Jan 29, 2015Comeback Athlete: Dave Angebranndt
University of Delaware
By Patrick Bohn
Patrick Bohn is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected].
Mercer County Community College baseball player Dave Angebranndt was rarely late for anything. So when he wasn’t at the team’s preseason meeting on Jan. 12, 2009, MCCC Head Athletic Trainer Lisa Camillone, Angebranndt’s coach, and his teammates wondered what could be keeping him.
What they didn’t know was that the catcher was being rushed to a hospital, his left arm severely injured in a car accident. Earlier that afternoon, Angebranndt was leaving a convenience store in his Jeep when another driver made an illegal left-hand turn and struck Angebranndt’s car on its passenger side.
Angebranndt drove with the windows down whenever possible, and this day was no different. When his car was struck, the impact jarred his left hand from the wheel and out the open window. The Jeep then rolled over three times, pinning his arm between the ground and the vehicle each time.
The injuries to Angebranndt’s arm were predictably horrific and included a compound fracture of his humerus, vascular damage requiring an arterial bypass, radial nerve damage, and a musculocutaneous nerve palsy in his biceps. Angebranndt, who had already signed a letter of intent to play for the University of Delaware upon graduation from MCCC in May, underwent several surgical procedures, including insertion of a metal rod in his arm. The prognosis was grim.
“The day after they fixed my humerus, I asked the doctor if I would be able to play baseball again,” Angebranndt says. “He asked if I wanted the doctor answer or the parent answer. I told him to give me both and he said, ‘As a doctor, I don’t think you’ll ever play again. As a parent, I think you’ll be able to, but probably not the way you’ll want to.’
“I broke down when I heard that,” Angebranndt continues. “I thought, ‘Who would say that to a 20-year-old kid?’ But, I told myself I would prove him wrong.”
Angebranndt’s uncle, Chuck Miller, PT, is a physical therapist at the nearby Trenton Orthopaedic Group and worked with his nephew during the rehab process. But Angebranndt’s health insurance only covered a certain number of physical therapy sessions so he also worked with Camillone, allowing him to go to therapy more frequently.
Angebranndt started working with Camillone in early April, but the process was slow as his body was still recovering from the surgeries. “Those first few days, my goal was just to make sure his arm could still function at a basic level,” Camillone says. “It was all about coordination, flexion, and extension. On April 3, I had him pronate and supinate his wrist for flexion. To work on his hand-eye coordination, he picked up marbles and put them in a milk jug.”
Though the exercises were a struggle, Angebranndt worked through his frustrations. He progressed to working on his triceps and biceps with Camillone, who did some assisted motion of the muscles, as well as some Russian muscle stimulation techniques. Camillone moved slowly through each phase.
“I had to make sure Dave didn’t do too much early on,” she says. “His arm still needed to heal, and if you do too much too soon, the muscles you’re focusing on can’t handle the load and others will take over the stress, causing overuse.”
Being forced to do simple exercises frustrated Angebranndt. “It got to the point where I was so mad I felt like quitting,” he says. “I remember thinking, ‘How is this going to work for me? I want to play baseball in September and I’m having trouble putting marbles in a jug in April.'”
Angebranndt’s sessions with Camillone included massage to improve range of motion, and as the weeks wore on, he started doing strength exercises. By mid-April, he began squeezing a hard rubber ball to strengthen his forearm and Camillone had him perform an exercise normally reserved for MCCC’s pitchers: She filled a five-gallon jug three-quarters of the way with rice and had Angebranndt stick his arm halfway in it to his elbow. He would then attempt to pronate and supinate his wrist while the rice provided resistance.
The rice jug exercise was one of many unorthodox exercises Camillone had Angebranndt try. “I’m just a small community college athletic trainer so I don’t have a lot of the latest rehab equipment,” she says. “Dave and I would be in the room and I’d look around and see what I had to improvise with. One day, a 20-pound bolt cutter caught my eye, and I said ‘Hey Dave, go see if you can pick that up.’ And he did.”
During this time, Camillone was in constant communication with Miller, who also began working with Angebranndt on April 20. “I was always going back and forth with his uncle and doctors, making sure everything we did was within Dave’s ability,” she says. “When you’re working with multiple people on a rehab, communication is key.”
When Miller first saw his nephew, his initial reaction was similar to that of Angebranndt’s doctor. “I thought, ‘He’s probably not going to be able to come back,’ Miller says. “But a lot depends on the player’s motivation, and Dave was dead set on playing again.”
The early indicators weren’t good. Angebranndt still had an open wound on his elbow and significant scarring had made it tough to gain flexion. “Dave couldn’t supinate his hand or forearm, and couldn’t flex his elbow past 72 degrees,” Miller says. “His arm was really tight, almost like a stretched rubber band.”
Miller’s first goal was to restore range of motion. “He could become as strong as he wanted, but if he didn’t have the range of motion to catch pitches, he wasn’t going to be a very effective player,” Miller says. “And because his arm had been immobile for so long, restoring it was not going to be easy.”
To gain elbow flexion and extension, Miller began doing joint mobilization and passive stretching work with Angebranndt. Pronation and supination of the arm was also key.
