By David Hill
David Hill is an Assistant Editor at Training & Conditioning.
Training & Conditioning, 11.9, December 2001, http://www.momentummedia.com/articles/tc/tc1109/stormback.htm
University of Mississippi softball outfielder Jessica Hamiilton got her college softball career off to a great start. Through the first 12 games of her freshman year, she led the team in hitting with a .429 batting average.
But game 13 proved to be the unlucky one when she turned on a fly ball. She caught her cleats in the grass and went down hard, causing a spiral fracture of her right fibula. The injury wiped out the 1999 season for her.
Hamilton recovered from the fracture, and by the spring of 2000 was back at play. Soon after her return, however, Hamilton was in the Rebels' outfield facing rival Louisiana State. As she dove for a fly ball, she came down hard on her outstretched left arm, jamming the humerus into the labrum in a painful dislocation of her throwing shoulder.
For many young student-athletes, two major injuries occurring a year apart would be devastating. Some would be left questioning whether to continue with sports and whether the months of early-morning weight-room rehab, painful setbacks, and lost time were worth the effort. Any such misgivings that Hamilton had were surpassed by her determination to return to play.
With the help of Oxford, Miss., orthopedic surgeon Edward Field, MD; the Ole Miss athletic training staff, including Graduate Assistant Athletic Trainers Edward Livingston, ATC, and Caroline Johnson, ATC, and Assistant Athletic Trainer Jeff Moore, ATC; and Head Softball Coach Candi Letts, Hamilton returned to play her first full season in 2001, leading the team in on-base percentage and recording the Rebels' second-highest batting average. For her determination and hard work recovering from two consecutive injuries, Hamilton has been named the Training & Conditioning Female College Comeback Athlete of the Year for 2001.
Not that Hamilton didn't have her doubts. As a left-handed hitter, her recovered right leg was exposed to oncoming pitches, so she couldn't help but think how much it would hurt if she were hit on the scar. And, naturally, the thought of another major injury lurked in the back of her mind.
"It just seemed that everything was going in a sequence," Hamilton recalls. "My freshman year I got to play about a quarter of the year, and then my sophomore year I got to play about half of the year. So I was thinking, 'Am I going to get hurt three-fourths of the way through my junior year?'"
Hamilton's first comeback, in 1999, began with surgery on the broken fibula just above the ankle. The twisting fracture came with a syndesmosis disruption requiring extra screws to hold ligaments in place so that they could heal, Field says.
Her range-of-motion therapy included towel stretches, ABCs, use of a slant board, and manual stretching followed by isometrics, marble pickups, ankle pumps, exercise band drills in all directions, and bicycle riding, according to Livingston, now Assistant Athletic Trainer at Lees-McRae College in Banner Elk, N.C.
By April 22, 1999, seven weeks after the leg injury, Hamilton added running and throwing to her rehab regimen. Over the summer, she moved to an advanced strength and conditioning rehabilitation program, which included a weight-room protocol, treadmill running, a stair stepper, slideboard, proprioception exercises, plyometrics, and softball-specific exercises.
The softball-specific rehab work included forward-back drills, hops and jumps, footwork for fly balls and ground balls, and practice reaching for the fence with her throwing arm when going back for deep flies. At the plate, she wore a shin guard over the scar. She used a soccer shin guard first, followed by a special-order baseball model that covered half her right shin.
Her running included stop-and-go zig-zag drills. "I would run in one direction, then stop and go in the other direction," Hamilton says. "It was just to see how it felt and to allow me to get comfortable with that again, because I was a little timid coming off that broken fibula."
Hamilton's rehabilitation continued through the fall of 1999. But as the spring approached, pain flared up. The pins inserted in her lower leg bones to facilitate healing were becoming a problem, Field explains.
"There's so much motion around the ankle that sometimes just the tendons rubbing over that hardware can fuss them enough to where it bothers you," he explains. "The average patient is not going to have that type of pain, but with a Division I athlete who's constantly using the ankle, most of the time I'll end up having to take the hardware out."
Early-season cold weather also seemed to bring out the pain. So on February 4, 2000, Field surgically removed the hardware. Hamilton stayed off the leg for five days. To maintain cardiovascular conditioning, she used an arm bicycle. Then she began towel stretches, slant-board work, manual stretching, exercise bands, manual resistance, proprioceptive neuromuscular facilitation drills, calf raises, heel-walks, and step-ups.
