Kolarik battles through long knee rehab

HARTFORD, Conn – If you want to see the personification of tough luck, look no farther than Connecticut Whale right wing Chad Kolarik.
 
After persevering through nagging hamstring problems last season to earn kudos from New York Rangers coach John Tortorella for his work during four games with the parent club, returning to continue his solid play in the AHL playoffs and then getting a contract extension on June 17 and married on Aug. 5, Kolarik was primed to enjoy a run at a steady job on Broadway.
 
Then on Sept. 20, the fourth day of training camp, Lady (Bad) Luck reared her ugly head. As Kolarik went to make a play along the boards, he caught his right skate in a rut in the ice at the Rangers’ training facility in Greenburgh, N.Y. Kolarik went to the dressing room, and over the next few days, took several ACL tests and was evaluated by Whale athletic trainer Damien Hess, Rangers athletic trainer Jim Ramsay and Rangers physician Andy Feldman, an orthopedic surgeon. Kolarik’s exam was not conclusive for a torn anterior cruciate ligament in his left knee, and he was scheduled to make his preseason debut against the Philadelphia Flyers six days later.
 
“It was an innocent play,” Kolarik said. “My skate got caught in a rut, and I just went the other way and my leg didn’t come with me. There was a little bit of a bump, but it wasn’t anything unusual. I just got stuck, and my knee went in. I felt something pop, but it just felt like a bone crack, something releasing. I honestly thought it was just something in my knee that cracked. Never once did I think it was my ACL. I could walk fine. It never swelled up. I even saw the doctor after the ACL tests and he said he thought I was fine.”
 
But when Kolarik tried to skate a few days later, the pain persisted and he couldn’t push off. He informed the trainers that something was wrong and went for an MRI on Sept. 26, the day the Rangers left for Europe. Kolarik then headed for Hartford, where he got the news, which wasn’t good. In fact, as hockey injuries go, it was as bad as it gets unless he had torn his Achilles tendon.
 
“When I got the MRI, I thought it could be an MCL (medial collateral ligament) and I’ll be out for a couple months and then be back,” Kolarik recalled.
 
But when the doctor called, Kolarik learned the freak accident had resulted in a torn anterior cruciate ligament. Forget that preseason game. In fact, forget possibly 60 or 70 games, maybe the entire season.
 
“All I could think of was how long I would be out and if surgery was needed,” said Kolarik, sporting a four-inch scar on his left knee. “Josh Gorges on the Montreal Canadiens has played seven years without an ACL. You can strengthen the muscles around it, but I’m only 25 years old and hopefully have a long career ahead of me, so I figured I’d get it done now.”
 
After Kolarik prepared for surgery by strengthening the muscles around his torn ACL as much as possible, Dr. Brett Wasserlauf, an orthopedic surgeon and head team physician, performed a two-hour operation at St. Francis Hospital and Medical Center in Hartford on Oct. 5, taking the central third of Kolarik’s patella tendon and using it to replace the torn ACL. Using part of an athlete’s body prevents any chance of rejection, and a bone plug makes for a more secure fixation in the tunnels that are drilled.
 
“It’s generally the graft of choice with athletes who have torn ACLs,” Hess said. “The only thing that you have to be careful with is guys will sometimes get patella femoral pain, but that just comes from rehab because you’re pushing so hard. But, knock on wood, the guys who we’ve done here – Dane Byers, Michael Sauer, Brent Henley and Francis Lessard – haven’t had any significant patella femoral pain.”
 
The other two pieces of the patella tendon will eventually fill in with scar tissue so the tendon becomes whole again and hopefully makes the knee stronger than ever. But that will take countless hours of often tedious rehabilitation “to try to put a smile on my face” with Hess and Whale strength and conditioning coach/trainer Mark Cesari.
 
“I feel pretty good, but I’ve never had anything like this,” said Kolarik, who usually works out three hours a day, six days a week. “At first, it was tough mentally when you’re missing most of the season, out five to six months for sure. It wears on you in the first couple of weeks because you can’t do anything for yourself. I just got married this summer and thank God for my wife Kylee. She was taking care of me the first two weeks (after the surgery) because I could barely walk and couldn’t make any food for myself.
 
