Monday, January 21, 2013

Building and Rebuilding Nolan Berry: Part Two

I was encouraged to learn that Nolan was put in splints and not casts.  Immobilization of any joint makes rehab more challenging. But immobilization of the elbow ups the ante. It is a complex joint with many connections, articular surfaces and degrees of freedom. It connects the shoulder and the wrist and allows the basketball player to handle and shoot the ball with grace and unlimited variety.

Failure to do the rehab well from the beginning might compromise Nolan’s ability to shoot and play in the future, not just keep him from playing this season. I had to make sure he understood this from day one, regardless of how painful, boring or monotonous the work was.

It is interesting to note that immediately after the fall on November 19, Nolan's wrists hurt the most and were the focus of initial evaluation.  He could move his elbows fine.  It was only after sitting with ice on his wrists for several minutes that the injury to the elbows became apparent. After icing his wrists, he discovered he could not bend or straighten his elbows.

The splints were removed November 26, exactly one week after the injury.  Nolan was given instructions to “let pain be your guide” and to move the arms as much as possible doing simple tasks of daily living--wash hair, put on socks, use laptop, button shirts, open doors, etc. The one limitation was to not lift anything of significance--someone even had to carry his school backpack. He started physical therapy at Pro Rehab on Tuesday November 27th and was supposed to see me on Wed the 28th, but got the flu and missed all of his sessions at Pro Rehab that week.  I knew it was imperative to get him moving; he was able to start with me on Friday November 30th.

Again, Nolan's work at Pro Rehab focused specifically on the hand, wrist and elbow. His work with me would focus on integrating the arms into common gross motor/sport movements and with the shoulder and scapula.

Here are some highlights of Nolan's progression and our work during the first two weeks . Keep in mind, about the only thing he could do with his arms on Nov 30 was feed himself with his R hand.

Nov 30:  Entered w/R hand holding L in protective manner. No arm swing.  Mom had to untie/tie shoes and help change clothes.  Lacked about 40 deg extension in L and 30 in R.  Less than 50% of flexion. No pronation or supination R/L .Reviewed home exercise program (HEP) from Pro Rehab therapist with mom and Nolan.  Discussed need to incorporate and set goals with  activities of daily living (ADLs). Began shoulder ROM exercises in supine/standing.  L hand particularly “dead” and inhibited by pain. Wax on-wax off with wash cloth, fold towels.

Dec  1:  Today able to walk with both arms at side;  R shoulder abduction full, L shoulder abduction with stick assist, but not independent secondary to “heavy sensation and pain.”  Put basketball in hands, wax on wax off, fold towels—folding VERY challenging for L arm/wrist.

Dec  5:  Walks holding 2 lb power balls and Indian clubs to distract elbow and maintain full extension. Light leg work, shoulder movements in all planes.  Now able to abduct L arm/shoulder without pain, full range of motion. 

Dec 6: Diagonals 1 and 2, light tubing shrugs (scapular emphasis, elbows straight), step ups with weighted vest, incline DB press (no dumbbells), tubing rows (no tubing), foam tennis ball wall touches, review 4-way jumping jack arms (in standing; too painful to jump).

Dec 7: Light jogging, squats, lunges, squat jumps on side of court during practice. Nolan begins to join team at practice even though he cannot participate in contact. First running and reconditioning begins.

Dec 8: First day being able to put on and tie basketball shoes, put on sweatshirt independently. Full shoulder abduction and flexion with L arm.  L hand and fingers moving normally again.  Shadow throwing motion with R arm (football, foam ball)—can throw and catch foam tennis ball against wall with R.  Able to incline press with stick without pain. Attempted jump rope arm motion: only able to get jumprope around/over head 1/4 of time; able to use R UE and L for single rope turning.

Dec 9:  Light running in practice; jumped up and touched rim with both R and L (gingerly) hands; dribbled with R arm and shot a few layups with R (no pain reported to coach).

December 11:  First day of driving while supervised. Begins ball handling/shooting work in earnest to work on pronation/supination. Farmer’s walks and Hexlite bar deadlifts for full elbow extension; no pain. Still painful, especially in L wrist with pronation/supination. Unable to bear anything but very light pressure on either arm. Unable to put full back-spin and follow-through with R (shooting) hand due to lack of full supination combined with elbow flexion. See some of the things we did in the video below.

Dec 12-14:  Able to drive independently now, but still very painful in L wrist after two full weeks of therapy and work. Nolan seems to have lost some enthusiasm and focus—mom, coach and I notice change in demeanor.  Progress since Tuesday of this week has been limited by L wrist pain.

So here we were, it was December 14--less than 4 weeks after the accident--and we had made very, very good progress, but it seemed like it had stalled. Nolan seemed a bit distant. He was not happy sitting on the bench in street clothes.  His goal of playing in the Meramec Tournament was slipping away.  And the continued pain in his L wrist and forearm was disconcerting. Were there injuries lower in the arm that the xrays hadn’t shown?

