You're not Superman

Despite major medical advances, the everyday athlete won't be on a Lance-like timetable for recovery

Staff WriterApril 7, 2009 

  • Injury: Torn anterior cruciate ligament and stress fracture to tibia (shin).

    Treatment: Continued playing, winning five of six tournaments before having corrective surgery. After nine months of rehabilitation, he returned to play in February, winning last month's Bay Hill Invitational.

    Treatment for the rest of us: Similar, thanks to pioneering developments in arthroscopic surgery in the 1970s designed to get athletes back in action more quickly.

    Lance Armstrong

    Injury: Broke collarbone in four places in a crash during the Tour of Castilla and Leon in Spain last month.

    Treatment: Surgery involving the insertion of a five-inch stainless steel plate and 12 screws to stabilize the break. The seven-time Tour de France champion riding again within two weeks of surgery.

    Treatment for the rest of us: For a common collarbone break, recreational cyclists are advised to stay off the bike for six to eight weeks. For a compound break such as Armstrong's, doctors said the typical downtime is 10 to 12 weeks.

    Ty Lawson

    Injury: Stubbed toe during practice.

    Treatment: Played two days later for 36 minutes against Duke, then sat out the ACC Tournament while resting, icing and taping his toe and applying anesthetic cream before returning for the second round of the NCAA tournament.

    Treatment for the rest of us: Extensive rest and staying off foot for an extended period.

You fall off your bike and break your collarbone, and your doctor tells you to stay off the bike for six to eight weeks. Lance Armstrong falls and breaks his collarbone in several places, and he's back in the saddle in a couple of weeks.

You stub your big toe shuffling around the house early one morning, and the persistent pain has you hobbling for weeks. UNC point guard Ty Lawson jams his and two days later plays 36 minutes in a game against Duke.

Tiger Woods injures the anterior cruciate ligament in his left knee and goes on to win five of his next six golf tournaments before deciding to have the knee surgically repaired. You injure your ACL and sit on the couch watching Woods win those five tournaments.

Why is it that injuries that take the rest of us out of action for weeks, months, possibly forever, only bench elite athletes for a short time? Is their body makeup that superior? Do they have a heightened tolerance for pain? Do they have access to cures of modern medicine unavailable to the rest of us? Are they simply treated differently?

The answer, according to those whose job it is to mend our broken bodies: Yes. William Howard, an orthopedic surgeon with the Arnold Palmer SportsHealth Center at Baltimore's Union Memorial Hospital, tells the story of a college lacrosse player who came in one Monday complaining of abdominal pain. The next day, the player's appendix was removed. Two days after that the player came to him with a question.

His team was in a key game the next day, and he wanted to know if he could play. Just a few years ago such a request would have been unthinkable, the incision from traditional surgery taking several weeks to heal and the jostling from a contact sport such as lacrosse making a tear likely. But this player's appendix had been removed via laparoscopic surgery, in which much smaller incisions are required. There's considerably less risk of infection, and the incision heals much faster.

Howard's answer: Sure, why not?

While laparoscopic surgery has been available to the masses since the 1990s, it's one of several medical procedures pioneered to help athletes get back in the game faster.

"Philosophically speaking, sports medicine is something of a space program for orthopedic care," says Dr. Claude Moorman, director of sports medicine at Duke Health. "Advances gained through those efforts trickle down to all of us."

One of the biggest applications of laparoscopic surgery is quick repair of damaged knees.

"In the '70s," says Moorman, previously the team physician for the NFL's Baltimore Ravens, "athletes would have what we called 'zippers' on both knees" -- long, zipper-looking incisions where doctors had gone in to make repairs.

"Very seldom would you have surgery and be back in the same season," Moorman says. "Now, they're back playing in two to four weeks."

Another injury that once all but spelled the end for athletes, especially baseball pitchers and football quarterbacks: a damaged rotator cuff, or a tear in the shoulder joint tendons. "Our recognition of shoulder injuries and treatment was archaic 20 years ago," Moorman says. "There just wasn't a lot you could do for them."

