How Kyrie Irving Duked Season Ending Turf Toe

Kyrie Irving

I’m always amazed to see athletes come back to play. I know just how hard everyone works to get athletes competing again. As March Madness is in full swing, I thought I would provide some insight into Duke’s point guard Kyrie Irving coming back – Turf Toe and all.  His big return to the hardwood this past Friday night, after not playing for 3 1/2 months because of a serious right big toe injury against Butler in early December, marks a huge boost for the Duke Blue Devils.

We all know how good the 6′ 2″ star is on the court and now we know how tough he is in the athletic training rehab room.  Overcoming a serious case of Turf Toe is tougher than anyone can imagine. Here’s how Kyrie’s injury probably progressed for the 15+ weeks that he didn’t play for the Duke Blue Devils:

Week 1: Test, tests and more tests.  The orthopedic exams by the Duke medical staff, which is one of the most respected groups of sports medicine experts in the country, would include x-rays, an MRI and a CAT Scan because of the involvement of the sesamoid bones under the first metatarsophalangeal joint, commonly referred to as the “ball of the big toe”.

The decision is to manage this injury non-operatively and a conservative plan is implemented.

The player is wisely fitted with a cast, provided crutches and given the “you better not put any weight on this foot if you ever want to run again” scare speech.  Rest is king because the torn ligaments that stabilize the under-surface of the big toe require a great deal of healing.  Any additional disruption of those ligaments may results in prolonged laxity of the complicated great toe mechanism.  The results of such a problem are not good.

Weeks 2 -4: Upper body conditioning, total body flexibility, non-weight bearing pool conditioning and all the necessary modalities to decrease localized swelling; these exercises dominate the rehab plan.    The objective:  Decrease swelling, minimize pain and avoid all activities that interfere with the all-important healing process of Kyrie’s Turf Toe.

Weeks 5 – 8: Shifting activities will make any athlete excited – it signals progress and cures boredom.  Initially, non-weight bearing components will be added like toe range of motion and bike riding. These will help lighten the mood for any competitive athlete who is now tired of watching his teammates having fun – and winning – without him.  Somewhere in middle of this phase of his rehab schedule is when they probably removed the cast and placed the player in a walking boots. As an aside, I wonder how Kyrie made it from class to class with his cast for that time period.

Weeks 9 – 12: During the many exams of Kyrie’s great toe, they discovered that he genetically had an additional sesamoid in his base of his right or injured big toe.  This unusual finding is referred to as bipartite sesamoid bone.  It’s unrelated to the injury and it is not present in his big toe on his left foot.  Because of this finding, they most likely prolonged his controlled walking/running activities more than  usual while closely monitoring any pain within the sesamoid structures located in the ball of the toe.

By the end of this phase, his precise orthotics have been adjusted 2-3 times and the plan for his playing shoes and Turf Toe tape job would have been clearly documented.

Weeks 13 – 15: This is the phase of the rehab program that probably kept a few of the Duke’s great athletic trainers awake at night thinking about the progression of Kyrie’s activities and the loads on his injured foot.  There is a delicate balance to pushing a player forward without creating a situation where the injury regresses. Players want to play and we, as sports medicine specialists, know that and want them to get back playing. Players will lie and “tough it out” just to get that ball back in their hands. I’m sure this future superstar was no different.

With an organized approach that would make NASA proud, Duke’s medical staff finely tuned Irving’s ability to run, change directions and jump.  These agility and basketball drills were gradually increased in both volume and intensity over a 4-6 week period of time, based on the player’s symptoms and subjective feedback.

The media hype is on.  The coaches, the administrators and everyone else is asking the same question:  “Is he ready to play?”  It’s not an exact science to bringing a player back “on time”, but everyone wants you to convince them that it is so they can sleep better.

The process of making this decision for an Athletic Trainer plays like a highlight reel in his mind: “Kyrie’s proved it over and over again in his rehab.  I’ve been there for every treatment and ever revolution on the bike and every one-on-none basketball drill on the lonely end of the court.  I’ve looked him in the eye and had the conversation with him at least a dozen times.”

I can see it now, Coach K asking if he can play. The typical response for the Athletic Trainer cuts through the air with sharp confidence: “Heck yeah, Coach.  He’s more than ready!”

