A Leg to Kick On

A gruesome injury turns into a tale of recovery

By Dennis Read

Dennis Read is an Assistant Editor at Training & Conditioning

Training & Conditioning, 12.7, October 2002, http://www.momentummedia.com/articles/tc/tc1207/legkick.htm

As Wabash College place kicker Todd Bower lay on the Hiram College football field with a double compound leg fracture and a compound ankle dislocation, Jack Mansfield, ATC/L, Head Athletic Trainer at Wabash, thought back to an athlete he had treated a few years earlier. That athlete suffered a compound ankle dislocation and still walks with a pronounced limp. So Mansfield’s hope was that Bower might eventually be able to walk normally again.

Bower had completely different thoughts going through his mind. As Mansfield prepared to cut Bower’s sock and special kicking shoe to allow for reduction of the ankle dislocation, Bower told him, with shock setting in, “Don’t cut my shoe. It’s a brand-new shoe, and I’ll need it for next year.”

Although Mansfield didn’t think there was much chance Bower would ever need that shoe again, he complied with the player’s request. And Mansfield was more than happy to be proved wrong when, less than one year later, Bower boomed his first kickoff of Wabash’s 2001 season, marking the conclusion of a remarkable comeback worthy of Training & Conditioning’s Male College Athlete Comeback Award.

Mansfield had good reason to be skeptical. Either injury by itself could be serious, a point driven home when San Jose State defensive back Neil Parry had his right leg amputated just below the knee after his compound leg fracture became infected. Bower’s injury occurred on Oct. 21, 2000, just a week after Parry’s, and like Parry’s, happened in a pile of players as he made a tackle on a kickoff return.

Upon reaching Bower, Mansfield stabilized the leg and called for Wabash’s Orthopedic Consultant, Ron Noy, MD, who had accompanied the football team to Hiram. Noy directed Mansfield to continue stabilizing the leg while he reduced the ankle dislocation.

“Todd knew he was hurt, but he wasn’t aware of the extent of the injury,” Mansfield says. “We didn’t want him to do any more damage by trying to get up or lifting the leg up where he could see it.”

After Noy reduced the dislocation, they put on a vacuum splint to hold the leg in place and put Bower in an ambulance headed for University Hospitals Health System Geauga Regional Hospital in Chardon, Ohio. Bower’s parents were at the game and followed him to the hospital.

“The initial plan was for him to go to the hospital for immediate care and stabilization,” says Mansfield, who remained at the game. “Depending on the results, we thought we might try to transport him back to Indianapolis to have our orthopedic group take care of him.

“But the orthopedist in Ohio started to care for the wound and felt that the injury needed to be taken care of right away,” Mansfield continues. “And after what I later read in the paper about the player out west [Parry], I’m glad we didn’t wait to provide that care.”

George Kellis, MD, directed Bower’s care at the hospital. Bower underwent surgery that involved internal fixation of the tibia and fibula and repair of the deltoid ligament of the ankle. He was placed in a lower leg cast and returned home to Indianapolis the next day with firm instructions to put no weight on the right leg.

“Dealing with this kind of injury is more difficult on the road because you’re in an unfamiliar setting and a little at the mercy of what they have available,” Mansfield says. “Thank goodness the athletic trainer from Hiram [James Johnston, ATC] was out there and had his emergency plan in place.”

Two days after returning home, Bower went to see David Porter, MD, of the Methodist Sports Medicine Center in Indianapolis to begin follow-up care. He was instructed to put no weight on the leg for another week, at which point he was cleared to begin bearing partial weight.

By the end of November, Bower was bearing full weight while still in a cast. In mid-December, the staples from the original surgery were removed, and he was put in a smaller walking cast. As the new year began, Bower was fitted with a removable cast/brace and commenced range-of-motion exercises for his ankle.

The screws and plates were removed on Jan. 23, 2001, and Bower’s last appointment with Porter was on Feb. 6, after which he began an aggressive rehabilitation. Mansfield started the program with alphabet range-of-motion exercise, towel stretches of the calf, cord exercises, and Stork stands for proprioceptive re-education. After a few weeks, Bower progressed to Phase Two of his rehab, which added walk-jog-run therapy and functional progressions, followed by calf extensions and squats.

