Jan 29, 2015Barry Bock
Milan (Mich.) High School
By R.J. Anderson
R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected].
Have you ever hoped that one of your athletes wouldn’t return to the field after a devastating injury? Amanda Kaiser, ATC, Athletic Trainer at Milan (Mich.) High School, has. She lobbied for star football and baseball player Barry Bock to sit out his senior year of football after spending nine months helping him rehab from a major knee injury suffered the season before. Kaiser did not get her wish.
Despite a ruptured patellar tendon, ACL, PCL, LCL, and MCL, and a torn meniscus–not to mention Kaiser’s reservations–Bock returned to the gridiron, earning all-conference honors at linebacker and never missing a snap because of injury. Along the way, he impressed his athletic trainer, who was with Bock during every step of his laborious and sometimes painful rehab.
His comeback story began during the team’s fifth game of the 2008 season. The muscular 5-foot-9, 200-pound Bock, who starts at fullback, linebacker, and on special teams, fielded the second half kickoff and prepared to cut to his right. As he planted his left cleat, an opponent dove at his feet, colliding with the outside of his left knee. The knee buckled and Bock collapsed to the ground, screaming in pain. He was helped off the field and Kaiser evaluated him on the sideline.
“It didn’t take me long to figure out that he wasn’t okay,” Kaiser recalls. “There was immediate swelling and I thought he might have a dislocated patella–but I couldn’t have imagined that it was ruptured. That just doesn’t happen very often, especially to a kid his age.
“Realizing that the injury was pretty severe, I shortened my examination and checked his pulse to make sure he didn’t have any arterial ruptures,” Kaiser continues. “His pulse was strong and stable, so I packed his leg in ice and sent him to the hospital with his father.”
During the 45-minute ride to Saint Joseph Mercy Hospital in Ypsilanti, Mich., Bock felt every agonizing bump. Doctors x-rayed his leg and told him to come back on Monday for further evaluation. But the next afternoon, Brian Borden, MD, an orthopedic surgeon with Orthopedic Surgery Associates at the Michigan Orthopedic Center, called Bock’s mother and told her to bring her son to the hospital immediately. After evaluating Bock’s x-rays that morning, Borden had determined the injury was much worse than originally thought. “He told me I may never be able to play sports again,” recalls Bock. “I’ve played sports my whole life and everything I do revolves around athletics, so it was very hard hearing that.”
Never having dealt with this combination of injuries before, Borden faced a difficult decision. “A patellar rupture repair and ACL repair are so much in opposition as far as how you perform them and how you conduct rehab afterward, the surgeon [Borden] had to do some research and decide how to proceed,” Kaiser says. “He could have done the surgeries separately–which would have made the rehab last a year and a half–or done them at the same time and allowed us to perform the rehabs simultaneously, which would mean a faster recovery process.”
Borden chose the latter. The surgeries proved successful, and a week later Bock began rehabbing with Kaiser, a self-employed athletic trainer who works part-time at Milan, a small-town school outside Ann Arbor. Choosing Kaiser over visiting a clinic for rehab was an easy decision for Bock and his family. “I’ve always trusted her,” says Bock, who has known Kaiser since he was in eighth grade.
At first, the two met every day. “I don’t work in a clinic and my only job is providing coverage at the high school,” says Kaiser. “He could make an appointment to work with me whenever his schedule would allow, whether it was after school or when he had a break between classes. I was always available.”
Like Borden, this would be Kaiser’s first time working with a simultaneously injured ACL and patellar tendon. As such, she was in constant contact with the surgeon–even attending Bock’s monthly doctor’s appointments. “They were in the afternoon and we would just close down the training room and go,” says Kaiser. “It was a big help for me to see all the x-rays and ask questions as they came up.”
Besides seeing Borden at the appointments, Kaiser phoned him about every two weeks with additional questions. “The conversation would go something like, ‘Barry thinks he’s ready to walk… what do you think? Barry wants to do this… tell me what we can do,'” Kaiser recalls. “And I would usually play Barry’s advocate. I would tell the doctor how he was feeling and what range of motion he had, and ask what was holding us back.”
