The Dreaded New Injury: Why Do They Happen?


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With Mike McKenna

What does it mean to be “ready” to return from an injury? Sometimes everything on paper suggests it’s time, but intuition doesn’t.

A memory ingrained in the brain of Matt Nichol, longtime high performance coach of professional athletes and NHLPA player health and safety advisor, illustrates this point. Years ago, one of his clients was nearing the end of a period of rehabilitation. They were meeting with the surgeon who had repaired the injury, going over all of their information, which was spread out on a medical table. Imaging showed significant improvement. Field tests were okay. So, was the athlete ready to return?

« Just one last thing, » Nichol recalled, the surgeon asked him. « Do me a favor: can you jump on the medical table here? » Awesome. To get up. Now I want you to jump up and land on one leg.

« Whoaaa, » said the athlete.

“You could see the look of fear in their eyes,” Nichol recalled. « And the doctor said, ‘OK, we don’t need any more diagnoses or tests. If you can’t do the two-foot jump as a professional athlete, it shouldn’t be a daunting task.

Sometimes, then, the right instinctive reaction at the right time can prevent an athlete from coming back too soon.

But it doesn’t always happen that way. Often, as far as we know, an athlete is loan and the return does not go as planned. What a heartbreak it was for Ottawa Senators fans Monday morning when center Josh Norris, just days after returning to the team’s roster, was ruled out for the season. He will need surgery on the same shoulder he injured earlier this season, the same shoulder that had already cost him 38 games. The news came just days after the Carolina Hurricanes’ Max Pacioretty suffered a season-ending Achilles tendon tear that aggravated an earlier injury from which he had just returned.

When Norris was first injured in October, his expected recovery schedule was all season. Still, he only returned in mid-January for the final three games. Pacioretty’s projected schedule this summer was six months and he returned after five. Are these injuries a case of bad luck? Or are you worried about players rushing in or being dismissed from injuries too quickly in hopes of making an impact?

In Norris’ case, he had opted for 12 weeks of rehab rather than surgery before returning, after seeing five doctors and two specialists, and was in good health when he joined the roster on January 18. But it was telling that he wasn’t taking faceoffs. Despite what we assume were the best intentions between player and team, the optics suggested he was rushing back.

I am not a player. I’m not a doctor either. I am not qualified to speculate precisely as to why these things happen. Speaking to a rep for an NHL player, I felt like it wasn’t a player’s decision to rush.

« Players don’t have the ability to come back too quickly, » the rep said. « All the players want to play and come back from injury and get back into the lineup. It’s not up to them. It’s 100% up to team surgeons and doctors to allow players to return to the roster. game. It is the responsibility of medical professionals and clubs to ensure that players have followed all return-to-action protocols. A player may say, three months from shoulder surgery, « I I’m ready! » No team should take this guy out and let him play.

From Nichol’s perspective – not to mention specific injury cases but only injuries in general – there is often no blame to blame. There could be as much internal pressure for a player to return or a sense of ‘inmates running the asylum’. Sometimes an injury eludes everyone, from team to team, because the picture can be deceiving.

« The problem is that we’ve become a bit too dependent on imagery at times, » Nichol said. “Things can be beautiful in imagery and they can’t be beautiful in real life. And sometimes things can look bad on imagery and they can be great in real life.

« I use an analogy with my clients – phantom limb pain. You may have someone who doesn’t have a leg, but they may have leg pain that no longer exists. That doesn’t mean that the pain isn’t real. They have very real pain in a leg that isn’t there. There are other people who don’t have pain and say they feel fine but they like when you make diagnoses, whether it’s pictures and imaging and MRIs or field tests, you can say it’s good that you feel fine, It’s good that you’re not in pain, but your right leg is 20% weaker than it was before the injury. »

What is the interpretation of a real player on the return from injury? I can ask that directly to my colleague, retired goaltender Mike McKenna, a 13-year-old professional between the NHL and AHL, who collaborated with me on this story.

Mike – you were an extremely durable player during your career. But how many times has that required playing through injuries and/or rushing after minor injuries?

Well Matt, I was very lucky. I have never missed a game in my career due to injury. But I played through some pretty serious ailments.

