ABOUT THE AUTHOR
Russ Toronto, MD
Dr. Russ Toronto has served top athletes in Utah since 1981 through his own private practice and through affiliation with various orthopedic groups. He received his medical degree from the University of Utah in 1979.
With over 25 years of experience treating, coaching and playing along side his patients, Dr. Toronto is uniquely qualified to treat any athlete, any time. As one of the first sports medicine specialists in Utah, his level of expertise can be seen in a distinguished career. He has served as a team physician for University of Utah football, the Triple A baseball team, and at many high schools, helping direct sports medicine for their programs. In 2002, he served as one of the venue physicians for Olympic Snowboarding. He has also served on the Governors Council for Physical Fitness and as a medical advisor for many club sports including gymnastics, running and soccer. Dr. Toronto has provided care for pro athletes, college athletes, high school athletes, and recreational athletes in a wide range of sports. He has been invited to present at over 50 sports medicine conferences, written a newspaper column, and has discussed sports medicine topics in videos and on the radio.
In addition, Dr. Toronto is a former collegiate baseball player, avid backcountry skier, and proud husband and father of five children. His passion is returning athletes to the playing field at whatever level they participate.
Follow Dr. Russ Toronto on Twitter: @DrRussToronto
SportsDoc Update: Dr. Paulos 11/08/2013
"Aaron Rodgers (Green Bay QB) reportedly has a fractured clavicle or collar bone - should be out for 3-6 weeks. Read about this common shoulder fracture and what is expected."
Aaron Rodgers suffered a fractured clavicle or collar bone on his left shoulder in the game on Monday against the Bears. The collar bone is the most fractured bone around the shoulder. The fracture happens from landing on the shoulder with the arm tucked in. It is kind of like putting a toothpick between your thumb and finger then squeezing it. It usually doesn't happen from a direct blow. This is important to know when it comes to 'return to play' decisions because if the risk of it getting it re-fractured is low, such as in basketball, baseball, or tennis, then one can usually return to sport in 3-4 weeks. If football where contact is the rule is the sport returning to, then the return to play decision is a little more difficult, because taking a hit is a lot more likely. This is where judgement and taking into consideration the situation, like is this a senior who has only 2 or 3 more games to play, comes in. The main risk of playing too early is re-fracturing it which will just add healing time to the injury. Fortunately Rodgers' injury is on his non dominant side, so it will be interesting how much of a risk they will be willing to take when it gets to 3-4 weeks. That is when it is healed enough to hold in place with normal shoulder movements, but closer to 6 weeks is when it can safely take a hit.
Treatment involves using a figure of eight wrap to allow the arm freedom of movement (not a sling which is another common way it is treated and should be avoided). Everyone knows someone in the family who has had this injury as a kid, a high school player (as a now famous radio personality and once high school football QB had), or what now seems like an epidemic of bicyclers who crash as adults. Fortunately, it is most often an uncomplicated course of healing that takes the usual fracture healing time of 4-6 weeks that we have talked about previously. Occasionally, the fracture is more complicated and in multiple fragments which may longer to heal, and, very rarely needs surgery. Unfortunately, some surgeons are getting "cut happy" and more often recommending surgery where it used to not be considered except in unusual circumstances. If you or a family has this injury get a Sports Medicine doctor to help care for it as it is important to do some rehab exercises once the bone is healed so the muscles work well again.
" Is Chase Nelson's (QB Logan) suspension for this week's playoff game legit from an ejection/penalty for kicking a Bountiful player, or was his action a "physiological and neurological reaction to an injury" as quoted from Coach Mike Favero of Logan in the Tribune, and he should be allowed to play?
The Logan High School administration has been on a public crusade to have the UHSAA overturn a ruling made in the playoff game they won against Bountiful against their star quarterback when he was called for a flagrant foul for kicking a Bountiful player after scoring a touchdown. Their contention, elucidated in both papers on Tuesday, was that he was responding to an injury he sustained to his left knee on the play and was just a reflex. Therefore, he shouldn't have received the penalty that disqualified him from continuing in that game and by UHSAA rules, missing the next game as well. They went to the effort of having a well respected physician state in a letter that his apparent kick was "a spinal cord response out of his control".
While it is true there is a spinal cord response to pain, and Nelson did have a documented injury, what happened when the film is reviewed (from channel 13), was not the typical "spinal cord reflex" from an acute injury. When your hand gets burned on a cooktop, the reaction is to withdraw your hand toward you to get it away from the painful stimulus. When someone sustains a knee injury, the "spinal cord reflex" is to pull the knee towards you and not put weight on it, and if you try to put weight on it and it hurts, your knee will uncontrollably give out. On review of the tape, Nelson does not pull his knee up while on the ground. He then stands up and proceeds to initiate a kicking motion with that leg, that if it made contact, would have struck the Bountiful player in the face as he was still struggling to get up off the ground. That would not be consistent with the "spinal cord reflex" spoken of, but more a conscious effort to initiate that motion. Two officials saw the play and both agreed on the call. No one can dispute that there was a knee injury, but the reaction wasn't that which would be expected from an involuntary "physiological and neurological reaction to an injury" as purported. While the extent of the penalty could be argued since no one was hurt, the reason for the penalty is justified, and the ramifications clearly stated in the Rulebook. It's too bad for the player, but the way it was called, and the argument why it should be overturned does not fit with the science about response to injury. It's just my opinion, but I can back that up with 30 years of experience covering college and high school football games from the sidelines seeing and evaluating hundreds of game time injuries to knees and the realtime reaction to those injuries.
