Cardiovascular training. Strengthening. Alter G.
These are just some of the many modes of therapy Kevin Ware will be facing over the next year. On March 31, 2013, after almost 30 years since Joe Theismann’s horrific injury, Kevin Ware, a 20-year old basketball player for the Louisville Cardinals sustained a similar injury. After landing awkwardly while attempting to block a shot at the Midwest Regional NCAA finals, Kevin suffered a compound fracture of his right tibia and fibula, the long bones of his lower leg.
A compound fracture, often referred to as an open fracture, is a type of break in which the broken bone pierces the soft tissue that encapsulates it and is exposed to the outside air. The treatment for such an injury always requires surgery where a doctor uses specialized tools coupled with metal rods and screws in order to join the bone(s) back together.
It is important to note that even after surgery, patients are at increased risk of developing a number of potentially life threatening conditions. A shortened list should include infection, deep vein thrombosis and compartment syndrome. An infection is the most immediate risk. Any open wound, as in the case of a compound fracture, runs the risk of being contaminated by bacteria outside the body and spreading within. Deep vein thrombosis, or DVT, is a condition in which one of the deep veins in the limb develops a blood clot that may partially or completely block blood flow from the affected area. If left unchecked, the clot can turn into an embolus (a traveling clot) and lodge in the lungs causing a pulmonary embolism and potential death. The last on this list is compartment syndrome. This syndrome is characterized by pressure build up in an enclosed space to dangerously high levels preventing blood flow to and from the affected limb. Without proper blood exchange, soft tissue, blood vessels and nerves can be severely damaged. The treatment for such a condition is immediate fasciotomy, a surgical procedure where an incision is made above the area to alleviate the pressure that is preventing proper circulation to the surrounding tissue.
In a case like Kevin Ware’s, where surgery has been needed to reduce and fixate at least 2 broken bones, the rehab protocol may vary greatly depending on a number of factors. Age, comorbidities such as Diabetes Mellitus, type of bone and type of immobilization are only some of the factors considered when developing an individualized treatment program. Generally speaking, a fracture may need as little as 4-6 weeks for the bone to heal. Compound fractures, however, are much more complicated and may take several more weeks or months to properly heal.
So…What is in store for Kevin Ware and how long will he likely have to rehabilitate his leg before attempting to get back on the court? At this point, unfortunately it is difficult to say. The good news, however is that he has already begun his rehabilitation and recently tweeted a picture of himself riding a stationary bike in physical therapy. Over the next few weeks, in addition to riding the bicycle (which can help with increasing range of motion and maintaining some level of cardiovascular fitness), therapy will likely focus on maintaining flexibility, gait training with axillary crutches and reducing any residual pain and swelling that may still be present since the surgery. After about 6 weeks and new x-rays that confirm his bones are healing well, the doctor may clear him to begin weight-bearing exercises. To be on the safe side, the doctor may start weight bearing at 10-25 % of full weight bearing and gradually increase it over the next few weeks until he is able to put 100% of his weight through the involved side.
One of the machines that could be used during therapy is the Antigravity Treadmill or the Alter G. Used at a SportsCare facility in Cedar Knolls, NJ, this is a machine specifically designed to unweight the body by up to 80%. This gives the patient the ability to maintain weight-bearing precautions but at the same time perform a very height intensity workout.
In as early as 4-6 months post surgery, Kevin Ware may be able to initiate straight ahead jogging with sport specific functional training taking place sometime after the 6 month marker. An unfortunate accident for such a young, aspiring athlete is difficult to swallow. A realistic, long term prognosis is that it may take close to a year or more for full recovery with return to play.
by Jim Collins, PT, OCS, CSCS