That's Gotta Hurt

The Injuries That Changed Sports Forever

Dr. David Geier

• Publisher: ForeEdge
• Year: 2017
• ISBN:
  9781512600698
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

In That's Gotta Hurt, the orthopaedist David Geier shows how sports medicine has had a greater impact on the sports we watch and play than any technique or concept in coaching or training. Injuries among professional and college athletes have forced orthopaedic surgeons and other healthcare providers to develop new surgeries, treatments, rehabilitation techniques, and prevention strategies. In response to these injuries, sports themselves have radically changed their rules, mandated new equipment, and adopted new procedures to protect their players. Parents now openly question the safety of these sports for their children and look for ways to prevent the injuries they see among the pros. The influence that sports medicine has had in effecting those changes and improving both the performance and the health of the athletes has been remarkable. Through the stories of a dozen athletes whose injuries and recovery advanced the field (including Joan Benoit, Michael Jordan, Brandi Chastain, and Tommy John), Dr. Geier explains how sports medicine makes sports safer for the pros, amateurs, student-athletes, and weekend warriors alike. That's Gotta Hurt is a fascinating and important book for all athletes, coaches, and sports fans.

1 / JOAN BENOIT

The Advent of Arthroscopic Surgery

May 12, 1984

Olympia, Washington, was the site of what would be a historic race. In all, 238 runners left the starting line in the US qualifier for the 1984 Olympic marathon. That marathon would soon become a milestone as well, marking the first ever women’s marathon in the Olympics.¹

One of those 238 competitors made the race historic for an entirely different reason. Joan Benoit left the starting line only 17 days after undergoing knee surgery.

Benoit started the race quickly, staying in the front of the pack. Due to her recent injuries, she ran cautiously for the first 12 miles.

After running 5:40 miles for almost half of the race, Benoit increased the pace and quickly built a large lead. She knew, though, that the race wasn’t over. Three days before the trials, Benoit had told Kenny Moore of Sports Illustrated, “Those last six miles are scary. Anything can happen.”²

Benoit had a 400-yard lead at the 17-mile mark. There, standing on the side of the road, stood her Athletics West coach, Bob Sevene. Sevene, who had helped guide her through her race preparation and recovery from surgery, tried to gauge her status.

“Sev, I’m all right,” Benoit told him.

Her coach jumped for joy right there on the side of the road. “When she says that,” Sevene told Moore, “you can go wait in the bar. The race is over.”³

Benoit might have been all right, but the race was far from over. With those last six scary miles left, Benoit’s legs became weak, including her surgically repaired right knee. She slowed her pace to six-minute miles, but she hung on to win the race in 2:31:04.⁴

Many years later, in an interview with Amby Burfoot of Runner’s World, she called the 1984 Olympic trials “the race of her life.”⁵

Sevene professed that Benoit’s mental strength, especially in races, was unlike anything he has ever seen. “The sport is 90% ability and attitude, 5% coaching, and 5% luck. In her case, her ability is mental as well as physical.”⁶ Benoit’s ability to fight through 26.2 miles and beat the entire field of healthy runners serves as a testament to that mental strength.

With her win, she went on to compete in Los Angeles against many of the best marathoners in the world. In 1984 the Soviet Union and its satellite states in Eastern Europe boycotted the Olympic Games in response to the US pullout from the 1980 Games over the Soviet invasion of Afghanistan. Even without the athletes from the boycotting Communist nations, Benoit would soon face some of the top female athletes in the world, including Norway’s Grete Waitz and Ingrid Kristiansen and Portugal’s Rosa Mota. She knew she still had work to do.

“I feel I’ve really been tested,” said a relieved Benoit to Moore after the trials. “The knee, the operation, the hamstring, the emotional ups and downs. Somehow, with all the people who helped, all the people who love me, I made it. I can’t believe it. Now I’m looking forward to two months of solid training.”⁷

Sevene became emotional as he described the end of the Olympic trials and Benoit’s TV interview after she won. He still has a picture of her in his arms after that race. He held her because she didn’t want to be seen on television crying.⁸

Bob Sevene knew Benoit could train and win the Olympic marathon, since she had just overcome a bigger obstacle than any competitor. As she crossed the finish line, Sevene held Benoit and exclaimed, “The greatest damn athlete in the world.”⁹

Often considered the greatest marathoner of all time, Joan Benoit was widely known to be a religious trainer early in her career. She ran about 200 miles each week. Perhaps it was that volume of training that led to the knee injury that almost kept her out of the Olympics.

