When the AT is Injured

January 10, 2019
By David Csillan
 

David Csillan, MS, LAT, ATC, is Athletic Trainer at Ewing (N.J.) High School and the Chair of the NATA District Secretaries/Treasurers Committee. He also serves as a member of the Korey Stringer Institute Medical and Science Advisory Board, New Jersey State Interscholastic Athletic Association’s (NJSIAA) Sports Medicine Advisory Committee and the NJSIAA Liaison with the NATA and NFHS. Csillan was inducted into the Athletic Trainers’ Society of New Jersey Hall of Fame in 2008 and received both the NATA’s Most Distinguished Athletic Trainer Award and Athletic Trainer Service Award in 2016. He can be reached at: njatc5@gmail.com.


 

Aug. 5 of this year marked T-minus 24 hours before starting my 28th year of preseason camp. Like any other athletic trainer in the same situation, I needed to get the most out of my last personal day until Labor Day. First on the agenda was giving my lawn a haircut.

While riding my mower, I experienced tightness in my low back. There was no need for alarm, since I’ve had chronic low-back issues for approximately 10 years. Little did I know what lied ahead.

Upon dismounting from the mower, I fell to the ground. My entire left lower extremity was numb. It was then I realized having no knowledge of the human body may be better than having some.

After hobbling into the house, I immediately went to a mirror and observed myself saying a sentence, smiling, raising my arms, and sticking out my tongue. You know where I’m headed with that. Having no bowel or bladder issues eased my tension significantly. For the rest of the day, I remained on a regimen of heat and stretching. By evening, sensation and motor function returned in the leg but not the foot.

A formal physician evaluation, followed by X-rays and a MRI, confirmed a herniated disc at level L5/S1. Four options were explained to me:

1) Do nothing

2) Get a cortisone injection to decrease the inflammation

3) Try physical therapy for six weeks

4) Opt for surgery.

Radicular symptoms in my left lower leg have been my “Achilles heel” for years. Therefore, I chose the grand prize of L5/S1 microdiscectomy and laminotomy behind door number four. While waiting for my surgery date, I completed three weeks of preseason camp on one good leg. Those three weeks made me appreciate many things I took for granted, like walking.

The Big Day

The morning of Sept. 13 was like any other day. I showered, dressed, and was off to attack my agenda for the day. However, my agenda called for me to arrive at my destination and go to sleep on the job.

There were many nervous faces in the pre-surgical room waiting for their turn. As a medical provider, I wish I could’ve spoken to each one to ease their tension. Don’t get me wrong, I had my own concerns, but the confidence displayed by my surgical team instilled me with a Chuck Norris mentality.

So, I blinked and the nurse asked if I wanted anything to drink. Peering at the clock on the wall, either my surgery was over or someone advanced the time. The nurse instructed me how to walk, sit, and lie in bed. Next, she gave the order to rise (aka The Monster in Frankenstein). A brace was applied, and I walked out of the hospital pain-free.

Post-Op Care

“No BLTs or formal therapy for the next six weeks,” stated my surgeon. No BLTs? I love those sandwiches and didn’t get the correlation. He continued, “No BLTs as in bending, lifting or twisting. Starting tomorrow, your best therapy for the next six weeks is walk, walk, walk, walk, walk. Every half hour, stand up and walk. Try increasing the distance each time”. Those instructions were easy enough, I thought.

Athletic trainers ensure athletes follow their treating physician’s orders. Walk, walk, walk, walk, walk. I got this. Day one, I walked to the corner of my block and back. Slight tenderness was felt at the incision site, however there was no back pain. Later in the day, a trek to the corner was doubled. And so it went for the remainder of the day. Fast forward to Day three and I was walking 1/4 mile. Day seven took me two miles.

On Day 10, I boasted my progress to my surgeon and was met with, “What?!! You should walk no more than 1/2 mile, three times per day. I say walk, walk, walk because most people want to stay in bed following surgery”. He was quickly reminded that I’m not most people. I’m an athletic trainer, and I need parameters.

Formal Therapy

Week seven commenced with formal physical therapy with the focus on improving my trunk and lower-extremity flexibility in addition to core strength. Although my surgeon was comfortable with me setting up my own program at home, I preferred to play the role of a patient.

Through my experience as a practitioner, I’ve come to understand the importance of having someone supervise a patient performing core exercises. Quite often, as the body tires, technique suffers and compromises the benefits of the exercise. For anyone who routinely performs core exercises, you know exactly what I’m talking about.

So for two hours, twice a week, I rented a 7’ x 7’ piece of real estate in a local physical therapy facility. The intensity level which an exercise band, stretching strap, playground ball, and resistance ring bring will not be missed. As a matter of fact, they left my body with friendly reminders for days following my sessions.

Exercising in a formal setting provided me with constant reminders of maintaining proper posture during my sessions. In addition to the consistent positive reinforcement, I picked up many new exercises to add to my practitioner toolbox.

A Brand New Day

As I mentioned earlier, I lived for 10 years with chronic low-back discomfort and sciatica. Most often, activities were performed in haste with little regard to proper technique. I experienced many good days interspersed with a few bad days every month. Waking up at night just to roll over in bed and get back to sleep became routine.

Now, at the expense of surgery, I’ve become more aware of my posture when bending, lifting, and twisting. Prior to surgery, my physician explained that my improvement may be slow and whatever I have recovered by month nine will be what I have for the rest of my life. Well, I’m happy to say my improvement was immediate. The deep tendon reflexes are normal, lower leg and foot sensation and strength close to normal, and my low back is pain-free.

Standing idle has never been one of my greatest virtues. Given the choice, I’d prefer working in the rain on the football sidelines versus watching unlimited television while sitting on a hard chair. However, I’ve come to understand the importance of being a patient “patient.” I’ve learned first hand that specific rehabilitation exercises coupled with proper rest results in positive outcomes. Upon my return to work, I welcomed those who offer assistance with carrying heavy coolers. Also, I requested that the younger, stronger coaches lift and accompany injured athletes off the field.

After 11 weeks, I was back to the daily grind. Ahh, the sweet smell of disinfectant and athletic tape. The excitement of taping that first ankle. Work them hard and let them rest. Home sweet home.

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