By Bob Chen
From China Sport Coaches, 2014, Issue 1, Volume 22 (No.84), P15-16
Before the Sochi Winter Olympics, the unexpected injury and surgery of Wang Meng, the main force of Chinese short track speed skaters, had me seriously worried. I have participated in the preparation for summer Olympics three times, and the winter Olympics two times with the Chinese Sports Delegation, and I am keenly aware that while athletes challenge their physical and mental limits, they also face problems of injury and recovery. Due to chronic or acute sports injuries, athletes such as Yao Ming, Liu Xiang, Zhao Ruirui, Liu Qiuhong, and Zhao Hongbo, all had to go through surgeries to resolve problems that conservative treatment could not solve, but the stories of their various postoperative recovery situations were different. Some recovered quickly, and got back to the arena; some went through a long and difficult rehabilitation process; some had to be forced to retire quietly. With the development of competitive sports, people are searching for better, faster, and safer methods for injury recovery and rehabilitation. Here, we will discuss a new rehabilitation concept – preoperative rehabilitation.
I. Preoperative Rehabilitation is Commonly Used on Ligament Injuries
Everyone knows that most sports injury rehabilitation takes place after surgery. However, the concept of preoperative rehabilitation suggests that patients who are diagnosed and have decided to go through surgery should not be rushed to the operating room. Instead, they should use a period of conservative treatment and rehabilitation, wait for the swelling and pain symptoms in their joints to go away, and for range of motion and muscle strength to recover to normal or near normal condition, and then operate. This preoperative rehabilitation concept and method is popular overseas, and is commonly seen especially before joint ligament reconstruction surgery. Here, I will take reconstruction surgery of the anterior cruciate ligament (ACL) of the knee joint as an example and explain.
The ACL is the critical ligament of four main ligaments of the knee joint. When athletes run, jump, land, twist their bodies, halt, and make other movements, this ligament can prevent forward movement of the tibia, which plays a role in stabilizing the joint. The facts show that the ACL of athletes in sports such as soccer, basketball, baseball, rugby, hockey, winter sports, and wresting, etc., often break. Statistics show that the injury ratio for the sports mentioned above accounts for 80% of all injury occurrences.
An injury study of 18 top soccer clubs in Italy shows that 10.4% of professional soccer players had ACL injuries. An article of the American College of Surgeons points out that in the sports mentioned above, “70% of ACL injuries are sustained through non-contact mechanisms;” incorrect joint position of the body when landing, slippery surfaces, turning of the body, sudden stops, changing of directions, and so on would require the knees to bend, while inside buckling of the knees could cause ligament damage. The remaining 30% of ACL injuries result from direct contact. This is commonly seen in alpine skiing, freestyle skiing, and other winter sports. This is because when athletes fall while skiing downhill, the ski under their feet did not break off in time, and their bodies and ski twist and bend, causing their knee ligaments to tear.
When ACL injuries occur, they are often accompanies by two kinds of phenomena: one is a crisp, breaking sound that people nearby can hear; the other is that they frequently lead to ligament injuries; medial collateral ligament injury (MCL) is one of these. Since the medial collteral ligament and the medial meniscus are connected, it could lead to the latter being injured. Together they are called the “unhappy triad.”
II. The wonders of Scientific Preoperative Rehabilitation
I once encountered a typical case. An amateur alpine skier of over fifty years old accidentally fell while skiing, and seriously injured his knee joints. Not only was his anterior cruciate ligament torn, but his posterior cruciate ligament, medial collateral ligament, and the medial meniscus were affected as well, a rare “four-part” injury. With such a serious injury, no one believed he could even stand on the ski slope again, but his only concern was whether or not he could return to skiing the next year. For this reason, he went to the United States, accompanied by his family, to seek help from winter sports injury specialists. After a routine examination, the doctor provided him with a treatment plan, which was: first they would connect his medial collateral ligament by surgery, followed by a two-month period of rehabilitation, and then wait until his conditions had reached certain requirements. Finally, they would perform the major surgery, which was the reconstruction of his anterior cruciate ligament and meniscal repair.
