The road to recovery: Coming back from injury
Skaters talk about the rehabilitation process they went through after getting hurt
|Courtney Hicks said it took eight months for her to feel fully recovered from the fractured tibia she suffered in October 2011. (Getty Images)|
Six skaters shared their stories of injuries, surgeries and rehab: Alissa Czisny, who had hip surgery in June; Evan Bates, who had to recover from a severed Achilles tendon; Courtney Hicks, who fractured the growth plate of her tibia; icenetwork.com blogger and pairs skater Drew Meekins, who had surgery for a torn labrum in his shoulder; Jeremy Ten, who fractured one ankle and had surgery on the other; and James Morgan, who also had labrum surgery.
Two-time U.S. champion Alissa Czisny had surgery to repair the labrum in her left hip on June 6. (The labrum, in both the shoulder and hip joints, is a ring of cartilage surrounding the socket of the joint; when it tears, the joint loses stability and becomes painful). After the surgery, Czisny was on crutches for four weeks, with limited mobility.
"I could put 50 percent of my weight on the left hip, so I wasn't completely off the leg for a month," Czisny said.
Czisny started physical therapy the day after the surgery, and she has been going twice a week.
"Obviously, at the beginning, the therapy is limited," she said, "But it slowly increases, and we continue to add new exercises each week. On the days that I don't have physical therapy, I do the exercises on my own at home, in addition to other exercises and therapy, such as swimming."
As well as physical therapy, Czisny has been diligently working with her personal trainer on strength exercises, although in the beginning she was only able to do upper body and arm exercises.
"I am working with a physical therapist who is located at our rink, so we can easily add physical therapy exercises specific to skating," Czisny said. "I will probably continue to do physical therapy for quite a while, even when I am back to full strength and mobility, in order to ensure complete recovery and prevent any further complications. On the plus side, physical therapy really does help make me stronger and better than I was before the injury!"
Evan Bates' left Achilles tendon was severed in practice in 2010, in the middle of a lift. Then partner Emily Samuelson was moving from a high to a low position, down Bates' back, when her blade went into the back of his boot.
"The injury happened on September 28 -- I'll remember that day forever," Bates said. "I was really fortunate that I had the surgery just two days later. The tendon was elastic and hadn't retracted much, and the surgery went really well; they only had to make one incision."
After the surgery, Bates was not allowed to put any weight on his left leg for six weeks.
"I remember falling out of shape so quickly, burning zero calories a day sitting around," he said. "I'm a really active person, and all of a sudden I had to be a couch potato."
Bates was allowed to do some aquatics while he was on crutches. Once he was able to start physical therapy, he devoted a lot of time to it.
"I was doing pretty intense physical therapy, a few hours a day," he said. "That was the main focus of my day: rehabbing my foot."
After he got out of his walking cast, Bates had a multi-layered heel lift in his shoe. He was allowed to pull off a layer every week or so.
"The Achilles is the biggest tendon in the body, and mine was completely severed," he said. "It took months of working the injured area. I'm glad it's over with now!"
The doctors told Bates it would take a year to recover from the injury, but he says that he was naïvely optimistic at first that he might be able to salvage the second half of the season.
Four months after the injury, though, he was only beginning to skate again.
"I started really tentatively, skating five minutes at first, then 10, then 15, and building from there," he said. "It was sore for a long time, and it was swollen and big for a long time, so I had to do constant therapy on it. But I was skating on it more and more. It took about nine months before I was 100 percent again."
Courtney Hicks tapped in for the first jump of her program, a triple flip, last Oct. 9 during the Junior Grand Prix Italy. As she fell, she knew something was very wrong.
"I rotated the jump and then I fell, and it wasn't working," Hicks said. "I fractured the tibia, and the growth plate popped up."
At first, Hicks was more concerned that she had to withdraw from the competition than she was about the injury, because the doctor in Milan didn't think it was a fracture.
"The ligaments and tendons felt like they were in line," she said. "They took me to the hospital and got it X-rayed, and we saw that it was fractured. They put it in a half cast and wrapped it. We went back to the hotel, and we went home on the plane the next day. I had surgery a few days after we got home, to put the growth plate back down."
