Minus a rib and two muscles, Molly O'Brien still gains All-America
honors.
By
R.J. Anderson
R.J. Anderson is an Assistant Editor at Training &
Conditioning.
It's not every day that an All-American
volleyball player is told that a rare circulatory condition will end
her career. But on Jan. 7, 2003, after leading her team to the second
round of the NCAA Division I tournament, Northern Iowa University
junior Molly O'Brien was diagnosed with thoracic outlet syndrome and
told by doctors that her playing career was likely finished.
The two-time Missouri Valley Conference Player of the Year was
not ready to look ahead to life without volleyball, however, and thanks
to a steady-handed surgeon, a hard working and communicative sports
medicine team, and her own relentless work ethic, O'Brien--this month's
Comeback Athlete Award winner--was able to reverse that career-ending
verdict.
While home in Williamsburg, Iowa on her winter break,
O'Brien had just completed a weight training session when she noticed
her right arm was swollen and turning purple. Alarmed but not in pain,
O'Brien visited her family doctor, who referred her to Mercy Hospital
in Iowa City. After an ultrasound, O'Brien was diagnosed with thoracic
outlet syndrome (TOS) as well as a deep vein thrombosis (DVT) (commonly
known as a blood clot) in her subclavian vein.
Although doctors
cannot pinpoint a definitive cause of TOS, many see weight lifting as a
common thread among athletes with the condition. Muscles and tendons
swell, compressing the arteries, nerves, and veins in the neck and
shoulder region. Although TOS can build up over months or years, its
symptoms may be acute. O'Brien hadn't noticed any problems before her
workout. The condition often results in arm, numb fingers, swelling,
bruising and, in the worst cases, thrombosis. O'Brien's thrombosis
occurred in the subclavian vein, which extends through the anterior and
mid-scalene muscles between the shoulder and neck.
With limited
experience treating TOS, the Mercy Hospital doctors referred her to
Robert Thompson, MD, a Professor of Vascular Surgery at Washington
University Medical School and an attending surgeon at Barnes Jewish
Hospital in St. Louis. Thompson, who sees at least one case of TOS each
month and has treated several professional athletes for the condition,
examined O'Brien and admitted her to the hospital. During her four-day
stay, he put her on blood thinners and began treatments to dissolve the
thrombosis. In describing the procedure he would be perform to relieve
the pressure on her subclavian vein, Thompson told O'Brien there was a
50 percent chance she could get back on the court for her senior
season--but he couldn't guarantee she would return to All-America form.
The procedure, which Thompson scheduled for a month later,
involved removing O'Brien's top right rib and anterior and mid-scalene
muscles to create space around the subclavian vein. This would reduce
the likelihood of the vein becoming constricted again and keep the
blood clot from re-forming. There was however, a downside: Once the
scalene muscles were removed, O'Brien would have to relearn movements
as simple as raising her arm above her head.
While describing
the surgery, Thompson also shared his experience treating other
athletes who have had TOS. After sending O'Brien home with medication
to help the vein recover, Thompson had one of his former patients--a
player in the National Football League--call O'Brien to tell her what
to expect from the surgery and rehabilitation. "He didn't sugarcoat
anything," O'Brien says of her conversation with the NFL player. "He
told me it was one of the hardest things he has ever gone through. He
answered all of my questions and even described his scars."
That raised O'Brien's spirits. But, she would be the first
volleyball player to go under Thompson's scalpel.
Surgery took
place Feb. 4 at Barnes Jewish Hospital. During surgery, Thompson
noticed extensive scarring in the walls of the subclavian vein, and
performed a reconstruction using a two-inch section of vein from
O'Brien's thigh to bypass the damaged portion. Thompson estimates that
in 60 to 70 percent of his TOS cases requiring surgery, he has had to
perform a vein reconstruction.
Ten and one-half hours later,
O'Brien emerged from the operating room--minus two muscles and one rib.
"It felt like a freight train had hit me," says O'Brien. "I couldn't
move for the first couple of days."
O'Brien's rehab began
almost as soon as she woke from surgery. It started with basic
movements like sitting up in bed. "You have no idea how hard it was for
me to even raise my arm," she says.
During the first couple
weeks, O'Brien, who was given her removed rib as a souvenir, says she
was very frustrated at being unable to do things on her own. Activities
as simple as carrying a gallon of milk from the grocery store to the
parking lot or taking notes in class were enough to fatigue and
frustrate her.
After a week of home-rehabilitation to improve
her posture and the range of motion of her neck, O'Brien returned to
NIU to join her classmates in the spring semester, which had begun a
month earlier. While her teammates lifted weights and worked on their
conditioning in preparation for spring workouts, O'Brien went to the
athletic training room and began the long road back, with the help of
Matt Gage, MA, ATC, Assistant Athletic Trainer at NIU who handles the
women's volleyball team.
When first diagnosed, O'Brien had
called Gage with the news. Gage spent the next six hours researching
and talking to his colleagues about TOS. He knew getting O'Brien back
on the court would be no easy task.
With the scalene muscles on
her right side removed, O'Brien's head had a slight tilt to the right.
Gage worked with O'Brien to strengthen her neck and encouraged her to
become more conscious of standing up straight with her shoulders back
and chin up.
"We strengthened those muscles by having Molly lie
on her back and do chin tucks," says Gage. "She would bring her chin
toward her chest and try to hold it. It started off as just an
isometric contraction. Once she was able to do that well, I would lift
her head up for her so that her chin was tucked, then slowly let go of
her head, and she would try to keep her chin tucked."
