Jan 29, 2015Junior Cadougan
His 2009-10 stats might lead you to believe that Marquette University point guard Junior Cadougan had a disappointing freshman season. In reality, the fact that Cadougan was able to play in 12 games for the Golden Eagles was an eye-popping achievement as he worked his way back from a ruptured Achilles tendon in just four months.
During a September 2009 workout, everything seemed normal and Cadougan was feeling good. He was running sprints when out of nowhere Cadougan says his right Achilles tendon “just shredded.” Pain or hot spots around the Achilles can be warning signs of an impending rupture, but in Cadougan’s case, there were no such signs.
When he received word the injury would keep him out six to eight months, possibly costing him the entire season, Cadougan was understandably upset. “I came to Marquette wanting to have an immediate impact,” he says. “I put in all the hard work and suddenly this freak injury happened. At first I thought, ‘How am I going to walk again?’ But my next thought was, ‘How am I going to get back on the court?'”
It was a job for Ernest Eugene, MS, ATC, NASM, PES, CES, Athletic Trainer for men’s basketball at Marquette. But there was one major hurdle: Eugene had never overseen an Achilles rupture rehab. Undaunted, he embarked on a rigorous research kick to help formulate his protocol.
“Sports medicine and rehab techniques are always evolving and you’ve got to make sure you’re on top of it,” he says. “Our entire staff, including athletic training students, team physicians, and the orthopedic surgeon, read articles and share information with one another. That’s how you learn in our profession.”
Eugene had to study up quickly because Cadougan was itching to get to work. “Three to four days after the surgery, I was asking Ernest if it was time to start rehabbing yet,” Cadougan says. “I wanted to do something as soon as possible. I was in pain and on medication, but I wanted to work hard so I could get back on the court soon.”
Eugene and Cadougan had met only weeks before, but they began working together seven days a week, sometimes meeting more than once a day. “It wasn’t that we needed to meet that often,” Eugene says. “It’s that Junior always wanted to do more. He now calls himself the King of Rehab.”
Eugene’s general rehab philosophy is to utilize a model of integrated training to get all the muscle groups working together. But for an Achilles rupture, that wasn’t going to be easy because Cadougan would be unable to put any weight on his right foot during the first four to five weeks of his rehab.
Eugene spent the first few weeks working out Cadougan’s hip flexors and extensors, as well as his abductors and adductors. For example, to work Cadougan’s quads, Eugene would have him sit on a low table with a half foam roll beneath his heel to raise his knee slightly. Cadougan would then push down into the roll and try to get the back of his knee touching the table.
Going into the second and third weeks, Eugene added toe pickups. Cadougan would pick up a cotton ball or a marble with his toes and move it to the other side of his body before placing it down.
Eugene says the main goal of the early exercises was simply to get Cadougan’s muscles to resume doing what they had always done. “Junior wasn’t weight-bearing, which meant he wasn’t walking up stairs using his quads or down stairs using his hamstrings, so we were trying to get those muscles to know that they still needed to do work,” he says. “It only takes 24 hours of immobilization for atrophy to occur.”
The exercises were designed to lay the foundation for Cadougan’s next rehab steps. “From zero to three weeks, we built up those muscles,” he says. “Once they were strong, we incorporated them into our weight-bearing activities and then into functional, return-to-play activities.”
In the fourth and fifth weeks of Cadougan’s rehab, Eugene began adding manual resistance, which allowed the muscles to strengthen both concentrically and eccentrically. When working on hip flexion for concentric strength, Cadougan would try to raise his leg from the table while Eugene pressed down on it. To build eccentric strength, Cadougan held his legs up off the table while Eugene applied pressure to push them down.
It was around this time Eugene began to notice Cadougan was progressing ahead of schedule. “At week five, we placed Junior in a walking boot, and that doesn’t usually happen until week six,” says Eugene. “Rehab protocols are used as a baseline, but every athlete is different. Junior was in front of the protocol at that point, and I felt that with his attitude, he would be able to remain in front of it.”
To ensure that Cadougan stayed ahead of the curve, Eugene stepped up his work on range of motion (ROM) exercises around week six by having Cadougan sit with his legs in front of him, wrap a towel around the bottom of his foot, and pull it back toward himself. Eugene would then push his foot back even further for greater ROM.
After five weeks, the initial muscle strengthening had supplied a solid base, but Cadougan was going to need more than a strong ankle with decent ROM to return to the court. So Eugene added a few more layers to his rehab program.
