Why Steph Curry Will Probably Be Back Sooner Rather Than Later

Photo Credit: KNBR

Photo Credit: KNBR

All of DubNation held their collective breath Monday for what probably seemed like an eternity. Awaiting the MRI results on Steph Curry’s knee injury, Warriors fans breathed a sigh of relief with the good news that there was no structural damage and it was just a Grade I MCL Sprain.

But now people want to know- How long will the rehab take? When will Steph be able to get back into the Warriors lineup to lead this team on their march to another NBA Championship?

GM Bob Myers told the media that there are no guarantees (and there aren’t when it comes to rehab because everyone’s different), but expects the timeline to be around 2 weeks. That’s based on typical expectations for a Grade I MCL sprain with a 2-3 week return to activity. It could be longer he said, but I actually think that it will be less than 2 weeks barring any unforeseen circumstances. Let me explain why.

Steph Curry Knee Injury

The Injury

With the replays and pictures of how awkwardly the reigning MVP fell Sunday afternoon at the Toyota Center, I’m sure many were shocked and surprised his injury was not more serious. I saw many a tweet from pundits and professionals alike predicting a more serious MCL sprain or even an ACL tear.

Upon further review of the footage, I noticed two things that helped minimize the stress to Curry’s knee when he fell:

1) His Right Foot Was Not Planted- It actually slipped, just like his left foot did, from the sweat that was on the floor.

2) He Has Good Hip Mobility– His right hip internally rotates when he slips, banging the inside of his right knee into the floor, right where the MCL is.

At first glance, it looks much worse. But because Steph’s hips are mobile, and his right foot is not stuck to the floor, he’s able to preserve the alignment between the right hip/knee/ankle, thus saving his knee.  If either one of those factors were not there, than we may be talking about something else.

LLIstress.jif
The Diagnosis

An MCL (Medial Collateral Ligament) sprain is an injury to the ligament on the inside of the knee that connects the tibia to the femur. With these types of injuries, forces usually come from the outside causing what we call a valgus stress to the knee. This valgus stress causes gapping (or stretching) to the inside of the knee resulting in a sprain. With a sprain, there can be partial tearing (Gr. I) all the way up to a complete rupture (Gr. III) of the MCL. These injuries may result in swelling, pain, and tenderness along the inside of the knee where the ligament runs. Higher grade sprains are also associated with instability in the knee when tested manually by a clinician. Gr. I sprains do not show evidence of instability.

But wait? How can Steph have a Gr. I MCL Sprain (partial tear) if there was no structural damage on the MRI? Does he have a tear or doesn’t he?

As I mentioned earlier, it looks like Curry was saved from more serious injury by the way he fell. I actually did not see any valgus stress to the knee when you look at the slow motion replays. What may look like valgus, I believe, is just the way his knee was flexed as he was getting ready to plant that leg.

Without any visible valgus deviation or movement to his knee, Steph should only have sustained minimal, if any, stress to his MCL. He did, however, bang the inside of his knee quite hard into the floor. (You can see this if you watch the replay in real time). Swelling from that would be in the same area as his MCL.

So in the absence of any positive structural findings on the MRI, the diagnosis of a Gr. I MCL Sprain is basically made because he has swelling and tenderness on the inside of the knee in the area of the MCL. It could just as easily be a bad bruise though. There’s no way to really distinguish between the two, all you would see is swelling and pain on the inside of the knee.

Steph Curry Stretching

The Treatment

In the absence of any structural findings, meaning there is no instability in the knee, it’s just managing pain and swelling from here and getting Curry moving when he’s comfortable. Inflammation typically lasts from 48-72 hours after the initial injury, so they won’t know where exactly Curry will be until probably Tues/Wed. As he feels better and moves more, he should continue to improve.

With a top-notch medical staff that has already garnered recognition from Klay Thompson earlier this year for helping him through a back injury, and cutting-edge equipment at their disposal like the AlterG Anti-Gravity Treadmill, I have no doubt they will get Steph back in action as soon as it’s safe to do so. I wouldn’t be surprised if Steph Curry starts feeling good towards the end of the week. That gives him a few more days to get his legs back under him before he’s released to return to full participation. So my estimate is he’ll probably feel ready to go at around 1.5 weeks (especially knowing that Steph wants to get back on the court with his guys). But as we’ve seen with these playoffs, it will be up to the medical staff and Kerr when he actually gets back on the court.

