Cleared to Play

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00:00And I think before we even bring Doc Feeley on, we should let everybody hear a little

00:04bit about what Kyle Shanahan said on the conference call today.

00:07That's a good idea.

00:08Right?

00:09Because we're all looking for more information on how did we get here and where do we go

00:13from here.

00:14So Kyle Shanahan, why was Christian inactive?

00:18Just the same stuff that was bothering him all week.

00:19There was a little too much today.

00:21Game time decision.

00:22He came in, just talking to him about it.

00:24It was still there.

00:25Thought it was going to be smart to keep him out and glad we did.

00:28Okay.

00:29And that is from last night after the game.

00:32Conference call today.

00:33Update on CMC's calf.

00:34Well, yes.

00:35I believe they're similar.

00:36I know it was a calf then and it's a calf now.

00:38You guys could ask Christian more on that.

00:40Definitely.

00:41I believe if it was a playoff game, he would have played.

00:45You know, but when you, you know, it's not just the calf, it's the Achilles and, you

00:49know, the Achilles is tendonitis and that stuff comes and goes.

00:52And when it is acting up, somebody's got to be very careful about, Christian's very diligent

00:56about that stuff.

00:57And if it was a playoff game, you know, he made it very clear to me that he believed

01:03he could go.

01:04But when you hear that type of stuff and it's not a playoff game and it's week one, and

01:08especially when you're dealing with the lower extremities like that, it was a tough decision.

01:14But hearing all the words and stuff in the long run, it made it easy.

01:18Okay.

01:19Achilles tendonitis.

01:21That's not good.

01:22It's not good.

01:23And it's the first time we've heard that term, right?

01:26So let's dive into it.

01:28And we're, we're excited to, not about the injury, but, but to, to, to have this definition

01:35about it to the river islands, gas line cleared to play, take you inside the tent, get you

01:40updated on the latest injuries in the Bay and proud to partner with UCSF health on this

01:44segment and bring in Dr. Brian Feeley.

01:47Hey doc, how you doing?

01:48What's going on?

01:49Good.

01:50How are you guys?

01:51We're, we're, we're good.

01:53It's a, it's a victory Tuesday, but let's talk Achilles tendonitis.

01:57What does this mean for Kristen McCaffrey and the Niners?

02:01You know, I really don't think it means all that much different than what we were thinking

02:05the week before.

02:06If it was a calf strain, if you look at, I think the best comp for a backfield player

02:11for a calf strain was Joe, Joe burrow last year, he was out for the entire preseason.

02:16He came out and he started slow.

02:18When you have a calf strain that's kind of on the inside of your calf at the top part

02:24of your Achilles, when you have Achilles tendonitis, there's a whole spectrum of problems

02:29that that can be.

02:30It can be very mild to you can't put weight on it based on how he's been practicing.

02:36This is probably more on the mild side and they're being conservative on being able to

02:41keep him out knowing that they have a good back backup and he's got an incredibly long

02:45season.

02:46And I don't think it's honestly all that controversial to say that Jordan Mason might have been told

02:50he was a starter and that McCaffrey was probably hoping he was going to play up until the last

02:56minute and then the decision was made.

02:59He's not going to start.

03:00He's not going to play just out of an abundance of caution.

03:03And the abundance of caution does not necessarily indicate a severity of injury, right?

03:08Tendonitis does not necessarily portend to future traumatic injury.

03:14No, tendonitis in many ways the calf strain is going to be just as bad if not worse than

03:19the Achilles tendonitis.

03:21It really just depends on the severity of the tendonitis.

03:24All it really means is there's inflammation along the tendon, which as a 28 to 30 year

03:30old running back with a lot of mileage, it's kind of expected he's going to get that at

03:34some point during his career, if not this year, next year.

03:38So I don't think it's the big deal.

03:39He's going to get a lot of treatment for it.

03:41I think it's important for him to be able to limit his reps during the season.

03:45I think we've seen that in the last couple of years.

03:47He's somebody that does a great job at a certain number of reps.

03:51And then if we have a suitable backup, that's even better.

03:56Doc Feely is with us.

