Our weekly NFL report this season evaluates injuries to players of local (Patriots, Giants and Jets) or national interest with commentary by the Bone & Joint Institute at Hartford Hospital’s sports orthopedic specialists.
Player: Rob Gronkowski, New England Patriots tight end.
Injury: Groin.
How it happened: Gronkowski appeared to suffer a groin strain during a 21-yard reception late in the third quarter during the Patriots’ 36-20 victory Sunday over the New Orleans Saints.
Expected time missed: Patriots Coach Bill Belichick declined to discuss Gronkowski’s injury when speaking to the media Monday, but Gronkowski is listed as questionable for the Patriots’ game Sunday against the Houston Texans. Gronkowski has an extensive injury history. In recent years, he has dealt with back (herniated disc, fracture), hamstring, knee (ACL tear) and arm (forearm fracture) injuries.
Dr. Clifford Rios, Bone & Joint Institute orthopedic surgeon and board-certified in sports medicine: “Having Gronk on the bike that early indicates likely a mild-grade strain. With the information available, I would expect him to be back for the next game.”
What is a groin strain (or pull): A muscle injury caused by sudden or forceful movement in the front hip that affects the primary hip flexor muscles or the hip adductor muscles (or, sometimes, both areas).
“The adductor (groin) muscles are a group of muscles that primarily adduct the thigh, or bring the thigh closer to midline (squeezing the legs together),” says Dr. Rios. “They are involved with lateral movements primarily, but also have activity with running straight. It will be important to test agility and strength with cutting and other explosive lateral movements prior to returning to competition.”
Groin strains are common in any sport that requires running and jumping. Hockey players are also susceptible to groin injuries.
The three degrees of groin strains:
Grade 1: Overstretched or torn muscle, damaging up to 5 percent of muscle fibers. It’s possible to walk without pain — perhaps contributing to Gronkowski’s “I’m good” comment to reporters after the game — but running, jumping, stretching and other “football activities” are truer tests of the injury.
How “good” for Gronkowski?
“I’ve seen athletes on the sideline who say ‘I’m good’ when they have a fracture,” says Dr. Rios. “Athletes would rarely disclose the full extent of an injury before the medical team has a full chance to evaluate them and make a diagnosis and treatment plan.”
Gronkowski called the injury “nothing serious” Monday and classified himself “day-to-day.”
Grade 2: More significant damage to muscle fibers caused by a tear. Walking might cause pain.
Grade 3: A tear through most or all of the muscle or tendon. The injury causes severe pain, immediately, and much swelling and bruising. Don’t even try running or jumping. The injury is so severe that you might actually feel the space where muscle fibers have been torn.
A groin strain can feel like a pop or snap when it happens, but later you might also feel pain when:
- Closing your legs.
- Raising a knee.
What might appear to be a groin strain deserves closer examination because the similar symptoms are caused by bursitis of the hip, a hip strain or a stress fracture.
Recovery/Treatment: A mild groin strain might require three weeks of rest. A more serious strain could take up to six weeks. A complete tear would require surgery and up to three months’ recovery. There’s some speculation the Patriots will request an MRI to confirm a mild-grade strain.
“An MRI can provide some objective evidence regarding the extent of the injury, but is not typically necessary for every muscle strain,” says Dr. Rios. “If an athlete can get up and bear weight with minimal or no assistance, this is a good sign that the injury may be more mild. An athlete who cannot put weight on the injured leg may have a more severe injury.”
How much time missed often depends on treatment. A standard regimen includes protection, rest, ice, compression and elevation, or P.R.I.C.E.
A closer look:
Protection: Don’t aggravate the injury. A Grade 2 groin strain might require crutches.
Rest: Let the injury heal. It takes time.
Ice: Ice reduces swelling and lessens pain. Treat the injury for 10 to 15 minutes, skin protected, pause up to two years, then apply ice gain. For profession athletes, a cold-therapy machine provides consistent cold temperatures for deeper penetration into damaged tissue and active compression that aids recovery.
“Icing is important, and will be part of the treatment,” says Dr., Rios, “but mobility is good for muscle recovery too. The muscle will want to tighten up after an acute injury and early motion can help with the recovery process.”
As treatment progresses, with reduction in pain and swelling, heat (either moist or dry) replaces ice as rehabilitation shifts to regaining strength and range of motion. Heat applied for up to 15 minutes increases circulation to the affected tissue, increasing tissue extensibility. With renewed flexibility, you can begin stretching exercises.
When full range of motion is restored, you can begin functional exercises for the hip, such as lunges and wall squats. In the final stage of recovery, the athlete resumes exercises related to his or her sport.
Dr Clifford Rios, a sports medicine surgeon with Orthopedic Associates of Hartford, is Site Director for orthopedic resident education at the Bone & Joint Institute. Click here to find out why the Bone & Joint Institute is the athlete’s choice, with a Motion Lab for performance analysis, the area’s most comprehensive sports rehabilitation facility and 30 fellowship-trained orthopedic surgeons.