Jan 29, 2015Paul Astrain
McClintock High School, Tempe, Ariz.
Paul Astrain was about to enter his freshman year at McClintock High School in Tempe, Ariz., in 2009. He was lifting weights with several of his teammates in preparation for the upcoming football season when he felt something amiss.
“We were doing power cleans, and I didn’t have the form right,” he says. “I felt a little tweak in my lower back. At the time I thought I had just pulled a muscle, so I didn’t tell my coaches. I went home and talked to my older brother who told me that I was going to be sore all the time and was just going to need to deal with it.”
Astrain iced and stretched his back, but over the coming months, the pain persisted and eventually grew worse. He still didn’t tell his coaches about the problem, and pushed his way through the football season despite being very uncomfortable. Then, in the spring of 2010, he was playing in a club soccer tournament in California when he suffered another injury.
“I was playing defense and was sprinting after a ball,” Astrain recalls. “I jumped to try and clear it, and I felt a pop in my back. The pain was much worse than the tweak I had felt while lifting the previous summer.”
Astrain finished out the tournament, but upon returning home the pain continued, so he had his back examined by a doctor. An x-ray revealed a herniated disk, and Astrain was told to immediately stop all physical activity, including lifting weights with any of his teams and during gym class.
He soon started going to physical therapy and his back began to improve. After missing baseball season, Astrain was cleared for football practice over the summer, and finally felt like he was getting back on track. But when Astrain was playing dodge ball with some friends that fall, he felt sharp pain in his back again. When doctors examined him this time, the diagnosis was grim.
“When the doctors looked at my back, they told me it resembled that of someone much older,” Astrain recalls. “It was really scary to hear that, especially because by that point it didn’t hurt very much anymore.”
In November of 2010, Astrain underwent a microdisectomy for the herniated disk, and when he emerged from surgery, he was forced into a sedentary lifestyle for nearly a month. “I had to stay home from school, and about all I could do was watch television,” he says. “I even had to sleep and get out of bed a certain way, which was really difficult. I’ve always been active and involved with sports, and to have to sit on the sidelines like that was discouraging.”
Once he was able to start moving around again in December, Astrain began working with Mollie Callanan, PT, a Physical Therapist at Ahwatukee Sport & Spine in Phoenix. The first week that they met, Callanan evaluated Astrain’s functional mobility and strength deficits. She reviewed proper posture and body mechanics with him while he was sitting and standing, and put him on a light stretching regimen.
“My basic goals for Paul coming out of the surgery were to help him regain functional mobility, maintain a neutral spine, and get him on a hip and core stabilization program to help him regain strength.” Callanan says. “I focused on neutral spine stretches–being careful to avoid extension and the surgery site–and basic stretching such as pelvic tilts, lumbar paraspinals, and hip flexors.”
In the second week, Astrain started riding a stationary bike. Callanan had noticed in Astrain’s initial evaluation that he displayed weakness in his hips and glutes, so she had him start a hip series and exercises such as clams and bridges as well.
By this point, Astrain had gone through a handful of sessions with little pain, so Callanan focused on improving his strength while remaining cautious. “Pain is a reminder of when you need to stop or alter an exercise,” Callanan says. “But Paul was very motivated and I had to be careful he didn’t overdo it. You can tell when a patient is pushing too hard, because it causes them to lose form. I always emphasize quality over quantity.”
Astrain began doing supine bridges–both double- and single-leg–on a therapy ball, and started using leg weights to increase his quad and hamstring strength. Callanan also had him start to focus on balance with standing, single-leg balance activities on a Bosu.
Throughout the rehab process, Callanan was never concerned that Astrain wouldn’t be able to return to sports. However, she made sure his motivation to return didn’t result in disappointment when any setbacks arose. “One week he came in a little more sore than usual and was very disappointed,” she says. “So I explained the healing process to him and the normal length of recovery for someone who undergoes a procedure like his. He seemed more hopeful after that.”
By the end of his first month, Astrain began light weight training, doing rows, extensions, and core presses. Not long after, he added leg presses, squats on dynamic surfaces, and focused on building up his quads, hamstrings, and hips with step-ups and step-downs.
Heading into the final few weeks of his rehab, and with his functional strength returning, Callanan began incorporating sport-specific training into Astrain’s rehab. “We began with some light jogging exercises, and he started doing running drills with cones,” she says. “I wasn’t trying to do anything difficult–just test the waters, so to speak.”
