retain his range of motion, strength, and help control the pain with modalities like the Gameready ice machine:

File_000(note: this is not Blake Bortles)

A grade/type 2 sprain is a more significant tear of the acromioclavicular ligament as well the ligament below the clavicle called the coracoclavicular ligament.  

A grade/type 3 sprain is a severe injury to the shoulder.  In this situation, both acromioclavicular and coracoclavicular ligaments are completely torn.  The shoulder is very unstable and an athlete will often choose to have surgery to stabilize the joint by placing a screw or looped suture into the collar bone to anchor it back down.  This grade of injury will mean the player misses weeks or months of their sport.

So What’s the Prognosis?

Fortunately for Bortles he has been diagnosed with the most mild form of an AC sprain, a grade one.  Early in the week his shoulder probably felt sore and a little weak or unstable  He may have had some difficulty reaching overhead or across his body and lifting activities might have been uncomfortable.  Kinesiotaping can be helpful in giving stability and pain relief during this phase of recovery.

 

With daily physical therapy rehab, Bortles’ symptoms will likely improve significantly or resolve completely by Sunday.  

Prediction: Blake Bortles is able to play in Week 6 against Houston

 

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.