Ten days after the pins were removed, Hamilton suited up for the Rebels' 2000 opening tournament. Through 32 games--starting in all but two--Hamilton hit at a .264 pace with six RBIs and a .331 on-base percentage. Then, on March 28, 2000, came the fateful dive and the shoulder dislocation.
Many such separations are dealt with conservatively, with medication and therapy, Field says. But Hamilton continued to experience pain, and an MRI showed a partial tear of her rotator cuff. On June 9, Field performed an arthroscopic laser capsulorrhaphy to suture the tear, debrided necrotic tissue in the rotator cuff, and performed an arthroscopic subacromial decompression.
"All it does is kind of put the rotator cuff in a healing mode as well as give her some ability to get the shoulder up again," Field says.
After two weeks of immobilization, Hamilton began range-of-motion exercises, including Codmann's, wall walks, T-bars, as many isometrics as she could tolerate in all directions, and low-level exercises for surrounding joints. These included ball squeezes, wrist flexion, extension, radial deviation, ulnar deviation, supination, pronation, bicep curls, and tricep extensions, according to Livingston.
As her range of motion improved, Hamilton began strengthening her rotator cuff through empty-can exercises, internal and external rotation while standing and side-lying, 90- and 110-degree Hughston's, and some isotonic shoulder work and scapular strengthening, including rows and push-ups. The final stage consisted of PNF patterns, 90 degrees of abduction and external rotation, Hughston's at 180 degrees, dynamic stabilization, advanced proprioception exercises, closed kinetic-chain exercises, and plyometrics for throwing.
Hamilton took a break during summer vacation in July. When she returned to the Oxford campus in late August 2000, she resumed her shoulder rehabilitation. This included work with exercise bands and weights in the two-pound range. She stayed out of the Rebels' fall season to concentrate on preparing for spring.
In late September, Hamilton began a throwing program, starting with short tosses of 20 to 30 feet and working up to long throwing from the outfield. It was almost like learning to throw all over again, Hamilton recalls. She was careful to use proper form, and she worked with the coaching staff to relearn the skill correctly. This meant using her body more than her arm, taking time to set up properly instead of simply rushing the ball back to the infield, and adequately following through, says Head Softball Coach Candi Letts.
Working with Field, the athletic training staff also made sure Hamilton rested when pain in her shoulder flared up. Johnson blames Hamilton's pain on bicipital tendinitis, which was handled by backing off on her exercises when the pain returned.
Despite her determination, it wasn't always easy for Hamilton to remain positive about her recovery. Livingston recalls that Hamilton was emotionally down from not being able to take part in the sport that brought her to Mississippi from her hometown of Nashville, Tenn., not being able to help the team through a difficult year, and from being stuck on campus when the team went on road trips during her first stages of rehab.
"Body language speaks a lot," Livingston says. "She couldn't hide it. We spent a lot of time talking."
Johnson did a lot of talking, too. "I tried to get her to tell me what was going on and have her talk through it so that she was not keeping it inside," she says. "On those not-so-good days, I had to remind her that rehab is a roller coaster and that it's okay to have a bad day because we can rest and get back up to a good day. I would remind her what the overall outcome was going to be."
Hamilton credits her athletic trainers, Field, and her coaches with helping her look beyond missing games. "It was encouraging to have the coaches come and tell me that I was doing a good job through my rehab and to keep it up, and to have the athletic trainers come in and tell me I was ahead of schedule," she says. "They would all tell me that I would be out there on the field again one day and having fun."
The admiration goes both ways. "Even though she was back playing this past spring, she was in here every morning at 6:45 doing her rehab and her specific shoulder and rotator cuff strengthening exercises," Johnson says.
Field noticed it, too. "Every athlete who gets hurt kind of punches their lips out early on and has that 'Why me?' look," he says. "But Jessica, throughout every surgery she's ever had, has been a champion, and she's really gone at it hard and refused to quit."
Category: College Female
Injury: Spiral fracture of right tibula and dislocated left shoulder
Performance Team: Edward Field, MD, of Oxford, Miss.; Edward Livingston, ATC, and Caroline Johnson, ATC, Graduate Assistant Athletic Trainers at the University of Mississippi; Jeff Moore, ATC, Assistant Athletic Trainer at the University of Mississippi; and Head Softball Coach Candi Letts.