Dr. Mandy Huggins Armitage

Thoughts, musings, and a little bit of education from a female physician in the Sports Medicine world.

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Why I’m boycotting ESPN. For now.

I never thought it would come to this. I always flip to ESPN because the news is too depressing. I’ve been a subscriber to The Mag for as long as I can remember. But the time has come. I’m sick of yelling at the TV, “I don’t care! Move on!” I’m boycotting ESPN because I’m over it. I’m SO sick of hearing about A-Rod. The Hernandez investigation. Ryan Braun. And now Riley Cooper. Hey SportsCenter, isn’t there anything else you should be sharing with us right now? Or are you having too much fun beating a dead horse?

It seems that ESPN has a fetish with bad dudes. And dudes the rest of us don’t care about. A-Rod? Not a good guy. Ryan Braun? Bad dude. Hernandez? Clearly a bad dude. Mark Sanchez? Don’t care. Tim Tebow? Don’t care. You get the picture. Why are these names consistently shoved in our faces when we really don’t give a crap?!? I don’t care that police are searching that lake in Connecticut again. I don’t want to hear about his violent past. It just reminds us how many people turned a blind eye for the sake of winning. Just tell me when it’s over; tell me that (hopefully) justice has been served and he’s in jail for life. Can you imagine what Odin Lloyd’s family goes through, seeing Hernandez get so much media attention day after day? It makes me sick.

Alex Rodriguez. Please just go away! No need for a rant here, so suffice it to say I’ve never been a fan. I really, really don’t care what his lawyers are planning or who he bought off. Just tell me when it’s over. Ryan Braun? He let a ton of people down and tried to blame everything on some poor lab employee. Shameful. I’m so sick of hearing about millionaire athletes acting like dummies (Justin Blackmon, Yovani Gallardo, Gilbert Arenas: I’m looking at you). I want to hear about professional athletes acting like professional athletes and being good role models. Why don’t we hear more about Drew Brees’s foundation? No, we have to focus on the tip he left at a restaurant last week. What about this awesome story about Roger Federer? Can’t we get an update on Steve Gleason or Johnathan Taylor? No? Marcus Vick’s tweets are way more important? Oh, my bad. Seriously, ESPN you make me sick.

It also seems that ESPN doesn’t know when to quit. Tebow “mania” would have never even been “mania” in the first place if it weren’t for ESPN. Kaepernick wants to wear a Dolphins hat? Good for him. We shouldn’t care, and we definitely don’t need to hear hours of “expert” opinion on it. And Johnny Manziel. Poor thing. He’s a young college kid with too much attention; let’s get over it and move on. If I were him, I’d drink, too.

Will my boycott last? We’ll see. I’m sure I’ll tune in again in the near future. Especially because it’s going to be difficult to get my Colts fix while living on the west coast (yes, I did get sick of hearing about Peyton Manning’s neck injury, too, thank you.). So I’ll watch for a while and then be disappointed all over again during the NBA playoffs next year when ESPN gives the Pacers a whole 2 seconds of exposure. Sigh.

Injury report – Kobe Bryant

Last night, Kobe Bryant reportedly tore his Achilles tendon. According to reports, he will undergo an MRI today to “confirm the diagnosis,” although this isn’t really necessary. There aren’t many other injuries that can be confused with an Achilles rupture. Here’s the lowdown:

The Achilles is a large tendon that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It is the thickest and strongest tendon in the body. Achilles tendon ruptures occur more commonly in men between the ages of 30 and 50, and up to 75% of them occur during sport or activity. Some may comment that Bryant did not previously have any trouble with Achilles, but this is often the case with this injury. Achilles ruptures can be treated surgically or conservatively, and there is ongoing debate in the literature about which method of treatment is better. That being said, professional athletes typically undergo surgical repair because it is thought that surgery offers a lesser chance of re-rupture (although there’s a higher complication rate). Most athletes take around 8-9 months to fully return to sport after this injury, but I wouldn’t be surprised if Bryant aims for 6. He wouldn’t entertain the idea that this injury is career-ending, and I agree that it is way too early for that speculation, even if he is 34. This is Kobe Bryant, after all. However, it should be pointed out that it is extremely difficult to get that “push-off” strength back, which is critical in his game. Here’s to a speedy and uneventful recovery for the Black Mamba.

