Getting Back in the Game: How prevention protocols, recovery plans, and mental support are helping athletes overcome physical and emotional injury
Mar 06, 2017 10:58AM ● Published by Nicole Gould
The crowd roars as the first jump approaches, watching 13-year-old Travis Pastrana effortlessly fly through the air as he leads the pack with hopes of qualifying for the amateur national motocross championships, which takes the top 42 riders from around the country to compete in Tennessee. But when Pastrana lands, his foot slips off the foot peg and, instantly, a rush of pain speeds through his leg forcing him to ride off the track.
With tears in his eyes, Pastrana knew he wasn’t getting back into the race.
The diagnosis: A tibia plateau fracture, which included an ACL, PCL, MCL, and a Meniscus tear all at the same time. The timetable for recovery—and not riding—was eight months.
“Getting hurt and being off for a year was the best thing that happened to my career,” Pastrana says.
Unfortunately, he was unable to get the ACL reconstructed because his growth plates were closed. Without a stable ACL, Pastrana would have to strengthen the surrounding muscles. With guidance from his Uncle Alan, who was a quarterback for the Denver Broncos in the early ’70s and suffered a career-ending concussion, Pastrana began to understand the healing process. After applying exercises per his uncle and physical therapist to his everyday routines, such as leg lifts while watching TV, Pastrana started to regain his strength and flexibility.
“It was funny, but it was getting going and understanding that your body is something you need for the rest of your life,” Pastrana says about finding motivation to recover. “Even if you’re not trying to get back to your sport, you have to get back to doing stuff.”
Twenty-plus years and 33 operations later, Pastrana has had an equal amount of surgeries to his age.
“It gets hard to count when you’ve had so many. I’ve had 40 fractures in my foot at the same time. There was nothing [left] to hook the foot together. I had a month where I just had to lay in bed,” Pastrana explains.
Though athletes often have a sense of invincibility, playing through bruises, tears, strains, and even broken bones, the era of “no pain, no gain” is, seemingly, coming to a rapid end. A new era of athlete safety, recently ushered in by several professional sports leagues, has trickled down to the collegiate, high school, and instructional levels. Now is the time to start respecting body awareness as much as athletic ability.
IT CAN HAPPEN TO YOUPlaying a sport can often lead to an injury, whether it be something small, such as a sprain or bruise, or something more severe, such as an ACL tear or a bone break.
And one of the most important aspects of an injury is recovery. However, no two people have the same physiology, so even if they have the exact same injury, the approach to treatment and recovery could be vastly different.
“A couple of the most frequently asked questions from our patients are: how long will my course of treatment take and when can I return to practice, training, sports, the gym, or other physical activities,” explains Dr. Anthony T. Hardnett, owner and chiropractor at Effective Integrative Healthcare. “I always wish that I could give the same answer for everyone, but it really is very different for each patient.”
In terms of treatment, it varies based on the athlete’s particular injury. According to Hardnett, the most effective treatment to help an athlete recover from an injury is the customized combination of chiropractic, physical therapy, massage therapy, and acupuncture or dry needling.
Before an athlete can receive treatment, they must go through a comprehensive evaluation to develop a physical therapy plan.
“It is important to note that the goal of treatment isn’t just to eliminate pain. That is only the first of three essential phases and usually happens the fastest,” Hardnett explains. The inflammation (pain stage) is followed by the repair (improvement stage) and then the remolding (strengthening phase). The strengthening phase is by far the most important stage. Without completing the last stage, the athlete is left vulnerable for another injury at the same site.”
IT’S NOT JUST PHYSICALWhen an athlete endures an injury, they often become frustrated because their athletic career has been put on hold, which is a normal reaction. However, for many that angst gets pushed aside by the determination to recover.
But when an athlete is told their injury is going to keep them out of play for an extensive amount of time, the initial drive can revert to frustration.
As a collegiate athlete myself, I’ve suffered a severe injury, one that took my athletic career and turned it upside down. During my freshman year of college, I was diagnosed with a Stage-4 SLAP tear, which is short for “Superior Labral Tear from Anterior to Posterior.”
During my recovery time, I was taken away from team practices, unable to travel for competitions, and felt as though I was missing out on the world I knew. Unfortunately, I had no support from the coaching staff and I began to question whether or not putting the work to get back into competition was worth it. I developed a lot of built up anger, frustration, and sadness. There were multiple occasions when giving up was an attractive option.
But with the support of my family, I came to the realization that it didn’t matter if I returned to the athlete I once was; what mattered is that I never gave up. I never allowed the negative energy from the coaches, who no longer believed I could do it, affect me any longer.
I got back up on my feet and did what I knew was best; to prove to myself that I could finish what I started. Although I had plenty of failures, the little successes are what kept me going.
