Sunday quick thoughts on Hogan, Mitchell, Bennett, altitude

The Patriots are a mile high in Denver today and will be staying the week in Colorado Springs to prepare for an even higher altitude and tougher playing conditions in Mexico City next weekend. They traveled with an old familiar face, but will he be able to overcome his own injury to help an offense whose receiving core has sustained some deep wounds starting in the pre-season? Here’s my take on a few of the major health concerns for the Patriots in the near future…..

Chris Hogan (WR) – Hogan went down with a right shoulder injury on October 29th.

He took a helmet to his right upper arm. This week he was spotted in the Patriots’ locker room still in a sling. The video doesn’t clearly give me enough information to know what Hogan’s injury is. Given the hit to the upper arm, my early suspicion was an AC joint injury. In any case, the fact that he is still in a sling 2 weeks after the injury indicates that it likely will not be a 2-3 week injury. I would not expect to see him back before the team returns from their trip in a week and a half.

Malcolm Mitchell (WR) – Mitchell is on IR for a knee injury with a possibility of being designated to return. He has a significant history with his right knee. He tore his right ACL in college and had it reconstructed. A few months later, he returned to the operating room for a second surgery to address a meniscus tear. In week 16 last season he seemed to re-aggravated the knee on this play

Mitchell missed two games after this seemingly minor injury and appeared to struggle at times with knee discomfort for the remainder of the season. He returned to Patriots’ practice this pre-season but repeatedly came up grabbing his right knee in pre-season games. He was placed on IR in early September and recent reports from ESPN’s Mike Reiss say that the wide receiver has recently started running again.

Given Mitchell’s knee history, my concern is that he has a more degenerative process going on. If this were a simple meniscus tear, I would have expected off-season surgery, which we have not heard about. This seems to be a situation in which Mitchell’s medical team is hoping that an extended period of rest (possibly with stem cell or PRP, steroid injections?) may help quiet down what appears to be a chronic issue. The fact that he just started running again recently means that I don’t expect to see Mitchell back on the field for at least another 4 weeks as he gradually works his way back up to sprinting and hard change of direction.

Martellus Bennett (TE) – I’ve already written about my thoughts on Marty returning to the Patriots on Boston Sports Journal, but I’ll address them briefly here. Speaking purely medically, I suspect that Bennett has had rotator cuff issues for a while. He re-enforced that idea in his most recent Instagram diatribe Friday. My best guess is that he has had multiple shoulder MRIs over the past few seasons (he had shoulder issues that limited him in practice for the Patriots). Something acutely changed for him in the past few weeks – whether it’s a reflection of loss of desire to push through a painful injury after the loss of a star quarterback or an actual worsening of his rotator cuff tear isn’t clear. I suspect his rotator cuff tear is significant and one for which surgery can be considered. These decisions are not made in a vacuum – athletes meet with team doctors, agents, staff and ultimately the athlete is the one to decide for or against surgery. We will never hear the other side of this story from the team doctor or second opinion surgeons because of patient confidentiality, but I think that the support for team docs that Jordy Nelson and Aaron Rodgers wrote this week speak volumes.  NFL athletes can and have played through rotator cuff tears and held off on surgery until the post-season in the past. Bennett made the trip to Denver this weekend, so it looks like he has decided to try to play. It is possible that even with a rotator cuff tear he can be as effective as he was for Tom Brady and the Patriots last season, but we’ll have to wait and see how this unfolds.

Altitude – The Patriots are playing this weekend at an altitude of 5,280 ft, one mile above sea level. Next weekend, they will be in Mexico City at Estadio Azteca, which sits at 7200 ft. It was no surprise to me that Bill Belichick seized the opportunity to get a competitive edge by buying his team some time to acclimate to high altitude conditions. I feel like this isn’t a great time to mention that the US Men’s Soccer team generally trains at altitude in Denver in preparation for playing in Mexico City. Regardless of their recent results, here’s why it can help…

The act of the human body getting used to higher elevations is called “altitude acclimatization.” The basic concept is that the air pressure (not oxygen concentration) is much lower at high altitude than at sea level. Because of this, it’s much harder for the body to absorb and distribute oxygen to the muscles, especially important in the case of endurance athletes (60 minutes, people). Within a few hours of acclimatization, the body is already trying to fix the situation. One of the immediate responses is that they body tries to concentrate the blood so that for every mL of blood the body is working hard to pump to the muscle cells, there is an increased amount of oxygen-carrying red blood cells. Heart rate and breathing rate also increase to supply more oxygen per minute. These things would happen in Denver and Mexico City even if the team came home in between. However, it’s the more mid-range changes in the body that the Patriots hope to capitalize on (along with 10 days of bonding at a military landmark). Within the first couple of weeks at altitude, the body is already producing more red blood cells (increasing the hematocrit) and making extra little energy factories called mitochondria in cells to aid with energizing the muscles and brain cells under low-oxygen conditions.

The Patriots players will experience earlier fatigue, heavier-feeling muscles, thicker body secretions, faster heart and respiratory rates, possibly headaches and even nausea/decreased appetites in response to the higher altitude in Colorado Springs. Hopefully many of those symptoms will improve by the time they travel to Mexico City next weekend. In addition to the elevation issue, Mexico City also brings other environmental challenges.  Luckily, the weather in Foxborough was unseasonably warm until about a week ago, so the average high temperature of 72 degrees F in Mexico City this time of year shouldn’t be much of a problem. The air quality, however,  is very poor due to pollution and may pose an issue especially for athletes already dealing with asthma. I’ve never been a huge fan of the NFL expanding to games in Mexico City, now you can understand why (along with all of the security and contaminated food concerns).

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