Wait… medicine isn’t like Grey’s Anatomy?

As I was watching one of my favorite shows, Nashville, last week, yet another TV medical error presented itself on TV. The daughter of one of the main characters sustained a head injury at a concert and was taken to the local hospital. When the parents arrived at the ER, they were told, “We’re going to get a CAT scan, just to rule out a concussion.” AARRRRGGHHH. Okay, a) nobody calls it a “CAT” scan, b) the CT does NOT “rule out” a concussion and c) can’t these billion-dollar networks hire a medical consultant already?!? Similarly, in a recent episode of Dallas, Pamela was treated by a physician who was miraculously an obstetrician AND vascular surgeon! Wow, talk about a lifetime of training for that lady. That’s impressive.

I’ll admit, I love watching some drama. Forget those idiots on reality TV, give me fiction any day! But part of the reason that I watch these non-medical dramas (Nashville, Dallas, Scandal) is because there’s little chance I’ll be frustrated by medical inaccuracies. Recently that reason has gone out the window. I’m guessing this happens in other professions, for example, lawyers changing the channel 10 minutes into Law & Order. But why don’t the shows care to fix it?

Back in the day, my med school roommates and I would watch Grey’s Anatomy every week. It didn’t take long before we were pointing out the mistakes. “They never wear eye protection in the OR!” or “That resident would so get fired for that in real life!” We also wondered if there was really that much sex in the residents’ call rooms. The show provided lots of drama, yes, but it was also completely inaccurate most of the time.  So the neurosurgeon is now performing heart surgery? Sure. Insert eye roll here. I finally stopped watching the show after Meredith miraculously recovered in 5 minutes after being unconscious, intubated, and on a ventilator for days (maybe even weeks? I can’t remember) after some traumatic event. No amnesia, no grogginess, no cough, no sore throat. Oh, and her eye makeup still looked great. This wouldn’t happen in real life, people!

Listen, I get it, it’s not a big deal. Most people aren’t paying attention to the details. But I am. And to that, I say: hey, Hollywood. I’m more than happy to help. Just call me.

Quick workout tips

“I don’t have time to work out.” Have you said this before? Do you say this on a regular basis? If you answered yes or “ain’t nobody got time for that!” please keep reading. I’d guess that most of us are “too busy” to (fill in the blank). Here’s the thing: if you want something badly enough, you’ll try to make it happen. Here are some tips to help you squeeze in a little bit of fitness into your busy schedule.

  1. Push-ups. These can be done practically anywhere and become easier to do with practice. I personally like to do about 10 push-ups as a pick-me-up if I’m struggling. Is 2:30 pm rolling around and you feel like you need a nap? Skip the gimmicky 5 hour stuff and do some push-ups. You’ll thank me later.
  2. Planks and side planks. Great core work can be done anywhere.
  3. Take the stairs. Yes, I know, you’ve heard this before. So do it! Not only is it terribly lazy to take an elevator up one or two measly flights (pet peeve, sorry), but it’s a waste of time. If you truly don’t have time to get to the gym, at least walk up a few flights of stairs.
  4. Walk. Oooh, groundbreaking! Seriously, think of ways to increase your walking. In a new city? Walk instead of taking a cab. Running errands? Park as far as you can from the store’s entrance.
  5. Consider exercising at home. You can save a considerable amount of time (and money!) by sweating it out at home. Think about the time it takes to drive to the gym, change in the locker room, talk to people that think gym time is social hour, etc. I’m not going to advocate for particular workout, but there are some great workouts available on DVD. People commonly say they won’t have enough motivation to work out if they don’t leave the home. Again, if you want something badly enough…
  6. If you’ve got a few free minutes, try any of the tips below. Doing something is always better than doing nothing. Or as my husband would say, “at least you’re not eating!”

