A New Handle

His doctors saved his hand, but it took Noah Brown a year of rehab to get back on the court.

By RJ Anderson

RJ Anderson is an Assistant Editor at Training & Conditioning.

Training & Conditioning, 13.9, December 2003, http://www.momentummedia.com/articles/tc/tc1309/newhandle.htm

After viewing Noah Brown’s mangled left hand, doctors told him there was nothing they could do—it would have to be amputated. Brown had been involved in a two-car accident in his hometown of Keene, Texas, on May 31, 2002, and his hand had been crushed.

A 2001 Southern Conference All-Freshman team selection and sophomore starter for the Appalachian State University men’s basketball team, Brown immediately thought his basketball career was finished. He begged the doctors not to let that happen.

Four hours later, another doctor came in to assess the damage. Carl Hubbell, MD, a hand specialist in Keene, told the 20-year-old that he could save the hand, but that Brown wouldn’t be able to pick up a basketball for at least a year. After inserting pins and over 100 stitches, the surgery was complete and Brown’s hand was wrapped in a soft cast. He was told the road to recovery would be long and challenging.

The accident that changed Brown’s life happened when his Ford Explorer was run off the road by another vehicle and tipped over, landing on the driver’s side. Attempting to brace himself, Brown instinctively reached his left hand up to keep the roof from caving in over his head. He missed the safety handle located near the edge of the roof, and his hand went out the open window. When the SUV flipped over on its side, Brown’s hand was trapped underneath the wreckage and dragged along the asphalt at 50 miles per hour.

Brown was wearing his seatbelt, which protected him from further injury (his only other injury required a single stitch on his right hand), but his left hand was shattered. His pinkie was barely attached, his middle finger was twisted 180 degrees, and the skin on his ring finger was peeled almost completely from the bone. Only his thumb survived the accident unscathed.

“I could sit here and tell you over and over what my hand looked like,” says Brown, a right-handed shooting guard, “but there is no way you can possibly visualize just how bad it was. It kind of looked like ground beef.

“After the surgery, the doctors told me I was going to need skin grafts and they kept telling me I wouldn’t have feeling in my hand for six months,” says Brown. “They weren’t being positive about anything. It was all negative.”

Luckily for Brown, it didn’t turn out that way. His skin grew back quickly, making grafts unnecessary, and feeling returned to his hand after just two months. When the pins were removed, seven weeks after surgery, it was time for Brown to go to work.

At the beginning of his rehabilitation, Brown could not move his fingers, so he spent a lot of time massaging the feeling back into them. “I couldn’t remember how to separate my fingers,” he says. “So the first couple of weeks I just concentrated on separating my fingers and trying to get them to bend. I played with a lot of Silly Putty and did sand grabs—anything to work on bending my fingers.”

Brown estimates that during the initial stages of his rehab, he spent between six and eight hours every day working to regain dexterity in his fingers. He also spent hours in his driveway working on form shooting with his right hand while his brother and sister rebounded for him.

In August 2002, Brown returned to Appalachian State to begin the fall semester, intent on continuing his rehab and ready to ratchet up its intensity. It was then that he met with one of the athletic department’s orthopedic surgeons, hand specialist Stephen Fleming, MD, who was assigned to monitor Brown’s progress and decide if any further surgery was necessary. After this meeting, Brown was allowed to begin dribbling a basketball again.

Despite the rapid skin re-growth and what seemed like a very speedy recovery, Fleming and the rest of the sports medicine staff at Appalachian State noticed some problems with the way Brown’s fingers were healing. “His fingers were very angulated,” says Jamie Moul, PhD, ATC, Assistant Athletic Trainer and Athletic Training Curriculum Director at Appalachian State. “I wasn’t sure if we could get him all the way back because he didn’t have good range of motion and his grip was very weak.”

By October the guard’s hand was functional for his day-to-day life, but it was not ready for athletics. The tendons in three of his fingers had healed awkwardly and resembled crooked J’s, making it impossible for him to make a fist.