As you can see in this video, Kyrie had a traditional Turf Toe tape job with a moleskin reinforcement anchored to solid ankle tape support.  He also had two steel shank inserts placed under his shoe’s custom orthotics to provide exceptional support to the forefoot and great toe.

The combination of the ankle tape job, the Turf Toe strapping, the custom orthotic, and the double steel shank is the perfect plan to allow for normal alignment of the injured toe while minimizing the extension of the entire forefoot.

Duke 73  Michigan 71.  Duke moves on to the Sweet 16.  Kyrie Irving expects to play a much bigger role now that he has two tournament games under his belt.

Personally, I love to see these type of medical success stories.  I’m thrilled for both Kyrie Irving and the Duke University Athletic Training Department.  Few know the amount of hard work and dedication it takes on everyone’s part to see that #1 Duke jersey walk out onto that basketball court after a very serious injury.

I’m happy for this young man and I’ll be cheering for him and his Duke Blue Devils as they try to earn a ticket to Houston.

Cheering for Duke…..coming from a UConn graduate, that’s saying something.

Sports Medicine Tips for Fun in the Mud Run

This weekend may prove to be the dirtiest, most fatiguing, most fun and most rewarding time that you’ve had since your were a kid at summer camp.  More importantly, this weekend’s event is for a great cause to help others who need our support.

This Saturday is the 3rd annual National Multiple Sclerosis Society’s Mud Run here in Jacksonville.

I’ve run in the past two Mud Runs here in Jacksonville, finishing in 2nd place in last year’s individual division.  I’m thrilled to be crawling in the mud again this weekend to raise both money and awareness for this chronically disabling disease.

A Mud Run is unlike any race that I’ve had the pleasure to compete in.  As an athletic trainer, physical therapist and an endurance athlete, I’ve learned a few tricks that I want to share with my fellow racers.

To help my readers to have a successful Mud Run and a healthy finish, I’ve put together my sports medicine tips to share with you.

Race Day “To Do’s”

Breath – The “butterflies” in your stomach will wake up before you will.  Breath and relax.  It’s time to get the calories and fluids in you as you double check your racing supplies.

Carbs are Your Friend – Push the carbs because they are the best source of fuel to get you through today’s race.  Toast, bagels, whole-grain cereals, non-citrus fruits and pasta are all smart options.  Today is not the day to try any new foods or drinks, even if that guy at the gym “swears that it’ll make you run like the wind”!

Drink Early & Often – It’s going to be hot so you will need fluids early & often.  A smart plan which I recommend to our professional football players is:

  • Consistently drinking 50% water / 50% sports drink before, during and after the race will keep you fast and safe.

Grease Up – Blisters can quickly make the race seem twice as long.  Your feet will be WET so plan on it.  A generous coating of Vaseline or petroleum jelly on toes, heels, ankles, inner thighs and anywhere you may experience chaffing will help improve your comfort level during the race.

Don’t Be a Sponge – You will be spending a lot of time in the mud and water on Saturday so avoid bring it home with you.  What you wear is the key.  Wearing thin socks, water-friendly boots, non-cotton pants, and DryFit-type shirts can literally save you from carrying an extra 4-5 lbs for the 6 mile race!

Lighter Attitude – While you lighten up the weight of your clothing do the same with your attitude.  Having fun, interacting with your fellow racers and expressing gratitude towards the race volunteers will make your Mud Run a wonderful experience.

Recovering From the Mud Run

Your recovery starts the minute you cross the finish line.  Here are a few tips to help you avoid complications and to feel like a champ quickly.

It’s Happy Hour – Sure, you just consumed more muddy water than you care to think about but getting clean fluids in you is very important.   Using the “50/50 Rule” noted earlier, will safely replenish your fluids, calories and the ever-important electrolytes.  Heat Illness is always a concern and the 50/50 Rule is your best defense for all strenuous activities.

Push the Carbs – Carbohydrates have gotten a bad wrap in the weight-loss world but after any hard race or cardio workout, they are your best friend.

Walk it Out – When you finish the race, the sudden urge to flop on the ground will be strong.  To allow your body time to properly cool down, 10 minutes of walking and rehydrate is the smart thing to do before you get off your feet in the shade to reflect upon your amazing accomplishment.