03:58If he's been dealing with this since late in the regular season last year, why has it

04:04not gotten better?

04:06How does it get better?

04:08Yeah, so the problem with any of the tendinopathies in the lower extremity, whether it's your

04:14quad tendonitis, patellar tendonitis, or Achilles tendonitis is once it's there, it tends to

04:20just kind of linger often up to one to two years.

04:24The reality is, is it does not seem to increase your risk of a traumatic injury.

04:28So it doesn't seem to increase the risk of getting an Achilles tendon rupture, which

04:32is really what you want to avoid.

04:34But it does make it annoying to plan.

04:36You cannot plant and push off quite as hard.

04:39You don't have quite the amount of explosive ability.

04:43The problem is there isn't a magic cure for it.

04:46It's not like you wear special shoes, there's no special injection.

04:49You essentially just have to do the stretching, the conditioning, and work your way through

04:54it.

04:55And if he's not feeling perfect, you hold him out.

04:58And part of that feeling, does it get exacerbated or made worse when you have to play on an

05:03artificial surface as opposed to grass?

05:06Yeah, I think that's a really good question.

05:09And I think we know we, Dr. Pandya and I just published a paper that showed that the lower

05:15extremity injury rate is higher on turf than it is on grass.

05:19And if I'm playing in on turf next week, early in the season, I'm probably going to be a

05:26little bit extra conservative because I think it is a little bit riskier and it hurts a

05:30little bit more.

05:31Grass is softer.

05:32Doc, I wonder this.

05:34I think Bay Area sports fans are really triggered by this because of Kevin Durant.

05:39Are we talking about a similar situation where this is a precursor to something serious or

05:44is it different?

05:46So there's no proof that this is a precursor to something serious.

05:50So when you look at the literature, does Achilles tendonitis lead to an Achilles tendon rupture?

05:55There's no proof for that.

05:57The problem is in the literature means you're looking at the average normal person with

06:02Achilles tendonitis and Achilles tendinopathy.

06:06We're not talking about people that are seven feet tall and jump for a living or six foot

06:12one, 195 pounds and run through a defensive line.

06:16So I think in general, we can assume that it's low risk that he's going to get a more

06:21serious injury, but we can't rule it out just because the demands on the professional athlete

06:26at this level are so much higher than what we typically understand for everyday people.

06:31Doc, I don't want to ask you to speculate, but based on everything we're talking about,

06:36what do you think the chances are that Christian McCaffrey, whether it's week two, week three,

06:43week four, whatever, when he gets going, what are the chances of him being a 25 touch per

06:50game player for the full season?

06:54Well, by definition, he's no longer for the full season, but I think he'll probably be

06:59able to for the rest of the season once he starts.

07:02I think when you look at his usage rate last year, he was 18 to 22 touches a game, maybe

07:08up to 25, 28 carries for Jordan Mason was the most Kyle Shanahan player has ever had

07:14in a game.

07:15So ideally you have them in the 15 to 20 and I think that's totally reasonable.

07:21I think the other nice thing is as soon as you put him out there, even if he's not the

07:25first, second or third option, he's a decoy because he's so good.

07:29So I think once he gets out there, he will play.

07:32I think the athletic training staff and the medical staff is doing everything right.

07:37You take it slow with him now, especially if you're going to win a couple of games with

07:41his backup.

07:42It's a long season.

07:43You know, it's hopefully is another season that goes well into February.

07:47You want them fresh and you want them feeling as good as possible.

07:50We know all these players don't feel a hundred percent by the end of the year.

07:53Do you want to conserve him as much as possible for the second half of the year and into the

07:57playoff?

07:58If you were sitting at a bar next to somebody who picks Christian McCaffrey, number one

08:03overall in their fantasy league, and they had a tear coming down their face, what would

08:08you say to him?

08:09This is why I don't draft 49ers in my fantasy league.

08:13I hold them too close to my heart, man.

08:16There it is there.

08:17They're there, buddy.

08:18Okay.

08:19Hey, Doc, thank you very much.

08:21That was very, very informative.

08:23Yep.

08:24No problem, guys.

08:27Talk to you soon.

08:28The proceeding was sponsored by UCSF Health.

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