Published: Oct. 17, 2006
Updated: May 31, 2011
For a variety of reasons -- from the Title IX legislation that encouraged young women to participate in sports to the "baby boomer" generation's famous reluctance to grow old -- Americans are exercising their right to exercise in greater numbers than ever.
Athletes and fitness buffs of all ages now fill parks, playing fields, and health clubs around the country. But all that cardiovascular conditioning and beefed-up bone mass has come at a price: each year, more people are hurt in recreational activities than in automobile crashes.
Just in case you're about to conclude that a couch-potato lifestyle is safer than lacing up, however, think again.
Recent Duke studies have confirmed that regular exercise can, among other things, lift depression, lower cholesterol, improve blood sugar metabolism, strengthen bones, minimize the risk of strokes, prolong life for congestive heart failure patients, improve mental functioning in older adults, and reverse fat accumulations associated with heart disease.
So becoming more active is a great idea for just about everyone. The idea is to do it sanely and sensibly, take precautions to avoid injury, and get the right kind of care.
It's not always possible, of course, to avoid injury. Accidents happen, and a single wrong move or hard fall can tear joint tendons, cartilage, and muscles.
The result: persistent pain, weakness, or a joint that feels dangerously unstable. In fact, joint strains and sprains are the most commonly reported types of sports injuries (31.5 percent), followed by bone fractures (22 percent). Many more injuries, however, are not split-second mishaps, but conditions such as tendonitis and bursitis -- the result of chronic misuse, overuse, or both.
While a serious injury that causes swelling, severe pain, and other obvious symptoms clearly demands immediate attention, people with more mild injuries often try to get by with self-care. For many of them, the classic RICE approach (rest of the affected limb or joint, ice, compression, and elevation) just might do the trick. But when pain, weakness, and loss of mobility linger or a cycle of repeated reinjury sets in, it's time to get professional help.
People who tend to think of sports medicine specialists as a sort of medical pit crew for hard-driving athletes are often pleasantly surprised to learn what the discipline can offer the average person. Far from the exclusive domain of the "jock doc," it's for the athlete in all of us.
"Sports medicine represents a true team approach to the support and enhancement of all aspects of physical activity," says Claude T. Moorman III, MD, director of Duke's Sports Medicine Center. "Our patients include not only professional and college athletes, but people of all ages, activity types, and levels of achievement."
While the highly skilled orthopaedic surgery that allows injured athletes to rejoin the game is the most high-profile aspect of sports medicine, it's hardly the whole story. In many cases -- even with injuries like a tear of the ACL (anterior cruciate ligament, which stabilizes the back of the knee) -- surgery turns out not to be necessary. Rest, non-steroidal anti-inflammatory medications, bracing of the joint, and physical therapy often do the trick.
Indeed, says Moorman, "Unless it's a severe injury that is drastically limiting the activities of a very active individual, we usually opt for a more conservative approach, at least initially."
Should such interventions not solve the problem, however, surgery may become the best way to restore pain-free mobility, stability, and strength. Many injuries that simply can't heal on their own, no matter how much non-surgical TLC they're given -- like a complete tear of a knee or shoulder ligament -- respond well to surgical repairs, and minimally invasive techniques are an option in an ever-greater number of surgeries.
According to Moorman, Duke surgeons have pioneered the use of regional anesthesia in a number of procedures, minimizing surgical risks and recovery times.
As in any type of surgery, experience counts -- something Duke's sports medicine surgeons have in spades. Most have served as team doctors on the Olympic, professional, or collegiate level and all bring a high degree of expertise to the table: from arthroscopic ankle surgery to freeing frozen shoulders, says Moorman, there's at least one Duke surgeon who specializes in it.
Not that surgery offers a quick panacea: while a repair or reconstruction procedure can work wonders, extensive physical therapy is always necessary to ensure optimal results. Jim Trimm, a Chapel Hill resident who had his injured knee repaired at Duke, was instructed to exercise both before his surgery to increase muscle strength and afterward to regain normal knee function.
"I'm retired, and it became my job to rehab," he says. "I was exercising every day -- I'd have a hard day, then I'd have an easy day -- and I came through it with flying colors. I was back up and playing golf in short order."
Of course, there's no point in repairing an injury if it's just going to recur -- so prevention of both new and repeat injuries is a strong sports medicine focus.
At Duke, injury prevention has a high-tech pedigree. Within the Michael Krzyzewski Performance Research Laboratory (or K Lab, as it's affectionately known), surgeons, biomechanical engineers, exercise physiologists, and other experts use state-of-the-art monitoring technologies to enhance understanding and prevention of athletic injuries.
Through Duke's Human Performance Program, these discoveries are then made available to world-class athletes from baseball pitchers to sumo wrestlers who are seeking to safely bolster performance -- and offered via workshops and clinics to individual and team athletes of every age and skill level.
To be truly effective, any sports medicine intervention must be tailored to individual needs: A 15-year-old hurt in a football scrimmage and a 50-something nursing a case of golfer's elbow have vastly different concerns. Because sports injuries in youngsters, who are still growing, can lead to serious consequences if not treated properly, Duke offers dedicated personnel and programs for young athletes.
Women have their own issues: due to differences in anatomy, for example, they tend to sustain certain injuries, such as ACL tears, a whopping five times more frequently than men.
"We bring together a range of services for active women, from teaching the best ways to grip a golf club to helping young female athletes manage activity-related hormonal imbalances," says orthopaedic surgeon Alison Toth, MD, leader of Duke's women's sports medicine program.
Committed to keep setting the pace in this fast-moving field, the Duke Sports Medicine team has a number of clinical trials underway at any time to enhance the efficacy and safety of treatments. For example, they're investigating how anatomical features such as slight bowleggedness or variations in knee structure can complicate injuries and make significant differences in surgical outcomes.
They're leading collaborative research with several other institutions to analyze the results of thousands of knee surgeries to identify which procedures work best for which patients and injuries.
They're even recruiting "soccer moms" to the cause: more than 6,000 mothers of children who play soccer recently responded to questionnaires Duke sent them about their children's sports injuries, therapy, and response to care, creating a mother lode of data that will help the Duke sports medicine team develop injury prevention guidelines.
Meanwhile, deep within Duke's research laboratories, current basic science studies could lead to futuristic-sounding therapies such as the reprogramming of fat cells to function as replacement tissues for cartilage and bone.
Duke is one of only a few centers in the U.S. providing several cell-based therapy approaches to reconstruct cartilage defects and using pig skin grafts to reconstruct large tears in rotator cuff tendons.
From the Petri dish to the playing field, it's all geared toward one overarching goal.
"Sports medicine is such a rewarding specialty," says Moorman, himself a former athlete, "because we give people the tools to live more vibrant, active lives. There's nothing better than seeing a former patient come in beaming to show you they can now walk easily or lift their arms with no effort. The ability to use your body and move without pain is one of those things you tend to take for granted -- until you lose it. We help people get it back."