I’ve been really impressed with how the trainers and therapists have been able to keep guys like Bogut, Iguodala, and Livingston not just healthy, but playing at a very high level. #StrengthInNumbers to me applies to the whole organization. From the fans to the players, coaching staff to the medical team.  That’s why I’m hopeful that Steph will be back sooner rather than later. And that’s why I’m anticipating they’ll make a nice long run this post-season towards another NBA Title.

 

If Your Ankles Are Weak, Then Strengthen Your….Hips?

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A few years ago Steph Curry was having problems with his ankles. Now the All-Star NBA MVP is having an amazing season having missed only 1 game. The secret? A training and injury prevention program that focuses on his….hips. That’s right, his hips.

A great ESPN article came out today to highlight the success Steph has had with this training program. Even though the problem lies all the way down the chain at his ankles, the hip plays a major role in controlling position of the lower body joints. If there is weakness up higher in the chain, the lower joints end up taking more stress. By working on stability at the core, Steph and his trainers have given him a much more stable foundation to move, change direction, accelerate, decelerate, and juke other players out of their shoes.

This is another reason why a good physical therapist, athletic trainer, or doctor doesn’t just focus on the injured area. Remember, the injury is where the athlete broke down, but the cause could be elsewhere. We see that all the time at our clinic. Someone that has plantar fasciitis, ankle sprains, knee tendinitis could have the root of their problem at the hips. So just massaging the injured area, applying ultrasound or ice, and exercising the painful body part will only produce temporary results.

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For truly successful outcomes, you need to treat the whole person. Look at Steph. He was good before and treating his ankles allowed him to play and be an All-Star. Treat the whole person, and he’s the NBA MVP and on the verge of an NBA Championship.

Another MMA Fighter Working With ESPT

Elite Sports Physical Therapy is pleased to announce that we are working with MMA fighter Dominique Robinson, “The Real Fallen Angel.”

Dominique is a young up and coming MMA fighter who’s origins lie in the deep south of Louisiana. He began his training at American Kickboxing Academy under the tutelage of Bob Cook. He left when Frank Shamrock had a falling out with the gym. After splitting with Frank, he began to offer himself up as a training partner for the Cesar Gracie Fight Team.

Currently Domique works with Felipe Martinez on his boxing and calls this 2-Man Band the “Goon Squad.”He is willing to go where he can to seek knowledge and take is MMA fighting the the next level. At the current time, he is the only fighter to have studied under both the Shamrock and Gracie families. Dominique has a career record of 6-4 with 4 TKO’s and 2 Decisions.

We are proud that we can help Dominique continue to pursue his fighting dreams. You too can have access to the elite care that the The Real Fallen Angel receives. For information how, you can check out our website at www.espt-ca.com.

Go Sho!!

Elite Sports Physical Therapy (ESPT) is proud to be able to help people continue their pursuits. Whether you are trying to get back to work without pain, or compete at the very highest level athletically, Elite Sports PT is the place to go to help you get there.

In this blog, we want to give a shout out to Sho Nakamori who will be competing at the Pan Am Games in Guadalajara, Mexico this week. You can find the schedule here. We wish him and the rest of the US Men’s Gymnastics Team the best. If you want to follow Sho on his journey, not just at the Pan Am Games, but to his ultimate goal, London 2012, you can go to his website at shonakamori.com.

ESPT is not just reserved for elite athletes though. Anyone can come receive the high quality physical therapy care that our clinicians provide. Spending time with patients is how we separate ourselves from our competition. Combining that with the best and newest equipment and first-class customer service, ESPT provides the best physical therapy in the Tri-City and Tri-Valley with offices in Fremont and Dublin.

To schedule an appointment, visit our website at www.espt-ca.com for details.

Change In Physical Therapy On The Horizon?

In it’s June 2010 report to Congress, the Medicare Payment Advisory Commission (MedPAC) is recommending a policy option to exclude physical therapy from the in-office ancillary services (IOAS) exception. This would be a start in prohibiting physician self-referral for physical therapy services. A step that the American Physical Therapy Association (APTA) supports and will help eliminate abusive financial patterns by these physicians and help maintain the quality of physical therapy care for patients.

