Jan 29, 2015
Back in Business

Kristin Mahoney works her way back from a spinal fusion.

By R.J. Anderson

R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at [email protected].

On Halloween of 2002, while most of her friends and teammates were putting their costumes together, 15-year-old Kristin Mahoney was undergoing a spinal fusion. A standout volleyball, basketball, and softball player at Madison (Ind.) Consolidated High School, Mahoney had played the previous year through excruciating back pain, accompanied by numbness in her legs and feet.

That summer, doctors diagnosed the pain as a result of her bottom vertebra sliding forward on her sacrum, a condition that placed a tremendous amount of pressure on the nerves in that area. While they knew what the injury was, the doctors were unsure of its origin and how long she had been playing with it, though Mahoney says she had experienced back pain in one form or another for about five years.

“She had a grade IV Spondylolisthesis,” says Dave Pappenheim, LAT, ATC, Athletic Trainer at King’s Daughters Hospital and Madison High. “A grade V is when the vertebra is completely shifted off the sacrum bone, meaning that basically, your upper and lower torso are disconnected. The surgeon said Kristin was on the verge of having a grade V. It was a very serious injury.”

It was so serious that her surgeon, Alvin Crawford, MD, FACS, Professor of Pediatric Orthopaedic Surgery at the University of Cincinnati Medical Center, doubted she would ever return to competitive athletics. “When Dr. Crawford first told me about the surgery, he said no varsity sports, ever,” says Mahoney, now a 17-year-old junior at Madison. “That freaked me out and I panicked, because sports are pretty much my life.”

After the surgery Crawford backed off his statement. “He said, ‘I’m not saying you can’t play. It’s just not what I recommend. Coming back will be very difficult,'” says Mahoney. “That was all I needed to hear. From that point on, I knew I could do it.”

Because Mahoney was relatively young for the procedure, Crawford took an unconventional approach. Instead of stabilizing the vertebra with screws and a metal plate, Crawford used a bone graft from Mahoney’s right hip and packed it around her injured vertebra to facilitate the fusion. Avoiding metal and allowing the bone to heal on its own would benefit Mahoney later in life Crawford felt. But it would add months to her recovery time.

The surgery left Mahoney in a body cast that she would remain in for eight weeks, requiring her to be in a supine position. Unable to sit up, everyday tasks were impossible, and even eating was difficult. Yet Mahoney didn’t miss a single Lady Cubs basketball game. Thanks to a reclining wheelchair and the dedication of her parents, she was able to attend every home and away contest.

After her cast was removed, Mahoney spent the next 16 weeks in a specialized body brace. The brace locked her right knee in place, which immobilized the area where the bone graft was taken and allowed it to heal. At that point, Mahoney was cleared to begin walking, though she needed a walker. When the donation site healed, she got a brace with a hinged leg extension, allowing her to walk without assistance. Mahoney eventually graduated to a simpler back brace that made walking easier, and returned to school after a four-month absence.

As the one-year anniversary of her surgery approached, she was finally cleared to take her brace off. First she removed it only for sleeping, then gradually for longer periods throughout the day. She was eager to get back to sports, and immediately began some conditioning—primarily abdominal work and light running. Mahoney was cleared to join her basketball team for practices at the end of November.

“My first day back, everyone was really excited, but they were all afraid to touch me,” says Mahoney, a 5’6″, kneepad-wearing point guard with a reputation for aggressive play. “But I banged and blocked people out. My coach was really nervous and said he didn’t expect me to come back and play so aggressively.”

But after a couple weeks, it became apparent that Mahoney’s aggressive nature was too much for her under-conditioned body to handle. At a mid-December practice, while jumping in the air to steal a pass, she had a collision with a teammate who outweighed her by nearly 50 pounds.

“My torso was twisted and she landed on top of me,” says Mahoney. “I thought I had hurt my back or broken my pelvis. When I tried to get up, I fell back down. All that went through my head was that I was going to have to do it all over again—the surgery and the rehab. All that hard work was down the drain.”

Thankfully, that wasn’t the case. A trip to the emergency room revealed no back or pelvic injuries. Mahoney had, however, severely pulled her groin muscle and a number of stomach muscles, and injured her sacroiliac (SI) joint—an area very close to where her bone graft was taken.

The incident also proved to be a wakeup call. Paul Rosenberg, MD, an Orthopedic Surgeon at King’s Daughters Hospital and Madison High’s team physician recommended that Mahoney delay her return to the basketball court at least until mid-season and work with Pappenheim to improve her strength.

For the next three months, Pappenheim helped Mahoney build her body back up. “We rehabbed five days a week,” says Mahoney, noting that Pappenheim often stayed later than his regularly posted hours to work with her. “We’d work for about an hour and a half each day while my teammates were practicing. He would tell me what to do, go tape somebody in the athletic training room, then come in and check up on me. Then, after everyone else was taken care of, he’d come in and work with me and we’d start the harder exercises and the drills that required two people.”

