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
"Tony Romo goes from a season ending back injury to possibility of playing in an important game against Philadelphia this weekend. How can this go from such a dire diagnosis to a more optimistic one for Romo , especially when he was in such obvious pain last game? Look further for a possible explanation -
Explanation - Earlier in the year Romo apparently had a surgery for a cyst in the disc area of the lumbar spine or low back back. These cysts are benign collections of fluid around the disc which are like a piece if hard rubber between the bones of the back. They usually cause pain from pressing on the nerve that comes out of the back in the disc area and goes down the leg. It is commonly called sciatica or an inflamed Sciatic nerve. This is a fairly common problem in the general population but is usually from a degenerated disc instead of a cyst. The cyst is usually removed then it no longer presses on the sciatica nerve and the pain is gone. Sometimes, however where the cyst was removed it can recur or the disc in the are bulges out and either can be pressing on the nerve again causing it to get inflamed. This can cause pain all the way down the leg to the foot and ankle , and even create some weakness or inability to move well. This is usually from the nerve being inflamed, and can at times be effectively treated with a cortisone shot into the spine to relieve the inflammation and therefore the pain and weakness. I would guess this is what the medical staff is doing with Romo. Injecting it early this week to see if the inflammation will come down enough to allow him to be functional. They will also take into consideration if Romo's long term health will be put at risk if he plays, but many times while very painful, this condition is stable, so don't be surprised if you see him playing.
"Is Green Bay's Aaron Rodgers still being held out with a fractured clavicle on his non-dominant arm. What's the deal with that? Most players are able to play 4-6 weeks after this injury which is the normal healing time. Are his Doctors just being ultraconservative or are there other issues with agents etc. calling the shots?"
Explanation - A broken collar bone or clavicle is a pretty common fracture in sports that involve contact. One of our more famous Sports radio commentators had one in High School. These breaks generally heal with no problems in about 4-6 weeks. Most athletes I cared for can be back playing their sport as long as their strength and range of motion are back to normal which can be as soon as 4 weeks, with the caveat that the fractured area is probably only about 80% of full strength, so it can work but not take a full blow. The risk is if it gets hit again a certain way, during the next two weeks it could be re-injured and just take a little longer to heal. If an athlete is at the end of a season, it's usually worth taking the chance and playing especially if it is an important position player and the chances are pretty low that it will be re-injured, and if it does, it's just a matter of more healing time. Rodgers is way past where it should be solidly healed and playable given it is his non-dominant arm, but many times agents or gutless doctors will want there to be absolutely no risk of re-injury, even when the athlete wants to and could play. It seems for this very important match-up with the Bears which has play-off ramifications, letting Rodgers play would be the reasonable choice. The disclaimer is that I have know other knowledge than what is in the paper and am basing my opinion on my treatment of these injuries for 30 years.
Kobe Bryant suffers a fractured tibial plateau. How might this be related to his torn Achilles and what thing does his injury have in common with RG III being benched for the Redskins? Maybe something to do with not being able to mess with with Mother Nature?
While there will some that say that Bryant's injury is just another injury, I am convinced that it was from inadequate time to recover his Achilles tendon injury. Besides the Achilles itself healing, which takes at least a year to be normal if you're lucky, there are many other things that happen to the rest of the body during the time of healing. One thing is that it is necessary to not put any weight on the repaired tendon for a 6-8 week period of time. That creates an imbalance in the muscles of that leg and the other leg. There are changes in bone strength that happen when you change the amount of weight you put on your leg for a long period not to mention the muscle changes. Also you lose some of the reflex fast twitch muscle firing patterns that are part of the ability to change direction fast and explode to the basket in basketball or get away from a lineman in football if you are a quarterback. These are subtle changes that take time and just doing the movements to get back. Unfortunately simple measurements of just strength which are commonly done to test an athlete's ability to return to play don't and can't test these things
Some athletes seem to think they can be "the one" that heals faster than everyone else because they work harder and have superhuman healing capacity. This may be because they are exceptional in their athletic abilities and that can carry over into how they heal. In RG III's case, it is well known in the Sports Medicine community that a knee isn't "right" for a year after an ACL repair. The ability to plant ,cut, and change direction in a repaired knee takes more than just strength. While an athlete can think they are ready because their knee feels strong, there are still functional aspects to being normal that take about a year to be back to normal. His surgery was done less than a year ago, so to expect him to be able to do the same things he did pre-injury to start this season is/was unrealistic and I think his coaches saw he just didn't have it, yet.
The lesson here is that there are certain aspects of healing that just take a certain amount of time, no matter who you are. You can't mess with Mother Nature, no matter who you are or how many special injections you can get. Those factors need to be considered before return to sport, especially at the highest levels. It looks like both Kobe and RGIII are finding that out.
SportsDoc Update: Dr. Paulos 11/08/2013
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