In chapter 8 of their report, MedPAC highlights the rapid growth of physical therapy services provided in physicians’ offices and shows that some of the services ordered by those physicians are not clinically appropriate. Specifically the report states that these ancillary services “experienced rapid volume growth under the physician fee schedule from 2003 to 2008… the volume of outpatient therapy services rose by an average of 11.4% per beneficiary per year.”

Until there is legislation enacted to effectively end physician-owned physical therapy practices, our best advice to you as a patient is: Do your due diligence. You have the right to choose which physical therapist you go to, regardless of who your physician refers you to. And if they refer you to a facility they have a financial interest in, they are obligated to disclose that to you.

At Elite Sports Physical Therapy, we are committed to not only providing you with the highest level of care in the Fremont area, but we hope to educate you regarding your rights and privileges as a patient. We want you to feel empowered by having control over the quality of care you receive.

Feel free to compare us at www.espt-ca.com to any other facility in Fremont. We are confident that you won’t find better clinical care, customer service, and cutting edge equipment anywhere else. We would be glad to answer any of your questions as well at 510.656.3777.

For more information about physician owned practices, check out our previous blog here.

All Physical Therapy Is Not Created Equal

Just as there are many different types of hotels and restaurants, there are different types of physical therapy clinics. There are 5 star hotels like the Four Seasons and there are budget hotels like Holiday Inn. There are fine dining restaurants like French Laundry and there are casual dining experience like Applebee’s. But the bottom line is you will always have to pay for the best quality and the best service.

Fortunately, for physical therapy and medicine, there’s a little thing called insurance that helps people out. Insurance is the buffer so that people can have access, even to the very best medical services, without breaking their bank. And in Fremont, the very best physical therapy is found at Elite Sports Physical Therapy.

Remember, selecting a physical therapy facility is not like picking up a prescription from a pharmacy. You don’t just want to select the one closest to home out of convenience. That’s because one physical therapy clinic can be absolutely different from the next. And that difference could mean a good or bad outcome for your recovery. That difference could mean you just getting back to a level where you can function or you exceeding your expectations and being able to do things you never though possible.

At Elite Sports Physical Therapy, we do not just want to be any other clinic. Our vision is to be the best and set the standard for sports and orthopedic rehabilitation. Our focus is excellence in clinical care. Our mission is to make sure that the public sees what true evidence-based physical therapy is all about. Check out our latest press releases on Newswire and on PR.com to see what sets us apart.

So remember……when choosing your physical therapy clinic: All physical therapy clinics are not created equal. And you now have the opportunity to access the best at ESPT

What’s With The Tape?

Most people watching the olympics in Beijing were probably attracted to the colorful tape seen on numerous athletes throughout the event. It was present on track athletes, water polo players, basketball players, and for us in the US, especially on Beach Volleyball athlete Kerri Walsh.

I’m sure people were probably asking themselves some of the following questions: “What is the function of that stuff?” or “Does it really have any medical benefits?” or “Can I get some of that?” Well I’m here to inform you on what the “stuff” is and to tell you where you can get it.

What Is It?

The tape seen on all these athletes is called Kinesiotape and it was developed by Dr. Kenzo Kase over 25 years ago in Japan. The Kinesiotaping method uses patented tape to help treat musculoskeletal disorders and assist with lymphedema reduction.

Since it’s introduction into the United States medical arena, Kinesiotape has been used by all practitioners including: physicians, athletic trainers, physical therapists, occupational therapists, chiropractors, and muscle therapists. The tape can be worn for several days with comfort and ease, thus allowing the individual using it to receive the therapeutic benefits 24 hours per day. It is currently used in hospitals, clinics, high schools, and professional sports teams.

How Does It Work?

The tape can applied two ways: UNSTRETCHED or STRETCHED. Both provide different desirable effects for the body, resulting in decreased pain and thus, increased performance.

UNSTRETCHED: With this application method, the SKIN over the affected area is stretched before the kinesiotape is applied. After application, the taped skin will form convolutions when the skin and muscles contract back to their normal position. The convolutions lifts the skin, and the flow of blood and lymphatic fluid beneath the skin improve.

STRETCHED: If joints or ligaments are injured, the TAPE should be stretched before application on the skin. This will allow the tape to hold some tension and to take the place of the damaged joints or ligaments.