Dry & Clean – Getting your feet dry as soon as possible will help you avoid complications that can happen with wet and dirty feet.  Any cuts, blisters or abrasions should be cleaned thoroughly for obvious reasons.

Massage and Stretch – Get your legs, feet and hips massaged and/or stretched as soon as possible will help minimize the post-race soreness and discomfort associated with any difficult physical endeavor.

Ice and Compression Sure ICE hurts but it’s a needed tool if you’re training and racing hard.  If your legs hurt, ICE them for 15 minutes and follow up with a compression sleeve when you’re walking or running for the next few days.  This is a great way to control extremity edema and accelerate your recovery.

I hope these sports medicine tips from Mike Ryan Fitness help you to have a fun and safe Mud Run with a fast recovery.  Stay Healthy & Happy!

 

Fun Chatting With Jaguars’ Fans

Live Chat With Mike Ryan

My “Live Chat” today on the Jacksonville Jaguars’ official website was so much fun.  The number of questions and the interest that the fans had in injury management, for both the Jag players and themselves, was impressive.

I loved being able to see first hand the type of questions the Jag fans had on their mind.  As you can imagine, the questions ranged from specific injuries to general advice to avoid injuries and from the serious to the hilarious.

I was happy to see so many questions regarding health and safety for young athletes in our communities.  This a topic is dear to my heart and I have strong opinions about caring for athletes in our youth leagues.  Proper concussion management and the importance of having an emergency-trained Certified Athletic Trainer involved with our school systems dominated those replies.

There were some entertaining questions that we were not able to answer because…..we either ran out of time or if I did answer them like I wanted to, I may not have been asked back to the Live Chat!

Today’s Best Unanswered Questions:

Q – “How the hell do you tape 53 ankles every day before practice?”

A – I have two great assistants, Rod Scott & Justin Bland, and we can all tape an ankle is less than 40 seconds from years of practice.  NEWS FLASH: Each player actually has two (2) ankles and the head coach likes it when we tape both of them before every practice and game.

Q – “What is the coolest thing you’ve seen during your 23 years in the NFL?”

A – The cool factor is large in this business.  If I had to pick one, I’d have to go back to October of 2001.  During an uneventful practice on the south side of then-Alltel Stadium, the unmistakeable sound of three Apache helicopters suddenly froze everyone on the field.  These amazing war machines suddenly stopped and hovered over the St John’s River looking down on our team.  Still numb from the horrors of Sept 11th just 4 weeks earlier and understandably shaken by the new threat of domestic terrorism, the image and sound of those helicopters overhead was impressive, to say the least.

What happened next still evokes strong emotions in me, 9 1/2 years later.

The middle helicopter suddenly draped a long USA flag as the three war machines proudly watched as a field of grown men cheered and paid their respects to the very people that protect our freedom.  Many of us wiped away tears as the copters made their way back to NAS-Jax while we all stood a little taller and proud to be Americans.  The goosebumps on my arms as I type this blog proves that the military’s presentation of our USA flag that day was beyond “cool”.

Q – “I know that you’re an athletic trainer but do you actually enjoy the sight of blood?’

A – Do I look like Dracula?  The sight of blood does not bother me as long as the source of that squirting blood is not me.  On a serious note….With any injury I see from an athletic injury to a car accident, if there’s blood visible I know it’s my job to help that person.  As a sports medicine specialist, that becomes my only concern.  I’ll worry about the “gross factor” the next day.

It’s the end of another great day and Jaguars’ fans made today special.  Thank you for your great questions, your loyal support and your interest in sharing my mission:  To Enhance the Health of Others.

Tips for Fast & Healthy Running

The big race is this Saturday…the Gate River Run 15 km USA Championship Race.  This race goes well beyond a local “bragging rights” race by being one of the most organized sporting events in the country, thanks to Race Director Doug Alred and his 1st Place Sports staff.

I ran my first River Run in 1995 and I try to compete in the very challenging race every year.  What I’ve learned from this race is that the distance, the large number of turns and, of course, the bridges make it a race that can easily leave me sore.

