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Playing through thigh injury right call for LeBron James, and all athletes

LeBron James is down with a thigh contusion after taking a knee to his thigh while driving the basket.

LeBron James is down with a thigh contusion after taking a knee to his thigh while driving the basket.

When LeBron James suffered a deeply bruised thigh contusion in Monday night’s game against Charlotte, most people would have understood if he needed to take a timeout.

But by continuing to play, he actually did the best thing he could for his injury. I spoke with Ray Horner from WAKR yesterday about why remaining in the game was a good call.

Below is an audio file and transcript of our discussion.

0:00

HORNER: Dr. Joe Congeni, (from the) Sports Medicine Center at Akron Children’s Hospital in our studio.

He always comes to the table with good topics. I know I have one for him as well. Something that he and I have talked about for quite some time that we saw come down today.

But you wanted to start off with a little bit pertaining to LeBron, is that right Joe?

DR. CONGENI: Well if you saw the game the other night — the thigh contusion he had. It looked like a deep contusion. Those are tough injuries and they’re mistreated a lot in the high school and junior high setting. I guarantee you it won’t be mistreated in the LeBron situation. He’ll have the best doctors and trainers treating him all the way.

He is an incredible physical specimen – watching him grow up and the physicality of the NBA – to get out there every night.

HORNER: (laughing) But if those things aren’t treated right they can linger a long time. I had one in high school I remember. Of course we’re turning the clock way back, but that thing hung around for like 4 or 5 weeks.

DR. CONGENI: Yeah. Let me explain why that is a little bit. People get a little mixed up between a thigh contusion and a hip pointer.

What LeBron had – and what’s very common in sports – you get kicked or kneed in the thigh very hard. Going to the basket on this one particular play is how it happened in that game. You break a lot of the small blood vessels in the muscle.

So what happens is the blood will collect in the muscle and we get a thing called a hematoma. A hematoma is a walled off area of blood in the muscle. You need to mobilize that and get that blood out of there. The easiest time to do that is the first 24 to 48 hours. If you wait much longer than that, and that blood sticks around, it starts to try to heal and thickens and scars and actually hardens into bone sometimes.

There are about 15 to 20 percent of those that go on to a thing called myositis ossificans (which is the long medical name). This (is when) bone can form in the muscle 3, 4 or 5 weeks later.

So, the first 24 to 48 hours are critical. What happens a lot in young kids – even high school kids – is it’s so painful they get on crutches, put a brace on and don’t use it at all. (But) then they don’t get that blood moving at all and don’t get that blood out of there in the very critical first 24 to 48 hours.

Dr. Joe Congeni

Dr. Joe Congeni

In fact, you might have seen in this game, they didn’t even let LeBron sit down. He continued to play – even in the 4th quarter – when he’d normally get his rest because it will stiffen up in that short a period of time. You want to keep moving.

In the first 24 to 48 hours we’ll do treatments like stim and deep tissue massage to break up that hematoma and get that blood moving.

Otherwise it will stiffen up and thicken up and actually even harden in some situations and we don’t want that to be the case.

HORNER: Wow. If it hardens what do you do?

DR. CONGENI: It takes months to get better. It can be the size of a fist, a lemon, a softball – sitting in the muscle. (It looks like) a hardened, bony area that we see on X-ray, but it never happens sooner than 2 weeks.

So what happens is a lot of people miss it. They come in, they get an X-ray because they feel something hard in the first 10 days and they miss it. Later on it will harden.

Very occasionally you even have to do surgery when it’s done fully maturing and take it out. It was something that can be a no big deal injury, but it’s not really a no big deal as you and I were saying in you having had one.

Going back and just playing right away after the next timeout (for LeBron) – but that’s the way he is – he’s an amazing specimen physically.

Thigh contusions can be mistreated very frequently. You’ll see a lot of people miss the next game or they’ll miss even a week because they’re extremely painful and difficult.

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About Dr. Joe Congeni - Director of Sports Medicine

Dr. Joe Congeni is the Director, Sports Medicine; Clinical Co-Director, Center for Orthopedics and Sports Medicine at Akron Children's Hospital. For the past 25 years, Dr. Congeni has been the “go to” source for national and local media looking for information about pediatric sports medicine.

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