Stephen Strasburg to get El Chapo treatment?

I am sure that Washington National’s fans and Stephen Strasburg fantasy owners are holding their breath with the latest mishap of a career full of injuries. The information reported on this injury is somewhat vague, but Strasburg appears to be suffering from an upper back strain after dislocating “a couple of ribs” during a workout incident. Considering this information, I assume this to be a posterior (toward his back rather than toward his chest) dislocation of his ribs, with the subsequent upper back issue being due to the trauma of the ribs coming out-of-place and then being put back into place, which caused irritation to the tissues in that area. I think for this particular player that any injury needs to be taken seriously, but even if this was not Stephen Strasburg I would have a moderate level of concern with this type of injury.

When most people hear the term dislocation they think of a bone moving to a place where it should not be. When I hear the term dislocation, I think of the structures and tissues that need to be overpowered and damaged to allow the dislocation to occur. Additionally, I think of El Chapo and how he escaped from prison. A bone dislocation can be very similar to a prison break as there needs to be force and there needs to be an overpowering of many layers of protection for either to be successful. Furthermore getting the bone back in place can be just as traumatic depending on the methods used to achieve this. El Chapo was captured with a finesse method which would be similar to a Physical Therapist or other healthcare professional carefully pushing the rib back into place with the help of other muscles and positioning. On the other hand, his capture could have gone another way with the inclusion of firearms and brute force; which represents the dislocation that is popped back in by a friend at the pickup football game. In most cases this method causes more damage getting the bone back in, as compared to the damage caused on the way out.

Similarly, with Stephen Strasburg, I am worried about the trauma during the dislocation, and I also worry about the trauma suffered when the bones were reduced (put back into their proper place). The tissues that suffer during this trauma are the ones we need to focus on, in order for the joint and the surrounding area to return to normal. In this case, the costal cartilage on the chest side which connect the ribs to the sternum; the various ligaments that connect the ribs to the thoracic vertebrae on the back side; and whatever other muscles and soft tissues that are positioned near the site of the dislocation; are all at risk for trauma and injury. Considering Strasburg is primarily complaining of discomfort in his upper back, we can assume that the structures that received the most trauma were the tissues in that area. Each rib has a group of ligaments to secure it to the thoracic spine, and as the rib moves to the surface there are layers of muscles that would be irritated or even injured by a rib pushing into them. Without knowing the severity of tissue strain, it is difficult to give an exact timetable for Stephen Strasburg’s injury. In a general sense, I would give the irritated soft tissues in his back at least 3 weeks to heal.

strasburg

With soft tissue healing, much of the assessment relies on time, as we know how long most tissues take to heal; but we also use performance followed by assessment of how the tissues react to the performance. The issue with this approach with a player who has an extensive injury history and has not shown himself to be an exceptionally fast healer is that assessing that performance too early may cause a setback rather than just allowing you to gather the information you want. If this were another position or another sport, I think this would be considered a minor injury that I would pencil in for a quick return. However, when you consider the length of the baseball season and the time this provides you to make sure you get this right, I would take my time with a 3 week minimum. If Stephen Strasburg attempts to come back too early, this could turn into a lingering issue for the rest of the season. The anatomy of this injury gives Strasburg no options as to avoiding the use of this area as the upper back area is directly connected to his scapular movement, and his scapular movement is one of the two most important pieces to his throwing motion. If Strasburg would have tried to be a tough guy and push through on this past Sunday, the discomfort that he felt when trying to warm up for his start against the Brewers would have progressed with every pitch to the point of pain and dysfunction. The risk of repeated dislocation is always in play when you don’t allow the structures that allowed the first dislocation to regroup and heal. The thought of him going out there and trying to pitch right after the ribs were reduced would be like putting El Chapo right back in the same cell he escaped from, before you can close the hole and change the prison guards.

The Washington Nationals and fantasy owners should embrace the thought of Stephen Strasburg taking at least 3 weeks off to heal as anything sooner than this would seem to be risking the chance for a chronic situation that could put his season in jeopardy, after such a good start. If managed properly with the appropriate rest, physical therapy, and gradual return to throwing; there is no reason Strasburg will not return at near 100 percent in about 3 weeks.

The NBA Finals MVP NOT named Steph or Lebron!

All eyes will be on Steph Curry and Lebron James on Sunday night but in my opinion, there is someone else that will decide this game 7. If you watch enough basketball, you know that Tristan Thompson’s performance is very unlikely to be repeated on the road, as role players tend to only shine that bright at home. With the Cleveland role players coming back to earth, I think we can expect Lebron and Kyrie Irving to carry the load like they did in game 5. Additionally, we can assume that by returning home that the Warriors role players will step their games up. But there is one person that I bet no one is looking at as having the biggest role for Sunday night’s game….take your guess before you read on.

If you guessed Andre Iguodala you are the close, but not quite. Chelsea Lane is actually my guaranteed MVP for Sunday night. In her case the P stands for PhysioTherapist or as the Warriors label her “head performance therapist”. She is the lady who always has her collar popped on the sidelines. You probably noticed her massaging Andre Iguodala’s back in game 6.

sfcchronicle.com
sfcchronicle.com

When you go back to my theory that the role players for Cleveland will return to their shells, it leads you to the fact that stopping Lebron from scoring will be essential in the Warriors getting this win. No one in the world is better equipped to stop Lebron James than Andre Iguodala, but if his back is not allowing him to move, the Warriors are in big trouble. This leads us back to Chelsea Lane.

The status of Iguodala’s back will be mostly on Lane in preparation for game 7. While the exact diagnosis for Iguodala has not been reported, he appears to have a low back strain/sprain type injury. Generally this is a minor issue that does not take long to manage, however it does typically take more than 2 days. If this were more of a typical rehabilitation for a back injury, the responsibility is more of a shared burden between the player and the rehab staff; but in this case I put the majority of the task on the staff. Andre Iguodala will likely be receiving a regimen that is modality heavy over the 68 hours that separate game 6 and game 7. These modalities will help loosen and relax the injured area, while also helping healthy blood flow to the area to support healing. Additionally, Chelsea Lane is likely to give a good amount of manual therapy to the area to manipulate and mobilize the tissues in his low back.

It is doubtful that Iguodala will have much of an active role with his short-term therapy as this may lead to fatigue in his low back and therefore elevate his risk for recurrence during the game. This puts the ball almost solely in the hands of Lane and her staff to make sure that the reigning Finals MVP can help the Golden State Warriors win a second championship. While Lane will not be playing on Sunday night, she will need to be on her game during the break between games to likely decide the NBA champion. I literally believe the Warriors have no chance if she does not do her job well.

With an abundance of experience with these types of injuries and knowing the pedigree of Chelsea Lane, I am 1000 percent sure that Andre Iguodala will at least take the court on Sunday night. The measure of how well Lane manages this injury will be based on how long he can play. Back injuries are impossible to run from as your back has to be active in nearly every movement you make. For many patients I use back stability braces or other adaptive equipment to protect from re-injury; but with basketball players this is not much of an option due to the flexibility demands on the basketball court. Lane will simply have to hit that perfect balance of helping Iguodala be loose but not too loose, so that he can survive for about 30 minutes on the court. Furthermore, she will have to keep him loose when he is not on the court. I expect moist heat, bike riding, and anything else that will keep his low back warmed up.

In the end I believe the Physical Therapy that Andre Iguodala receives will decide the the NBA championship. With that said, I am betting on therapy and Chelsea Lane to succeed!