The Fitness Principle

Optimum Performance: The Triple Whammy of Knee Injuries

While on the road in New York working with our team to prepare No. 1-ranked female tennis player Serena Williams for the U.S. Open, which starts Monday, I read with interest and concern for the severe knee injury sustained by Miami Dolphins tight end Dustin Keller last Saturday night in a preseason game against the Houston Texans. Football, as we all accept, is a train wreck, where human beings crash into each other then make contact with the ground. Some get up on their own, while others may need assistance. Some even get carted off the field.

Keller, who was tackled by Texans safety D.J. Swearinger, sustained combined tears in his anterior cruciate, posterior cruciate and medial collateral ligaments in his right knee and dislocated the kneecap.

 

 As the postgame reports stated, “the hope is Keller can be ready for the 2014 season, but he faces a long rehabilitation.” According to the U.S. National Library of Medicine regarding non-surgical and surgical treatment of the multiple ligament tears with a dislocation, “acute surgery in patients with combined ligament injuries of the knee can lead to stiffness, primarily with medial-side (inner) injuries. Knee dislocations with lateral-side injuries require acute repair to achieve a good long-term result.”

Examining the anatomical function of each of the these three important components of the knee which Keller injured, we find that the anterior cruciate ligament (ACL) functions as “one of four ligaments critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility.”

The posterior cruciate ligament (PCL), according to the American Academy of Orthopaedic Surgeons, “is located in the back of the knee. It is one of several ligaments that connect the femur (thighbone) to the tibia (shinbone). The PCL keeps the tibia from moving backwards too far.”

An injury to the PCL requires a powerful force. A common cause of this type of injury is a bent knee hitting a dashboard in a car accident or a football player falling on a knee that is bent.

Having worked with the NHL’s St. Louis Blues from 1989-99, the PCL injury is not uncommon in skaters. It tends to occur on a breakaway, when the attacking forward slams into the goal post, while attempting to score in close quarters.

The medial collateral ligament (MCL) injury, on the other hand, is an injury to the ligament on the inner part of the knee. This ligament keeps your shinbone (tibia) in place.

“On the scale of ligamentous injuries to the knee of multi-ligamentous injury tears that Keller sustained,” explained orthopedic surgeon and Zephyr team physician William Sherman, “it is the most severe and often associated with long-term instability.” Surgery for this injury, commented Sherman, “is extensive and requires a protracted rehabilitation course of up to a year.”

Not to be outdone, San Francisco 49ers running back Marcus Lattimore suffered a similar string of injuries last October while at the University of South Carolina.

The surgery time to repair this complex injury, according to orthopedic surgeon Field Ogden, “is one and a half to two hours, usually performed arthroscopically (scope), along with an open procedure to insert and secure the various grafts.” Said Ogden, “ Keller would be on crutches for around six to eight weeks, followed by bracing for another six to eight weeks. Then, bracing as needed, determined by his surgeon.”

There is a potential long-term downside to this type of injury. Sherman said: “With any multi-ligamentous injury, there is always a certain degree of instability and change in mechanics that may lead to the premature development of arthritis.”

Maybe Keller needs to look at the research relative to the use of the supplement combination of glucosamine and chrondroitin sulfate relative to addressing this potential problem. Of course, only after he first consults with his surgeon.

If you realize that the knee is one of the most injured areas on an NFL player’s body, it is hard for me to comprehend that it has taken the league this long to mandate players wear protective thigh and knee pads this season. While not a great solution to the sustained impacts to the knee, at least NFL players now have some type of protection.

As a former college wide receiver at Tulane in the mid 1970s, such padding for the thighs, hips and knees were standard issue to all players. But, things have changed with speed being the operative word in the NFL today.

Having had a change to fly the second seat in an F-15 fighter jet, compliments of the 159 Fighter Wing based at the Belle Chase Naval Air Station, I learned that prior to aerial battles, this incredible aircraft drops its reserve fuel tanks to reduce vulnerability during turning. Much like the F-15, many of the skill players (wide receivers, running backs and defensive backs) in the NFL felt that thigh and knee pads slowed them down.

Now, with the new NFL padding rule, players will be policed during the warm-up and in games to make sure the pads stay in place. So, at least the playing field has been leveled for everyone. Let’s hope and pray Keller makes a safe and speedy recovery from what many medical experts consider a career-threatening injury. The take-away is that football can be a brutal game with a very high potential for multiple injuries to it participants.

Fans should understand that players are expendable in the sense that when one player goes down, there will always be someone to take his place. As we all know just like in life, the game must go on, at least for the sake of the TV ratings.

 

Mackie Shilstone, a regular contributor to NOLA.com | The Times-Picayune, has been involved in the wellness sports performance industry for nearly 40 years. He is currently the fitness coach for Serena Williams and has trained numerous other professional athletes and consulted a litany of professional sports franchises. He's the Executive Director of the Fitness Principle with Mackie Shilstone at East Jefferson General Hospital. Contact him at mackieshilstone.com.

 

Mackie Spotlight

EJGH’s very own Mackie Shilstone, Executive Director of the Fitness Principle, is in New York working with Serena Williams as she goes for another U.S. Open title. As Williams’s Fitness Coach, Mackie will be part of the team preparing her for matches throughout the tournament. To give everyone a behind-the-scenes look at how Williams prepares for every opponent, Mackie is writing a daily postcard for Nola.com detailing all the day’s happenings. Check back daily for updates. 

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