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A closer look at Andrei Vasilevskiy’s injury, recovery and prognosis

The Lightning goaltender’s back injury that required surgery is expected to keep him out at least two months. What does his future hold after that?
 
Medical experts say it can be rare for "someone in their 20s" to have the type of back injury that Andrei Vasilevskiy had surgery to correct, but acknowledge the wear and tear on goaltenders' bodies is significant.
Medical experts say it can be rare for "someone in their 20s" to have the type of back injury that Andrei Vasilevskiy had surgery to correct, but acknowledge the wear and tear on goaltenders' bodies is significant. [ DIRK SHADD | Times ]
Published Oct. 3|Updated Oct. 3

TAMPA — The Lightning have long leaned on goaltender Andrei Vasilevskiy. His teammates call him the best goalie on the planet, and NHL player polls agree.

But through at least the first two months of this season, Vasilevskiy will be sidelined as he recovers from surgery to repair a herniated disc in his lower back.

Early in the 2018-19 season, Vaslievskiy missed a little more than a month with a fractured foot, and backup Louis Domingue did a good job of carrying the load in his absence. The Lightning went 12-3-0 without Vasilevskiy. When he returned, they led the Atlantic Division with a 24-7-1 record on their way to the Presidents’ Trophy before losing in the postseason’s first round to Columbus. That was the last time Vasilevskiy missed a significant amount of game action.

“It seems like light years ago,” Lightning captain Steven Stamkos said. “We’re just going to have to play really well defensively and buckle things down a little bit, but it’s going to be tough. Any time you’re without a really important player, you just try to stay afloat until that guy gets back and try to push from there.

“We have a really good group, we know that. But it’s going to be difficult. We’re going to have to find a way”

Vasilevskiy’s long-term health has long been a concern, especially as he draws closer to age 30, which he turns next July, and considering that no goaltender has played more hockey over the past four years than him. Medical experts, however, say he can return to his old form.

It is unclear how Vasilevskiy initially sustained a herniated disc in his lower back, but it happened in August well before training camp started. Initially, an injection alleviated the issue, but Vasilevskiy felt pain again during his first practice of camp; a second injection, treatment and rest didn’t work.

“Being a goalie, the load on the spine from squatting up and down is tremendous and actually even more than your regular hockey player," says Dr. Neel Anand, Professor of Orthopaedic Surgery and Director of Spine Trauma at the Cedars-Sinai Medical Center in Los Angeles.
“Being a goalie, the load on the spine from squatting up and down is tremendous and actually even more than your regular hockey player," says Dr. Neel Anand, Professor of Orthopaedic Surgery and Director of Spine Trauma at the Cedars-Sinai Medical Center in Los Angeles. [ DIRK SHADD | Times ]

“I always say the best analogy is like a car tire getting a tear and the air is leaking out,” said Dr. Neel Anand, Professor of Orthopaedic Surgery and Director of Spine Trauma at the Cedars-Sinai Medical Center in Los Angeles.

“In this particular case, there is a jelly in the disc … and that jelly comes out through a tear in the disc. But unfortunately when it comes out, the nerves are right behind, so it starts pinching up on the nerve and it can create pain going down the leg. ... Many times it gets better on its own at some point, but if not, you have to do surgery.”

The microdiscectomy procedure Vasilevskiy had on Sept. 28 is a minimally invasive surgery that removes the portion of the disc that is putting pressure on the nerves and generally, the disc itself remains largely intact.

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“We have a lot of athletes with microdiscectomies who are in major professional sports who have gone back doing what they do, but then unfortunately, it is genetics to a large extent that ultimately will determine, and his disc, just where that will go,” Anand said. “Being a goalie, the load on the spine from squatting up and down is tremendous and actually even more than your regular hockey player.

“But he’s a professional athlete and extremely gifted and motivated and he can get back to normal. I feel confident that, as long as the surgery went well, he can get back to where he is and get back to the level he was at, as most professional athletes do.”

The injury Vasilevskiy had is more common in a football offensive lineman than a hockey goaltender, said Dr. Robert Volk, an orthopaedic surgeon specializing in sports injuries at The Centers for Advanced Orthopaedics in Washington, D.C.

“For a goalie, in particular, with just some of the way they make kick saves and some of the things that they have to do to contort their body in order to tend the goal, (they) have stresses that they can put on their back,” said Volk, who has served as a team physician for the Tampa Bay Bucs, Miami Dolphins and Florida Panthers. “It’s not a super common injury, but it does happen.”

Lightning goaltender Andrei Vasilevskiy’s goalie mask and equipment sit in the locker room on the first day of training camp. He'll remain idle from game action for at least the first two months of the season.
Lightning goaltender Andrei Vasilevskiy’s goalie mask and equipment sit in the locker room on the first day of training camp. He'll remain idle from game action for at least the first two months of the season. [ DIRK SHADD | Times ]

Vasilevskiy likely would be able to keep working out with cardiovascular training like cycling or swimming shortly after the procedure, but wouldn’t be able to do much weight training until about four to five weeks after the surgery. Exercises like lifting weights overhead from a seated position or doing weighted squats would put pressure on the disc.

“He’ll be able to bounce back relatively quickly, which is why you’re hearing projections of eight weeks after surgery,” Volk said. “A lot of times after surgery, it’s a couple months.”

“It’s rare for someone in their 20s to have this type of injury,” he added. “It’s not super rare, but it does happen more commonly in the third or fourth decade of life. But it’s actually maybe a good thing for him that he’s a little bit younger, and, obviously genetically, very gifted. So he should bounce back much quicker than the average 40-year-old who has this type of injury.”

The Lightning said Vasilevskiy is expected to miss the first two months of the season. If that is in fact the case, he wouldn’t return until the 30th game of the season in mid-December. Anand said that two months is an average, but sometimes it can take up to three months to fully recover.

As far as a long-term prognosis, Volk said that studies predominantly focusing on NFL players who have had the same injury saw that they can return to form for several years after surgery.

“Those research studies suggest that on average, players are able to return to their same level of sport for an average of two and a half to three and a half — or an outlier of four — years after their surgery,” Volk said. “And one of the best prognostic indicators we found in the study is the number of games played at that level prior to injury. So the prognosis is good for (Vasilevskiy) to make a good recovery given the amount of time he’s already played at a high level. ...

“Obviously, as you get a bit older through professional sports, you’ve got to spend that much more time on things like conditioning and core stretching, things like that. And I’m sure he’ll take a professional work ethic towards this and get himself back to where it needs to be.”

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