two knees

Tuesday, January 25, 2011

The body, like any other machine, has the potential for breaking down and depending upon the amount of damage, the ability to complete its assigned task may be in jeopardy. And so goes the diverging stories of Lindey Vonn and Jay Cutler, two elite athletes suffering similar injuries, but because of the different stresses put on their bodies, one is able to stand on the victory podium while the other sits on the sideline unable to play.

The knee is a hinge joint (almost, there is some slide to it) that connects the femur and tibia. The knee has to be solid to allow movement in the proper direction and it is stabilized by four ligaments. The anterior and posterior cruciates prevent the knee from sliding front to back while the medal and lateral collaterals prevent side to side movement. The medial collateral ligament (MCL) sprains when excess force is placed on the outside part of the knee, stretching or tearing the fibers of the ligament. The knee joint doesn’t like this injury at all; it feels unstable and there may be significant pain, bleeding and swelling associated with the injury depending upon how badly torn the fibers. Worse yet, the body tries to protect the knee joint by making the quad and hamstring muscles go into spasm, decreasing the ability for the knee to move and effectively shutting down the joint function.

But with the same injury, why was Vonn able to win a downhill ski race two days later, while Cutler sat huddled on the sideline? The answer lies in what the body is asked to do. Skiing makes the knee flex and extend absorbing the force of gravity as the skier flies down the hill. The quarterback needs to side step back to throw the ball, planting the back foot, placing stress directly on the medical collateral ligament and in effect reproducing the injury.

Elite athletes are asked to endure pain as part of their job description. After her injury, Vonn had a couple of days to recoup and race for 90 seconds. Cutler had halftime to hope that an unsteady knee would work. Vonn had a preplanned course to attacks while Cutler had defensive lineman attacking him with no knowledge where or when the next hit would come. But pain has a purpose. It is meant to protect body parts that are damaged to potentially prevent further injury. Even the strongest mind may not be able to stop the limp as the knee gives way with each step.

The lesson to be learned has nothing to do with comparing two athletes; it is understanding what a person’s body does when recommending treatment for an injury. Returning to normal function is the usual goal but not every person has the same normal function. If a finger laceration involves the sensory nerve, the tip of the finger may develop numbness. This may be an inconvenience to a construction worker who may not be willing to endure an operation and weeks of rehabilitation to potentially get the return of normal feeling. However, the same injury might be devastating to a violinist who would consider almost any option to be able to feel the strings of the instrument.

The difference between the elite athlete and the rest of the world has to do with timing and longevity. Injuries seem to happen at the most inopportune time. The person on the street may be inconvenienced by an injury or illness. There may be family plans disrupted or a vacation postponed. For the athlete, any time away from training and competition is time that is lost forever. Careers are often measured in months not years and the opportunity to play for a championship present itself only once, if ever. And for most, that career ends on the injured list, not holding a trophy.

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