According to Mansfield, Bower’s drive and determination were the biggest factors in his comeback, but they also presented a potential hurdle to his rehabilitation. “The biggest challenge with Todd was keeping him from overdoing it,” Mansfield says. “From the time we started, we had to hold him back and say, ‘Todd, let the wound heal before you start to rehab.’

“We explained that to him several times, but at that age, they start feeling better and think, ‘I can move ahead by leaps and bounds,’” Mansfield continues. “There were a couple of times he got a little sore, which was a good indication that he was pushing too hard. Sometimes when you overdo it, you cause some setback or new injury, but fortunately for Todd, the soreness only slowed him down a little.”

Bower started kicking a soft football in the middle of April and by the end of the semester was kicking a regulation football. By this time, Mansfield was convinced that Bower would be able to come back.

“Once I saw how much success he was having with his functional work, I began to think he really might kick again,” Mansfield says. “The concern was still the compound dislocation. If scar tissue develops on a ligament or in the soft tissue around the ankle, then that can cause an adverse effect on function. And if scar tissue builds up in that joint space, when you kick a ball, the trauma from the impact can be painful and eventually you stop kicking.”

Bower continued to kick throughout the summer, but faced a new challenge when he reported for the first football practice on Aug. 22. The coaching staff turned over completely after the 2000 season, leaving Bower to prove himself to a new group of coaches.

“I have to admit, I didn’t think he would be a factor for us,” says Brian Ward, Wabash’s special teams coach. “People kept telling us about how hard Todd was working, but it was hard to believe he’d be able to come back from something like that.”

It didn’t take long for Ward to be convinced otherwise. “It was on the first day of camp,” he says. “He came out and crushed a kick off and we said, ‘Hey, this guy still has some leg.’”

Ward says Bower’s kicks didn’t have quite the distance they had before, but they were long enough. The coaching staff did make a few adjustments on Todd’s behalf, though. First, they told him he was more valuable as a kicker than as a tackler and asked him to avoid any unnecessary contact.

Knowing that he was unlikely to heed that advice, the coaching staff slightly adjusted their kickoff coverage strategy. Instead of kicking down the middle, they had Bower kick toward the sidelines in hopes of reducing the chances for a long return by pinning the receiver. The idea was to have someone else tackle the returner before Todd could get to him. “Whenever he got on the field, it was like trying to collar a pit bull,” Ward says. “I don’t know if they come much stronger-willed than him.”

In the fall of 2001, Bower was kept busy handling kickoffs for the Little Giants, who ranked 19th among NCAA Division III teams in points scored. He helped the kickoff team hold opponents to an average return of 16 yards on 63 kicks and made three tackles, including one on the opening kick of the season.

Bower’s contributions were felt off the field as well. Kickers are not always viewed as the toughest players on a football squad, and Bower is 5-foot-7 and 150 pounds. But when Bower’s teammates saw what he went through to return to the field, his size or position didn’t matter.

“We had some guys with knee injuries, and looking at Todd they saw a smaller guy working hard with a great attitude,” Ward says. “And his attitude ultimately overcame the injury he had.”

Not surprisingly, Bower wasn’t content with simply returning to the football field. He had played soccer and football in high school, but stopped playing soccer when he came to Wabash so he could concentrate on football. In the spring semester of his senior year, Bower returned to the soccer field and played with the Little Giants during their spring season.

“There are no real lasting effects from the injury,” Mansfield says, “though I’m sure it aches with the weather and those kinds of things. And I think there are two reasons he was able to recover that way. One was the medical care he received after the injury. The work the doctor on the sidelines did to reduce the ankle dislocation and the care he got at the hospital were remarkable, top-notch care.

“Then there was Todd’s will and determination,” Mansfield continues. “There were some long days for him, but I don’t think there ever was a doubt in his mind that he would recover.”

Award Winner Todd Bower
Category: College Male
Sport: Football
School: Wabash College
Injury: Compound ankle dislocation, double compound leg fracture, torn deltoid ligament
Comeback Team: Jack Mansfield, ATC/L, Head Athletic Trainer, Wabash College; David Porter, MD, Methodist Sports Medicine Center; Ron Noy, MD, Methodist Sports Medicine Center; George Kellis, MD, University Hospitals Health System Geauga Regional Hospital.