Jan 29, 2015Comeback Athlete: Debra Huss
Seattle Pacific University
By R.J. Anderson
R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected].com.
It was Feb. 4, 2006, and Seattle Pacific University gymnast Debra Huss had just sprung off the vault, flipped through the air, and landed awkwardly. She felt an unfamiliar popping sensation in her left ankle and limped off the mat. The reigning USA Gymnastics (USAG) Women’s Collegiate national champion in three events–all-around, floor exercise, and uneven bars–Huss was one athlete nobody wanted to see injured.
But Huss told her coaches she was not in significant pain and iced her ankle. It appeared to be a very minor sprain. Minutes later, she felt better and readied for her floor routine. Then, while completing her first tumbling pass, Huss felt the popping sensation again, this time accompanied by shooting pain. She fell to the mat, clutching her ankle.
Upon examining Huss, Jeanette Kotch, ATC, Assistant Athletic Trainer at Seattle Pacific, saw no signs or symptoms that indicated a major injury. “There was no swelling, and Debra was even able to walk on her ankle a little,” says Kotch. “The team doctor originally thought it was an ankle sprain, and a couple of weeks later we let her return to practice and work on events that had low impact on her ankle. She did well during practice and began competing again on the uneven bars, where the only ankle impact was on the dismount.”
About three weeks after her initial injury, Huss was working on her balance beam routine in practice. Upon landing on the beam after a series of moves, she felt her ankle pop again. This time, she could not flex her foot in a plantar function.
Knowing that something wasn’t right, Kotch took Huss to a foot specialist, Edward Blahous, Jr., DPM, Assistant Director of Podiatric Residency at the Swedish/Providence Medical Campus, where Huss underwent a series of MRI tests. Blahous reviewed Huss’s MRI results several times before finally diagnosing her injury as posterior tibialis tendon dislocation.
The injury occurred when Huss’s left retinaculum ruptured and allowed the posterior tibialis tendon to dislocate. Surgery was required to relocate the posterior tibialis tendon behind the medial malleolus and suture the retinaculum back to the bone.
“Debra had surgery in April,” says Kotch. “But neither Dr. Blahous nor I knew if she would be able to return to an elite level of gymnastics competition, if at all. I had never seen that particular type of injury, and he had never seen it happen to a gymnast.”
In dealing with an unfamiliar injury, Kotch says it was imperative that she maintained close contact with the physicians. “I stayed in constant communication with Blahous and the clinic’s co-director, Dr. Richard Bouché [DPM],” says Kotch. “Because of my unfamiliarity, I really had to trust in their knowledge. At the beginning, I would either e-mail or talk to them on the phone at least once a week. Once Debra started progressing with her weight-bearing work, I talked to them every couple weeks.”
The rehab plan was fairly straightforward. The initial goals were to return Huss’s range of motion and strength levels to pre-injury levels. But several challenges awaited Kotch: the uncertainty of Huss regaining her form, demanding coaches who wanted Huss back as soon as possible, and the fact that this was the junior gymnast’s first major injury.
After the surgery, Huss was non-weight bearing and on crutches for four weeks. During this time, Kotch’s work with Huss concentrated mostly on restoring range of motion in her ankle. While wearing a protective boot, Huss also performed limited strengthening exercises such as hamstring curls and straight leg raises in four directions. She started with only body weight then progressed to lifting with very light weights on her thighs. She also did upper-body strength training that didn’t stress her ankle.
After a month, Huss was cleared to begin weight-bearing exercises. Kotch started this phase in the athletic training room by having the gymnast do side-to-side shifting movements and forward and backward walking. Huss also continued doing range-of-motion work. She progressed quickly, and six weeks post-surgery, she was bearing full weight.
“We didn’t focus on gymnastics at that time, but rather on regaining her strength and conditioning,” says Kotch, who worked with Huss five days a week for about two hours a day. “She felt very confident in her gymnastics ability and that she could regain her skills in just a few months prior to the season. So we focused on getting her endurance up with walking, biking, and eventually some ellipticals.”
Kotch was not on campus during the summer, so Huss worked with Chris Glatz, PT, a Physical Therapist at Advanced Manual Therapy & Sports Rehabilitation, who was in contact with Kotch via e-mail. Huss and Glatz met three days a week, continuing to improve her ankle’s range of motion and her strength.
When the fall semester began, Huss was anxious to resume her gymnastics training. However, she still had lingering pain in her ankle. “There was some lack of rotation and movement in my ankle, which made it painful to do certain moves,” says Huss. “At that point, the doubts started creeping in. I wasn’t sure I’d be able to compete in every event, especially the vault. But I kept doing all my rehab exercises with Jeanette and eventually the ankle started responding.”
