Jan 29, 2015Comeback Athlete: Kelsie Johns
By Mary Kate Murphy
Mary Kate Murphy is an Assistant Editor at Training & Conditioning. She can be reached at: [email protected]
Kelsie Johns’s summer break in 2012 started on a high note. Returning home to Wilmington, N.C., after a successful freshman year with the Xavier University swim team, during which she entered the school’s top 10 list in the 100-yard butterfly and posted top 20 times in the 100- and 200-yard breaststroke, she was looking forward to several months of relaxation. For Johns, that meant making up for missed time with her horse.
About a week later, she decided to go for a morning ride. As she was ending her ride, coming to the woods in her yard, the horse got spooked. Before he could take off, Johns decided to bail.
“I’ve had to jump off horses before, but I’d never been seriously harmed by it,” she says. “When I landed this time, though, I had to hold my arms out to brace my fall, and my right arm took the brunt of the impact. When I looked down and saw the injury, my first thought was, ‘I can’t swim anymore. My life is over.'”
It was a gruesome sight. Her ulna was broken in three places, and part of it had pierced through her skin. Another piece of her ulna had fallen out through the open fracture. She also had a dislocated radial head. The on-call physicians in the emergency room decided to operate immediately, inserting a plate and six screws into her arm. Their post-op diagnosis backed up Johns’s original fears of never swimming competitively again.
“They told me I’d be lucky if I ever straightened my arm or turned my palm over, which would have made swimming nearly impossible,” she says. “I went through a bit of depression after that first surgery, because I didn’t think I’d ever get in the pool again.” An additional operation six weeks later set the stage for Johns’s rehab. “The doctors had to do a bone graft with a piece of my pelvic bone to replace the missing ulna segment,” she says. “And because they wanted to make sure the bone had time to heal properly, I was ordered not to lift anything heavier than one pound for the next three months.” Still on summer break after the surgeries, Johns started her initial rehab at home. When she returned to college, she worked in tandem with a local hand therapist and Kelsey Pilati, MS, ATC, a Graduate Intern Athletic Trainer with Xavier at the time. “Kelsie was referred to a hand therapy clinic that I had worked with before, so I was familiar with the physician and the techniques involved,” says Pilati, who is now an Assistant Athletic Trainer at Oberlin College. “Kelsie attended hand therapy once a week, and I would often go with her to get an idea of the exercises they were giving her. Then, I would adapt them so Kelsie could continue her hand therapy in the athletic training room for the rest of the week.” In addition to continuing the work prescribed by the hand therapist, Pilati’s main focus for Johns’s rehab in the athletic training room was regaining range of motion in her forearm and elbow. Although she would not be able to return to her pre-injury range of motion, there was much work to be done. “Shortly after we started rehab, doctors found scar tissue in Kelsie’s arm, which would prevent her from ever having full range of motion, so they put her in a brace that held her arm at a right angle,” Pilati says. “While in the brace, Kelsie had to do an exercise in which she gripped a bar and turned knobs on it. The brace turned out to be beneficial, because it prevented Kelsie from letting go when she experienced discomfort. It forced her to hold her position and complete each movement, which ultimately helped her reach her range-of-motion goals.”
A typical session began with heat to warm up Johns’s muscles followed by ultrasound and a massage over her scar to break up any adhesions that had developed. After that, Johns started her exercises. “I wasn’t allowed to use weights, so I laid on the floor and Kelsey would manually straighten my arm at the elbow and bend it back up as far as it would go to try to get my thumb to touch my shoulder,” says Johns. “For another exercise, I faced a wall and tried to walk my fingers up it.”
Pilati believes being in the athletic training room helped Johns get the most out of her rehab. “It’s easy to cheat when you are doing range of motion, so I had Kelsie hold a pencil when rotating her wrist to make sure she was going all the way around,” says Pilati. “At times, I pushed on it for a few seconds, and Kelsie had to resist against me.” In September, three months after the bone graft, Johns was eager to start ramping up her rehab with weights. However, because the graft in her ulna hadn’t healed completely, the doctors pushed her weight-bearing date back another month, a disheartening blow for Johns. “I was disappointed because the swim team had already started fall training, and I was hoping to participate,” she says. “It was frustrating going from lifting three times a week and swimming twice a day, six days a week before the injury to simply trying to straighten my arm and being excited if I had a one-degree increase in my range of motion.” The additional month did the trick, though, and Johns was cleared to slowly start adding weights to her rehab in October. “We began with bicep curls without weight and gradually increased to one pound, which was extremely difficult for Kelsie at first,” Pilati says. “Once that started feeling pretty easy, we upped the repetitions and slowly moved to a two-pound dumbbell.”
