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Old 10-05-2011   #201
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Default Re: AJ out a few weeks, has procedure

McClain on 610 radio this morning was asked about the surgical procedure AJ had. He did not correct the interviewer, but went on to nonspecifically refer to "the procedure." He said that grabbing the back of the knee had everyone thinking it was an Achilles or knee ligament injury. Distal hamstring was not originally entertained. He said that the procedure was to avoid scar tissue from forming during the healing.....causing it to heal quicker.
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Old 10-05-2011   #202
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Default Re: AJ out a few weeks, has procedure

All the studies I've seen surrounding platelet rich plasma and tissue repair are too small and the results have been somewhat mixed. I know that theory sounds good on paper, and injecting rats with it seems to improve outcomes, but it hasn't translated well into humans. The other problem with it is that no one has any sort of dosing, the amount of growth factors in the injection varies highly, and we don't even know what is the proper amount per injection.

We also don't know all the long term effects of it.

It may work great, but right now it needs to be studied thoroughly before it becomes the mainstay for therapy.
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Old 10-05-2011   #203
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by Texans_Chick View Post
Interesting. I will see what I can find out. Is it surgical procedure or mistaken reference. Perhaps aspirating a pocket of blood? Reduce scar tissue but doesn't really aid recovery. What surgical procedure could have him ready by Titans game? BTW agents reference to HIPAA is joke- not relevant to discussion.
Another thought, TC. Typically, hematoma drainage is not performed unless the hematoma is LARGE (otherwise treated with massage and ultrasound treatments to help absorbtion, decreasing swelling and softening of any scar tissue that forms. Unless large, the morbidity (infection, drain if left in place, further scarring, etc) in performing a surgical draining typically outweighs its use. A further complicating factor is that when a player sustains an injury like this, they have usually ingested blood thinner elements such as anti-inflammatories (Aspirin, Motrin, Advil), alcohol (we know most players love their beer, wine and spirits), fish oil supplements, antioxidants, etc........many of which can affect bleeding for up to 10 days. The troublesome point is if there was a complicating LARGE hematoma, there will be significant surrounding tissue inflammation and potential for significant increased scar formation (albeit possibly somewhat less than if not drained) anyway........despite drainage.
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Old 10-05-2011   #204
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by CloakNNNdagger View Post
Another thought, TC. Typically, hematoma drainage is not performed unless the hematoma is LARGE (otherwise treated with massage and ultrasound treatments to help absorbtion, decreasing swelling and softening of any scar tissue that forms. Unless large, the morbidity (infection, drain if left in place, further scarring, etc) in performing a surgical draining typically outweighs its use. A further complicating factor is that when a player sustains an injury like this, they have usually ingested blood thinner elements such as anti-inflammatories (Aspirin, Motrin, Advil), fish oil supplements, antioxidants, etc........many of which can affect bleeding for up to 10 days. The troublesome point is if there was a complicating LARGE hematoma, there will be significant surrounding tissue inflammation and potential for significant increased scar formation (albeit possibly somewhat less than if not drained)........despite drainage.
Yeah, I've drained maybe 3 hematomas in my life, and they were always on patients on anticoagulants. And in all 3 cases they were to prevent compartment syndrome. I wouldn't see any reason to do so in his case.
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Old 10-05-2011   #205
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by hradhak View Post
All the studies I've seen surrounding platelet rich plasma and tissue repair are too small and the results have been somewhat mixed. I know that theory sounds good on paper, and injecting rats with it seems to improve outcomes, but it hasn't translated well into humans. The other problem with it is that no one has any sort of dosing, the amount of growth factors in the injection varies highly, and we don't even know what is the proper amount per injection.

We also don't know all the long term effects of it.

