It's body-beautiful over body-functional, aesthetics over athletics.

WE ARE SUCKERS for packaging. It makes Britney Spears a star and inflates sticker prices. So it should not shock that packaging has shanghaied fitness, too. There is so much emphasis, ego, pressure — and money — riding on the way the body looks that how well it works becomes secondary.

It's body-beautiful over body-functional, aesthetics over athletics.

Yet the true beauty of the body is in its engineering. It's a machine of synchronized components and interlocking systems. When one part lags, another automatically tries to pick up the slack. It comes with an automated warning system (lingering pain we often ignore) of potential or actual breakdown. It can move on all kinds of planes, is triggered by mere thought, and can repair itself.

The mechanisms are complex, influenced by and adapted from genetics, attitude, training and that thin line where use spills into overuse. Age is a constant in how the body evolves, but so is how you treat it.

At elite levels, the sport usually selects the athlete as much or more than vice versa. Certain strengths, body types and biomechanic skills match certain sports. Runners, in general, are svelte; the tall have a built-in advantage at basketball. And particular sports-related routines have profound influence on how the body develops. Hard-core weight-lifters build bulk. Rowers cultivate shoulders and backs. Swimmers boast powerful lungs. And in keeping with the wonder of the human body, there are exceptions to each of these rules.

How can someone exercise repetitively and excessively and not break down, while half as many movements chafe another athlete's joints and tendons? What causes that jab of pain at the end of a throw? How does someone rehab a back injury, stay healthy and be competitive, too? What mental adjustments offset age?

Top athletes face those sorts of questions all the time, but they concern the casual athlete and those who just want to stay active, too. With that in mind, we had doctors at the University of Washington Sports Medicine Clinic take a look at four athletes in various levels of fitness, commitment, circumstance, age and activity to get a picture of how the body develops, excels, breaks down and rebuilds.

WHY CAN KELLY STRONG run so far so fast so much and not wear out?

It's part genetics, part focused training and part hunger to achieve. An assistant UW track coach, Strong is a national-caliber distance runner in her prime, and she looks it. Slim, long-legged and 26, she runs 90 miles a week as she trains to race in the steeplechase at the USA Championships in three weeks (and perhaps qualify for the world championships).

Her build and gliding gait give her a chance against the best. So does her ability to process oxygen. Dr. Tom Robertson of the UW Medical Center's Pulmonary Diagnostic Lab recently put her on a treadmill to test her VO2 Max (the volume of oxygen consumed while exercising at maximum capacity). She produced the second-best score of any female runner he has ever tested in the lab.


It's the bursa that burns from overuse
Bursitis is inflammation of the bursa, a slippery sac that lies between tendons, bones and muscle. When it gets inflamed, often from overuse or repetitive movement, it gets swollen, which causes friction within the tight space it has to operate. Chet Morgan, an aggressive baseball player and dirt-bike racer, has lived with the ache for some time.


Under the "six-pack" is what counts
The rectus abdominis, what we often call the "six-pack" muscle, has the sex appeal, but it is the deep transverse abdominis that does the most work in stabilizing the spine. The rectus abdominis allows the trunk to flex, which causes the lumbar spine to flex, too. The transverse abdominis effectively surrounds and supports the spine. Olympic rower Jennifer Devine developed her transverse abdominis to help compete despite a history of back problems.


At stress points, tendons take the heat
Tendinitis is common around the elbows, shoulders and knees. It occurs when a tendon—which attaches muscles to bone—gets inflamed. Morgan's injury was below and on the inside of the elbow, which is why he feels it most at the end of a throw or at the bottom of a bicep curl.

ILLUSTRATIONS BY PAUL SCHMID
"The amazing thing about athletes at her level," Robertson said after the grueling test, "is that if I put her back on there right now, she would probably give the same result." Robertson's clinic usually sees people recovering from surgery and suffering lung-related diseases. Most of them won't be running races, but all of them need to improve how they process oxygen. And they can.

Strong, who grew up near Portland, began running in seventh grade because her school didn't offer girls' soccer or softball. She was a natural and had a good high-school coach who helped refine her technique. She attended Arizona State, where, as Kelly MacDonald, she earned five All-American honors and three Pac-10 titles and set five school records.

"At first, the sport chose me, but then I chose it after I saw I had potential and that it was something I could do for a long time," she says. "I am still getting better. Many women runners don't reach peak until late 20s or early 30s."

Athletes at her level push their bodies to the brink, the thin line between fine-tuning and breaking down. She strained an Achilles tendon and lives with constant little aches, but has escaped significant injury. Her durability interests doctors, and she believes it is a function of mechanics as well as mental approach. She has a smooth, natural stride; her foot strokes the ground rather than pounds it. Although she works out in 13 sessions a week, she varies the routines.

"I think a key component is my competitiveness," she says. "I've increased my mileage and do all the extras like weights, drills, core work, medicine-ball work, strides, because that is simply what it takes to get better."

Going solely by her "body mass index" number, which loosely determines weight ranges in which people of certain height and gender should be, she is underweight. Yet Strong is strong because she adheres to good nutrition and sensible eating. She eats when she's hungry.