ORIGIN-TO-INSERTION: Starting from where the muscle begins (origin), tape is laid along it and ends where the muscle ends (insertion). This is typically used for support by pulling and stimulating the skin/muscle back towards the point of origin, thus assisting with muscle contraction.

INSERTION-TO-ORIGIN: This is used for preventing cramping or overcontraction (overuse) of muscles. The tape is laid from the end of the muscle back towards the starting point. This is good also for strain/sprains and tendon injuries where it is desirable to decr. tension/stress on tendons, muscles, or ligaments.

What’s So Special About The Tape?

To ensure that the muscles can still move freely, Kinesiotaping is most effective with elastic tapes that have an elasticity of 130-140% of its original length. This will allow the muscle and joint to maintain its free range of motion, which will then allow the body’s muscular system to heal itself bio-mechanically.

The elasticity of the tape also creates the convolutions on the skin, which help facilitate lymphatic drainage and improve circulation. This results in pressure and irritation being moved off of neural and sensory receptors, thereby alleviating pain.

How Can I Get It?

You can check out Kinesio Taping at their website at: http://www.kinesiotaping.com/. Or be on the lookout at ESPT, as we will be providing this service in the very near future.

Tiger Woods’ Knee

On my way to work I usually listen to sports radio and catch the top 6 sports news stories from the day before, just as I walk into the office. Today, the #1 story was Tiger Woods’ season ending knee surgery. As I had a little bit more time to think about and learn what he had been diagnosed with, it brought into perspective just how amazing his win this past weekend was.

So lets summarize some the medical findings that came to light:
1) Tiger Woods will have ACL reconstruction on his left knee and will be out the rest of the season. This is for an ACL tear he say he sustained jogging in July 2007.
2) He had been diagnosed with stress fractures in his left tibia 2 weeks prior to the US Open and his doctors recommended he not compete.

Based on these findings, here are some ponderings I had today on how amazing an athlete Tiger Woods is:

Realization #1: Tiger Woods has been playing with a torn ACL. Specifically a torn ACL in his left knee. And he hasn’t just been playing, he has been winning!!! He won the PGA Championship last year, the BMW championship and a few other tournaments to end 2007, he came in 2nd at the Master’s this year, then won the US Open this past week. ALL ON ONE KNEE!!!!! For those of you who do not know much about the ACL, that is a major stabilizing ligament in the knee. Without it, the knee usually feels unstable and the shear forces and torque produced in the knee are higher than normal. These forces could possibly lead to incr. stress on the cartilage and meniscus. And for a right handed golfer with a swing like Tiger’s, the forces on his left knee are probably ridiculous.

Realization #2: I have read articles where people have been questioning Tiger’s timing in electing an April surgery, but like anybody else, Tiger Woods probably wanted to try all his options before going to the last resort- ACL reconstruction. This explains his decision to have arthroscopic surgery in April. I would assume this was a debridement type surgery where his surgeon would just clean out some of the damaged cartilage, so he would not get as much pain and stiffness. If the strength would return and his knee would feel stable, he could then opt for the ACL reconstruction at a later date. Usual timeline for rehab in this type of surgery is 4-6 weeks. Obviously this was not enough.

Realization #3: Perhaps trying to push his progress after the surgery, the stress to Tiger’s knee after eventually lead to fractures in his tibia. Painful, but with time these will heal. It is amazing though that he walked 7,607 yards x 5 over the weekend with these fractures. All I can say is this guy is a gamer!!!

Realization #4: I am sure that the doctors went over all this with Tiger, and he said himself that he probably should have heeded their advice. Which probably would have meant having that knee surgery last year in July, after a problem with the ACL was discovered. But for an athlete that had yet to win a Major in 2007 and that was probably trying to win the FedEx Cup, staying in the game was the only option. Once again, the competitive nature of these elite athletes is something that is difficult for most of us in the general public to understand.

Having worked with athletes for the majority of my professional career, I understand how special some of these situations/competitions are for them and how special they are. And many times, my job is to help them just be ready and get by. Of course I have opinions about what is medically sound and what is not, but many of the decisions I leave up to the athlete. Because I’ll never be their shoes. I’ll never know what it’s like to compete at the Olympic games or an NCAA championship. I’ll never walk 18 holes in a US Open playoff at Torrey Pines with a chance to cement my place in history as one of the greatest, if not the greatest, golfer of all time. So, all can really do is watch, be amazed, and be ready when these athletes come calling.

