Double Trouble

One ill-fated landing + two knee surgeries + one determined athlete. This is Ashley Hughes’ story.

By Jim Catalano

Jim Catalano is an Associate Editor at Training & Conditioning.

Training & Conditioning, 13.3, April 2003, http://www.momentummedia.com/articles/tc/tc1303/doubletrouble.htm

Right away, Ashley Hughes knew something was wrong. She had leapt above the volleyball net for an attack, but just after her feet touched the floor she felt a pop in both of her knees.

“I landed wrong, and hyperextended both of my knees,” she remembers. “They popped and I fell down, and I was thinking, ‘Oh my gosh.’ I knew something really bad had happened.”

That play, which occurred March 9, 2002, during an off-season volleyball tournament, threatened to derail Hughes’ senior season at Wapahani High School in Selma, Ind. A season in which her team was focused on attaining its first state title.

The day after her injury, Hughes’ knees were swollen and lacked full active and passive range of motion. She called Julie Wilson, MS, ATC/L, Athletic Trainer at Wapahani, and described her symptoms.

“I was really worried that one or both ACLs were torn,” says Wilson. “So I tried to prepare her by telling her, ‘You may have a torn ligament or torn cartilage or both.’”

Hughes was examined by Jeremy Hunt, MD, a sports-medicine-trained physician at Central Indiana Orthopedics (CIO) in Muncie, Ind., who diagnosed her with an acute ACL tear in the left knee and a medial meniscus tear in the right. “She was lacking a lot of range of motion in both legs, which made it hard to get a good exam,” Wilson says. “He determined the left ACL was torn and would need surgery, but it was hard to tell with the right knee because it was almost locked. She couldn’t get full extension or full flexion, and he thought the meniscus might have been causing the locking.”

The torn left ACL diagnosis was confirmed by L. Jay Matchett, MD, a surgeon at CIO. On April 10, Hughes underwent ACL reconstruction surgery with a patellar tendon graft on her left knee. Matchett also decided to test her right knee when it was totally relaxed under anesthesia.

“When he checked the right knee, he said, ‘I think she’s torn this one too. I’m not getting a good end point,’” Wilson remembers. “He said she would need to get an MRI done once she started rehabbing the left knee.”

Nine days later, Hughes began rehab under the care of Beth Panwitz, MS, ATC/L, athletic trainer at CHS HealthStrategies in Muncie. Three-times-a-week sessions consisted of range-of-motion exercises, neuromuscular re-education, and soft-tissue mobilization along with closed-chain exercises and functional sport-specific activities for strengthening.

Two weeks after her surgery, Hughes complained that her right knee actually felt more unstable than her left. Matchett ordered the MRI of her right knee, which revealed a torn ACL and medial meniscus.

Hughes took the news hard. “After I found out I tore my second ACL, I thought there was no hope,” she says. “At first I was just really depressed and sulking about, because I’m an athletic person and all I do is athletics. But then I decided that this didn’t need to make or break my life. I knew I could do anything I set my mind to, so I just decided to work my hardest to make it back.”

And make it back she did, in time to help her team take the state title. For her determination to overcome the odds, Hughes has been named T&C’s High School Female Comeback Athlete for 2003. Also honored are the members of her comeback team: Wilson, Matchett, Hunt, and Panwitz.

Before her injury, Hughes was slated to play a key role for Wapahani, since the 5’7” outside hitter had already played two seasons on the varsity team. “We thought she was going to be our best offensive player coming back,” Wapahani Head Volleyball Coach Mike Lingenfelter says. “After she blew out both knees, I wasn’t planning on her ever making it back.”

Hughes, however, was increasingly confident of a successful double rehab. “My first surgery came out really well, so I felt confident with my second one,” she says.

Six weeks after her first ACL surgery, Hughes returned to the operating room to have her right knee reconstructed. Ten days later, she started rehabbing that knee, following the same protocol she had commenced on the left in April.

