Recuperative therapy: no pain, no gain

Olympic athletes know injuries.  Ligament damage in knees, torn muscles in shoulders and broken bones are part of their world.  So are months of intensive recuperative therapy. 

Their sports have changed little over the years, but the athlete’s ability to recover from those debilitating injuries has changed considerably. 

In April 1994 Lori-Ann Muenzer was a 28-year-old Canadian track cyclist who was chasing a dream in Cuba.  She was undergoing intensive training when she went down hard from her bike. Her shoulder hit the ground first and she broke her collar bone. 

"If you can't bench press a broom, there's no way you're going to be able to pull and steer your bicycle," she said. Muenzer’s road training was over for months.

Immediately after returning home from Cuba, Muenzer went to the hospital, and began a long, tedious program to regain her strength.  She began training on a bike in an upright position. She slowly regained strength in her upper body, eventually using soup cans as dumbbells.  

Muenzer worked as hard as she could, but missed the Commonwealth Games that August. A decade and a half later, her rehabilitation would still have been painful and tedious, but it probably wouldn’t have taken nearly as long. 

It is now possible for athletes with injuries like this to resume training immediately and return to competition sooner.  

Active Release Therapy

Many athletes, Lori-Ann Muenzer among them, have used Active Release Therapy (ART) in order to stay healthy. Dr. Curtis Masters worked with Muenzer before and after the 2004 Games in Athens where she won her gold medal in the cycling match sprint finals. She was 38 years old in Athens, but has retired and won’t compete in Beijing.

Muenzer says, "I love the ART because it takes it up another level, so it's combining deep tissue massage, but with stretching, with the movement, with the chiropractic principles."

Active release technique is a relatively new soft tissue therapy that breaks down scar tissue in ligaments, tendons and muscles. The constant and repetitive training causes a build up of scar tissue, making movement more difficult. 

Masters, Muenzer's chiropractor, began ART treatments with her before her 2004 Olympic win. He likens the procedure to peeling an onion. "It's a hands-on technique, it deals with shortening the muscle, then lengthening the muscle, and as they lengthen the muscle, I'm physically holding onto these adhesions. In a sense we kind of peel them or break them down and can re-establish normal motion."  

The procedure isn't a pleasant massage, but an aggressive manipulation of already painful tissue.  

This type of therapy is used on a regular basis to keep the athlete in top form, but is also used in conjunction with other techniques after an acute injury. According to Dr. Masters, chiropractors will begin ART treatment immediately after the injury, to prevent muscle restriction and speed recovery.  

‘Higher stakes’ injury 

Injuries that occur close to the Olympics are "higher stakes," according to Dr. Robert McCormack, the chief Canadian medical officer for the Beijing Olympics. Many of Canada’s top medal contenders now find themselves in such a bind.  

Alexandre Despatie, Kyle Shewfelt, Brent Hayden and Perdita Felicien are among the top in the world in their respective sports. They are also fighting to return to top form before the Games in August.  

Although McCormack notes that too many treatments can be just as bad as too little, he admits that medical staff will "throw other things at it even if you're not 100 per cent sure it works."  

One of the treatments used on the athletes for acute injuries is cortisone injection. The use of these injections in competition is controversial. It can make the joint more vulnerable and cause further injury.  

Cortisone injection is often used exclusively for pain control, which means the athletes could be injuring themselves further and not know it because they aren’t experiencing any pain.  

These injections are permitted in Olympic competition, as long as athletes can prove they are necessary. They must submit an application to the World Anti-Doping Agency prior to competition.  

Another type of injection now being used on athletes is called proliferative injection therapy, or "prolotherapy." This is a new technique, and is still considered experimental.  

It involves injecting tendons and ligaments with sugar solutions at the site where the tissue connects to the bone. The injection will cause inflammation, which increases blood flow to the area and stimulates the growth of connective tissue. This treatment is used on athletes with injured ligaments and tendons. 

Platelet-rich plasma

A similar type of injection is called "platelet-rich plasma." A sample is taken of the patient’s blood, and then a small portion rich in platelets is taken from the sample. This is injected into the injured ligament or tendon to help it regenerate.  

Dr. John Ho, a Toronto sports physician, says that if an injury occurs close to a major competition, such as the Olympic Games, then "definitely you get a little more aggressive with the treatment. You start considering using injections and things a little bit more. So that’s when you move up those things like the prolotherapy."  

Dr. McCormack notes: "Things where time might make it better on its own, but you haven’t got that time, then an injection to either make it more comfortable, or to try to reduce inflammation or even try to speed healing can hopefully get you back in a little sooner." Dr. McCormack says this can also make the joint more vulnerable after injection.

The problem worsens when training regimes become more intensive as the Games approach. Dr. McCormack deals with athletes who try to push the envelope and compete despite their injuries.  He sees his role as that of an advisor, who is able to give information to the athlete, but ultimately the decision to compete or not is up to them.

"Yes, sometimes athletes will do things that are not in their best long-term interests, and yet, for them, it's worth it."