Rehab for Alex Gordon’s Injury
The hottest sports story in Kansas City today is the recent news that Royals All-Star outfielder Alex Gordon suffered a “Grade 2+ groin strain” in the game last night. Reports surfaced today in the media that he’ll be out about 8 weeks. Royals nation has collectively started to panic over the timing and nature of the Alex Gordon injury. What better time to talk about groin strains than now.
What does “Grade 2+” mean?
Typically, muscle strains are graded from I-III. A grade I strain is a rather mild “overstretching” of a muscle with the possibility of some very small tears. Usually, there is minimal strength or range of motion loss. A Grade II strain, as you may expect, is a little more severe. There are typically some fibers of the muscle torn with associated bruising, swelling, and soreness with associated loss of strength. Grade III strains usually involve complete ruptures of the muscle itself. Obviously, more swelling and bruising is likely to occur and the athlete may have a significant limp when they walk. Depending on what muscle is ruptured, an athlete may be a surgical candidate. For example, if the hamstring is ruptured from it’s attachment point on the ischial tuberosity (your “sit bone”), most athletes need surgery to fix that. In Alex Gordon’s case, he probably had a strain worse than a II, but not quite a III. His groin muscles may be “hanging on by a thread.”
Is it worse to strain muscle or tendon?
First of all, tendons attach muscle to bone. Secondly, tendon strains take longer to heal because tendon tissue isn’t as oxygenated as muscle tissue is. Muscle has lots of blood supply and heals faster than tendons do. So if there is a bright spot here, it sounds like Alex got more muscle than tendon. Muscle strains tend to occur when a muscle is actively lengthened greater than resting lengths (Brugheli & Cronin, SCJ 2008). Typically, the combination of rapid lengthening of the muscle (as he’s striding during a sprint) coupled with a rapid contraction (as he brakes and goes into the next stride) often leads to muscle injury (Frieden & Lieber Acta Physiol Scand 2001). Based on the fact that they commented in the press conference that he didn’t pull it from the bone, we’ll assume he either strained the muscle itself or at the point where the muscle meets the tendon, called the musculotendinous junction.
Why did it happen?
For the most part, groin strains can occur from fatigue, over-striding, a sudden change of direction, a “slip and fall,” a combination of the above, or many times, because the athlete has a history of groin strains. Truthfully, groin strains are far more common in soccer, accounting for 11-16% of all injuries (Engebretsen et al, AJSM 2010) as well as hockey (Tyler et al, Sports Health 2010). The single greatest predictor of injury is previous injury to the same area. Risk factors for groin strains include a higher level of play, i.e pro sports (Inklaar, Int J Sports Med 1996), insufficient core stability (Leetun et al, Med Sci Sports Exerc 2004), decreased hip abduction range of motion (Arnason et al, Am J Sports Med 2004), and weak groin muscles as well as poor abduction: adduction strength ratios (Tyler et al, AJSM 2001). Typically though, a complex interplay between flexibility and strength results in muscle strains (Tyler et al, Sports Health 2010).
Could it have been prevented?
Always the million dollar question in sports. The best way to prevent muscle strains of any kind is to stay hydrated, stay flexible, and make sure any deficits that might put you at risk for a strain are addressed. For example, weakness in specific spots or if he has any injury history to the area. Many times, athletes get hurt during the season and never really get better. They “get good enough” and often don’t re-visit the issue during the off-season. It sounds like Alex is a workhorse and the Royals athletic training staff has a fantastic reputation, so we’re guessing that is not the case.
How do you treat them?
Well, it appears he’s on crutches right now. Initially, you have to just let this injury settle down a bit. First and foremost, you have to get the pain under control. Crutches will definitely help that. He’ll probably have a compressive wrap to help support the very vulnerable area. He’s not likely to do much other than walk around for the first several days and get palliative treatments like ice, electrical stimulation, and perhaps some light massage. He’ll do some upper body work and use an arm bike to stay in cardiovascular shape, but that’s about it. Depending how sore he is, he may do some exercises to strengthen other muscles around the hip and the quadriceps. Light range of motion exercises, like marching in place, will help Alex begin get normal movement back. Remember with an injury like this, even getting in/out of bed or the car can be really painful.
Transition to phase II of rehab usually happens when he can “adduct” his leg pain free in sidelying. Basically, he has to lay on the injured side and elevate his leg towards the ceiling – that shouldn’t hurt. He’ll start and/or progress some exercises to strengthen the muscles around the groin. From lack of use, those muscles will get weak and well, the stronger other muscles are, the better it is for the groin. He’ll probably get in the pool to do some light hip range of motion, walking, and side-stepping because in the pool, you’re in a more “weightless” environment so it’s easier on injured tissue. Phase II is usually a good time to start stationary cycling and some light stretching too. Once his gait is normal, pain is under control, and normal range of motion isn’t bothersome, he’ll start things like squats, step ups, etc. Those activities always start in a “straight ahead” motion first before moving to lateral movements. Once strength improves to around 75% and he’s not having any pain with daily activities, he’ll begin some light jogging, again only forward and backward first, and progress to more lateral and multi-directional movements. He’ll start working again on his flexibility in more challenging positions at this time too. Typically, he can start more “baseball-specific” drills once his strength is about 90-100% of his uninvolved leg. Understand that this is a very general outline of what might be done and how a progression might look. Several factors are taken into consideration when designing a rehab plan for an injury, particularly at the elite level he plays.
The key that most people need to understand about an athlete at this level is that while he may be physically ready, he’s going to need more time than the “average Joe” to get in game shape, get his timing back, get his confidence again, etc. Alex is clearly a team guy and won’t put himself out there if he’s not able to go 100%. That’s why we love him here in KC.
Is it really gonna take 8 weeks?
You bet. All of it. Would be very surprised if any sooner. That’s a tough injury for a guy that has to move as fast as he does and for how much ground he has to cover. Alex seems as tough as they come, so for him to be carted off last night, he must be really hurting.
We wish Alex luck. We know he’ll work his butt off to get back ASAP!
If you have a groin or any other muscle strain for that matter, look no further than the sports PT’s at SSOR to help you get back to what you enjoy doing. We’re confident our approach is unparalleled in the metro. It would be a privilege to serve you and partner with you in your care.