Stevan Ridley: Understanding His Injury

From John B: The Summer of New GGN Writers continues. Ketul Shah is a certified strength and conditioning specialist and is studying physical therapy. If you are a fan of the New York Mets, you might recognize him from SB Nation's Amazin Avenue.

Since shortly after this site started, I have been hoping to find somebody with a background to discuss injuries and the recovery process. Today we begin this new series by looking at Stevan Ridley.

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Will Steven Ridley be ready for Week 1?

The newly signed running back began his Jets career on the PUP list (1) and the big question that is still up in the air is when we will see him on the field. This article will provide an overview of his injury and his road to recovery.

What is the injury?

In last year's Week 6 matchup against the Bills, the then-Patriot tore his ACL and MCL which prematurely ended his season. (2) The Anterior Cruciate Ligament and Medical Collateral Ligament are major ligaments in the knee that aids in stabilization of the joint during movement. The ACL prevents the tibia (aka shin bone) from moving too far forward while the MCL acts to prevent the knee from buckling inward.

(3)

Traumatic force, such as having a 300 lb lineman diving towards your knee to make a tackle, often results in ligamentous injures in the knee; in this case, the picture shows how the force from the lineman caused the knee to go inward, tearing the MCL. The impact was so great that the ACL was disrupted as well.

What did Ridley's recovery look like?

Fortunately, the Jets have a crowded backfield and can afford to have Ridley 100% before seeing the field. When one typically tears the ACL and MCL, ACL reconstruction surgery is delayed for about 6 weeks to allow the MCL heal. The MCL can heal successfully without surgery as the person will wear a knee brace and undergo physical therapy for pre-ACL surgery treatment. If the conservative treatment fails, then the orthopedic surgeon will likely repair the MCL surgically in addition to the ACL. Ridley likely took the conservative/nonsurgical route as the injury occurred in October and he underwent ACL reconstruction surgery in December. During this time before surgery, Ridley's physical therapy sessions involved exercises to improve strength and range of motion of the knee to minimize the post-surgical effects such as stiffness and atrophy.

An athlete can return to sport anywhere from 6-12 months after ACL surgery; the length is so varied because it is based on the type of sport, type of surgery done, the protocol used to rehabilitate that athlete, and the discretion of the physicians and coaches. There are several protocols out there and some are more accelerated than others. For the sake of this article, I used the ACL protocol from Massachusetts General Hospital to describe a brief summary of Ridley's recovery. (4)

Post-operative ACL rehabilitation occurs in 6 stages. The first three stages are within the first 3-4 months after surgery where the primary goals are to limit the swelling and start regaining the range of motion and strength of the knee. Range of motion is crucial in the early phases of recovery because it is tremendously hard to regain as the stiffness can become permanent. Ridley wore a knee brace and/or was on crutches to help get around and limit how much he bends his knees. After the first 2 weeks, he began to slowly wean off the crutches and return to a normal walking pattern. At about 6 weeks, the patient is weaned off from the brace and continues to focus on knee range of motion and strength of the muscles around the knees and hips to walk more independently.

These first few stages sound simple but anyone who underwent surgery can attest that this process is slow and painful. Physical therapists will act to gently stretch the joint as well as massaging the muscle to help increase the range of motion. In addition, they will mobilize the joint manually to further promote increased range of motion. Exercises gradually become more functional and work multiple joints opposed to only one muscle (as done initially); these include squats and balance exercises for example. Setbacks can easily occur at any stage if pushed a little too aggressively so physical therapists are slightly more cautious when proceeding from stage to stage.

The final 3 stages is when Ridley and other patients can begin sport-specific activities such as working on speed and agility, plyometrics and jumping, and cardiovascular endurance. The final stages do not start until full range of motion is restored, all of the inflammation and swelling has settled down, and the patient has enough strength to handle high performance exercises. This is a general timeline of landmarks physical therapists aim towards during ACL recovery.

Sports	Return		Activity	Weeks Post-Surgery
Normal walking/stairs	1-2 months		Running Slowly	12-16
Light individual sports	3-4 months		Return to sports practice	24-32
Running and jumping	6 months		Full return to sports	32-36
Contact/high performance	9 months

Bottom Line

When Week 1 comes, Ridley will be about 9-10 months from surgery and right at the point where he can complete high performance activities. As a result, I would not be surprised if Ridley starts the season on the PUP list given the depth the Jets currently have at running back. This would give him a lot of time to get back to game condition with confidence as the Jets return from their bye.

If however, he looks amazing (i.e. cuts well, demonstrates good stop and go speed, can break tackles/absorb hits, etc.) and gets off the PUP list during training camp, then I envision him back to his true form by mid/late September. In this case, he would be ready for Week 1but would be gradually eased into the mix as his conditioning and confidence returns.

References

1. http://www.ganggreennation.com/2015/7/29/9071519/colon-ridley-and-vickerson-start-camp-on-pup-list

2. http://www.nfl.com/news/story/0ap3000000410505/article/stevan-ridley-tears-acl-mcl-lost-for-patriots-season

3. http://www.boston.com/sports/football/patriots/extra_points/assets_c/2014/10/ridley%20knee%20injury-thumb-600x320-134654.png

4. http://www.massgeneral.org/ortho/services/sports/rehab/Anterior%20Cruciate%20Ligament%20Reconstruction(ACLR)%20protocol.pdf - PT protoco