It may work great, but right now it needs to be studied thoroughly before it becomes the mainstay for therapy.
Agree on all points. I wrote extensively on this subject when AJ was treated with this modality for his high ankle sprain............and the literature has not been any more supportive since that time.
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Old 10-05-2011   #206
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by otisbean View Post
While some injuries cannot be helped, hamstring injuries can be prevented. Injury prevention should be the strength and conditioning staffs primary job. The fastest way to achieve optimal performance is to get an athlete as healthy as possible. Look for muscle imbalances and correct them, look for restrictions in proper joint mobility and improper posture and correct these issues, and properly condition your athletes so that fatigue isn't a factor. I would say the biggest risk factors in hamstring injuries are muscle imbalances, postural issues, and improper mobility not being fast sprinter. Speed is related to the amount of mass specific force you produce, the more force you put into the ground per pound of bodyweight the faster your run. If you can produce the force you should be able to handle it.

Here's where the above mentioned factors become an issue, if you have muscle imbalances you are asking certain muscles to do more than their fair share of the work involved in producing movement. These overloaded muscles have a higher propensity for straining. For example, the gluteals are the body's primary hip extenders, the hamstrings aid in this function. If the glutes are weak or inhibited than the hamstrings will try to perform more than their fair share making injury likely. If the quads are too strong then they can over stress the hamstrings, as they work in opposition, making injury more likely.

Poor posture, primarily an anterior pelvic tilt, can over stretch the hamstrings, which can increase the likelihood of injury. The more a muscle is stretched the less force it can produce/handle. Weak abdominals, obliques and tight hip flexors create this issue and over stress the hammies. This anterior pelvic tilt can also inhibit the gluteals - which causes issues as stated above.

Improper weight training can also lead to injury. When sprinting, the muscles involved have to turn on and off very rapidly. The difference between elite athletes and average Joes is seen not only in their ability to turn their muscles on to a higher degree but also to turn them off to a greater degree. If the muscle is carrying too much tension at a time when it is supposed to be relaxed then injury can occur. Weight training can foul this sequence up if the training program is improperly set up. Noted strength coach Barry Ross ( the strength coach for Allison Felix, one of the top 200 meter sprinters in the world) focuses much of his training around the deadlift. When performing the DL, he has his athletes drop the bar once it gets above the knees to avoid a slow eccentric contraction with a heavy load. These slow eccentric contractions can cause issues in sprinters performing high speed sprints. Noted strength coach Charles Poliquin has stated the fastest way to pull a hamstring is to have athletes leg press and perform leg curls. These two exercise complete ignore the hamstrings primary function of hip extension, predisposing it for injury. Fast eccentrics, such as plyometrics and exercises such as the kettlebell swing, can help prevent muscle strains by exposing the muscles to higher stretch loads but in a manageable way.

Admittedly there are lot of factors involved in prevention, but hamstring issues can be avoided. There are some issues that may not be avoided. All athletes get fatigued during competition and when muscles are fatigued they can't handle the same forces as when they're fresh - the easy answer would be to get into proper condition so that fatigue doesn't happen as easily. Additionally, when being tackled or trying to avoid a tackle the athlete can get into funky positions which can over stress a muscles, but fast eccentrics can aid in this situation as well by creating a better tolerance for higher stretch loads.
Otisbean, very good post.
You and I have discussed this on the board in the past, almost to exhaustion.
No doubt that the occurrence of hamstring injuries cannot be totally eradicated. But they definitely can be very much minimized with careful adherence to the basic principles by players and their conditioning personell.
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Old 10-05-2011   #207
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Default Re: AJ out a few weeks, has procedure

BTW, Rick Smith on 610 stated that he had no idea where the 2-3 week time table came from...........essentially saying he will be back when he will be back.
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Old 10-05-2011   #208
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by CloakNNNdagger View Post
McClain on 610 radio this morning was asked about the surgical procedure AJ had. He did not correct the interviewer, but went on to nonspecifically refer to "the procedure." He said that grabbing the back of the knee had everyone thinking it was an Achilles or knee ligament injury. Distal hamstring was not originally entertained. He said that the procedure was to avoid scar tissue from forming during the healing.....causing it to heal quicker.
OK, was able to run some traps this morning.

