Twice Motivated

During her rehab from two successive ACL tears, Katie Scherle found the motivation to not only recover, but to become a better athlete.

By Shelly Wilson

Shelly Wilson is an Assistant Editor at Training & Conditioning.

Training & Conditioning, 12.3, April 2002, http://www.momentummedia.com/articles/tc/tc1203/cbacktwice.htm

When Katie Scherle began her freshman year at Clearview Regional High School in Mullica Hill, N.J., in 1998, she had visions of leading her school's basketball and softball teams to success. A 6' 10" center, she also had the dream of playing NCAA Division I college hoops one day. But two successive, season-ending knee injuries in two years would call that dream into question.

Rather than focus on the injuries and the limitations they posed, Scherle concentrated on her desire to compete again and found motivation where many others find only frustration. With the help of orthopedic surgeon Arthur Bartolozzi, MD, of 3B Orthopedics in Cherry Hill, N.J.; Clearview's Head Athletic Trainer Guy Midure, ATC/R; Clearview's then-Head Basketball Coach Phil Stumpf; and Mary Jane Bianco, MS, PT, of NovaCare Outpatient Rehabilitation in Blackwood, N.J., Scherle not only recovered from her two injuries, but actually surpassed her previous athleticism. For her unfaltering determination and resilience, Training & Conditioning is pleased to name Katie Scherle the 2002 Female High School Comeback Athlete of the Year.

The first injury occurred in Scherle's freshman year. During an inconsequential match at the end of her basketball team's regular season, Scherle anticipated her opponent's pass and tipped it loose. In the scramble to gain possession, Scherle and an opposing player collided. Hard. It took Scherle only one moment to realize something was wrong with her left leg, and it took Midure only one look to suspect an ACL injury.

"There was immediate swelling and immediate muscle guarding," says Midure. "All the special tests, like Lachman's and anterior drawer, were inconclusive because of the muscle guarding. But Katie said she felt something pop and something give, and because of the mechanism of injury, I suspected an ACL if not an unhappy triad. So I immediately packed her in ice, immobilized her, and sent her over to the emergency room."

An MRI revealed a Grade 3 rupture to Scherle's left ACL. When Scherle discovered she'd need surgery, she took the news very hard. "I was very upset," she recalls. "I cried and thought for sure that was the end of me playing sports. But that's because I wasn't that knowledgeable about knee injuries. Once my doctor told me that many athletes experience this kind of injury and that it was something I could overcome very easily, that lifted my hopes."

During the three-week wait for surgery, Scherle followed Bartolozzi's pre-surgery therapy regimen. "Basically we did a ROM and strengthening program to get the joint ready to undergo surgery," says Bianco, "because some people lose range of motion and that can make the rehab more difficult post-surgery. So, she did the stationary bike, the Stair Master, and strengthening exercises on various machines."

While many would have been preoccupied with their own plight, Stumpf recalls how quickly Scherle's attention turned toward her teammates. "We were about to enter the postseason and the team was wrestling with personnel switches without our powerful center," says Stumpf. "But Katie attended every practice and game while simultaneously preparing for surgery."

"I still wanted to feel like I was a part of the team," Scherle explains. "And I wanted to give every ounce of support I could to my team."

With surgery on her knee completed and a cadaver ligament replacing her torn ACL, Bianco settled her into rehab. They met three times a week for three months. The first eight weeks of work went slowly and focused on range-of-motion work, quad tone and strengthening, plus hip, hamstring, and calf strengthening exercises. To protect the grafts in her knee, which are at their most vulnerable point during weeks four through eight, all early work was done closed chain.

"Because part of the protocol focus was on quad tone and strengthening, we utilized neuromuscular re-education--electric stim to promote the contraction of the muscle," says Bianco. "We did that 10 minutes each day prior to starting her full rehab. To improve range of motion, we worked her on the bike, and during weeks one through four, she was allowed to do mini-squats and use the Stair Master."

By week eight, Scherle's ROM had improved, and rehab moved to open-chain activities. Proprioceptive drills, including balance board work, were introduced to enhance multi-plane movement. Cuff weights, squats without support, and work on machines like the leg press and the Cybex machine with an anti-shear device were used to build strength in her knee.

Meanwhile, Scherle had to carry out an at-home exercise regimen three times a day. That regimen included quad sets, straight-leg raises, and stretching. What's more, she was instructed to spend six to eight hours a day on a passive-motion machine.

While Scherle had come to terms with how long it would take to return to play, her optimism was challenged by the physical discomfort of rehab. "I had no clue what kind of pain I'd have to go through in order to come back," she recalls. "And lifting weights to re-build my leg muscles was the hardest part to cope with. Prior to my injury, I took it for granted what good shape my legs were in. In rehab, it was really hard to push that bar up and I really had to focus to do it, which was frustrating. But that made me even more determined to overcome the injury because I thought to myself, 'I can't be doing this for the rest of my life!'"

