Greetings from the Edinburgh airport – Paul and I are waiting for our flight to Belfast which will leave in a few hours. I actually have no problem waiting in airports, it gives me time to catch up on some work.
One of you asked me via twitter (@GoalieTraining) to chime in on Tuukka Rask’s injury the other night. Since we have been hiking in the Scottish Highlands for the last four days (the photo that will appear in some random location on this page is Paul and me at the summit of Ben Nevis – the highest peak in the UK)
So, I looked at the video of the injury mechanism to see what was up. It was an active mechanism, so no one smashed into him. To me it looked like he was set up to make the save, but then the puck was deflected so he quickly had to kick his left pad out to deflect the puck – and down he went in a world of hurt.
So what can we see from the mechanism – not ACL, not MCL, with the rapid lengthening contraction of the adductors, it could also be groin, but I feel like I talk about your groins a lot already (that didn’t sound right) – so for the sake of this discussion I am going to say meniscus.
Why? Because put his knee into some internal rotation (the hip actually was rotated in) and then he extended his knee. When a physio evaluates a knee for meniscal tears or irritations, they put the knee through this series of movements to see if the athlete will jump right off the table.
A physio I used to work with had a great way to describe meniscal tears or irritations. She said that they were like a hang nail on your finger. If you catch it going with the grain, it is fine – no pain. But if you catch it going the wrong way – then WOW – that hurts.
So if Rask had a pre-existing irritation, this awkward movement could have certainly caught hold of that and given him a bigger tear.
Is this a bad injury for a goalie? Yes, it is. Hopefully Rask’s was more of an irritation and not a major tear. The goalie needs to be able to make the complex, multiplanar movements about the knee without pain dropping him/her to the ice from time to time.
The meniscus also has an important role in the knee – it was not just stuck in there to be extra. The menisci (each knee has two – one medial and one lateral) have two main rolls – they provide some shock absorbtion between the thigh bone and the shin bone since they sit on the tibial plateau (picture two small jelly donuts about the size of a looney – that’s a dollar coin for you non-Canucks – sitting flat in the middle of your knee) AND they give the knee joint a little more depth for stability.
What are the treatments?
There are some treatment options – 1) rest and rehab; 2) surgery to trim the torn portions; 3) surgery to stitch the meniscus back together.
Of these the best outcome is rest and rehab with a full painfree return to play. The menisci have a terrible blood supply toward the centre of the disc and a so so blood supply toward the outer rims. In short – no blood supply, no healing. So if it is a smaller tear toward the outer portion of the meniscus, a goalie can do pretty well with this going the rest and rehab route.
If, however it is a larger tear and/or located more toward the inner portion, then the orthopod may want to get in there and trim off the sharp edges – the same way you may trim down the flap on a hangnail – so they will not get caught and yanked again. The surgeons are a little limited on how much meniscus they can remove because it’s shock absorption has a protective effect on the articular cartilage. Remove the meniscus (like they used to do 40 years ago) and you are on the fast train to degenerative arthritis – ask Bobby Orr.
If the trim is successful, an athlete can often be back to play in 3-6 weeks.
Finally, if it is a big tear, but fairly clean and where there is a decent blood supply the surgeon can actually stitch the meniscus back together – just like a split lip. That is the good news. The bad news is that the goalie will wake up with their knee in a full leg brace that will be locked into full extension (fully straight) for 3-months and THEN they can start working on return to play. Like I mentioned, a poor blood supply slows healing so this one takes a long time. These goalies are looking at a 6-month return to play and a risk of re-injuring the meniscus again.
Hopefully by the time I get home I find out that his injury was just a sprained big toe and I was completely out in left field – but at least you know a little more about meniscal injuries.
Have a great day.
Cheers,
Maria
PS – anyone know a website where I can catch NHL games from the UK or Ireland?? Please let me know.