Hicks now has two screws below her right knee. After the surgery, she had to wear a brace and use crutches until December. She started going to physical therapy about a month after surgery, starting with electrical stimulation to promote muscle re-growth.
"Once I got off the crutches, I had to start walking and learn how to bend the knee again," Hicks said. "They put me in a machine that would bend my knee for me. For the doctor to give me the 'all clear,' I had to get my heel to my butt. The machine helped a lot."
In mid-December, only a week after Hicks started walking again, the therapist put her back on the ice.
"For a long time, I was only able to stroke and do footwork," she said. "But I couldn't spin or do twizzles on the right foot. I did a lot of stroking and edges. I was stretching and doing workouts basically all day. After Christmas, I went to a trainer and we worked on getting the muscle back to full strength, three times a week."
Hicks started jumping in January, while the 2012 U.S. Figure Skating Championships were taking place.
"The first day, I went all the way to double Axel. I was like, 'I need to do it.' But mostly I did singles really slowly, making sure I had the technique," Hicks said. "I probably started working on triples a week to two weeks after I started jumping, but I started with Salchow -- that was the only one I was doing for a while. Then I added flip, and then loop."
Hicks said she felt fully recovered in June.
"I felt full strength; all my jumps were back, the spins were back," she said. "I have no pain."
Drew Meekins dislocated his right shoulder in 2002, during practice.
"I was skating around the rink doing a stroking pattern, and I collided with someone at high speed," he said. "I fell with my arm fully stretched out and dislocated it."
Once someone has had a shoulder dislocation, the injury tends to happen again. The labrum, a stabilizing ring of cartilege around the shoulder socket, can tear, leaving the joint loose. Meekins thinks he fully dislocated the shoulder five more times in the following years, and subluxed it (a partial dislocation) another four.
Last November, Meekins had surgery at the Steadman Clinic in Vail, Colo., to repair the labrum, which had a 180-degree tear. Following the surgery, Meekins had to keep his arm completely immobilized for almost nine weeks.
"That's incredibly long," he said. "It was a very conservative approach because of what the demands on my shoulder would be after my recovery. Typically, a patient would be immobilized for about two weeks. It was pretty difficult.
"After, I had to return to normal life and start coaching again. I had six weeks having people tie my boots for me. I couldn't carry things at the grocery store. Plus, I'm right-handed, so it even made brushing my teeth and shaving very difficult."
Once Meekins was able to go to physical therapy, the therapist started working on passive range of motion exercises.
"At first, the therapist moves your shoulder," he said. "The whole point of the immobilization is so the tissue heals itself very tightly, tighter than you would ever need. The therapy is to get it mobile enough for lifting and throwing. The passive range of motion hurt, as if you were forced to do splits for 45 minutes. The shoulder was so tight, and they were stretching it in all directions, and it was excruciatingly painful."
Meekins went to physical therapy almost every day for several months. He also went to the Howard Head Sports Medicine Clinic in Vail several times and spent several hours a day in PT there. After a month of passive exercise, he progressed to assisted range of motion.
"I would let my arm hang and then move my body to make the arm swing, for another month or so. And then I started more active stuff. On top of PT, I did exercises at home that took about an hour. At first it was isometrics, where I would contract the muscles without using my arm. And then I progressed to a little bit of movement, and then a little bit more."
Meekins had lost all the strength in his arm and shoulder; he says that at first, he didn't have enough strength to lift his arm over his head. Once he had the full range of motion back, the next step was to be able to move with strength.
Pairs skaters have to lift more than groceries -- they have to be able to lift and throw another person.
"I was so excited when they first told me I could use weights," Meekins said. "And the therapist came back with a one-pound weight, which was disheartening. It took about three months until I could lift the weight of a person."
The therapist devised exercises that would mimic the lifts and throws a pairs skater needs to do.
"One of the things we did first was catching things, a required skill for a pair skater," Meekins said. "There was a trampoline at a 45-degree angle, and I would throw a 10-pound ball and catch it, in front of my chest and then over my head. And then I would do it with one hand, and then with a 20-pound ball.
"Then we progressed to more complicated things. I would have my arm hooked up with four or five resistance bands tied to it, and my leg on a rotating disc, and a ball in my hands. I could pivot through the takeoff of a throw and throw the ball across the room, and my therapist would catch it."
