It’s never a good time to get hurt

Tuesday, March 24, 2009

There is more than just talent that separates the elite athlete from the rest of the crowd. Timing is just as important. It’s not the timing needed to hit a baseball, throw a pass or turn in the pool but rather the timing of a season and a career. While most of us can measure our working lifetime in decades, an athlete may measure it in months and rarely in years. And that may be why Lance Armstrong has opted for surgery to fix a broken collarbone where the real world would wait the 4-6 weeks to let it heal.

Armstrong crashed over the weekend and broke his clavicle or collarbone, the strut that connects the breast bone or sternum to the shoulder blade. Its main purpose is to allow the arm more freedom of movement away from the body. As well, the clavicle helps protect the major arteries and veins as they pass from the arm to the chest.

Clavicle fractures occur frequently and they heal relatively easily and rarely is surgery necessary. The initial treatment is a sling; some doctors still prescribe a clavicle strap or figure 8 splint, but all that is needed is gravity and the weight of the arm in a sling acting as traction to pull the broken ends of the bone into alignment and relieveing the muscle spasm surrounding the break. The initial pain of the bone ends rubbing resolves quickly as the body lays down calcium to form a healing callus. Then it’s a matter of the body remodeling the bone. After a month or so, all is well. Surgery is occasionally needed if a piece of bone pokes into the overlying skin of if there is damage to the subclavian artery and vein that are located just beneath the bone. And occasionally, the healing callus forms a lump that somebody may choose to have reshaped for cosmetic reasons.

And that brings us to Lance Armstrong. With just a few weeks until the Tour de France and other major bicycle races, taking 4-6 weeks off is like losing a year in his competitive life. Attempting to ride a bike would be unbelievably painful as the weight of his upper body would have to be supported by the broken collarbone as he held onto the handlebars. It has been done though. Floyd Landis broke his collarbone during the Tour de France and continued to compete. Instead of the tiem away or the pain, Armstrong has decided to have an operation. Usually a titanium plate, that spans the length of the clavicle, is screwed into the bone. The plate stabilizes the fracture and allows the use of the arm within a few days after surgery instead of the few weeks that nature needs to repair the bone.

Had the fall and the broken bone occurred 3 or 4 months ago, the decision to have surgery may not have been as urgent, but timing is everything. Athletes struggle through injuries that are repaired as soon as the season is done, hoping that they can rehab in the off season. For the weekend warrior, the work needed to recover from an injury takes its place in line behind work and family obligations. Spending 8 or more hours a day in the training room and in physical therapy is a full time job sometimes available only to the pros. Just like the titanium hardware that will grace Lance Armstrong’s collarbone.

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