I was informed that Andre Johnson did receive PRP treatment.

I was unable to get any details about the injury.

That a person received PRP treatment doesn't help you figure out how fast they will return.

Updated my post here: http://blog.chron.com/texanschick/20...ring-leg-knee/
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Old 10-05-2011   #209
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Default Re: AJ out a few weeks, has procedure

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OK, was able to run some traps this morning.

I was informed that Andre Johnson did receive PRP treatment.

I was unable to get any details about the injury.

That a person received PRP treatment doesn't help you figure out how fast they will return.

Updated my post here: http://blog.chron.com/texanschick/20...ring-leg-knee/
Thanks, that would have been the most likely "medical procedure" performed.
Unfortunately, at this point in time there is no proof that PRP therapy has any more effect on recovery than beads and gords.
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Old 10-05-2011   #210
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Default Re: AJ out a few weeks, has procedure

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Agree on all points. I wrote extensively on this subject when AJ was treated with this modality for his high ankle sprain............and the literature has not been any more supportive since that time.
The Steelers were one of the first teams to use this in the NFL. They've had some anecdotal positive responses to it.

Hard to do studies on this involving elite athletes receiving tons of care. Because teams don't want to share their stuff.
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Old 10-05-2011   #211
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Default Re: AJ out a few weeks, has procedure

TC, back to back multiple MRIs would be somewhat unusual for purposes of obtaining multiple angles since the angles of an MRI are actually obtained by the "3-dimensional" MRI software manipulated off a single MRI.
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Old 10-05-2011   #212
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by CloakNNNdagger View Post
BTW, Rick Smith on 610 stated that he had no idea where the 2-3 week time table came from...........essentially saying he will be back when he will be back.
Dammit.
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Old 10-05-2011   #213
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by CloakNNNdagger View Post
TC, back to back multiple MRIs would be somewhat unusual for purposes of obtaining multiple angles since the angles of an MRI are actually obtained by the "3-dimensional" MRI software manipulated off a single MRI.
Hmmm. I guess at this point we are talking about semantics because we don't know if we are talking about back to back multiple MRIs. We are in vague land. Sometimes intentionally so.

I will add that to my post.
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Old 10-05-2011   #214
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by Texans_Chick View Post
The Steelers were one of the first teams to use this in the NFL. They've had some anecdotal positive responses to it.

Hard to do studies on this involving elite athletes receiving tons of care. Because teams don't want to share their stuff.
Anecdotal stories appear in medicine when there are occasional positives mixed with numerous cases of no apparent effects. With all the different variables in injury and concentrated traditional techniques being applied simultaneously, it is impossible to attribute any positives to that treatment alone. Controlled studies are the only way to see that a placebo effect is not in effect. Existing controlled studies when analyzed have not proven the value of these injections.

Last edited by CloakNNNdagger; 10-05-2011 at 10:38 AM. Reason: SP
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Old 10-05-2011   #215
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Default Re: AJ out a few weeks, has procedure

Quote:
Originally Posted by otisbean View Post
While some injuries cannot be helped, hamstring injuries can be prevented. Injury prevention should be the strength and conditioning staffs primary job. The fastest way to achieve optimal performance is to get an athlete as healthy as possible. Look for muscle imbalances and correct them, look for restrictions in proper joint mobility and improper posture and correct these issues, and properly condition your athletes so that fatigue isn't a factor. I would say the biggest risk factors in hamstring injuries are muscle imbalances, postural issues, and improper mobility not being fast sprinter.
I always remember our coaching staff in High School remodeled our conditioning program when I was a sophomore to mirror what Nebraska was doing at the time. One thing that always stuck out was the repeated insistence to keep the hamstring "max out" at 60% minimum of quad "max out". That was specifically to prevent the classic "blow-out" where the runner drops the (football, baton, etc.) and starts grabbing the back of his leg.

