Editor's note: Author Zito Madu, who has played soccer across various levels throughout his life, recently wrote on why athletes play through injury. Now, he examines what one top neurosurgeon is doing to aid the recovery of athletes.
His name is Dr. Robert S. Bray Jr, but he's been given the nickname "Dr. Fix-It". Founder of DISC Sports & Spine Center, the official medical services provider for Red Bull athletes and a partner of the Los Angeles Kings, the neurological spine surgeon helps some of the world's most elite athletes return quickly to their chosen sport. Dr. Bray has assisted in the recoveries of such top athletes as Hurdling’s Lolo Jones, MotoX’s Robbie Maddison and Big Wave Surfing’s Ian Walsh.
Dr. Bray is undeniably a pioneer, one who is quickly redefining sports medicine. He's doing that through a focus not only on minimally invasive procedures, but also by focusing on outpatient treatments, with 95 percent of his procedures falling under this category, as opposed to the nationwide 20 percent average.
When I spoke with Dr. Bray, the conversation began with what we all know: athletes constantly try to push through injuries and in turn, continuously play through pain. Few professional athletes are ever at 100 percent -- making their ability all the more impressive, as it suggests that they are better at half power than most of the world is at full strength. Professionals belong to an elite class of athleticism.
The problem with constant injuries, as Dr. Bray explained, is that due to their ever-present nature, athletes will then try to simply push on. Some take painkillers, others get taped up before games by trainers, and some just continue on without disclosing their pain. This leads to "guard-tending," which is when the athlete begins to favor the injured limb or area. Guard-tending is more harmful than helpful, as it leads to smaller injuries, with other parts of the body becoming more stressed in order to accommodate the original injury.
As an example, we looked at a collateral ligament strain, an injury that usually heals in 10-14 days if managed properly. If athletes instead try to play through the strain, the ankle will try to accommodate the injured ligament, leading to tightness in the knee and ankle. The uninjured leg will then become more stressed as the athlete favors the injured one, and in some cases, even more small injuries develop. In the end, the individual suffers longer, with more injuries, and has a hard time returning to their peak.
The desire to push through the pain has been wired into almost every athlete, and no professional reaches that level without being able to do so. Dr. Bray realizes this, and explained that if an injury is not debilitating, there is normally no reason that the athlete should not be able to continue playing. The trick -- or rather, the solution -- is a proper soft tissue rehab program that could ultimately make the patient stronger.
That program requires shifting the mindset away from painkillers, taping and the belief that constant, little knocks should not impede performance. Injuries need to be caught while they are still small, then attacked aggressively. Athletes need to know that proper therapy and rehabilitation are necessary -- and that there are ways of healing that actually make sitting out a last resort.
Dr. Bray also believes in getting to know the athlete and understanding their situation, establishing a connection between doctor and patient. He inquires about their next big game, future events, even their full schedule. He then designs a program that works with that schedule rather than interrupting it. The clinic tests the athlete's range of motion, posture, joints, and more, as playing through injuries is detrimental to many of those things. They make sure the patient is actively involved, a critical part of the program because athletes need to realize that the doctors are not there to limit them but to help.
It's essential to overcome the fear, the belief that the doctor might be the enemy. Dr. Bray stresses it will take time and effort to overcome this mindset, as many players see doctors as the last people they should visit, synonymous with missing an extended amount of playing time. One way to overcome this fear is to have properly trained medical staff who have played that specific sport, or at least can consult with other medical professionals who have.
The goal is create an atmosphere of understanding and empathy, assuring the athlete that the point isn’t to take them away from play but rather to treat the injury. Dr. Bray makes it clear that many problems, with proper diagnosis and aggressive treatment, can be healed while allowing play to continue, which in turn limits further secondary injuries. Rather than than play through pain until they can recover during the offseason, an athlete can continue to perform while in treatment, a new concept for most.
But the athlete still must clear the first hurdle, must trust that the doctor is there to help rather than hinder. One suggestion is that those responsible for a patient's treatment must be the ones with the athlete's best interest in mind. For instance, coaches and owners may want what’s best for their team rather than what is individually best for the player, which often leads to improper treatment, early returns and re-aggravation of injuries.
There’s also a generally accepted belief that athletes are, for lack of a better word, disposable. They can be used up and then replaced, so when one breaks, there are usually two ready to take their spot. As such, athletes will often refuse to disclose certain injuries until it becomes apparent that they are suffering. Athletes need persons responsible for their treatment that will have their best interest in mind, rather than the interest of the team or the thoughts of the money that might be made off their performances.
The problem, of course, is that's the nature of sports in general. Changing mindsets -- whether the way an athlete views a doctor, or the way the system views an athlete -- will be a slow process. Doctors will need to understand that their patient's goal is to continue playing while undergoing treatment, athletes will need to realize that the physicians are there to help rather than to hinder, and the powers that be will have to change their mentality regarding the disposability of players. Indeed, if the first two are in place, athletes may no longer be seen as disposable, particularly if players were able to keep playing through treatment.
The process may be slow, but Dr. Bray's successes have lead to better performances and longer careers. This is exactly the sort of hope injured athletes need.