As the 1984 Olympic trials approached, Benoit quit her job and moved to her home state of Maine to train full time. Rumors spread throughout the running world that she was training 130 miles per week with sub-five-minute interval miles.¹⁰

Sevene claimed that Benoit was doing some “scary” workouts to prepare for the trials. Since it was winter in Maine, she trained on the flat 200-meter indoor track at Bates College. “I would tell her to run 4:55 in practice, and she was running 4:40s for the mile,” he remembered.¹¹

On March 16, just under two months before the race in Olympia, a normal training run threatened to derail her quest.

When she was 14 miles into a 20-mile run, Benoit felt a catching sensation in her right knee. Within a mile she developed pain that completely shut her down. It was the first time she had ever quit a training run.

“Joanie was training in Maine, and I was out in Eugene, Oregon, with Athletics West,” Sevene recalled. “I got a call at 7:00 in the morning of all things. Joanie had just gone out on her run. She told me that her knee locked up, and of course I just said, ‘Don’t worry about it. It’s probably an IT band problem,’ because it was on the lateral knee. Of course Joanie knew her body.”¹²

As many runners do with new onset pain, Benoit took a few days off. The pain improved, but it returned quickly once she resumed training. She decided to try a cortisone shot, which gave her 10 days of relief. But soon she had to stop another training session and walk.

After a second cortisone injection into her ailing knee and five more days of rest, she still had pain.¹³ She flew to Eugene, Oregon, the hometown of her coach. Sevene arranged a consultation with an orthopaedic surgeon in Eugene, Dr. Stan James.

Dr. James prescribed five more days of rest and Butazolidin, an anti-inflammatory medication. Benoit, who had finished 10 marathons and risked missing the 11th, was not pleased.

“Joanie immediately came outside and for the first time I ever heard her swear in her life,” Sevene remembered. “She was so pissed off because she said, ‘Sev, there’s something in my knee.’ ”¹⁴

After five days of rest, Benoit’s fears proved to be true. During the 10-mile test run Dr. James had suggested she do on April 24, she only completed 3 miles before she had to walk. When she told him of her setback, he gave her a final option.

“He said I only had one option—surgery,” she told Moore. “Actually I was hoping he’d say that because I thought there was something there. But to do it with so little time …”¹⁵

They chose to proceed with arthroscopic surgery the next day, April 25, just 17 days before the Olympic trials.

As the surgery approached, Dr. James remained pessimistic that the 26-year-old world record holder could recover quickly enough to qualify for the Olympics. He told Frank Litsky of the New York Times, “It is possible, not probable, she can run in 12 to 14 days. We’ll have to play that by ear. It would be nice if the trials were six weeks away and not three weeks, so we’re pressing the issue.”

Benoit’s record time of 2:22:43 in the Boston Marathon a year earlier would have won every Olympic marathon contest before 1960—for men. And it was fast enough to earn her a spot on the 1980 Olympic team, only four years earlier, based on the times finished by the men’s qualifiers.

Now knee surgery threatened to keep her off the team that would compete in the first-ever Olympic marathon for women. But she entered the operating room that day with a backup plan.

“If I don’t qualify for the marathon,” Benoit told Litsky prior to going under the knife, “I think I’ll try the 3,000. I have a possibility of making the team. But it’s not the same. My chances in the Olympic marathon are pretty good, but in the 3,000 I’m not world class.”¹⁶

At the time, she held the American record for 25 kilometers, 10 kilometers, 10 miles, and the half marathon in addition to the world record for the marathon. She had her heart set on the marathon, though. Now this knee injury threatened her chance of winning a gold medal for her country.

“This injury is bad,” Sevene warned Litsky ahead of the procedure, “not so much for her as for the country. She had the best chance of any American woman, even Mary Decker, to win a gold medal in track.”¹⁷

Arthroscopic knee surgery was practically unheard of in the world of athletes and orthopaedic surgery until the mid-1970s. Its use grew quickly in the years leading up to Benoit’s surgery.

Traditionally when an athlete suffered a musculoskeletal injury, such as a torn ligament or meniscus in the knee, the orthopaedic surgeon sliced open the knee, making an incision six to eight inches long to look inside the knee, determine what structures were damaged, and treat them.

Many of these open surgeries served their underlying purpose, but they were invasive. Recovery took months—not just time spent overcoming the ligament or meniscal work, but also to recover from the skin and muscle damage the surgery inflicted.

Arthroscopy promised to deliver equal ability for surgeons to fix whatever damage had led to the surgery with less trauma to the knee. Instead of one or more long incisions, the surgeon made two or three small incisions barely big enough to insert instruments the size of ink pens. Theoretically, with less soft tissue trauma, the patient would regain range of motion and strength much more quickly than after an open surgery.