“Now I can do stuff on my own. I’ve still got a little bit of a limp, and I’m trying to train my brain how to get over that limp. When you’ve been limping for three weeks off crutches, you kind of get used to it. I don’t need to limp. I don’t have anything wrong with my knee anymore, but it’s just in your mind you have to get rid of it.”
 
Yes, the mental drain has been the most difficult part so far for Kolarik.
 
“It’s different for me coming to prepare (for rehab) and the guys going on the ice to be prepared for a game,” Kolarik said. “I have to be prepared to struggle a little bit and try to get over that hump. Two weeks ago I couldn’t do step downs, and now I can. It’s rewarding to achieve those little goals. The mental part is definitely crazy. You try not to look at the big picture.
 
“That six-month mark is tough to keep out of your mind because it will just eat at you, but if you can keep little goals and go week-by-week, day-by-day and try to get better, try to make little strides and do a new exercise every day, it helps mentally. You try to put that smile on my face to know that you’re progressing every day.”
 
Kolarik “warmed up” for his unprecedented rehab with several months of workouts to combat hamstring issues last season, when he was traded to the Rangers from the Springfield Falcons, the AHL affiliate of the Columbus Blue Jackets, for Byers, a left wing and Wolf Pack captain at the time. Kolarik had 17 goals and 14 assists in 36 games with the Whale and tied a franchise record for points in a period with four, including a team-record two shorthanded goals, in the first period of a 6-3 victory over Wilkes-Barre/Scranton on Jan. 16. He also had one assist in four games with the Rangers before missing nearly the last two months of the regular season. He returned for the playoffs and had three goals and two assists in three games, but the Portland Pirates eliminated the Whale in six games.
 
Then came Kolarik’s contract extension, marriage and … disaster.
 
“I had never been out for any significant time until last season, but that’s nothing compared to major surgery and reconstructing your ACL,” Kolarik said. “I thought my chances to make the Rangers were all right. I wasn’t thinking I was going to make it right out of camp because they had 13 forwards on one-way contracts, but I hoped to play well in Hartford and get a call-up. Anything can happen, as it has this year (with Andre Deveaux, John Mitchell and Carl Hagelin) and last season, when six forwards got called up. I was hoping it would be a big year for me, but stuff happens and you have to roll with the punches.
 
“I don’t want to be cliché, but when these things happen, you have to just stay positive and keep the little goals in mind instead of thinking about that six-month mark. The good thing now is the doctors are real good at it, and Dr. Wasserlauf did a great job. We did a test two weeks ago, and he said the left knee is stronger than the other one.”
 
Whale coach Ken Gernander said Kolarik’s injury was “an unfortunate situation” after the right wing had a solid 2010-11 season and wanted to show himself in training camp and hopefully get to play in a preseason game or two and see where things took him.
 
“To be taken out of the equation by an injury, not anything that he could control himself, is tough,” said Gernander, whose worst injury in a 30-year playing career was being out for six weeks with a sprained knee and having to wear a brace for the remainder of the season. “If you came into camp in bad shape or played poorly, then you can kind of beat yourself up a little bit and learn from it. But an injury is just an unfortunate setback through no fault of your own. And it doesn’t matter how it happened because you’re left to deal with the injury, and he’s going to have to put a lot of hard work into rehabbing and getting himself back into top shape so his game picks up where it left off.”
 
Kolarik is thankful for the help from Hess, Cesari and Kylee, a star gymnast whom he met at the University of Michigan, where he was senior when Hagelin was a freshman. He also is indebted to Whale defenseman Jared Nightingale, who tore an ACL when his skate caught a rut on a seemingly innocent hit during his rookie pro season (2006-07) while he was with the ECHL’s Idaho Steelheads. Nightingale again showed why he was the Whale’s AHL Man of the Year last season when he spent time with Kolarik discussing what he faced and how to deal with it.
 