Johns continued to make strides throughout October, and doctors cleared her to begin swimming. “It was strange to be back in the water,” she says. “In the beginning, I was only permitted to swim the equivalent of a warm-up, but it was great to feel like I was doing something again.” The return to the pool was not a return to normalcy, however. Johns still couldn’t fully pronate or supinate her forearm, which affected her strokes. In addition, she was allowed to increase her distance no more than 10 percent each week, and doctors limited her swimming to once a day instead of twice as the team was doing. Pilati carefully monitored Johns’s progress in the pool. “At times, she swam fine but would come into the athletic training room the next day and her entire arm would be sore,” says Pilati. “When that happened, I would hold her out of practice. She seemed to keep taking two steps forward and one step back throughout her rehab. But we focused on the fact that she was moving forward.”
Open communication was crucial during this up-and-down period. “Kelsie knew I wasn’t holding her out to be mean, but it’s obviously disappointing for any athlete to be prevented from doing what they love,” says Pilati. “So it was important that we formed a good relationship. She was very honest about how she felt every day because she didn’t want to hinder her progress, and I was open about what I thought she should attempt.” There was one more hurdle to get over. Because Johns hadn’t used her right shoulder for four months, its muscles were very weak. In the pool, her tendons tried to overcompensate for this frailty, causing them to become inflamed. About a month after taking her first strokes, an official diagnosis of tendonitis in her shoulder meant Johns was out of the pool again for a week to rehab the new injury. “We put heat on her shoulder and used ultrasound to reduce the inflammation,” says Pilati. “Then we did a lot of internal and external rotation exercises on her rotator cuff and flexion and extension stretches on her shoulder. Even after she got back in the pool, Kelsie continued this protocol three times a week to keep her shoulder strong.” The reward for all her hard work came when Johns got the opportunity to swim at the Atlantic 10 Conference Championships in February. She had participated in a handful of meets beforehand, and her coach entered her in several events. She came away with season-best times in the 100- and 200-yard breaststroke and the 100-yard butterfly. “Once I got back in the pool, my goal was to swim at the conference meet,” says Johns. “I didn’t really have high expectations for myself. I just wanted to go in, give it my all, and see what happened. I was thrilled by the results.”
After a fulfilling end to the 2013 season, Johns spent the summer at home training and lifting every day with swimmers from the University of North Carolina-Wilmington. Motivated by the setbacks of the previous year, she entered the fall preseason at Xavier with equal strength in both arms–and in the best shape of her life. Her aspirations for her junior season are high, and she is eager to improve on her times from her freshman year. Throughout all the moments of frustration, Johns says she got through the difficult recovery process by trying to remain positive at all times. “I reminded myself that I was lucky to even have the chance to swim again,” she says. “I took everything day by day, and I celebrated any improvement, whether it was one degree in range of motion or one pound in strength.”
Pilati says that she was amazed by Johns’s attitude throughout the rehab and did her best to provide encouragement whenever needed. “During Kelsie’s moments of doubt, I talked about how her situation was not permanent,” says Pilati. “She had already gone through the injury and the surgeries. Compared to that, I told her, everything else was a minor setback. “Her positive attitude actually often lifted my spirits,” Pilati continues. “I could be having a tough day in the athletic training room, and Kelsie would come in so happy it would brighten my mood. I’d think to myself, ‘This girl broke her arm and she can’t lift anything, but she is positive and ready to get to work. I can get through the rest of the day.'”
And as for Johns’s other extracurricular activity, after some trepidation, she got back on her horse and enjoyed riding again this past summer. “It was scary at first, and I was a little uncomfortable,” she says. “But then something clicked and I started loving it again. I rode almost every day after that.”