A Journey Back to the Olympics: How Physiotherapy Helped a World-Class Athlete Make a Comeback
In March 2017, Mark McMorris, Canadian professional snowboarder and winner of 15 X Games medals and 1 Olympic medal, found himself in the hospital after hitting a tree in a serious backcountry accident in Whistler, BC. He suffered from a ruptured spleen, stable pelvic fracture, broken ribs, a collapsed left lung, a broken jaw and a broken left arm, leaving him terrified that he may never be able to snowboard again.
One individual who played a large role in Mark’s recovery is physiotherapist Damien Moroney. Damien, a Vancouver-based physiotherapist, has been a member of the CPA since 1992 and has worked extensively with professional and national team athletes. Currently, he has 3 primary professional roles.
Damien is the Director of Rehabilitation and a member of the Senior Leadership Team at Fortius Sport and Health, an Athlete Development Centre located in Burnaby, BC. Their primary focus is optimizing athlete performance for life, noting that anybody with an objective and motivation is an athlete.
He also works with Red Bull Canada™ as an Athlete High Performance Consultant, where he provides rehabilitation services, event preparation and performance support to their sponsored athletes.
Lastly, Damien is a part of the leadership core and a Rehabilitation Consultant with B2Ten. This organization engages with Olympic National team athletes, programs and support services to assist elite performance, drive professional development and organizational enhancement.
We recently had the opportunity to speak with Damien about his career and his time working with Mark.
- Why did you choose physiotherapy as a career?
I had an exposure and interest in it at a young age because my mom is a physiotherapist. She worked in a Child Development Centre with developmentally handicapped children. When I was in grade school, on my days off I would go with her to the facility. I got to know the kids plus better understand her role and the profession of physiotherapy. I appreciated the rewarding challenge of assisting people towards maximizing their physical recovery in a wide variety of settings and medical conditions. I decided to apply and was accepted to the University of Alberta Physical Therapy program right out of high school. I felt there was an opportunity to pursue a career path that was most engaging to each individual within the program.
- Can you tell us about Fortius Sport and Health Integrated Athlete Development Centre?
Fortius is a multidisciplinary institute that has sports medicine doctors, massage, chiropractic and physiotherapy practitioners, nutritionist, sports optometry, mental performance services, a biomechanics and physiology lab, a gymnasium and outdoor soccer pitch plus lodging for athletes, teams and clients. The goal of Fortius is to work with athletes from pathology or injury through to performance support. It is transferring the structures, ideas and best practices from high performance environments to a sustainable community model. It is a resource that is open and available to all members of the community that are interested in health, wellness and training.
- How/when did you first meet Mark McMorris?
I met Mark in 2012 while working with Red Bull ™ as a high-performance consultant. Mark was already a successful competitive snowboarder and had just won gold in both of his X Games events. I was engaged to provide a performance gap analysis that would enable us to focus and target regions that we could assist him with for competitions and ultimately enhance his preparation for the Olympics. I evaluated his off- snow training and how he could further build strength, power production, load absorption, mobility, durability and sustainability. We began working together at event venues on how to enhance his readiness and consistency in his approach to competition.
- Can you tell me about some of the other injuries you have helped Mark rehabilitate from?
Unfortunately, we have been through some serious injuries…
At the 2014 Winter X games, he fell on a rail feature and broke a rib during the final event before the Sochi Olympics. This was on January 26, and the event qualifications for the Olympics were February 6th. Fortunately, through extensive consultation with the Doctors of the Canadian Medical Team, it was determined that if he was ready, then it was safe to compete. (shout out to Dr. Rod French, Dr. Jim Bovard and Dr. Bob McCormack for their support and assistance throughout this process). There was only 9 days and we still had to fly to Austria for 4 days then into Russia and up to the Olympic village. It was a challenge, but we just pushed every day, maintained mobility through the spine and hips, tried to sustain his energy systems, stretched in the sauna, got in the pool, started work back in the gym and slowly progressed back to being on a snowboard. He had to skip the first official practice session as he slowly built up the confidence to manage the stress of hitting the jumps and the rail features that were involved with riding the slopestyle course. Mark managed to pull through and deliver a bronze medal performance…. a pretty heroic effort on his part.