Crawford had nixed any weight training after the surgery, so Pappenheim designed Mahoney’s workouts around elastic band, medicine ball, and body-weight exercises that strengthened her trunk and leg muscles. Pappenheim says Mahoney has permanent restrictions against doing weighted squats or military presses—or anything else that would compress her spine.

Several weeks into her second go-round of rehab, it became apparent to Mahoney and her sports medicine team that instead of returning to the basketball team that year, it was in her best interest to focus on getting back for the upcoming softball season. “Before we completely took her out of sports, she would say, ‘Let me try to go to practice today,’ and she’d go in and do too much and re-aggravate her groin strain,” says Pappenheim. “We’d give her some more days off, she’d feel better, then she’d go back in, do too much, and re-aggravate her groin strain again. She was getting really frustrated, so Dr. Rosenberg finally said, ‘We just need to stop and focus on getting her better instead of trying to ease her back into a sport she’s not ready for.’

“At that point we started working on total body conditioning,” adds Pappenheim. “We treated it as if she was coming off a very serious injury, started with the basics, and progressed from there.”

Mahoney started her program with multi-plane lunges and squats, using only her body weight. She quickly progressed to using elastic bands for resistance. With enhanced emphasis on core stabilization, Pappenheim had Mahoney do quadruped and mat exercises, eventually moving to medicine ball activities in which the primary force came from the lower extremities to ensure minimal stress was placed her fusion. Upper-extremity exercises were performed using body weight and elastic bands with emphasis on contraction of the abdominal muscles.

Despite not playing in the games, Mahoney kept her spirits up by wearing her uniform on the bench and participating in pregame warmups and shootarounds. “I’d run around the gym with the team during warmups—it gave me goose bumps every time,” she says.

After three months of working with Pappenheim, Mahoney’s injuries had healed, her body had grown significantly stronger, and by mid-March she was ready to join the varsity softball team. The transition was made easier by the fact that the team’s conditioning program was also designed by Pappenheim and was very similar to the one Mahoney was already following.

“When they were doing their preseason conditioning, she was still doing her rehab with me,” says Pappenheim. “The coach eased her into softball over four weeks. During that time I was still working with her twice a week before practice.”

While basketball is her favorite sport, Mahoney feels softball represents her best opportunity to compete at the collegiate level. Because of her back surgery, Mahoney was moved from catcher to third base, where she started and enjoyed a stellar season.

After the season and the school year ended, Mahoney again joined forces with Pappenheim, taking part in a six-week athletic enhancement program at King’s Daughters Hospital. “We did a lot of medicine ball throwing, agility work, pushups, running, and exercises to improve my vertical leap and strengthen my core,” says Mahoney, who worked out twice a week with Pappenheim, and twice a week at her home in addition to participating in a preseason volleyball conditioning program.

A valued reserve, Mahoney made it through her junior year of volleyball without any setbacks. She had progressed so far that by the beginning of the season she no longer needed to work with Pappenheim. “I told her, ‘I think you’re fine, you don’t need to see me anymore. Just check in and let me know how you’re doing,'” he says.

Volleyball ended, and Mahoney excitedly prepared for basketball season. It was during her first practice that she realized she was back to normal. “I could do the same things as everyone else,” she says. “I didn’t have any limitations.”

The team leader in scoring and assists, Mahoney’s intensity set the tone as the Lady Cubs made it to the second round of the sectional tournament before being eliminated. More importantly, Mahoney remained pain-free for the entire season. “If I didn’t see the scar, I wouldn’t know I had ever been operated on,” she says. “And my doctor says the fusion is stable, so I can continue playing.”

Pappenheim calls Mahoney the hardest working patient he’s ever been around. “She never missed a session for three months and was super-intense the whole time,” he says. “If I said, ‘Do 50 reps of this,’ after I walked away she would do 150 reps. I frequently had to step in and tell her not to overdo it.”

Mahoney is quick to return the praise. “Dave is amazing. He pushed me hard and knew exactly what would help me,” says Mahoney. “Without him, I doubt I would have been able to get back all my strength or have done it as quickly.”

As for her future, Mahoney wants to study sports medicine in college. “I want to be either a physical therapist or maybe an athletic trainer,” she says.

Since college is more than a year away, she plans on making the most of her remaining athletic career and has no plans to curb her aggressive play. “My mom tells me to take it easy sometimes and that there will be other games, but the way I see it since the surgery, I don’t know when my last game will be,” says Mahoney. “Unlike other people, I could get hit and re-injure my back or pull my groin and be out for a really long time. I try to play every game like it’s my last, because I never know when my last one will be.”

PROFILE: Kristin Mahoney

  • Madison (Ind.) Consolidated High School
  • Sports: Volleyball, basketball, softball
  • Injury: Grade IV Spondylolisthesis
  • Comeback Team: Dave Pappenheim, LAT, ATC, Alvin Crawford, MD, FACS, and Paul Rosenberg, MD

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