On October 10, state police arrested Nauman Hussain in Watervliet and charged him with criminally negligent homicide, a Class E felony, the least serious under New York law.[5][100] He was taken to County Court in Cobleskill and arraigned, after which he pleaded not guilty to the charge, posted $150,000 bond and was released.[5] Mallery asked for higher bail than usual, and for the court to require that Hussain surrender his passports, claiming he was a flight risk; she told the court that his vehicle was found packed with his personal belongings and several suitcases.[5][56] Hussain had not been fleeing, Kindlon maintained, but moving house in response to death threats he had received; investigators did not find that claim credible.[5][56]
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If they did, those lawsuits might have less chance of succeeding, due to the outcome of similar actions against the state brought by the families of victims of the 2005 Ethan Allen accident, where a small tour boat on Lake George capsized in the wake of a bigger one, killing 20. The NTSB had later faulted state regulators for not reducing the boat's passenger capacity; however the state's highest court, the Court of Appeals, had dismissed the suit, holding that the facts of the case did not create an exception to the state's sovereign immunity, a legal doctrine under which governments it applies to can be sued only if they allow themselves to be. A lawyer who had represented some of those victims, and had been retained by two of the families of limousine crash victims told the Times Union that the state's more direct role in regulating Prestige might result in a different verdict.[55]
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In these situations, a combination of impact workload modification, education about proper jumping/landing technique, and building quad/hamstring leg strength is the first line of help. Beyond this, checking for limited ankle mobility can be useful. If a gymnast has a very stiff ankle joint, it may drive the foot to over-flatten with the arch collapsing and creating inward motion at the knee joint which might create pain. In some cases, but not all, a hip strengthening program might be useful as well. This is usually best implemented if specific strength testing with a dynamometer shows a noticeable strength deficit. Lastly, at some point, direct strengthening of the inside of the knee, with exercises like adduction raises and then Coppehnagen side plank progressions, can help rebuild tissue capacity.
During all of these situations, there is some degree of tissue irritation as oftentimes the stabilizing structures are stretched out. There can also be bone bruising or cartilage irritation that occurs on the backside of the patella, or the outside of the knee joint groove during the instability. With patellar instability or less severe cases of subluxation, typically a course of rest, rehabilitation, and strength work is the main approach. This is in an effort to calm down the knee, increase strength of the quads/hamstrings/hips, correct any concerning movement patterns, and resolve pain.
Just behind the knee cap sits two structures that are very common sources of pain in gymnasts who undergo lots of impacts. One is the fat pad, which serves to help absorb forces between the kneecap and knee joint bones during bending. As mentioned in the study by Dye, it can be one of the most sensitive structures in the knee and commonly produce pain. The second structure is the prepatellar bursa. Bursas are small, fluid-filled sacs that help to reduce friction points that experience lots of bending or rubbing. In this case, it also serves to help prevent excessive friction on the front of the kneecap as the skin and soft tissues glide over it. There are also important bursas above the knee cap around the quad tendon, and below the kneecap around the patellar tendon. More research on that here and here.
Unfortunately, there are times when the high forces of gymnastics landings will fully tear the ligament. These are Grade III injuries. They tend to be the hardest to deal with, as they come with notable tissue damage, pain, swelling, and interference with movement. They most often require surgery and extensive periods of rehabilitation following repair or reconstruction. While I will break these injuries out below for the sake of learning, keep in mind that due to the very high impact forces of gymnastics, there may be times when multiple ligaments or multiple structures are damaged. These create very complex, unique situations, and must be taken on a case-by-case basis with a great team of medical providers all working together.
In the early phases of knee rehabilitation, this can be very hard to do as someone often times has pain that may limit their loading tolerance. This is where. itis crucial to understand not only what is a normal response to exercise vs an abnormal response that increases symptoms. For most cases (minus some surgeries) I tell people that some sort of discomfort is expected, say a 2-3/10, as long as the pain levels do not increase after exercise or elevate in the day following exercise. Muscular soreness and general fatigue are expected, where sharper or more intense pain is not. I also closely monitor swelling levels of the knee joint, and range of motion, during this time. If exercise causes the knee to increase in swelling or create losses in the range of motion, we may be pushing too fast too soon.
Effective November 17th, Montville Township is suspending all outdoor Township recreation programs, and closing the community basketball courts, playing fields, playgrounds, pavilions, and Dog Park. Please note that this was a very difficult decision, but it has been made for the protection of public health and safety concerns, and to further mitigate the increase of Covid-19 cases Montville Township is currently experiencing. 2ff7e9595c
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