After going through a two-month rehabilitation before the major surgery, the swelling of his injured knees basically disappeared. With kneepads he could walk freely, and his muscle strength was restored to 80%. By this time, the reconstruction of his anterior and posterior cruciate ligaments and the meniscal repair operation were able to proceed. Two weeks after the surgery, he came back to China with his American rehabilitation specialist, and decided to choose our studio for his postoperative rehabilitation. After 6 months of rehabilitation, he returned to ski slopes as he had wished when ski season arrived. This was undoubtedly a typical case in which scientific preoperative rehabilitation effectively ensured a successful operation, and greatly reduced the difficulty of rehabilitation.
Prior to this, I also encountered an opposite case. At that time I was the director of the Sports Rehabilitation and Sports Performance Enhancement Center at Hong Kong Polytechnic University. I received a mainland athlete who was eager to participate in the National Sports Meet. Her case was similar to the one described above: it was also a serious “four-part” injury. She immediately underwent surgery after the injury. But six months after the surgery, she could not bend her legs freely; her knee joints were still swollen, and they looked thicker than her thighs. Her joint range of motion was only 60°, and there was severe muscle atrophy and stiffness. Doctors believed that there was no hope to improve their functions further, and that it was best for her to go home and rest.
Looking at these two rehabilitation experiences, it is not hard to find that the biggest difference is that one went through a full preoperative rehabilitation, while the other did none at all. It is proven that the effect of postoperative inflammation control is closely related to preoperative rehabilitation. It is equally clear that the surgical procedure also increases the degree of inflammation. Foreign scholars believe that in order to ensure the effectiveness of the surgery and postoperative recovery, surgery should be preceded by eliminating inflammation and other complications first to reduce the difficulty of the surgery.
The patient who went through preoperative rehabilitation greatly reduced the complications, and just four weeks after the surgery his joint range of motion was restored to 90%. As for the professional athlete, who did not go through preoperative rehabilitation, six months after the surgery her joint range of motion was only restored to 40%, while the swelling and pain persisted. From the long-term point of view, the former has been skiing happily for the past two ski seasons, and one could not tell he had had injuries; the latter went through two more months of rehabilitation training at our studio, and she could barely bend her knees to 95 degrees. The effect of these two people’s rehabilitation experiences forms a sharp contrast.
III. Scientifically Carried Out Preoperative Rehabilitation Based on Specific Injuries
Operating immediately after injury, the sooner the better, has long since been the general consensus. But the truth is, from the moment one gets injured to the time of being healed, or even restored to competitive state, is a complicated systematic process, and surgery is just one of the important links. Like rehabilitation, surgery is also a matter of timeliness, which includes choosing the right time, making reasonable arrangements, establishing cooperation between patients and doctors, and so on. The key of preoperative rehabilitation is to restore patients’ normal range of motion and strength, and to eliminate adhesions, swelling, pain, and other symptoms as much as possible; at the same time, it is to help patients to master skills such as exercising on their own and restoring their walking motion, and lay a solid foundation for intra-operative and postoperative rehabilitation. It has been proven strongly that the better the preoperative state of patients, the better intra-operative results are; faster postoperative recovery means fewer complications patients must face, which makes the rehabilitation process much easier.
Many people think that preoperative rehabilitation is unnecessary, or even a waste of time and resources, and wonder why it cannot be combined with the postoperative rehabilitation. One must know that when a person is injured, especially if he is injured seriously, his physical condition has declined and will be accompanied by inflammation, adhesions and other complications. If he is operated on at this time, the condition of his injury and body will worsen. Furthermore, he will have to face and deal with more problems during surgery, which would make his journey to recovery much longer and more difficult. Preoperative rehabilitation appears to delay the operation time, but it can not only reduced greatly the complexity of the surgical procedure, but also enhance greatly the level of the postoperative recovery, reduce the difficulty of rehabilitation, and shorten the recovery time. Therefore, overall, it is the more economical, effective and safe way of rehabilitation.
WEIBO
courses
courses
