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How much, how soon?

To shorten the recovery from sports injuries, we may have to speed up the body's healing process.

January 09, 2006|Greg Miller | Special to The Times

WHEN Alicia Di Rado Dingsdale tore her hip flexor muscle in a soccer game in 2004, she was determined not to let it hold her back.

A week later she ran a 5-kilometer race in Arcadia. "By the time I finished I was crawling," she says. She did physical therapy for a few months and eased back into running -- but not slowly enough.

"I had missed running so much I started doing too much," says the 36-year-old. Last summer, her doctor told her she'd aggravated the original muscle tear and probably compounded it with tendinitis.

The second time around, Dingsdale took a different approach to rehabilitation that included more cross-training and more gradual increases in the miles she ran. Now she says she's 100% pain-free and back to her usual 30 miles a week, running faster than before.

For many dedicated athletes, finding the fortitude to swim a few extra laps or play an overtime period is easier than finding the patience to sit on the sidelines. In recent years, their eagerness to return to play has been supported by a shift in medical opinion toward more aggressive rehab: Gone are the days when athletes were banned from working an injured limb for many weeks. But today, many sports medicine specialists think the pendulum has swung too far in some cases, raising the risk of further damage.

Playing injured, they add, is almost always a bad idea.

Compounding the confusion is the fact that even today, nobody really knows the right amount of activity. Each injury is unique, and there's surprisingly little rigorous research on sports injury rehabilitation. Many experts think that fine-tuning rehab has gone about as far as it can -- and that the biggest obstacle today to faster recovery is the biological healing process.

"We're about 90% there in terms of rehab, but only 10% there in terms of biological healing," says Dr. James P. Tasto, a professor of orthopedics at UC San Diego.

Researchers are working on strategies to speed up the biological healing process with drugs, stem cells and even gene therapy, but most of these treatments won't be available in the near future.

In the meantime, injured athletes will have to learn patience -- and seek the best physical therapist or athletic trainer they can afford.

There are few hard and fast rules on the best way to rehabilitate a particular injury and how to know when an injured athlete can safely return to play, says Dr. Thomas Best, chief of sports medicine at Ohio State University in Columbus. That's partly because the rigorous clinical trials used to evaluate drugs for cancer and other ailments are rarely done in this medical arena.

"Most of sports medicine is expert opinion," Best says, meaning a doctor just has a preferred way of doing things. Troubled by the lack of hard data, he co-wrote an editorial in the November issue of the Clinical Journal of Sports Medicine, urging more of this kind of research.

There is, at least, broad agreement on how to approach common and less serious sports injuries such as strains, sprains and stress fractures (see box). In general, activities that exercise the injured area without causing pain can speed recovery and can start almost immediately after an injury. Not so for activities that cause pain or increase swelling. These can slow healing and lead to worse problems.

Physical therapy can help immensely with rehab from injuries, but health insurance doesn't always cover as many sessions as doctors recommend. Many injured athletes end up paying for therapy out of pocket, or going to a few sessions to learn the exercises and then doing them on their own, at home or at a gym.

Amateur athletes shouldn't expect to bounce back from an injury as fast as professional athletes do, says Dr. Jonathan Chang, an assistant professor of orthopedic surgery at the University of Southern California.. Pros usually have access to the best care and facilities -- and no office job to take time away from rehab -- so they can get back twice as fast on average as someone who sees a physical therapist three times a week.

Pro athletes also have financial incentives and other pressures to recover quickly. That's not always a good thing. Many sports medicine doctors see a cautionary tale in the experience of Jerry Rice, the former star wide receiver for the San Francisco 49ers. In 1997, Rice had reconstructive knee surgery, and returned to play just 14 weeks later. During his first game back, he broke his left kneecap.

Common knee injury

REHABILITATION after knee surgery, particularly surgery to repair the anterior cruciate ligament (ACL), is possibly the most controversial area in sports injury rehab and return to play. ACL tears are common in sports that involve jumping or quick cuts and turns and are one of the most common ways that athletes find themselves in an operating room.

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