A model patient throughout her rehab, Scherle's enthusiasm for recovery did, at times, mean Midure and Bianco had to restrain her activity. "She was always the type to ask, 'Can I do more work?'" says Bianco, "but we just weren't able to because of the parameters of the protocol."

In late August, with no setbacks, Scherle was cleared to return to activity and turned over to Midure's care. "I gave her a training program that included some very minimal plyometrics, leg strengthening, speed work, and cardiovascular exercises that she followed in the weight room next to my office," says Midure.

By the time basketball rolled around, Scherle was ready to test her knee in competition. "When I started playing, I was real hesitant and needed to regain confidence in my knee," she says. "Also, I had to wear a big brace on my leg whenever I did anything physical, so I had to get used to the limitations that created. At first, it was uncomfortable, and I would bang my other leg against it and bruise the inside of my right knee. But it didn't weigh down my leg at all, and eventually I got used to it."

In addition to regaining confidence in her knee, Scherle wondered how so much time away from competition would affect her game. But according to Stumpf, her worries were groundless. "Despite the lost time, Katie arrived for try-outs her sophomore season stronger and more fit than the previous year," Stumpf says. "She played with an even greater, but more focused intensity, and eclipsed her previous year's scoring average by five points to bring her to 20 points a game."

With a full comeback apparent, and only a few weeks left in her second season, Scherle began to breathe easy. Relief, however, would be short-lived. Almost a year to the day after her first injury, Scherle suffered her second torn ACL--this time to her right knee.

"It was at the end of the regular season, again, and I went up for a rebound," she recalls. "This time no one touched me. I came down hard and I felt my right leg go out on me. The second it happened I said, 'I did it again.' Everyone else was saying, 'No you didn't. Don't say that. You're going to be fine.' But they were in denial."

While her second injury was eventually diagnosed as another ACL tear, Scherle also suffered a torn meniscus. Bartolozzi prescribed the same pre-surgery and post-surgery rehab protocols as before, but this time, because of the meniscus, Scherle's knee mobility was a little less favorable.

"Her range of motion was limited in the beginning," says Bianco. "When she started rehab the second time, she had only 59 degrees of motion actively, and on her belly she had 81 degrees bending knee flexion. So that's pretty limited. But then again, she had only had surgery one week prior. Because of the meniscus tear, we weren't able to stretch her past 90 degrees for the first weeks. But once she got past the four-week mark, we were able to stretch her beyond that [and proceed more quickly]."

Despite being faced with yet another greuling rehabilitation, Scherle never let her circumstances get the better of her. "The second time around it was more of a mental challenge," she says. "I remember thinking on my first day of rehab that this was going to take forever. But I just kept thinking, 'Your left leg is fine. Look how great it's doing. It can hold its weight. It's working. And that's how your right leg is going to be when you're done with this.'"

As another basketball postseason and another softball season passed her by, Scherle worked with Bianco on her recovery, attended all basketball and softball practices, and supported her teams from the bench. And this time, when Scherle began her fall fitness regime with Midure once again, the junior had some company.

"She took about three or four freshmen under her wing and had them doing it with her," Midure says. "That's the kind of leader she is."

For Scherle, mentoring the recovering freshmen was a logical move. "I had learned so much during those two rehabs about how to train my legs and about cardiovascular fitness--what to do, what not to do, how to do exercises differently to improve how your muscles react--that I wanted to help other people through their injuries and give them some inspiration."

When she entered her junior basketball season, Scherle's rehab efforts were rewarded. With her at the post position, the Pioneers won 21 games, took the Tri-County Championship, and advanced to the semi-final round of the state tournament.

Her inaugural year on the mound was no less impressive. "The team had no pitching her sophomore year and went something like 0-13," says Midure. "The following season, with her on the mound, they made it to the finals of the state playoffs." What's more, Scherle led her region in both strikeouts from the mound and home runs as a batter.

This year, with two successful and injury-free seasons on the court behind her, Scherle was able to look back with satisfaction. But the future still created some uncertainty. She knew she had done her best to overcome her injuries, but she didn't know how those injuries would impact her college hopes.

"During the recruiting process, coaches would actually question me about my injuries and wanted to look at my legs before they offered me a scholarship."

Now slated to play basketball for Loyola College in Maryland in the fall of 2002, Scherle looks back on her experience with gratitude rather than regret. "At the time, I didn't know how hurting my knees would affect my abilities," she says. "I wondered if it would make me slower or if I'd be unable to do certain things. But I've found it's just the opposite. I can do a lot more now, athletically. I know both of my knees are stronger than they were before, and the comebacks taught me how to jump better so my knees don't take so much of the stress. When I jump, play the post, rebound, shoot, and land I'm more stable. I've learned how to move better, and that has helped me playing basketball and softball.

"It's also given me a lot more self confidence on the court and mound," she adds. "A lot of people ask me if I hurt my knees again, will I just say, "That's it. I quit. I'm not playing sports again!' And I've always found myself telling them, 'No. I'm going to get myself right back up, dust myself off, and do it again.'"