After six days of Fall Camp and two-a-days starting today (Friday), the injury report has been encouragingly modest. Well at least comforting as to what the Notre Dame staff has been officially releasing and reporting. Mike Ragone (TE) was hospitalized and since released for a heat related condition. On Wednesday, he appeared wobbly and the training staff and team doctors quickly got his temperature down and introduced fluid.
Been on the LaBar complex fields at midday and can attest to the radiating heat coming off the artifical turf field (see blog below). What is hard to imagine is how and why the training staff let it happen in the first place. The miserable hot days and the intense regimentation of the Kelly style of practice/play require everyone on the staff to be constantly alert for heat exhaustion, which can quickly lead to heat stroke and sometimes-even death.
You read about it every fall, it happens on high school practice fields as well as in college and the Pro’s.
Having spent 22 years in the U.S. Army, anytime a soldier came down with heat related issues that soldiers’ chain-of-command had a lot to answer for as to why it happened in the first place. Prevention is the key. Let’s hope that this is a wakeup call for the entire Kelly staff and Notre Dame. Not sure that Kelly and his staff are used to training and practicing players on a plastic field in the brutal August sun of Indiana.
Tight ends appear to be the only casualties thus far.
It was reported that Kyle Rudolph (TE) “tweaked a hammy” early in the week and was being held out in practice with only limited activity as a precaution. “Tweaked a hammy,” OK what does that exactly mean? I remember hearing it for the first time from Charlie Weis at a press conference when he was reporting on a player’s injury. (Wish I could remember who that was now?) Anyway, what’s the difference between a tweak and a pull?
How many times have you seen after a solid hit, a baseball player tearing down the base path for first base only to see him fall down like a sack of potatoes and hold the back of his thigh? Now that’s a pulled hamstring.
We decided to get this cleared up and go to a professional for answers. (Our first Guest Poster here at Subway Alumni Station)
Alex Brenner has over 14 years of physical therapy experience in the military, private clinics and the U.S. Public Health Service. He is rated as a DPT, Doctor of Physical Therapy. If, God forbid, the injuries grow during fall practice and during the season, SAS plans on calling on Alex to explain the injuries and give us a realistic timetable for recovery.
Here is his take:
Background
The hamstrings are a group of muscles that attached from the bottom of the pelvis and extend down the back of thigh and attach to various locations on the back of the femur and tibia. They are the primary flexors of the knee and are very important during the initial propulsion from a football stance. It is very common for this group of muscles to be injured, the most common injury being a muscle strain also known as a Apull.@ A muscle strain is a result of actual tearing of the muscle fibers either partially or completely depending on the severity.
In Kyle Rudolph’s case, Coach Kelly described the injury as a Atweak@ of the hamstring. To me this would indicate that Kyle has a minor strain. Hamstring strains, like most other injuries, vary in degree of severity. A severe muscle strain actually results in a complete tear of the muscle or an avulsion of the muscle away from the boney attachment. This almost always happens where the muscle attaches on the bottom of the pelvis although it can also happen in the mid belly of the muscle or less commonly from the attachment down directly behind the knee. A more severe muscle strain will result in bleeding which will leave the skin around the injury appearing to be bruised. This severity of muscle strain takes much longer to heal and usually results in the athlete being confined to crutches for ambulation. I doubt that Rudolph has this severe of an injury.
How and why does this happen?
I remember from my own high school football days that we would have several players suffer this same injury early in the football year, usually during our late summer double sessions. Although this can happen to any level of athlete at any time, I feel when it occurs early in the football season this type of injury is due to improper or lack of proper conditioning. It is not caused by weakness in the muscle; to the contrary, these high level athletes have highly developed hamstring muscles groups. Unfortunately, straight weight lifting and gains made in the gym do not translate over to function on the field. Most hamstring injuries occur during Aquick starts@ like a runner coming out of the sprinting blocks or in Rudolph’s case, coming out of his stance during the hike of the football.
Prevention
I would be surprised if the strength and conditioning coach wasn’t doing this but the best way to prevent early season hamstring strains is to conduct sprinting drills to augment the weight training. I would argue that the sprint drills would be more important in prep for intense summer/fall football practices. Players should perform repetitive Aquick start@ drills where they go from a football stance and sprint 5 yards. Start at 50% effort and progress to 100% effort, conducting multiple sets.
Treatment
Acutely, the muscle group should be iced daily for 20 minutes every few hours or so. If there is a large echymosis (bruising) an x-ray may be indicated to ensure that there is no avulsion of the bone. I highly doubt Rudolph needs to worry about this. The hamstring muscle group also tends to tighten up or shorten after injury so gentle static stretching is indicated to retain/maintain flexibility of the knee joint. Remember too, the muscle is torn so the stretching should be performed in the pain free range, maybe holding a gentle stretch for 30 seconds and repeating twice (repeat 3-4 times daily). I have also had success with wrapping the hamstring tightly with ace wrap or coban to take pressure off the damaged muscle or tendon. This puts the hamstring tendon in the best position to facilitate healing. Once the knee regains its normal range of motion and flexibility then it is time to progress to strengthening and then slowly back to functional/skilled activities such as sprinting and cutting on the football field.
Conclusion
From what I gather on Rudolph, he has a minor hamstring strain that will be better in 1-2 weeks. I doubt that he is receiving any extensive treatment and the medical staff is just monitoring him at this time. This early in the practice season and there is no reason to have Rudolph push through this injury and risk the chance of progressing the minor strain into a more severe injury which could affect him well into the start of the season. I suspect the medical staff will treat him as I indicated above. Look to see him back 100% participation in another week.
Alex Brenner, DPT, OCS
Board Certified Orthopaedic Physical Therapist
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