"Mike Hague of BYU had successful IT Band surgery allowing him to return to play and contribute to the Cougars’ success. Extremely unusual for a football player to have IT Band but very common in runners. Even more unusual to need surgery to resolve it. Read my take on it."
Mike Hague/IT Band - As reported in the D-News, MIke Hague had successful IT Band surgery before the season started which has allowed him to play and according to his account, feel the best he's felt in a long time. In general, it is very unusual for a football player to have this problem as is comes from distance running. It is most likely induced from off-season conditioning/training that he did. IT band is responsible for probably 30-40% of the runners that come into my clinic with knee pain. The majority of the time, it is caused by worn shoes, running too fast down hill, increasing mileage too fast, or running on a slanted surface. It usually presents as a pain on the outside of the knee that can be dull or sharp and painful enough that it will stop the runner from running, but go away when he/she stops and walks. The pain comes from the IT Band rubbing against the bone on the outside of the knee, causing the bursa (a small fluid filled sac) between them to get inflamed. While very painful, it doesn't cause damage to the knee itself.
Treatment of IT Band involves correcting the biomechanical problem that caused it. If shoes the are worn out (more than 300 miles), get new ones, and make sure they are right for your foot. Decrease mileage to what can be done without pain and run on flat, even surfaces. Running more with landing on the mid foot instead of landing on the heel can help, also. There are also some stretches that can help the IT Band be more flexible and not rub as easily. Dealing with the inflammation with icing after runs and using some medication if it is staying sore after running can also be beneficial. In resistant cases, an injection of cortisone can be helpful and can also help to resolve it quicker if there is limited time before an important event with no long term risk of problems. As mentioned, it is very unusual to need surgery - only about 3-5 % of cases and then only if all other options have been exhausted because it isn't a universally successful surgery. Fortunately with the right combination of treatments, it can be resolved and full return to activity (running) expected. Fortunately for Hague, he went to the right surgeon to resolve his IT Band problem after trying all other options, and it has been successful.
"Trey Burke's finger fracture - is it 4, 6, 8, or 12 weeks? "
As has been reported Trey Burke has a fracutured finger that required surgery to repair. As we discussed on the radio, in the old days we would have just pulled on the finger if it looked like it was going sideways to line up the bones and then buddy tape it and let it heal, most of the time continuing to play. Many of us old jocks have one or more fingers that look a little crooked that we can hold up that are evidence of our athletic careers. If you ever get the chance to shake Coach Mac's hand you'll see this on his 5th finger, I've got a couple of those, too. At least we have a story behind the injury to remember.
With improved techniques and hardware (pins and plates that weren't available or used in the "old days") finger fractures can be repaired and the bones held in place by surgical techniques. The timing on how soon an athlete can return to play is dictated by the time it takes for the bone to heal, the amount of scar tissue that forms and restricts movement, and how conservative the physician that does it is.
The 4 week time is the time it takes for the bone to heal sufficiently to hold together on its own. While not at full strength, the finger bone can usually be splinted at this point and rehab to get range of motion back can be started. At 6 weeks the bone will be stronger and some of the movement regained, so it is now that playing with a splint on is possible if everything has gone well. More conservative care would require full range of motion to be attained before playing and this would be generally at 8 weeks. The 12 week time given was if things don't go well like an infection after surgery, failure of the bone to heal properly, too much scar tissue forming so the range of motion is too limited to allow the finger to function, or a very conservative physician.
In the best of circumstances Burke would be allowed to play with a splint on in four weeks while rehabbing the injury. That would be while he is still rehabbing the finger. It may not be game ready, but he could at least be practicing with the team which would be huge for him and the team.
Dr Lonnie Paulos
The most common fracture that would fit with Murphy's situation would be a Navicular fracture. It is a small bone in the wrist that often gets cracked in a fall and feels like just a bad sprain. Many athletes are able to keep playing with it cracked sometimes for weeks before they get it checked. Because it heals poorly and we now have minimally invasive ways to surgically fix them, surgery is often done using a small screw. While it does need protection with a cast while it heals, one can certainly play with a padded cast on the wrist while it heals without taking undo risk with the healing process.
While that might not be what Murphy has specifically, the fact that it didn't need immediate surgery would indicate it wasn't too serious. That they are saying he can't play is usually coming from the doctor who did it. Some physicians are by nature conservative and maybe not caring as much about whether Murphy plays or not. If he was my kid or was him, I'd want to make sure all options about playability had been discussed and get another opinion as to whether it could be casted and padded and he could continue to play. He is a great player and should have that opportunity if safely and reasonably possible. One could say there might some liability issues, but the individual should be able to make that choice.
On a personal note, over my thirty years of doing Sports Medicine, I have had countless athletes who have been told their season is over with a wrist or hand fracture, and with appropriate casting, bracing, or splinting we've been able to get them back on the playing field. There hasn't been once where there has been a failure to heal or any compromise in the care of the injury. It usually just takes a little thought and effort to come up with the best way to protect the injury so the athlete can continue to safely play while it heals.
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