In an effort to help my readers to experience a successful race and a healthy finish, I’ve put together my sports medicine tips for healthy running.

Pre-Race Checklist

Train Smart – It’s too late to make any significant gains this late in the week for a Saturday race.  My rule of thumb is the best thing to do to help myself during race week is to ensure that my legs are FRESH.  Be smart and allow yourself to relax and rest more than squeezing in the last few dangerous miles…..and your legs will thank you on the Hart Bridge.

Grease the Dogs – A 1/2 inch blister can ruin a great race.  A light coat of Vaseline or petroleum jelly on toes, arches, heels and anywhere you may experience chaffing will help you run comfortably during the day and give you a great reason to dance painfree that night.

Drink Early & Often – In cool or hot weather, you still need fluids.  A consistent habit of consuming a 50% water and 50% sports drink mix starting 24 hours before the race will keep you fast and safe.  Keeping the same plan both during and after the race is always smart.

Recovering From the River Run

Your recovery starts the minute you cross the finish line.  It doesn’t take much effort on your part but if you implement these tips to supercharge your recovery, you’ll be thankful that you did come Monday morning as you head back to work to brag about your record time in “the big race”!

Push the Fluids – I know that the post-race beer trailer sure looks more inviting than the Hart Bridge but it might not be the best option for you 90 seconds after hitting the finish line.  Drink extra water and sports drinks to replace the fluids, calories and the ever-important electrolytes before you toast a cold one with the crew.

Carb Time – Carbohydrates have gotten a bad wrap in the weight-loss world but after any hard race or cardio workout, they are your best friend. Healthy running needs good sources of calories and carbs is the key to that fuel.

Drain Your Legs – Elevate your legs straight up in the air and pump your ankles within 20 minutes after the race for 5 – 10 minutes.  Use gravity to your advantage to help your lymphatic system to drain “the bad stuff” from your hard-working legs.

Run Out the Pain – Trust me on this one….run the next day after every race and every hard workout.  It may only be an easy 1 mile trot on the soccer field or a 10 minutes of light side-shuffles and agility drills on the soft beach but its extremely helpful to force your legs be lightly loaded the day they are pushed aggressively.

Massage and Stretch – Get your legs, feet and hips massaged and stretched as soon as possible to keep the natural waste products from the race to become embedded in the membranes of your muscles.

Pain Relief – If you have no medical complications, taking a small dose of over-the-counter anti-inflammatory medicine a few hours after the race and before going to bed the night after the race will help put some skip in your step when the sun comes up in the morning.

Ice and Compression Sure ICE therapy hurts but it’s necessary if you’ve raced hard.  If your legs hurts, ice them for 15 minutes and follow up with a compression sleeve when walking or running for the next few days.  This is a great way to control extremity edema and accelerate your recovery.

I hope that you’re as excited about the race as I am.  I hope these sports medicine tips from Mike Ryan Fitness help you to have a fun River Run with a fast recovery.

Stay healthy & happy and I’ll see you on the road this Saturday!

 

Invest in Yourself: Focus on Your Carrot

Mike Ryan Biking in Colorado July 2010

March 1st is here and we can officially stop blaming our health and fitness on the holidays.  It’s time.

It’s time to take back our health and for each us to realize that WE are responsible for our own fitness.

If you’re like me, your financial statements and 401K numbers are depressing.  It’s time for all of us to change our investment strategy.  There has never been a better time than now to start INVESTING IN OURSELVES! Any wise investment guru will suggest that one should “protect your principle”.  Can you think of a more important “principle” than your own body?

When most of us look at the reasons why we are not healthier, a physical injury/ailment typically tops the list along with our lifestyle.  As for the medical issue, generally speaking, most orthopedic issues can usually be improved, minimized or often eliminated with the proper plan.  Often a plan to strengthen or elongate injured tissue in conjuction with enhancing cardiovascular condition will result in amazing improvements in someone’s health if their motivation is sufficient.  In other words, if the carrot or prize is enticing enough, most of us will address an injury with the proper plan to move towards that carrot.

What does my new carrot look like?

