Knee Surgery Information

The hurt is both physical and psychological when an athlete is injured.The first part is obvious. A torn knee ligament, a herniated back disc, they can produce excruciating pain. But the mental anguish is significant, too. Researchers have found that injured athletes tend to go through the stages of denial, anger, bargaining, depression and acceptance common to those who have lost a loved one, or have been diagnosed with a potentially terminal illness.   

“It’s definitely an emotional hurdle,” said Dr. Aimee Kimball, a mental training consultant with UPMC who has worked with high school, college and pro athletes. “A lot of times the sport is so important to the athletes, it is like they are losing a significant part of themselves.

“The first thing to do is help them deal with stress. A lot of times athletes are supposed to control their emotions and they’re supposed to be seen as tough. I let them know other people have experienced this and it’s OK to be upset.”
Kendall Simmons, the offensive guard who was already learning to deal with his diabetes in 2003, was having a strong 2004 preseason camp with the Steelers when the anterior cruciate ligament in his right knee was torn in practice.

“You get used to doing something and you’re feeling like, I guess you could say, invincible to a certain degree,” Simmons said. “And something takes you out of what you love to do and you don’t know whether you’re going to completely recover from it, then you do have a period of vulnerability. All of us go through it if you have something serious. You know you’re going to make it back, but there’s always that little doubt.”

Athletes in team sports experience a sense of isolation when injured. They’ve been taught from an early age to think of themselves as part of a unified effort. When injured, that identity is gone.

“It’s hard seeing your team out there, especially when your team is doing good,” said Steelers nose tackle Casey Hampton, who missed all but six games of 2004 with a knee injury. “You want to be out there helping them. That’s the main thing. You want to play so bad, you feel you let them down.”

“The hard part is going to the games and watching the games when you wish you could be out there,” said Penguins winger John LeClair, who has missed considerable time in recent seasons with back and shoulder problems that have required surgery. “It gets frustrating.”

At least LeClair, 36, has a long, productive career in the books, no matter the injury problems of his latter years. For Pirates pitcher Sean Burnett, a 23-year-old fighting his way back from “Tommy John” surgery on his left elbow Sept. 22, 2004, the rehabilitation process comes with a greater sense of urgency. He was throwing from a mound earlier this month in Florida for the first time since the surgery.

It’s been a long haul trying to resume a career interrupted so early by injury.

“It’s not really the physical part of it,” Burnett said. “Mentally, though, it’s tough. You have to keep reminding yourself of why you’re doing it and you have to remind yourself every minute, because if you don’t, it becomes easy to get down on yourself and give in.

“I kept telling myself that I wanted to come back better than I was before. I think that coming up and tasting some success at the Major League level made me want it more.”

Coming back

Advancements in surgical and rehabilitation techniques have turned what used to be career-ending injuries into something less final, and significantly shortened recovery times from lesser injuries.

Fresh in our minds is how wide receiver Terrell Owens needed just seven weeks in the 2004 season to return from a surgically repaired ankle and catch 9 passes for 122 yards in the Super Bowl for the Philadelphia Eagles. Still, the road back can be a difficult one.

Steelers running back Duce Staley, who had knee surgery the past August and has been little-used this season, was a rehabilitation pioneer in 2001 when he came back from a Lis Franc sprain to his foot. The injury is named for Jacques Lisfranc, a surgeon for Napoleon, who treated soldiers who had suffered it when thrown from their horses and their feet got caught in the stirrups. It describes an injury where the toes are separated from the bones in the middle of the foot. This had been a career-ender in football

Staley, who had back-to-back 1,000-yard rushing seasons with the Eagles in 1998 and 1999, suffered the Lis Franc injury in 2001. An intensive rehabilitation allowed him to return as a 1,000-yard rusher in 2002.

“It was a lot of rehab that was experimental with that injury,” Staley said. “There was not a lot of knowledge as far as rehabbing and strengthening the foot, so we had actually try a lot of things, but it worked and I’m definitely thankful for it.”

Among the techniques was an exercise in which Staley picked up marbles with his injured foot.

“I could see where it worked,” he said, “not being able to actually strengthen the foot muscles unless you walk or run on your foot, but at the time, I couldn’t do either. I had to do something else to work the ligaments and the muscles in the foot.

“If you’re ever at home, try picking up marbles with your foot and you can see how tired your foot gets.”

The Steelers’ Hampton, a 325-pound nose tackle, has torn the anterior cruciate ligament in each knee. The first injury was sustained when he was playing college football at Texas. The second came during the 2004 season with the Steelers.

But the Steelers were so confident in Hampton’s recovery that they signed him to a five-year contract extension before the 2005 season.

His agent, Brian Overstreet had said at the time of the injuries, “It’s like a flat tire. You patch it up and it’s as good as new.”

“It’s not that simple. It’s tough. It’s total reconstruction of the knee. It’s a tough injury,” Hampton said. “But, with today’s technology and the way they have rehab set up, it’s the kind of injury guys can come back from and be just as strong.”

That has been true in Hampton’s case. Others aren’t as fortunate.

Simmons has seen careers cut short by injury and that’s why he was concerned about his future when he injured his knee.

“I can’t lie. I did have doubts because I’ve had a couple of buddies who didn’t make it back, who were outstanding players (in college) who probably should be up here right now where I’m at, but they didn’t make the full recovery,” he said. “They just didn’t have the same kind of pop they’d normally have after the injury.”

Complete recovery

Former Steelers coach Chuck Noll had an oft-used saying regarding injured players, “You don’t make the club sitting in the tub.”

He referred to a whirlpool tub and if a player spent too much time nursing relatively minor ailments at training camp and not practicing, he risked falling behind and losing his job.

That pressure, and the naturally competitive nature of athletes, means they often return to the playing field less than 100 percent recovered.

“Each week this year I’ve been getting a little bit better,” said Simmons, who late in the postseason still does not feel fully recovered. “Around the middle of training camp, I could feel I had a little strength. At first, I was out there kind of really just using one leg and just getting around. I could move, but I didn’t have the same strength as I needed in the leg to move people like I wanted to. Each week this season it seems my leg gets a little stronger. I know by this time next year I should be 100 percent.”

Even when a player is fully recovered physically, there is another emotional hurdle to clear.

“A lot of times you can end up playing on one leg and hopping around out there until you get confident,” Hampton said. “You can always tell yourself it’s good, but your body doesn’t let you go full-tilt at first. You’ve got to get hit on it or you’ve got to get used to being out there again.”

The Penguins’ LeClair has more experience with this than he’d like, something he shares with former teammate Mario Lemieux, who Tuesday announced his retirement saying he didn’t have another comeback in him.

“We’ve talked about how it’s tough getting back in the swing of things the first couple of games,” LeClair said. “You’re not quite up to speed. That stuff takes time. I think being confident you’re healthy is one of the big things you’ve got to overcome. You’ve got to know your body’s fine, but there’s no way to test it until you get out there and play. Once you pass that test, things work well.”

Dr. Kimball has a technique to help clear that last mental hurdle of rehabilitation.

“One of the things I do is I encourage athletes to keep journal of their injury and their rehabilitation,” she said. “Then, when they’re cleared to return, they can look back and see where they started and where they are now and trust their physician when they’re cleared.”

Dr. Kimball said the appreciation of the importance of the mental side of rehabilitation didn’t really gain widespread acceptance until the late 1990s, but, she added, “My guess is the first athlete ever injured realized this.”

 

Knee Surgery Information