“They pretty much had her first ACL knee doing functional work and speed work before surgery on the other one,” Wilson says. “It didn’t take that long to get back, mostly because she was in such good physical condition. Even before this happened, she was the type of girl who was in the weight room, lifting, doing plyometrics, and doing what it takes to become better at her sport. That’s what helped her get back to what she loves doing, which is volleyball.”

By August, Hughes was doing well enough with her rehab that Matchett allowed Panwitz to progress her to an advanced level of sports-specific training. Hughes worked on passing, setting, and hitting form, and quick movements for both knees that avoided planted feet. She soon advanced to deceleration techniques and plyometrics.

“It was difficult at first,” Hughes says. “I thought everything was going to take a lot longer, but Beth was a really good therapist and she helped motivate me a lot, helped me set my goals and stay on track.”

Impressed with Hughes’ progress, Matchett released her from a formal clinic-based protocol in late August. Hughes continued with her sport-specific rehab activities at school under Wilson’s supervision.

“At that point, the first knee was 95 percent better, and the other one was getting there quickly,” says Wilson. “So we starting doing things that would get her back into practice. She started with the fundamentals of volleyball, worked on things slowly, and built from there.”

Hughes began working on blocking form and improving leg strength, running through drills such as wall sits, plyometrics, proprioceptive techniques, and jumping and landing techniques. Hitting was the final skill that Wilson targeted. Wilson started with imagery drills, in which Hughes imagined approaching the net and attacking the ball while analyzing each component of the hitting process. She soon began hitting drills, and once she regained her technique, she was cleared to resume live hitting.

“We really worked hard with imagery for getting back into hitting,” Wilson says. “She had to really focus on what her perfect hit would be—not the last one she took, which was when she blew out her knees, but every one before that. I stressed to her to think, ‘How do you set up? How do you approach the ball?’

“I wanted her to overcome those fears before she ever tried to hit a ball, or even worked on the approach,” Wilson continues. “I was worried there would be a mental factor, but there never seemed to be one because she really wanted to get back and participate. Someone had taken her spot in the starting rotation and that ticked her off. She wanted to work hard to come back and contribute.”

In early September, Hughes was released from Matchett’s care and allowed to fully participate in the remainder of her senior volleyball season. A week later, she returned to the court as a junior varsity player.

“We put her on the j.v. squad, like a rehab assignment going down to the minor leagues,” Lingenfelter says. “She took to it right away, and never had a problem with it. She just wanted to get on the court and prove herself. At no point did she ever seem afraid or hesitant, which kind of surprised me.”

“It was hard for me, because I had played varsity the previous two years,” says Hughes of her j.v. stint. “But I had to look at it as helping me get to where I needed to be.”

Hughes continued to work on improving her vertical jump, and by October, she was ready to reclaim her varsity status. But she had to accept a new role. “The young lady who was playing in front of her was doing a nice job, so Ashley had to assume more of a utility role,” Lingenfelter says. “But it was nonetheless a critical role in our success. Without her, I don’t think we’d have gotten where we did.”

“When he put Ashley in, it was like she had never left,” Wilson says. “Since she wasn’t able to get the height yet, she became the back-row specialist. She’s got really good hands, and in the place she was at in the rotation she could easily place some balls that would take a lot of pressure off the setter.”

Hughes quickly adapted to her new role. “I was used to being a starter, but I felt like I helped the team more by being at practices,” Hughes says. “I would’ve liked to play a lot more and start and be more of a contributor in the games than I was, but I’m satisfied with how everything went.”

Lingenfelter agrees Hughes has much to be proud of. “She did a lot for us off the court, and she did a good job with her teammates as far as inspiring their drive and getting them to focus,” he says. “She never really let them break down.”

That season turned into a stellar one for Hughes and her teammates. In November, Wapahani claimed its first-ever Class 1A state title, with Hughes playing a key role in the team’s playoff run. “During the tournament she gave us valuable minutes, especially in the semi-final game and in the final game when she came up with a big block and a big save,” Wilson says. “She was almost back to her old form at that point. It was just great to see her out there again playing like that.”