00:00This is the Injury Report, presented by NYU Langone Health.
00:05Matt Barzell is skating again, and the Islanders say that his knee inflammation is under control.
00:10So why is there still no timeline for his return?
00:13Well, this week on Injury Report, we're going to break down the checkpoints before Barzell's comeback
00:17and the difference between returning to the lineup and returning to full strength.
00:21And to do that, we're going to talk with Dr. Guillaume Lomas of NYU Langone, who joins me now.
00:27Dr. Lomas, how are you doing?
00:28I'm doing great. Thanks for having me on.
00:31Now, glad to have you on here on Injury Report.
00:33And doctor, let's get right into it, because Matt Barzell, he's been sidelined by knee inflammation since training camp.
00:38And for fans hearing that description, what does inflammation actually tell us?
00:43And what additional information would you need as a doctor to understand why it's keeping a player off the ice?
00:50Yeah, I mean, look, inflammation is sort of a general term for discomfort, for pain, right?
00:56Oftentimes, that's what we're using.
00:57It's pretty it's pretty vague.
00:58So in this case, I think really what it's telling us is there's something that's bothering him that's not letting
01:05him either practice or play at his full potential.
01:09And so that's that's probably where where we'd have to leave that, because it is a pretty generic term and
01:16really not not too specific about, you know, what injury we might be looking at.
01:20Right. And so the other thing when you talk about Barzell and you look at him is that he previously
01:25underwent surgery to repair broken left kneecap.
01:28So generally speaking, how can the history of a surgery like that factor into recurring knee symptoms and how would
01:34doctors determine whether the current problem is connected to the original injury?
01:39Yeah, no, I think that's a great point.
01:41And that history probably plays, you know, quite a bit into trying to figure out what's going on here.
01:46So anytime you injure a bone that's in the knee area, right, there's a chance, you know, any bones that
01:56are going to be covered by cartilage, by articular cartilage.
01:59You know, there's a chance that you are going to have an injury to cartilage at the time of the
02:04fracture.
02:05The interesting thing about cartilage is oftentimes symptoms related to damage there don't necessarily rear their head until, you know,
02:13weeks or months or even years after.
02:16So it's not saying that this is definitively tied to his past kneecap fracture, but that is one possibility that
02:23there's some pain or discomfort that's still related to that injury.
02:29Interesting there to look at that it could be some pain or discomfort related to the injury there.
02:33And we did get an update, though, Dr. Lomas.
02:36Alan Dersia, Matthew Dar, says the inflammation is under control, says Barzal has no setbacks.
02:41How encouraging is that update and what's the difference between having symptoms under control and having a knee that's actually
02:47ready to play in NHL hockey games?
02:51It's extremely important and it's very encouraging.
02:54And, you know, as we know, you got to walk before you can run or in this case, skate.
02:59So having everything that's calmed down, that allows a player to sort of progress along the rehabilitation ladder.
03:06And really, we're looking for more load, a player to be able to tolerate more load as that gets, you
03:14know, as a player essentially sees that.
03:17Right. And that's going to happen over the course of, you know, first off ice training and then practice and
03:23then increasing the intensity until he's finally game ready.
03:29Now, Darsh did say this, Dr. Lomas.
03:31He said that doctors would be comfortable with Barzal ramping up when he feels ready.
03:36So what can an athlete feel during a rehab that a medical exam or a scan might not capture?
03:42And then how would you, as a medical professional, as a doctor, weigh that feedback alongside objective testing?
03:49Yeah, I think this is very multifactorial and every case will be different.
03:54You know, first of all, MRIs, imaging, they don't always capture the reason for someone having discomfort.
04:02But there's another component here, too, which is, you know, these players are playing at the kind of their redlining,
04:08you know, their effort.
04:09Right. They're playing at that most rarefied level.
04:12And you've got to be ready to do that.
04:15And especially if you're playing on ice, you know, you're skating 20 plus miles an hour, seeing pucks coming 100
04:20miles an hour at you, skates, pucks, a lot of sharp objects.
