To help athletes stay at the top of their game after a serious injury, sports doctors and physical therapists are pushing the edge to find the right balance between healing and maintaining strength and motion.
Marion Walker, a high school defensive back who injured his ankle during a football game, was up and running three months later. Under the watch of an orthopedic physical therapist, Walker has been performing sports-specific drills to be eligible for track season, when he will compete in the 800-meter race and relay events.
The 19-year-old Miami athlete, recruited to play collegiate football in California, was diagnosed with a torn deltoid ligament, dislocated ankle, and separation of the syndesmosis, a sheet of ligament connecting the leg's fibula to the tibia.
"With the treatment plan we used, at three months it's very realistic for an athlete to return to competition after suffering these injuries. We are so used to treating athletes that we are comfortable in knowing it won't result in a failure of the surgery," said Christopher Hodgkins, MD, the orthopedic surgeon who repaired Walker's ankle at Doctors Hospital's Center for Orthopedics & Sports Medicine in Miami.
Walker was injured when another player slammed into him as he was getting up from a tackle during a game for Coral Gables Senior High School, a four-time national champion that's the alma mater of San Francisco 49ers' running back Frank Gore and Houston Texans linebacker Darryl Sharpton.
"I wanted to stay in the game so I kept playing, but the pain got so bad I finally had to leave the field," Walker said.
Surgery and Early Rehab
During surgery on Walker at the end of October, Hodgkins used an advanced device called a suture button to fix the syndesmosis tear, necessary to return stability to the ankle. Without treatment, athletes most likely would be unable to return to sports and could develop ankle arthritis if the injury is neglected, Hodgkins said.
With the suture button, athletes are able to move their ankle much earlier than usual, allowing them to work on gaining motion and strength as soon as possible without interfering with the healing process, he said.
Traditional stainless steel screws are still used by some physicians to repair the ligament, yet the screws sometimes break and have to be removed, causing further surgery for the athlete and time out of play, said Hodgkins, who specializes in conditions of the foot and ankle.
After surgery Walker wasn't allowed to put weight on the foot for six weeks. He complied with doctors' orders, but felt dejected at keeping the foot elevated and using crutches to get around. His spirits improved, he said, when he convinced friends to push him down the school hall in a wheelchair.
Two weeks after surgery, Walker started rehabilitation when the rigid half-cast came off. Placed in a boot, Walker was ready for range and motion exercises.
"If the foot is kept in a cast the entire first six weeks, the patient can't move the ankle and muscles begin to atrophy. With the suture button device, we are comfortable with the athlete beginning to move the ankle at a very early stage," Hodgkins said.
"Our goal in physical therapy is to make the transition from the first rehabilitation range-of-motion exercises to those more specific to sports, including jumping, hopping and running backwards. With the button device, athletes tend to make the comeback quicker because the range of motion isn't lost," said Jorge Giral, DPT, one of more than a dozen orthopedic physical therapists in the rehabilitation department at Doctors Hospital. Three physical therapists are certified in rehabilitation techniques with Pilates equipment and stretching. Giral has additional certification in orthopedic manual therapy and strength and conditioning.
During the second six weeks, Walker was walking and undergoing intensive physical therapy with aggressive strengthening, motion and balance exercises.
"The average time to start walking is at six to twelve weeks. We at Doctors Hospital have a lot of experience treating athletes, from professionals to the weekend warrior, and are more confident with them bearing weight. The sooner they can walk, the sooner they can get back to playing," Hodgkins said.
Walker began walking on an anti-gravity treadmill, a machine developed by NASA that makes the body buoyant, reducing impact on joints and ligaments. Giral zipped him into the harness of the anti-gravity treadmill, a high-priced machine used in the sports world for about seven years for training and rehabilitation.
"I had been afraid to put weight on my foot and to walk on the regular treadmill," Walker said. "With this other treadmill, I didn't have any pain so I gained confidence."
Giral said the anti-gravity treadmill allowed Walker to begin walking correctly while keeping up cardiovascular conditioning.
Once only accessible to professional and college sports teams and specialized hospitals, the anti-gravity treadmill has become a standard tool for physical therapy. The machine pumps air into a chamber wrapped around the body from the waist down. The increased air pressure on the body lifts it up, reducing the impact when feet touch the ground. It can be calibrated to change the body weight from 100 percent down to 20 percent.
"Physicians have taken a liking to the machine, because the patient is able to return to weight-bearing and high-impact activities quicker," Giral said.
Aquatic therapy remains popular, but its limitations include access, movements that are less natural, infection, and fear of water. People with incisions from surgeries such as ACL repairs are susceptible to reopening the wound.
"Most patients who fit in the harness are good candidates for the anti-gravity treadmill," Giral said. "The use of the technology was initially for athletes, but we are now treating people with knee replacements, osteoarthritis and car accident injuries. Patients are happy. They feel like they are progressing because they are doing functional movements earlier in their recovery. It returns them to a sense of normalcy."
Progressing from surgery to running is a slow transition period and the speed of doing the exercises depends on the athlete. The healing process is monitored with a series of X-rays, physical exams by the doctor, and subjective patient reports on the level of pain.
"The less pain, the more progress he or she is making," Hodgkins said.
"Dr. Hodgkins says I'm where I should be," Walker said. "The therapy is really helping me get into shape for track season."
Melissa Lichtenheld is a freelance writer affiliated with Baptist Health South Florida, the parent company of Doctors Hospital.