Jan 29, 2015Comeback Athlete: Brian Butch
University of Wisconsin
By Dennis Read
Dennis Read is an Associate Editor at Training & Conditioning. He can be reached at: [email protected].
As he had done countless times before, University of Wisconsin basketball player Brian Butch put out his right arm as he tumbled to the floor. His legs had been cut out from under him while crashing the boards for a rebound during a nationally televised showdown between the Badgers and Ohio State University, the two top-ranked teams in the country at the tiime.
But upon impact, the six-foot-11 forward experienced pain like he had never felt before. He screamed for help when he saw the dislocated elbow that left his right arm in a grossly distorted position.
“I really didn’t know what was going on,” Butch says of the injury, which was witnessed by a packed house at Value City Arena and millions of viewers on CBS, and replayed over and over on ESPN’s Sportscenter. “I knew my elbow wasn’t supposed to be where it was. I was in shock and the first thing I did was yell out Henry’s name because I knew I needed some help.”
“Henry” is Henry Perez-Guerra, LAT, ATC, Assistant Athletic Trainer at Wisconsin. Along with John Wilson, MD, a Sports Medicine Fellow at the school, he reduced the dislocation within minutes. With his elbow back in alignment, Butch, a leading scorer and rebounder for the team, lobbied for a return to the action.
“I thought it was like a dislocated finger where you put it back into place and go play again,” Butch says. “I didn’t know the severity of the injury until they got me into the athletic training room and told me what the outcome would probably be.”
Perez-Guerra explained to Butch that he wouldn’t be playing again that night. And despite a valiant rehab effort over the next three weeks, Butch would not return to the floor that season.
After three months of rehab, however, he was ready to play in July’s tryouts for the United States’ Pan-Am Games team. And he expects to be back to normal for the Badgers this winter, though the rehab will continue through most of the season.
While this was Butch’s first experience with an elbow dislocation, it was not Perez-Guerra’s. He knew that the sooner the dislocation could be reduced, the better, even if that meant performing the procedure on the team’s bench. The longer the elbow remains dislocated, the tougher it is to reduce since swelling and stiffness quickly build up. Plus, a dislocated elbow hurts–a lot.
“Our philosophy here is that if we can reduce it quickly, then sometimes the outcome will be a little bit better,” he says. “Dr. Wilson and I brought him over to the bench and checked for any obvious large fracture. Then we made sure he was neurovascularly intact before we decided to go ahead and reduce him. We felt that from an anatomical perspective everything looked stable–there wasn’t a large fracture and he wasn’t having any numbness or tingling in his hands.”
The two then performed a traction-type reduction. “I pulled up and Dr. Wilson pushed down,” Perez-Guerra says. “And the elbow went right back into place.”
Perez-Guerra estimates that the entire decision-making process and subsequent reduction took about three minutes. “There’s always the question of whether you reduce a bad injury like this in front of thousands of people or not,” he says. “But at that point, Dr. Wilson and I felt immediate reduction was in Brian’s best interest, so we decided to do it right there on the sideline. Trying to get him out of the arena and back into our locker room area would have taken more time, and the longer the arm stays out, the harder it is to get back in.”
After Perez-Guerra and Wilson reduced the dislocation, they moved Butch to the athletic training room to continue the treatment process. Joining the Wisconsin contingent was Ohio State Team Physician Grant Jones, MD, who had also helped treat Butch when he suffered a severe ankle sprain while playing in Columbus the year before. “I can’t say enough about the sports medicine staff at Ohio State–their help was an important part of Brian’s treatment and eventual recovery,” Perez-Guerra says. “The Big 10 is kind of like a little medical community–no matter which school is hosting an event, we help each other any way we can.”
Following the game, Butch was able to return to Madison with the rest of the team, and after a CT scan and x-ray confirmed no major complications, the rehab process started. Although this kind of rehab is often measured in months, Butch desperately wanted to expedite the process with the goal of returning for the Badgers’ postseason run. The Big 10 tournament was slated to begin in about two weeks and the NCAA tournament started the week after that.
“Certainly it’s an important time of the year, and Brian wanted to be out there, but our job is to evaluate his condition and make decisions in his best interest,” Perez-Guerra says. “Brian is obviously part of that decision-making process, but we knew what he needed medically.
“Post-injury, there was a short period when Brian wore a brace to immobilize the elbow,” Perez-Guerra continues. “Then we started some gentle range-of-motion work and progressed from there. With an elbow dislocation, we get concerned about losing extension of the joint so we also worked at getting his extension back but without causing any further inflammation. We let Brian’s symptoms dictate the rehab.”
The initial work involving the elbow was passive and later followed by assisted range-of-motion exercises. Before the season ended, the elbow had stabilized enough that he was able to begin strengthening work, mostly using lightweight dumbbells.
“Henry emphasized that even though I wanted to get back quickly, I had to take it slow,” Butch says. “But that’s really the only pace we could have gone at, because the elbow wouldn’t allow my rehab to progress any faster. I’m pretty good at listening to my body and it told me what I could and couldn’t do.”
