By Jim Catalano
Jim Catalano is an Associate Editor at Training & Conditioning.
Training & Conditioning, 11.6, September 2001, http://www.momentummedia.com/articles/tc/tc1106/steel.htm
Jennifer Azzi of the Utah Starzz was pumped for the May 14, 2000, exhibition game against the Portland Fire. Azzi was beginning her comeback after a brief retirement from women's pro basketball and she intended to have a great season. But her hopes were soon thwarted. As she drove for a layup, Azzi fell hard and landed on her right hand. She instantly knew something was very wrong.
"My middle finger was going in the other direction, like it was broken in half," she recalls. "I pulled on my finger to put it back into place, just as a reflex. Then, when I went over to my athletic trainer, Leanne Stockton, she asked me if I could move my finger. I said, 'Yeah, but I don't think it's my finger. It's my hand.'"
She was right. Doctors later confirmed that the third metatarsal of Azzi's shooting hand had a spiral fracture. The injury threatened to keep Azzi off the court for most of the season, which could derail her reborn pro basketball career.
Instead of giving in to this injury, Azzi aggressively approached her rehabilitation with the same steely determination that made her one of the best-conditioned athletes in pro sports.
"It was a big challenge getting hurt," Azzi says. "I tried to channel the frustration from that injury by working out. I biked a lot, ran a lot, and worked my butt off to stay in shape with the goal of coming back to the game that same season."
Sure enough, Azzi returned to the Starzz midway through the season, finishing first in the league in minutes played per game.
For her diligence in rehabilitating her hand injury to regain her grip on the game, Azzi has been named the Training & Conditioning 2001 Comeback Award Winner in the professional athlete category. Also honored are Lisa Giannone, MS, PT, owner of Active Care Physical Therapy and Sports Medicine Fitness Center in San Francisco; and William Green, MD, of the California Pacific Medical Center in San Francisco, who performed the surgery on Azzi's hand.
Azzi's remarkable recovery is closely related to her fitness-oriented lifestyle. Ever since her days as an all-American guard at Stanford, Azzi's life has revolved around fitness. Her career includes three years in the American Basketball League (ABL), a spot on the gold-medal winning USA Olympic team in 1996, a stint with the WNBA's Detroit Shock, and her current position as point guard for the Starzz. She also runs a web site, www.mytrainingcamp.com, that offers fitness advice to adults.
The broken hand was the second serious injury in Azzi's pro basketball career. She suffered a dislocated shoulder during the 1996-97 ABL season with the San Jose Lasers. The weird thing is, both injuries occurred in the Portland Memorial Coliseum, on the same part of the court, and during a similar act of driving the lane for a layup.
"I had a sense of deja vu," Azzi says of the hand break. "I remember lying on the floor thinking, 'I cannot believe that this is happening here again.'"
After her fall, Portland team orthopedic surgeon Don Roberts, MD, immediately x-rayed the hand at the arena. "We saw it was a clean, solid break," Azzi says. "They put me in a splint, then I waited to get back to Salt Lake City to get x-rayed again. We had to see if it was something you could leave in a cast or if it was something that would require surgery."
Starzz team orthopedist, Lyle Mason, MD, put her in a cast, and Azzi consulted with Giannone, who had directed the rehabilitation of her earlier shoulder injury. Giannone helped arrange a consultation with Dr. Green, who is recognized for his work with local professional teams, and when further tests revealed that the fracture had angulated, or shifted, surgery was recommended. On, May 25, Azzi underwent a procedure in San Jose to insert a plate into her right hand.
The expected recovery time was four to six weeks, but Azzi was eager to get back on the court before that. "The doctor would have preferred that I not play at all last season, but there was no way that I was going to miss it," Azzi says. "My goal was to come back around the middle of the season."
Four weeks after surgery, Azzi was ready to begin the physical therapy that she hoped would resurrect her career. She returned to Giannone, who devised a rehab protocol for a speedy recovery. "She came out of the cast a bit earlier than normal--you can stay up to six weeks in a cast in many cases," Giannone says. "That decision allowed to us to start rehab work a little earlier."
