Jan 29, 2015Lakeisha Crouch
Xavier University
By Patrick Bohn
Patrick Bohn is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected].
When Xavier University women’s basketball forward Lakeisha Crouch tore her left ACL in an October 2009 scrimmage before her senior year of high school, she knew she was going to miss her final high school season–a tough blow for any athlete. What she didn’t realize, however, was that the injury would be the first in a series of setbacks spanning two and a half years and half a dozen surgeries.
In fact, after undergoing surgery that November and progressing through a standard rehabilitation, Crouch was cleared to return in June 2010. But when she arrived on Xavier’s campus for summer workouts a month later, the team’s orthopedic surgeon noticed some anterior translation in her knee during a Lachman’s test, which put her at a higher risk for re-injury. So Assistant Athletic Trainer Katie Svihlik, ATC, put Crouch on an aggressive rehab plan in hopes of getting her ready for the season.
“The rehab plan ran about six weeks,” Svihlik says. “One of the first things she did was work on a Cybex machine so we could compare the strength in her left leg to her right. She had a pretty significant deficit in her left leg, so our biggest goal was to build strength on that side.”
One of the exercises Crouch used to strengthen her glutes was the clam shell. She would lay on her right side with her knees bent and a resistance band around them and lift her left leg in order to fire her gluteus medius. She also worked on hip strength by doing hip abduction and four-way hip extensions with an ankle weight.
“For hip extensions, our standard for athletes recovering from an ACL tear is to have them start with no weight, then progress up to 10 pounds one pound at a time,” Svihlik says. “If they can do a specific weight easily, we add one pound the next day. Once they feel a bit of a burn when exercising, they stay at that weight for a week. When they can do eight sets of 10 in each direction, we know we can safely progress them again. Lakeisha moved through that process pretty quickly.”
To help Crouch’s quad muscles build more strength, Svihlik had her do a lot of straight leg raises using e-stim. Crouch also worked her quads by doing wall sits and incline squats.
“Lakeisha was seeing me for an hour a day four to five days a week over the summer,” Svihlik says. “She worked her butt off from the minute she got here, and that was great to see.”
Crouch admits that while the rehab itself wasn’t challenging, that first summer was a difficult one. “I was making the transition to college, which was hard in itself,” she says. “Between therapy, study table, and class, I felt like I didn’t have time to myself. There were days when it was tough getting up in the morning, but I had to keep focused on my goal of playing basketball again.”
It looked like Crouch would reach that goal soon, as her rehab progressed well and she was cleared for full participation in August 2010. But during an open gym session in September, Crouch felt her left knee bothering her. Although she managed to finish the pick-up game, the next day, her knee was swollen and it was difficult to walk. Still, when she visited Svihlik, Crouch figured it wasn’t anything serious.
“I thought my knee just wasn’t used to the amount of work I’d put it through,” she says. “I figured that once I got back into the rhythm of playing every day, I’d adjust.”
Unfortunately, Svihlik had a much different diagnosis for Crouch. She had torn her ACL a second time, and would miss her entire freshman season. Seeing Crouch suffer a second injury so soon after overcoming her first had Svihlik concerned.
“At first, I was worried about Lakeisha mentally, because some athletes don’t handle things like that well,” she says. “But she’s tough, and she told me almost immediately that she would make it back.”
Crouch underwent a second surgery in September 2010, and was told everything went well. But as Svihlik eased Crouch into her rehab by giving her range of motion exercises, stretching her quad and hamstring, and having her do quad sets, she noticed that the swelling in Crouch’s knee wasn’t dissipating. “It had been about three weeks since the surgery, and the thought was that she was just a sweller, so the doctors decided to drain her knee of fluid,” Svihlik says. “But when they did that, they discovered a staph infection.”
A coagulase negative staph infection, to be exact. The infection is challenging in that it doesn’t present with any of the normal symptoms like fever, redness around the incision site, or warm skin upon touch. Svihlik says that while the diagnosis caught her by surprise, she also learned from it.
“A lot of what athletic trainers do is based on the relationships we’ve developed with the athletes,” she says. “We know how their bodies respond after spending time with them in the athletic training room, but at that point, I didn’t know Lakeisha as well as I would know a student-athlete who had been on campus for a year or two. It really illustrated to me the importance of heightening my awareness about making sure dressings are always clean and dry post-op.”
Crouch would need to be administered IV antibiotics through a peripherally inserted central catheter (PICC) line for the next month. Normally, the procedure of flushing the line and administering the antibiotics can be done by the patient themselves, but the location of the PICC line in Crouch’s arm made her nervous about doing it on her own, so Svihlik stepped up and did it for her.
“I had never even heard of a PICC line before, let alone actually administered antibiotics through one,” Svihlik says. “So I didn’t know how to do it at first. But a nurse showed me the procedure, and I picked it up quickly. It was great to learn something new, even though it wasn’t something I ever thought I’d do.
“Some of the girls on the team call me mom,” Svihlik continues. “As an athletic trainer, you are that mom away from home sometimes. You need to do whatever you can to help your players get healthy.”
After a month of antibiotics, Crouch started her rehab again from square one. She began with towel slides to increase flexion in her knee, as well as active assisted range of motion exercises where she would sit off the edge of a table with her right leg under her left and go down into flexion and back into extension. Crouch also did “millions” of straight leg raises, as well as more e-stim for her quad.