I just signed up for two races today.  They are a big 9.3 mile (15 km) road race on March 12th and on March 26th I will compete in a tough 6.2 mile (10 km) Mud Run on a military obstacle course.  For me, the thrill of testing myself in a challenging situation is my carrot.  I’m a firm believer that competition is a healthy motivator when put in the proper perspective and AGE is a very lame excuse for avoiding an opportunity to challenge yourself.

Go ahead, I dare you.  Find physical challenges that excite you and then use them as an opportunity to hang that motivating carrot out their to focus on.  As for those sports-related injuries that are getting in the way, forward me your comments and I can help you with free sports medicine advice while showing you how profitable it can be to invest in yourself!

An Inside Look at the NFL Combine

NFL Combine Workouts

With the NFL Combine medical exams and individual workouts starting tomorrow, there’s a lot of excitement in the air here in Indy.  The anticipation of seeing which elite athletes will put their athletic skills in the fast lane is thrilling for fans, the NFL teams and, obviously, the young football players themselves.

We’ve all seen the highlights of this year’s superstar college players during the fall season.  Now is their time to showcase their skills in an NFL setting under the watchful eyes of all 32 teams at the Combine.

What is “The Combine”?

Simply stated, the NFL Combine is a very organized and well-structured job interview.  It is an invitation-only event where approximately 420 of the country’s best college football players are invited to Indianapolis in an effort to launch a new career as a professional football player.

As Head Athletic Trainer/Physical Therapist for the Jacksonville Jaguars, my main responsibility at the Combine is to oversee our team’s medical department and to coordinate a comprehensive medical documentation of every player attending the six-day event.  How difficult can that be?

I’m very fortunate to have an outstanding staff of highly skilled doctors and certified athletic trainers on my team.  The process of compiling and interpreting extensive amounts of medical data at the Combine is very much a team efforts and, I’m proud to say, the Jags’ have a great medical team at this year’s annual event.

Besides the examinations themselves, we all work hard sorting through mountains of medical information from medical history reports, internal medical exams, orthopedic exams, MRI’s, lab reports, surgical reports, player’s feedback, rehabilitation documentation, x-rays, and any other medical information available to determine the present medical status of each player.

Following the medical exams, the players are busy with the many phases of the Combine process.  These include personal interviews, bench press testing, cognitive testing and the well publicized on-the-field workouts.  The field drills are position-specific and closely watched by all the league scouts, coaches and interested personnel.

In summary, this week’s NFL Combine is a wonderful opportunity for both the players and the teams to take huge strides towards a successful fall season.  I tip my hat to National Football Scouting and the NFL for the massive efforts put forth to make the event happen so efficiently.  The amount of time and organizational skills needed to coordinate this event is more than impressive.  Personally, I understand how vitally important this event is to the Jaguars’ future and I’m proud to represent my team and the league as we all look forward to the upcoming season.

Shoulder Impingement Syndrome

I just posted an article on Shoulder Impingement Syndrome or Tennis Shoulder in my Shoulder Injuries section of MikeRyanFitness.com. A friend of Nate’s came to see me and his shoulder pain is very common and I think many of my readers can learn from a simple approach to eliminate his pain and get him back to an active lifestyle.

Check it out and let me know what you think.  Thanks for being a part of MikeRyanFitness!

Recovery: Avoiding Running Injuries

RUNNING WITH A SMILE

Today is an exciting day in Jacksonville, FL.  Today is the 4th annual 26.2 With Donna Breast Cancer Marathon with thousands of runners of all ages competing in this amazing event.  From the 1 Mile Fun Run, to the 5 km race to the 1/2 marathon to the “big race”, the marathon, all the runners have two things in common:

1.  They are raising money and awareness for a very worthwhile cause: Breast Cancer

2.  They will be sore tomorrow.

Why am I sore?

You worked allot harder than you think during both your training for the race and the race itself.  The average person takes over 41,000 steps in a marathon so you’re justified in having lots of aches and pains!  There are many reasons why you’re sore but here are just a few to make you feel better for feeling so bad:

  • Increased joint compression with ever step – toes, feet, ankles, knees, hips, low back,..etc.
  • Lactic Acid development  – a waste product that your body produces during intense muscle activity.
  • Soft tissue damage – tendons, muscles, ligaments and fascia are all stressed and they all suffer from micro-trauma damage as a results.
  • Bodily inflammation – from the pounding of your feet on the hard road all the way up to the tension in your shoulder muscles swinging your arms, inflammation is “in the house” and your body wants to rid itself of this toxin.

