Q&A with FSU football head athletic trainer Jake Pfeil
Editor's Note: This is the third part in a series about the recovery process for injured Florida State football players.
In this installment, Warchant talks with Jake Pfeil, the Seminoles' head athletic trainer for football and executive associate director of sports medicine. Pfeil discusses the different phases of the recovery process and provides additional information on the rehabilitation of wide receiver Keyshawn Helton.
Here were the previous articles in the series:
Q: Before we focus on Keyshawn's recovery, I wanted to ask a more general question to start. When it comes to putting together a rehab plan, is there a pretty standard timeline of how everything needs to happen? Or is every case relatively different?
A: They're all different -- everybody is an individual. But at the same time, with each injury there are certain protocols that we're generally going to follow. And those are generally generated by the surgeon -- the phases that you're going to reach.
The way I look at it is Phase 1 is the moment we go on the field, and we all have different roles through different phases. But when you have an injury to that degree, there is protocol that has to be initiated right then because there's a certain way to treat it. Especially when it's something that is as potentially severe as that was. So there's the acute care phase, then the surgical phase, which in his case was a few days later, the post-surgical phase, and then of course the rehab. So basically, the moment he's on the ground, we go out there get a quick evaluation -- me and Dr. [Bill] Thompson -- and that phase is starting right then.
Q: And how much do you usually know then, out there on the field?
A: Well, with Keyshawn, I didn't see the play. Everything happened so fast. But when all the dust had settled, there was a guy on the field. So Dr. Thompson, evaluating on the field, knew this was a significant knee ligament injury. We have significant instability, so we have to get him off the field a certain way. ... And one thing we can do, and we did it in that case, is take advantage of that "eye in the sky" -- the person looking for concussions.
They are able to review every play. It doesn't have to be a head injury. Any play that you wanted to know what was going on, he is able to run it back and film it and text it right to me. And we did that there because we weren't real sure what happened on the play. But as soon as we saw that video and saw the amount of hyper-extension that had occurred and displacement of the joint, "OK, we've got to evaluate for artery damage and things like that." So we had to get him to the hospital and make sure there wasn't any vascular damage. And we were able to bring him back the next day.
Q: So then Dr. Thompson performed the surgery later that week?
A: Dr. Thompson fixed it. Did a great job with it. And that's a really key component of it. You've got to have a great repair, and this was a multi-structure repair. And all of it has to be done perfect, so what Dr. Thompson does really makes everything else possible.
Once he goes through the surgery, Jerry [Latimer], our director of rehab, is going to have him mostly hands-on for the next period of time. He'll kind of work with him one-on-one daily for things that we've got to achieve -- range of motion out of the gate and things like that. And monitoring the post-surgical trauma, because surgery is a trauma -- another one -- so you've got to monitor the recovery of that over the next few days
Q: Does the surgeon help map out the rehab?
A: Yep. So with any surgery we have, that surgeon is gonna say, 'OK, when we get to this many weeks, we'll keep him at this range of motion doing this," or whether it's something simple like, "I want him totally non-weight-bearing for X amount of weeks, we'll go partial-weight-bearing for X amount of weeks, and we'll be on crutches at this week." Then they'll say, "We want to establish this range of motion by this date." And we'll go by his guidance. We all know general time frames for each recovery, and they're usually going to stay the same. But ultimately, that surgeon is going to have a lot of say in how fast or what all you can do.
Q: With a guy like Keyshawn, he's always had a reputation for being a real self-starter and a very hard worker. I'm sure that's a good thing, but do you sometimes have trouble keeping guys patient so that they don't overdo it? Or are they usually pretty good about following your instructions?
A: Sometimes you have to pull the reins. But you'd rather pull the reins than have to push 'em, right? Generally speaking though, these guys are going to do what you ask them to do. Sometimes it happens in the very early phases, when we're still in a protection phase -- right after a surgery. A guy will come sliding through one day not using his crutch like you want him to, or something like that. So you'll have to remind them during the early phase: "Hey man, I really need you to remember we're still on crutches right now. We're still in this sling on your shoulder for four total weeks." There's a purpose for that, and that's healing right out of surgery.
Q: And then there are some guys who maybe don't attack their rehab?
A: Yes. And that's something you have to watch in those early phases, when it's the most critical ...
Q: I imagine it can be devastating for some of them emotionally.
A: Sure. And the people that can get over that the quickest are going to get better the fastest. Because that early phase is so critical. If we're not achieving the range of motion that we need to achieve by a certain date, that's when we're going to run into problems. It's going to be uncomfortable, and we try to make sure they understand that going in. "This probably ain't gonna be real fun for the first month."
That's where Jerry and everybody are working on achieving that range of motion. If it's not getting there, it's going to get really uncomfortable. And it's a daily thing ... weekends, we're coming up here doing this stuff. Because if it doesn't get then, you're potentially looking at another surgery. Going in there to break scar tissue and things like that -- nobody wants to go through those things. So that early phase is critical. That people have their mind right, and they understand that it's a difficult time, but there's a reason. There's a purpose.
Q: When Keyshawn was getting carted off the field, he was shown on TV telling his teammates, "Don't quit." I imagine that attitude translates well to entering rehab.
A: Keyshawn's attitude and the type of guy that he is -- everybody's talked about it and it's been well-documented from Day 1 -- is all true and it's genuine. But he struggled at first just like everybody does. There are certain psychological phases after injury that we learn about -- anger, denial, acceptance -- like anything. Absolutely they're going to go through it. Some people wear it on their sleeves. Some people don't. We knew Keyshawn was going through struggles at times, but he's not the kind of guy to put it all out there. ... When athletes do have a tough time with it, we have all sorts of resources available. We've got Dr. [Keely] Kaklamanos in-house, our psychologist. And all those avenues are taken to help people get where they need to be, physically and mentally.
Q: I imagine you guys also have to help educate the parents and families about what's going on with their sons?
A: Absolutely. Communicating everything, to me, is critical from the get-go. I mean look at it from their perspective. They just saw their son get thrown in an air cast and put on a cart. They're sitting way up here in the stands, and there he goes into that corner [of the stadium]. So phone calls start getting made and, "Hey, this is where you meet us." In Keyshawn's case, they were at the game, so they were with him that whole time on the way to the hospital and stayed overnight. And that's what you want. The parents need to see him and know that he's OK.
Then there's usually more education when you get back about what's going to happen pre-surgery, and then the same thing after surgery. Luckily with that case -- and with a lot of them -- the parents were able to stay for a few days. That's huge. I love that. But everybody can't do that. And if a parent's not going to be here, obviously we've got it covered. We'll have them where they need to be, we'll be with him and we're gonna take care of him.