Jan 29, 2015Comeback Athlete: Jim Dray
By R.J. Anderson
R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected]
It was a play Jim Dray had made countless times before. While covering a punt midway through the 2007 season, the Stanford University redshirt sophomore ran downfield hunting the Texas Christian University return man. Out of the corner of his right eye, he saw a Horned Frog blocker lining him up for a blindside hit. Dray reacted quickly, planting his left leg into the grass and lowering his right shoulder to initiate contact and beat the defender to the punch.
As the two players collided, the force of the hit flowed through Dray’s shoulder and down the rest of his body, twisting his core and shifting most of the weight to his left leg. With his left foot still planted in the ground, his knee buckled and his thigh kept shifting to the left.
“That’s when I heard tendons and ligaments ripping and popping,” recalls Dray. “I crumpled to the ground. The pain was excruciating.”
Remarkably, Dray was able to get to his feet and limp to the sideline under his own power before collapsing. Stanford Head Football Athletic Trainer Steve Bartlinski, ATC, PTA, made his way to the injured player. “Jim was yelling, ‘my knee, my knee!’ So we got him on a sideline athletic training table,” says Bartlinski. “It was obvious he had multi-ligament instability. Based on how loose the knee felt, I figured he had multiple torn ligaments.”
An MRI revealed even more damage than that. In addition to tearing his anterior cruciate ligament (ACL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and meniscus, Dray had ruptured his popliteus and distal biceps femoris–he had essentially shredded his knee and ripped his hamstring from the bone. It was a devastating injury.
“I’d heard about similar incidents, but I had never seen anything like it,” Bartlinski says. “In most cases I’ve read about, it took years of rehab and usually the guy never made it back to his pre-injury ability, or he didn’t make it back to the field at all.”
The diagnosis hit Dray hard. “I knew what an ACL was, but I didn’t know anything about the other stuff–it all sounded pretty bad,” he says. “I freaked out for a minute, but once our team physician sat me down and explained all the options, I calmed down. He told me something like this could take two years to come back from, but he’d put me on a plan that would get me back faster than that.”
True to his word, Team Physician and Orthopedic Surgeon Jason Dragoo, MD, and the rehab team had Dray back on the field the following season. After two surgeries, countless hours of hard work, and a complete team effort, Dray reclaimed his position as the starting tight end, was a huge contributor to the Cardinal offense and special teams, and even scored a touchdown in his second game back. Along the way, Dray’s rehab did more than rebuild his knee–it also united a rehab team that began the 2007 season on relatively unfamiliar ground.
That January, Bartlinski had been named Head Football Athletic Trainer after spending a year caring for the school’s track and field teams, and Dragoo had moved into a new role as Head Team Physician for the football program. At the same time, Stanford also hired Head Football Coach Jim Harbaugh, who in turn brought along Shannon Turley, CSCS, as the team’s Strength and Conditioning Coordinator.
Along with Director of Athletic Training and Rehabilitation Moira Jamati, ATC, PT, CSCS, Bartlinski, Dragoo, and Turley formed the core of the football program’s rehab team, and Dray’s case marked the first major injury that would require an intensive group effort. Coordinating their roles in rehabbing such a multi-layered injury kick-started an expedited feeling-out process based on trust and frequent communication.
“After Jim got hurt, Dr. Dragoo and I had twice-a-day conversations about the surgeries and how Jim was progressing,” says Bartlinski. “Once he started his rehab, our entire team–physical therapy, athletic training, and strength and conditioning–met almost daily and exchanged lots of e-mails and phone calls to update each other.”
Dray underwent surgery on Oct. 18, five days after he sustained his injuries. During that procedure, Dragoo repaired the LCL, biceps femoris, and popliteus. “Once we realized he had muscle damage, we concluded that needed to be fixed first,” says Bartlinski. Dray emerged from the surgery with an eight-inch incision on a left leg that required complete immobilization. For the next month, he rested and allowed the incision to heal.
A week before the second surgery, Dray began seeing Bartlinski and Jamati multiple times a day to prehab for the procedure to repair his ACL. During that time, they worked on very basic range of motion increases and inflammation control. “That was a very tricky period because we needed the hamstring and LCL to heal and keep those surgical repairs as stable as possible, so we couldn’t really push the envelope,” Bartlinski says.
Unable to get aggressive prior to and just after the second surgery, Bartlinski used continual passive motion and oscillation therapy to promote lymphatic drainage. “We had considerable success with oscillation therapy to decrease swelling,” he says. “The device we used looks like a stim unit with two pads. I put one pad on Jim and one on myself to complete a circuit, and then massaged the injury as low-level electrical currents surged through both our bodies.
“We had just gotten the device when Jim was injured, so he was one of the first patients I used it on,” continues Bartlinski. “We’ve had great results with it. We’ve done girth measurements while we treat athletes and have seen reductions in swelling of two to three centimeters per treatment.”
Once his incisions healed, Dray began what Bartlinski describes as a standard ACL rehab that was initially focused on managing swelling, restoring ROM, and improving lateral and anterior stabilization. Six weeks post-surgery, Dray met Dragoo’s goal of having 90 to 110 degrees of ROM in his knee. But because the hamstring repair was still healing, Dray was prohibited from doing upper-body lifts. “When guys do lifts like the bench press, they tend to dig their feet into the ground, and we didn’t want him to activate that hamstring while it was still healing,” Bartlinski says. “So during that time he only did very basic lower-body work, like the straight-leg extension lift series, glute activation, and short-arc quad work.”
