What are the risks and roster impact if Evander Kane returns early?
Photo credit:Perry Nelson-USA TODAY Sports
By Jason Gregor10 months ago
Evander Kane was injured on November 8th when Patrick Maroon accidentally skated across his wrist. It was a gruesome injury, but Kane alertly jumped up and rushed to the bench and the Oilers’ medical staff did a fantastic job treating him. In December Kane mentioned he was still eight weeks away from returning, but he is on the road trip with the Oilers and there are rumblings he could return later this month, which would be two weeks sooner than the original prognosis of three to four months.
Are there any risks if Kane returns earlier than expected? I asked Grant Fedoruk from Leading Edge Physiotherapy. Fedoruk has treated many elite athletes in his 23-year career and focuses heavily on helping athletes, pro or weekend warriors, rehab their injuries.
Jason Gregor: Kane is skating with the team on the road trip. Originally the diagnosis was three months which would be February 8th. If he comes back two weeks earlier on January 24th or 28th, is there any increased risk of damage or re-injury at that point, or does it matter?
Grant Fedoruk: Soft tissue guidelines is what we are dealing with when he damaged that, those flexor tendons. And if you recall, way back when, when everybody was throwing up their, ‘oh no this is career or season ending injury’ I pointed out that the location of his injury was probably the best case scenario as far as if you’re going to damage a flexor or extender tendon.
Where he damaged it above the level of the tendon and the muscle girth and the bulk is one of the best places you can. It’s called zone five and most people will throw out a three month return to full activity. Meaning you are back doing what you did before, as long as you get your range of motion back, there is nothing, no restrictions, away you go. There is no restriction on what you do.
In the rehab protocol that he is following, as he’s been going through it, they are paying attention to very specific things. Because for every person there are some changes, there are nuances to your recovery and we just know that soft tissue goes through certain states of healing over that period of time. And by the time we hit about eight weeks, in about that window, resisted activity is allowed, from eight to 10 weeks he can start to do more and more resisted activity and it’s based more on what’s his range of motion. Because the restrictions and the risks are that he can develop scar tissue in there that prevent him from opening his hand all of the way.
Now as a hockey player, that’s not necessarily the biggest restriction. If you’re a piano player, absolutely, we would be scared that might happen because you’ve got to be able to extend those fingers. Imagine a piano player opening the fingers as wide as possible. And so that’s a bigger concern, but for a hockey player whose hand needs to close, really so long as he’s able to make a grip and he’s graining strength in there and he’s gotten up to a level of strength that might be required in order to hold a stick, exert force, like to take a shot, which, by the way, people have already seen him doing.
Then, obviously, he’s able to return to more and more activity and around that time frame when we’re talking about a period of a week or so. Is there a risk? There is always a risk, but less likely one that I would be absolutely concerned about him coming back too early from and say he’s pushing it too hard. I would say that he’s the best judge of that at that stage. And the people who are caring for him directly will know, here is his range of motion, this is his grip strength, and this is what he is able to do. And if he can do it in a lab or in a clinic, then there is no reason that he couldn’t do it at pace and at speed and that’s why he’s already on the ice today.
Gregor: A doctor told me that usually for nerve damage that regeneration is usually one millimeter per day. How could we know and to what extent nerve damage would be with an injury like Kane’s?
Fedoruk: Now again, it depends.
We talk function, especially for a professional athlete. And as far as the sensory nerves in his hand, if he’s lost some sensation, it can still be coming back for quite a long period of time. You literally can measure from your neck all of the way down to the tip of your finger, whatever the distance is, and then the 1.2 millimeters a day you can do the math and figure out how long it takes for that regeneration to occur. But, as far as function goes, is the sensation all that important if he’s got gross motor strength and he’s able to do what he needs to do.
Let’s say he has a little numbness in his fingers, I don’t need to make light of it, but for a professional athlete like him, even Evander Kane at 80% is better than me at 120%, or even more. And I can make fun of myself all day long. He certainly is valuable even at that stage and I don’t think that is the thing they are going to be waiting for.
Gregor: You mentioned range of motion. Wrist flexion on a wrist shot definitely becomes a factor on a wrist for sure. So how effective or “how soft” will his hands be based on the range of motion in his wrist?
Fedoruk: Well it’s based on how much he’s gotten to use it and again, somebody who is as high of a level as he is going into an injury, won’t have such a falloff in his skill performance coming back from an injury. So, when he starts to initiate activity which are the nuances of the game of hockey, especially at the speed that they play, he’s going to pick it up a lot quicker than you or I or somebody who has never played it before. And that’s just motor learning, that’s totally different than just range of motion.