“Dave would sit in a chair with his elbow flexed at 90 degrees at his side, while holding a six-inch stick with a one-pound weight attached to it,” Miller says. “He would rotate the stick back and forth as far as he could, trying to get his palm facing up and then down.”
Angebranndt also did 30 standing Swiss ball pushups at a time, holding a ball on a table and going down as far as his elbow would allow. He worked his shoulders by doing seven-pound shrugs, and used a Ther-A-Band for resisted forward flexion and extension work and internal and external rotation.
Over the next two weeks, Angebranndt began doing tricep pull-downs with up to 17.5 pounds of weight and progressed to holding a three-pound dumbell for arm pronation and supination. Miller also added a rowing exercise to the routine, and had Angebranndt do reverse flys and chest presses on the Swiss ball.
On May 1, Angebranndt was put in a Dynasplint while working on increasing his flexion and extension. “Dave was doing that three times a day for 30 minutes at a time,” Miller says. “It was helpful because light-load, long-duration stretching is the best way to improve range of motion.”
Despite making slow advances in the rehab, Miller grew concerned because Angebranndt’s biceps still weren’t functioning well. “According to his electromyography results, the musculocutaneous nerve was normal, which told me that the biceps weren’t functioning muscularly,” he says. “They were wasting away with atrophy. I was talking to his doctors, trying to find out what was wrong, but they didn’t have an answer for me.”
Although his biceps continued to be a mystery, the rest of Angebranndt’s rehab progressed relatively smoothly. By early June, his flexion and extension had gotten better and he was able to catch pitches and swing a bat lightly. He was also able to do full pushups on the floor, although Miller says his biceps still weren’t firing and Angebrandt’s other arm muscles were compensating.
By July, Angebranndt was swinging the bat more forcefully and able to hit slow pitches, and he’d started to regain arm strength. He continued to work with Camillone and Miller, but his time with them was winding down.
“At that point, we knew Dave would be going to Delaware in a month,” Miller says. “I knew the school’s athletic training program would be good for Dave because it’s an NCAA Division I school and it would be good to have a new set of eyes look at his rehab program.”
At Delaware, Angebranndt’s rehab was handled by Head Athletic Trainer John Smith, MS, ATC, with help from Assistant Athletic Trainer Courtney Butterworth, MS, ATC. When Smith took over the rehab he immediately focused on improving range of motion in Angebranndt’s elbow. However, this was complicated by the lack of strength in Angebranndt’s biceps.
“His inability to use his biceps was directly affecting his ability to gain range of motion,” Smith says. “Activating those muscles was critical to controlling his elbow.”
Smith began using electric muscle stimulation to assist with the contraction of the biceps. He also had Angebranndt do isometric work by holding a two-pound dumbbell for 10-second intervals, 10 reps at a time. Passive stretching rounded out most of Angebranndt’s days in the athletic training room.
“To stretch Dave’s arm, I would maneuver it in an extended position and let it hang there,” Smith says. “I’d also put a weight on his elbow or wrist and ask him to relax to get him to hang his arm that way. It was uncomfortable for him I’m sure because his skin was stretching. Anytime you have a joint held in one position for a long time, you develop contractures. In Dave’s case, those were very thick.”
Although the exercises helped, Angebranndt developed inflammation in his elbow, requiring a procedure to drain a skin lesion in October. Angebranndt was then diagnosed with a staph infection, and needed another surgery to debride the infection and remove the rod in his arm–the apparent cause of the staph.
By this point, fall classes had started at Delaware, and Angebranndt put his rehab on hold until the semester ended. Then, as the infection cleared up in December, he turned a major corner in his rehab.
“With the infection gone, Dave gained more motion and strength in his arm, and that just catapulted him forward,” Smith says. “He was able to begin a progression that included catching drills and a modified lifting program with the team. By late February, he was swinging a bat at full speed. The sport-specific work really helped him mentally and dramatically advanced his rehab.”
It was around this time that Smith began to discuss Angebranndt returning to play. “You could see a difference in the way the coaches and players looked at him,” Smith says. “It was the first time they saw him and thought, “Okay, he may be able to help us.”
Angebranndt continued to make progress, and on April 18, 15 months after the accident, he played his first game and ripped a double to the outfield. “That was one of the greatest feelings in my life,” he says. “To see my teammates and the fans that knew about the injury give me a standing ovation, I got chills. I still have the ball on my desk.”
Smith says a moment like that is the most rewarding part of being an athletic trainer. “Part of the reason we do what we do is so things like that can happen,” he says. “It’s very satisfying to see someone with an injury that severe come back and have success.”
Angebranndt continued to get more comfortable both behind and at the plate as the season progressed. He returned to the team in 2011 and remains a valuable contributor.
For Angebranndt, the process of returning from the injury was a long and difficult task. And it wasn’t always easy for the athletic trainers and physical therapists involved. But for those who helped him get him back on the field, the collaboration was worthwhile.
“Working with Lisa was great, and I have to give accolades to her,” Miller says. “Without her, Dave wouldn’t have gotten to where he is today. I know athletic trainers and physical therapists sometimes do battle, but I find working together to be invaluable.