Once back to skating and training, Meekins found that his shoulder was much better than it had been before the surgery.
"I first did lifts at the beginning of May, six months after the surgery," he said. "When I did my first lift, I felt a little weak, but my shoulder felt so stable and I didn't have to worry about it. I don't have the instability that I used to have and the worry I used to have. I was so happy! It was very successful and the right decision for me."
Jeremy Ten had surgery for bone impingement in his right ankle in January 2011. He also fractured his left tibia in June 2011, although he says that healing from that injury was straightforward.
Ten says he is still not quite back to 100 percent.
"It's around 80 to 90 percent," he said. "I get a little residual tenderness in my ankle. The fracture in my left foot is fine. It was a blessing in disguise, giving me time to heal longer."
Ten had the surgery as a last resort, after X-rays and MRIs failed to locate the cause of his pain.
"I was just, go in there and make the pain stop!" he said. "Finally my doctor just said, 'We have to go in and take a look around and see what is causing the problem.' I didn't have a lot of options, so I was like, 'Go in and we'll pray for the best.' It's a lot better now than what I was dealing with, and I'm so thankful for that."
As of July, Ten said he was practicing the jumps that cause him pain, flip and Lutz, but with limited repetitions.
"Flip gives me the most problems," he said. "The worst thing is, they're my favorite jumps. It's been hard to scale back. I always want something to be perfect, so I do way more than I should."
After a tough 2011-12 season, Ten says things are going well so far. He competed at the Glacier Falls Summer Classic, finishing seventh.
"Everything is going really great, considering last season," he said. "I feel like I'm as good, if not better, than where I was before my surgery. I landed two triple Axels in one program for the first time [in practice], and I'm working on my quad toe again."
James Morgan, the 2012 U.S. novice pairs bronze medalist with Alexandria Shaughnessy, had shoulder surgery May 5, 2011.
"I was diagnosed with a subluxing shoulder joint, which means it's partially coming out of the socket every time I use it, and some scarring tissue," Morgan said. "Every time I had to get the one-arm lift going, it got increasingly difficult, with more and more pain in the shoulder. So we were doing just two-arm lifts."
Morgan said before the surgery he did a training course to make the shoulder as strong as possible and speed up the recovery process.
"The first month was sort of just pain management and letting the wounds heal," he said. "I had stitches, and I had to wait for the wounds to heal before I could do any physical therapy. I was stuck in a chair for a while. The arm was in a sling with a stuffed thing between my belly and my arm. I was supposed to keep it as immobile as possible."
Once Morgan started physical therapy, he went twice a week for 20-minute stretching sessions. He had to do stretches at home as well, two or three times a day for half an hour at a time. After three weeks, Morgan started going to PT three times a week and began doing strengthening exercises.
"I had exercises to do every day," he said. "The only reason to go to PT was for him to stretch me out and check my form. The therapist had a big talk with me and said if people don't do their exercises at home, they never get better. I put in about an hour a day."
To get strong enough to lift a partner, Morgan did overhead presses and a lot of work with a Thera-Band, a length of stretchy material like a giant rubber band.
"You can be as strong as you want, but if you can't get your arm above your head, it's a problem," he said. "I'd say we'd go up to 10 to 20 pounds overhead in each hand. It's comparatively lightweight compared to a partner. The point of PT for me was to get me back to being able to work out at the rink again."
Morgan said he felt back to 100 percent in mid-August.
"We call it my bionic arm, because I have a little bit of anchors in my arm," he said, laughing. "Over time, as my shoulder strengthens, they morph into my body and then they disappear."
One last note: Several skaters contacted for this article chose not to discuss their injuries and recovery process.
Meekins explains why.
"'Injury' is such a taboo word in skating, because it has this association with being weak or not being as good as you used to be," he said. "It's not always true -- a lot of great athletes have to go through it, and it's part of what makes an athlete great.
"I looked up to Drew Brees, the quarterback for the New Orleans Saints. He had a 360 tear in his labrum, his arm was basically torn off, and he rehabilitated all the way back to being Super Bowl champion. You can come back from injuries better than you were before."