Say you’re out of town and the hotel charges some ridiculous fee to use their fitness room, or maybe it’s just too crowded. I once attended an annual conference of a sports medicine society and had this problem. It’s no surprise that sports medicine docs are pretty active, but when they all get together, that makes for one crowded hotel gym. In that case, I recommend stealing your favorite parts from various workouts to make your own hotel room-friendly workout. So the hotel floor might not be the cleanest, but you’re going to shower afterward anyways, right? Here are some examples:

Toning:

  1. Push-ups.
  2. Planks and side planks. Length dependent upon your fitness level and experience with this.
  3. Bird-dogs. On all fours, extend your right arm and left leg and pause before returning to starting position. Repeat.
  4. Tricep dips. These can be done if you find a stable ledge or chair – be careful not to tip.
  5. Tricep push-ups. If these are too hard for you, start with your knees on the ground.
  6. Arm circles or pumps. If you don’t have free weights, it’s a little more challenging to work the shoulders. Performing multiple reps of arm circles or pumps (small up and down movements) will really get those deltoids going.
  7. Squats. It helps to hold weight, but they are still effective if you don’t have weights. If they get too boring or easy, try adding pulses in the lower half of the squat. Also try turning your feet out and widening the squat to get the inner thighs.
  8. Wall squats. Think high school volleyball or basketball practice. Sit with your back against the wall, ankles and knees bent no more than 90 degrees. Sit. Sweat. Curse.

Cardio:

  1. Burpees. From a standing position, squat down and put your hands on the floor. Jump legs back to plank position. Jump back in. Jump up with arms overhead, land softly. Repeat.
  2. Squat jumps. From a slightly squatted position, jump up with arms overhead, land softly. Repeat.
  3. Lunge jumps. Start in a lunge with the right foot forward, making sure your right knee does not go past/over the right foot. Put your hands on your hips or over your head if you’re up to it. Jump while switching legs. Repeat.
  4. High knees. Run in place, trying to bring your knees as high as your hips. Don’t lean back; use your core to raise your knees.
  5. Jump. Simple, right? Mix it up by jumping side-to-side or forward and back over an imaginary line. Try incorporating jabs with your jumping. Jumping jacks are also an option.
  6. Stairs. Walk or run. Try two at a time if you want. But first, make sure you won’t get locked into the stairwell J
  7. Squat slides. Sit in a squat and shuffle 4 (or more, as room allows) steps to one side and 4 to the other. There is probably a better name for this, but whatever you want to call it, it works.
  8. Add music! It will make a world of difference in your workout. Just try not to move when you hear this.

Granger misses 55 games… and counting

What’s up with Danny Granger’s left knee? It seems to be a big question in Indy, and Granger’s not talking. He has missed over 50 games this season with a left knee injury and his recent return to play was cut short due to lingering “soreness.” The frustrating thing (for me, anyways) is that a google search reveals very vague news reports (seriously, “knee injury?” Can you be any less specific??) and very little detail about this supposed injury. From what I can gather, Granger is suffering from patellar tendinopathy, which is an overuse injury. It affects the tendon that runs between the patella and tibia. It’s common in jumping sports and can be a frustrating injury because it can linger. It’s unclear to me what kind of treatments Granger has had for this injury, but I wonder if he’s had PRP, FAST, or any other treatments that professional athletes commonly receive for tendon injuries. Chronic tendinopathy is difficult to treat and does not respond to just rest and ice. One would think that his absence was long enough, but because he continues to have pain, he may not have been ready to return when he did. Reportedly an MRI earlier this week was normal, but that doesn’t mean much. Tendinopathy is better assessed with ultrasound, while MRI is better for injuries such as meniscal tears and ACL ruptures. I’m guessing that the Pacers’ staff knows what it’s doing and chooses not to discuss things like ultrasound, tendinopathy, and injection treatments. After all, more familiar terms like “knee injury” and “MRI” are more readily accepted and understood. Fortunately, the team is doing just fine without Granger. As a fan, I’d like to see him get healthy and return, but I’m happy that PG, West, and company aren’t missing a beat in his absence.

RGIII’s injury – who’s to blame?

There’s been a lot of talk about RGIII’s knee injury lately. And I mean A LOT. There are differing opinions, as always, but I’d like to remind everyone that in controversial situations like this, we never really know the whole story. And when I say “we,” I mean sports fans. Sure, we watch the press conferences and follow it all on Twitter. But we really don’t know what happened between the athlete and his physician and coach or what was going through his mind. So should we point fingers? It’s certainly easy to do so. Many folks are blaming Coach Shanahan for gambling with RGIII’s health for the sake of a game. How much did he know about the knee injury? We can only go on what he tells us. Dr. Andrews has made comments about feeling uneasy about the injury, but he also says he didn’t get a chance to evaluate the knee before RGIII put himself back into the game. The athlete himself admits to wanting to be out on the field regardless of the injury, so is it all his fault?

