“I want to be able to run, play tennis, play basketball for my high school team, cycle around Central Park, play ball with my kids…” These are some of the goals I hear from my patients on a regular basis. As a physical therapist, it is my responsibility to help my patients work toward achieving their goals in a safe and efficient manner. I want to understand how my patients injured themselves and what their goals are for rehabilitation.
One of my patients is Lenny Krayzelburg, a world class swimmer with a strong body. Following Lenny’s competitive swimming career, his goal was to run and play soccer and basketball. While playing soccer, Lenny injured his anterior cruciate ligament (ACL), which brought him to HSS.
The ACL is the main stabilizing ligament in the knee. It can be injured when another individual comes in contact with your knee, but most often it is injured while you change direction, land from a jump or decelerate your body’s momentum in sports such as basketball and soccer.
Lenny’s body was fine tuned to swim at a world class level. His legs were trained to propel him through the water. Now Lenny’s leg muscles needed to learn how to perform on land – to change direction, to decelerate, to absorb shock during running and jumping. Whether recovering from an injury or surgery, it is important to be ready to perform those sport-specific movements.
Before Lenny could run, he learned to walk again in physical therapy. We were able to get Lenny in an environment that he was very comfortable in – water. He walked and practiced his balance in our underwater treadmill, which helped him normalize his gait pattern and regain the ability to stand on one leg.
In the early phases of physical therapy, it was important to control Lenny’s swelling and pain, which would aid him in regaining his knee’s range of motion and help improve his strength. He was able to work on his hip strength, flexibility and core strength as well. Education was a big focus of rehab initially – it always is. It was important that Lenny understood why he was doing or not doing something. Lenny asked questions, listened and became a student and active participant of his rehab. This allowed him to continue to make progress even as he travelled.
Once through this initial phase, we were able to focus not only on Lenny’s recovery from the surgery but also address deficits in his body that may have put him at risk for injury in the first place. His rehabilitation progressed to strengthening, balance exercises, proprioceptive training (mind-body connection) and biking. With the progression of his strength, we worked on functional strengthening of his core, hips, quadriceps, hamstrings and calves. We also worked on cross training for fitness and challenged his balance and proprioception even further. When Lenny’s muscles were ready — with adequate strength including eccentric control of quadriceps muscles which would help him absorb shock–a plyometric (jumping) and running program were gradually introduced. His training then became more dynamic.
These exercises have prepared Lenny to perform all the movements specific to his sporting endeavors. Today Lenny can run and train on land and in water.
Theresa Chiaia is a doctor of physical therapy and the section manager at the Sports Rehabilitation and Performance Center at Hospital for Special Surgery. She has guided athletes of all levels, from the recreational athlete, student athlete to the professional athlete along the road to recovery and a successful return to competition.