Saturday, July 05, 2014

The Brazilian star will miss the semi and the final too !!!

Sports and injuries go side by side. A player who does not sustain injury is a virtual player. Football player sustain numerous injuries. Most of the renowned players have undergone surgeries for their knees, ankles and wrist.  Ronaldo (BRAZIL) underwent 3 surgeries for his injured knee ligament. He was prone for knee injury as his body was disproportionate. In spite of repeat injuries he could push himself and compete with the world’s giants.  The other giant injured his ankle, Ronaldo (PORTUGAL). He had just recovered and was dragging himself to represent his country for this world cup. In general football players sustain lower limb injuries more than anything else. Toe injuries, ankle twisting, knee twisting, hamstring pull, muscles tear are few of the common injuries. Apart from these they have fair chances to sustain upper limb injuries, like wrist ligament injuries, finger injuries and shoulder elbow trauma while protecting themselves during landing.  Back injuries are not that common as they have good reflex to protect their back and they are trained to protect back during fall and landing. Football player prioritize and try to prevent knee and back injuries as they take longer to heal and require prolong rest and surgeries many times. Trauma and rest for a football player is a huge loss. It is a physical as well as a monitory loss for them.  So they are trained such a way that they pretend to fall and they hardly sustain injuries. They know how to protect various body parts during fall. But not all the time it works, and they too sustain real injuries. Let me concentrate to the injury that very few players have sustained so far. Most unlucky was Neymar who sustained this injury last night.
Spine injuries for the world rated player is a nightmare to the doctor and the player as well.  To examine, opine and treat such demanding professionals is a herculean task. No single surgeon or physician is ready to take up such challenges. That is the reason a group of physicians and surgeons are appointed to treat such players. The best in the globe are hired to treat the best in the world. But even for the best It’s a heart pounding task to decide to operate or not to operate.
Neymar sustained a direct knee thumping over his back by defender Juan Zuniga. Immediately he fell down.  This mode of direct thumping in the center of back results the fracture of spinous process of the vertebra. The direct injury in the side (off center) may result fracture of transverse process of vertebra.  But it requires more impact as transverse process is way deep and covered by muscles. It also results the hyperextension (backward bending) of the spine resulting the opening up of the anterior column resulting injuries of the ligaments of anterior column. This is what I feel Neymar has sustained. Other possibility of injury is hyperextension injury of his back while landing. This is high-energy trauma, which can cause more extensive injury than the previous one. This can virtually cause trauma to all the column (anterior, middle and posterior) of the vertebra. In that case his recovery will take a longer, as he might need surgery as well.
There are very few posts regarding his injury. The team of doctors first verifies these injuries and then they are circulated to the media. So Far he has been evaluated with X-ray and CT scan. CT scan was suggestive of fractures. This much was given to the media early morning. Few more details have been disclosed day time. The specific level of vertebra L3 is disclosed, the part that got fracture is the transverse process of L3. The associated injuries of ureter and kidney is to be seen in such cases. Probably he will be evaluated through MRI again and the injury details will be officially disclosed. That is what I believe the experts are planning.  The official doctor of the Brazilian team Rodrigo Lamsar says “ Unfortunately, he is not going to be able to play. He is very, very sad. It’s not serious in the sense that it doesnot need surgery, but he will need to immobilize it to recover” and the expected recovery period is few weeks….

With his statements what I can presume is  he has suffered a fracture of transverse process  of L3 and that is being treated conservatively with rest and immobilization. This is moderately a painful condition. The movement in the hip and lower limb will increase pain as iliopsoas muscle is attached to the fractured tip and that muscle in attached to the part of femur in the LT below hip joint. So initial few days will be complete rest to manage pain. Spine immobilization will be done by lumbar brace. A minimum immobilization of 6 weeks is an optimal time for such fractures to heal. Sometimes it takes a longer course and takes up to 12 weeks. In rare cases it fails to unite and stays ununited. But it does not require surgery.  By this time the ligamentous injury also heal. But, Does this mean he will be able to play after 6 weeks or 12 weeks in the worst case. The answer is a BIG NO. The immobilization and rest will waste his back muscles; his thigh muscles and entire fitness will be low. So he will take few more months to regain his fitness. I feel a minimum of 3-5 months will take to bring his form back. During this time he will miss couple of interesting games including the semi and possibly the final too.

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