So RG3 is scheduled to get into sprint and cut mode by fall 2013. When I did my sports medicine fellowship with DePaul in '95 I remember Preston Wolin showing some of his slides (no PowerPoint back then) on acl basketball players jamming from the foul line within 4 months post surgery! I also remember the gasps coming from the other docs at the conference. It seems like we push the envelope on getting people back into the damaging activity they were initially injured in. Why is this? To get more viewers? To be seen in your 4th year of athletic scholarship during March Madness? To win for the team? Nothing else to do?
Problem is we treat the ligament and do nothing for the person. Just cause you have a full boat scholarship doesnt mean you eat all organic, get quiet time to maximize healing, get good rest to recharge the brain, or dive into community love. Wouldn't you say the best chances for healing in cancer (the Emperor of all Maladies) is with medicine/surgery and all the above? So what is the difference with surgery for an acl and healing. In the last 20 years the materials used for acl repair have gone from mesh to cadaver to same side patellar tendon/opposite side patellar tendon to triple twisted hamstring. Regardless of which one, the longevity is overall about the same and results are more dependant on the health of the surgical candidate. (Put a million dollar graft in an obese, diabetic smoker and results will be poor/put a cheap piece of fiber in a fine tuned 20 year old and s/he will be performing 80% on a single leg hop within 3 months.)
So for the sake of this blog; things to improve outcome.
-You must know the ins and outs of your surgical issue and all the newest controversy. And don't just rely on Joe Mercola's website for information.....research acsm, google scholar, pubmed, nih to name a few places.
-Never stay with a rude surgeon no matter how good his reputation is. Some surgeons have "peculiar personalities" like to debate/name things after themselves/be captain of the ship....just kidding-many good friends are surgeons. (I also know of some big assholes that shouldn't be practicing medicine) First and foremost-a patient has to be his/her own advocate so know your rights and trust your gut.
-Most of the major sports teams have medical groups that pay to be the team docs. Yes they contribute indirectly to the sports franchise to be the guy. Not in kickbacks or financial incentive.....more like locker time, trainer training, "free coverage". So it depends on how good your results are, who you know on the board, and how much you can "give" of your time/staff. So if in a strange city (ie Colorado with an acl skiing injury) ask for the "pod" that works for a major sports team) Pod = orthopod for short but its like calling a police officer a cop.
-Always go to primary care to make sure you are maximized to heal. This doesn't mean get a family practice guy to sign off that you are ok for anesthesia. (I have always though this presurgery physical is a waste of time.....only thing I use it for it when I remind my surgical candidates that they have to lose weight, see a therapist, lower cholesterol or work to get off their medicines.) This means having a professional nit pick your sleep, nutrition, look for vitamin deficiency, get you into "prehabilitation" so you don't go into surgery with poor exercise tolerance, endurance, stamina, strength. Post surgery outcome can be improved if you fix the thyroid, improve the IBS, work on the food allergies or beef up the depression. You do want to start healing asap right?-why not prior to surgery. There are prolotherapy techniques that are only done by a few docs (I've been using Ross Hauser in Oak Park since the 90's) and now PRP, to mention one type, is catching on with orthopedic surgeons to facilitate healing. (essentially using natural healing products to speed the body to rebuild-that Hippocrates guy knew what he was talking about!!!) For the low grade acl tears/strains that the surgeon wont cut on, definitely worth prolotherapy but little expensive and not covered by insurance. Better than just watching it and using the ol' Donjoy "derotation" brace. I had a football coach for Holy____ High School every game lay down on the field and say he needs a second to get his knee back into place. He had an acl tear that was unstable, was told to just watch it by his orthopod, but wasnt told every time it gave out, there was an 80% chance of tearing a meniscus/cartilage. At this point he probalby has already gone through total knee replacement....nice advice from his doc. (I told you there are some docs that shouldn't be practicing medicine. A license to practice medicine and no concept of healing is like allowing the mentally unstable gun permits.)
-Get a good Chinese medicine trained acupuncturist to help with the healing process. As long as you don't use the chinese oral herbs, no need to ask the surgeon. If needles aren't placed within 6inches of the surgical site....cannot blame the acupuncturist for anything. And the surgeon wont know anything about acupuncture and will just say don't do it. I was at a ACSM conference with the biggest pods in the country and a question came up, if NASCAR drivers with back pain would benefit from acupuncture (heat usually comes right up the seat in the car) and a pod immediately said there was one study that said acupuncture doesnt work. (Kiss my sit bones dude, not reading the right papers!!!) Of course all the young up and coming resident/docs were writing in their notepads..."acupuncture doesnt work". Of course if needling speeds up recovery, it is the surgeons skills that did it!
-Pain control is to be coordinated with the primary care guy (if s/he is good with botanicals) or the naturopath. There are great botanicals that help with pain, decrease the dose of prescription narcotics, and don't interfere with healing. In fact there are great homeopathic meds that speed up healing not too mention aromatherapy (I love the essential oil-helicrysium....helped me get through 2 marathons with no pre marathon training!)
-Nutrition and food technology is growing by the minute so the old concepts of eating what ever tastes good can slow down and hurt your chances for fast healing. Enlist the help of a registered dietitian. What you are eating, when you are eating it, what supplements you take could be archaic. Why not give what every cell in your body needs to work DNA.....and no, Hooters Organic Chicken is not healing (maybe to the eye).
-I am a yoga instructor as well as a sports medicine doc so I always embrace the mind body medicine power of facilitating healing. Even if you dont meditate 30 minutes twice a day, visualization helps prior to and after surgery. I have a tutorial on how to improve outcome when "stuck" in a hospital ICU or orthopedic floor.....click the link I have great confidence in hypnotherapy especially in athletes! Steven Gurgevich from The Arizona Center for Integrative Medicine at University of Arizona is fantastic!
-God forbid....I know some athletes who stack roids....if you are on anything. Let someone know, don't just detox cold, get primary to check your liver/kidney/adrenals and "T". Need to maximize every organ in your body if you plan on asking the entire body to heal fast. Unless you are a steroid free proathlete (Lance has done some great things for cancer survivors but I wonder if roid use prompted testicular cancer?) Pro athletes are gifted humans....there was an EKG strip circulating around the primary care sports medicine community before Jordan was Jordan. His preparticipation stress tests showed a resting heart rate of 40!!! (as a reference, check your pulse rate now....probaly 80 right....imagine Michael Jordan's body was working off season at half the effort your body goes through in an average day). Pros would probably heal up quick even with a bad diet!!!
See you next season!