By week 12 after the second surgery, the goal was for Dray to achieve full ROM–a goal he narrowly missed and still hasn’t reached, but that didn’t impede his progress. For the next six weeks he performed stationary bike work, core and upper-body lifts, and more aggressive lower-body work, including partial weight-bearing unilateral and full weight- bearing bilateral closed-chain exercises.
The goals for week 18 were for Dray to perform a single-leg squat to 60 degrees and progress to closed-chain, multi-plane exercises, while also advancing his proprioception and strength work. During this phase, he began right lower-extremity lifting as well as elliptical and Stairmaster work. By week 24, Dray was doing straight-line running drills and select lower-extremity lifts.
Throughout those first six months, Dray became a fixture in the athletic training and physical therapy facilities. “I saw Jim every day, sometimes four times a day,” says Bartlinski. “Sometimes the session was a 20-minute ice and stim between classes, and other times he’d be here for an hour and a half doing rehab exercises.”
Through all the monotonous, grinding work, Dray never missed an appointment. “Jim stayed here during all his breaks from winter through summer–he even got treatment here on Christmas Day,” says Bartlinski. “I would like to say we had a huge role in motivating him, but he did that all on his own.”
In June, Dray was released to do all of his strength and conditioning work in the weightroom, which decreased his time in the physical therapy and athletic training facilities. He quickly grew stronger and regained the 25 pounds he’d lost due to inactivity. When the team began its training camp in August, Dray was a spectator, but he was feeling stronger by the day. On Sept. 3, he was cleared to return to the practice field for non-contact football activities. That’s when Bartlinski knew his patient was close to full strength.
“The team had a day off, but Coach Turley, myself, and my six-year-old son had Jim out on the practice field doing a passing route progression and he looked great,” Bartlinski says. “I remember that day, because my son looked at me and said, ‘Why are we here? He doesn’t look like he’s hurt.’ We all laughed about it, but my son was right–Jim looked completely healthy.”
Two weeks later, Dragoo released Dray to begin contact drills in practice. On Sept. 20, after practicing for a week without limitations, he took the field against San Jose State University for about 15 plays. The next week, against the University of Washington, he was in for 20 plays and caught a touchdown pass. It was an emotional six points for Dray and his rehab team.
“When he scored, we all just stopped for a second and time stood still,” recalls Bartlinski. “Then I turned to Coach Turley and said, ‘Job well done.’ We shook hands and hugged. Moments like that are why we do what we do.”
As the season rolled on, so did Dray. He didn’t miss a game, practice, or training session, and never had to take any plays off because of knee soreness. He was functioning virtually as though he’d never been injured. By his third game back, he regained the starting spot he’d held as a freshman and sophomore.
This season, Dray hopes to maintain his starter status and contribute to the team any way he can. And although he is healthy, he continues to do supplemental rehab to maintain stability and build up the muscles around the injury site. In addition to the team strength and conditioning program, he performs short arc work, step-down progressions, balance progressions, and single-leg exercises.
Bartlinski calls Dray’s story the best comeback he’s ever been involved in. “It was a big team effort, but ultimately it came down to his will,” Bartlinski says. “The physician can only repair the injury, and the physical therapist and athletic trainer can only direct the rehab–the patient is the one who determines how well it turns out. The real keys to Jim’s return were his hard work and positive attitude.”
Dray says his motivation stemmed from his love of the game and his dream of playing in the NFL. Throughout his comeback, thinking about a friend and teammate’s career-ending neck injury helped him keep everything in perspective.
“I wasn’t ready for my career to end,” says Dray. “When things got tough, I would think about my friend who was forced to quit the game after breaking his neck, and how disappointed he is not to be playing anymore. I knew if I worked hard, I would be able to play again, and that one day I’ll be able to leave the game on my own terms.”
Dray also credits the time and effort Bartlinski and the rest of the rehab team dedicated to him. “They were as invested in the process as I was,” Dray says. “They came up with a great blueprint and I tried to follow it as closely as possible.
“Fixing so many things in such a short time was incredible,” Dray adds. “They’d never seen an injury like mine, but it didn’t seem that way. They were always in sync with one another, and I owe them a lot of gratitude.”
In addition to the team approach and Dray’s hard work, Bartlinski credits Dragoo’s surgical touch and rehab strategy. “He drew up an integrated program that incorporated athletic training, strength and conditioning, and physical therapy,” Bartlinski says. “He gave us a nine-month timeline from the completion of the second surgery and guidelines like, ‘At week 10, I want unilateral closed-chain exercises to 60 degrees of flexion.’ He pointed us in the right direction, then opened it up for our input in terms of choosing therapies and exercises, and trusted us to do our jobs.”
Bartlinski says that trust is something he tries to incorporate into his own practice. “I approach sports medicine’s relationship with strength and conditioning as a cooperative,” he says. “When an athlete is cleared back into strength and conditioning, there is some advisement from me, the physical therapist, and the physician, but Coach Turley is allowed to do his job and design workouts that contribute to the rehab program.”
Aside from Dray’s return to the field, the lasting legacy of his rehab, Bartlinski says, is the open communication that developed among all members of the sports medicine team. “We have weekly meetings between physical therapy, strength and conditioning, and athletic training about all of our rehabs,” he says. “Jim’s case brought us together and helped set the tone for the way we do things today.