How Can I Minimize the Post-Race Soreness?

I ran my first official running race in the spring of 1979.  I’ve learned a few tricks over the years to minimize the post-race soreness to avoid additional running injuries, minimize the physical limitations in my life after the races and to allow me to return to running ASAP.  In 1996, I ran the NYC Empire State Building Run-up, the New Zealand Ironman Triathlon and the Boston Marathon within 6 1/2 weeks utilizing these exact recovery tips.

Tips to Accelerate your Running Recovery

Drink – Drink extra water and sports drinks to replace the fluids, calories and ever-important electrolytes that were used before, during and after the race.  The farther you are after the race, the more you need to emphasize the water compared to the sports drink.

Drain your Legs – Elevate your legs straight up in the air and pump your ankles immediately after the race and then 3x/day.  Use gravity to your advantage for once to help your lymphatic system drain “the bad stuff” from your poor legs.

Just Run – What?  Trust me on this one….run the next day after every race and every hard workout.  It may only be an easy 1 mile trot on the soccer field or a 10 minutes of light side-shuffles and  agility drills on the soft beach but its extremely helpful to force your legs be lightly loaded the day they are pushed aggressively.  I’ve actually proven this to myself and many athletes by having professional football players and triathletes run with only one leg on the treadmill the day after a competition to show that they will feel at least 50% better two days later when compared to their “rested” leg.

Massage and Stretch – Get your legs, feet and hips massaged and stretched as soon as possible to avoid allowing waste products from the race to become embedded in the membranes of your muscles.

Pain Relief – I don’t push the meds very often but if you have no medical complications, taking a small dose of over-the-counter anti-inflammatory medicine before going to bed at night will help put some skip in your step when the sun comes up in the morning.

Ice and Compression Are Your Best FriendsSure ICE hurts but it’s a needed tool if you’re training and racing hard.  If your legs hurts, ice them from the outside-in for 15 minutes with a compression sleeve and then let the sore tissue warm itself up from the inside-out.

Congrats to all the runners and organizers of this wonderful event.  I hope these tips help you to recover fast and allow you to get back to doing what you love to do:  Staying Healthy & Happy!

MDR

Athletic Trainers Shine in Super Bowl

I just finished watching a great Super Bowl, as I’m sure most of you did as well.  Maybe it’s just me being a “medical guy” but did you notice how many players where hurt during the game?

Pitt’s Bryant McFadden out with a hip injury while Big Ben is limping with a leg injury.  On the other side of the field Green Bay’s DB’s Charles Woodson & Sam Shields are both suffering from shoulder injuries and…..they’re still in the first half!

Injuries are part of all sporting events but when it’s the Grand Daddy of all football games, the pressure is on to stay healthy.  For every play that is missed by a key player, it can literally make the difference between winning and losing the game.  Believe me when I say, that fact is reinforced by everyone on that sidelines in the minds of the medical staffs taking care of those players.

Green Bay Packer’s Head Athletic Trainer Pepper Burruss and Pitt’s Head Athletic Trainer John Norwig are two of the best certified athletic trainers in the country.  Both teams on that field tonight were very lucky to have great medical staffs caring for their needs.

I tip my hat to both Pepper and John for having that many injuries to key players and doing an amazing job getting so many of them back so effectively.  I’ve worked many big playoff games, three divisional championship games and one Super Bowl so I can appreciate the pressure the medical staffs worked under tonight.

Athletic trainers and doctors will probably never get an MVP award but if you ask the players in most locker rooms they will tell you how valuable a caring medical staff is to their careers.

Jaguars Trainer to Tackle Corporate Wellness [JaxDailyRecord]

Mike Ryan - Corporate Wellness

I was really excited to be featured in the Jacksonville Daily Record this week. The article was run as part of the lead up to my presentation on Corporate Wellness for the Jacksonville Chamber of Commerce. It’s nice to be recognized and I appreciate Karen Brune Mathis, the Managing Editor at the Daily Record, for taking some time to write about what we’re doing here at Mike Ryan Fitness.

Read the JaxDailyRecord article