Jan 29, 2015Comeback Athlete
Christie McDonald, Duke University
By R.J. Anderson
R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected]
In April 2006, Elizabeth Zanolli, LAT, ATC, in her first year as Assistant Athletic Trainer at Duke University, found herself in a position foreign to most veterans. It was 8 a.m. on a Monday, and Christie McDonald, a freshman on the women’s soccer team, had climbed into Zanolli’s car knowing only that they had an appointment with the team physician. “Z, what’s going on?” asked McDonald. Zanolli paused.
During and after the 2005 season, McDonald had experienced what are still undiagnosed, randomly occurring foot shakes. Lasting 30 to 45 minutes, the episodes were more annoying than painful. Still, Team Physician Alison Toth, MD, was concerned and had scheduled an MRI the previous Friday to check for lesions on McDonald’s brain in hopes of finding the cause of her shakes. But the MRI found something worse.
As McDonald buckled her seatbelt, Zanolli turned to the 19-year-old and gave her the bad news. “Christie, they didn’t find lesions on your brain, they found a tumor,” she said. Seeing the blood drain from McDonald’s face, Zanolli quickly added that the news wasn’t all bad–the tumor was benign. “At that point, Christie stared at me and said that when she was in seventh grade, her best friend died of a brain tumor that wasn’t cancerous,” says Zanolli.
After shedding a few tears, McDonald composed herself and wanted to know more. “I was trying to remain calm so I could hear the rest of the details because I was aware that there are different types of tumors,” says McDonald. “I wanted to find out exactly what it was before I started freaking out.”
Doctors discovered that the tumor was pressing on the vestibulocochlear nerve in McDonald’s inner ear, a nerve responsible for hearing and balance functions. And follow-up tests revealed deficiencies in balance and left ear hearing–symptoms that had occurred so gradually McDonald hadn’t even noticed them.
Diagnosed with acoustic neuroma–a condition afflicting approximately 2,500 patients in the U.S. each year–McDonald was informed that though the tumor was noncancerous, over time it could grow to a point where it would press on her brain stem and become life-threatening. She was referred to Derald Brackmann, MD, an acoustic neuroma specialist at the House Ear Clinic in Los Angeles, and surgery was scheduled for May 12, giving McDonald time to complete her final exams and fly to California.
During a four-hour procedure, Brackmann successfully removed a 1.5-centimeter mass from the left side of McDonald’s brain. But because of the tumor’s location, her auditory and balance nerves also had to be removed, leaving her with no sense of balance and no hearing in her left ear.
Though the surgery was considered a success, McDonald was in excruciating pain for the next few days. “I was awake, but I couldn’t speak or make any movements with my face–it was just too painful,” she says. “I also didn’t open my eyes for a day and a half after the surgery because I knew once I did, the room would start spinning out of control. It was kind of like doing a bunch of somersaults and then standing up–but much, much worse.”
With her sense of balance destroyed, McDonald had to relearn basic functions, including how to stand and walk. After two weeks in the hospital, she flew to her parents’ home in Georgia for a month of rest and recovery. During that period, she wasn’t permitted to do anything but walk short distances, always with someone at her side. Doctors told her to also avoid getting her heart rate up.
“It was horrible,” she says. “It was a lot of sitting, waiting, and feeling really bad. Because I’ve been active my whole life, I had to learn to be patient–although I still didn’t do very well with it.”
But the four weeks of rest were a success, and McDonald was able to return to Duke on July 5 for the second summer semester. She took one class and began rehabbing with Zanolli. With a month until the soccer team’s preseason started, McDonald’s goal was simple, but tough: to be on the field the first day of preseason practice.
Though McDonald was cleared for full participation, she had limited balancing ability and much of her conditioning base was eroded. McDonald and Zanolli were basically starting from scratch. “I knew her conditioning was well behind where it needed to be,” says Zanolli, “so I designed a program based on building endurance and improving her ability to make quick bursts, which she would need on the soccer field.”
Zanolli’s job was made a bit easier due to Brackmann’s prescription for McDonald to work through her discomfort and dizziness–her only limitation was to avoid striking the ball with her head for the first couple of weeks. “Dr. Brackmann said Christie would become dizzy very easily and that regaining her balance would be difficult and unpleasant,” says Zanolli. “But her brain had to learn how to compensate for the missing balance nerve. The doctor wanted me to push her through those spells so that her tolerance would continue to increase.”
Zanolli began McDonald’s conditioning with a simple sprinting and jogging drill along a 20-by-20-foot cone-marked box. It was a workout staple that McDonald did every day of her rehab. “She would do an all-out sprint on one side of the square, then make a 90-degree turn and do a slow jog on the next side, then make another turn and sprint, and so on,” says Zanolli. “We did that for five minutes the first day and added about a minute each day after that.
“As she got her time down and became bored running in a square, we eliminated the cones and used the whole field,” continues Zanolli. “She would jog and then I would blow my whistle and she would make a cut like she was getting around an opponent and start sprinting. Then a few seconds later I would blow my whistle again and she would slow to a jog. Eventually, she worked her way up to continuously jogging and sprinting for about 25 minutes.”