Quote:
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Thanks, that would have been the most likely "medical procedure" performed.
Unfortunately, at this point in time there is no proof that PRP therapy has any more effect on recovery than beads and gords.
Leeches, you forgot leeches!
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Old 10-05-2011   #216
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by Texans_Chick View Post
TC,

At one point in time it may be useful for you to relate this basic bit of information to your readers. It seems to be a constant source of confusion. Whenever there seems to be a discussion about muscle, tendon or ligament injuries, the question comes up “Was it a sprain (or strain) or a tear?" A muscle or tendon injury is referred to as a “strain,” while a ligament injury is referred to as a “sprain.” BOTH are TEARS of their respective tissues, and are subsequently graded as to their severity.

Just a thought. Again thanks for your continuing very informative blogging. Keep up the great work!
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Old 10-05-2011   #217
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Default Re: AJ out a few weeks, has procedure

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I always remember our coaching staff in High School remodeled our conditioning program when I was a sophomore to mirror what Nebraska was doing at the time. One thing that always stuck out was the repeated insistence to keep the hamstring "max out" at 60% minimum of quad "max out". That was specifically to prevent the classic "blow-out" where the runner drops the (football, baton, etc.) and starts grabbing the back of his leg.

Leeches, you forgot leeches!
I've used leeches in my practice for digit replants and breast reconstruction flaps and on other injured tissues with poor venous blood return.............but they'd be just as worthless as the beads and gords on something like this..........maybe if you would eat them..........high protein, you know.........protein's good for healing............by gosh, Dissacks........you may just have hit on something...........quick, call the Texans!
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Old 10-05-2011   #218
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Default Re: AJ out a few weeks, has procedure

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Originally Posted by CloakNNNdagger View Post
Anecdotal stories appear in medicine when there are occasional positives mixed with numerous cases of no apparent effects. With all the different variables in injury and concentrated traditional techniques being applied simultaneously, it is impossible to attribute any positives to that treatment alone. Controlled studies are the only way to see that a placebo effect is not in effect. Existing controlled studies when analyzed have not proven the value of these injections.
Familiar with the studies. Just a difficult topic to study with football teams that don't want to share their techniques. Know that the teams that use this process very much believe in it.

Even if it were a placebo effect, given the importance of confidence in coming back from injury, that might not be a bad thing. I think they should also give him the baby unicorn stem cells too.
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Old 10-05-2011   #219
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Default Re: AJ out a few weeks, has procedure

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Familiar with the studies. Just a difficult topic to study with football teams that don't want to share their techniques. Know that the teams that use this process very much believe in it.

Even if it were a placebo effect, given the importance of confidence in coming back from injury, that might not be a bad thing. I think they should also give him the baby unicorn stem cells too.
Nah, I'd mix gazelle and rhino and let'em eat
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Old 10-05-2011   #220
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Default Re: AJ out a few weeks, has procedure

Quote:
Originally Posted by SheTexan View Post
It is what it is!! We can speculate about AJs injury until hell freezes over, and it will STILL be what it is!! Only AJ and his Docs know for sure, and that's fine with me!! We, as fans, are NOT on a need to know basis! If we are told the truth then the rest of the NFL knows the truth. I'm just fine with a bunch of misleading statements, if it throws off the balance in our favor. An "elite" team will find a way to win without their "STARS." We have a lot of weapons on our offense, JAMES CASEY, to mention one, and I think our guys will go out and bust ass for a win!! It's a TEAM sport! I hope we are never identified like the Colts, a team that is nothing without that ONE special player! Truthfully, I think our mild, easy going, soft spoken AJ, will be our biggest cheerleader for the next 3,6,9,10 whatever, wks he is out! He believes in this team, and every player on our team respects the heck out of AJ. Gotta have faith, and I intend to keep on believing in this team, even though I still close my eyes and hold my breath everytime JJ gets the ball!
Yeah!!!
You tell 'em sistah!!!
Rep worthy.




....meanwhile I chose to


It just makes me feel better.
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