After about 12 weeks, Svihlik was ready to ramp up the intensity of the workouts and add exercises like lunges, but doctors discovered more translation in Crouch’s knee, and re-opened the surgical site so they could clean it out again. It was then they discovered the graft that had been in her knee was nearly gone, possibly eaten away by lingering infection. So in late December, another PICC line was inserted to try and clear out the infection before a second graft could be put in.
“That was the one time I saw Lakeisha break down,” Svihlik says. “We were in my office, and she was crying. I felt devastated for her. She had worked hard and not complained at all up to this point, and she just kept getting hit. But after a few minutes, she regrouped and said, ‘I’m going to get through this.'”
Crouch’s next surgery was scheduled for February 2011, and the hope was that with the infection cleared out, this one would repair her ACL. The multiple ACL tears had also resulted in some rotary instability in Crouch’s knee, so work would be done on her MCL and LCL in order to assist in the stabilization. But when the surgeon opened up her knee, he discovered that the bone tunnels had dilated, which meant a graft wasn’t likely to heal properly. So instead of the intended procedure, he performed a bone graft, mixing cancellous chips with DBX Demineralized Bone Matrix putty and placing the mixture in the tunnels.
Crouch would then need a three-month healing period before the ligament repair surgery could take place. “At that point, I just buried myself in my schoolwork,” Crouch says. “I still wanted to play basketball eventually, but I knew that even if I couldn’t, I was going to make sure I got a great education.”
“That was a difficult time,” says Svihlik. “You always try to remain positive, but when a surgery involves bone grafting, it’s a lot harder to come back from it. I had her ride an exercise bike with her teammates just to get out of the athletic training room and feel like part of the team, but that’s all we could do.”
In May of 2011, Crouch underwent her sixth surgery and had a cadaver graft put in her knee. Because her mother couldn’t make the trip up from Tennessee again–she had come up for the surgery in February–Svihlik observed the procedure both as a measure of support and a learning experience.
“In school, you don’t get a chance to see anatomical structures in that kind of setting,” she says. “It was an invaluable experience for me, especially because the surgeon did open reconstruction on the inside and outside of her knee and that’s not very common. Being able to see what was going on and that everything went well was a great experience.”
The procedure went smoothly and three days later Svihlik and Crouch were ready to get back to work. Because the reconstruction had also involved the LCL and MCL, something Svihlik didn’t have as much experience with, a physical therapist worked with the pair once a week.
“That was very helpful,” Svihlik says. “She knew the exact protocol for rehabbing an injury like this, and if I had any questions or concerns, I could call or e-mail her and she would get back to me with an answer quickly.”
For the first two months, Crouch was in a brace with a footplate and non-weight bearing. Her rehab started with mostly range of motion exercises, as well as hip extension and flexion. She also did more straight leg raises, quad sets, and e-stim. By the fifth week, Crouch was doing seated heel raises, and added hip abduction work the following week.
By week nine, Crouch had progressed to limited weight-bearing on her left leg, so Svihlik prescribed weight shifting and single-leg balance exercises. “The balance exercises were the toughest for me,” Crouch says. “I had surgery on my left ankle in high school, so I was nervous about how I would do. But it worked out well.”
At this point, with her knee more stable and some quad tone back, the goal shifted to gaining strength. Crouch started doing leg presses and toe extensions, and progressed to knee extensions with a weight on her ankle. She also performed wall slides with a Swiss ball behind her back for support and squatted to about 75 degrees.
By late August 2011, Crouch was back on the Cybex machine, doing quad and hamstring strengthening exercises. Two weeks later, when Svihlik tested her on the Cybex, her left quad was at 69 percent the strength of her right, and her left hamstring was at 86 percent. The numbers were good enough that Svihlik had Crouch start light jogging.
Five months after the surgery, Crouch was cleared to practice jump shots–with no other players near her–and Svihlik started believing Crouch might return to play a bit ahead of schedule. “Everything was going smoothly,” Svihlik says. “When we progressed to cone jumps and line jumps and Lakeisha was pain free, I almost wanted to knock on wood.”
This was a key moment for Crouch as well. “It felt great doing some of these basketball drills again, because I felt like the journey was almost over,” she says. “I just kept pushing forward, hoping I could help the team out later in the year.”
By November, Crouch had started sprinting on a treadmill and running backwards. As her left leg strength continued to increase, she added full court lay-ups and post moves–again with no teammates around–and the Xavier coaching staff began to work with her in preparation for her debut on the Musketeers’ court.
In December, Crouch’s left quad was as strong as her right, and her left hamstring tested even stronger that the right. The light at the end of a long tunnel was finally shining. On December 29, 2011, after nearly three years of rehab and a career’s worth of setbacks, Crouch stepped onto the court for the first time in her collegiate career. Against the University of North Carolina-Wilmington, she tallied six points and eight rebounds, despite her nerves.
“My palms were sweaty, and I didn’t talk much,” she says. “I was so nervous about what might happen. It took me a few games to feel comfortable on the floor.”
Crouch improved as the season continued and finished the year as the Musketeers’ second leading rebounder, with 6.4 per game. And she has bigger goals for this season. “I want to be the Atlantic 10 Player of the Year and help my team win the conference title,” she says. “I’m feeling more comfortable in my role and knowing what I need to do to help the team succeed.”
For her part, Svihlik was overjoyed to see Crouch on the floor. “To see someone who worked that hard make it back after so long, I almost wanted to run on the court and take pictures,” she says. “I felt like a proud parent.”
