Pain in Erik Karlsson's groin area has highlighted one of the most common ice hockey injuries.
But it is not always a simple muscle fatigue. Sports medicine experts say that pain in the groin is difficult to diagnose and treat because it can signal variable problems.
A groin injury "is a generic term for pain" in the pelvis and hip area, said Travis G. Maak, Utah's jazz team physician and professor. Associate of Orthopedics at the University of Utah. "It's not really a diagnosis, in itself."
Karlsson's health was one of the major stories in the Sharks' first playoff series against the Golden Knights of Vegas. Many might assume that Karlsson, 28, has recovered from his thigh muscles to allow him to play at full power in the series. After all, Karlsson looked good in the initial win and the second game defeat.
Since Sharks officials do not reveal more than basic medical information, questions about Karlsson's condition can not be addressed specifically. All we know is what he told reporters: "It should not be an injury that would affect my short term or my long term," said the star defender. Karlsson added that an injury to the groin on February 26 was different from the one he had suffered in mid-January.
In all, he missed 29 of the 82 regular-season Sharks games this season. But Karlsson seemed confident of being able to play high-level playoff games. That 's why the Sharks brought him to San Jose as part of a preparatory transaction with the Ottawa Senators.
"From the beginning, we made sure we knew exactly what it was, how it was going to be, and so far everything went as planned," Karlsson said about the second injury.
Nirav Pandya, associate professor of orthopedic surgery at the University of San Francisco, described the groin area as "one of the most frustrating areas of the body to heal" because the pain could be the result of muscle fatigue, tearing or injury to the hip. .
According to Maak, the most common diagnoses associated with groin pain are femoroacetabular impingement, which involves hip bone problems, muscular and tendon strains inside the thigh and tendonitis of the flexor of the hip.
Injuries such as those of Karlsson are usually tearing of the muscle tendons caused by pressure on the thighs when they wring violently when fighting for the puck or when they quickly change direction while skating. Sudden movements on the ice make hockey players particularly vulnerable to strains of muscles and tendons that are attached to the bones of the pelvis and femur.
The internal muscles of the thigh, called adductors, pull the legs towards the body, while the abductor muscles located on the outside of the thigh have the opposite role.
The interaction between the two muscle groups is important for hockey players, said Michael Alaia, a surgeon at Langone Medical Center at New York University, who has worked with the New York Islanders and New York Jets. .
"The kidnappers are important for the generation of force, push, that explosive power to get during their stride," he said. "The internal adduct lengthens and tries to keep the hip stable and slow down each process of acceleration generated by the kidnappers. This is how tendons of the groin stretch and are considered a wound due to traction or possibly tearing. "
The adductors of the hip joint include six muscles whose adductor is most likely to sport injuries, experts said.
Karlsson, a 10-year-old NHL veteran who has twice been named the league's all-time best defenseman, looked fully recovered as he played 26 minutes and 25 seconds in San Jose's 5-2 win on Wednesday. evening.
But health problems become even more important as the player becomes a restricted free agent after the season if he does not sign an eight-year contract extension with San Jose. His Canadian-based agent, Don Meehan, did not immediately respond to an email comment.
Pandya, the surgeon at the University of San Francisco, said these injuries did not usually threaten the career, but they could affect the future of Karlsson because of his age. Pandya added that injuries due to muscular effort are rarely so serious that a player would miss most of the season.
But "is not he able to cut at the same level?", Said Pandya. "Can not it explode? These are the performance measures that can be affected. This is where you are worried.
Jazz's Maak stated that most athletes with muscle or tendon strains recover without persistent problems if they are treated appropriately.
"The return to the game is excellent and they find the same level of sport as before the injury," said Maak, a former Stanford.
Karlsson did not play for five weeks after the second injury. It would be enough time to properly heal a slight muscular tension in the groin, the doctors said.
According to an article published in 2010 in Sports Health, a high incidence of recurrent strains occurs "because of incomplete re-education or insufficient time for complete tissue repair".
The study also revealed that strengthening the adductor muscles before the season can reduce 18% of the strains in the groin for NHL players. Alaia, the New York surgeon working with the Islanders, added that patients with equal strength of the inner thigh and outer thigh muscles had a lower rate of tension in the groin.
"I'm sure the Sharks are following a program like this," said Michael Fredericson, director of physical medicine and sports medicine at Stanford Health Care. "Injuries are less common than we thought because we are doing more prevention."
Karlsson missed nine consecutive games starting in mid-January. It lasted a week before another groin injury prevented him from participating in the playoffs.
The chronology of Karlsson's recovery indicates a slight muscular tension – if what he said to the reporters is accurate.
The recovery can last from a few weeks to several months, said the specialists of sports medicine.
"I'm sure many players are dealing with a mediocre form and they play it," said Fredericson of Stanford.