Well the LA Kings have lost another important cog in their back 6. It will really test the depth of the club or the ability of Dean Lombardi to swing a trade that will help back there.
Thanks to Bob McKenzie flicking out a tweet I became aware of the herniated disc Greene has manage to get. Initial reports were Greene was toast for the season, then it was 'downgraded' to 3 months. Which with this shortened season, is basically the whole season anyway. This is one of the reasons a healthy roster is going to be just as important as team chemistry this season.
One of the things you can never say about a hockey player, is they didn't try their hardest to get back on the ice. A herniated disc does not have to have surgery to get better. This should be the last resort, rest and rehabilitation should be the path to recovery, not a short term fix of surgery. However being an athlete the need to get back out on the ice is just as important as life after sport.
The expected non surgical recovery of a herniated disc is approximately 1 month. About 50% of of cases people recover in this amount of time, however after 6 months 96% of cases are back to full functionality. So as you can see Greene is kind of trapped by hi need to get back on the ice as soon as possible. Seeing as Greene's load through his back will be much more taxing and extreme than a desk bound person, he will need the disc back to as close to 100% as he can.
Usually the herniation of a disc occurs at either end of the spine, top or bottom, it is not as common through the middle of the spine. These are the two areas of the spine that take the most pressure load due to dysfunctions in body posture.
Diagram: examples of disc issues
Ok, so there are 3 procedures Greene can go through depending on the damage found in his disc.
1. Discectomy
Commonly know as an Open Discectomy, is the removal of the disc material that presses on a nerve root or the spinal cord. This is the most likely procedure that Greene will be having.
Diagram: Lumbar Discectomy
2. Percuaneous Discectomy
Is used for a bulging disc that has not ruptured into the spinal canal. Using a special tool and through a small incision the herniated disc tissue is removed. This reduces the size of the herniation. This procedure is in decline as it is not as effected as an open discectomy. In this day and age, I find it hard to believe Greene will be going through procedure.
Diagram: Percuaneous Discectomy
3. Laminotomy and Laminectomy
These procedures are completed to relieve pressure on the spinal cord and/or spinal nerve roots caused by age related changes in the spine. A Laminotomy removes a portion of the thin part of the vertebrae this forms a protective arch over the spinal cord. Laminectomy removes all the lamina on the selected vertebrae and also may remove thicked tissue that is narrowing the spinal canal, this is where the spinal cord runs through the vertebrae. These can be done at the same time or independatnty of each other. Unless Greene's injury has a 'wear and tear' factor to it, this procedure will be unlikely.
Diagram: Percuaneous Discectomy
Recovery:
Well the most important thing for the Kings now is getting Greene back on the ice and in full health due to his time frames. If he does indeed get back in 3 months, he is going to be coming back right on top of the playoffs. Greene should be able to start his rehab about 1 to 2 weeks post surgery. Like any rehab Greene will need to be slow and concise in its application, any misstep will have him miss the whole season.
There are three types of muscles that support the spine and will need to be strengthened:
Extensors
These are the back and glute muscles. They straighten the back, lift and extend. They are very important for posture and protecting the spine from overload.
Flexors
These are the abdominals and illopsoas muscles. The bend and support the spine from the front. The lower set of the abdominals controls the arch of the lower(lumbar) spine, these will be very important for Greene to get stronger than they were before the surgery.
Obliques and Rotators
These are the muscles down the side of the abdominals. They stabilise the spine when upright, and rotate left and right. Building these back up will help Greene's spine handle all the hitting back on the ice.
Finally:
Greene will start off with some basic stretching, stiffness is a back's worst enemy so as soon as possible Greene will be looking to improve his range of motion and elasticity in the disc, muscles, ligaments and tendons around the repaired disc. Focusing on areas away from the effected disc is just as important, tightness in the hamstrings, hip flexors and quads affect the pelvis position and will put unwanted stress and tension through the repaired disc. Full body stretching within pain threshold will get things started on the right foot.
Once through the stretching Greene will look to strengthen his body to hold 'neutral spine' position. This is where Greene should feel most comfortable when standing, working on his extensor muscles and abdominal muscles will be very important. It is easy at this stage to create an imbalance front to back due to over working either the abdominals or the back extensors. Due to this it is very important Greene tracks his progress with regular assessments to ensure he keeps in 'neutral' spinal position.
Aerobic conditioning can be started once Greene is given the all clear, that his spine is adequotely protected by his strength work. The conditioning will start off with low impact, water therapy, walking or a stationary bike are good examples of options open to Greene.
Finally an extremely important factor in all of this rehab will be Greene's diet. Eating a high protein diet create the building blocks for soft tissue healing. Plenty of fresh fruit and vegetables will supply the vitamins and trace elements necessary for effective healing. Keeping away from empty calories (sugars such as: breads, vegetables, pasta and sweets) will be vital to Greene coming back on the ice in shape. Any weight gain from poor dietary choices will lead to many struggles getting back on the ice
References:
http://aol.sportingnews.com/nhl/story/2013-01-21/matt-greene-back-injury-lost-for-season-la-kings-defensive-depth-willie-mitchell
http://www.webmd.com/back-pain/tc/herniated-disc-surgery
http://www.spinecenteratlanta.com/treatment-options/surgical-treatments/
http://www.mybwmc.org/library/28/000420
http://graphicwitness.medicalillustration.com/generateexhibit.php?ID=4924&TC=&A=58650
http://www.dmcsurgeryhospital.org/procedures/?id=125&sid=1&did=spine-cervical&pid=126
http://www.mountainviewpaincenter.com/conditions/low-back-pain-2/herniated-disc/
http://www.spine-health.com/treatment/physical-therapy/back-exercise-pain-relief
http://www.healyourbulgingdisc.com/bulging-disc-exercises.html
http://health.nytimes.com/health/guides/disease/herniated-nucleus-pulposus-slipped-disk/exercise-and-physical-therapy.html
http://exercisesforinjuries.com/corrective-exercises-for-herniated-disc/
http://www.ehow.com/way_5731132_long-heals-should-rehab-begin_.html
http://www.dieselsc.com/innovative-glute-activation-get-stronger-and-fix-your-posture/
http://introtofitness-bov188.blogspot.com.au/2011/05/functional-exercises-to-blast-your.html
http://www.medicalook.com/human_anatomy/organs/Abdominal_muscles.html