The role of arthroscopy in the repertoire of orthopaedic surgeons was just developing around the time Dr. James used an arthroscope to look into Benoit’s knee.

One of the challenges facing an orthopaedic surgeon treating an athlete’s injury in those days was figuring out exactly what the injury was. X-rays only show bones. They are very helpful, to be sure, but often a young competitor has a more complex injury than simply a broken bone around the knee or arthritis.

What X-rays do not show are the soft tissue structures of the knee. These structures include the meniscus, or the C-shaped piece of cartilage between the femur and tibia that serves a shock-absorbing function. Articular cartilage, or the cartilage lining of the bones, also plays a role in absorbing impact and helps the bones glide over each other smoothly as the knee goes through a range of motion. The ligaments that stabilize the knee are likewise not visualized on X-rays.

Orthopaedic surgeons often used arthrograms to improve their diagnostic capabilities. An arthrogram is a radiology test in which contrast material injected into the knee is used to enlarge the joint and provide better images of small structures within it. Arthrography gave physicians a better ability to confirm or refute their impressions of injuries based on an athlete’s history and physical examination, but it still did not diagnose many joint injuries.

Magnetic resonance imaging was first available for use in health care in the early 1980s, but it was not a commonly used diagnostic tool by orthopaedic surgeons in Benoit’s day.

Now a minimally invasive surgery provided surgeons an opportunity to look inside a patient’s knee and figure out exactly what the cause of his or her symptoms was. If the surgeon found the cause of the pain, popping, or buckling, it could be treated on the spot.

This diagnostic and therapeutic option would change the care of athletes—and the field of sports medicine—forever.

If a marathon runner developed a sharp knee pain and catching sensation in her knee today, as Joan Benoit did on that training run, how might the diagnosis and treatment differ?

First of all, nagging knee pain with running can be a very common malady for avid runners. She might notice a localized pain in one part of her knee only with activity—pain with jogging but also physical activities like going up and down stairs or with squats or leg presses in the gym. She likely wouldn’t have pain at rest. There also could be symptoms other than pain, like a catching or snapping sensation in a specific location in her knee. Swelling could accompany these symptoms.

Thinking her pain is not serious, she probably would take a few days off from running or switch to biking or swimming to see if her troubles resolved. To be fair, many runners are extremely determined—some might even say stubborn—so she might try to run through the pain. She might use over-the-counter anti-inflammatory medications, ice, or a knee sleeve. Only when she cannot run at all or at least can’t run as well as she would like does she decide to see her doctor or an orthopaedic surgeon.

In that first orthopaedic surgery visit, the surgeon performs a history and physical examination. The surgeon asks a number of questions and performs a host of exam tests to determine the cause of the pain. He will usually obtain X-rays of the knee as well. Often the X-rays are negative, but they can show bony changes like osteoarthritis or stress fractures in runners.

Depending on the location of her pain and other knee symptoms, the orthopaedic surgeon might suspect an overuse condition such as patellofemoral pain, iliotibial band syndrome, or a painful plica. Often the surgeon does not order an MRI at the first visit unless he suspects an injury that requires surgery, like a meniscus tear. Occasionally though, the surgeon might obtain an MRI for a high-level athlete to ensure that he or she is not doing any further harm to the knee.

The surgeon might send the runner to work with a physical therapist if he does not suspect structural damage. In the case of a runner w...

Table of contents

• Cover Page
• Title Page
• Copyright
• Dedication
• Contents
• Introduction
• 1. Joan Benoit: The Advent of Arthroscopic Surgery
• 2. Bernard King: Return to Elite Sports after ACL Injury
• 3. Hines Ward: Use of Platelet-Rich Plasma and Stem Cells for Active People
• 4. Phillip Hughes: Use of Protective Equipment in Sports
• 5. Marc Buoniconti: Catastrophic Injuries in Football
• 6. Sarah Burke: The Dangers of Extreme Sports
• 7. Dave Duerson: Long-Term Brain Damage in Football
• 8. Sam Bowie: Medical Evaluation and Clearance of Athletes to Play
• 9. Michael Jordan: Return-to-Play Decisions in Sports
• 10. Hank Gathers: Sudden Cardiac Deaths and Universal Screening
• 11. Korey Stringer: Exertional Heat Stroke
• 12. Brandi Chastain: Prevention of ACL Injuries
• 13. Tommy John: Tommy John Surgery and Youth Sports Injuries
• Conclusion
• Acknowledgments
• Notes
• Index
• About the Author