Dr. Ben comments on Freeney’s injury

The Freeney situation has been bugging me all week.  Not just because I want him to be healthy, but because there are certain aspects of it that just don't add up.  That's why I'm so thankful for this email from reader Dr. Ben.  I'm glad to know that a professional is just as confused as I am.  This is what Dr. Ben says about the injury:

So you know where I'm coming from, I am a physical therapist who just graduated with my doctorate in PT this past summer (from the University of Indianapolis) and currently work in the workman's comp arena. That is to say, I do NOT work in sports medicine. However, as both are under the umbrella of outpatient, orthopedic medicine, it's a similar injury set (with patients that are far less in shape!)

What I can tell you is that this all seems a little…off to me. I saw the injury in person and later watched the replay, thinking very little of it. Freeney walked off under his own power-rather casually. No one walks off with a grade three ankle sprain when the consequences of said injury are decreased stability of the ankle.

70-80 percent of ankle sprains are to the Anterior TaloFibular Ligament or the CalcaneoFibular Ligament or both. Freeney's was probably the ATFL, judging by the replay. These ligs both guard against rolling the right ankle with cutting to the left.  Obviously crucial to Freeney's game.

With muscular injuries, there are always more surrounding muscle fiber to "pick up the slack." You can mask the pain or play through it, often without significant drop off in production.

Ligamentous injuries are different. Stability is the casualty. without stability there is more motion which screws up timing, speed and confidence…even when taped and with pain shots. The brain knows something is not right.

There is divergent opinion/protocol for this ruptured lig: surgical and conservative (non-surgical). Studies show that conservative treatment is no different in long-term stability but allows earlier return to function with less residual (long-term) pain/swelling. Obviously conservative course of action being taken as early surgery has the best outcome for the surgical option.

Conservative protocol includes crutches for first few days (mild ankle sprains) up to first two weeks (severe ankle sprains). Return to activity is achieved gradually due to the nature of the healing process: maturation of the collagen cells that restore integrity to the ligament takes weeks to months to complete. In this time, the lig is more susceptible to re-injury in its weakened state. And this is not to mention regaining other crucial factors as well, such as proprioception.

A lot is made of Freeney's history of fast healing and the 24 hr care he is receiving. Also Methodist Sports Medicine has advanced protocols that are much more aggressive than those used in the "typical" patient. However, you can only speed up a process (that takes several weeks to months) by so much without risking re-injury (or potentially, a career)–not to mention how ineffective one would be in the process of playing too early with such an injury.

That is why this does not make sense to me. Different types of injuries heal at different rates and I do not see how one  (or a whole medical staff with hyperbaric chambers etc…) could speed up this injury- as serious as it is being reported.

My guess is that an initial manual test of ligamentous integrity was performed on the sideline, indicating a grade III sprain (perhaps even influenced by residual laxity of lig from previous ankle sprain) and the Colts ran with it, knowing full well (or not wanting to know) that it was not accurate.

This fits with Freeney's appearance at the time of injury and his demeanor in the interview you posted but not with the Colts MO, historically speaking. The Colts are guarded about information but not misleading (or deceitful at worst).  Furthermore, the Saints organization has people even more watchful and experienced than me that must be watching and would see this as well. So what gives?

It is either being overstated, or Freeney is Wolverine.

All of this is to say that all the reports do not jive with what I've seen and experienced from my perspective as a physical therapist. I think there is something a little fishy about the whole thing.

There is information about schools online at Guide to Online Schools for people who are interested in careers in the medical field, and possibly interested in sports medicine or physical therapy, like Dr. Ben.  I'm optimistic based on what I know and saw…but then again, I've been wrong before. I'm still eating crow on McGwire.

 

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