It is the last football game of the year — the players are crouched at the line, waiting. Seeing an opportunity for a sack against the opposing quarterback, Matthew Smock ’10 goes in for the kill. But as he approaches his target, he feels a searing pain in his knee and collapses to the ground.
As Smock cuts — decelerating rapidly and changing direction — his anterior cruciate ligament (ACL) stretches and tears. The blood vessels inside the ligament rupture and blood begins to fill the area surrounding the knee joint — a characteristic symptom of an ACL injury.
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ACL injuries are just one of the many injuries athletes risk when on the field and on the court.
In treating athletes and their injuries, sports medicine trainers and doctors utilize cutting-edge technology to help with diagnosis, treatment and rehabilitation. While some medical technologies commonly used to treat sports injuries have been around for half a century, new developments in the past two decades have increased the ability to make accurate diagnoses and improved the recovery process, helping athletes get better and stronger faster.
Inside Payne Whitney
Yale athletes can walk — or limp — into Payne Whitney Gymnasium’s sports medicine department for any injury — whether a mild ankle sprain or a shoulder injury from a major collision. Trainers and physicians are on-hand at games to treat athletes right away, and for injuries that need ongoing treatment, the gym has a rehabilitation center staffed by six full-time athletic trainers. Chris Pecora, director of Yale sports medicine, estimates that between the trainers who are on-location at practice fields and those in the rehab room, he and his staff see about 250 athletes every day.
When competitive athletes push their limits either in practice or in rehab, Pecora said they risk crossing a fine line between working through their injuries and causing further damage.
“There’s a lot of frustration on the part of the athletes because their seasons are short and their careers are short,” he said. “They’re eager to get back into the game, and sports medicine helps athletes ease back so that they can safely return to play as soon as possible.”
Richard Kaplan, or “Kappy” as he is affectionately called by athletes, has worked in sports medicine for 30 years, and has seen everything from dislocated bones poking through the skin to a referee getting scalped by a hockey skate.
He said the process of rehabilitation is different for each injury, depending on the individual body and the athlete’s personal healing process.
“You have to respect your body — never underestimate an injury because your body is telling you something,” Kaplan said. “Even with technology, you can’t rush your body healing, because there’s the risk of causing other problems.”
Behind the treatment
Treatment for serious sports injuries that require surgery, like many ACL injuries, has been revolutionized by technology.
Patrick Ruwe ’83, head orthopedic consultant for the Yale Health Plan, said he sees athletes during the week at his Yale New-Haven Hospital clinic and performs approximately 25 surgeries per year on Yale athletes who have sustained serious injuries. Ruwe is a veteran of the Yale athletics program and was a former captain of the Yale football team.
“I can straddle the fence and understand what the athletes are going through and use that knowledge to help them better understand their injury and how to deal with it,” he said.
Ruwe said the biggest technological advances in treating sports injuries have been the use of magentic resonance imaging (MRI) and the advancement of arthroscopic surgery.
Previously, X-rays and computed tomography — or CT — scans only showed shadows and bone abnormalities, but with the advent of MRI, doctors are now able to understand the specifics of soft tissue injuries.
Arthroscopic surgery, which involves making tiny holes outside the joint and using a camera to navigate the surgery, minimizes damage to normal tissues. Ruwe said because arthroscopic surgeries create smaller incisions and less muscle damage, patients now experience less post-surgery pain.
In treating athletes and their injuries, Payne Whitney’s athletic trainers use a variety of technology, starting with older, more basic instruments, such as ultrasounds and X-rays. But for more serious injuries, Pecora said technological developments like MRIs help ensure more accurate diagnoses. This — Ruwe said — allows the athletes to get back in the game as quickly as possible.
Getting back in the game
After diagnosis and treatment, whether for a mild overuse injury or one that requires surgery, a vital part of the healing process is rehab.
Michael Barry ’09, a midfielder for the men’s lacrosse team, said rehab was an essential part of his recovery process from a serious ankle sprain. He said strengthening and conditioning are key, not only for working through the current injury, but also for preventing future ones.
“When you don’t rehab properly, each time you’re more susceptible to injuring it again if you don’t restrengthen the area,” Barry said.
In addition to the athletic trainers in the rehab room, athletes also work with strengthening and conditioning coaches to regain strength around the injury. Emil Johnson, the head strengthening and conditioning coach at Payne Whitney, said when athletes get injured, they can continue to work out but only on a modified workout plan that avoids the injured area.
“We work hand in hand with the trainers in program design — it’s a team effort to help the athlete get back in the game as soon as possible,” he said.
Now back on the football field, Smock isn’t letting last year’s ACL injury stop him from once again going in for the tackle.
“Forty years ago, an ACL tear was probably a career-ending injury, but now it’s only a season-ending injury if you have the will to go through all the rehab and are determined to get yourself better,” Smock said. “The advances in treating sports injuries have made it possible to heal from serious injuries and get back on the field.”