Sunday, March 29, 2015
Athletes like to compete. Surgeons like to operate. When injury happens, their worlds collide. Ideally, the goals of the athlete and the surgeon align; return to full time playing status at the same level of function and expertise as before the injury. Athletes tend to be more blunt, wanting to get back into the game as soon as possible and sometimes have to be protected from themselves in doing more harm. Often, decisions have to do with timing.
A pro athlete’s career is relatively short and missing even one season may be professionally and emotionally devastating. Rushing to surgery to repair an injury may be preferable than committing to physical therapy for a few weeks in hopes of avoiding an operation and then still needing to be repaired. Yet surgery is not a sure thing. Kevin Durant of the Oklahoma City Thunder broke the 5th metatarsal bone in his foot, (a Jones fracture). Surgery is usually the first option and it should have taken 6-8 weeks to completely heal, but in pro athletes, there can be a significant non-union and refracture rate. Mr. Durant developed that complication and now need further surgery and a lost year of competition.
But just because surgeons like to operate, does not mean that they always advocate for that as the first option. The success of New Orleans Pelican’s Eric Gordon using conservative therapy (non-surgical)in treating his torn shoulder labrum, is testament that the opportunity to avoid an operation should be given to everybody if possible.
The shoulder is the most mobile and least stable joint in the body. A ball and socket arrangement allows for a wide variety of movements, but its design makes it prone to become damaged and unstable. The glenoid fossa of the scapula (shoulder blade) forms a very shallow socket where the humeral head fits. The bony socket is extended by the labrum, a sleeve of cartilage that helps stabilize the joint and keep it from dislocating. The muscles that surround the shoulder are also key in that stabilization. However, in overhead athletes, (for example basketball and volleyball players, swimmers, tennis players and baseball players, the shoulder can be subject to violent forces and the structures in and around it can fray and tear.
When a shoulder labrum tears, the inflammation causes swelling and pain and this can shut down the surrounding muscles, weakening them and decreasing range of motion. Surgery can repair the damage and physical therapy can help return those functions, but the recuperation and recovery time may be as long as a year. Physical therapy alone may be successful in returning the athlete to normal function and it is a big decision for an elite athlete to forgo first line surgery in hopes that rehab alone might work. Mr. Gordon elected that second option and has continued to play throughout the season.
Mr. Gordon also used clothing made by AlignMed, also being worn by his teammate Anthony Davis and Dwight Howard of the Houston Rockets, to help with his shoulder that was recommended as part of the healing process. The shirts with built in bands that help with posture and muscle alignment have the ability, according to research from the Kerlin Jobe Orthopedic Foundation, to stabilize and increase rotator cuff function (one of the muscle groups that helps stabilize the shoulder). In another study from that group, the clothing helped increase stability of the scapula and increased muscle strength. The Stedman Research Institute found that the shirt might help decrease the risk of impingement and pain.
Most sport clothing companies, from Under Armour to Nike, make compression clothing that uniformly squeezes parts of the body. Perhaps the next step has been taken with the AlignMed concept to make functional clothing to apply pressure and help muscles, tendons, bones and joints, align more physiologically. This might allow mere mortals the opportunity to catch up to their pro athlete counterparts. Most people cannot spend hours a day in the gym or physical therapist’s office rehabilitating an injury. Work and family time get in the way. Pro athletes, on the other hand, can devote an 8 or 10 hour work day to their therapy regimens. And wearing the shirt all day long at work, whether it is on the playing field or in the office may help prevent injuries caused by poor posture and muscle fatigue.
Every patient is different and the treatment options presented and chosen will depend upon their injury, their underlying medical status and how active they were and will want to be after recovery. That said, it will be interesting to watch what happens with the Pelican’s Mr. Davis and Mr. Gordon and how they recover from their injuries. And as the baseball season begins, will players who strain or damage their shoulders look to physical therapy and clothing as an alternative to surgery. Because as Kevin Durant can attest, surgery is not a sure thing.This entry was tagged AlignMed, Anthony Davis, conservative therapy, Dwight Howard, Eric Gordon, physical therapy, shoulder labrum, surgery