“He was really good helping me out for the surgery,” Kolarik said. “I picked his brain for a long time about everything, and he straight up told me, ‘This will be one of the hardest things you’ll ever have to do rehab-wise. It’s four months of hell before you actually start doing stuff.’ ”
 
Nightingale said he wanted to help because when he looked back on his surgery, he had wished he knew someone who had been through the same thing.
 
“I knew initially he was going to be down mentally, and you can look at it two ways,” Nightingale said. “You either have to dig you heels in or not really feel bad for yourself. I just wanted to let him know things I wish I would have known. The first few weeks after surgery are really important and tough to go through as far as comfort and battling through. With ACL surgery, I think it’s key to get after it right away and get your momentum back, and Chad has done a good job. He already has a good attitude about that kind of stuff, but I think just me being through it …
 
“I think I came back as a better player going through something like that because I’m mentally stronger. And when Chad looks back, I think he’ll be thankful that he went through it. As strange as that sounds, I think he’ll appreciate things a little more when he comes back as a better player. I know it was frustrating at the time, but now looking back, I appreciate what I’ve got because it still took me a couple years to get up to the AHL. Chad has already had a taste of the NHL, and I’m sure he could get frustrated thinking, ‘Ah, if only this hadn’t happened.’ But I think some of the best stories are guys who have overcome adversity, and Chad has been amazing. He comes in and does his work better than I did five years ago. He has a very strong work ethic and good attitude.”
 
But Kolarik can’t make it all the way back without plenty of help.
 
After consulting with Nightingale and having surgery, Kolarik began rehab with Hess, with regaining range of motion the first key element.
 
“Generally the more you can get out of him going into surgery, the better you are coming out,” Hess said. “We tried to keep him as strong as we could and had to focus on his hamstrings a lot from last year, and hamstrings are vital in terms of an ACL rehab, so he had that a little stacked up against him going in.”
 
But Hess and Cesari made sure there was a quick start to Kolarik’s rehabilitation.
 
“It’s a long rehab, and if you immobilize something for too long, it just makes it more difficult,” Hess said. “Years ago, they would immobilize guys for four-to-six weeks following an ACL surgery, and they find now that that’s the worst thing to do because of the atrophy that makes it so stiff.”
 
Kolarik was close to bed-ridden for about two weeks, then used crutches for a month and got out of a brace after six weeks. He continues to walk with a slight limp, but Hess said Kolarik got all his range of motion back “fairly quickly” and the focus is now on getting his strength back to normal.
 
“He has more than enough motion to walk,” Hess said, “but from being in a brace for so long and favoring it for eight weeks he’s trying to retrain his brain to understand that his knee can tolerate the stress of walking.”
 
Hess and Cesari said Kolarik is on schedule, and once he regains his strength, he can work on more sports-specific rehab such as getting back on the ice.
 
“There’s a lot of head games you have to play with guys because there’s a lot to focus on,” Hess said. “They want to see the big picture, but I always stress that you can have a goal for the end game but have got to have objectives and goals to meet along the way. Otherwise, all you’re thinking about is six months, and that’s just too much to focus on when you’re dealing with a rehab that long.”
 
The early part of rehab is difficult because Kolarik and other patients aren’t doing much, just working on motion and don’t feel like a normal person because they’re not doing normal things. Cesari allowed Kolarik to use a stick to play with a puck in his office area without any body rotation a few weeks ago, and Kolarik began shooting off ice at Champions Skating Center in Cromwell on Friday. He is moving better and getting closer to normal, so the next few weeks are vital in terms of training so he can start feeling like an athlete again.
 
Cesari said Kolarik’s recovery is a four-step program of range of motion, strength, running and skating, which constitutes his “squat to sprint” philosophy. If the athlete can’t squat, then he or she can’t jump, and if they can can’t jump, then they can’t run without risking the body breaking down. So the first step was to get Kolarik’s range of motion in his knee back so he could squat and move forward.
 