Dr. John O'Kane, head UW team physician, had Strong stand one-legged on an unstable surface. She handled it flawlessly, which makes sense. She spends 90 miles a week perched on one foot or the other and has developed the kind of balance and hip strength her sport demands. She was only average during a test to measure core strength, which also makes sense, says O'Kane. Her sport doesn't demand anything special in that regard.

Strong also has loose, hyper-flexible joints, the kind that got her teased as a kid with nicknames of Gumby and Beanpole. Those pliant joints help her run well, but would make her more susceptible to injury in a sport that requires tightly anchored joints.

"People always ask, 'Should I run? I'm worried about my bones and joints,' " says O'Kane. "Anyone with two legs and a halfway decent pair of sneakers can run, but how far you're going to go depends on factors, some of which you can control and some you can't. You can't change your genetics. You can change your VO2 Max within a range (perhaps 10 percent), and some people are naturally leaner. But you can control your nutrition and you can listen to your body."

HOW DID JENNIFER DEVINE overcome two herniated discs to become a two-time Olympian in rowing, a sport notoriously rough on the back?

For one thing, she is tough-minded. She was an underdog through much of her early career, having been turned away from the UW crew team because she was considered too short at 5 foot 7. For another, she is smart and inquisitive. Now 36 and working long hours as a resident at the UW School of Medicine, Devine dissected the biomechanics of her sport to fit her body type and stroke, and tackled her rehab with the same clinical precision.

She also developed tremendous core strength — those trunk muscles that control the motion of the lumbar spine, but aren't highlighted on magazine covers.

O'Kane put her through the same two tests he had Strong do. Although the two women share physiologic markers (Devine also has an excellent VO2 Max score), they also show distinct differences. Devine's balance was ordinary. Although she and other rowers have powerful legs, they sit through their sport, so excellent standing balance isn't necessary. Her core test was another matter. On her back and using only her core muscles, she smoothly lowered her legs to just inches above the ground and let them hover. She was able to do the test with no spine extension, which O'Kane says was better than he's seen anyone else do.

Core training is the rage, but too often it is presented as the way to six-pack abs. Those look nice, but they aren't the muscles that protect your spine. For one thing, they are farthest away. The muscles that help most are the deep ones: the transverse abdominis, which wraps like a belt around the spine, and the multifidi muscles, spliced between the spine's stacking vertebrae. These muscles can prevent the spine from excessively extending and rotating during movement, and they are generally weak in people with chronic back problems.

"A lot of people don't really use those muscles," says O'Kane. "They need to work with a physical therapist or a trainer who understands how to get those muscles to fire. You can learn how to engage those muscles and then subject yourself to increasing challenges of trunk control. Maybe lie down and lift one leg off the floor while keeping proper muscles engaged. Then do it using a stability ball. Or try lifting two limbs together, all the way keeping the contraction."

Not only did Devine do what it took to rehab from herniated discs on two separate occasions to make the Olympic teams in 1996 and 2004 (she skipped the 2000 Olympics for medical school), she developed a style of rowing that minimized her weakness and played to her strength. Devine also discovered she had natural gifts. The women's single-scull race is a long event that requires endurance. Her VO2 Max is virtually the same as Strong's, but she also produces low levels of lactates, meaning she has slow-twitch muscles built for endurance even in her muscular frame.

After she was injured, Devine didn't just rehab. She developed a plan to prevent recurrence, working her abdomen and back muscles, flexibility and posture to protect her back. It makes sense that Devine, who speaks four languages and is a classical pianist, is about to begin her career as a physiatrist, a nonsurgical branch of rehabilitative medicine.

"Everyone has to take the time to figure it out," she says. "You can't go right back after getting hurt and do the same thing. Ask yourself why does it hurt? What muscles do I need to recruit? I see training and exercise as a good investment in the future."

Perhaps because Devine did much of her training, rehabbing and learning alone, she became intimately invested in the sport. And today, she sorely misses the long hours of practice.

"Most people view fitness and exercise as dreary, things they have to do," says Devine, whose grueling shifts as a resident have kept her from doing much of it lately. "I just love to row. I have always loved training. I had to learn to love competing."

WHY DOES CHET MORGAN'S right elbow zing and his left shoulder crackle?

While Strong and Devine have trained with goals in mind, recreational athletes like Morgan pursue a different form of passion — and at an uneven pace. As do many weekend warriors, he goes full steam ahead. "When I'm out there competing," he says, "I go 110 miles per hour, and feel like I'm 10 feet tall and wearing a bulletproof vest."

He plays second baseman in the 28-and-over division of the Puget Sound Senior Baseball League. He's 36, but looks younger. He's fast and aggressive, leading the league in stolen bases last year, and has also put on 25 pounds, mostly muscles, since he got serious about weightlifting in 2001.

The injuries Morgan presented in the clinic were the sort that someone of his age, sports and go-go attitude gets. The elbow problem seems to be tendonitis, and the shoulder looks like bursitis.

