DERRICK ROSE: IS HE INJURY PRONE or IS HIS REHAB LACKING?

Since the latest Derrick Rose knee injury, people have been questioning whether he is injury prone or is someone missing something during his rehabilitation/recovery.  Myself and Joe LaVacca PT, DPT from Perfect Stride Physical Therapy in Manhattan, New York worked together to create a blog post about the history of Derrick Rose’s knee injuries and possible reasons for the continued complications.

Let’s start from the beginning.  The initial ACL tear occured during landing after performing an explosive move to elude defenders.  Upon final contact with the ground, the knee “buckled” resulting in tear of the anterior cruciate ligament.  I believe the way Derrick Rose played and the amount of force he was able to generate played a role in the initial injury.  For someone who is around 6’2” tall and being able to produce so much force in order to get to the basket, elude defenders, and make spectacular plays eventually took a toll on his body’s structure.

As for the initial meniscus tear, I believe the tear was all ready present and finally showed up during competition.  Basketball is about being able to change speeds and direction quickly.  Occasionally a basketball player’s foot is going to be away from his/her center of mass and when he/she is trying to create increase levels of force, that places the body at a disadvantage.  The surgery of the initial meniscus tear was a meniscus repair in order to hopefully minimize the potential for long term effects of bone on bone degeneration (arthritis) and allow the shock absorber (meniscus) to still be present.  That was the reason Derrick Rose was out for the remainder of that season.  As a result of the meniscus repair, an individual is usually non-weight bearing for the first 6 to 8 weeks.  This allows for adequate healing to take place and eliminates increase stress from weight bearing.

With this latest injury, the likelihood of re-tearing was high secondary to the level of activity Derrick Rose wanted to return to.  He knew re-tearing was a possibility, but being conscious about his health, he opted for repair the first time to decrease chances of severe arthritis.  This time around, a menisectomy was performed which removes the portion of the meniscus that re-tore.   This allowed Derrick Rose to start rehabbing right away secondary to no weight bearing restrictions.  The three primary reasons people usually get re-injured are:  Previous injury (check!), Asymmetry (possible), and Altered Motor Control (which based on the way he has injured himself we can likely assume).  As mentioned the level of competition Derrick was returning too is associated with high risk – this year alone over 20 players have suffered season ending injuries however we usually only hear about them if they are “high profile” such as Rose.  What I feel should be added as a 4th reason players (and patients) get re-injured is decreased psychosocial readiness.  Derrick received a lot of heat when he opted to remain “on the bench” despite being cleared by the medical staff of the Chicago Bulls, however readiness to return to sport and psychosocial impact is directly linked to sport performance and re-injury.  Utilizing such tools as the TSK-11 or PRRS can be an excellent way to determine if the athlete feels as mentally ready as his “objective” measures in the clinic.  

The only part I question is what is being concentrated on as Derrick Rose returns to higher level activities.  Once cleared to begin more jumping, landing, sprinting, and cutting, is emphasis placed identifying the weakest link and building from the foundation up?  Is time spent working on landing mechanics, improving lateral stability, single leg balance, and etc. to optimize his return to sport and decrease chance of injury?  One would think and believe that one of the most storied franchises in all of sports is not utilizing mediocre care or Physical Therapy/Orthopedic services yet I frequently read blogs and comments on social media on how many of my fellow therapists are convinced they can do a better job.  While we would all like to try, I have/need/want to believe that the Chicago Bulls PTs realize that the knee is connected to the ankle and the hip. – although we never truly know.  The other aspect of his care is how much of it is really in the control of the healthcare professionals?  We saw a 30 second Adidas commercial where it looked like Derrick was working pretty hard, but when dealing with egos, sponsors, entourages and who knows what else things could get complicated.  Are you willing to face the music when the franchise player of the Chicago Bulls says YOU “hurt” him?

Even though no one can prevent injuries, measures can be taken to decrease the likelihood of injury.  In part 2, Joe from Perfect Stride Physical Therapy will post a blog highlighting some exercises used for improving overall stability for return to sport and tests/measures used to quantify return to sport.

 

References:

Arden, Clare, et al. “The Impact of Psychological Readiness to Return to Sport and Recreational Activities after Anterior Cruciate Ligament Reconstruction.” British Journal of Sports Medicine (2014): n. pag. Web. 20 Mar. 2015.

Jeffrey, Roelofs, et al. “Fear of Movement and (re)injury in Chronic Musculoskeletal Pain: Evidence for an Invariant Two Factor Model of the Tampa Scale for Kinesophobia.” Pain 131 (2007): 181-90. Web. 20 Mar. 2015.​