Now on the range of motion front, here is the risk. The risk is that he develops scar tissue along those tendons that he is rehabbing or that’s coming back. And certainly going back too soon, he’s at a higher risk of that particularly in the zone that he damaged.
There are two specific muscles that are on the flexor surface that are very important. One is called flexor digitorum superficialis and one is called flexor digitorum profundus and we need to know that they have gotten the range of motion back in both of those. So that means the very tip of the finger, does that move all of the way back without the other one bending and then the next digit to making a full closed fist. And if he’s doing that at this stage, which I am only guessing, as far as his rehab goes, but he’s in good hands and should have that range of motion back. He’s probably almost out of the woods by the time we talk about him going back to playing.
But the recovery, just for those listening, no matter what you do when you it comes to soft tissue, the body is still going through a phase of recovery for up to a year afterward. It’s called remodeling and it’s what your body does to make it look as much as normal and that applies to any soft tissue injury in the body, it takes 12-18 months through that phase.
That being said, by three months, or sooner he is back to being functional.
Gregor: So when you say it takes up to a year for that remodeling, how much of the remodeling factor for soft tissue, in the elite athletes that you’ve dealt with, impacts their ability to maintain what they were before? Is it the same, is it that remodeling doesn’t necessarily impact their skill or speed or strength or does it play a factor?
Fedoruk: By three months he’s at the stage where he’s getting back to normal, but he’ll continue to improve and recover for up a year afterward. Basically what I’m saying is by about a year, that’s about as good as it’s going to get. It’s not going to continue to improve beyond that. He’s going to continue to get better and better in how it feels and that kind of feeling like you never injured it or you didn’t do that damage takes up to a year to go through that process. So he’s going to get better and better after that period of time.
Gregor: Is there a higher percentage of re-injury on injuries that impact stability compared to a soft tissue injury like this?
Fedoruk: Yeah, when we’re talking about joint instability and stuff like that, the chances of putting a lot of stress and really going overboard can happen in so many different ways. So we’re talking about a knee and ligament instability, definitely we’re talking about something different compared to tensile strength of an actual muscle at a certain period of time. So, the answer is yes, they are totally different. Very little risk of re-injury like this unless he gets cut again, which is very rare.
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Kane is practicing regularly with the team, and seems he will return sooner than expected. His return to the lineup will be big boost, but it will also lead to some roster moves. The Oilers had a 21-man roster when Kane was healthy due to their limited cap space, and when he returns they will need to be there again, unless another player with a significant cap hit gets injured prior to him returning.
A quick look at roster options:
McDavid, Draisaitl, Kane, RNH, Hyman, Yamamoto, McLeod, Kostin, Nurse, Barrie, Ceci, Kulak, Bouchard, Broberg, Campbell, Skinner along with James Neal and Andrej Sekera buyouts ($3.416,667), Milan Lucic salary retention ($750K) and bonus overages of $896K and the Oilers are at $73,687,333 for 16 players from PuckPedia.
Which means they have $8,812,667 to fill out the remainder of the roster.
Devin Shore would seem like an obvious choice to be sent down. Mattias Janmark was sent down to start the season, due mainly for lack of cap space, but since being recalled Jay Woodcroft has played him regularly. In his 28 games Janmark is sixth in 5×5 TOI/game among forwards and is first in PK TOI/game. I’d be surprised if he was waived.
Puljujarvi ($3m), Foegele ($2.75m), Ryan and Janmark ($1.25m), Holloway ($925K), Niemelainen ($762,500) or Desharnais ($762,500) are the options to fit under $8,812,667.
If they keep Puljujarvi, Foegele, Ryan and Janmark they’d have to run with a 20-man roster, and they would have to send the other three down. A 20-man roster is not ideal long-term.
The other option which would allow them to have a 21-man roster is to waive one of Ryan, Puljujarvi, or Foegele (assuming Janmark isn’t an option).
I could see them running with a 20-man roster for two games. They can activate Kane on January 24th (or a few days earlier) and send Holloway and company to the AHL. They would be able to play six AHL games between January 25th to February 3rd.
The Oilers play two games on Jan 25th and 28th, but don’t play again until February 7th. So Holloway could play big minutes for six AHL games, while Holland would have two more weeks to make a deal and not waive a veteran.
But, they might opt to keep Holloway as they feel he could give them a better chance to contribute to wins on the 25th and 28th.
So which do you think they do?
Run with a 20-man roster or a 21-man roster and waive a veteran?
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