Per Borden’s orders, Kaiser used a patellar tendon repair protocol to guide the rehab timeline. “When I rehab a torn ACL, I don’t really follow a protocol–I progress the athlete based on what they are ready for and how their knee reacts,” she says. “In this case, Dr. Borden wanted me to adhere to relatively strict deadlines that drastically slowed down flexion progressions [versus an ACL tear rehab] so that the tendon could heal and completely reattach.”
Bock was also rehabbing his torn meniscus, which meant no bearing weight for three weeks and wearing a full-length brace locked at zero degrees of flexion. He used a wheelchair to get around, and its limitations frustrated him. “It was difficult at school, but the other kids were great about helping him,” Kaiser says. “We were counting down the days until he would be out of the wheelchair. There was a paper chain in the athletic training room with 21 links–one for each day he had left before he could walk. He got to remove a loop every day when he came in.”
Though those weeks were physically and emotionally difficult, Bock’s spirits were buoyed by the presence of a teammate who was rehabbing a ruptured ACL suffered during the same game. “Having someone to work with side by side was very helpful,” says Kaiser. “Even though the other player progressed more quickly, I think it really motivated Barry.”
At this point, Bock’s sessions with Kaiser consisted of 30 to 45 minutes of table-based exercises. He would lie on his back while sliding his heel back and forth to activate his quad and hamstring (with a rope attached to his foot so he could assist himself in moving his leg). He also performed isometric muscle contractions in all four directions of the hip, and used resistance bands for calf strengthening.
During this period and throughout the rehab, Bock worked very hard on improving his abdominal and core strength. “We did a lot of ab work because he could really go after it and feel like he was actually doing something,” Kaiser says. “An active kid like Barry needs to feel that he’s tiring himself out and making strength training progress. By the end of his rehab, we had worked up to about 1,000 ab and back reps per day.”
As with any knee rehab, addressing the inevitable quad atrophy–something that usually requires about two or three weeks–was among Kaiser’s earliest goals. And how Bock’s body reacted was one of her biggest surprises. “I did a happy dance when he fired that quad muscle for the first time after only three or four days of rehab,” she says. “That’s when I knew his rehab was going to be a success.
“I remember asking myself, ‘Is that rapid improvement a byproduct of his internal motivation, or is it because of his physical build?'” Kaiser continues. “He certainly had enough muscle already built up, and his motivation was off the charts, so it was probably a combination of the two.”
On Oct. 27, three weeks post-surgery, Bock tore the last link off his wheelchair countdown chain. A week later, his brace was released to allow 50 degrees of flexion and he began working with Kaiser for up to two hours per day.
By Nov. 10, he had progressed to 50 percent weight bearing, and his flexion was increased to 60 degrees. A week later the brace went to 70 degrees, and on Nov. 21, Bock was cleared to resume full weight bearing with a locked brace.
Throughout this time, Kaiser was looking for ways to incorporate cardiovascular conditioning into Bock’s workouts, so she introduced 20-minute hydrotherapy sessions once or twice a week. “Barry’s flexion wasn’t enough to water jog, so I had him swim,” she says. “I was concerned for his MCL and didn’t want the pressure from the water to push his leg into an awkward position and stress that repair. So I tied a foam buoy between his thighs for support, and we had him swim using just his upper body while clutching the buoy between his legs to increase adduction strength and protect his knee from side-to-side movement.”
A major rehab milestone arrived Dec. 1 when Bock was at 90 degrees of flexion and allowed to unlock the brace to 30 degrees for ambulation. The patellar tendon rehab protocol restrictions were complete, and Kaiser could base Bock’s range of motion and strength work more on his physical response than a rigid timeline. This helped clear the way for faster progress. “As soon as Barry could unlock his brace for walking and start moving again, he just flew through his rehab,” says Kaiser.
She began incorporating sprint mechanics drills borrowed from her husband, an assistant track and field coach at the University of Michigan. It was her first experience using them in a rehab. “I would take something traditional in the rehab setting, like straight-leg raises, and adapt it into straight-leg marches or straight-leg acceleration kicks–supine and standing–to mimic and enhance the movement,” Kaiser says.
“Barry started by walking through each of the sprint drills,” she continues. “For example, he would walk around cones and through an agility ladder. He would walk over mini hurdles in all different directions and thigh-high foam hurdles both forward and backward. We did cariocas at a walking pace, then a running pace. We did giant steps and mini lunges–during which we had to be very careful to not overstress his patellar tendon. Those drills took the rehab in a more functional direction and gave him something to look forward to.”
