"We've tried to minimize what's known as disuse atrophy," Kerns told BlueGoldNews.com Tuesday. "When you do not use a body part, it will shrink, get smaller. Muscles get weaker. Obviously, it's non-weight bearing, so all the muscles in his left leg will get smaller or weaker -- quadriceps, hamstrings, hip muscles and so on. So we do things in the athletic training room to try to minimize that disuse atrophy -- straight-leg raises, what we call multi-angle quads, hamstring curls, resistance which will be somewhere between the knee and the ankle, so as to not put stress on the foot."
"He'll throw a little bit. We came up with this last January when we went through this before. We have a stool which is on casters that will obviously roll on the ground, but also it allows for pivoting as someone would pivot or turn they body when they throw. We bend his knee to 90 degrees, he puts his knee on the stool, we make sure the height is correctly set and so on, and then we allow him to throw some conditioning throws.
"Now obviously he's not throwing at 100 percent capacity. He's not trying to throw routes. He's basically throwing to us, but keeping muscles working so when he is able to translate weight from foot to foot, we're not digging ourselves out of a hole. He's trying to keep his arm in some degree of shape so when he starts throwing, based upon allowing to transfer weight on his feet, his arm strength isn't zapped."
As for when Smith might be allowed to begin to put weight on that foot, Kerns and the West Virginia medical staff will know a bit more after a doctor's appointment scheduled for Jan. 31. At that date, Smith will again be X-rayed to gauge the results of the early portion of the recovery process.
"That will tell us what step is next -- whether it's progress to weight-bearing or [continue] not weight-bearing," said Kerns, who has worked with the Mountaineer football program since 1994. "It all depends on [what the] X-ray [shows as far as] healing, so at this point, nothing is really known with respect to, ‘Okay, what's the bone look like?' We don't know and won't know until Jan. 31.
"Minimally will we see any evidence of healing, but whatever [the doctor] decides to do with us at that point in time, we'll do with Geno. Two weeks from the 31st is probably going to show more evidence of healing. That would be February 14th. That looks like more of a target date to know where we are."
When it first came to light that Smith would require surgery after West Virginia's season ended with a loss to N.C. State in the Champs Sports Bowl on Dec. 28, Kerns expressed cautious optimism that the signal-caller would be ready to go in time for the team's spring practice sessions.
Nothing, at least to this point, has changed that opinion.
"We saw him for the first time after [surgery] the 19th of January. That was five days after surgery," Kerns recalled. "He was pain-free at that time, which is good. He claims to have been pain-free a couple days before that.
"In all actuality, backing the screw out and putting a new screw in didn't really change anything other than getting a better positioning for what wasn't healing, to put it in the best position to heal. So therefore, there's minimal reaction from the surgery, minimal pain. Seeing as how he played all last year on a screw holding that bone together, our optimism is -- we think we can protect him. As long as there's enough healing going on and the physician gives the okay, we can protect him well enough that he should be able to participate in spring football."
But the prognosis was also good throughout the recovery process last offseason, when Smith first underwent surgery to correct the same fracture.
That changed by the end of the summer, and Kerns and his training staff knew by late July that Smith would again require surgery after the 2010 season. Unfortunately, he said, there aren't many lessons to take from that previous experience.
"Nobody really knows why it didn't heal," said Kerns, a veteran of the athletic training field who holds his bachelor's degree from Penn State and a master's from Ohio. "Some people are just prone to that or that can occur.
"Looking at the X-rays from the surgery, this year to last year, it looks a little bit better compressed and held together, so we'll have a better result. From January's surgery last year through April 28 [when Smith was X-rayed again]...he had excellent callous formation and for all intents and purposes, it was healed.
"He was ramped up and allowed to do everything unprotected -- ran, did everything everybody else was doing, threw, jumped, twisted, turned, everything in May, June and into July until July 13, when he cut suddenly and twisted and had some sharp pain. When we investigated, we realized that there was bone resorption sometime between April 28 and July 13. Why? I don't know."
But Smith's re-aggravation of the issue wasn't likely caused by any particular move on the field or in the weight room.
"Usually that's more of a gradual process," Kerns emphasized. "Now why did it just get to a certain point July 13 that when he pivoted, it caused something to trigger a pain reaction? He had instantaneous pain, and then it disappeared. So the thought was, ‘Gee, it can't be anything major.' But obviously once we X-rayed, we realized what we had."
So will the West Virginia medical staff be even more careful and more gradual in bringing Smith back this time around?
"I don't think so, because no matter whether you're healing from a stress fracture, a muscle strain, a ligament sprain, the body will react to stress placed upon it. You're going to get stronger when stress is induced," Kerns said. "The worst thing you can do is when you hurt something, you completely just lay there, rest it and don't use it for 10 days, two weeks, three weeks, a month or whatever the case may be, then just go back to activity right after that without doing some gradual resumption of activity.
"That's kind of a misconception with the general public, I think. [They think] people get hurt, they rest it and they try to go back out to the level they were before. They can't. Reason being, there wasn't enough positive stress to create stronger tissue -- whether it's bone density or whether it's muscle or tendon strength in order to absorb the forces placed upon it with physical exertion. So there's a fine line. You try to introduce positive stress without creating negative effects.
"So to gradually bring someone along, yes, you want to do that. But to go too gradual would be a problem as well, because you're not going to get the positive effects of positive stress. Tissue won't strengthen. It'll take longer to heal."
Kerns wouldn't say if Smith would likely be able to play this season if an issue occurred as it did last year, emphasizing that each circumstance is different and even a similar injury with only slight variations in the damage to Smith's foot could change his pain levels significantly.
"Every situation is going to be specific unto itself. It would depend on what was found," the head trainer said. "You can't blanketly state, ‘Well, if this happens again, we'll do the same thing.'
"Every incidence is treated individually, because there could be something just a little bit worse, abnormal, different. Obviously, we then would have to address those specific situations. I'm not trying to dodge your question, but I can't say, ‘Oh yeah, he can.' Because something might be just a little bit different that causes us to have to pull the reigns and not let him go."