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So What is Wrong with Romain Gall's Knee?

Massive Reports Chief Medical Officer examines Romain Gall's knee injury and gives a detailed account of whats wrong, how the injury occured, and what to expect in the future from a medical perspective.

Joe Maiorana-USA TODAY Sports

So just what is wrong with Romain Gall these days? The midfielder last played in the first preseason game against FC Dallas and was subsequently held out with knee pain and details have been slim.

I commend Crew SC head coach Gregg Berhalter for being quiet about injuries, as it doesn't make sense to give opposition any injury information. Injury reports as a whole seem a little strange to me. It is as if the medical staff is saying, "Here are our weaknesses, and here's how you can render out best players useless."

That being said, as a nurse, and Massive Report's Chief Medical Officer, I have compiled what little information has been given into my best guess into what may be ailing Gall. I believe the 20-year old has a grade 2 knee sprain. This is actually decent news. Here's why:

What is a knee sprain?

There are four different ligaments in the knee (ACL, PCL, MCL, and LCL). When one of these stretches beyond its normal limits or tears, it is considered a sprain. This is different than a strain, which is when the muscle or tendon's stretch or tear and the healing process and symptoms are somewhat different. These terms are often used interchangeably to indicate a soft tissue injury to an area, but medically speaking they are quite different.

Gall likely has an ACL sprain

It is next to impossible to determine from the information given which type of sprain Gall has, but "doing things that are next to impossible" is my middle name. PCL, MCL, and LCL sprains are all caused by trauma to the knee. Depending on where the blunt force (such as falling to the ground, and errant tackle, or collision) occurs would determine which ligament is sprained. An ACL sprain, however, is caused by hyper extension or sudden twisting (such as cutting, sprinting, spinning, or sudden stopping).

Gall's knee yesterday while running at training
Photo Courtesy of Pat Murphy

In a picture of Gall's sprain (see above), his knee appears to be wrapped above and below, and without any protective device. This leads me to believe that Berhalter and his staff are not concerned with Gall reinjuring the knee by contact. If he had an PCL, MCL, or LCL sprain (all caused by trauma) its reasonable to believe he would have a more protective wrapping (see below).

Take all of this with a grain of salt however. It has been several weeks since his injury was first reported and treatment for all four types of sprains is almost identical. Without talking to the coaching staff, I can only offer an educated guess what which ligament  was damaged.

What are the symptoms of a knee sprain?

The symptoms of a knee sprain are similar to other soft tissue injuries. Gall was/is likely experiencing pain, swelling to the knee, stiffness, which in his case somewhat hinders knee movement and walking.

What do you mean grade 2?

Sprains are graded on a 1-4 scale. Ligaments are made up of interwoven fibers. Depending on how many of these fibers are over stretched or torn determines the grade. A grade 2 is worse than a grade 1, but would not be considered a serious injury. Grades 3 and 4 can require surgery to repair. Since Gall had no surgery, these are ruled out.

Recovery time for a grade 1 is often 2-8 weeks with recovery time for a grade 2 is typically from 6-12 weeks. Since Gall has been held out of training and limited to jogging (from what we can tell) for almost a month now it would seem his injury is more serious than a grade 1.

How is it treated?

For minor sprains, such as what Gall likely has, treatment is predictable and low stress. The old acronym R.I.C.E. (Rest, Ice, Compression, Elevation) applies. This prevents the injury from getting worse by overuse and decreases swelling, which can be detrimental to the healing process.

Other than that, Gall will go through several knee rehabilitation exercises. These exercises will actually focus on rehabbing the entire leg including quads, hamstrings, glutes, calf, and the knee. This is in order to prevent compensation injuries. These are injuries acquired by Gall altering the way he walks/runs to compensate for the knee pain. As the entire leg is rehabbed, it is strengthened at the same rate to reduce this risk.

Outlook

The obvious treatment that fans see is Gall being held out of games in order to prevent reinjury. This type of sprain should not stick with him all season if the medical staff is careful. This is why for even a minor injury, we see Gall being held out of games and practice.

On Wednesday's Media Day, Gall was seen doing some lateral cutting exercises followed by jogging continually around the field while his teammates practiced. This shows that his knee is likely close to full strength and Gall is probably only experiencing mild discomfort. But if he is rushed back, the newly healed fibers could easily tear again, so caution is best, especially this early in the season.

With proper rest and rehab Gall should be up to full training in six weeks from when the injury occurred. Barring any setbacks, this should put Gall's return to the game day squad in early April. This timeframe could be clouded by the fact that Gall is not a regular player, so Berhalter and the medical staff may take additional time for recovery.

Editor's Note: Berhalter said this week that they expect Gall back to full training next week.

As stated above, take all this with a grain of salt as nearly no details have been released on Gall's injury.