Assessing priorities: sports at the price of injury?
by
Daniel Witcher
It should have been another routine play, "Forty-three stack,
Mike, hit it." I had run it a thousand times, and thought I
would be running it a thousand more. But on that particular
frosty December night, something went wrong.
With the roar of the crowd seeming like a distant whisper to
me, I looked through my facemask and across the line as the
ball was snapped. I saw the play coming a mile away, made my
break, and met the running back head on. It's funny how you
remember the small details: the smell of freshly cut grass,
the sound of cleats crunching in the ground, the grunts of opposing
players, and the crack of impacting plastic shoulder pads. I
can even tell you the number of the last football player I ever
hit: number six. As I made impact, something felt terribly wrong.
I heard a loud pop coming from my shoulder area, and then I
felt the one thing a football player never wants to feel - nothing.
'Excruciating jolt'
To
say that the next hour of my life was a blur would be an understatement.
I remember looking up at the bright stadium lights and hearing
an eerie hush fall over the crowd. I was somehow transported
to the sidelines where my jersey and shoulder pads were cut
off and team doctors assessed my injury. The feeling of nothingness
that had overtaken me was quickly replaced by shooting pain
running down my right arm like electric currents. It was difficult
for me to keep my eyes open with the extreme pain I was feeling,
and I immediately knew exactly what had happened to me. I had
a dislocated shoulder. The forceful collision had jarred the
flexible ball-and-socket joint connecting the head of my humerus
(upper arm bone) to the end of my scapula in an area called
the glenohumeral cavity. The major soft tissue, including the
capsule, the glenohumeral ligaments, and the glenoid labrum,
which at one point had held the two bones together, were torn
or severely damaged (Walton 759). The stretching of the tendons
was what brought on the tremendous pain, and to prevent permanent
damage, the humerus had to be forcibly driven back into the
glenohumeral cavity. What they don't tell you about in medical
studies or anatomy books is the extreme pain that comes with
the reconnection of the bone and socket.
The countdown to popping my arm back into place seemed like
a space shuttle launch to me, and as the doctors reached one,
the conclusion was every bit as explosive. The excruciating
jolt shook my entire body, but before I could cry out into
the night air, my arm was placed in a sling and I was told
to take two little pills I assumed were Vicodin. Vicodin,
or hydrocodone, is a narcotic analgesic that acts upon the
central nervous system to relieve pain (American Society of
Health-System Pharmacists). It did just that. As the pain
(as well as my other senses) began to dull, I remember the
doctor's words to me: "Well…now all you have to do is wear
this sling for the next few weeks." The main purpose of the
sling was to immobilize my shoulder joint and allow the freshly
damaged muscles and tendons to begin the healing process without
interference.
Reviewing the damage
In the beginning
everything seemed great. On my first day back to classes I received
numerous cards, flowers, and offers from friends to do everything
from driving my car for me, to taking notes in my classes. My
initial trips to the doctor were relatively painless and they
assured me that everything was quite routine. After several
tests and x-rays, in true doctorly fashion, the medical staff
chose to give me the good news first. My rotator cuff muscles,
which work together to create a compressive force at the glenohumeral
joint during shoulder movement (Walton 759), were severely stretched
but not torn. In addition, the large muscles which cross the
glenohumeral joint, the latissimus dorsi and pectoralis major,
were also slightly stretched but would heal with time. Then
came the bad news.
The ligament
damage I sustained in the injury had destabilized the humeral
bone within the glenoid. Because a fully functioning healthy
shoulder has minimal bony containment of the humeral head in
the glenoid cavity (Walton 759), many times it is difficult
to tell whether the ball-and-socket joint is properly aligned.
The articular surface area of the humeral head is two to four
times that of the glenoid. In addition, the diameter of the
humeral head is nearly twice that of the glenoid width when
measured in the transverse plane (Walton 759). In other words,
even under normal circumstances, the shoulder capsule is relatively
large and loose, allowing for a wide range of shoulder movement.
While this allows for fluid arm motion, it oftentimes makes
misalignment caused by injury difficult to recognize and treat
in its early stages. When a joint like the shoulder is not properly
aligned, serious long term detrimental results can occur such
as "recurrent dislocations, persistent deformity, acromioclavicular
arthritis, and residual weakness" (Schlegel 699). Because of
these severe health risks, many athletes choose arthroscopic
stabilization surgery to clear out frayed ligaments and scar
tissue as well as to properly align the bone within its socket
(Bottoni 577). The procedure is low risk and is "an effective
and safe treatment that significantly reduces the recurrence
rate of shoulder dislocations in young athletes when compared
with conventional, non-operative treatment" (Bottoni 576). Complications
are rare, and the only substantial negative aspect of the procedure
is the lengthy recovery time. However, as I soon came to find,
time most certainly became an issue, and time was not on my
side.
