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Dr. David Geier on Erik Karlsson’s skating

“He doesn’t look interested.”

That’s what Ray Ferraro said of Erik Karlsson on TSN’s “OverDrive” radio show, after the San Jose Sharks lost 5-2 in Ottawa on October 27.

At that point of the season, just 12 games in, Karlsson was a minus-11. In the Senators game alone, Karlsson was a minus-four.

“He is so disappointing right now,” Jeff O’Neill added, echoing Ferraro, “He’s not even trying. I don’t know what the hell he’s doing out there, but he’s embarrassing himself.”

Fair or not, there’s no doubt we didn’t see the best Karlsson that night.

Things didn’t get much better for Karlsson in the beginning of November.

For the first time, Karlsson was audibly booed by San Jose fans surely frustrated by the initial returns on the eight-year, $92 million dollar contract that the Sharks had given him during the summer.

The microscope on the world’s highest-paid defenseman has continued in the midst of San Jose’s five-game winning streak.

Even in the same game, Karlsson’s skating has appeared to wax and wane. This was early against Edmonton on November 12, at the end of a 50-second Karlsson shift:

That’s not Connor McDavid turning the corner on Karlsson — that’s Jujhar Khaira.

But in the 6-3 victory, Karlsson also put up three assists (and a plus-three). On the next Sharks broadcast on November 14, San Jose color commentators Jamie Baker and Kendall Coyne Schofield remarked that it was Karlsson’s best game of the season.

With all this noise, it’s easy to forget that Karlsson underwent groin surgery last June. It’s also easy to forget how much skating drives Karlsson’s success, even more so than other NHL players. These are clearly related things: Any physical diminishment of Karlsson’s skating ability takes away from his arguable greatest strength as a hockey player.

So I spoke with Dr. David Geier about Karlsson’s groin surgery and how it might still be affecting his skating. Dr. Geier is an orthopedic surgeon and sports medicine specialist who has lent his expertise to The New York Times and ESPN, among other outlets.

Please keep in mind that Dr. Geier isn’t involved with Karlsson’s medical or surgical care — this is just informed analysis about the information that’s publicly available.

Sheng Peng: How do groin injuries affect a hockey player’s skating?

Dr. David Geier: Not all groin surgeries and injuries are the same.

But generally, what hockey players get are these injuries — we used to use the term, “sports hernia,” we’ve gotten away from, because it’s not truly a hernia injury.

It’s an injury where the lower abdominal muscles meets your inner thigh muscles, what we call your adductors. You get it a lot in hockey players because of the nature of the skating, there’s a lot of movement across your body with the skating motion. You’re pulling your leg toward the mid-line, so the speak. You’re doing it against ice, to cut really quickly.

What happens with hockey players sometimes — the lower abdominal muscles are pulling up, they’re pulling one way — the adductor thigh muscles are pulling sort of down and across. So they’re pulling against each other, and you get a tear of the muscle on either side. Or the fascia, the layer of tissue outside of the muscle that confines it to a compartment.

It’s just really uncomfortable. It’s not something you can’t play through — but it’s just uncomfortable. It limits you from doing things coming across your body. In hockey, it’s skating and making aggressive cuts. At the pro level, it’s hard to have and play at the same level as your competition.

A lot of times, we’ll shut a player down for two or three weeks, these athletes, to see if it’ll heal. If it doesn’t, then you’re probably better going ahead and having the surgery.

The good news is, when it comes to Karlsson, is that people almost always get back to full 100 percent participation with no lingering issues. But that can take a while.

The time it takes to get back on the ice isn’t necessarily the time of full recovery. I would expect — I don’t know him — that he’ll continue to get better over a few months, as he starts to get used to it.

The problem is, the same things that cause injury and bother you with injury are sort of the same things that are difficult with hockey. It’s the skating and aggressive cuts. It gets better, but that area is tight. You do those movements, and you feel the area where the surgery was done, where the repair was done. But that gets better over time.

SP: So does it make sense — Karlsson had his groin surgery in early June — that he’s still recovering?

DG: I’d say so. That’s five months. I would expect, for most hockey players, that’s about right. They may feel it a little bit; they may be a little hesitant on it. It may not be a physical thing either — it could be they’re just reluctant to aggravate it, so they don’t push as hard. But that gets better with rest and giving it more time to heal. So that could be completely normal.

SP: Karlsson’s skating appears even inconsistent in game. Sometimes, in the same game, he’ll look like the old Karlsson. But then sometimes, in the same game, he’ll just look old. Is this in-game inconsistency also part of the recovery from groin surgery?

DG: Absolutely.

My pro soccer players, we had a couple players get that surgery.

You see it two different ways. You see it early in the game sometimes, they were kind of stiff. But as they got into the flow of the game, it sort of loosened up, and they got better. The flip side of it sometimes is toward the end of the game, that’s when they start to feel it. You’re cutting, you’re moving balls across your body, 20, 50, 100 times a game. So it starts to fatigue.

So absolutely, that variation is a normal thing without anything bad going on.

SP: This is hard to answer because we don’t know everything about Karlsson’s surgery, but when would you expect him to be fully 100 percent?

DG: Every athlete is different. But generally, they really start to go where they don’t feel it much at all around the six-month point. But they can continue to get stronger and improve their strength cutting side to side up to nine months to a year.

They can do things way before that. But that area continues to get stronger; they get more confident on it. He may look better in, let’s say April, as the regular season is winding up, than he does now, even though there isn’t really anything different going on. It’s just the body gets stronger and you kind of get used to where those muscles are in terms of recovery.

SP: So in your opinion, is there anything long-term to worry about with Karlsson, related to last summer’s groin surgery?

DG: I wouldn’t think so. If you start seeing that they’re sitting him for games for thigh or groin or abdominal muscle things, I might start to get a little worried. But until you start seeing that, I don’t think there’s any real danger that he’s not healing the way he should.

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