But Perez-Guerra says Butch also took some convincing at times. “Every athlete wants to get back into action and play,” he says. “Every once in a while I had to remind him that it would take baby steps to get where we wanted to be. Sometimes, he was frustrated, and as an athletic trainer you have to realize that’s going to happen and be ready to talk him through it.”
Butch was almost able to make it back onto the court in time to rejoin his teammates for their postseason run. Still suffering from occasional pain and stiffness as the NCAA tournament began, Butch was fitted with a brace that limited his elbow extension while still allowing him to shoot. He practiced with the team during the NCAA regionals in Chicago and was medically cleared to play in the second round game against UNLV, but watched from the bench as the Badgers lost, 74-68.
Head Coach Bo Ryan said Butch likely would have played in the following round if Wisconsin had advanced. “Boy, he tried. He was working and he was trying to get back in there,” Ryan said in the postgame press conference after the loss to UNLV. “But he got really fatigued at practice yesterday–try sitting out a few weeks and then go play basketball again. If we could have kept this thing going, he’d have had a chance to get back for sure.”
Once the season was over, the rehab focus turned to long-term goals instead of short-term ones. Part of the challenge was working Butch’s elbow hard enough that he regained the strength he needed while not pushing so hard that the elbow hurt.
“With the season ending, we slowed down the process a little bit and let the symptoms guide the rehab,” Perez-Guerra says. “There were times when Brian got a little sore as we increased his activities, whether it was in rehab or the weightroom. That’s where I as an athletic trainer needed to step in and say, ‘Hey, we need to back down here a little bit and give this thing a chance to settle down.’
“We have an excellent strength and conditioning coach in Scott Hettenbach, and he was very cooperative,” Perez-Guerra continues. “He was more than willing to back Brian down when we needed and he always found ways to keep Brian active in the weightroom even though we had to limit his right arm.”
“Initially, Brian was in a sling and couldn’t run, so to keep his conditioning up we did interval work on the stair climber, exercise bike, and in the pool,” says Hettenbach, CSCS. “By the summer, Brian could do about 90 percent of our regular program, but we didn’t want to irritate the elbow, so we had to stay away from some of the Olympic lifts, especially the hang clean. Instead, we used single-arm snatches, box jumps, and triple extensions.”
Perez-Guerra also counted on a varied approach to help bring Butch back to health. Along with modality treatments to help with pain and swelling, he counted on joint mobilization, rhythmic stabilization, and band work to complement the strength training.
“I don’t believe there is one standard protocol for a rehab like this,” he says. “There are basic things you want to accomplish–like reducing swelling and pain and regaining range of motion–but it’s not like following a cookbook. I had to really listen to what Brian said about how he was feeling.”
Unable to return to the Badgers lineup before the season ended, Butch had a new goal in mind–the Pan-Am Games tryouts in early July. He stayed on campus with the rest of the team over the summer, which allowed him to work out and receive treatments daily. He even began playing pick-up games a couple of weeks before the tryouts. Although he was not selected for the Pan-Am team, Butch feels the tryout was a good experience.
“First of all, it’s an honor any time you’re invited to do something like that,” he says. “Then to be able to compete at that level and play the way I did was a big confidence booster. “
“Plus after I got back, I was able to concentrate on playing basketball instead of worrying about getting hit or falling to the floor,” he continues. “The longer I played, the more comfortable I felt, and I was able to continue to improve and really forget about my elbow injury.”
The rehab continued throughout the summer and fall. In addition to the strength work, Perez-Guerra felt it was also important to prepare Butch for the next time he might fall to the floor.
“There were some proprioceptive issues we had to address,” Perez-Guerra says. “If he gets undercut again and has to extend that arm out, we want his muscles ready to fire and protect him, so we made that part of the rehab plan. We did work on uneven surfaces. We had him use a stair climber with his arm and shoulder rather than his feet. We also put him in provocative positions with medicine balls and had him do some rhythmic stabilization exercises.”
Although Butch feels like he’s back to normal, Perez-Guerra says there’s still a little work left to be done. “This is something that will take almost a year before it is 100-percent normal,” he says. “The elbow still acts up from time to time, so we have to back down a bit when it does. And though he’s close to his original strength benchmarks, we still want it to get stronger before we say he’s 100 percent. But he’s about as close as he can be, and he’s ready to go.”
Listed as a possible All-America candidate by many publications, Butch is expected to be a big part of a Badgers team seeking its 10th straight NCAA appearance. Although disappointed that he missed out on last year’s postseason run, he says there has been a silver lining behind the pain and frustration the injury produced.
“I don’t want to say it was a good experience getting hurt, but I’ve realized how important all these people are around us players are–people who are sometimes taken for granted,” Butch says. “There were five or six key people involved with helping me, including Henry–who was there for me every single day. I would like to say thank you to everyone who has helped me get through this.