Tendinosus vs. Tendinitis

I had a patient come to me the other day that had been dealing with achilles “tendonitis” for the last 2 years. 2 years he had this achilles pain!!! He had been to 2 other PT clinics with some minimal improvement, but had never been able to return to his recreational activities (hiking, tennis, etc.), without his achilles flaring up. He finally went back to his podiatrist, who subsequently referred him to our facility. He said that most treatment focused on modalities with some degree of LE loading, but usually involving the whole leg without any isolated ankle activities.

Unfortunately I had to be the bearer of bad news and tell him that the modalities and ROM may have made him feel better, but they would never address what was really going on in his achilles. For after hearing his subjective Hx, and after completing my objective examination, I told him that what he had been dealing with was not “tendonitis,” but tendinosus.

It’s disappointing to me to see that even today medical professionals are still having difficulty distinguishing between achilles tendonitis and tendinosus. In the early 1990’s, it was discovered by sports medicine professionals that most people that have achilles pain have achilles tendinosus. Accoding to Wilson et. al, American Family Physician, there are such things as acute tendinopathies, but most patients that have chronic symptoms suggest they have a degenerative condition that would be better characterized as a tendinosus or tendinopathy.

In radiologic tests (such as an MRI), the difference between a tendinosus is: a) the absence of any inflammation and b) a change in the appearance of the collagen of the tendon. Histologic studies done on painful achilles tendons have demonstrated a more disordered collagen arrangement together with increased proteoglycan ground substance and neovascularization. In layman’s terms, the muscle tissue is scarred and thickened, and that must be corrected to allow for the muscle to heal properly and function correctly. Otherwise loading will result in more “tearing” or further damage to the scarred collagen, leading to increased pain.

Treatment options for this patient should have started with cross-friction massage, which he did not receive at all from either of the previous PT clinics. This would have allowed for the scarred collagen to be broken down. To assist with the proper collagen repair, exercises focusing on stimulating the achilles tendon should have followed, progressing from low load isometrics to eccentric muscle activity. Something he also did not receive at the previous facility. It is important that clinicians realize the difference between the two different tendon diagnoses. For the diagnosis will help to determine the appropriate treatment plan. And the appropriate treatment plan, can help to prevent a prolonged course of rehabilitation and allow for optimal outcomes and a quicker return to full function.

For more information on achilles tendon injuries or tendinosus check out these sites:
www.achillestendon.com

www.tendinosis.org

What is a Sports Clinical Specialist?

Almost every physical therapy owner in private practice will say they provide sports physical therapy. But the truth is that most of these owners haven’t really seen “true” sports PT. They’ve probably gone from outpatient clinic to outpatient clinic since graduation, seeing a few weekend warriors or high school athletes along the way, and say they are thus qualified to provide sports physical therapy or sports rehabilitation. I think this is why some physical therapists and athletic trainers clash. They each feel that the other is not qualified to perform some of the duties unique to each profession.

Just as there are many areas of medicine that one can specialize in (neurology, cardiology, nephrology, orthopedics, dermatology, etc.), the American Physical Therapy Association has established 7 specialty areas that physical therapists can be board certified in. Only 10% of the physical therapists in the U.S. are Board Certified in a specialty, which requires demonstrated experience in the specialty field and a passing score on an extensive written exam. This allows the Board Certified Specialist to display that they have a greater breadth of knowledge and skills in a particular area of practice than their peers. This includes sports rehabilitation.

So next time you are looking for someone with true knowledge in sports physical therapy, you want someone Board Certified as a Sports Clinical Specialist. These specialists must be certified athletic trainers or EMT’s, and must have completed at least 2,000 hours working directly with athletes. They know the biomechanics of sport, exercise physiology, and sports medicine. And they know how to get you back in the game!!!

For an article about treating athletes with quotes from our director, please see: http://news.todayinpt.com/apps/pbcs.dll/article?AID=/20080526/TODAYINPT0105/80523019
For more about what sets Elite Sports Physical Therapy apart from our competitors, please visit our website at: www.espt-ca.com.