Rushing to rebound
While the
injury that I sustained occurred in the final football game
of the season, it also occurred the week before the start of
the basketball season. The coaches and other athletes had all
planned on me turning in my cleats for high tops and hitting
the hard wood the day after my final football game. However,
the serious injury I sustained made this an impossibility, and
greatly jeopardized our team's chances of having a winning season.
As the senior starting point guard, I was a captain of the team,
and a leader on the court. The athletic department's stance
was that they needed me on the court, and as soon as humanly
possible. It was this reason that led the medical staff and
me to bypass any chances of surgery and begin rehabilitation
of my shoulder as soon as possible.
Phase
one of my rehabilitation was referred to as the acute phase.
The goals of this stage were to "diminish pain and inflammation,
normalize motion, retard muscular atrophy, reestablish dynamic
stability, and control functional stress/strain" (Wilk 139).
My day would begin with ultrasound and electrical stimulation.
Despite its charming name, the procedure was not as warm and
fuzzy as it may sound. Imagine what it feels like when your
friend shuffles his feet around a static filled room for five
minutes, sneaks up on you, and shocks you with his finger.
Now imagine that same feeling multiplied by a thousand and
running through your already sensitive arm for fifteen of
the longest minutes of your life. Following this wonderful
procedure were the "dynamic stabilization exercises" (Wilk
139). I would do several stretches with little to no resistance
to reestablish muscle balance within the joint. With the end
of each visit came the deep tissue massages and a reassurance
that everything was going according to plan, and that I would
be back on the court in no time.
Within
a week the athletic staff believed that it was time for me
to advance to the second and third stages of my rehabilitation.
These stages, called the intermediate and advanced strengthening
phases (Wilk 139), included progressive strengthening exercises,
controlled stretches, and finally, aggressive strengthening
meant to increase my strength, flexibility, and range of motion.
I began lifting light weights and stretching my arm more and
more each day. The weight I was able to lift was increasing,
and my flexibility was slowly improving. Yet the one thing
that was not getting better was the pain and discomfort I
was feeling within my joint. However, as the weeks went on,
the basketball season was coming to a close, and the team
was struggling. We had been flirting with a winning record,
but with the start of playoffs quickly approaching, the team
needed me back on the court. At the close of the fourth week
I was fitted with a neoprene brace that limited movement of
my arm and I returned to the gym to practice with my team.
'Emotional return'
Playing basketball with one arm is not exactly easy. But playing with constant pain in your arm while having it strapped against your chest is something different altogether.
However, I did the best I could, continued my rehab, and made
the decision to make my first real game time appearance at the
final home game of the season. I remember walking through the
tunnel that lead to the gymnasium like it was yesterday. As
I approached the gym, the once distant sound of the crowd grew
to an intense roar that filled my entire body with energy. I
burst through the doors and onto the court as my name was announced,
and immediately, all thoughts of pain in my shoulder disappeared.
We won
our final home game of the season, and although I only played
a small portion of the time, the newspapers attributed much
of the victory to the emotional return of one of the team's
senior leaders. Our team then went on to compile a small winning
streak before making it to the playoffs and losing in the
semi-finals.
A constant reminder.
I'd like
to say that I rarely think about my shoulder injury today, but
the truth is, there isn't a day that goes by that I don't think
about that fateful December evening, now four years behind me.
Each morning when I wake I feel the stiffness in my joint that
reminds me of my current condition. Although it is rare, I sometimes
am awakened in the middle of the night by an aching or burning
feeling in my shoulder. Doctors assure me that getting surgery
now will not help, and that the only thing that will ease the
pain is a steady workout routine that will keep the muscles
around the joint tight. For many athletes, this is the cross
that they must bear down the road in order to perform for their
team as soon as possible. While today's physical therapy methods
can greatly decrease the recovery time for these injuries, the
lasting effects of rapid recovery can be permanently detrimental
to an athlete's health. I found out the hard way that the shortest
road is not necessarily the most effective route to take, and
am now left with the constant reminder that I was once a football
player, but can never be one again.
Daniel
Witcher is a junior biology major, with a minor in sculpture.
A Leo and originally from Camarillo, California, his favorite
movie is Teen Wolf, starring Michael J. Fox.
Bottoni,
Craig R. MD. "A Prospective, Randomized Evaluation of
Arthroscopic Stabilization Versus Nonoperative Treatment in
Patients with Acute, Traumatic, First-Time Shoulder Dislocation."
The American Journal of Sports Medicine Vol. 30, No.
4, 2002.
Schlegel,
Theodore. "A Prospective Evaluation of Untreated Acute Grade
III Acromioclavicular Separations." The American Journal
of Sports Medicine Vol. 30, No. 5, 2002 ."
Walton,
Judie, PhD. "The Unstable Shoulder in the Adolescent Athlete."
The American Journal of Sports Medicine Vol. 30, No.
5, 2002 .
Wilk,
Kevin E, PT. "Current Concepts in the Rehabilitation of the
Overhead Throwing Athlete." The American Journal of Sports
Medicine Vol. 30, No. 1, 2002.