The first phase in Azzi's treatment focused on regaining the mobility in her right hand. "Not only did her hand get stiff right around the injured bone, but all of her fingers got stiff, along with all the carpals in her hand, her wrist, and even her shoulder," Giannone explains. "For her hand to reform to its normal position to be able to support and shoot the ball, it took a lot of very directed hands-on stretching and mobilizing of all the soft tissues and many small joints of her fingers and hand. But I also had to work her wrist and forearm. That's the tricky thing about hands--even though it's only one little bone, it all ties together in a complicated fashion."
In order to speed the recovery, Giannone taught Azzi to do very specific mobilization exercises on her own. "There is a series of active ROM and self stretches that she did in the first phase of her rehabilitation," Giannone explains. "She had to regain a certain amount of mobility before she could safely add strengthening loads. So I had her do detailed hand work, things like tapping each finger at varied intervals, plus end-to-end, thumb-to-finger squeezing, going through all the digits at varying pressures and speeds. We also had her do some gross motions such as squeezing balls of various densities and sizes."
Eventually, light weights were added to the regimen. "She used some hand weights where she was rolling a dumbbell down to her fingers and curling it all the way up into her hand to address the intrinsic muscles of her fingers and hand," Giannone explains. "Then we addressed her forearm muscles by doing wrist curls. We emphasized flexion, extension, and motion in all planes that the wrist moves in. Then we worked on rotational motion of the lower arm, which is supination and pronation, while holding the end of a dumbbell. Another exercise was to attach a weight to a stick with a string, and roll that up and down to get detailed activation of the wrist and hand. Then we worked up to the biceps, triceps, and shoulder."
A crucial element in Azzi's rehab was pacing her weight work. "You can't start adding weight prematurely because you don't want to put big loads in a hand before it's ready," Giannone says. "Until you have mobility and enough muscle firing to support the fracture, you can't start dropping eight- or 10-pound weights into your hand to do a bicep curl or any sort of tricep rope press."
Azzi's previous shoulder injury was also addressed during her rehab. "We got a little bit worried, because if she didn't keep her shoulder toned pretty well, it could have led to trouble with pain while throwing or shooting the ball," Giannone says. "So we were anxious to get back to addressing her rotator cuff and shoulder in general."
Giannone had Azzi hold onto a cord with proper hand grip mechanics and go through motions related to her shoulder and elbow. "These turned out to be some of the more important things we did to address her hand, wrist, and shoulder combined," she says.
In the final phase of her rehab, Azzi started adding loads to her exercises. "She started with pushups," Giannone explains. "She'd do that in various angles, so she'd be pushing a part of her body weight to start, then a greater part of her weight by changing the angle of the pushup, and then full body weight as in a regular pushup. She also did things like bench presses, changing the weights and the angles through which she would support the weight."
Unlike many competitive athletes, Azzi didn't try to go too fast in her rehabilitation, which continued after she returned to the Starzz in early July 2000. "She's pretty diligent about doing what she has to do when she has to do it," Giannone says. "She wanted to push, but didn't push too much."
When Azzi first returned to the courts, her progress was slowed because her right hand frequently swelled up. As a result, her long-range shooting ability was limited. "Three-point shots were a lot harder coming back," Azzi says. "It wasn't until the last three or four games that I even started to take three pointers."
Azzi continued to ice her swollen hand and follow her rehabilitation regimen through the rest of the WNBA season. She was still doing some exercises in the postseason. By the fall, her hand was fully recovered.
Azzi's 2001 WNBA season has gone well, as she's back among league leaders in minutes played per game, assists per game, three-point field-goal percentage, and free-throw percentage.
She still has the plate in her hand, but plans to have it removed as soon as possible. "I'll have to wait until the end of the season before it comes out, because it takes four weeks of not doing anything during recovery." And right now, Azzi is too busy continuing her remarkable comeback to sit still and do nothing.