NHL Injury Analysis: Details on the Recovery Process

As they say, "good things come to those who wait." And at last, the NHL season is upon us. But it does not start slowly. There are still some big injuries that are already affecting teams. There is no bigger news than the status of Sidney Crosby for the Pittsburgh Penguins. Luckily for the Pens, the news is on the good side. Late last season and the offseason were filled with speculation and question marks. But it looks like he is getting near to getting back in the lineup. He is practicing and, from all indications he is not having any post concussive symptoms. It appears that he may be back in the lineup in a few weeks as long as there are no changes. Concussions or head injuries of any sort are never minor and can be career ending. When it comes to a sport figure-head like Crosby, one can never be too safe. The final test will be to see how he feels once in a game situation. Will he have any headaches? How will his balance be? Will there be any changes in vision?

The same applies for Edmonton's Ben Eager. He is diagnosed with a concussion. The effects of a concussion can be long lasting and may impact any or every part of someone's life. In the most severe cases, it will affect one's ability to walk and stand up because just changing positions can be a problem. In other cases, it may only be a problem with significant physical exertion. For a hockey player, this can be problem. The battery of tests will be repeated until the player show repeated success and consistent success. As in many things, someone may be successful once by chance or luck but repeated success cannot be duplicated by chance or luck. It is reflective of consistent improvement. With concussions, improvement is something that has to be seen over and over again before a player will be given clearance to play again.

Then there are those players that had early season surgery that will delay their start to the season.

Drew Bagnallof Minnesota had offseason shoulder surgery. He is not cleared to play as of yet. The reason I bring this up is mostly to talk about shoulder surgery and the impact it has on recovery. The shoulder region is a relatively unstable area because it has only one bony attachment to the body. Muscles and ligaments suspend the shoulder. So when a player goes through surgery and then has a period of immobilization and decreased activity, the amount of motion, strength and motor coordination that can be lost can be quite it a bit. A surgeon may predict return to activity in 3-4 months but this is reflective of a broad norm and may not reflect the individual and what may impairments that the individual has to overcome. Sometimes, the motion and strength is regained but that is not the end of the rehabilitation. The player has to regain normal motor coordination and sequencing of movements. If the player utilizes abnormal movement patterns to achieve the task, the player may be establishing a new mechanism by which he may be opening himself up for another injury. This is also true with many other injuries or surgeries.

Byron Bitzof Vancouver had hip surgery and will be out indefinitely. The same that was said for Bagnall can be applied to Bitz. The difference is that the hip is also explicitly important to a player's ability to be stable and to move. The hip joint can be very important to one's stability on ice. An unstable hip joint places more stress on the knee and the low back. In the end, they may develop a knee problem or low back pain. It is also important movement because it is the engine that drives the body. It is what propels us on and off the ice. A decrease in hip strength and ability to generate power efficiently places added workload on the surrounding areas, leading to overuse injuries. Rehabilitation always includes surrounding areas to ensure complete recovery and injury prevention.

When I see athletes with injuries like muscle tears, I ask myself "what are they compensating for?"An elite athlete has gone through hours of training so to tear a muscle can be sign of compensation for other deficiencies that may be present. It may a lack of mobility in one area, a decrease in stability in an adjacent area or altered motor control pattern that is placing added stress on the muscle. So in rehabilitating a tear, the focus is not only on the torn muscle but the surrounding synergistic muscles. For Chris Campoli of Montreal, the hamstring tear rehabilitation would also require rehabilitating the quad, glutes and calf to name the big muscles. The rehab process may include anything from gaining flexibility and stability to re-training motor recruitment processes. This can definitely be an unpredictable process depending on the many different facets that are integrated in the rehab process.

The unpredictability of recovery can be seen in the most minor of surgeries. Generally knee surgeries can be seen as quite routine especially if they are minor such as a meniscal repairs done arthroscopically. But even the most minor surgeries can be unpredictable. Scott Clemmensen, the goalie for Florida, had minor knee surgery and is expected to be out for one month. Normally, this would be expected but as we have seen it does not always turn out this way. Early on, pain and swelling must be controlled. Any excessive swelling and pain will affect movement and, in return, affect recovery. Playing through pain, even though it is normal for professional athletes, can lead to issues that may continually impact a player's performance. Especially goalies, with all the lateral movements they perform, need great knee stability. Knee stability ends with the knee but starts with developing good hip control. So the rehabilitation of the knee must include assessment of the hip and how it is moving in relation to the knee.

My goal for this year is to provide some insight into the rehabilitation needs of the different injuries as well as covering specific players. This will assist the fans to be better informed as to the impact of the injuries not just short term but the long term as well. A rehabilitated injury does two things. One, the specific injury does not impact the player's current ability to perform. Two, the injury does not compromise the player's ability to perform into the future. The caveat to this is that many players cannot take extended breaks from the game so complete recovery may be at times very difficult, especially if the team is in the playoff race. So there are always injuries that linger or may re-surface several times throughout the year. So to me, that is why the offseason is so important in determining how a player might perform during the season. What is a player doing in the offseason in preparation for the season? How are they dealing with old injuries or, more importantly, the small problems that they have ignored many times in the past because "... it really doesn't bother me?"

Anyways, I'm looking forward to a great year and, if the hockey gods are willing, maybe another run for the Canucks (without the riots).