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Women's Sports Medicine Program Drives Elite Athlete's Return to Ultimate Frisbee

9 minute read
A person is captured mid-air while catching a frisbee on a grassy field. The setting appears to be an outdoor sports event with cones marking the play area. The individual is dressed in athletic attire, and the background includes a hill and a yellow tent. The scene conveys action and focus.

Right away, Camila Flowerman knew something was terribly wrong.

Camila, who had turned 30 three days earlier, was playing in an ultimate frisbee tournament. While leaping and twisting to catch the disc, she felt something pop in her left knee.

"I remember thinking, 'I just tore my ACL,'" said Camila, an accomplished ultimate veteran. "I had an immediate sensation that something had torn, and it was super excruciating for the first few minutes."

A few days later, an imaging test confirmed Camila's worst fear: She had suffered a complete tear of the ACL (anterior cruciate ligament). Suddenly, her ultimate career was in doubt. But thanks to her commitment to her rehabilitation plan and her care team at the Mass General Brigham Women's Sports Medicine Program, she has returned to the sport she loves.

"She really listened to me and heard what mattered to me. I felt like she saw me as a full person and not just another patient with an ACL tear. I didn't even need to get a second opinion. I got on her (surgical) schedule that day."

Camila Flowerman
Patient

A devastating injury

Camila lives in Arlington, Massachusetts, with her husband, Jacob. Over the years, she has played a lot of ultimate, including stints with two professional teams.

Soon after suffering the injury, Camila went to the Orthopedic Walk-In clinic at Newton-Wellesley Hospital, part of the Mass General Brigham health system. A clinician there referred her for a magnetic resonance imaging (MRI) scan at Mass General Imaging, which revealed a torn ACL. This is a devastating injury for serious athletes, who typically need at least eight months to reach their previous athletic level again.

Wary of the long road ahead, Camila set out to find a doctor for her ACL reconstruction surgery, which was essential for her to resume her ultimate career at a competitive level. On the recommendation of an ultimate contact, she made an appointment with Miho Tanaka, MD, PhD, of the Women's Sports Medicine Program.

Dr. Tanaka is a team physician for the Boston Glory, a professional ultimate team, along with the Boston Red Sox and the Boston Ballet. She is also head team physician for the New England Revolution. Beyond her credentials, it was Dr. Tanaka's bedside manner that won Camila over.

"She really listened to me and heard what mattered to me," Camila said. "I felt like she saw me as a full person and not just another patient with an ACL tear. I didn't even need to get a second opinion. I got on her (surgical) schedule that day."

Meeting the distinct needs of female athletes

A young woman wearing a white jersey with the number '16' is actively playing ultimate frisbee on a grassy field. The setting is an open outdoor area with scattered players and spectators in the background. The scene captures dynamic movement and a casual sports atmosphere under clear skies.

The Women's Sports Medicine Program, which Dr. Tanaka launched upon joining Massachusetts General Hospital in 2019, helps women at all levels of athletics get back to their sport as quickly and safely as possible. Providing world-class care tailored to the distinct needs of female athletes is central to the program's mission.

"This population has been relatively understudied, in part because there traditionally were fewer female athletes than male athletes, especially at the elite levels," Dr. Tanaka said. "But that divide is going away, and we're focused on addressing the factors that are unique to women, from hormones and pregnancy to differences in injury incidents, nutrition, and psychology."

Camila wanted to maintain her active lifestyle, which includes hiking and basketball in addition to ultimate. Dr. Tanaka kept this in mind when developing the surgical plan.

"You can't take a 'one size fits all' approach to ACL surgery," she said. "You have to customize the surgery based on things like knee size and anatomy to ensure the ACL provides the stability the patient needs for their sport."

A critical step in surgical planning involves choosing which tendon from elsewhere in the body will replace the damaged ACL. Common options for what's called a "graft" include patellar (knee), hamstring, and quadriceps tendons.

"Taking a tendon will result in some kind of deficit in that location," Dr. Tanaka explained. "Athletes in different sports use their bodies differently, so what could be a significant deficit for one patient could be manageable for someone who plays another sport."

