NFL injury chat

On Tuesday, Oct. 5th, Dr. Warren King, team physician for the Oakland Raiders and a member of the Association of Professional Team Physicians (PTP), fielded an array of user questions on everything from back spasms to concussions to creatine as the NFL season entered its second quarter.

Dr. King, who has been working with the Raiders since 1996, is an orthopedic surgeon at the Palo Alto Medical Foundation in Palo Alto, Calif. He received his medical degree from the University of Southern California and completed a sports-medicine fellowship at the Kerlan-Jobe Orthopaedic Clinic in Inglewood, Calif. In addition to his work with the Raiders, he also serves as team physician for the San Francisco Giants, the San Jose Sharks and the U.S. national rugby team.

Here's an edited transcript of the chat:

Skip: How often does it occur with football players that an ACL tear is also accompanied by tears to other knee ligaments and cartilage damage, as was the case with Terrell Davis?

Dr. King: It's very common to have additional injuries to the knee, including other ligaments and cartilage, when the ACL is torn. Approximately 50 percent of all patients who tear their ACL will tear a meniscal cartilage pad and approximately 20 to 30 percent will suffer additional ligamentous damage.

Zome: What is a torn ACL and how long does it take to repair 100%?

Dr. King: A torn ACL is the tear of the anterior cruciate ligament. This ligament sits in the center of the knee and is a major stabilizer of the knee along with three other major ligaments. Recovery after reconstruction is between three months and eight months.

karl: Have there been more injuries at the start of this season than in past seasons or is it getting more attention because of the big names going down?

Dr. King: It's my belief that the occurrence of injuries is similar this year to years past. I believe that with the advent of 24-hour sports networks, there is more attention and more knowledge about these injuries by the public.

John: Dr. King, what is the difference between a regular ankle sprain and a high ankle sprain? Is their a difference in treatment and recovery time?

Dr. King: "High ankle sprains" generally refer to an injury to the ligament between the two bones of the lower leg, called the syndesmosis. These injuries generally take longer than the usual ankle sprain to recover.

steve: Dr. King---I've noticed the increase in the number of athletes who have been incapacitated because of back spasms. Why the increase? What can be done as far as prevention and treatment? I've suffered through a number of these myself and can vouch to the incredible pain involved.

Dr. King: As football players and other athletes get bigger and stronger, more and more stress is placed on the back and can result in painful injuries, including spasms. The best way to prevent these injuries is to condition specifically the muscles of the lower back and abdomen and also to treat these injuries as soon as they occur with aggressive rehabilitation.

jimmy: dr. king how long is the recovery time for a completely tear of the achiles tendon

Dr. King: Achilles tendon ruptures generally will completely recover in approximately one to one and a half years following repair, but athletes can be allowed to return to their sports prior to complete recovery after six months.

Jeremy: What is an MCL? How does that differ from a ACL. which one is worse?

Dr. King: MCL stands for medial collateral ligament. ACL stands for anterior cruciate ligament. The MCL is a ligament that is outside of the knee joint and located on the innner aspect of the knee. The ACL is located inside the knee joint in the center of the knee. Tearing the MCL is better than tearing the ACL because the MCL will heal itself because it has adequate blood supply on the outside of the knee joint. The ACL, because it's located inside the knee joint, loses blood supply when torn and has no capability of repair. Most ACL injuries require surgery to prevent instability. Most MCL injuries can be treated without surgery when they occur in isolation.

Ross: How bad it turf for knees? Is the wear-and-tear from turf bad on all body parts?

Dr. King: Most athletes who play on artificial turf don't like it because of the way it makes all of their joints feel the day after the game. Because it does not cushion or absorb force as well as natural grass, there is increased force placed throughout all the joints, bones and muscles in the body, and generally after a "turf game," athletes are much more sore than after a game on grass. Whether or not this leads to increased degenerative arthritis in these athletes is unknown.

ACL: What remedies exist to help professional athletes with plantar / foot problems?

Dr. King: Problems on the bottom of the foot primarily involve plantar fasciitis, or inflammation of the sole of the foot at the insertion into the heel bone. Most athletic shoes are built with an orthotic device inside of them, but many athletes also add additional orthotic devices to help prevent some of these problems.

Brad: Once a concussion is sustained, why are you more susceptible to a reoccurance?

Dr. King: The studies suggest but do not prove that susceptibility to a second concussion is increased after a first concussion. The studies do show, however, that there is a possibility of increased damage to the neurologic structures if a second concussion occurs before the first concussion has a chance to repair itself. But these studies also are somewhat inconclusive.

bg: Can someone recover 100% from a torn bicep? Will this injury have a major effect on the person who is returning with this type of injury?

Dr. King: Yes, a near-complete or complete recovery can be expected, and it should not affect future activities.

Kim: Are new injuries occurring today that you didn't commonly see 10 years ago?

Dr. King: I don't think so. But certainly people are more knowledgeable about injuries because of increased media coverage and there may be certain injuries, such as to the back and neck, that have increased as a result of increased size and speed of the athletes.

Matt: How much does participating in an offseason workout program affect the chance of injury?

Dr. King: Offseason conditioning is probably the greatest insurance against having an injury during the season. All modern-day athletes participate in year-round conditioning programs.

chuck: what exactly is turf toe?

Dr. King: Turf toe is an injury to the big toe at its base. It is usually cause by jamming the toe backward or directly on the tip. The condition is quite painful but usually will respond to steel plates being inserted inside the shoe, tape protection to prevent excessive motion, anti-inflammatory medication and injections.

Kim: Is it difficult to inform an athlete that his/her season is over due to an injury?

Dr. King: It is one of the most difficult things for a physician to discuss injuries with players. But most players already know the answer to the question before they ask it, so that it's not a surprise when the physician confirms that the injury is season-ending.

Dr. King: Thanks to everyone for all the great questions. I hope to do another chat later in the season.