One new goal was improved muscle control. To address this, Eugene had Cadougan sit in a chair with his legs bent at 90 degrees and do calf raises. “He’d come up on the balls of his feet as high as possible, then lower his heels until they barely touched the ground,” says Eugene. “I tell athletes to pretend there’s an egg underneath their heel and that they just want to tap it, not break it. That shows control of the muscle as well as good strength.”
Another goal was to improve Cadougan’s balance by working on his proprioception. This was the part Cadougan struggled with most. “I was scared to stand up on only my right leg,” he says. “I didn’t know if my Achilles was going to pop again.”
Eugene massaged Cadougan’s fears by having Cadougan first balance on both feet. “The tendency is to shy away from the involved side, but that leads to compensating,” Eugene says. “I knew he wasn’t going to have the confidence in the right leg immediately, so we re-trained his body to say ‘I can stand on two feet again.'”
Eugene had Cadougan stand in front of a waist-high table while trying to keep his balance. (The table was there for support if needed.) That progressed to stork stands in which he stood on just one foot, first on an even surface and then on an uneven surface like a half-foam roll. All the while, the focus was on making steady progress.
“We’d set short-term goals every two weeks,” Eugene says. “For example, if he could balance for a certain period of time on the uninjured side, we’d try to go to at least half that long on the opposite side. As Junior saw those goals being achieved, he wanted to accomplish even more.”
Two months into Cadougan’s rehab, with his balance returning and his right foot strong enough to bear weight again, the next step in integrated training began: getting the various muscle groups to work together. Two of the exercises Eugene utilized were wall-ball squats and modified lunges.
With an exercise ball between his lower back and a wall, Cadougan would squat while using his glute-medius muscle and engaging his core. In the lunges, Cadougan would put his trailing foot on a slide board, which allowed the back knee to drop almost to the board. He would then pull himself up to a neutral position using his front leg, engaging his glutes and core in the process.
At this point, Eugene also had Cadougan work out on the AlterG, an anti-gravity treadmill that uses air to displace an adjustable percentage of body weight, making walking or running low-impact. “I think that was a big part of what got us to the next part of the rehab,” Eugene says. “We put him in an environment where he was able to do weight-bearing running and walking and we could view his mechanics. This allowed him to progress and gain confidence that his Achilles would hold up under pressure.”
By early December, Cadougan was still well ahead of schedule and began going to the gym on his own to do some dribbling and stutter stepping. After that went well he began asking Eugene when he could return. “I told him, ‘Let’s keep working hard every day and we’ll see how it stacks up,'” Eugene says. “He was already convinced he could contribute to the team again.”
So Eugene added more basketball-specific exercises like running up and down the court at various speeds, changing directions, and agility drills using ladders. They also began incorporating plyometic exercises into his routine.
“One that worked well was the Mikan drill, in which the player starts underneath the basket and makes a layup by banking the ball of one side of the backboard, then catches it out of the net and lays it up on the other,” Eugene says. “He was jumping and landing quickly, and not only did he challenge himself from a basketball standpoint, saying ‘I’ve got to make 25 baskets in 30 seconds,’ but he concentrated on it from a rehab standpoint by exploding off the ground and landing soft.”
Eugene attributed Cadougan’s ability to perform these drills to the plyometric work they had done earlier. By doing box jumps on a box six to eight inches off the ground, Cadougan had retrained his body to land correctly after a jumper.
In early January, Cadougan participated in a workout with the coaching staff and Eugene saw that the talented freshman was on the verge of completing his comeback. “He was getting tired as he progressed through the workout, but he still remembered all the things we had worked on,” Eugene recalls. “He kept his core tight and made sure his toes were pointed straight ahead when he landed after a jump shot. Even at his most tired point, I know he started to think, ‘There’s potential.'”
Not long after, Cadougan went through a practice and had no trouble keeping up with his teammates. So he met with coaches to discuss his return. “I felt I could really play at this level,” he said. “I told my coaches, ‘I just want to get the experience of practicing and running through the plays, so I’ll be comfortable.'”
On Jan. 23, Cadougan made his return against Syracuse University, playing eight minutes. He appeared in a total of 12 contests over the remainder of the season for the team, including its NCAA Division I Men’s Tournament game.
“We learned from everything we did,” Eugene says. “The next time I oversee an Achilles rupture rehab, I’ll start the same way. With Junior, because of our extensive research, we were on the cutting edge, and we will be next time as well.