04:24You know, you really want to feel confident that you can perform.
04:28And so I think you've got the physical side of things and it sounds like that's going well.
04:32There's also a psychological component and a player has to be prepared to return.
04:36And so both of those things factor into it.
04:39And I don't think, you know, we know exactly, you know, what combination of that, you know, where Barzal is
04:46at yet.
04:47But it sounds like physically, objectively, things are improving.
04:51And so that's probably the last step is just having him feel confident to get back on the ice and
04:56ramp it up to game intensity.
05:00That's such a good point about the mental aspect of it, too, that affects so many athletes and, you know,
05:05anybody else that is trying to return from an injury.
05:08And it kind of leads into my next question here, Dr. Lomas, because Barzal, he has resumed skating individually, but
05:13he hasn't returned to team practice.
05:16What would be the checkpoints that you'd be looking for as a doctor that you would generally want a player
05:22to pass before moving from solo skating to non-contact practice to then full contact and eventually game action?
05:28What would you want to see?
05:30You're looking at them being able to tolerate that next step.
05:33You know, one thing that's interesting is we put force monitors on some of these players and you see games,
05:39you know, they're usually generating 20 percent, 30 percent more force or power than during practice.
05:46So even when practice is going hard, you know, that that game adrenaline, that intensity ramps it up even more.
05:52Basically, at every point you want to see him tolerating it well.
05:56You want the player to feel confident, comfortable.
05:59And essentially, you're checking in, you know, after practices, after testing it a little bit, seeing what's the response?
06:08How does he feel the next day?
06:09How does he feel afterwards?
06:10And then continuing to progress along those lines?
06:14So, you know, I think fortunately it looks like he's on the right trajectory and now it's really just a
06:20matter of time until everybody's on the same page and he's feeling comfortable.
06:24Yeah, it's going to be time.
06:26I guess the last thing for me is, speaking of time, because there still isn't a set return timeline for
06:31Barzal.
06:31So without trying to put a date on his comeback, wouldn't ask you to do that.
06:35What makes a recovery like this difficult to predict and what should fans understand about the difference between returning to
06:42the lineup and then returning to full performance?
06:47I think this is one of the hardest things in professional sports, especially when someone has been sidelined for a
06:52while.
06:52You know, these players are gamers.
06:54They want to play.
06:56This is their livelihood and they love playing.
06:59So, you know, they want to do it.
07:01You also know that they want to be effective.
07:03Right.
07:03And that's another component of it.
07:05And finally, you want to make sure that you're not potentially exposing them to additional injury.
07:10And we know you can get injured at any point.
07:12You know, there's no guarantee that that can't happen.
07:14But you want someone to feel, again, confident that they're able to handle the stresses and they're able to feel
07:22like themselves.
07:22They're able to be, you know, that effectiveness.
07:25And sometimes that's even a question we ask them, you know, hey, what percent do you feel like yourself now?
07:30So that's really, you know, what they're looking at.
07:33And I think these injuries are difficult.
07:37Truly, each one is different.
07:39You cannot predict, you know, because one person had, you know, a certain return to play timeline.
07:45You can't predict that someone else will.
07:47It has nothing to do with the individual being, you know, not having their head in it.
07:52It just has to do with the body being different, the history that the players had with injury.
07:57And ultimately, you know, look, the teams and the players are aligned here.
08:01You know, their interest is in having that player return, perform, get back to their job, their livelihood.
08:07And I think all of these players want nothing more than to do that as well.
08:11So the alignment's there.
08:13And it's just a matter of just getting to the point where they're capable of returning.
08:17Yeah.
08:18Matthew Brazell undoubtedly would like to get back to the ice.
08:21The Islanders would like to see that as well, too.
08:22And as you said, doctor, the recovery is different for everyone.
08:26That is Dr. Guillaume Lomas.
08:28He does a fantastic job with NYU Langone.
08:31Dr. Lomas, I appreciate you coming and breaking it all down for us here on Injury Report.
08:34Thank you so much.
