Top-flight professional or pot-bellied weekend warrior, it's the rare athlete who makes it through his or her sporting life unscathed.

For all of the physical, mental and spiritual benefits sports affords us, the inevitable truth is that the longer you pitch, hit, dribble, pass, shoot, jump, set, spike, swing, drive, stroke and kick, the more likely it is that you will one day feel the twinge, pop, grind, squish, snap, swell, scratch, burn, tear or ache of human frailty.

No one knows this better than Honolulu orthopedist Kimo Harpstrite, who treats torn rotator cuffs and ruptured tendons with the frequency some general practitioners treat colds and flu.

"It's the nature of sports," says Harpstrite.

Beyond the everyday sprains, strains, bruises and abrasions recreational athletes endure as the price of playing, there are a myriad of injuries that require the attention of trained physicians.

Harpstrite, 42, says the majority of patients who limp their way into his office suffer from repetitive-use injuries, ailments that develop over months or years of specific movement. Traumatic injuries, those that result from a singular event like an accident or a sudden tear or rupture, are not as common but are more likely to require surgery.

As Harpstrite notes, recreational athletes tend be migratory creatures, shifting their outdoors pursuits to match the sport du saison. Thus, during the NFL and college football seasons, his office is likely to see more of the shoulder and knee injuries that are part and parcel of the gridiron. When the season shifts to hoops, the office will likely see an increase in basketball-related injuries, like ligament tears of the knee.

While Hawai'i tends to fall in line with the rest of the country in the incidence and frequency of sports-related injuries, the state does have higher incidences of certain types of injuries.

Given Hawai'i's long tradition of surfing and other water sports, Harpstrite, himself a surfer, is familiar with various ailments of wiped-out weekend warriors.

Surfers who "dunk" their boards to get through big waves can suffer separated or dislocated shoulders when the board pops to the surface.

Surfers are particularly vulnerable to medial collateral ligament tears, a result of pushing their weight forward on the board to gain speed.

"When a wave hits them, the knee is forced inward, causing the MCL to tear," he explains. "But because water tends to be forgiving, you don't see many combined injuries, like ACL (anterior cruciate ligament) tears."

Reefs, however, are much less forgiving than waves.

"In the ER, you'll see pelvic fractures, humerus and tibia fractures, knee dislocations and things like that from surfers being slammed on the reef," he says. "In big, heavy surf, you name it, it can happen."

Hawai'i sports medicine doctors also tend to perform more knee replacement surgeries than hip replacements, a result of the state's large Asian population, Harpstrite says.

Such surgeries are usually needed to remedy osteoarthritis due to wear and tear on the knee.

"Asians have a higher knee arthritis rate than hip arthritis," he says. "I do three knees to every two hips."

FEMALE ATHLETES

Before puberty, boys and girls share the same risks for repetitive-use and traumatic injury. However, as their bodies mature, women find themselves more vulnerable to certain types of injuries, particularly ACL tears.

According to orthopedist Elizabeth Ignacio, women are as much as nine times more likely than men to suffer an ACL tear "due to their inherent ligament laxity and female boney anatomy."

Specifically, women's ligaments tend to be looser than those of men, which may contribute to a less stable knee structure (studies on this have yielded conflicting results), and women tend to have wider quadriceps angles or "Q-angles" (a measurement of the angle at which the upper and lower leg bones connect), which can contribute to instability when landing.

The injuries often occur in non-contact situations, and most frequently in basketball, volleyball and soccer.

Ignacio says women can reduce their risk of ACL injury through core strengthening and plyometric exercises that emphasize proper jumping and landing techniques.

(As coach of his 12-year-old daughter's soccer team, Harpstrite says he includes drills that improve muscle-reaction time in explosive movement situations "to lessen the chance that they'll land in a funky position.")

Female athletes are also at higher risk for Achilles tendinitis (inflammation of the Achilles tendon), plantar fasciitis (inflammation of the tough band of tissue at the bottom of the foot), chondromalacia patella (erosion of the cartilage beneath the kneecap), and spondylosis (a form of spinal arthritis that can result in a slip in the backbone), Ignacio says.

RIPE FOR INJURY

As Ignacio notes, age is often a factor in what types of injuries an athlete might suffer.

Harpstrite says he sees ACL tears more often in athletes under 30, while older athletes are more vulnerable to tendon ruptures.

He explains that as athletes age, their tendons — strong cable-like structures that attach to bone — lose their tensile strength, even as their muscles maintain their power. That imbalance can lead to serious injury.

"It's a physiologic balance," Harpstrite says. "You're perfect at 20. As you age that tendon degenerates but your muscles aren't any weaker. So, when you do that same explosive jump you did when you were 20, the force might cause that tendon to rupture.

Harpstrite says athletes over 50 tend not to have as many traumatic injuries, in part because they have learned to play within their physical limitations. That sort of awareness often escapes athletes in their mid-30s and 40s.

"Guys that age still think they can run with the young guys," Harpstrite says. "It's hard because you can still play, you can still run and jump, but you don't know when to back off."

Harpstrite speaks from fresh experience. Two days before he spoke with The Advertiser, he ruptured his patellar tendon while playing basketball. Ignacio performed his surgery that very night.

"I stretch and all of that, but it's just a matter of 'stuff happens,' " Harpstrite says, shrugging.

Harpstrite returned to work the next day with new insight.

He feels your pain.

Reach Michael Tsai at mtsai@honoluluadvertiser.com.