Nonsurgical treatment has figure skater back on blades

For some injuries, focusing on physical therapy is the best option.
Nov. 5, 2019

They may look graceful as they leap with apparent effortlessness and land with flair, but figure skaters return to Earth with forces of up to about eight times their body weight on ice not known for its forgiveness.

skater working on a jump after recovering from a talus fracture.
Figure skaters like Maggie land jumps with a force of up to eight times their body weight. Photo by Todd Neff, for UCHealth.

Maggie Johnson, 17, had been figure skating since she was 6 and was all too familiar with the pounding of proper landings – not to mention the bumps and bruises her sport imparts. But the injury that would bring her to UCHealth happened a long way from her home ice at Centennial’s Family Sports Center.

Maggie, a junior at Cherokee Trail High School in Aurora, was in the Louvre Museum in Paris on the first full day of a March 2019 school trip to France and Spain. She had just checked out the Mona Lisa and was walking down the stairs when she seriously twisted her right ankle. Being well-versed in dealing with physical pain, Maggie gutted it out. The next stop was the Eiffel Tower. Facing long elevator lines, she and her classmates took the stairs down from the second floor.

coach and skater talk at ice rink
Maggie and Lalonde talk jumping form. Photo by Todd Neff, for UCHealth.

The Eiffel Tower’s second floor is 674 stairs and 31 floors above ground level.

Maggie somehow made it down and through the rest of the trip – even attempting to flamenco dance in Sevilla despite the bruising and swelling. When she got home, her mom Lorena had already booked an appointment at UCHealth Lone Tree Medical Center. There, Dr. Alex Ebinger examined her ankle, ordered an X-ray and an MRI and referred her to Dr. Kenneth Hunt, a surgeon specializing in foot and ankle orthopedics and the medical director UCHealth Foot and Ankle Center in Denver’s Stapleton neighborhood.

Skip the surgery for talus fracture

What Hunt found underscored just how tough Maggie was: there were torn ligaments, there was an avulsion fracture where part of a joint capsule had torn off a bit of bone, and she had a talus fracture.

image of a foot, showing the talus boan inside where the foot bones meet the ankle.
The talus bone. Getty Images.

None of it was good news, but the talus fracture was the greatest concern. The talus serves as the ankle’s fulcrum and bears the body’s weight with each step – or, depending on the jump, each landing. The Fort Collins Invitational, which was coming up the following weekend, wasn’t going to happen for her. The good news was, there would be no surgery.

Hunt has done many surgeries on broken taluses, including one on former University of Denver hockey star Tariq Hammond. But what’s right for one bladed athlete may not be right for another. Maggie’s ankle ligaments and the avulsion fracture would repair themselves – and so would her talus, which had what’s called a nondisplaced fracture. It means the bone broke and then resettled right where it had been before. As long as the bone stayed put and the ankle was rehabilitated properly, the talus, too, would heal on its own, Hunt concluded. He sent Maggie home with an ultrasound stimulation device to speed healing and a referral for physical therapy (PT).

PT would be the key to Maggie’s recovery and return to the ice. And so, following a brief period on crutches, she started her weekly visits to UCHealth Steadman Hawkins Clinic Denver.

Call it POLICE

skater in mid spin on ice after recovering from talus fracture.
Maggie mid-spin. Photo by Todd Neff, for UCHealth.

When she started PT soon thereafter, Maggie was still in a walking boot. Not too many years ago, Hunt and other surgeons would have prescribed what’s known as RICE – rest, ice, compression, and elevation – for a couple of weeks and perhaps longer. Now, Hunt says, the acronym is POLICE: protect, optimally load, ice, compression, and elevation. You still do the icing, compression and elevation to reduce swelling and inflammation, but these days, doctors know that those who safely work the joint as early as possible do better in the long run.

Steadman Hawkins physical therapists Gillian Brown and Meghan Clusserath took the lead in Maggie’s PT. The first step was to understand Maggie’s goals and motivations. They differ from patient to patient – not everyone intends to propel themselves skyward and land again on a quarter-inch-wide blade – and the PT process will vary depending on the patient’s ultimate goal. Universal is the message that doing PT at Steadman Hawkins as well as at home can make an enormous difference in long-term outcomes.

skater on the ice after a fall.
What goes up must come down – a lesson figure skaters know all too well. Photo by Todd Neff, for UCHealth.

Brown or Clusserath, depending on the week, started slowly with gentle range-of-motion work to get the joint moving and to relax and enhance the flexibility of the ankle’s muscles. Maggie’s ankle, which had been dysfunctional for weeks, had to be coaxed into regaining proper motor control.

Soon Maggie had graduated to weight-bearing and band exercises focusing on improving strength and stability. That work extended up to the hip and core muscles, all of which play a role in the kinetic chain that Maggie’s damaged ankle had rudely interrupted.

Then came plyometric exercises – jumping and hopping movements – that strengthened and prepared her body for a return to the ice. By August, she was back in Stapleton to see Hunt, who said she was ready to skate again.

Returning to the ice

In early October, Maggie stroked around a Family Sports rink with her coach, Sacha Lalonde. She competes as a Novice, a U.S. Figure Skating tier which, considering she and her fellow competitors have skated most of their lives and can do double jumps, seems a misnomer (it’s actually two levels from the very top). She warmed up first, spinning away and doing single jumps.

skater turning in air while coach holds a harness to support her landing.
: Maggie Johnson practices double toe loops as coach Sacha Lalonde spots her with a pole harness at Family Sports Ice Arena in Centennial. Photos by Todd Neff for UCHealth.

Lalonde then connected a safety harness to something a sport fisherman would feel comfortable handling. Lalonde followed Maggie round after round as she worked on double toe-loops – a new jump for her. It involved smashing her right toe pick into the ice to attain greater altitude as she leaped off the left foot, then landing on the right foot with a force equivalent to some multiple of her body weight. Lalonde’s role wasn’t to lift, but to soften the inevitable falls. Maggie then took off the harness and tried the jump perhaps a dozen times or more without Lalonde’s spotting.

skater talking to coach at ice rink.
Maggie and Lalonde talk jumping form. Photo by Todd Neff, for UCHealth.

“You’ve got the arms – you were missing the legs,’ Lalonde called out.

Finally, she landed it – cheated, as it’s called when the landing skate doesn’t quite do the full rotation – but a triumph nonetheless.

“She’s ahead of where she was before the injury,” Lalonde said.

Maggie looked satisfied with the effort. She was planning on competing again early next year – perhaps at the Denver Invitational in March; perhaps in Fort Collins, which she missed this year because of that ankle. After that, it will depend on where she ends up in college. But clearly, she loved being back on the ice.

“Six months after the injury, I’m in a good place,” she said.

About the author

Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado, where he was a Ted Scripps Fellowship recipient in Environmental Journalism. He is author of “A Beard Cut Short,” a biography of a remarkable professor; “The Laser That’s Changing the World,” a history of lidar; and “From Jars to the Stars,” a history of Ball Aerospace.