Rehabbing the High-Performance Athlete
By Hayley Wickenheiser, Assistant Director, Player Development, Toronto Maple Leafs
A year prior to the 2014 Sochi Olympics, I took a slap shot off my foot in practice with the national team. My foot was sore, and it ached for a while, so I went to see a sports medical doctor. They did an x-ray and it was negative. The advice I was given was to not load the foot, there may be a small crack and let it heal with no impact but playing should be ok. The injury kept nagging me and finally I went back to a different doctor, who did a CT only to find I had a crack in my navicular. First lesson here, suspected Navicular Fx needs a CT not a X Ray!! Don?t mess around with the feet.
There?s currently no set standard of care for whether a board or scoop should be used to remove a player from the ice. The method used for SMR is usually determined by the City, State, Provence, Fire Department, Ambulance Company or a local Authority. As healthcare providers in sports we can still pre-plan for injuries and have what we need ready to treat them. We can also take advantage of some of the differences between treating patients in the field and treating our players on the ice.
By this point, the crack was not going to approximate, and my frustration was through the roof. I played through the Sochi 2014 Olympics in a lot of pain, modifying my training and surviving thanks to the Incredible medical staff on the national team. After the Olympics finished, I went to see renowned foot surgeon Dr. John Lau at Toronto Western Hospital. Dr. Lau decided I needed a screw in my foot to try to pull the bone back together. 3 months later and doing everything I was told to do and I returned to the ice. Two games back, I remember taking a sharp tight turn and my foot literally crumbling under the screw. I went from one crack to a navicular that was in 4 pieces and my career in jeopardy. I don?t think anyone realized the amount of torque a foot undergoes, even in a hockey skate.
Back to Dr. Lau I went, who had to do a complete fixation using a bone graft from my hip, with a plate and 8 screws. He also gave me strict orders that if I touched my foot to the ground for even a moment before 4 months, I may never walk right again let alone skate. I took his advice to heart and went back to Calgary to begin my rehab.
I started rehab on day 10 post-surgery with a plan led by my amazing friend, and trainer Dr. Syl Corbett. Syl devised a plan that would see me work backwards from the day we projected me to skate again. Day one for me started with a garbage bag taped around my giant cast I had on, so I could start swimming. Ever seen a hockey player swim? It is not pretty, let alone with a cast on. That is where I lived for the first 2 months, in the pool! Fast forward to 4 months later and 10 months before I was playing again, I came back with personal bests in almost every area of my fitness testing and with more drive and appreciation of being a pro-athlete and what my health meant to me. To this day, it has been a long road to say the least, but without Dr. Lau?s great hands and Dr. Corbett working 5 hours every day with me, I?m not sure I would have ever played again. Dr. Lau would tell me it was one of the top 3 worst breaks of the navicular he had ever seen. Great!!
Today I am happy to say he saved my career, I am back to running and training normally and I am able to stay on the ice, this time in my role with the Toronto Maple Leafs. There were countless days I wasn?t sure I?d be able to do either. Here is what I know from that experience that may help all of you when working with any athlete, whether it be a pro or weekend warrior:
- Every athlete is an individual case: there is no box or timeline for certainty in recovery and athletes will do remarkable things in healing and recovery that defy all ?normal people? rules. In saying that, your job more often than not, is to pull the reigns back, but keep in mind how driven athletes really are.
- Start with a goal of return to play and work BACKWARDS from that date to formulate a plan. I always felt better when I knew where I was going and the plan to get there. Yes, swimming sucked but I knew I would be fit and strong and keep progressing for when I hit land. I slept better, had less anxiety and felt calm knowing my team had a plan and believed in it.
- It?s about who can keep their head on: much of injury rehab is physical yes, but once the physical rehab is over, the mental rehab of return to play is more crucial. Even though I couldn?t play hockey, I could watch it, visualize it, and continue to work on my game when not on the ice. Within my rehab I incorporated game simulations as much as I could so when I stepped back on the ice, I felt less behind. Athletes will often want to stay close to their sport.
- There will be THOSE DAYS…when either you or your athlete want to choke each other out! Stay Positive. Rehabbing injuries, especially big ones are very scary and uncertain for maybe both of you. Be honest with them, talk about the valleys and plateaus they will hit, let them vent and don?t fall into the dark black hole when they do. Remember, it?s not about you, it?s the fear and uncertainty that grips so many and makes us all crazy at times.
- Find the silver linings in every day: there is always something that can be worked on ?always a way forwards. Stay creative and be prepared when your athlete comes to work with you. The best way to keep athletes following your plan and on side with you is to show you are as committed and invested in their rehab as they are.
- Ask for help if you need it. I always had tremendous respect and I do to this day studying medicine, when I work with health professionals who admit it when they don?t know something. We can?t know everything there is to know in rehab, research or the latest and greatest training. If you don?t know, say so! Your athletes will trust and respect you more in the end. This is not a sign of weakness but strength in knowing your limitations. I will be forever grateful to those doctors and therapists who kept me on the ice relatively injury free through my career. My navicular injury was the worst I have ever experienced, but with a great team of folks on my side, I was able to return to the ice and more importantly, feel that I can have a long life after hockey with a relatively healthy foot to live an active life.
Hayley Wickenheiser is the Assistant Director of Player Development with the Toronto Maple Leafs, a second-year medical student at the University of Calgary and a four-time Olympic Gold Medalist with Canada?s Women?s Hockey Team. She has partnered with Dr. Syl Corbett to create an athletic balm, Rock on Clay*. She?s pleased to offer our readers 10% off until Dec 15. with the code: navicular. You can purchase the balm by visiting her site here, http://www.rockonclay.com/
Photos courtesy of Jon Sanderson & Hayley Wickenheiser
* The appearance of advertisements or promotions is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality, or safety by PHATS/SPHEM.