But for other athletes, when something they’ve worked so hard for is stripped away in an instant, they can mentally spiral into depression.
“I lost a really good friend, Dave Mirra, who was diagnosed with a concussion and ended up in depression,” Pastrana says.
Dave Mirra, a BMX biking legend, captured a record 24 medals at the X Games. As most sports develop over time, the new generation of BMX riders took the sport to new heights. Although known as one of the best, Mirra began struggling during his bigger tricks, resulting in multiple injuries, including concussions. On February 4th, 2016, the sports world was left in despair when Mirra took his own life at age 41 after suffering severe depression following multiple concussions. After his death, Mirra was diagnosed with Chronic Traumatic Encephalopathy (CTE), which is most commonly found in athletes who have suffered multiple concussions, potentially leading to depression and lack of impulse control.
As the case of Dave Mirra demonstrates, not all athletes that suffer severe injuries are able to overcome the associated mental hardships. However, there is hope and help.
CONNECTING WITH THE ATHLETESAs the youngest of four children, Annapolis resident Ryan Brant was a competitive athlete. He started playing lacrosse at a young age and became the number five ranked goalie in the country during his senior year of high school. He was eventually recruited to play lacrosse at Ohio State University in 2009
“Ultimately, I felt like I was invincible,” Brant admits.
Soon into his collegiate career, he suffered four knee surgeries, which ultimately led to a back surgery as a result of over-compensation during the recovery process, and a few concussions to boot.
After being told he was a medical liability, Brant transferred to Hofstra University where he continued to play lacrosse, but not without the support of his family, hard work, and countless hours of rehabilitation. During his transition, Brant went through severe depression and was dealing with a loss of self-identity.
When he neared graduation, Brant noticed there were a lot of other athletes going through a similar situation, but they lacked a support system. When Brant graduated, he developed the nonprofit organization, Positive Strides, to advocate, educate, and support youth injured athletes and their parents through the difficult process of recovery.
“When you’re going through the injury process, you learn how quickly some of your circle is to leave and kind of jump ship,” Brant admits. “I found out who my real friends were and which coaches and medical staff where really in my corner to help me as an athlete, but also as a person to get whole mentally, physically, and emotionally.”
A big part of the Positive Strides organization is advocating through educational seminars. Brant brings these seminars to high schools and youth organizations, where he creates awareness about specific injuries that are on the athletic forefront to athletes, parents, and coaches.
According to Brant, over the last 24 months, concussions have been the top injury, but there has been a significant increase in ACL injuries and depression. His goal is to teach athletes and parents how they can be proactive in terms of concussions and injuries, and properly evaluate themselves.
“You can never be overeducated and the more you know, the better off you’re going to be if and when something does occur,” Brant explains. “You’ll understand the process and know that we’re ultimately here to guide you through that process.”
Brant has made a lasting impact in the lives of many different athletes and families through Positive Strides.
He was contacted by the parents of a particular athlete who was a two-sport standout at the high school level. She had suffered a severe concussion, leaving her hospitalized for a few days and eventually she had to re-learn how to walk. During the transition process, she had earned a scholarship to play lacrosse at the collegiate level, but was unable to play her freshman year and depression started to set in. She was still dealing with concussion symptoms, unable to play, and feeling left out. Brant became that support system and another channel of communication to lift her spirits and let her know that there is life after athletics.
“I love athletics and wouldn’t change all my injuries for the world because they taught me so many different life skills to transition into the real world,” Brant says. “I’m looking to bring this education to middle schoolers. We play sports for fun and recreation, but also to learn these traits that are going to help us long-term.”
With early education, awareness, and understanding of athletic injury and prevention, a multitude of sports could become safer to play.
C IS FOR CONCUSSIONToday, more children are getting involved with athletics at a very young age. With the popularity of contact sports, such as football, soccer, lacrosse, and hockey, among others, young athletes are increasingly susceptible to suffering blows to the head.
“It’s the scariest of all injuries, even though there’s nothing to be seen on the outside,” Pastrana admits.
According to Dr. Robert Graw, founder of Headfirst Sports Injury and Concussions Care Centers, the number three sport associated with head injury and concussions is girls’ soccer, number two is girls’ lacrosse, and the number one sport associated with head injury and concussions is bicycle riding.
“The younger you are, the more likely you are to have long term effects,” Graw says. “Young people do not have their brain fully formed and their necks are not strong enough to protect them, forcing the head to get tussled around.”
As a leading professional in the local medical community, Dr. Graw has committed himself to educating parents, athletic trainers, athletes, as well as the general public, on the prevention and treatment of traumatic brain injuries.
“Education is the most important thing we do,” Graw says.
After traveling the country and speaking to multiple individuals who were managing concussions, he came to the realization that the general population didn’t know a whole lot about this subject and invited these individuals to come speak to members in the community.