Will Armstrong feel pain in his collarbone -- now being held in place by a 5-inch stainless steel plate and a dozen screws -- as he trains for the Giro d'Italia, a three-week race that begins next month? Probably. Was Lawson aware of his big toe during this past weekend's Final Four? No doubt. Did Woods test even his renowned mettle during an eight-month rehab from ACL surgery? More than likely.

But it didn't stop them. That, says Howard, is a large part of what make them Lance Armstrong, Ty Lawson and Tiger Woods.

"Any superb athlete can handle pain," says Howard. "When you get to be at that level, you're a different breed of cat."

In part, he says, it's because they're used to it. To reach that level they've had to endure so much pain that it becomes commonplace.

That resolve and willingness to put up with some pain helps elite athletes rebound from any number of injuries more quickly, says Howard. Shoulder separations, ankle sprains, bruised and cracked ribs, broken noses -- all can be endured with minimal risk of additional injury, says Howard.

And it's not just a matter of a paycheck -- a big paycheck -- being on the line.

"Competitive recreational athletes, sometimes they push themselves harder than a lot of pro and college athletes," says Dr. Richard Jones, an orthopedic surgeon with Southeastern Sports Medicine in Asheville. His practice sees college athletes from Western Carolina University and the University of Tennessee, as well ultracompetitive amateurs drawn to the Asheville area's outdoor playground.

"I really treat them [college athletes and competitive amateurs] about the same," says Howard.

So for a mountain biker who breaks her collarbone, he may let her back on the bike in a month. And for a shoulder separation -- be it a linebacker taking a violent hit on the field or a kayaker jarring it loose in some particularly gnarly whitewater -- he's still going to suggest that you let it rest for four to six months.

For most of us, Howard believes we get different treatment than the Lances, Tys and Tigers for a very simple reason: liability. "You can't go wrong telling someone they need to lay off longer than they need to," says Howard. "Emergency rooms are not in the business of getting into trouble if they can help it."

Concussion awareness

One area where advances in medicine have lengthened the amount of time an athlete is benched: concussions.

"With concussions, we used to just wait until we thought your head was cleared," says Howard, whose experience as a rugby player gives him firsthand experience with many of the conditions he treats. A lot of times, he adds, that meant a kid being able to answer "yes" when the coach asked, "You ready to go back in?"

Today, multiple concussions will end a pro career with no such questions asked. Two Super Bowl quarterbacks -- the Dallas Cowboys' Troy Aikman and San Francisco 49ers' Steve Young -- are prime examples.

Last year, a football player at Greenville's J.H. Rose High School died from a hit two days after suffering a concussion. But football helmets have been designed to be more protective -- helmets used by West Mecklenburg School in Charlotte even have impact sensors -- and Howard says growing awareness is leading to increased caution at all levels.

Future of treatment

The next big advance in sports-driven Star Wars medical technology may be platelet-rich plasma therapy, a technique intended to help injuries such as tennis elbow and knee tendinitis heel more quickly. The therapy involves taking a patient's own blood, extracting the platelets, then injecting them into the damaged muscle, bone or other tissue to stimulate healing.

The treatment has been used with success on Pittsburgh Steelers players Hines Ward and Troy Polamalu, and Los Angeles Dodgers pitcher Takashi Saito. Saito underwent the treatment last July to repair a partially torn ulnar collateral ligament in his throwing elbow. Such an injury typically benches a player for a year or more; Saito was back on the mound in September.

Despite such medical advances, common-sense solutions still have their place. Howard recalls the story of another athlete, this one a runner who showed up in his office on a Friday with an ingrown toenail that had caused severe infection.

"He said, 'Doc, I'm training to run a marathon, can you fix me?' I said, 'Well, sure. When's the marathon?' He said, 'Monday.'"

It was the Boston Marathon and the first time the runner had qualified to run the fabled race. He was not to be denied.

"So I fixed him up and he had a personal best," says Howard. "And you know what I did?

"I cut the end off his shoe."

joe.miller@newsobserver.com, 919-812-8450, blogs.newsobserver.com/joemiller

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