Flyers fans learned last season what Eagles fans had learned the year before, what many athletes have learned before then and what Dr. William Meyers has learned since first cutting into a cadaver at Duke University more than three decades ago.
No two sports hernias are alike. In fact, the very term is what often leads down the path of recurrent trouble, said the surgeon who estimates he has evaluated over 15,000 core muscle injuries since 2001.
"I don't want to trash any of my colleagues,'' Meyers, now 67, was saying recently in his office at the Navy Yard-based Vincera Institute. "There's more people getting the guts to operate on these things now. But they're using the old sports hernia model. And so it's becoming a bigger and bigger issue. Every clinic day we're seeing more and more…
"About 50 percent of my cases now are re-dos."
Protective of the privacy of his active clients, it's as close as he will come to commenting on one of his more recently publicized ones: the operation to repair Nolan Patrick, the Flyers' No. 1 pick, chosen second overall. Touted a year ago as the odds-on favorite to be the overall top pick in this year's amateur draft, Patrick was instead shut down five games into his 2016-17 season with the Brandon Wheat Kings after experiencing pain and discomfort on the left side of his lower abdomen. He played in just 33 games, creating health concerns that compelled the New Jersey Devils to bypass him and select Nico Hischier with the overall No.1 pick.
Patrick had undergone surgery to repair what was described as a sports hernia before last season. According to the Wheat Kings official website, the surgery was performed by Dr. James Robinson at Grace Hospital in Winnipeg. Initially, Robinson repaired the right side only, said Patrick, and a slighter injury to his left side was not initially detected.
When Patrick was quickly shelved after five games that fall, he speculated to NHL.com at the time, "It was a combination of maybe coming back too early and overcompensating a bit. My muscles weren't really training to move how they're supposed to after the surgery. I think I was still tight in certain areas and so I was overcompensating.''
It actually was a full-fledged tear of the pelvic muscles on his left, and is one reason Meyers would like "sports hernia'' eliminated from the lexicon. It's inaccurate and misleading, he said, and when it's treated as an intestinal injury and not as an injury to the complex group of muscles and ligaments connected to the pelvis –"orthopedically'' is the word he uses – it can linger and lead to further injury.
Over thousands of surgeries over the last 25 years, Meyers has identified at least 20 variations of that injury. Often surgery involves the mending of several. When he was able to play last season, Patrick said that he was between 60 percent and 75 percent effective and that even then he felt "sharp pains through skating."
"That is mostly what bothered me, so my skating didn't get to where it needed to be," he said. "It's tough to explain, it is kinda like a sharp shooting pain through my lower stomach.''
In other words, no two core-muscle injuries are the same, which is why recoveries vary, as well, said Meyers. His repair work and the work done by a team of surgeons at Vincera are not always quick fixes – both Claude Giroux and Shayne Gostibehere struggled last season after summer procedures by physicians at Vincera.
Giroux's surgery was more extensive, involving his hip, as well, and, unlike Gostisbehere, he conceded toward season's end that it affected his mobility. Dallas Stars forward Jamie Benn also suffered a down year after Meyers performed extensive surgery on his core – although it should be noted that Benn underwent surgery on both hips the previous summer.
But there is little doubt Meyers has built a base of trust across a wide spectrum of professional athletes and organizations. Signed photos and thank yous from bull riders and Premier League soccer players hang aside those of more recognizable American stars such as Justin Verlander, Miguel Cabrera and Troy Tulowitzki. The list of known pros is expansive and includes stars from every professional league: Marshawn Lynch, Adrian Peterson, Grant Hill, Cliff Lee, Robinson Cano, Brent Celek, Zack Ertz and Jason Kelce just to name a few.
Clearly, the Flyers believe in Meyers. Over the years, they have channeled numerous players, such as Mikael Renberg, Simon Gagne and Mike Richards, to him. Danny Briere, after missing most of the 2008-09 season because of an extensive core muscle surgery performed by Meyers, returned with a big season in 2009-10, scoring 38 goals and 45 assists while playing in 98 games, regular season and postseason, as the Flyers reached the sixth game of the Stanley Cup finals.
Already 32 by then, Briere scored 30 points in those playoffs.
"It didn't slow me down,'' Briere said this week. "When I started the following year everything was back to normal and I've never had any issues from that point on. So I'm very, very happy with the way things worked out.''
And Donovan McNabb rebounded from an extensive 2005 core muscle operation performed by Meyers to post a 4-1 record at the start of the following season. Injuries to key players — including his own ACL tear – derailed that campaign.
"He really ripped things apart and totally avulsed the muscles from above and below,'' Meyers said. "He had really done a job on it. It was similar to what we see in a lot of bull riders. They tend to just rip muscles off."
Meyers describes his expertise, in person and in Vincera literature, to be in core-muscle injury. For years it was a "no-man's land'' he said, with orthopedists' concentration on the hips, general surgeons taking care of problems of the colon-rectal, internal inguinal ring, and the scope of urologists and gynecologists narrowed on the organs that reside in the pelvic region.
"It gets into just understanding the pathophysiology and the anatomy,'' said Meyers. "Someone is feeling a lot of pain on one side and none on the other side but we can see on the MRI that there's damage on the non-pain side. After a number of years, I realized we have to do the other side, because the other side is going to come back.''
So that's what he did in early June, all but assuring that Patrick would drop from his status as odds-on No.1 pick in the NHL draft, and into the Flyers' lap at No. 2.