Interview With Dr. David Geier: Arian Foster's Surgery Concerns

Arian Foster and Brian Cushing are two casualties of the 2013 season. Gain some knowledge on their injuries here. - Bob Levey

In order to gain some perspective on Arian Foster's injury and subsequent surgery, Battle Red Blog's David Corzo interviewed Dr. David Geier, a sports orthopedic surgeon and sports medicine specialist. Dr. Geier talked risks, recovery and shared some insights on the apparent outbreak of knee injuries in the NFL.

Dr. David Geier specializes in sports medicine and injuries. He's accumulated quite the pedigree throughout his career having worked with a variety of professional and non-professional sports leagues.. With Arian Foster's recent injury woes and trip to the Injured Reserve list, I thought some expert information was in order. I hopped on Battle Red Blog's private jet and flew out to Charleston, SC to talk with the good doctor. In a nearby French Quarter coffee shop, we chatted for a good five or six hours over beignets and Dr. Pepper while overlooking scenic Charleston Harbor. Read on for his answers to my questions:

(...actually I just emailed him, and he replied, but a BRB private jet DOES exist... maybe.)

1.) Last week it was confirmed that Arian Foster is done for the rest of the season. How did this happen? Does a bulging disc in the back develop and worsen over time or does it sprout up suddenly?

Bulging discs and herniated discs usually occur after a traumatic event, although athletes do not always remember the specific incident. Many athletes have bulging of one or more discs in their lumbar spines and don't have symptoms. If an athlete has a disc that presses on one of the nerve roots as it exits the lumbar spine, it can cause pain that shoots down the leg or neurologic symptoms such as numbness, tingling or weakness.

2.) We've heard some horror stories from some of our readers about the ineffectiveness of surgery on bulging discs-- what is your opinion of this? Any light you can shed?

"I had surgery on mine (bulging disc) last December. Should have left it alone."

"I am amazed in our era of "advanced medicine" how crude 90% of most back surgery actually is."

"I'm worried about the surgery because I know how often it makes things worse. I don't like the odds that we ever get Arian back. I hope he at least achieves a decent quality of life after the surgery."

To be fair, it is hard to group all back surgeries, or even disc surgeries, into one group. There is a difference in terms of effectiveness and outcomes for a single-level herniated disc with no degenerative problems of the spine compared to a disc surgery in a patient with significant degeneration or multi-level disease of the spine. Patient-specific factors, like age, weight, activity level, smoking status, and much more, influence results of surgery as well.

3.) What's the typical timetable for recovery and what are some possible setbacks for this kind of back surgery?

The timeline for recovery depends specifically on what the nature of the surgery needed is. For a straightforward surgery to remove the portion of the disc material that has herniated and is pressing on a nerve root, recovery might only require several weeks or months. A more extensive operation could require a longer recovery. Generally though, once an athlete has recovered from the initial surgical procedure, the surgeon usually allows the patient to start a stretching and strengthening program. If he progresses appropriately, he can gradually start jogging, and later he can start a return-to-play program. The length of that recovery varies depending on the severity of the surgery and other rehab factors specific to the athlete.

4.) Any personal experience in treating athletes with an injury like this?

I, like most sports medicine surgeons, do not perform spine surgeries. I have had a number of athletes in my practice that have had lower back and disc problems. I refer them to spine physicians or surgeons for their treatment.

5.) In your opinion, is there anything that can be done to prevent serious knee injuries in the NFL? Through October, 45 players have had their season ended because of torn ACLs alone. This year Brian Cushing tore his LCL on a low block, but, too often, players blow out a knee without any contact at all (like Reggie Wayne, for example). Is there any remedy for this for team trainers?

Most ACL injuries are actually non-contact injuries rather than the result of tackling by other players. There are different ACL injury prevention programs that involve players performing exercises before practices and games every day. These exercises are designed to improve athletes' landing and turning mechanics. The programs have been shown to decrease the rates of ACL injuries in some studies.

The aspect of knee injuries this season that has gained a lot of attention is the change in tackling thought to be result from the targeting rule. Potentially players could be aiming for the lower body to avoid hitting above the shoulders. We will need much more injury data in the coming years to determine if this is a real consequence of the targeting rule.

***

Big thanks to the doc for answering my questions. If sports injuries and the strategies to prevent them interest you, I highly suggest you check out Dr. Geier's website. He writes in depth about torn ACLs, the injury risks of Thursday Night Football, and more. Pretty cool stuff. Hopefully he'll be available to share some more insights in the future. Leave your thoughts and possible questions below.

Dr. David Geier has served as a medical consultant for the U.S. Women's Soccer team and is the head physician for many high schools and recreational sports leagues. A graduate of the Medical University of S. Carolina, he completed his residency at the Campbell Clinic in Memphis and a sports medicine fellowship at Washington University, where he served as team physician and assisted in the orthopedic care of the St. Louis Rams. His sports medicine interests include knee, shoulder and elbow injuries, pediatric and adolescent sports medicine, arthroscopy of the shoulder, elbow, and ankle, and sports injury prevention.

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