Saturday, 27 February 2016

Canadiens medical staff under the microscope.

What with Carey Price's injury and re-injury, seemingly butchered concussion diagnoses on Nathan Beaulieu and Dale Weise (and Michaël Bournival?), and now the less than limpid situations regarding Tom Gilbert and Jeff Petry, the Canadiens' medical staff has come into question by some disgruntled fans.

A trope that has cropped up on social media is that Carey Price shouldn't come back until he's "absolutely 100%", that he should pack it in and not even play in the World Cup to make "absolutely sure".  Which isn't so black and white an issue.

It’s fair to question every aspect of a team, with a balanced outlook, absolutely, and the Canadiens' docs shouldn't be above scrutiny.  There are various reasons to have trust in them.

1) Having to choose between rest and rehab or immediate surgery is common in hockey, and sports in general. Ski racers are constantly having to make that decision, they try to race on a knee that’s 90%, have a catastrophic injury and then go under the knife, and we hear about it, but you never hear that Pirmin Zurbriggen or Lindsey Vonn or Rob Boyd raced with a bad back but managed to hold it together and win. You only hear about the ‘fails’, those are the ones that are publicized.

Ryan Miller has had to choose between surgery and rest and rehab in Vancouver. He chose the latter and won his gambit. Evander Kane was playing with a bum shoulder in Winnipeg, soldiered through, got his track suit thrown in the shower by Big Buff, said “Eff all y’all”, and had season-ending surgery.

NFL players commonly play with separated shoulders, dislocated thumbs, etc., until their team is out of the playoffs, at which point they go on Injured Reserve and to the operating room, their season done, to liberate a spot on the roster.

James van Riemsdyk tried to rehab for a couple of months, but has now thrown in the towel and called it a season.

2) Carey Price’s injury is, I suspect, a MCL. It gets a lot of attention and gets us thinking the docs maybe aren’t on the ball, what’s taking so long, but there really is no surgical repair techniques for MCL strains. An ACL tear is pretty much always a complete rupture, and must be repaired surgically, Josh Gorges notwithstanding, but an MCL is rehabbed by rehab. The only consideration is that the more severe the tear, the longer the rehab period.

It’s not that the doctors are making the wrong decision by not electing to operate, there is no such decision they can make. Jeff Petry, with a sports hernia, is a completely different case, it’s a common injury that responds differently to different treatment. It’s quite common for athletes to try therapy, and hope to avoid the knife, until they realize that they’re not responding well to rehab.

3) Also, the idea that Carey wasn’t 100% but the docs let him back on the ice is not so black and white. There’s not a gauge or test that’s definitive, the athlete has input. The docs and physios poke and prod him, ask him to perform certain tests, and ask “Does that hurt? How about this?” And depending on the player’s individual pain tolerance, his ‘honesty’ and motivation to come back, his actual recuperative powers, they ramp up the intensity of the exercises, introduce new ones, get him doing light skating, etc. If the athlete guts it out and says “No, I’m fine, it doesn’t hurt”, that’s what the docs are going on. There’s no clear, defining line.

And according to the reports, Carey got hurt again when he stepped on a puck, which caused him to slip and his knee to bend in exactly the wrong way, and reinjured him. When I came back from my MCL, I was allowed to get back to normal activities at work and on the mountain, but a lot of warnings and cautions, “Go easy at first, take your time, don’t go crazy on the squat rack, …” So was I 100%? According to WorkSafeBC, I was.

What if I’d been unlucky, something happened, and my knee ‘bent the wrong way’? While prior to my injury, nothing would have resulted from it, but now, in this case I would have been injured again. So, was I 100%, or really 90%, when the docs and physios cleared me?

Rehab isn’t something that has a clear, objective finish line, but is rather a continuum. Dare I say it, it’s a process.

4) The Canadiens always rave about how well they’re treated, how everything is first class, and that includes the docs, they often mention them in their chats with the media. Geoff Molson is a fan, holds the team and the players dear, he won’t stint on the players’ care.

In the NFL, where players are disposable, and you can save money by cutting athletes from your roster, I understand the skepticism some fans and players have with respect to team doctors. In the NHL though, with guaranteed contracts, and lots of investment in players who are seasoned in the minors, as opposed to drafted out of college and thrown onto a churning 70-player roster, there is lots of incentive to have the players’ best interests at heart, if only to protect their investments.

An example is how one Broncos player explained that he has had a long, productive career because he pays for his own medical care, his own physios and therapists, out of his own pocket, rather than trust the team docs. We saw a hint of that when Carey was flown to New York for a second opinion on his injury and treatment, and apparently was told much the same thing he was by the Canadiens’ docs, he seems to be satisfied that he’s on the right track.

The San Diego Chargers have had a quack as their team doctor, and from a distance, the difference was night and day. Players left the Chargers embittered, feeling used, talking about lawsuits. We get none of that from the Canadiens, quite the contrary in fact.


 “Truly 100%” is a concept we use in conversation, but it doesn’t really apply in an injury rehab case. It’s not like there’s a dial with a needle that has to hit 100, at which point the athlete will be ready.

What happens is that Carey is being put through exercises, through drills, and based on how he reacts, how he feels, they increase the pace, and introduce new ones. They tell him “Try this”, and to trust his body, “go with the pain”, meaning when you feel some, back off a smidge.

The classic exercise when you get a knee injury is to get on a stationary bike, and with the injured leg, go back and forth on the pedal, slowly, at the bottom of the stroke, forward and back. At first you push the pedal from 4 to 8 o’clock, back and forth, that’s all you can do, until the pain and swelling and stiffness subside, and you can go from 3 to 9, then 2 to 10, and eventually you can do a full revolution and your physio makes a big deal about it and makes you feel like a hero.

This is what’s happening with Carey, he’s probably shown enough that they feel he can drop to his knees, gently, and get through that barrier. He won’t do any big moves or splits yet, just work his way up. And eventually, he’ll be doing those, sometimes feeling a twinge, sometimes feeling a little looseness. And he’ll have to be honest about it, and communicate that.

And he’ll know that the stakes on the season have changed, that maybe he should be cautious, that despite the pressure he feels to get back to action, the desire he has to play, that maybe he should take more time, take an extra day here and there.

The athlete plays a big role in deciding if he’s ready, if he’s 100%. Think of how many times a player is miraculously ‘ready’, in time for the big game. Think Ray Lewis for the Super Bowl, or Thomas Davis this year, good to go with a broken arm. Think ski racers coming back from an ACL, magically recovered in time for the Olympics.

Carey has a guaranteed contract, an agent. This isn’t the 1950’s Red Wings with the Norris family, pushing players to play or sending them to the minors. Marc Bergevin and Michel Therrien have very little influence in whether Carey plays.

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