On Bird's injury: What does it mean that her knee "basically hyperflexed"?

Seattle Storm point guard Sue Bird hopes to return quickly from injury, but hyperflexed knees can take time to heal. Photo via jlindstr.smugmug.com.

With 5:51 left in the third quarter and the game already safely in hand, the Seattle Storm suffered a loss when Edwige Lawson-Wade fouled her near midcourt.

Richard Cohen of SportsPageMagazine captured the likely feeling among Storm fans by writing, "Sue Bird scared the hell out of every Storm fan on the planet."

A Seattle native at the game sent me the following three line message (censored for our readership, but feel free to use your imagination):

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****

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Both Seattle Times reporter Jayda Evans and Kevin Pelton of StormBasketball.com have more on the injury and Bird's response. Although the official announcement during the game was that it was a "sprained left knee", she provided a little more insight in her post-game comments.

Sue Bird Update " StormTracker - The Official Blog of the Seattle Storm
"It’s a knee that I’ve had multiple surgeries on," explained Bird. "I’m sure anyone who has been in that situation can tell you, when it gets pushed in a direction it doesn’t want to go, it can be painful. It doesn’t seem like any damage has occurred. I don’t have my extension or my flexion, and it basically hyperflexed. My ankle touched my behind is the layman’s way of saying it. I don’t normally go that far, so to get pushed that far is very painful. He just thought – and we were up by a lot, the team played amazing – rather than risk something worse, let it calm down."

Bird is optimistic she can get back on the floor quickly.

"The best thing about this," she said, "is our next game is not until Friday, so I’ll have some time to take care of it. We’ll see how it reacts tomorrow. Hopefully it’s just something small."

"She's going to be fine," said Storm coach Brian Agler in his remarks to the media after last night's game. "We'll monitor her day by day, but I expect her to play in the next game. Whatever the doctor wanted to do we'll do and he wanted to hold her out."

Storm fan or not, we all hope that Seattle Storm point guard Sue Bird's knee injury is something small because nobody wants to wish a severe injury upon another human being. Unfortunately, hyperflexed knees can result to mild to severe injuries to the posterior cruciate ligament (PCL) that sits just behind the anterior cruciate ligament (ACL). While ACL injuries tend to be more prevalent in sports, PCL injuries can be just as serious...or minor annoyances.

Nobody at Swish Appeal is a doctor, but while we wait for official word, perhaps this might provide some initial insight.

Apparently, the ACL and PCL work together to keep the knee stable: while the ACL keeps the femur from moving forward, the PCL keeps it from moving backward. A little more on the PCL here:

Posterior Cruciate Ligament Injury
The posterior cruciate ligament (PCL) functions mainly in preventing the tibia from traveling backwards on the femur, known as posterior drawer. It also helps to prevent the tibia from twisting outwards. Injury to the ligament leads to knee instability with the shin bone having a tendency to 'sag' backwards when the knee is bent at 90 degrees.

The PCL is injured by hyperflexing the knee, described much in the way Bird's injury occurred.

Posterior Cruciate Ligament Injuries - PCL Tear - PCL Reconstruction
How is the PCL injured?

The most common mechanism of injury of the PCL is the so-called "dashboard injury." This occurs when the knee is bent, and an object forcefully strikes the shin backwards. It is called a 'dashboard injury' because this can be seen in car collisions when the shin forcefully strikes the dashboard. The other common mechanism of injury is a sports injury when an athlete falls on the front of their knee. In this injury, the knee is hyperflexed (bent all the way back), with the foot held pointing downwards. These types of injuries stress the PCL, and if the force is high enough, a PCL tear will result.

However, it seems as though the level of force is important in determining the severity of the injury, which would explain why athletic trainer Barton Anderson claims that the only sports related PCL injuries that he has seen have been with football players.

PCL Knee Injury - Sports Injury Info
How it is Injured

The most common way to injure the PCL is with forceful flexion, or bending of the knee. The sports related PCL knee injuries I have seen have all been with football players. They were either fallen upon, or tackled, forcing their knees to bend very forcefully, farther than they would normally bend. This forceful flexion places great stress on the PCL, and can lead to rupture.

So that bodes well for Bird.

First, she was not tackled by a linebacker running at her full speed. Second, if the level of force matters, there are three grades of PCL injuries ranging from partial to full tears meaning a low force injury might not be too severe. Third, it appears that surgery is only recommended for Grade III tears. Fourth and more optimistically, some athletes -- like Ohio State University quarterback Terrelle Pryor -- are able to play through the injury. Fifth and most optimistically, PCL injuries are indeed rare in basketball.

Nevertheless, it's also important to note that PCL injuries do happen in basketball.

Most recently, Boston Celtics center Kendrick Perkins tore his PCL and MCL during the NBA Finals and could be out several months. But let's stick to the PCL alone for now.

Another example is Utah Jazz forward Paul Millsap who injured his PCL in December 2008 and was expected to be out 7-10 games, but only ended up missing 6 games that season (which ended up being something of a career year for him). In contrast, Denver Nuggets forward Kenyon Martin missed nearly two months dealing with a PCL injury, which in WNBA time would really hurt the Storm.

However, Storm fans don't have to make the leap to the NBA for examples of the consequences of knee injuries. Bird herself had arthroscopic knee surgery in 2007 but only missed 5 games. But last season, former Storm forward Katie Geralds suffered a PCL injury on August 4th in KeyArena and missed the remainder of the season and playoffs (14 regular season and 3 playoff games). Furthermore, the reason given for Geralds' decision to forego this season was that she was "experiencing a few difficulties following the 2009 PCL tear in her left knee", according to a Storm news release.

The bottom line appears to be that cursing and scared Storm fans are not yet in the clear with regard to Bird's injury: she could play through it, miss a few games, miss the season, or missing more extended time. Then there's also the possibility that there was no PCL injury at all and that it just requires rest. We will have to wait for a doctor's opinion, but as we see with Martin's case, things could still be uncertain for an extended amount of time.

"I just thought, 'Please God protect my friend'," said Storm forward Lauren Jackson. "You don't like to see anyone go down, especially Sue. I just hope that she's ok."

Let's all hope for the best.

UPDATE (6/23/10): Bird Gets Good News on Knee

UPDATE 2 (from Storm practice on 6/23/10): Bird practices, knee feels ok.

Related Links:

Silver Stars get "out hustled and out punched up in all areas of the game"

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