“Just because you have the range of motion doesn’t mean you can squat,” Cesari said. “About 95 percent of people cannot squat. They think they can, but they can’t do it properly. So the job is to get the muscles strong enough to allow him to do that squat, and that’s basically where we are right now. Eight-to-12 weeks is the time where things start to get a little more interesting in the sense that by 12 weeks he might be able to run. Then maybe he can start on the ice, but it all depends on the individual.”
 
Kolarik reached the eight-week mark last Wednesday, and again, the key is to keep him or anyone focused on the end result but setting goals along the way to divert his or her attention. Cesari said he has seen a lot of improvement the last few weeks as far as range of motion, strength and confidence.
 
“It’s a tough surgery for anyone to come back from, let alone try to come back as quickly as possible and still being strong enough to compete in your sport,” Cesari said. “My job is to make sure that he comes back only when he’s 100 percent and strong enough. And sometimes this surgery is a blessing in disguise in the sense that you break down the body, teach the body to re-walk, how to move and how to be strong. Once you have surgery, you’re off your feet for a couple of days, you forget how to walk, you’re not allowed to walk at first and muscles have to regenerate and learn how to use them again.
 
“And the brain plays a big part in the surgery. Let alone the physical demands of the rehab, the mental demands are probably just as high, if not more. So my goal is to get him as strong as possible, as functional as possible, so not only can he come back and be a force for us in the playoffs, but also so he can come back and not have to worry about hurting the knee again. Subconsciously, once you tear you ACL, it’s always in the back of your mind. My job is to make him as strong as he possibly can be so his confidence is there so he doesn’t have to stress about his ACL. It’s not an easy task.”
 
Once rehab began, Cesari monitored Kolarik’s progress and limitations, and they meet periodically with Dr. Wasserlauf to make sure Kolarik is progressing. Kolarik is to the point that he can now squat and has functional movement while strengthening his quads, hamstrings, glutes, outside hip and groin as much as possible. He rides the stationary bike, works on balance and does bridging to try to make his hamstrings strong. Most of the exercises that Kolarik is doing are what Cesari described as “two-leg stable activity. No rotation, all linear, front to back.”
 
“The graph is good, but we don’t want to test it too much because the body has to heal that graph,” Cesari said. “We basically want to make his balance as good as we can get it. Proprioception is a struggle of muscles, so it’s basically a tug of war. So when you’ve had a surgery and been off your feet for awhile – or even a regular day Joe – if you try to stand on one leg, you’re all over the place and your knee is buckling. That’s because your muscles are fighting each other, so one is pulling one way and the other is pulling the other way, so which one is going to win? I have to make sure that those within themselves within their respective strength are in the right range so they can be perfectly stable.
 
“The first eight weeks are the hardest because that’s where he can’t see the light at the end of the tunnel. Now I think he can start to see that, and he’s starting to get excited, which is why I let him start stickhandling a little bit to give him a taste of hockey while standing straight up. I’m not a psychologist, but I was a hockey player and understand how they think a little bit, so I’m giving him a little taste of the cake without letting him have the whole piece yet. I think he’ll be good because he’s dedicated, he’s strong mentally and he wants this.”
 
Players usually are back on the ice after 31/2-4 months of rehab, so Kolarik has about 4-5 weeks to get his strength and gait mechanics back to normal so he can do dry-land training before he resumes skating. The first two weeks on the ice is usually alone and/or in non-contact drills with the team. Then Kolarik hopefully can get cleared to play after two weeks of contract drills.
 
Hess said a mid-to-late March return would be good for Chad as far as something to work for, good for the coaches because they could play him in some games and feel comfortable that he’s ready to go and good because Chad would have some games under his belt before the playoffs.
 
Cesari reiterated that range of motion, strength and confidence are imperative, but in the end, it’s Dr. Wasserlauf’s call as to when Kolarik can return to the ice. Cesari has a list of things that Kolarik must accomplish before he can reach the running or skating plateau.
 