Not many people know this, but I tore my groin in the 2017 AHL Calder Cup playoffs when I was a member of the Syracuse Crunch. And again – really badly – ​​the following year, when I was a member of the Texas Stars and we played against the Toronto Marlies in the Calder Cup final.

Every time I went down the butterfly I felt like someone was stabbing my groin with a chef’s knife. The over-the-counter meds couldn’t do much – the pain only subsided once my adrenaline kicked in for the first period. But these first stops hurt a lot.

I broke my index finger once and had a very deep cut on my kneecap another time. But I’ve played through both. Neither wound could really get worse, so I just drained it. My team needed me.

Almost every season I’ve had a few minor tweaks or pulls. But the training staff never stopped me, or even advised me to consider it. I’m grateful that I never had to make those choices.

If a player is willing to return but is not cleared, does he ever have the option of canceling the team or the doctor, or will he still have to abide by what the team decides, like did the player’s representative suggest?

The players rep is right, Matt. The team medical staff must clear a player to return to the line-up. And that’s a good thing because players would absolutely force the issue if they could.

I’ve seen it happen many times in my career, especially with head injuries. Remember that my professional career started in 2005, long before the concussion protocols that the NHL has adopted in recent years. But even now I know there are players who want to come back to the lineup as soon as they feel good. Not great. Not perfect. Just, in their eyes, good enough to play.

And this is where the medical staff is so important. Players simply cannot tell for themselves if they are fit to return to activity involving physical contact after sustaining a head injury. I’ve seen players get knocked down after joining the roster because their heads didn’t come back 100%. And it was the right choice.

The other wounds are tricky. Soft tissue damage is quite easy. For the most part, it comes down to the player’s pain tolerance. But for structural problems – bones, joints, etc. – doctors must be involved.

But let’s face it. If it’s the Stanley Cup playoffs and the player wants to be on the roster, it’s going to take something major to keep that person off the ice. Doctors know this. But doctors also won’t put their credibility and professionalism on the line by allowing someone to gamble who shouldn’t. It’s a delicate balance that requires a lot of communication and honesty on both sides.

On the other hand, are there cases where a player is not ready to return but, medically, he is cleared to do so? Are the obstacles more mental in these cases? Does the player feel pressure to hurry back?

Oh absolutely, that happens too. But it’s usually more about conditioning than mental. When players miss action due to injury, it’s the lungs that really suffer. I heard it all the time from players when they were in rehab. That the strength was there, but they didn’t feel like they were in good shape. And that’s not a good headspace for a gamer, thinking he can’t keep up with the game.

I know of instances where players have been urged to return to the lineup. There is definitely pressure to join the lineup once a player is cleared. And the level of stress really depends on a team’s position in the standings.

If the club is in an uphill battle to make the playoffs, the player goes into the lineup whether he likes it or not. But whether a team is comfortably in (or out of) the Stanley Cup Playoffs picture, things are different. The team has more leeway to give the player time to feel closer to 100% before adapting to the action of the game.

This is also where the term “day to day” comes from. Players who receive the designation are generally capable and authorized to play. It all depends on the level of comfort. Sometimes the pain is too strong. Or the swelling will not go down. There are many variables.

Is it sometimes the case with an injury that appears healed in imagery, but you can’t really tell until it’s been tested in a game situation?

Nor will I pretend to be a doctor here. But I’m sure there were times when everything looked good on film, only to find out later that it didn’t.

But what you mentioned about game situations is important. It is really difficult to simulate this intensity in practice. And a player really won’t know if their injury is rehabilitated enough to endure the rigors of playing action without actually participating in it.

That’s why you’ll see players come back for a few games and then end up in the stands a few days later. Perhaps the return was a bit rushed. It happens. Pulling, tearing and squeezing – these can be aggravated quite easily. And it’s a very difficult situation for a player: the endless cycle of rehab just long enough to get back into the lineup, for the injury to come back. Or get worse.

These are the ones that concern you. And possibly, team medical staff may have to step in and make a judgment on whether the player should be retired for the rest of the season.

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When a player returns from an injury, it is generally assumed that he, his team, his doctors and his coaches are rowing in the same direction. Nobody wants an athlete to come back too soon and aggravate an injury. But sometimes, whether it’s due to bad luck or the inability to really test in a game situation, it just happens. It is a sad reality of sport.

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