Sunday, January 20, 2013

Vianney's Sean O'Brien 2013 McDonald's All-American Nominee

Congratulations to 6' 9" Vianney senior Sean O'Brien on his McDonald's All-American nomination!

I have had the pleasure of working with Sean since the spring of his sophomore year. Sean is one of the hardest-working and modest young men I've met. He relished his role last year as 6th man on a state-quarterfinalist team, and then embraced the new role of captain and leader of a this year's young and inexperienced team.  The Griffins are 12-5 at this time and getting better with every game, with Sean averaging 16 points, 9 rebounds and 1.8 blocks per game.

Sean is still considering his college options, but wherever he goes, he is sure to be a positive asset to the program. Physically, the sky is the limit for this 6' 9" young man; there is so much untapped potential.  But even better, Sean is a student of the game who relishes the opportunity to be a role-model for younger athletes. He wants to be teacher and coach. I wouldn't be surprised to see him someday take over the reigns at Vianney from Coach Kevin Walsh. 

Saturday, January 19, 2013

Thursday, January 17, 2013

Building and Rebuilding Nolan Berry (Part 1)

Tonight Nolan Berry will play on the DeSmet home court for the first time this season.  A few weeks ago, I wasn't sure he would play any of his senior year.

Tuesday November 20, 2012, I received the following text from Meg Berry, Nolan's mom:

"Big Bird broke both of his arms in practice last night. So sad."

My heart sank.  The kid was in the best shape of his life. Just the week before, DeSmet coach Kevin Poelker had texted me to say that Nolan was leading his team in practice and looking "stronger than ever."  We had successfully rehabbed a bad ankle sprain back in June and a dislocated patella in late July and August; gotten him to personal bests in all of his lifts and up to 226 lbs.  He was fit, strong and ready.

The fractures were at the radial heads. Two in the left arm and one in the right. Ugh. The elbow is such a persnickety joint. So hard to get full range of motion back after being immobilized for long periods. He'd be in bilateral, full arm casts for weeks. Not a fun prospect for an 18 y.o. boy or his mom.

But wait.  He wasn't casted; just placed in splints for 1 week and told he would begin therapy the next week.  Maybe there was hope. I asked my friend Ed Ryan, the ATC for the USA Women's Olympic Basketball Team, what the rehab timeline might be as I'd never worked with this particular injury before. He said 6 weeks if everything went well and there were no complicating factors.

Six weeks and three days later, Nolan Berry was cleared by his MD for full participation in practice and games. He scored 11 points and had 8 rebounds in his first game back on January 5th. The story of his rehab and recovery are unique, if not remarkable. I am proud to say I played a part in his return to the court and would like to share our journey (with Nolan's permission, of course) over the next week or so.

Nolan's rehab was successful and quick because of the following:

1. The fractures did not require surgery, pins or long term immobilization.

2. He worked with an upper extremity therapy specialist for rehab proper.  She focused on range of motion and function of the elbow, hand and wrist. For him to play basketball in the future, full range of motion at the wrist and elbow were an absolute necessity.

3. His home exercise program and work outside of therapy were guided by me, a physical therapist who specializes in returning athletes to sport--and one who understands the demands of basketball .I was not going to let him have more than 24 hours without structured exercise in the first few weeks. I would keep him focused on returning to play and use the basketball as much as possible, as soon as possible.

4. Nolan had a physical literacy and athletic development training base of 4 years with me.  We had a vast library of movement from which to rebuild his body and confidence, while he was doing traditional upper extremity therapy. This would be key if he was to safely return to full strength during the season.

I knew exactly what his previous abilities were and exactly how much I had to emphasize the importance of his compliance with therapy for him to return to 100% function.  18 y.o. boys are not exactly known for their attention to detail.  But I had the ear and trust of his mother and his coach, so between the three of us, we could hold him accountable.  After 4 years of working together, this was definitely going to be our biggest and most interesting physical, emotional and psychological challenge.

Before I get into some of the details of our work, I thought it would be fun for people to see a bit of what Nolan did over the last four years; how much he has changed physically and some of the not-so-glamorous things he has done to become a durable big guy.  Other than injuries from collisions--ankle sprains and the patellar dislocation--Nolan has not suffered any of the nagging overuse issues (knees, feet, back) that have plagued DeSmet big guys in the past.

My focus has not been sport specific--on building a basketball player. It has been on building a durable, physically competent athlete with a movement vocabulary that will prepare him for the collegiate level and beyond. Like all young athletes, Nolan needed basic infrastructure: mobility, strength, body awareness and control. He had the basketball skill and IQ.  My job was to help him build the physical foundation and confidence to express his basketball gifts.

Stay tuned for Part 2: The First Three Weeks