“We basically follow all of Dr. Wasserlauf’s recommendations, and he’s great because if we hit a snag, he asks my opinion,” Cesari said. “At the end of the day, his expertise is the surgery, and my expertise is the rehabilitation. Brett has been really good at asking for my advice and telling me, ‘Hey, as long as you stay within these limitations, whatever you think is going to get him better.’ ”
 
Surgery is always a last resort, but in Kolarik’s case and in his line of duty, it was a necessity, even though hockey is the easiest sport to play without an ACL because there’s not the kind of stopping that there is in a sport such as basketball, where the ACL is holding back the anterior translation.
 
“There are some athletes who choose not to do it, like Josh Gorges, who was OK for seven years and then his meniscus started acting up and they decided to do the surgery,” said Cesari, who has lived with a torn ACL for 13 years since he was injured at 16 playing soccer. “There’s guys in the NFL who play without an ACL, and that’s impressive because that is the biggest test of an ACL. But at the level that Chad is in his career, it needed to be done, and there’s no doubt in my mind that he will be a good skater again. I’ve never seen a guy go through ACL surgery and lose his skating stride.”
 
Cesari said that while the ACL is an important factor in skating, it’s not THAT important because the stride is an outward motion, and when you go out on a 45-degree angle and point your toe, the ACL is not under any weight-bearing stress. The most stress is when a player is going into a turn, losing an edge or getting his knee in a bad position against the boards, but he’s safe with a straightforward stride.
 
“Hockey is not straightforward, but if we do our job well and integrate him into practice correctly, he shouldn’t be hesitant, and that’s also a mental thing,” Cesari said. “If we can mentally get him strong enough, he should be fine.”
 
Cesari said he continually pushes Kolarik because he knows the body, and what it can and can’t handle from his athletic training background. His strength coach job is to determine what his mind can and can’t handle.
 
“As an athlete, I can relate, but since I didn’t have the surgery, I didn’t have that first six weeks of the muscles really atrophying,” Cesari said. “Walking is really hard to do when you don’t know how to do it because you’re relearning it. When my ACL was torn, I started rehab right away, and Chad’s biggest challenge still is walking without thinking about it. You want your subconscious to be just as good as your conscious walk, and that’s hard to do. Just like posture for everyone else. If you don’t think about it, you’re not in a good posture. You should think about it all the time.
 
“Those are the kinds of things that I’m working with Chad on now, to make him strong mentally, and the only way that I can do that is to let him see the progressions that we have going. And because it’s day to day to day to day, he sees the difference. The first little while progress is hard to come by, and most people will tell you that you’ll have five or six setbacks during the rehab process, usually about once a month. Those are hard to overcome because you feel you’re doing so well and then something happens, but he’s doing really well.”
 
Kolarik said he’s encouraged because he is able to do so much more than he could just a week ago. And he has March 23 etched in his mind. That will mark 24 weeks after the surgery and when he hopes to be back in the Whale lineup – if not sooner.
 
“That’s not a ‘hard’ date, and hopefully the doctor will clear me before that,” said Kolarik, who attends Whale home games with his wife. “But it’s something you don’t want to rush. It takes six months to fully heal, fully get that blood circulating back into the new ACL. At eight weeks, it’s actually dead in my body. The bones have adhered to my femur, but there’s no blood circulating in there yet, so this is the time where you have to be careful. It feels good and you want to do more, but you’ve got to relax a little bit and keep doing what you’re doing.
 
“The doctor said it’s stronger than the right knee because bone growing on bone is way stronger than any ligament you’ll ever have, which is why they do the bone-patella-bone instead of doing the hamstring. But it was just a freak accident like what happened to Dane (Byers). Fluke things happen in hockey, but it’s worse in football. I tend to notice now more guys tearing an ACL. I’m sure it’s the same, but now that I’ve had it, I see each week in a football game where a guy goes to cut and you can just tell when he injures his ACL.”
 
Yes, Kolarik is more cognizant of such injuries and empathizes with the victims of such mishaps. Here’s hoping Chad is a fast healer and is skating, passing and scoring before March 23. To paraphrase that McDonald’s theme, he deserves a break today, especially after what he has had to endure for more than a year.
 
By Bruce Berlet of the Connecticut Whale
 
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