We also spent 8 months rehabilitating from a surgically repaired femur fracture that occurred at a big air event in Los Angeles in February 2016. Mark would fly up to Burnaby to work with an integrated team of practitioners to re-develop his mobility, strength, power and fitness.
In November of 2016, he had returned to competition and landed a front side triple cork 1440 (3 off axis flips and 4 full 360 degree rotations) to win the Olympic snowboard big air test event at Pyeongchang, Korea.
Details of this injury and the rehabilitation are in this Globe and Mail article
- What was your plan of action to get Mark back to where he was prior to the crash in 2017?
The injury was on March 25th, 2017. He had the benefit of already being named to the Olympic team for 2018 based off his competition results since the femur fracture. This security removed the added pressure of having to compete for the opportunity to represent Canada on a very highly competitive and successful team of snowboard athletes. Canada had 6 of the top 10 male athletes in the world and could only send 4 to the Games. Being pre-selected certainly gave us the benefit of more time with less pressure.
When we discussed and evaluated each injury individually, everything was potentially recoverable and returnable to snowboarding. That didn’t mean that we knew that he was going to be able to get back to competitive snowboarding, but there was an optimistic outlook for his potential to return to riding.
All he could do was take it one step at a time and work through the process of recovery. We engaged an amazing team of practitioners that could address the multitude of injuries and physical limitations. We created a plan that promoted bone healing, energy system development, nutritional advice, holistic mobility, functional strength and power development for the specific requirements of highly acrobatic snowboarding.
Each aspect moved quicker than you might think and enabled us to continue to load and stress the demands on his body. Mark was extremely diligent in what he needed to do. We had been through a number of significant rehabilitations to date, so he understood that there would be ebbs and flows throughout this process. We had an objective, a vision and a plan. We had to build on the successes and mitigate the setbacks. We would adjust on outcomes or progression to stay true to that path. Mark kept improving and building confidence. From there, it was a matter of returning to the snowboard park to determine whether or not he had the physical and mental tools to still be competitive. It’s really an ongoing unknown until you get back on the board and start hitting those large jumps again.
Mark is truly extraordinary in his physical capacity to heal and his mental ability to focus and re-engage in a highly competitive environment. He returned to compete in China at the Beijing Air and Style, in November of 2017. This was only 8 months after the crash. He not only was able to manage the high demands of elite international competition, he won the event!
- Your daily sessions lasted 3-4 hours, what did they consist of? What were some challenges or set-backs?
I may have been the team lead, but the rapid progress and ultimate successful outcome of this rehabilitation was only enabled through the engagement and dedication of a lot of talented practitioners (huge thanks to Amanda Kriebel, Erik Yuill, Kobi Jack, Richard Hawes, Sean McKeown, Beth Gnatiuk and Jeremy Sheppard).
He would usually do two sessions in a day with a break in between to re-fuel and rest. We would create a weekly plan on how to optimize each recovery block. This plan would incorporate hydrotherapy sessions in the pool for functional movements (squatting, lunging, single leg balance, jumps) and the underwater treadmill to build up from walking at 80% reduced body weight to sprinting at 8.5 miles per hour against water jets. It would also include clinical 1:1 pilates with a physio instructor for strength through range. He would utilize yoga, breathwork and mindfulness to facilitate movement and mental health. Chiropractic and massage sessions would optimize soft tissue mobility throughout the body. There would be planned periodic sports science testing in the lab to provide data to guide training and recovery. This would be done on either dual force plates to evaluate his jumping power, load absorption and reactive strength or physiology testing of his energy systems on the bike or treadmill.
Challenges: Every long or significant rehab is a grind. The difficulty of the sustained physical stress and maintained mental focus required to continue to put your best into each session, while dealing with ongoing pain, frustration and uncertainty.
There is always a shadow of doubt in an athlete with a significant injury. They are often unsure if they can come back to their sport at the same level as prior to the injury. There are days that are harder and where their symptoms are aggravated and the journey feels tougher. Rehabilitation can be slow, boring and stressful. Conversely, at stages it can be extremely engaging, progressive and rewarding.
It’s a matter of continuing to talk through the process, to take it in pieces, build both the physical and mental confidence, plus have some ongoing objective measures of progress and accountability to outcome goals.
