I will share the Rocky Bleier story with you here, as well as that of a modern-day Rocky Bleier—a spirited and determined man with whom I have had the honor and privilege of working.  Following a serious motorcycle accident that had left him “mangled,” my client and I worked determinedly to return him to health and normal functioning.  I hope that his story inspires you as it has me—like the Rocky Bleier story, it shows what can be accomplished with a focused intention, a solid belief and a big heart.

Fighting Back

Rocky Bleier was a standout half-back for the Notre Dame Fighting Irish football team during the mid-1960s.  In 1966 he helped the Irish win the National Championship, while in 1967 he was named captain of the team.  He was drafted by the Pittsburg Steelers in 1968, and then shortly therafter, by the U.S. Army.  Rocky Bleier was on his way to Vietnam.

During the war, Bleier was shot in the left thigh, and while down, he was hit by a grenade that sent shrapnel into his right leg.  Rocky was told he would never play football again; in fact, he would be lucky if he could ever walk.

But Rocky Bleier, being a natural fighter, was determined to walk, and he was even more determined that he would play ball again.  By using the strength of his mind and will, he worked hard to rehab his legs, and he regained his ability to walk.  He returned to the Steelers in 1969.

That first year back, Bleier came in at only 180 pounds, but worse, he could barely walk.  For the next two years he worked hard to regain a position on the team, but his recovery was slower than he wanted, and he eventually got cut from the team…twice.  But again, his mind didn’t falter.  He spent several more years pounding the rehab and training pavement, and in 1974 he remade the team, weighing in at a solid 212 pounds.  Football fans will recall that Rocky Bleier not only made the team, he was an integral part of four Super Bowl championships.  He even made the winning catch inSuper Bowl XIII.

I don’t know about you, but I find Rocky Bleier’s story so inspiring!  Maybe it’s because I work with people suffering from various musculoskeletal and sports injuries, and I see firsthand how hard it is for many to recover.  And not because they can’t, mind you—which is the point of this story—but because the mind is the most powerful player in the healing game, and for many, it works against their complete recovery.  I find that if the mind is not completely aligned with the desire, belief and certainty of a complete recovery, as well as being prepared for the rigors that will accompany it, then achieving it will be highly unlikely.

Modern-day Rocky

Eleven weeks ago, a dear friend and long-time chiropractic patient in my office, Mr. Beau Robb, was involved in aharrowing motorcycle accident.  A female driver making a left turn in her truck, possibly texting or dialing a telephone number at the same time, drove at full acceleration broadside into Mr. Robb’s motorbike. Unfortunately the only thing separating the two vehicles at the moment of impact was his left leg.

Taken by ambulance to nearby Cedars Sinai Medical Center, Mr. Robb was rushed into emergency surgery to save his leg.  He had fractured his left femur, tibia and fibula, while incurring several open wounds to his left leg.  He was told by staff at the hospital that his leg when he came in the night before had been “mangled.”

I would have to say that, judging by what I saw the first day he came hobbling into my office some six weeks after the accident, mangled was a good description.  With massive wounds to his shin, calf and thigh, which looked as if chunks of flesh had been shorn from the bone, his doctors had described to him the protrusion of bone fragments that pierced his skin, and how they had worked for hours inserting metal rods into his three broken leg bones that fateful night.

Initial Assesment

Fortunately, Mr. Robb has had the best doctors on his team.  From the orthopedists that restored his leg, to the emergency room and general staff at Cedars Sinai, to the plastic surgeons that worked their reconstructive magic, he had a solid squad that pretty much repaired the structural damage, but the time had come for neuromuscular re-education.

Mr. Robb presented to my office walking on crutchesand equipped with a foot boot.  The purpose of the boot was primarily to prevent the foot from “dropping” while inactive, which it had been for a month and a half. It also protected the shin and calf wounds, which were the exit points for the shattered tibial fragments.  The wounds were a little runny with pus and other exudates, but for the most part they seemed to be healing well.  He reported three compound fractures—the femus, tibia and fibula—but apparently no ligament tears.  He was having pain in each of the three bones, as well as a loss, or change, in various sensations.  Some areas felt numb, some tight, some hard and nodular, while others were just painful.  The most outstanding sensation, though, and the one Mr. Robb was mostly concerned about, was an inability to bend the knee or the ankle (dorsiflexion) sufficiently.  Each one of these issues would have to be addressed to return Mr. Robb to full and normal functioning.

Pain and Disability Can Be a Mind Game

It has been said that pain is all in the mind.  In some ways that might be obvious, considering our pain processing centers reside in the parieto-insular cortex of the brain.  But studies now show that chronic pain can actually make physical changes to the brain itself, leading to further processing dysfunction, and thus further pain.  These findings suggest that the brain plays a major role in the development and treatment of pain syndromes.