According to Graw, most private doctors don’t seem too confident in trying to manage someone with a concussion, so when he decided to open Headfirst, he learned how to do a better job evaluating people and started giving the ImPACT test (Immediate Post-Concussion Assessment and Cognitive Test) for free.
“We call it a community-based concussion program,” Graw says. “We have specialists in the community to help them recover depending on what the problem is. There are so many different things that can happen to your brain; emotional problems, psychological, headaches, balance, et cetera, and we learned for each tract there are resources in the community we can use.”
As a veteran of several sports, Pastrana admits, “The hardest part is usually that athletes want to come back too quickly. I always believed I was better than I was. I always believed I could go faster than I could. I always wanted to win and that confidence got me to where I am, but also why I was on the ground more than pretty much every other motorcross racer.”
Athletes are strong willed, so they often disregard signs and symptoms of a concussion and hop right back into the game. Fortunately, especially at the collegiate level, athletes no longer have the option to just get back up and continue playing, risking further damage to their health.
After investing $30 million dollars in research, the NCAA passed concussion safety protocol legislation in 2015, which created guidelines for a safe return for any student athlete who experiences concussion signs or symptoms. All universities now keep athletes from performing the same day and are required to perform a concussion protocol checklist before an athlete can return to play.
CONTINUING CAREMany athletes assume once they are given the go-ahead to jump back into play, they are magically healed. What they may not realize is that ignoring a previous injury can cause additional harm. The best way to prevent further injury is to continue caring for it, possibly with physical therapy or chiropractic care.
Dr. Ray Infanti, owner of Chiro 1st Chiropractic & Physical Therapy, admits, “I am a big fan of physical therapy and am proud to work alongside one in my practice. [And] I do not believe that chiropractic is a panacea. I believe that having collaboration between different professions whose sole goal is to benefit patients’ leads to the best outcome measures.”
Through physical therapy and chiropractic care, the athlete has the opportunity to rebuild strength, improve flexibility, and preventfurther injuries from arising.
Some of the most well-known treatments for sports injuries include kinesiology taping, Graston, cupping, and Active Release Technique (ART).
Kinesiology taping is a rehabilitative taping technique that is designed to assist the body’s healing process while supporting and stabilizing the muscles and joints, all without restricting motion.
“I do believe Kinesiology taping is effective depending on what the application is for the individual,” Infanti explains. “For example, I love that it supports the knee of a runner with patellar tendinosis and still allows the knee to move, whereas structural taping would be too rigid and braces can be cumbersome or may not fit properly.”
Graston techniques, one of my favorite, are used to effectively break down scar tissue, fascial restrictions, and increase range of motion in the injured area. Although it may seem strange, the Graston technique is used with stainless steel tools by physical therapists, chiropractors, and athletic trainers where there is chronic inflammation.
“A very good example of this is the runner who seeks treatment for iliotibial band syndrome or lateral thigh/knee pain,” Infanti explains. “As the tool glides over a dysfunctional iliotibial band, the clinician will feel like they are hitting little ‘speed bumps’ which are knots within tissue. The Graston technique in essence is trying to smooth out those bumps’.”
One of the newer and very effective techniques is known as cupping. This form of therapy was an ancient development by the Chinese. Today, cupping is used to create suction on the skin of the injured area and can be used to help alleviate pain, inflammation, and increase blood flow.
The final, and what proved to be the most effective therapy for me, was the Active Release Technique. This technique is best used to help relieve tight muscles and reduce joint stress and muscular pain by using the athletes’ movements to break up fascial restrictions.
Outside of the physical rehabilitation, another important factor when coming back from an injury is nutrition. Proper nutrition is a critical key to recovery.
“When you are an athlete and doing heavy regular exercise, it is true that you require extra calories to sustain energy, including protein for muscle building,” explains David Anderson, owner of Annapolis Medical Weight Loss.
According to Anderson, athletes who are training heavily several times per week should be mindful about getting enough calories, both to fuel physical activities, and to promote muscle growth, repair, and recovery.
“When one is injured, that calorie intake needs to be adjusted down to compensate for the decreased expenditure,” says Anderson. “It should come as no surprise that stopping exercise can result in weight gain if people continue to consume the same amount of calories as when they were avidly working out. As we age, another process occurs, muscle tends to decrease, which slows metabolism.”
Although nutrition can’t prevent injuries, it can play a huge role in the recovery time for the athlete.
Since incurring a sports injury can prevent an athlete from participating in the sport they love, knowing proper prevention strategies is key, as well as, the proper recovery protocols. Should the unthinkable happen, the athlete will then need to execute his or her willingness to persevere so a full recovery is possible.
Throughout his roller coaster ride of an athletic career, Brant continues to spread positivity and live every day by his motto, “You can never leave an athlete behind.”