Given Camila's sport and personal preferences, she and Dr. Tanaka agreed that the graft would come from the quadriceps.

Learn about Mass General Brigham Sports Medicine services

Sports Medicine services

Multidisciplinary expertise enhances care experience

During the surgery, Dr. Tanaka made two tiny cuts around the knee joint. She then inserted thin surgical instruments and a camera to view her work on a video monitor. After taking a piece of the quadriceps tendon, she threaded it into two small tunnels drilled into the thighbone and shinbone (which the ACL connects). Over time, the tendon would form a strong bond with each bone.

The surgery lasted about an hour. Camila was able to go home with Jacob the same day.

The early days of recovery were tough. Camila's knee was swollen and painful. She could not squeeze or tighten her quadriceps, limiting the use of her left leg. She wore a brace in a locked position for a few weeks and then in an unlocked position for a few more weeks.

A hallmark of the Women's Sports Medicine Program is the multidisciplinary expertise available to each patient. Having various specialists working within the same program prevents fragmentation of care and promotes a holistic approach to treatment, Dr. Tanaka noted.

A few days after surgery, Camila began seeing senior physical therapist Ashley Wiater, PT, DPT. Outside of her sessions with Ashley, Camila was religious about sticking to her exercise program at home.

"I told her from Day One, 'You'll never have to worry about me not doing my exercises. If you tell me to do six sets, I'm going to do six sets. I'll never skip it,'" Camila said.

During physical therapy (PT), which lasted nearly a year, Camila had plenty of ups and downs. Ashley helped her get through the low points while stressing that every patient's recovery journey is different.

"With ACLs, you can't control how fast your body heals," Camila said. "You can do things to support your body, but you don't get to decide things like how much muscle your quad puts on in a two-month period. Ashley was really sensitive to what an emotional process that can be."

Another key player in Camila's recovery was sports psychologist Rachel Vanderkruik, PhD, MSc. Early on, Dr. Vanderkruik helped Camila set immediate goals for rehabilitation, such as whether she even wanted to play ultimate at an elite level anymore. Later, they focused on concerns like the slow pace of recovery and fears about reinjury after returning to action.

"I'm an active person, and ultimate means so much to me. All of that had been taken away, and I wasn't handling it well," Camila said. "It was super valuable for me to work through a lot of issues with Dr. Vanderkruik."

Putting her knee to the test

A woman looking and smiling at the camera stands in a hallway featuring wooden paneling and warm tones. The setting includes blurred background elements such as framed artwork and a door. Her outfit includes a dark jacket and a green sweater.

The months of rehabilitation passed slowly for Camila. Starting to run again about six months post-surgery was a major milestone. But all the while, she kept in mind the "big picture" goal: a return to ultimate.

That day finally came about a year after surgery, when she took part in an indoor pickup game. While she had some trepidation about testing her rebuilt knee, she knew she had done all she could to prepare, both physically and mentally.

Camila's knee held up fine that day and throughout the rest of the indoor season. In the spring, she earned a spot on the Boston Sprocket, one of the country's top mixed club teams. To optimize her health, she lifts twice a week, incorporating many of the exercises she learned in PT. She also does mobility exercises most days to retain her knee extension.

"I'm still not 100% of my old self. Part of that is being old (by ultimate standards). Part of it is it takes awhile to get back your former explosiveness," she said. "But being able to compete again at such a high level of intensity and to do it without reinjuring my knee is a big success."

Camila isn't sure how many years of competitive ultimate she has left. Regardless, it would mean a lot to walk away on her own terms rather than because of injury. The team at the Women's Sports Medicine Program has given her that gift.

"I'm grateful to all of them individually, as they each provided such a high quality of care and understood what my experience is like as a female athlete," Camila said. "And I'm grateful for how everyone came together collectively to give me all the support I needed."

Women's Sports Medicine: Tips for Reducing the Risk of Injuries

Why are women more prone to some sports injuries than men? What are common injuries in female athletes? How can women minimize sports injuries? Miho Tanaka, MD, PhD, orthopedic surgeon and researcher at Mass General Brigham, offers tips that may help reduce the risks of injuries to female athletes.