It’s important to understand that if the athlete is not completely disabled by an injury, these discussions about “in or out” tend to happen quickly, if at all. It’s not like the game stops and everyone has a little conference on the sideline. Ideally, yes, we’d like that to happen. In reality? No. If the athlete thinks he can play, he’ll do his best to escape the medical team and/or the coaches, and just run back in. (I learned the hard way that this is why you take his helmet away when you tell him he’s done for the day.) We’d like to think that RGIII was smart enough not to risk his own physical health for the sake of playoffs, but we’re not in his shoes. Right now we’re waiting on reports from his visit with Dr. Andrews, since the MRI was apparently not very helpful in assessing the integrity of the ACL. I just hope that whatever they decide, we see RGIII return to the game. He is incredibly fun to watch, and if he stays healthy, he’s got a lot more football left in him. But it worries me that he continued to play through his injury, and we would all hate for this to be career-ending. Hopefully that won’t be the case, and we can all return to happily placing blame on Twitter and blogs.

NFL injury report – week 15

Dr. Mandy Huggins’ Medical Analysis

San Diego Chargers RB Ryan Mathews unfortunately suffered yet another injury on Sunday, this time a left clavicle (collarbone) fracture. As you may recall, he suffered a fracture of the right clavicle during the preseason. Clavicle fractures are classified by location of fracture: distal (outer) third, middle third, or proximal (closer to the midline) third. The location of Mathews’ fracture has not been reported, but it is most likely in the middle third. These fractures occur with direct trauma or after a fall onto the shoulder and are very painful. Localized pain, swelling, and a deformity (bump) are seen, and x-rays confirm the diagnosis. Unless the ends of the bone are significantly displaced (do not line up with one another), most clavicle fractures heal fairly well in 4-6 weeks. There is a period of immobilization, though, to allow the bone to heal back together. Needless to say, Mathews will be out for the remainder of the season.

Alicia Jessop’s Contract Analysis

Matthews was signed to a five-year deal by the Chargers in 2010.  Matthews’ contract is worth $25.65 million contract and includes $15 million in guarantees.  The good news for Matthews, thus, is that a significant portion of his contract is guaranteed, so he arguably will not be hurting financially.  The bad news, though, is several things.  First, the bulk of Matthews’ base salary in his contract comes in the 2013 and 2014 seasons, where he’ll earn $1,195,500 and $1,478,250 in base salary, respectively, on top of other bonuses built into those years.  Thus, it is of utmost importance that Matthews fully rehabs so that he can come back in 2013 and play through 2014.  Additionally, another issue is that his continuous bouts with injuries may hurt his earnings potential moving forward.  Matthews was targeted as being the “heir apparent” for LaDainian Tomlinson.  If he continues to be dealt the blow of injuries though, he may not surpass L.T.’s career success.

“Concussion-like symptoms”

While watching Sports Center this morning, the bottom line caught my eye (as it usually does). I saw that yet another professional athlete will not be playing tonight due to “concussion-like symptoms.” Insert eye roll here. I’ve seen this over and over again, but I have no idea why it continues. What exactly are concussion-like symptoms? And how are they different from symptoms of a true concussion? If you’re saying to yourself, “I really don’t know… it doesn’t make sense,” I would have to agree with you! Here is my point: if an individual suffers a head trauma, no matter how mild, and subsequent symptoms (headache, dizziness, confusion, etc.), that person has a concussion. Not concussion-like symptoms. Not an unspecified head injury. Not anything else that sounds incredibly vague. You cannot have “concussion-like symptoms” without having a concussion. Call a spade a spade and quit confusing people already.

Just my 2 cents. Thanks for reading.

NFL injury report – Fred Davis

The post below was originally written for Ruling Sports. Each week, sports lawyer Alicia Jessop and I evaluate an injury sustained by an NFL player. My role is to explain the medical aspect of the injury, while Alicia breaks down the potential contract ramifications for the player.

