Features January 2008 Issue

Coping with Old Sports Injuries

The joint pain you’re experiencing now might be the result of trauma suffered long ago. Redirecting your activity may help relieve the problem.

A vivid memory: Plowing over center for that winning high school touchdown…or that painful body check you took after slamming the puck for the final goal…or that "pop" you heard while flying out of your ski bindings.

You’ll never forget it. In fact, you think about it every day—a half-century later—as you hobble down the street to the local grocery store. That’s because of that split second in which you twisted and tore the ligaments in your knee or your shoulder and you’ve been suffering the consequences ever since.

"We see a tremendous number of individuals with this kind of problem," says Gary Calabrese, PT, director of Sports Health and Orthopaedic Rehabilitation at Cleveland Clinic, "pathology resulting from injuries they suffered long ago and have affected their joint mechanics over decades."


Vulnerable areas

In the lower extremities, the most common of the long-standing pathologies that can be traced to a sports injury are the result of tears in the ligaments of the knee, especially the anterior cruciate ligament. Over time, Calabrese notes, such an injury is apt to be responsible for an altered gait and, consequently, progressively abnormal joint architecture. "And this, in turn, will contribute to the onset of osteoarthritic changes in the articular cartilage," Calabrese says.

As for the upper body, the sports injuries of long ago that most often persist in causing dysfunction are those involving the shoulder. "If you had a traumatic shoulder injury as a younger person—a dislocation, for example—that was never addressed surgically, it’s likely that a certain amount of looseness has persisted in the joint capsule," Calabrese says. "Over time, the movement in the joint causes constant microdamage to the cartilage and can lead to osteoarthritis.

A number of physical changes that normally accompany advancing age may exacerbate the pain and immobility caused by an old sports injury, says Calabrese. Loss of muscle mass, for example, or the thinning of protective tissue surrounding the joints typically begin during a person’s 30s and 40s. Also, he notes, as people age they tend to develop aggravating bone spurs in their joints. And, he adds, "Our posture tends to change as we grow older. We lean a little bit more forward, and this puts additional stress on the spinal column."


Moving forward

Whatever the cause of a patient’s painful joint condition, orthopaedic physicians will address the disorder as they currently observe it, regardless of its origins. Patients should adopt a similar here-and-now attitude. "Accept the fact that you’re never again going to have your original equipment, and move forward," he says.

Is surgery ever recommended? "Only if re-operating on an old injury is the only option that will improve function and reduce your pain," says Brian Donley, M.D., vice chairman of Cleveland Clinic’s Department of Orthopaedic Surgery. "For that reason, it’s important that you see an orthopaedic surgeon, who can assess your condition and determine if another operation may be beneficial."

Patients whose condition is not serious enough to require re-operating—or prefer not to undergo surgery in the first place—should embark on a physical therapy program aimed at accommodating the disability while also protecting the affected joint, says Calabrese, who recommends the following:

• "Exercise in an environment that is not stressful to your joint—a swimming pool, for example. The buoyancy of the water will protect you from experiencing any weight-bearing stresses on your joint."

• "Consider the use of an unloader brace, or orthotics in your shoes—anything that will relieve pressure on the joint."

• "Avoid using heavy resistive weights. Instead, use lighter weights and increase the number of repetitions."

• "Consult a physical therapist about exercises that focus on strengthening your core—that part of your body from your knees to your chest."

• "Get started on an activity—such as biking, swimming, or golf—in which you can continually improve. Then try to get as good at it as you can."

"Don’t dwell on your old injury," says Calabrese. "Move forward!"