They also
targeted her scapular stabilization by re-educating O'Brien's lower
trapezius and rhomboid muscles to pick up the slack for her missing
scalene muscles. "The common thing is for people with shoulder injuries
to compensate for the weak or injured muscles by contracting the upper
trapezius muscle and completely ignoring the lower trap," says Gage.
"The trick with Molly was to get her lower trap and her rhomboids to do
most of the work."
To do that, Gage had O'Brien lay prone. As he
pushed her scapula toward her spine, he put his fingers over her lower
trap and rhomboids to force contraction. He then let go of her scapula,
leaving O'Brien responsible for holding it in place. At the beginning,
their goal was to complete two to five quality reps--which, at the
time, was extremely difficult. When she was able to do 30 reps, she
moved on to the next step--contracting the muscles on her own to raise
the scapula. Gage says he uses similar exercises with other volleyball
players who have shoulder injuries.
Along with two to three
hours a day working with Gage, O'Brien had two weeks of schoolwork to
catch up on. That caused a great deal of stress for the 2002 first-team
MVC Scholar Athlete. She dropped a class, but found her remaining
instructors very accommodating.
"I talked to lots of different
motivational speakers, from professors to athletic trainers," continues
O'Brien. "They advised me to make a list of short-term and long-term
goals. So I sat down with Matt and we talked it over and made some
goals that we both thought were realistic."
During her rehab,
O'Brien kept a journal. Along with recording her exercises, O'Brien
inserted motivating quotes. "If I was feeling bad about myself, I would
read those words of encouragement, or look back and see that on a
certain date I couldn't do something, but look at what I can do now,"
she says. "It really helped me get through some tough
times."
Gage used exercises prescribed by Lynette Khoo-Summers,
MS, PT, a physical therapist at The Rehabilitation Institute of St.
Louis, who coordinates rehab for many of Thompson's patients. Gage
would either accompany O'Brien on her monthly trips to St. Louis and
meet Khoo-Summers in person, or O'Brien's father would videotape
Khoo-Summers demonstrating the next stage of exercises. Gage called if
he had questions.
He says he and Khoo-Summers spoke about every
two weeks in between trips. "It also helped," adds Khoo-Summers, "that
Matt was so willing to watch and learn so that he could have Molly do
the exercises correctly."
O'Brien was also working on her
conditioning, leg strength, and footwork. "Her endurance was somewhat
poor at first," says Khoo-Summers. "She rode the bike to get back into
cardiovascular shape. That way, when her arm was ready, her legs
wouldn't have to catch up."
On April 14, nearly 70 days after
her surgery, O'Brien was cleared to begin a limited upper body weight
training program and some volleyball-specific activities. "The idea was
to slowly take what we were trying to educate her muscles to do in the
athletic training room and apply that to the court," says Gage.
Gage would take O'Brien to the volleyball court for simple
drills. In the beginning, that included having O'Brien set the ball to
herself for 30 seconds and hit 10 serves over the net from the 10-foot
line. She started with lightweight balls and worked up to
official-sized balls. "When she was able to start touching a
volleyball, that was probably the high point of our rehab," says
Gage.
By the middle of June, O'Brien--who remained in Cedar
Falls over the summer to take classes and continue her workouts with
Gage--was cleared to practice but not to play. That came Aug. 14, six
months post-surgery. Even after being cleared to play, she continued
her rehab.
The real moment of truth came during the team's
first preseason practice in August. "I was very excited, but still
scared because I didn't know how my shoulder was going to feel after
two-a-day practices--I was very uncertain about how it would all pan
out," says O'Brien. "Then during the first day of practice it felt
great and I could do everything that everybody else could do, which
gave me a lot of confidence. After preseason was over I thought, ÔOkay,
I did that, there is nothing in my way now. I can definitely make it
through the season.'"
If making it through the season includes
leading your team to the second round of the NCAA Tournament, earning a
third consecutive MVC Player of Year award, and being named an
Honorable Mention All-American, then O'Brien definitely made it.
Despite being completely cleared to play volleyball, O'Brien
continued her workouts with Gage on a limited basis for the rest of the
season. "At the very beginning of the season we worked out every single
day before practice for 45 minutes to an hour, and at some point during
the season, as she got stronger, I only had her come in three days a
week," says Gage. "We knew that if we didn't continue these rehab
workouts throughout the year, her muscles would get fatigued, and we
didn't want her to get another shoulder injury, whether it be TOC, a
strain, or anything else."
Although her comeback is not
unprecedented--there have been at least two other volleyball players to
come back from similar circumstances--being able to return to her
previous high level of skill separates O'Brien from the others.
"I couldn't have done it without the support of all the great
people around me," says O'Brien. "I had a great doctor, a great
physical therapist, and Matt was just unbelievable--he meant so much to
my rehabilitation."
"The biggest thing that I gained out of it,"
says Gage, "was seeing Molly come in every day, and the dedication and
hard work that she put in to get where she is today. To be honest,
that's what makes my job worthwhile. I can't tell you how much
enjoyment I got out of watching her this year and I learned more from
her case than I learned from any class I ever took."
The
experience of working with Thompson and Khoo-Summers has also resonated
with Gage. "They are some of the best in their profession," says Gage.
"Without the two of them, I don't know if we would be where we are
today."