By this time, Astrain’s exercises included therapy ball pushups, chest presses, and flys, as well as diagonal and sideways walking with a Thera-band. His progression continued smoothly, and by the end of January 2011, he was cleared by his doctors to resume athletic activities–provided he take it slow.
But in February, Astrain injured his knee in a club soccer game and was once again forced to the sidelines. He recovered in time to play baseball for McClintock in the spring of 2011, and over the next few months began focusing on playing sports at the high level he was accustomed to previously. To help achieve his goal, he started working with Alex Arteaga, CPT, a Personal Trainer at Just Fitness in Tempe. Knowing his client had suffered multiple injuries, Arteaga had a simple goal in mind when he began designing Astrain’s workout.
“All I wanted to do initially was get Paul’s core and back stronger,” Arteaga says. “He’s a young kid, very athletic, who wants to be outdoors playing sports. And instead he was getting injured and forced to stay inside playing video games because his core and back muscles simply weren’t strong enough to handle physical activity for any length of time, especially at the level he wanted to play at.”
Arteaga prides himself on thinking outside the box when it comes to devising a workout plan. In keeping with that spirit, his work with Astrain took place not in a gym using traditional equipment, but outdoors, where Arteaga used natural surroundings to his advantage. “I don’t often have the people I work with use machines, because I think they can do that on their own,” he says. “What they’re looking for from a professional is something different.
“In Paul’s case, I thought that doing his rehab outdoors would be good for him physically and mentally,” Arteaga continues. “He needed to get outside and be active.”
Arteaga spent his first week with Astrain working to strengthen his core and back. But like Callanan, he had to be careful not to push Astrain too hard. His doctors had recommended that Astrain not put any weight on his shoulders (so he didn’t compress his spine) or sprint. Those restrictions meant that for the first week they worked together, Astrain was mostly limited to dynamic stretching, light jogging, bodyweight squats, sit-ups, and pushups.
“Rather than focusing on getting him able to lift weights, I had Paul concentrate on the importance of using correct form,” Arteaga says. “For example, he was initially struggling to do squats with the correct form, so I brought him over to a park bench and told him to sit and stand like he normally would. After he did, I told him, ‘That’s a squat,’ and I could see the light bulb go off in his head.
“I emphasized to Paul that if he used the correct form, he would advance quicker through his rehab,” Arteaga continues. “It got to the point where he would stop doing an exercise on his own because he didn’t feel his form was good enough. It was great to see that because I knew then that he really understood its importance and wasn’t just doing the exercise because I was telling him to.”
The dynamic stretches focused on getting Astrain’s legs and back stronger. “To work his legs, I’d have him start with his feet together, then squat down almost like a sumo wrestler,” Arteaga says. “That stretches the glutes, hamstrings, quads, and calves. For his back, he did butt-kickers, high-knee hugs, and straight leg marches. He also did lunges with back twists.”
In addition to traditional strengthening exercises, Arteaga had Astrain try Muay Thai combat training–mostly combinations of punches and kicks. Arteaga says it helped the rehab go smoother. “I wanted to break up the monotony of doing certain exercises and give Paul something to work toward. He knew if he got through his exercises, he’d get to do Muay Thai.”
As the weeks progressed, Astrain started doing single-leg high step-ups on park benches, stationary lunges, and a pair of unique exercises performed on playground equipment. “We would go to a small swing set and Paul would grip the top bar, bend his knees a little bit, and do a pull-up,” Arteaga says. “I had him do triceps extensions in a similar fashion. Then we would go over to a slide with safety bars on the sides about three to four feet high, and I’d have him get situated almost like he was going to do an incline pushup. He’d grip the bars, bend his knees, drop his elbows in, and push back and forth. It worked several muscle groups at once.”
Astrain’s back was holding up nicely by the end of the summer, so Arteaga’s goal at this point became getting him in shape for soccer. “I’d have Paul do frog pushups and single-leg jumping lunges to work on his explosiveness,” Arteaga says. “At this time, he had been cleared to sprint, so I would have him run around the park, then do some Muay Thai, then run around the park again. It was all about getting gas in his tank for soccer.”
Last fall, all his work finally paid off. Astrain, fully recovered from his injuries, was the captain of his high school soccer team as a junior. He stopped playing football and baseball, however, to minimize future injury risk. He says the long rehabilitation process never got him too discouraged. “Confidence was key for me,” he says. “My father always told me not to worry about things I can’t control, and that’s what I tried to do.
