Livers: Words matter. Stress injury vs stress fracture
This is getting a long waybinto the weeds from an advanced imaging perspective, but calling the press release called it a stress injury.
Overuse injuries to the bones and soft tissue structures arise during repeated minor injuries, which are, however, too weak to cause a rupture of tendon or a full fracture. Overload injuries are especially common in sports such as running. However, the clinical manifestation of these lesions may be nonspecific. Overuse lesions occur in relatively constant locations like the subchondral part of talar trochlea. Stress reaction can often be seen in the distal tibia, distal fibula, or the calcaneus.
Stress fracture is a different animal.
When the bony trabecular load is higher than normal, loss of mechanical integrity through injury is possible. This happens with weakened bone tissue (osteopenia) or with vigorously repeated mechanical forces. In these situations, a fatigue fracture or insufficiency fracture, respectively, may occur. Linear low-signal disturbances oriented perpendicular to the load axis, usually surrounded by extensive bone marrow edema (BME), are consistent with stress fracture. A slight periosteal edema is the first sign of stress fracture which, in the absence of treatment, is followed by BME in the medullary cavity. Intracortical changes occur while the limb is still bearing weight.
MRI can detect a stress fracture in the early stages.
The long and the short of it means IMHO calling the MRI findings an injury and not a fracture are decidedly important. This like Davis's determination that he was "out indefinitely" with his plantar injury surprised us all when he returned after a few weeks.
UofM has some of the best sports medicine people in the world and my gut tells me that we could see his return if the team makes a deep tournament run.
My 2 cents.
GoBlue
March 14th, 2021 at 10:01 AM ^
Congrats, you're a super fancy doctor.
There, is that what you wanted?
March 14th, 2021 at 10:51 AM ^
congrats, you’re something much different.
March 14th, 2021 at 11:13 AM ^
It's a stress fracture. It's sad to hear the disappointment in his voice.
"You never know. I'm going to rehab asap to be with this team because I know they're going to make a deep run and I want to be there for it"
Fuck yeah, dude. Fucking love this guy.
March 14th, 2021 at 12:23 PM ^
Why are you so miserable? The guy is just trying to help us understand and you turn it around to a negative.. just like everyone else in America right now..Jesus Christ
March 14th, 2021 at 12:54 PM ^
congrats your an ass hole. is that what you wanted?
Why the comment, they simply gave an insight to something. What a sad existence. Are you that insecure? Really?
I figure wisecrackker stayed at a Holiday Inn Express last night.
I actually did last night for the MACtion men's tournament in Cleveland! #boom
Cool
amusingly, he just copied and pasted from a journal article, lmao
GTFO you're a cancer to this blog.
Though I appreciate that the OP posted with hope for Livers’s return, it’s really not cool to copy and paste the above data from someone else’s article and pass it off as your own knowledge (or at least not cite that it came from elsewhere).
March 14th, 2021 at 10:04 AM ^
You’re assuming they are giving us a verbatim interpretation of his imaging which they are likely not. All thumbs are fingers but not all fingers are thumbs. You’re welcome.
March 14th, 2021 at 10:08 AM ^
Can you please admit that you copied and pasted this content directly from RCMB?!
All snark aside, this is great info. Thanks so much for sharing. My initial reaction was "stress fracture", but you nicely describe the full spectrum of possible stress-related injuries.
March 14th, 2021 at 10:11 AM ^
He's not coming back. If you look at the tape of the previous games, this has been bothering him since the Illinois game, if not the end of the game before. He played through it to win the league title, and he can no longer play through it. He's done, so just say thanks for the memories and heal up for the draft. Look at the bright side, if it lingers and hurts his draft prospects, he could come back next year and help this team repeat.
March 14th, 2021 at 10:30 AM ^
This is most likely - he's been dealing with this injury for the better part of a month - another few days will not make much difference.
March 14th, 2021 at 11:06 AM ^
There is another strong argument that for most of the 2020-2021 season Livers has been dealing with a lower leg injury (how many times has he reached for his lower leg after landing under the basket this year?...how many times has he limped for a little bit after some big landing?).