The reality is that a rehabilitation project of this magnitude is expensive in time and budget. This is often what it takes to return athletes to high performance. We were fortunate to have financial support through Red Bull investing in the high level return of an athlete that they are supporting and Canada Snowboard contribution towards the budget plus their technical expertise from coaches and sport science.
I think it is really important to further understand and apply principles from performance sport to challenge the convention of community athlete rehabilitation. These athletes are often returning to similar high demands with challenging schedules. They may have school or work and might have several teams or sports they are trying to return to. There can be fiscal restraints on post operative or significant injury rehabilitation projects. We need to find solutions to optimize recovery, integrate professional expertise and enhance recovery for athletes of all ages and skill levels.
- During Mark’s rehabilitation, you used a HydroWorx ® , what is that? What effect did it have on Mark?
HydroWorx ® looks like a small pool, but the entire base is an active treadmill that is approximately the width of double patio doors. The treadmill bed can rise up out of the water to sit flush with the ground. A client walks on to it and the whole treadmill surface is mechanically lowered back down into the water. The lower you are in the water, the more body weight is reduced. There are four cameras with two monitors, so you can see yourself from the side and as you move in the water. A client can start working on early basic movement patterns in the pool then add the treadmill demands or plyometrics to stimulate specific energy systems and create a functional challenge. It’s basically a way of unloading bodyweight and starting to build movement and determine how you’re doing without having too much stress on the joints.
This has been instrumental in Mark’s recovery from the femur fracture and his backcountry crash. It enabled him to get early multi joint movement with reduced stress on the healing fractures and joint tissues. It provided a mental boost to get moving and consistently see himself improving, tolerating more stress and looking more “normal” and rebuilding back to running and jumping.
- Can you tell us how you and Mark are continuing to work together on Mark’s health and wellness?
We continue to work from a performance support model that integrates with Canada Snowboard. They have an excellent team of support providers from coaching to off-snow support. Mark is healthy now and is having fun snowboarding. He continues to set goals, progress his riding, optimize his event preparation and looks forward to competing in 2018/2019.
- What advice can you share with other physiotherapists who work with athletes?
#1. We are more effective as a team. I think the key is really to understand your skill set and your role within the rehabilitative process. This role may vary with therapist training or experience, their clientele and work environment, the level of sport a client has an objective to return to and the extent of structured support that will assist with their re-integration into this training environment.
#2. Rehabilitation is more likely to be successful when return to sport is based on an assessment of readiness rather than a timetable based on preparation for a specific event or competition. Although this may be the reality of some situations, it also leads to a higher risk of recurrence of injury. All injuries are challenging for the athlete and their families, but it is always tougher if there is a re-injury or ongoing recurrence. Do not be afraid to have the tough conversation if the athlete is not ready to return. This is easier with objective evidence and a thorough understanding of the sport demands. I would also suggest a clear alternate plan of action that will heighten their chance of success
#3. Athlete confidence in their ability to return can be as important as their physical outcomes. It is important to be aware of their mental state throughout the rehab process. Progressive achievement of increasingly challenging physical tasks can foster this confidence. Self-report questionnaires or subjective discussions may flag potential struggles. It is important to have professional resources to refer for support in this process if required.
#4. Continue to be an open learner. Put yourself in environments that foster learning. It can be physiotherapy courses, but it can also be real world experience. Don’t necessarily limit this educational opportunity to our profession. It could be with a nutritionist, physiologist, surgeon, strength coach or technical coach. It might be a couple of arranged conversations with a sport optometrist in relation to their work in the field of concussions or with a mental performance practitioner on the stresses associated with injury as an adolescent athlete. There is no need to gain an expertise in each of these fields, but simply expand your understanding of their role with injury rehabilitation and sport performance.
#5 Be a mentor, share your experiences and skills. Let’s continue to expand, enhance and drive our profession forward.
For a more in-depth look at the injury, rehabilitation and ultimate recovery, click here
We appreciate Damien taking the time to speak with us, and we can’t wait to see what’s next for both Damien and Mark!
This interview was conducted by Brittney Stoddart, CPA’s Communications Specialist.