Health & Fitness

Rehab a difficult time for physically active students

Daniel Angulo, last year a center for the Christopher Columbus football team, (Number 66), runs a play at a game against American Heritage School.
Daniel Angulo, last year a center for the Christopher Columbus football team, (Number 66), runs a play at a game against American Heritage School. credit

When she was in the eighth grade, Tiffany Raymond landed the coveted role of Clara for the Mencia-Pikieris School of Dance’s production of The Nutcracker. Prior to her performance, she tore one of the four major ligaments of her right knee — the ACL — when she landed from a calypso leap. She could no longer be Clara.

In the 10th grade, as Tiffany was preparing for a national dance competition for the Coral Reef Senior High School dance team, she tore her left ACL while doing a turn.

The rehabilitation process, which took a year in total, required her to wear a brace from ankle to thigh for several weeks and undergo physical therapy and surgery.

For Tiffany, the most difficult part was going from dancing every day to not being able to dance at all. Activities that seem basic, like walking and climbing stairs, she couldn’t do.

“You don’t expect things that seem simple to be so hard,” she said. “I had to reteach myself.”

Sports injuries, in a broad sense, are injuries sustained during exercise or sports.

“A lot of injuries occur because you’re stressing the body beyond its tolerances,” said Dr. Alan Novick, medical director of the Memorial Rehabilitation Institute, part of Memorial Healthcare System in Broward.

Sports injuries can be narrowed down to two types — overuse injuries and traumatic injuries. Overuse injuries result from overexercising a particular muscle, like doing too many repetitions with heavy weights or increasing the resistance on a stationary bicycle by too much. Tendinitis, muscle strains, stress fractures and pulled muscles fall under the umbrella of overuse injuries.

Traumatic injuries — broken bones, torn ligaments, sprains and dislocated joints — are more likely to require surgery.

These injuries can be a nightmare for people who are highly active because they often require long periods of inactivity, physical therapy and, sometimes, surgery.

Gym dwellers and athletes are not the only ones who can suffer from activity-related injuries. Children face unique challenges when it comes to these injuries: their parents.

Dr. Stephen Swirsky, an orthopedic surgeon at Miami Children’s Hospital, said parents sometimes push their kids too hard to perform well in sports.

“The developmental years are a time for kids to enjoy sports,” Swirsky said. “Lots of parents will push their kids to do one sport, and the kid gets hurt. The kid gets burnt out playing a sport they don’t enjoy to please their parents.”

Swirsky recalls seeing a young baseball player whose patients pushed him and didn’t allow him to take the proper time to rest and recover.

“Some parents get it and some don’t,” Swirsky said. “It’s a fine line you have to walk with an athlete and a parent about what is causing the problem.”

The physical therapy treatments depend on the type and severity of an injury. In general, they consist of a period of immobilization and rest to reduce swelling and pain, followed by periods of working on range of motion, flexibility and strength. This process can be repeated after surgery if physical therapy alone does not work.

That was the case for Daniel Angulo, 18, who played right guard on the football team in his senior year at Christopher Columbus High School. He sustained an injury while blocking the opposing team’s defensive tackle from getting to the quarterback.

Angulo felt his right arm extend all the way back as he blocked the defensive tackle, and the tackle kept running. Angulo felt a sharp pain and a pop in his shoulder.

“After the play ended, I popped it back into place, took four Advils for the pain and kept playing,” he said.

Afterward, he underwent physical therapy, but it proved to be insufficient. He had surgery to repair a labral tear, an injury of the cartilage in the shoulder joint, and is working on rebuilding his strength.

After surgery, he depended on others to help with everything from getting dressed to getting to school.

“Getting his socks on was a nightmare,” said Christine Stiltner Angulo, his mother.

Getting back in shape after suffering an injury is an active person’s main priority, but doctors say undergoing appropriate treatment for injuries is crucial to making a successful reentry to an active lifestyle and avoiding additional injuries.

“He thought he was invincible,” said Angulo. “He thought he could have surgery and be back to normal the next day.”

Patients sometimes experience depression and fear while recovering from sports injuries, said Dr. Gautam P. Yagnik, an orthopedic surgeon for the UHZ Sports Medicine Institute at Doctors Hospital in Coral Gables. He has seen the negative psychological impact his active patients experience when the exercise they thrive on is taken away.

“I see it at all levels,” Yagnik said. “At the college and professional levels, sports are their livelihood. At the high school level, a large part of a child’s identity and social interaction revolves around sports. Kids withdraw when they can’t participate.

“After about three months, patients are not as far as they think they should be,” Yagnik said. “But at the six-month point, they turn the corner. Their motion is good, the pain is good, their strength is better. They start to see light at end of the tunnel.”

At Memorial Regional Hospital in Hollywood and Memorial Hospital West in Pembroke Pines, the resolution program helps people ease back into an exercise program after undergoing physical therapy.

“Transition programs help continue the process of maintenance after physical therapy by setting up a formal program with a physical therapist, exercise physiologist and personal trainer at a fitness center,” said Novick. “It’s about providing comfort and motivation.”

In addition to physical therapy, Tiffany participated in the Jump for Return to Sports program with Swirsky at Miami Children’s Hospital, a six-week program dedicated to treating and preventing ACL injuries in athletes.

“That program played a big part in her recovery,” said Tiffany’s mother, Carol Raymond. “It was more intense than the physical therapy, and really worked her muscles.”

For Tiffany, losing the leg muscles she built through years of dancing was devastating. She started on a stationary bicycle to improve her range of motion and, as time progressed, she started doing leg raises, squats and wall sits to regain strength.

Daniel Angulo did shoulder-specific therapies for about three months after he had surgery in March 2014.

Both Tiffany and Angulo go to the gym to maintain their fitness levels. Tiffany, a senior, takes dance classes at her high school, and Daniel coaches the freshmen football team at Christopher Columbus. He graduated in the spring and is taking courses at Miami Dade College.

Their experiences inspired them to follow in the footsteps of the people who helped them recover. Tiffany shadowed Swirsky at Miami Children’s last year and wants to become an orthopedic surgeon. Angulo volunteers at the UHZ Sports Medicine Institute three days a week and wants to become a physical therapist.

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