He definitely needs to find a long-term solution to this problem, but over 2021 he also has shown the ability to get back to a point where he can assume his 2021 main role...stationary 50% shooter from behind the arc.
March 14th, 2021 at 11:13 AM ^
You post a lot of nonsense.
You don't know anything, you're just saying things. You do that a lot, and should dial it back.
He's a senior, and has played all four years, so no he can't come back.
March 14th, 2021 at 11:53 AM ^
Covid year, everyone has the opportunity to come back.
March 15th, 2021 at 10:01 AM ^
Well shit. You're right, and I apologize.
March 14th, 2021 at 12:02 PM ^
Hahaha. Everyone can come back. It was decided in fall. How many times does this have to be stated?
And Livers isn’t coming back and shouldn’t come back. He has given everything.
Now Brooks and Smith different story
March 14th, 2021 at 12:25 PM ^
he's given everything AND he's clearly as ready as he's going to be. another year in college would not get him closer to being an nba player.
And Brown too
March 14th, 2021 at 12:02 PM ^
Doesn't this year not count for eligibility purposes because of Covid?
March 14th, 2021 at 12:07 PM ^
Damn, Timmmaay...you blew the dude up, but surely you knew that ALL players are eligible for another year:
https://www.ncsasports.org/coronavirus-sports/ncaa-eligibility-coronavirus
March 15th, 2021 at 10:02 AM ^
No, I forgot. I'm ritard.
March 14th, 2021 at 12:16 PM ^
If I'm Juwan Howard and we win a blowout in the national championship game I'm putting Livers out there in a boot for the final minute and just telling him to spin in circles while shouting WHEEEEE!!!!!!
March 14th, 2021 at 10:15 AM ^
Thanks for the in-depth dissertation. It's a hopeful post.
March 14th, 2021 at 10:26 AM ^
Since we're offering medical interpretations from afar, we might as well psychoanalyze Mark Turgeon. It's pretty obvious he suffers from Napoleon Complex, and the taller the person he has a beef with, the more agitated he gets.
March 14th, 2021 at 11:05 AM ^
Turgeon has the rare form of the Napoleon Complex that effects the Izzoid region of his brain.
March 14th, 2021 at 11:47 AM ^
So glad he did not have a Lafayette complexe.
Username cheques out.
March 14th, 2021 at 10:35 AM ^
From the man himself. Stress fracture. He is somewhat optimistic though. Similar to OP.
https://twitter.com/bradgalli/status/1371086686613028864?s=21
March 14th, 2021 at 10:58 AM ^
OP is all moot.
March 14th, 2021 at 10:49 AM ^
Just what I was thinking.
i try not to gossip, but i heard you broke your "talar trochlea" on a date with a woman of ill repute...
[seriously, i'll need to get my stedman's medical dictionary off the shelf to interpret the OP]
March 14th, 2021 at 11:05 AM ^
Livers referred to the injury as a stress fracture
March 14th, 2021 at 11:15 AM ^
I had to reread that first sentence several times
March 14th, 2021 at 11:15 AM ^
I think the OP is just emphasizing that there is a continuum on the degree of bone injury.
Whatever the MRI indicates.....it does NOT appear to be from a specific event at Illinois. Here is what Livers says:
DetNews:
Livers said he first started to experience discomfort in his right foot when Michigan played at Maryland on Dec. 31. Then it lingered. In last week’s loss to Illinois, fifth-year senior center Austin Davis rolled up on his lower right leg during a busy closing stretch where the Wolverines played five games in 11 days.
Then in the first half of Friday’s Big Ten tournament quarterfinal win against Maryland, Livers said he aggravated the injury during a defensive play in transition that ended with him limping off the court.
“I've had foot issues halfway through the season that I've been battling,” Livers said. “I've never had a stress fracture. I feel like I've been playing on it for like the last four to five (games) maybe. It wasn’t as bad as it was.
