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Dave Siebert, MD
(Featured Columnist)
on November 8, 2013
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Chicago Bears fans received surprising but welcome news this week when ESPN's Jeff Dickerson tweeted that quarterback Jay Cutler will return to the field in Week 10:
Cutler is starting versus #Lions, per Trestman.
— Jeff Dickerson (@ESPNChiBears) November 7, 2013
Cutler tore a muscle in his groin back in Week 7. Fox Sports' Jay Glazer announced that doctors believed the injury would cost the signal-caller at least four weeks.
Two-and-a-half weeks later, he's already back.
Wait. What?
Let's take a closer look to figure out what happened.
Though precise medical details are not available, the original projection of at least four weeks suggests a Grade 2 groin strain.
Grade 2 strains are partial muscle tears. On the other hand, Grade 1 strains—the mildest type—represent stretching and microscopic tearing, whereas Grade 3s are complete muscle or tendon ruptures.
The hip adductors bring the leg back toward the body's midline. Credit: Wikimedia Commons.
An initial MRI likely showed significant inflammation in the area of one of the several muscles of the groin as well as a partially disconnected muscle body or tendon.
Following injury, a strained muscle brings about pain whenever a player activates it.
For instance, if a strain involves the iliopsoas muscle group, pain comes with hip flexion—or kicking the leg out forward.
In Cutler's case, according to CBS Chicago's Adam Hoge, he damaged a hip adductor.
An injury to one or more of the hip adductors produces discomfort when bringing the leg back inward toward the body's midline.
Very generally speaking, Grade 1 groin strains are a week-to-week injury. Grade 2 strains, however, usually require at least a few weeks of recovery—and often more.
With that in mind, how did Cutler beat his in less than three?
Hoge's report had some possible answers. He writes that, simply, as an NFL quarterback, Cutler has access to more recovery resources than most.
The first of those resources? Well, people:
Bobby Slater, the team’s director of rehabilitation, and Chris Hanks, the head athletic trainer, put in extra work, while Josh Akin, the team chiropractor, spent hours with Cutler every day doing soft tissue work.
More tangibly, however, are a few extra forms of treatment. Hoge continued, describing a technique known as ARP:
ARP stands for Accelerated Recovery Performance, which is a machine that breaks down scar tissue to allow increased blood flow to the injured area, thus accelerating healing time. The ARP machine is becoming more popular among NFL players, including Bears running back Matt Forte and cornerback Charles Tillman, who have used it in the past.
Blood flow is essential to the healing process, as blood transports healing cells and proteins. Tissues sporting relatively low blood flow—such as ligaments, cartilage and muscle tendons—heal more slowly than blood-rich tissues such as the skin or lightning-quick inside of the mouth.
Hoge also mentions Cutler underwent platelet-rich plasma (PRP) therapy.
PRP involves injecting a concentrated sample of the player's own platelets at the injury site. Many physicians believe the extra platelets—which carry many types of healing proteins—speed recovery from injury, though the efficacy of the procedure remains somewhat controversial.
Platelets, seen here amongst red blood cells and highlighted by blue arrows, carry many proteins crucial for the body's healing process.
Dr. Mark Niedfeldt, team physician for the Milwaukee Brewers and associate clinical professor of family and community medicine at the Medical College of Wisconsin, explained further to this author in February:
Platelet-rich plasma contains a more concentrated amount of platelets than whole blood. These platelets contain powerful growth factors and are fully functioning, complex coordinators of coagulation, inflammation and repair. Concentrated growth factors within the PRP work to initiate a healing response within the injured tissue.
In the end, the Daily Herald's Bob LeGere reported that Cutler went through a full practice on Thursday—suggesting minimal or no pain and weakness:
#Bears QB Jay Cutler went through a full practice with no restrictions.
— Bob LeGere (@BobLeGere) November 7, 2013
Which therapy made that possible?
If Jay Cutler remains healthy, will the Bears make the playoffs?
Yes; they will win the NFC North.
Yes; they will win a Wild Card.
No; they will not make the playoffs with or without Jay Cutler.
Submit Vote
vote to see results
If Jay Cutler remains healthy, will the Bears make the playoffs?
Yes; they will win the NFC North.
66.7%
Yes; they will win a Wild Card.
22.2%
No; they will not make the playoffs with or without Jay Cutler.
11.1%
Total votes: 9
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More than likely, a combination of all of the above is responsible.
However, returning to the field is the last step of the recovery process, so Sunday will be Cutler's final test.
If he can make it through the game without aggravating his groin, he may very well take the reins of the offense once again.
With the NFC North wide open, Bears fans are certainly hoping for nothing but.
Dr. Dave Siebert is a resident physician at the University of Washington. Find more of his written work at the Under the Knife blog.
For more sports, medicine and sports medicine, follow Dave on Twitter:
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