As Huss began a slow reintroduction into sport, she trained mostly on the uneven bars. From there, she progressed to practicing her balance beam dance moves. “We slowly added tumbling on the floor,” says Kotch. “She wasn’t doing any leaps or flipping at that point.”
By November, Huss was doing all of her flips and tumbling moves at 100 percent on uneven bars, beam, and floor. The one discipline she had not attempted was the one she feared most.
Due to the jarring nature of both the takeoff and landing in the vault, and because it was how she had injured herself in the first place, Huss was hesitant to welcome the event back to her repertoire. But her reluctance frustrated her coaches.
“Before my surgery, my head coach told me she expected me to come back and compete in the all-around (which requires gymnasts to perform every discipline, including vault). I wasn’t really motivated to vault, and I didn’t think it was very likely that I would compete in all-around competitions,” says Huss. “But eventually I realized that if I could vault again, it would help the team. So I started working on it at the end of November.”
When the season began in mid-January, Huss was expected to compete in the all-around and Kotch was confident the senior was ready. Despite being physically prepared for the season, performing that first vault was difficult. “I was very nervous, especially since I had not been training for the event that long, and I hadn’t even practiced landing on the hard mat. I had only used the really soft mat,” says Huss.
To help promote more stability in the ankle, Kotch used a somewhat unorthodox taping method on Huss. “I did a standard ankle tape and on top of that I did an Achilles taping,” says Kotch. “When she was preparing for the vault we would tape to her ankle a half-inch felt pad cut to fit the anterior side of her ankle. This prevented her ankle from going into dorsiflexion and added to the Achilles taping.”
As luck would have it, at the season’s opening meet, vault was the first event Huss was scheduled to participate in. “I was so unsure about how it would feel and if it would hold up,” says Huss. “But I had to trust my ability and just go for it.”
All the hard work then paid off. Huss landed her vault with no pain. And as the season progressed, she improved in the event to the point where she posted repeated personal bests. “I was even better than I was before I got injured, which was weird,” says Huss. “It made me realize I could do much more than I ever thought I could.”
The onset of competition didn’t mean Huss was done with her individual sessions with Kotch. Before every practice, Huss visited the athletic training room for 30 to 60 minutes of ankle flexibility, strength, and balance work.
“Because gymnasts have such great balance to begin with, balance work with them can be a challenge,” says Kotch. “I would start by having Debra do some exercises using a floor-height balance beam and when that became easy, we progressed to a medium-height beam and then to one that was regular height. I had her start by balancing on the beam using one foot for 30 seconds, then progress to doing it with her eyes closed, then do it while turning her head.”
Kotch also carefully monitored Huss’s workload during the team’s grueling three-and-a-half hour practices. Sometimes, Kotch and the coaches had different ideas on how much Huss could handle. “I had to explain that if Debra took a little time off here and there, it would benefit her in the long run,” says Kotch, who chalked up the coaches’ approaches as an element of the sport’s culture. “I had to constantly remind them that she was a senior and her body was worn down after years of competing. I explained that when the tendon flared up, she shouldn’t be pushed because we did not know how her ankle would react to that.”
As she moved through the season, Huss continued to surpass even her own expectations, competing in every meet and finishing as runner-up in the USAG Women’s Collegiate all-around. She was also named team MVP for the third time.
Along her long road back, Huss says she learned some valuable lessons. “I’m kind of glad it happened to me because at that point in my career, I think I needed a challenge,” she says. “It taught me to be more understanding and patient. Having to train harder than I was used to changed my perspective on what it means to work hard and appreciate the competition.
“It also made me a more well-rounded teammate,” she adds. “It forced me to concentrate on supporting my teammates and cheering for them.”
Kotch also came away from the experience with a few lessons. “Debra had never suffered a serious injury before, so I had to constantly help her understand what level of pain was okay and what wasn’t,” Kotch says. “At the same time, I had to listen carefully to what she thought was the right progression.
“Even though I sometimes wanted to move things along more quickly, I realized that I had to let her dictate the pace,” continues Kotch. “Sometimes with an athlete, you want to push them through something because you know they can do it. But there were times with Debra that I had to let go a little bit. If she said she was hurting, I backed off.”
Kotch says she also learned to trust Huss’s assessment of her own gymnastic abilities. “When she would say, ‘Jeanette, I don’t need to train this skill today or this week. I’ll be fine,’ I found that she really did know what was best and that it was okay for her to do less,” says Kotch. “She wasn’t trying to get out of a workout or a practice, she just really understood her skill level–which is obviously very high.
“Each person you work with is different, and as an athletic trainer you have to be willing to adapt your methods and expectations for each athlete,” adds Kotch. “My philosophy is to empower the athlete by giving them the tools and teaching them how to use them. And I’ve learned that there is a time to step back and let that athlete use the tools. Knowing when and how to do that is different for each athlete.