In January and February, Kaiser began ratcheting up the loads, and Bock did a lot of body weight activities such as stair climbs, squats, and lunges. She also utilized med balls for stability, core, and functional movement exercises and prescribed flexibility work for his glutes, calves, hip flexors, quads, hamstrings, piriformis, and lower back.
For each exercise, Kaiser offered a thorough explanation of how it would affect his progress. “I would tell him the reasons behind the stuff he was doing,” she says. “When I told him he needed to dorsiflex his foot during a drill, I would explain that he can’t run fast without dorsiflexing his foot. And when we worked on hip flexibility, I told him he couldn’t squat deeply without increasing his ROM. If you can’t squat deeply, you can’t lift heavier weights and get stronger. He bought into all of it.”
By late February, Bock’s cardio workouts involved 25 minutes on the bike and 15 on the elliptical machine. He slowly progressed to doing more on the elliptical and less on the bike.
From there, he moved on to light jogging. “We started him slow, then sped him up very gradually,” says Kaiser. “There wasn’t a day when we said, ‘Okay, today you can run.’ It was just kind of phased in. And it worked out nicely.”
As winter turned to spring, Bock’s return goals began to take shape. And first on his list was re-joining his teammates on the baseball diamond. Kaiser was hesitant and held him out of baseball preseason, but allowed him to participate in certain workouts. “Our baseball team does a lot of unique things like yoga and other core training, and I would pull him out of rehab and send him to do those types of activities with his teammates,” she says. “By the time they were ready to start the regular season, he was doing full sprints and chomping at the bit to get back on the field.”
Bock re-joined the team in time for its first game, ending his rehab sessions. “Fortunately, baseball isn’t that stressful on the body,” Kaiser says. “He could stop and start and run the bases, so the doctor felt he was okay to play. Also, Barry played first base so he didn’t have to run very fast or far.”
Though he didn’t start, Bock was a super sub on a senior-laden team that reached the semifinal round of the state tournament. And through it all, Kaiser was a very nervous spectator. “I’d spend part of the game sitting with his parents, then go down to the dugout,” she says. “I bit my fingernails every time he took the field.”
Three months passed and Bock prepared for an even bigger challenge: returning to the sport that had injured him. After strength and conditioning work with his football teammates all summer, he played sparingly in the preseason due to soreness in his surgically repaired knee. Kaiser was concerned.
“I talked to him about it being a big gamble,” she says. “I said that if he re-injured his knee, it might never be the same again.
“Dr. Borden and I weren’t in favor of him playing, but neither of us felt it was our risk to take–it was his and his family’s,” Kaiser continues. “The doctor said, ‘He’s strong and capable of withstanding the punishment, but if he were my child, I wouldn’t let him play football.'”
Despite Kaiser’s and Borden’s objections, Bock suited up for the team’s first game. “I was sitting on the sidelines before the game shaking from nervousness,” Bock says. “But after that first hit, when it didn’t hurt, I knew I had made it all the way back.”
Bock scored a touchdown in that first game and helped lead his team to a 6-3 record and a berth in the playoffs. Though his speed and lateral movement didn’t return to pre-injury levels, he improved his mental game to compensate. “When I knew my speed wasn’t going to be the same, it forced me to improve my angles on tackles and blocks,” says Bock, who led the Milan Big Reds in tackles.
“Barry didn’t complain about his knee the entire season,” says Kaiser. “He was a true leader on the team. The doctor and I hate that he played, but we’re so proud that he did.”
Bock’s successful senior year carried over to baseball, as he started at first base and helped his team to a top-10 state ranking. He also took on a senior internship, working under Kaiser to study athletic training.
Inspired by what he learned during his own rehab, Bock will attend Wayne State University this fall and major in physical therapy. “After making it back like I did, I really want to help other athletes get through their injuries and return to the field as soon as possible,” he says. “Much like Amanda did for me.”
Barry Bock is an amazing athlete. Only a mentally strong person could make a come back that soon after such a devasting injury. The doctor and the trainer also took a personal interest in his recovery which I believe played a big part in his success. All doctors and trainers should do the same. – Sandra Southerland