Getting Back in the Game

“We are doing reconstructive surgery on people who are a lot older than we used to. People expect to be healthier a lot longer. They want to stay active ” says Dr. Douglas Messina of Carolina Sports Medicine & Orthopaedic Specialists.

he field of sports medicine is a relative newcomer to the medical field. It came onto the scene about 30 years ago when a group of orthopedic physicians who enjoyed the sports aspect of the field began specializing in covering athletes from the sideline to the operating table and into recovery.

Nowhere is that more apparent than in this vibrant outdoor community we call home. People of all ages are whacking balls over nets and across tapered greens. If they’re not using a ball they’re swimming surfing running sailing or generally rummaging around in the dirt in their lush gardens.

“Things that were reserved for the younger higher-level athlete in the past we are seeing in the older population ” says Dr. Messina. His patients are saying: Hey we’re not ready to give up tennis yet.

And orthopedic surgeons are determined to get their patients back out there quicker and in better shape. Dr. William Sutton of the Wilmington Orthopaedic Group gives an example of a 45-year-old athlete who injured his knee while playing ball in high school. Thirty years ago the athlete wrapped his knee up and kept playing. Now at age 45 the patient is hampered by an arthritic knee. “A replacement doesn’t do well in a 45-year-old. Now we can treat it arthroscopically by realigning the knee or something along those lines ” says Sutton. A patient no longer has to be sidelined until he gets old enough or symptomatic enough for a knee replacement.

The advent of the arthroscope has redefined the surgeon’s ability to diagnose and repair the joints that give the active adult so much trouble. The arthroscope is a small device the surgeon inserts into a joint through a little incision. The tiny lens and fiber optic light of the arthroscope is connected to a camera and monitor which allows the orthopedic surgeon to see inside the joint.

“We can treat the injury now without greater soft tissue injury from the exposure ” explains Dr. Sutton. The arthroscope has given surgeons about 95 percent of the information they need to know about the knee and nearly the same 90 percent about the shoulder.

There is though a problem with that small incision. Patients can forget about it and all the work done under the surface. If that’s the case it makes it harder for the physical therapist who works with the patient after surgery because the patient may think the non-intrusive arthroscopic surgery will shorten the recovery time. “Patients come in and say ‘Well I only got scoped ’” says Jai Isear a physical therapist and athletic trainer at Carolina Sports Medicine. “In some cases however the patient must follow similar post-operative precautions activity modifications and recovery times.”

“You can’t force biology ” adds Dr. Messina. “You have to give time for the body to heal and remodel the tissues that we’re repairing.”

Even so patients are back on the field sooner than ever. Even as recently as five to 10 years ago damage to an anterior cruciate ligament (ACL) — one of the four major ligaments of the knee and the most commonly injured by athletes due to the large amounts of pressure weight and torque the knee must withstand — would require a year’s worth of rehab says Dr. Messina. Today time off is closer to six months.

Orthopedic surgeons have gotten a lot of help from magnetic resonance imaging (MRI) — a medical imaging technique used to visualize the structure and function of the body — in this quest to diagnose and reduce rehab time. The MRI is close to 100-percent accurate says Dr. Robert Boswell of Atlantic Orthopedics. “It’s a fantastic tool that allows us to look inside the body non-invasively. Traditionally we relied on physical exam techniques that had a certain degree of error.”

Of course like any tool the MRI can be overused. Some of the parents of injured UNCW athletes want to know what the MRI says before the surgeon has a chance to perform a physical exam laughs Dr. Sutton UNCW team doctor. An MRI may not be cost efficient if surgery is not the solution. The question to ask says Sutton is “Will the MRI change the management of the injury?” If not that may be an expensive way to accumulate information.

Another source ripe for overuse is the Internet say area physicians. Today’s patients are a lot better informed says Dr. Boswell. “Interactions can be a lot more fruitful.” On the flipside some of the information on the net is “hogwash ” he laughs. And doctors have to talk their patients down from being attached to a certain procedure.

Surgery is not always the answer say the doctors. The surgeons work closely with physical therapists (PTs) and sometimes athletic trainers. The PTs teach strengthening and flexibility exercises to help their patients improve the mechanics that got them into trouble in the first place.

“I may not be able to improve your score ” says Julie Lemley a physical therapist at Wilmington Orthopaedic Group’s Physical Therapy Center “but I can help improve your swing!”

Physical therapist Jai Isear takes a broad view of any injury. “We don’t just put the blinders on and say ‘Well it’s a knee sprain so let’s focus on the knee.’ We take a look at areas above and below the site of the pain at the foot and the hip as those two joints influence how the knee will function.”

Like other physical therapists Isear integrates the work he does on the table or a machine with the more important functional training. He tailors the patient’s rehabilitation to be as “sports-specific” and “position specific” as possible. “That’s the main part the part that gets them back to their activity ” says Isear. “We want to reproduce the demands of their sport in the clinical setting to ensure the best opportunity for a full return to their pre-injury (or higher) level of function.”

A physical therapist’s goal is to help the patient recover from the injury and to use this information to prevent injuries down the road. That is also the surgeons’ mission. Dr. Boswell advises his patients to increase activity by no more than 10 percent per week. Overuse is one of the biggest factors in athletic injuries he admits. Adequate warm-up and cool-down exercises are critical to the overall health of the body as well.

The advances made to speed up recovery for the multi-million-dollar big league baseball pitcher translated into better care for the active adult population at large. “It’s just as important to get the recreational athletes back healthy and doing what they want to do as it is with the high-level elite athlete ” says Dr. Messina. Most of us weekend warriors gardeners and daily lap swimmers would agree.