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Rebounding abounds
Last fall, when I asked for feedback from skiers who had joint replacement surgery, I never expected such a huge and enthusiastic response. I received 25 lengthy e-mails and a number of phone calls. Among those who responded were two of the most influential people in the development of cross-country skiing in America. The first, John Caldwell, coached the U.S. Ski Team in the 1960s and his books were my first source of information. Thanks to Caldwell, there's no question roller skiing is essential to training. The other cross-country icon I heard from was Marty Hall, former U.S. Ski Team and Canadian National Team coach. Hall shared his kick waxing secrets with me and even visited our house in 1980 to watch skiing videos and discuss technique. Caldwell and Hall contributed to the 14,000 words worth of feedback I received, which I will summarize here. But because all e-mail was well thought out, articulate and informative, I have posted them in their entirety, at thesimplesecrets.com. Click on “Silent Sports Articles� from the side menu. So how successful was joint replacement for the cross-country skiers who responded? The following quotes will give you some idea of the tenor of the replies: "My celebratory American Birkebeiner of 2006 was accomplished in three and a half hours, which was a full hour faster than what I thought at the time to be my last race. I gave the surgeon my bib." "Success of surgery? Best $40,000 I've ever spent." "Would I have the surgery again? In a heartbeat." "I finally went ahead and had it done. It was the best thing I've ever done." "If I were to do it all over again, I would definitely have the surgery done. It has been a boon to my life. I can sleep pain-free. What a blessing. Life is good." In fact, all of the respondents raved about the results and said they'd do it again in an instant. My son, Bret, a doctor himself, had predicted this. He said the happiest surgery patients he's seen are those with successful joint replacements. The reason is obvious: They're finally able to move and sleep without pain. But this group was different than your usual joint replacement crowd. They were all active skiers, so their bar for success was set much higher. Every one of them insisted on being able to continue the outdoor activities they loved. And every one of them returned actively to pain-free cross-country skiing. The ages of individuals who contacted me ranged from their mid-40s to 79. Most were in their 50s and 60s. Last winter, for example, one 76-year-old respondent completed the Birkie and Noquemanon ski marathons with his new knee. After skiing the Noque again this year, he reported "my knee held up fine. No pain during or after effects of any kind. My problems are really with the rest of my body!" Several older skiers said they were told by their doctors that they had greater bone density than the average person their age, which likely contributed to the success of their surgeries. Several joint replacements were said to have lasted 15 to 20 years. But many more people reported having their surgeries within the last few years. Regardless of when they underwent surgery, all of them said running and other high-impact activities were likely to shorten the time before they needed to undergo surgery again. Almost all said the worst part of the ordeal was the post-surgical therapy. But once that was over, they were much better off than before. Most said it took several months to return to normal activity, with easy biking the first aerobic activity they could handle. Many said they were on crutches initially during rehab. Most were able to both skate and stride after their joint replacements. Hip replacements seem to affect skiers differently, leaving some only able to do one technique or the other. Only one skier had complications (an infection) requiring his knee replacement to be redone. But he, too, was very happy with the end results. Joint replacement is advertised as 94 percent successful, so it is not surprising that only one skier developed problems and his were eventually solved. (My own knee doctor, Mark Wichman, noted an interesting phenomenon after reviewing the responses. He said that in the normal population, knee replacements are more common than hip replacements. But the skiers who needed new hips far outnumbered those with knee problems.) The stories these skiers shared also indicated that joint surgery is improving. For instance, resurfacing hips is a less extreme alternative to total hip replacement. And small incision knee replacement surgery is a recent development, one which greatly aids in recovery time. There were two books that helped me understand this whole process. What Your Doctor May Not Tell You About Knee Pain and Surgery and the sequel What Your Doctor May Not Tell You About Hip and Knee Replacement Surgery by Ronald P. Grelsamer, M.D. Both of these books are a must to read for anyone contemplating one or more joint replacements. If nothing else, these books helped me read my own X-rays and ask my physician more informed questions. But the letters I received are also a treasure trove of information. Again, you'll find them on thesimplesecrets.com. Avoiding joint replacement surgery While almost all