Fleming eventually made the decision that the hand was not making enough progress and recommended additional surgery to insert plates in the middle phalanx portions of the fingers in order to straighten them. On Nov. 1, Fleming performed the surgery to re-break Brown’s fingers, effectively ending his comeback for that season and forcing him to redshirt. The setback was devastating to Brown.

“I can’t even put into words how bad it felt,” says Brown. “All the stuff I had done to get better, I was going to have to do all over again.”

“Deciding to have the second surgery was really difficult for him,” says Moul. “But once he realized that this was what he would have to do to achieve his goals in basketball, he worked exceptionally hard to get there.”

After the plates were inserted and the fingers straightened, Moul says they were able to extend the range of motion and work on rebuilding Brown’s strength. Along with constantly massaging the hand to break up scar tissue, they began doing a lot of different grasping and bending exercises. “We did some things with fishing weights where we would isolate individual joint movement,” says Moul. “I put a fishing line through the weight, hung it off of his finger and had him lift it, just like he would do with a leg-extension exercise.”

Moul says they also did a lot of work with medicine-ball tosses. Brown concentrated on using his fingertips to catch the ball—like he would eventually have to do with a basketball—gradually increasing the weight of the ball as his fingers grew stronger.

Working with Brown on a daily basis for seven months, Moul was careful to avoid some of the psychological pitfalls typically encountered during long-term rehab by varying the exercises. “Sometimes we would do fishing weights, sometimes we would do marble pick-ups, sometimes small-ball pick-ups,” she says. “But whatever the exercise, Noah knew what he had to do. He had a goal in mind, and he worked very hard to achieve that goal.

“I felt very fortunate to be able to work with him during those seven months,” she adds. “Not just from a professional standpoint, but from a personal standpoint as well. He’s really a fine young man and was great to work with.”

Brown also worked hard in the weight room. Even before he could grip a weight, Tommy Hoke, MS, CSCS, Head Strength and Conditioning Coach at Appalachian State, worked with him to strengthen his legs and abdominal muscles. “We did squats and lunges, plyometrics, all lower-body work until he got to where he could start gripping,” says Hoke.

“Once we got the okay that he could grip a weight, we started using dumbbells and free weights,” he continues. “With the aid of a strap on his left wrist, we could do wrist curls, that kind of stuff.”

Brown made the commitment to stay and train at Appalachian State during the summer of 2003 and the results were impressive. By the end of August, he was able to complete all of the exercises in the basketball team’s regimen, including snatches and jerks, without using the strap. During a recent test, he set personal bests in every lifting category and nearly won the basketball team’s maximum strength award, given to the squad’s strongest athlete.

“He was in the weight room extra days and always doing extra stuff—big and small,” says Hoke. “I give all the credit to Noah and the desire he had. You never know what you’ll miss until you can’t do it anymore. Having to sit on the sidelines and watch his teammates compete without him last year really tore him up.”

Waiting and watching apparently won’t be a problem for Brown this season as he is expected to regain his position as the team’s starting shooting guard. “I actually think I’m a better player now,” says Brown. “Before I got hurt I relied on out-muscling guards and getting to the hole. But you can’t outmuscle people when your hand is all messed up.”

After he was released to play pick-up games, Brown says that he was initially hesitant about driving to the basket, out of fear of falling and landing on his hand. To combat this he began working on a one-dribble, pull-up jump shot. Developing the new move, along with regaining his confidence to drive to the basket, has made his offensive repertoire more multi-dimensional.

These days, Brown’s work with Moul is complete and his workouts with the strength and conditioning staff are no longer any different than those of other players on the team. “There’s no doubt that I’m back—not just physically, but mentally,” he says. “In fact, I don’t think you can tell by looking at it that my hand was injured in the first place.” Some of the knuckles at the ends of his fingers remain stiff and inflexible and his middle finger is classified as a mallet finger—slightly bent at the last knuckle—but otherwise, Brown has almost full dexterity in his left hand.

Brown says his goals for the season include leading the Mountaineers to the NCAA Tournament. “I want to show people that sometimes there are obstacles in life that you just have to conquer,” he adds. “If you make the best of it, they can be a blessing in disguise.”