Dr. Christopher Wahl, UW surgeon and team physician, says Morgan shows common overuse injuries, the kind that, if untreated, linger and can affect other parts of the kinetic chain. With repeated throwing and weightlifting, an athlete like Morgan gets micro-tears in the fibers of his biceps tendons. If those tears don't have time to heal, fewer fibers are left carrying a proportionally bigger load.

"We see this a lot in throwers," Wahl says. "A pitcher may see his velocity dropping or mechanics falling apart, so he starts pushing the ball or doing things with the rest of his body to compensate. He might have a shoulder or elbow problem, but he is developing low back pain because of changing his mechanics."

The first step to treatment is to recognize something's wrong. Then you need to rest and rehabilitate the injury. Many people, however, do what Morgan does. They grit their teeth and play through it. That often leads to a longer course of rehab and sometimes more injuries.

The source of Morgan's pain is at the far end of the biceps tendon on the inside of the elbow. He originally felt it throwing to first base on a cold day. He kept throwing after the first tweak, and it hurt more until he chalked it up to the inevitable price of aging. He continued doing heavy biceps curls at the gym but made sure he didn't extend the motion completely.

Wahl says rather than continuing with the standard curls, Morgan should focus only on the lowering motion of the exercise. Studies have shown that lowering — what's called "eccentric" exercise — helps rebuild the affected area more quickly than even complete rest.

Morgan's shoulder problem is an impingement of his bursa, which acts as a cushion where bones, muscles and tendons must slide across each other. The shoulder is our joint with the most range of motion and enables our arms to reach, stretch and rotate. That mobility also makes the shoulder most susceptible to dislocation and other injury, especially the farther from the torso the arms stray. Your shoulder stability is almost as unique as your looks. Two mechanisms determine how well the bone and socket stay connected: a fibrous envelope called the joint capsule and the rotator cuff muscles.

When Morgan lifts heavy weights, he exercises the muscles that tend to push and pull across the shoulder joint. To ensure the cuff muscles can hold their own and make these rotations frictionless, Morgan and other athletes should take the time to develop them through lightweight but targeted exercises.

"These are balance issues," Wahl says. "A lot of us are out of balance, and we choose to be by what we do and the way we train. Lifters want to lift huge weights. That's great until the amount or frequency of it exceeds the cuffs' ability to keep the head of the shoulder stable in the socket."

HOW LONG CAN LORI SABADO keep doing triathlons?

Sabado supervises physical therapy at the sports clinic and has been in need of such services, too, through much of her active life. She has hurt her hip and a shoulder in separate skiing accidents, and her back playing softball; ankle problems have dogged her since she was 12. She's had considerable knee problems, too.

Yet, she has done more than 70 triathlons and, at 49, plans to keep going. Through cross-training and compromise, she walks the fine line to balance aches and aging with her relentless energy. In fact, injury led her, at age 32, to her first triathlon. She learned how to swim after fracturing her back. After a year, she competed and finished the Emerald City Open Water Swim at Seward Park. That propelled her to competing in the Seafirst Triathlon. Her goal was simple: Don't be last. She beat five competitors. That was about 17 years ago, and she has been a dedicated triathlete since.

Sabado underwent a knee operation, a scoping of the patella, a few years ago, but it hasn't fully recovered so she uses her expertise as a physical therapist to monitor and rehab it. Knee injuries account for about 50 percent of the cases that come through the physical-therapy clinic. The joints just aren't prepared for the mayhem athletes put them through.

We all know about injuries caused by a traumatic mishap — we "blow out" something. But most knee injuries are caused by attrition and some are connected with imbalance elsewhere in the kinetic chain, from a weak hip to a pronated foot. The knee joint can be pulled side to side or excessively up or down or in a number of directions. These injuries often linger.

"We have to be pain detectives and try and deduce the factors that activated the symptoms," says Dr. Carol Teitz, a surgeon and UW team physician. "If you get hit by a car in the crosswalk and are treated for the injuries, you probably aren't going to go out and stand in a crosswalk again. But if you're a runner, you don't want us to tell you to stop running. So we have to look closer and come up with a plan."

That plan often involves rest, but also alternative forms of activity. The ability to train without jeopardizing an injured part enables athletes like Sabado to keep going. Some think that's why triathlons are so popular. She also usually chooses activities — swimming and biking — that are easier on her troublesome ankles and knees.

"I have to listen to what my body is telling me," she says. "When I feel that irritation, I do something else. Instead of running, I'll maybe bike or swim."

Although lingering pain should be taken seriously, soreness is also an initial step of the critical regeneration process. When you work out, you cause micro-damage. The body dispatches cells that release chemicals that clean up the site and produce inflammation that attracts other cells charged with rebuilding and regenerating the affected area. Taking anti-inflammatory drugs within that window, often between 36 and 48 hours, can delay the regeneration process.

Sabado's goal is longevity, not where she finishes in the standings.

"When I started running again I was smiling in all the pictures. A friend told me I wasn't working as hard as I needed to. I said, yes I was. I could have worked harder and been miserable. I wanted to enjoy what I was doing.

"Are the hours worth it to me? As I age, the answer is increasingly yes. I'm just happy to be out there. It takes enough time to train, and if I pushed harder, I'd probably be miserable. I prefer to dial it down some and enjoy the experience more."