“It's not something that just happened one day. Obviously, a stress fracture is an injury that happens over time. It was something that I was battling, and we were rehabbing."
March 14th, 2021 at 12:29 PM ^
Check out my post further down below. Isaiah said he noticed something as far back as the Dec 31 game...hmm, I had a similar feeling in heal bone 3 or 4 months before I had the MRI. I ran on my "sore and tender" left heal (calcaneus) bone almost daily and yet there were times I had a take a day or two off then go slower at other times.
Bottom line, it got progressively worse just like Isaiah's injury.
March 14th, 2021 at 11:36 AM ^
Check out the big brain on Brett!
March 14th, 2021 at 12:38 PM ^
A Pulp Fiction reference. Can’t say I expected that in this thread. You’re a smart mother fucker, that’s right.
well played.
March 14th, 2021 at 11:43 AM ^
I concur.
March 14th, 2021 at 11:45 AM ^
My best buddy from Med school is an orthopedic surgeon and he said that usually stress fractures are not weight bearing, so there is some hope in that they are allowing him to walk/stand with boot and put weight on it.
I’m an MD, though not an orthopedist. In athletes, most stress fractures are weight-bearing— tibia and fibula in the leg, and the bones of the foot, including the bottom of the ankle joint (the “talar trochlea” the OP referenced) and the calcaneus, or heel bone.
The “subchondral” part of a bone refers to the bone beneath the cartilage of a joint. It’s the shock absorber. That implies load bearing, though the load may be a force other than weight (e.g., elbow stress on a baseball pitcher).
I wonder if your friend was referring to the fact that stress fractures are very common in older folks with decreased bone density. Those happen in places like the pelvis or the spine, which have less weight-bearing responsibility.
March 14th, 2021 at 11:52 AM ^
Appreciate the information. Need to give credit.
March 14th, 2021 at 12:04 PM ^
Or they just didnt want to give away much info about the injury.
This way their opposition will have to prepare for Livers to be in the lineup .
March 14th, 2021 at 12:21 PM ^
Highly technical and credible. I had a stress injury in my left calcaneus (heal) bone some 4 years ago. It was increasingly difficult to run on it prior to the diagnosis. I had to frequently ice it afterwards. Then there was some swelling. Finally, after running on it, I could hardly walk on it so I got to an orthopedic doctor a few day s later. The initial diagnosis was that it was a stress fracture but she ordered an MRI which was a days later. The results revealed a few stress lines that were about to fracture. Technically, the MRI showed different density areas of the calcaneus. Had I run on it another day or even another mile, I would have fractured the bone. If that would have happened, I would not have been able to put any weight on it and been sidelined twice as long.
The doc told me to treat the injury as a stress fracture and not run on it for 6 weeks. I complied. The injury completely mended and then I was able to jog on a grassy surface for a while and then ramp up very slowly. During the recovery process, I was able to walk without a boot and continue the daily ice treatments and it got a little stronger each week, such was the nature of that injury.
While I do not know exactly what part of of Isaiah's foot has this "stress" damage is, it is to be treated as a stress fracture, so he is not to play or practice on it whatsoever for several (as in 3 or more weeks, depending) It means a 99.9% chance his season is over. He'll make a full recovery later this spring.
Yes, an MRI can reveal stress areas that are about to fracture in the bone, wherever and needs to addressed as a fracture so as to insure a complete and more speedy recovery.
All of that was news to me at that time but I completely understand Isaiah's diagnosis, which is not confusing to me.
For the purposes of UM's tournament hopes, fracture vs reaction doesn't matter. Even if it's not fatigued to failure, 1 month isn't enough for him to safely assume high impact activities.
For Livers, it's an important distinction because a stress reaction can heal with protection. A stress fracture can too but the nonunion rates are higher. That's why a lot of athletes with this injury (assumption is that it's his 5th metatarsal--it may not be) end up getting a screw placed.
It would not be in his best interest to try to play in this time frame.