There was no hotter topic across the nation yesterday than Jay Cutler, particularly here in Illinois. A lot was made of a very simple issue, and it didn’t take an MRI to figure it out, it took an athletic trainer.
The simple fact is that football players, by definition, are warriors and would give anything to play the game. We see that with the concussion issue. And even though this injury was not a concussion, it was an injury and the athletic trainer and medical staff did the best they could to allow Cutler to play. Forget for a moment your fandom, remove your emotions, and understand what in all likelihood occurred at Solider Field this past Sunday.
BELOW IS AN EDUCATED GUESS AS TO WHAT HAPPENED, this is to better clarify what we do as professionals… I hope that I am certainly not “assassinating” anyone’s character.
Cutler most likely reported to the athletic trainer that he hurt his knee, at which point an interview was conducted and very little was done at the time. The fact that he was upright and not in obvious distress warranted the staff to look closely at him during play. After they noticed that he was not performing up to par, they most likely went to a sideline evaluation, which occurred just prior to halftime. During that evaluation the athletic trainer tested the stability of the knee ligaments (four major), ACL, MCL, PCL, LCL and if the evaluation was thorough, it would have included a screen for a meniscus issue as well.
After that initial evaluation, it warranted the staff to take Cutler to the locker room early, most likely for a more in-depth evaluation, in a “relaxed” setting, as well as allowing the doctors to do the same tests as the athletic trainer. What was most likely found on the sideline and confirmed in the locker room was the MCL had laxity or stretching. This can be discovered through touch, one of the key components of athletic training. Along with a proper history of the injury and specific area of pain, special tests can be done to test the integrity of the ligament in question, as well as surrounding structures for collateral damage. In this case the test is called “valgus stress” where force is applied to the lateral portion of the knee at the joint line (with the knee slightly bent) to apply pressure DIRECTLY on the medial collateral ligament. If the MCL is intact then it will act like the opposite or uninjured knee, in most individuals there will be no giving way or “sloppiness”/”opening” of the joint, like pushing on a 2×4. In the case of a ligament sprain/tear (same thing) it will give way and instead of a solid feel it will open like a half-sawed through 2×4. This will lead the athletic trainer to believe that his ligament was compromised.
This test is about 100% accurate in detecting a MCL sprain and therefore the medical staff knew at halftime that his injury was significant. With all the study in physics, biomechanics and kinesiology that athletic trainers have, playing the quarterback position with a severely damaged MCL is nearly impossible. If the knee does not have the lateral stability provided by the MCL, that joint is exposed to greater injury when planting or cutting, including but not limited to an ACL tear and meniscal injury. That is why he was advised not to continue, and Coach Lovie Smith even stated that Collins was going to be the QB to start the half. However, Cutler wanted to play and tried in the next series. Even with the bracing and taping applied he soon realized that standing on a knee without an MCL was difficult, and trying to play NFC Championship-level football on that same knee was not going to happen. That is why he was removed from the game, period.
Now, I understand perception, that is why the only thing different that I would have done was to put him on crutches and place a big ice bag on his knee just to quiet any rumors and at least create the illusion that he was injured and not hurt.
The point of the post is that the athletic trainer in most cases can detect and analyze injuries though their extensive training that sophisticated machinery is used for. Because we have that ability, we can protect the athlete from further damage and begin the rehabilitation process as soon as possible.
Athletic trainers are not limited to the professional sports, they can be and want to be utilized in the secondary school setting. Not only for the injury assessment but for the safety of the athlete, concussions not withstanding.