Snap, Crack, Pop

As prominent athletes tout the healing powers of sports-medicine procedures, the tools used by the pros and their doctors are trickling down to weekend warriors. But what really works, and what’s nothing more than hype? A look at the front lines of sports medicine in Colorado.

April 2012

CASE STUDY: Back in Action On July 16, 2011—about halfway into the Colorado Rapids’

MLS Cup–defending season—leading scorer Conor Casey tore his Achilles tendon. The rare injury ended Casey’s season. Here’s how he’s returning to playing form. Conor Casey laid chest-down on a medical exam table deep inside Seattle’s CenturyLink Field. Pain stabbed his left ankle as his feet dangled off the back of the table. Casey, the Colorado Rapids’ star striker, couldn’t see what the doctor was looking at, but the feeling in his gut told him something was seriously wrong.

Minutes earlier, Casey had been on the field. The score was tied at 1, and halftime was approaching. The Rapids earned a throw-in, and the ball was played to Casey, who cradled it off his chest. He strode forward to meet the ball as it hit the ground. Then, in an instant, he collapsed.

In the trainer’s room, Casey explained to the Rapids’ head athletic trainer, Jaime Rojas, that someone had kicked him in the back of the leg—hard. But as the two men watched the play on tape, they realized that Casey had gone down untouched. As he moved forward to trap the ball off his chest, the closest defender was a few feet away. Rojas wrapped Casey’s ankle and gave him a pair of crutches, and Casey traveled with the team back to Colorado. Days later, an MRI confirmed that he had ruptured his Achilles tendon. Rojas waited about a week for the swelling around Casey’s ankle to subside and scheduled surgery. The Rapids’ team doctor, Wayne Gersoff, successfully repaired the tendon, which connects the calf muscle to the heel bone, and Casey and Rojas started rehab. »


Phase 1

TIMEFRAME: Late July to mid-September

GOALS: Manage pain, reduce inflammation, increase range of motion

The first eight weeks of rehab were the most difficult for Casey. He couldn’t move his ankle for two or three days after surgery, and his lower leg felt like it was disconnected from his body. Casey tore his ACL earlier in his career, but this already seemed more difficult. “Not being able to walk was the big thing,” Casey says. “I didn’t realize I’d be on crutches for those first three months. With an ACL, you’re doing things almost from day one.”

Rojas’ two immediate concerns were managing Casey’s pain (he received shots to numb his leg) and reducing swelling around the injury (Casey alternated between hot and cold tubs). Then, Rojas focused on returning range of motion to Casey’s ankle. They started simple: Casey would slowly tilt his toes toward his chest and rotate his ankle side to side. Even those simple movements helped keep his muscles from atrophying.

“The sooner we can get an injury moving,” Rojas says, “the better the recovery.” When he wasn’t working his ankle, Casey wore a boot with a heel lift—the high angle helped his Achilles tendon heal. The lift was lowered gradually until Casey was comfortable flat-footed. Rojas also started Casey on upper-body strength work.

Phase 2

TIMEFRAME: Mid-September to February

GOALS: Regaining strength and function

By month three, Casey ditched his crutches and had full range of motion in his ankle. Rojas now focused on strengthening Casey’s leg and helping him regain his normal stride. They used a Thera-Band—essentially a giant rubber band—to add resistance to Casey’s ankle exercises and graduated to working with weights. This part of rehab can be frustrating: “You make some progress, and it plateaus, then you make some more progress, and it plateaus,” Rojas says. “It can get depressing.”

Having already been through the experience of rehabilitating his ACL, Casey was prepared mentally for the peaks and valleys. He started to work on conditioning (low-impact exercises like cycling and swimming), an important part of the recovery process. Once an athlete is physically healthy, Rojas says, you want to make sure they’re ready to step on the field—if they don’t work on their cardio, they’re more likely to reinjure themselves.

Phase 3

TIMEFRAME: March to present

GOAL: Return to sports activities

The last few months of rehab are all about “getting a soccer player back to playing professional soccer,” Rojas says. He and Casey started with light jogging for five or 10 minutes and then increased the length and pace of the runs. For the first time in months, Casey broke a good sweat and kicked a soccer ball. “It’s nice after being idle for so long,” Casey says. “Just messing around a little and hitting a ball is a great feeling.” Rojas had Casey jump rope and run side-to-side shuffle drills. He mixed in yoga and work on a balance board to help Casey’s balance. On the field, Casey started dribbling and passing.

As his work turned more aggressive, Casey felt pain in his abdomen. He was diagnosed with a sports hernia at the beginning of February, about seven months into his rehab—a setback, but not a major one. Casey had laparoscopic surgery and was back working with Rojas after just five days. As Casey nears the nine-month mark in his rehab, Rojas is focused on integrating Casey into team drills and making sure he’s fit to play 90 minutes. “Some sports you can put a player in and limit time,” Rojas says. “I don’t have that option.” Rojas has been pleased with Casey’s progress—he’s on track to miss only a couple of games this season. Which, if you ask Casey, is a few too many. “It’s hard because I’m anxious and I want to come back,” Casey says, “but I know I have to wait ’til I’m 100 percent.”