the skiers who responded to my query said their joint replacement surgeries were successful, a possible downside to the procedure is inescapable: That is once one undergoes such a surgery, one is resigned to repeating it if it fails. While the success rate is somewhere around 94 percent, there are those who do develop blood clots or infections. I actually interviewed two people who related those horror stories to me. The first was a runner I happened to be standing next to at the 2007 Lapham Colorama Run. He had a close friend who had been bedridden for a year because of an infection he got at the hospital. This unfortunate person had his artificial knees removed and antibiotic pads inserted that still didn't eliminate the infection. Upon hearing this, I did a little research and found that about one out of 1,000 knee replacement recipients get infections and have to have their legs amputated above the knee. Ironically, the next day I was talking to Rod Barnes, an occasional workout partner, who is a chiropractor. He said one of his patients died last spring from a blood clot he incurred during joint replacement surgery. So while rate of success is overwhelmingly favorable, there remains a risk. Therefore, it's wise to try other means to alleviate joint pain before resorting to surgery. Over the years I've written this column, I've been asked a number of joint replacement questions, mainly "If I get it, can I skate ski again?" But this time my main motivation was my own painful knees. I started researching how I could avoid surgery since the risks, although small, are nothing to shrug off. This is what I found. Try to realign the leg joints to relieve pressure caused by misaligned bones. The best source I found was a book called Pain Free by Pete Egoscue. Because "muscles align bones," Egoscue believes in retraining the muscles to promote mechanically sound joint alignment. He provides a series of exercises designed to realign the joints so that bones don't rub on each other. Since my pain is on the inside of the knees, I found an article suggesting I slip wedges under the outside of my shoe inserts. Following this advice, I found it helped take pressure off the inside of knees by opening up the gap in the knee joint where the bones are now rubbing against one another. These inserts do help relieve pain while walking. I also found that a special shoe further relieved the pain and helped my overall posture. The shoes took some getting used to. But I even played basketball pain-free with my grandson for the first time in years while wearing these shoes. The shoes are not meant for this activity because they lack ankle support, but surprisingly they worked for me. Glucosamine/chondroiten and unsapon-ifiables may help. There are actually two substances that research shows can help grow back cartilage and can be bought without a prescription. The first, glucosamine/chondroiten, has come under fire lately. But one skier told me it has helped him immensely in avoiding knee surgery. (He has been bone-on-bone for about 15 years and has undergone several arthroscopic surgeries. He said he can tell the difference when he doesn't take the glucosamine/chondroiten.) Glucosamine/chondroiten has had mixed results in some studies. It has not proven effective for people with misaligned knees. The second substance is avocado-soybean unsaponifiables (ASU). In fact, ASU is a prescription medicine in France and has research to support its effectiveness. Cortisone shots are a stopgap, not a long-term solution. In fact, too many cortisone shots can weaken a knee. There are also expensive hyaluronic acid injections that can postpone surgery for up to six months. I had the latter and they didn't seem to help. But in my interviews, I ran into someone who said this approach eliminated his knee pain so he could function normally again. As for me personally, as long as I can sleep, walk, ski and bike pain-free, I will avoid going under the knife. I'm no worse off than I was last fall, thankfully. But if the pain gets too great, I'll seriously consider total knee replacement. It sounds like an almost miraculous means to get rid of pain and restore functionality. The future of joint surgery may be stem cell repair; the body repairing itself. In fact, some athletes are already storing their stem cells for future use. But for most of us that option is well into the future. Go to thesimplesecrets.com for an article on the stem cell future as well as access to all the feedback on skier joint replacement. Lee Borowski is a past USSA Nordic Coach of the Year, Badger State Winter Athlete of the Year, and the coach of several Junior, Senior and Collegiate Skiers of the Year. He has also coached many master skiers who have won both national and world championships. In addition, Lee is the author of several books, many articles and four videos on cross-country skiing. He runs the website http://thesimplesecrets.com/. To order Borowski's NEW Simple Secrets of Skating or The Simple Secrets of Striding (demonstrated through footage of Olympic and world champions and available on VHS and DVD), send $25 plus $1.75 shipping (Wisconsin residents add $1.27 tax) to Lee Borowski, 4500 Cherokee Drive, Brookfield, WI 53045. | |
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