00:00and joining us on the river islands guest line is our friend uh it's doc pandia hey doc what's
00:05happening i'm good how are you guys doing uh we're great but of course everybody's terrified
00:10uh all of the injuries are going to ruin everything that's just how it works here in the bay
00:15but i definitely wanted your reaction to the specifics of what kyle shanahan said about
00:22nick bosa they're saying no concern he's saying this happens to 90 percent of acl injuries it's
00:29just a little follow-up tendonitis what is your reaction to all of that so it is something that
00:36you do commonly see after acl surgery um you know basically the way you're doing acl surgery is you
00:42take something from around the knee and that becomes your new acl in that area where you take
00:46it from frequently can get tendonitis particularly as you wrap things back up the two things that
00:51make this a little bit different for nick bosa is that this is the second acl surgery that on this
00:55knee he had something done in high school and has it done now so that knee's ability to withstand
01:00tendonitis maybe it's a little bit less than someone who's getting their first acl done
01:04and the second thing i think it was in bleacher report last week they said he actually has been
01:08had a history of quad tendonitis and he described the surgeon quote-unquote cleaning up quad tendonitis
01:14at the time of his acl surgery so if this is a kind of re-aggravation of what he had
01:19before
01:20that's a little more worrisome if it's just related to where his acl graft was that's not
01:25necessarily something you worry about but regardless at the end of the day anytime anyone that big has
01:29had two acl surgeries you do worry is that something that's going to compromise his ability to you know
01:34be effective on the field uh particularly given his history what is the normal process for pain
01:41management as you get closer to week one is it just kind of a week by week pain medicine shot
01:46or are
01:46there other things that he has to try and do i think the biggest thing is just decreasing down
01:51load i mean you know honestly with this injections things like that around tendons um can cause the
01:56tendon to be weaker which is the one thing you don't want to do uh around that knee particularly
02:00doing things like cortisone etc um so it is a lot of just like resting you know icing making sure
02:05you're
02:05not loading that area which then becomes problematic as you get a little bit later in the season because
02:10the preseason is necessary to kind of build up everything strength wise and we do see players
02:14who don't necessarily have that preseason workload they can be at risk for injuries later down the
02:19road um so it is one of those things you have to worry about because if you're not practicing you
02:23can't build that natural strength and explosiveness that you need um which can then be problematic as
02:29you get later in the season doc i i know you're not examining these guys directly but when you hear
02:35tendonitis following acl um and we are i think four weeks and two days away from the 49er game is
02:44that
02:44is that a relevant conversation right now or or is there uh the thought that you know something
02:50like this he he should be able to play four weeks from now i get a little worried partly because
02:56he's
02:56been out for so long you know it's been several days where you haven't seen him um the fact that
03:00he's still you know relatively close to when he had a surgery i know it's a year ago but for
03:04someone
03:04who's getting a second acl surgery it's relatively close so absolutely i think it's something to watch
03:08very closely um anytime you've a player who's been multiply operated on and has a history of injuries
03:13unfortunately you do get worried about it and it's a short turnaround particularly with all the
03:17travel so um this may be something that does linger and we saw you know christian mcafree have
03:22you know achilles tendonitis so he's you know that kind of impacted his season as well too so
03:26definitely something to kind of watch i get less worried about the calf strains and sprains and all
03:31those other things that are going on right now but when you have it in the knee you have surgery
03:34on
03:34something to watch more closely have the surgical techniques advanced to the point where nick
03:39bosa has a better chance of playing through this as opposed to 10 years ago when he had his first
03:44procedure yep they definitely have and i think a lot of it is things are a lot more less invasive
03:50which allows you to rehab a lot more aggressively uh we understand a little bit more about what's
03:55normal what's not normal during the rehab process so in general if you look over the past 10 years
03:59rehab is advanced surgery is less invasive we know that you can add other things to an acl
04:04surgery to make the knee more stable so absolutely uh there's a lot of things that advance which does
04:10increase his likelihood of being successful if you can deal with all the secondary stuff that occurs
04:15along the way doc i know that you're uh you're tapped in and watching a lot of the camp videos
04:19when
04:20you see george kittle moving like he is what what does that do to your brain when you think about
04:26the idea of week one i think it's absolutely a possibility and i think this really speaks to how
04:33surgical techniques as dan mentioned in that other question have really changed a lot is that you
04:38know you would never think that a player coming off uh in achilles would be even thinking about
04:42playing week one based on when he had a surgery but as we've seen the techniques are allow you to
04:46rehab a lot more strongly he had a little bit of a different kind of tear as they described that
04:50has better blood supply so that heals better as was reported in the media and he looks great like
04:55he's running he's sprinting so if his conditioning is in there and he's not having any soreness
04:59it is totally not out of the realm that you could see him week one
05:02i think the biggest thing is going to be that travel do you hold him out and just kind of
05:05say
05:05hey you know you're going to stay back and not kind of you know kind of stress your body but
05:09he looks great i don't see anything in his videos that's of concern what specifically would stress
05:14the body through travel is it just being you know up there in the elevation is it the time just
05:20spent
05:20sitting in a chair what's the biggest concern doc i think it's a combination of those things it's
05:25like you we do know that in nfl teams when you look at the data whenever they're traveling the
05:29farther they travel they're more likely to have a risk of injury so part of that is that the body
05:33just isn't set you're practicing at different times you're stiff from these long flights you get
05:38swelling when you're going up and down so all those things uh make you more at risk for injury
05:42particularly from a soft tissue standpoint so you know if they're flying two hours away i wouldn't
05:46be as concerned but when you're taking a long flight it's your first game back um and you're
05:50going to get that stiffness that naturally occurs from a long flight um you worry about it it's
05:54just a lot harder than if you were just flying over to cincinnati doc does this make sense to you
05:58that the rams say that they're flying to australia the day before the game and the niners are doing
06:02it eight days before the game yeah i heard that they're you know they're they're kind of banking on
06:07the adrenaline um that's a little risky i understand that from like a logical standpoint where you're
06:13like you don't have time to adapt you're just going to go into it but we know that coming off
06:16flights the first 24 to 48 hours you're more susceptible to get sick you're more susceptible to have
06:21issues in terms of adapting so it doesn't make sense to me but you know if they go out there
06:26and they perform well maybe they're going to kind of revolutionize how we look at these uh long travel
06:29games um thank you my friend for hopping on that was helpful absolutely anytime guys okay doc pandia
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