Buster Posey Injury Update!

Just a quick Thursday morning post, ESPN is reporting that Buster Posey's X-rays have come back positive for a broken ankle.  In addition, reports are now showing that he may have injuries to the ligaments of his left knee.  Pending an MRI, the severity of the break has yet to be announced, but we will discuss prognosis of a clean break versus one requiring an ORIF.  Needless to say, Buster is more than likely done for the season and the long-term potential of his career may be in jeopardy.

The results of the MRI will  more than likely determine the course of action that the orthopedic surgeon take to bring Buster back to playing health.  Here are a few scenarios that include potential prognosis for returning to play:

Scenario 1:  Fractured bone without additional ligamental injury;  Treatment:  CAM (walking) boot and physical therapy; Time out: 6-8 weeks;  Prognosis: Should return to full ability with no loss of function.

Scenario 2:  Complete fracture with ligamental injury.  Likely treatment:  ORIF (open reduction, internal fixation) and physical therapy;  Time out: 4-6 months; Prognosis:  Given age, should return to close to full strength with minimal limitations.

Here's a picture of the ORIF.  Note that hardware that is inserted will be a limitor of what he is able to gain back functionally.  The more hardware, the less movement he will be afforded.

Scenario 3:  Complicated fracture, in which the bone is completely shattered.  Likely treatment:  ORIF and physical therapy;  Time out: Out for the year;  Prognosis:  May not ever get back to original playing ability.  Given the severity of this injury, significant limitations may be present for the rest of his life.

Just a reminder, the these are only three possible scenarios of what may come about in the future with Buster's ankle.  The commentary provided is just what I have experienced in the clinic, and is in no way a definite answer to the question of how long he will be out.  Professional athletes do typically have a shorter recovery period than the normal lay-person, but given the money involved, the Giants will not rush him back into action.  As a medical professional, here's to hoping that his injury is not too severe and he will be able to play to the potential he has shown in his young career.

Have any questions or comments? Please feel free to email me at jcachodpt@gmail.com and I will get back to you as soon as possible.  

Knee Pain Continued: Patellofemoral Syndrome and Other Patellar Injuries

This week's topic: patellofemoral pain syndrome (PFPS).  For those of you who aren't familiar with this terminology, patellofemoral pain syndrome is characterized as pain originating from the areas underneath or around the patella (kneecap), due to abnormal forces being placed upon the patellofemoral joint. This can result in potential irritation to the underlying articular cartilage (chondromalacia), irritation/inflammation of the synovium, and finally damage to the bones themselves. Common signs and symptoms that accompany patellofemoral pain syndrome are anterior knee pain that occurs with activity, and is exacerbated with ascending/descending stairs/hills.

The question that may be running through your mind, is WHY DOES THIS HAPPEN?  As stated earlier, the probable cause for PFPS is abnormal forces acting upon the patellofemoral joint.  In my clinical experience, it seems as though muscle imbalances (tightness/weakness of certain muscles) seem to be one of the primary causes of this issue.  Weakness of the quadricpes/gluteal musculature and tight hip flexor musculature seem to be quite prevalent in my encounters in the clinic. 

Prior to jumping right into treatment, it's important that we use a special test to verify that the individual is suffering from PFPS.  For these purposes, we will use the eccentric step down test, which a study conducted by Nijs et al, determined that it's results are most likely to indicate PFPS.  The test can be completed as shown in the following video:             

Finally, let us examine treatment of patellofemoral pain syndrome.  Before we start, let me remind you that the information presented on this blog should not be used as a substitute in any manner for skilled services. In addition, I am in no way making diagnoses or providing treatment via the blog. This blog is solely intended to educate the readers in the area of injuries/rehabilitation. If feel as though you may need help, please see your physician or physical therapist (in direct access states) for a referral/evaluation.  As stated earlier, we will be focusing on fixing the muscle imbalances of the lower extremities.  Use the following stretches and exercises to help with your  PFPS:

Let me apologize for the lack of posts in the past couple weeks.  When I started the blog off, I was writing 1-2 articles per day and I got a bit burnt out.  Needless to say, from here on out, I am going to try to do a lengthier post every other week, and then post the sports stuff whenever something important comes up.  Tiger Woods' latest knee pain/achilles tendonitis will probably be my next professional sports subject, so keep an eye out for that one golf fans.  Thanks again for reading my blog! Keep checking it out for new updates!

Student Shoulder: I'm So Tense!!!

Have you ever reached the end of a long school and work day and felt an annoying tightness and soreness extending from the top of your shoulders and into the neck? Chances are you are dealing with what has been aptly described as "student shoulder" or in clinical terminology, soft tissue limitations of the upper trapezius, levator scapulae, and other shoulder girdle musculature.  When this happens, the typical response is to have a friend/family member/significant other come and massage the affected area for a bit...  The problem is that within a matter of time, the pain/tightness/soreness comes back.  This can be extremely aggravating, and potentially debilitating in certain situations.  


In order to address this issue in the best way possible, we must first separate ourselves into two categories.  Our first category is people with postural tightness of the upper trapezius secondary to a passive insufficiency of the scapular stabilizers (your back is weak), or the second group in which the upper trapezius is actually tight from excessive activity. For the purpose of this post, we will use a quick and easy screen to figure out which of the two categories you fit in.  Use the following picture and subsequent instructions to get through the test:

• Begin the screen by sitting in a relaxed slouched position like in figure A.
• Feel the muscles extending from your shoulder, up to the neck-record what your feel.
• Next, assume a nice, tall posture like the one in figure B.
• Once again feel the same muscles and record what it feels like.

Ok, now that our screen is completed, categorization of your type can be completed.  For the purpose of this blog, we will refer to postural tightness as Type 1 and overwork tightness as Type 2.

• You probably have TYPE 1 tightness if your muscles were tight in the slouched (figure A) posture, but relaxed in the tall posture (figure B).
• You probably have TYPE 2 tightness if your muscles were tight in both slouched and tall postures.

Treatment Options:

Depending on the severity of your issue, I would recommend consulting with a physician/physical therapist in the event skilled services are required.  If you are dealing with a minor affliction, here are some options you can try...

If you are dealing with Type 1 tightness, this is typically caused by a passive insufficiency of the posterior shoulder girdle musculature.  What this means is that because your posterior shoulder girdle muscles are weak, we assume the slouched posture as in figure A.  The shoulders have now been drawn forward to weakness of the back muscles and potential tightness of the anterior musculature.  This forward position pulls the upper trapezius on stretch, leading to that tight feeling.  Because the trapezius is already on stretch, there is no need to stretch it.  The key is to stretch the anterior musculature (pectorals) and strengthen the posterior musculature.  Here are a few examples of things you can do:

Ok on to Type 2, or overwork muscles of the upper trapezius.  In many individuals, the upper trapezius is a frequently overworked muscle.  This is typically due to weakness of the other back muscles, leaving the upper trapezius to do all the work.  For this scenario, the upper trapezius is actually tight and should be stretched in addition to strengthening of the posterior musculature.  In this case, skilled services from a PT may be necessary as the individual may have issues properly activating the right muscles. But here is a few options you can try out:

Alright, I believe that is all for this post.  Again, please consult with your physical/physical therapist prior to engaging if you are dealing with a specific injury.  Hope this can help ease some of your tension!!