Proprioception work was also introduced on day one and continued for the duration of the rehab and into the season. “After she did her running, I had Christie balance on one leg for 30 seconds or until she got tired,” says Zanolli. “She did that with her eyes open, then closed. Eventually, she advanced to balancing on one leg and kicking a ball back and forth with me. We interspersed those drills throughout the workout. She would do a conditioning drill, a quick balancing drill, go on to something else, and then go back to a balancing drill.”
One week into her rehab, McDonald started working in the weightroom with Anne Tamporello, CSCS, Head Strength and Conditioning Coach for Olympic Sports at Duke. “Christie got back on the team’s program, but I asked Anne to watch her more closely because of her balance deficiency,” says Zanolli, adding that the workouts were mostly done using very light weights and high reps. “After Christie had been lifting for a couple of weeks, I asked Anne to start introducing more single-leg exercises to increase her strength while balancing.”
At about the same time, Zanolli began incorporating more soccer-specific exercises into her own work with McDonald. “Once Christie started regaining some endurance and could do more than just stand and kick a soccer ball, I asked the coaches what her position would require and what skills she needed to work on,” says Zanolli. “Using soccer drills was a good motivator and livened things up. There were times other players would join in and partner up with her, which was important for bonding with her teammates, and also because my soccer skills only go so far.”
Zanolli and McDonald met every day during those four weeks, usually for about an hour to an hour and a half. McDonald also did a lot of running and ball handling drills on her own. She progressed rapidly and Zanolli had no problem getting her to push her limits. But she also had her share of bad days.
“Some mornings she woke up extremely weak and fatigued and sometimes she became very frustrated if she didn’t feel like she was at the level she should have been. On those days I would remind her that two months ago she couldn’t even walk,” says Zanolli. “But she was very determined, and her positive attitude helped her to constantly bounce back and make it to the field every day. Christie’s work ethic is one of the best I’ve seen.”
And all of that hard work paid off. When preseason practices started on Aug. 10, McDonald had achieved her goal of making it back for the first day. She also surprised her teammates by dominating the team’s fitness testing, finishing in the top five in every event.
“I think I really shocked my coaches and teammates with what good shape I was in,” says McDonald. “But most of all, it was great just to be with all of them again because that was really what I was training for–I wanted to come back and feel like I was a part of the team from day one.”
Her strong preseason carried over, and McDonald was named a starting forward for Duke’s opening match. She played in all 21 games in 2006, helping Duke advance to the second round of the NCAA Division I Women’s Soccer Championship before falling to Tennessee in penalty kicks.
However, just because McDonald made it back to the field did not mean Zanolli’s work was done. During the early season, McDonald was having trouble tracking balls that were kicked or thrown high into the air, so Zanolli designed special drills for her to do before and after practice. “I would throw the ball up really high and she would have to head it, or we would have another player jostle her and compete for the ball in the air with her,” says Zanolli. “Or we would have a coach kick long balls to her and she would have to track the ball and either trap or head it.
“She also came to the athletic training room after practice and walked on a two-by-four balance beam while I tried to push her off it,” continues Zanolli. “This helped her get used to maintaining her balance and focusing on the ball at the same time.”
Along with adapting to her balance deficiency, McDonald had to adjust to not being able to hear out of her left ear. The problem was exacerbated after she made the switch from offense to defense in mid-season. “I played center back and there were a few instances when I didn’t hear my left back tell me to pick up a mark or something like that,” says McDonald. “But I’m learning to be more aware, keep my head on a swivel, and be conscious of the fact I can’t always hear my left back and that I need to keep turning and looking at her.”
Despite never having faced an injury like McDonald’s, Zanolli says she didn’t fear the unknown when it came to designing her rehab program. “Sound rehab principles are the same for a lot of injuries–it comes down to knowing what an athlete’s limitations are,” says Zanolli. “With Christie, her doctor told us we could push her as long as her headache wasn’t too bad or she wasn’t so dizzy that it was affecting her movement.”
From that Monday morning car ride through thousands of drills and constant discussion, McDonald is glad she had Zanolli in her corner. “There’s no doubt in my mind I wouldn’t have gotten back to where I did when I did without her,” says McDonald. “Z was with me through some of the worst moments of my life and I feel like I can talk to her about anything, not just soccer. If I have 20 extra minutes when I’m on campus, I always stop by her office.”
McDonald says her recovery and rehab taught her about working through adversity. “I could have made a lot of excuses while I was trying to come back and I knew nobody would have blamed me if I didn’t come to preseason in very good shape or if I didn’t go all out for a 50-50 ball,” says McDonald. “But I made a personal decision to get back to playing soccer the way I used to–I wanted to become an even better player and a stronger person. I found out I could push myself a lot further than I previously thought.
“The tumor made me realize how short my soccer career is in the overall scheme of things,” she adds. “So I’m really trying to savor every moment I have left in these next two years.