The key, then, in any rehab protocol is to decrease pain as soon as possible.  The longer pain hangs around, the less likely it will resolve at all.  But the good news is that pain and functionality run together—so, often, as one improves so does the other. Under many circumstances, function is the most important factor in the rehabilitation process, but in some cases (and I have reason to speculate that the degree of injury is a major component here) pain needs to be address first.

Mr. Robb was prescribed pain medication, as are all people involved in motor vehicle accidents, to help him get through the inevitable pain he would likely experience over the next few weeks.  He made it very clear at the beginning of our sessions that he wanted to be as medication-free as possible; he had little interest in dealing with thedependency that might develop as his injuries healed.  Although I definitely understand and value the role pain medication can play in a recovery process, especially when administered responsibly, I had no problem with Mr. Robb’s decision, under the agreement that he would use them if necessary.  He agreed.

His decision, I knew, would have significant benefits to the rehab program, mostly in his being fully present throughout treatment, as well as during his home care, but also in re-establishing the vital connections between his sensory nervous system and the joints, muscles and tendons of the limb.  Also the potential cognitive and spiritual advantagesmade this an attractive approach, as the right mind can connect to a greater power and higher brain function to help the healing process along.

My approach was to start with simple movements, both passive and active, lightmyofascial release (similar to massage), and chiropractic adjustments.  Once the initial pain and disability were to be overcome, we could then move into proprioceptive work, and finally into stretches and weight-bearing exercises.

Rehabilitation of Severe MVA Injuries

The following is a list of treatment protocols and the rationale behind them, as well as the chronology with which they were introduced into the rehabilitation for Mr. Robb.  I will also include the progress both subjectively and objectively as we witnessed it.  At the time of this writing, we are still working, as we finish up the eleventh week of rehab.

Round 1:

• Mr. Robb received chiropractic adjustments every session to his low back (lumbar spine and pelvis), upper/mid-back (thoracic spine) and neck (cervical spine) regions.  Additionally, we adjusted his ankles every visit.
  • Rationale: To attain and maintain proper joint motion, as well as to free the nervous system of any biomechanical impedance.  Locomotion and all movements rely on proper joint motion.  Thenervous system, as the master control, needs to be free of interference, so that it may liberally innervate the musculoskeletal system.  Also as the primary healer, the nervous system is involved in reestablishing reflex, proprioceptive (sense of where we are in space), sensory and motor function.
• Much of our initial work included myofascial release of the quadriceps, calves (gastrocnemius/soleus), iliotibial band (ITB) and tibialis anterior (shin).
  • Rationale: To break up scar tissue and adhesions, particularly around wound sites where the fractured bone exited the leg and thigh.  To add length to reflexively guarded muscle tissue and prepare the thigh and lower leg (neurologically) for simple movements.  Also to reestablishsensory function in all surrounding soft tissue, and to stimulate blood flow for the transportation of nutrients and oxygen.
• Basic movements of the knee and ankle joint, done both actively and passively.
  • Rationale: Again, neurologically, our goal was to reestablish connection to the joints involved in lower limb movements, including functional locomotion.  Starting at the base level of proprioceptors and motor units, Mr. Robb worked daily dorsiflexing/plantarflexing the foot (a self-described area of major restriction), as well as flexing the knee.
• Therapeutic modalities: ultrasound and electric muscle stimulation(interferential current).
  • Rationale: Ultrasound as a deep heater for breaking up scar tissue and adhesions around wound sites, and muscle stim to reduce guarding and compensatory spasm of the psoas major muscle.
• Home care: Basic movements, self-massage, ice as needed, pain pills as needed, lots of water, increased protein, nutritional supplementation
  • Rationale: My main instruction was to drink plenty of water andincrease protein intake by one half (three eggs instead of two, for example) for optimal healing, and 1000 milligrams vitamin C forcollagen formation (connective tissue)

We carried out the above regimen three times per week for two weeks. Toward the end of this first round, Mr. Robb was examined by his plastic and orthopedic surgeons, both of whom reported excellent progress.

My hope with this article is to document and share an effective rehabilitation protocol for the most drastic of neuromusculoskeletal injuries.  The rationale behind this program is appropriate for most major traumatic and surgical recoveries, although region-specific changes might need to be considered.  Saying that, our approach was universal in that we strove to reestablish neurological connections to the limbs first and foremost, while also paying attention to proper nutrition and primary sensory stimuli, before moving onto tissue lengthening, and ultimately, motor movements and control.

Next month, I will continue where I left off and discuss Rounds 2 and 3 of Mr. Robb’s rehabilitation program.  You will see how we slowly transitioned into each new phase, conducting a balanced dance between repetitive conditioning (learning) and constant, yet ever changing, challenge.  Rocky Bleier would be proud.

Novermber 3, 2011