Dr. Mandy Huggins’ Medical Analysis

One of the more notable injuries recently in the NFL was that of Fred Davis, tight end for the Washington Redskins. He reportedly ruptured his Achilles tendon in the first quarter while running a route into the end zone.

The Achilles is a large tendon that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It is the thickest and strongest tendon in the body. Achilles tendon ruptures occur more commonly in men between the ages of 30 and 50, and up to 75% of them occur during sport or activity. It has been reported that Davis did not previously have any trouble with Achilles, which is often the case. These injuries can be treated surgically or conservatively, and there is ongoing debate in the literature about which method of treatment is better. That being said, professional athletes typically undergo surgical repair because it is thought that there is a smaller chance of re-rupture. Davis had surgery in Charlotte to have his Achilles tendon repaired. Although early mobilization after surgery is more commonly encouraged these days, a full recovery will still require months, so he will not return to play this season.

Alicia Jessop’s Contract Analysis

A season-ending injury is never welcome news for an NFL player or his team.  This season, because of the franchise tag, Davis will earn his fully guaranteed salary of $5.446 million.  Davis and the Redskins were unable to reach a long-term contract last off-season.  As such, at the end of this season he will become an unrestricted free agent at the end of this season, unless the Redskins use the franchise tag on him again.  Therefore, Davis must zealously rehab and show commitment to coming back from injury.  If he is able to do this, it is likely that another team will pick him up next season.

NFL injuries

The post below was originally written for Ruling Sports. Each week, Alicia Jessop and I evaluate an injury sustained by an NFL player. My role is to explain the medical aspects of the injury, while Alicia, a sports lawyer, breaks down the contract ramifications of the injury.

Dr. Mandy Huggins’ Medical Analysis

In week 1 against the Patriots, Titans QB Jake Locker dislocated his left shoulder after attempting to make a tackle. In week 4 against the Texans, Locker went down again with yet another left shoulder injury. According to NFL.com, he sustained the same injury, a dislocation. Fortunately for Locker, his left arm is his non-throwing arm, so there is a good chance that this won’t need immediate attention. However, it is yet to be determined if he’ll be back in time for next weekend’s game against the Vikings.

To put this injury in simple terms, let’s think of the shoulder as a “ball and socket” joint. The top of the arm, or the humeral head, is the “ball” while the “socket” is a bone called the glenoid. The glenoid is actually part of the scapula, or shoulder blade. When imagining the “socket,” think of a golf tee because that’s how shallow it is. There are many ligaments, tendons, muscles, and a capsule around the joint to keep it from slipping out of place. However, with trauma, the shoulder can dislocate, or “pop out,” as people like to say. If little time passes between the dislocation and evaluation by the medical team, the shoulder can usually be reduced, or put back into place, as was the case with Locker after he left the field Sunday.  It’s not a pain-free procedure.

Although dislocations can be reduced, it is important to remember that damage can occur to associated structures. These include fractures of the humeral head (arm bone) or the glenoid. It is also possible to sustain a tear of the labrum, which is a piece of cartilage that lies on the “socket” side of the joint. The need for surgery usually depends upon these associated injuries after a dislocation or recurrent dislocations. The younger the patient, the more likely the shoulder is to dislocate again, and instability ensues. Depending upon how bad Locker’s symptoms are, and whether or not he’s experiencing significant instability in the shoulder, he may or may not need surgical intervention sooner versus later. That definitely would not be the case if we were discussing his throwing shoulder, so in that regard, he’s lucky.

Alicia Jessop’s Contract Analysis

As Dr. Huggins pointed out, Locker is incredibly lucky that his throwing shoulder was not injured.  However, it is disconcerting that he has now injured the same shoulder twice in one season.  Given that his non-throwing shoulder was injured, it is unlikely that this injury will have any serious contract ramifications in the near future, so long as he makes a full recovery.  However, it is possible that future contracts may include an injury exception for injuries sustained by Locker to his left shoulder.  If such an exception is placed in Locker’s contracts going forward, if he were to sustain an injury to the left shoulder that prevents him from playing, he would not receive his salary for those games.  Given that he has now injured the same shoulder twice in one season, it is likely that teams will demand this waiver from Locker going forward.