Jan 29, 2015Jessica Bramhall
Loudoun Valley High School, Purcellville, Va.
By R.J. Anderson
R.J. Anderson is an Assistant Editor at Training & Conditioning. He can be reached at: [email protected].
For Jessica Bramhall, the moment was a long time coming. Standing atop the podium at the 2011 Virginia AAA Northwest Regional Gymnastics Championships, the high school senior basked in the success of an achievement that once seemed impossible, but was now inspiring those around her.
As she accepted the gold medal for winning the floor exercise, Bramhall began wrapping her mind around the significance of what she had accomplished. Looking back, she recalled injury after injury that ended season after season of her high school career. Now, the regional title and the near-school record score of 9.7 that secured it provided the perfect cap to her senior gymnastics campaign–the first full athletic season she completed since entering high school.
Bramhall’s comeback story began at an early age. In seventh grade, competing in both soccer and gymnastics, she had surgery to clean up torn ankle ligaments which led to her first taste of physical therapy. Then in ninth grade, a badly sprained ankle knocked her out of gymnastics and later soccer–a spring sport in Virginia.
Along with the ankle injuries, Bramhall had chronic pain in her right knee. That problem came to a head her freshman year of high school when she was hit in the lower leg while playing soccer. The hit resulted in valgus stress to her knee, and an MRI revealed that she injured her right medial retinaculum. Years later, doctors surmised that she had also subluxed her patella in the incident. She missed the rest of her freshman soccer season and spent the spring and summer going to physical therapy to strengthen the muscles around her knee.
Then in January 2009, while working on her floor exercise routine during gymnastics practice, Bramhall took an awkward step and fell to the mat. With the gymnast howling in pain, Loudoun Valley Athletic Trainer Andrew Gordon, ATC, rushed to her side. “The head coach was holding her right leg and it was pretty obvious her patella was dislocated,” says Gordon. “All I wanted to do was straighten the knee and put a little pressure on it to reduce the injury and alleviate her pain, but she wouldn’t let me touch it. “Jess was screaming in agony,” he continues. “Her quadriceps were completely in spasm. So I called EMS and they got her to the hospital and gave her some pain meds and muscle relaxers before reducing the patella. She was fitted for an immobilizing leg brace and that was it for her sophomore season.”
Based on doctors’ recommendations, Bramhall and her family decided against surgery in favor of aggressive rehab. After waiting a few weeks to allow the swelling to subside, Bramhall met with Richard Mead, DPT, a physical therapist with a local practice. The two immediately went to work on building strength and improving range of motion.
“The first day, I instituted simple quad strengthening exercises that could be done without significant motion at the knee to increase the tone of her quad,” says Mead. “That included straight leg lifts, terminal knee extensions, and quad sets. We continued that kind of general strengthening with gradual progressions based on her readiness.”
Meanwhile, Bramhall kept attending team practices and meets. “I only missed one practice–the day after my injury when I was in the hospital all night,” she says. “I love gymnastics and being with the team was my home away from home. I could also do more in the gym than at home where I’d just be sitting around.
“At practice, I would do conditioning work like pushups and crunches–anything that didn’t involve my right leg,” she adds. “I worked on leg strengthening three days a week during my regular physical therapy appointments with Rick.”
Mead worked with Bramhall for the next two months. By then, her condition had improved significantly, but Mead was skeptical about her ability to return to competition. “Because of the nature of the injury, I had my doubts,” he says. “I thought there was a decent probability the injury could happen again. Jess, her family, and her doctors were all aware of the risks, but she was dead set on competing again–she’s a very determined, strong-willed young lady.”
Bramhall also got more out of her physical therapy appointments than most patients, asking questions and working hard to understand the mechanics of her injury. By the end of her two months with Mead, Bramhall was considering physical therapy as a possible field of study in college. She began interning at Mead’s clinic, working there Monday through Thursday after school answering phones, doing laundry, and observing Mead working with patients.
“She was here through the summer,” says Mead. “It was great because when she wasn’t busy in the office, she would work out. Also, while she was here, she was exposed to people coming back from very serious injuries, which gave her a healthy perspective on her own situation.”
It was this perspective that helped her persevere. “There were two or three patients I worked with and talked to who had really bad injuries and had been doing PT for over a year,” Bramhall recalls. “So I would think that if they can do it and still have smiles on their faces, then I can certainly continue to work hard and get through it. It was motivation for me.”
As the summer progressed, Bramhall felt better and better. She exercised frequently, worked on the family farm, and won ribbons for showing her animals at 4-H events. Then one morning while getting dressed, she pulled on a pair of jeans and caught her right foot awkwardly in one of the pant legs. Her right kneecap subluxed again, and she was back at the doctor’s office.
“The doctors gave me the option of having surgery, but told me I’d miss the gymnastics season if I did,” says Bramhall. “I again decided to forgo surgery and instead work on my leg strength. But we made a deal that if my kneecap dislocated again, I would have the surgery. At that point, there was a 50 percent chance that I’d make it through the season okay.”
There was also a 50 percent chance she wouldn’t make it. On Dec. 16, 2009, at the third meet of the season during her junior year, Bramhall was warming up on the balance beam when her right foot hit the side of the beam and she felt her patella pop. She let out a scream and hopped to the floor.
“I don’t really know what I was thinking then, just that I knew that my kneecap was dislocated and it needed to go back in,” she says. “I didn’t want to go through what I did the first time when my quad started to spasm.”
So Bramhall grabbed hold of her knee brace, twisted it, and reduced the injury herself. “Having gone through it before helped me stay calm,” she says. “It was also at an away meet, so I didn’t know the athletic trainer and felt more comfortable doing it myself. I knew what I had to do to fix the situation.”
Not needing an ambulance this time, Bramhall left the gym under her own power–and said goodbye to yet another season. On Dec. 30, she had arthroscopic lateral release surgery on her knee, a procedure that involves cutting tight lateral ligaments to allow for normal tracking of the patella.
Two weeks later, Bramhall made the familiar trip back to Mead’s clinic for more rehab. This time, however, she would be starting from scratch. The work would be more intense, physically and mentally, and last about six months longer.
“Her goal was to return to gymnastics and part of my job is to help temper high expectations,” says Mead. “I always tell young people with these types of injuries, ‘You’re only 16 years old and you have another 80 years on this earth, so you need to take care of your knees.’ But Jess didn’t want to hear that. She was determined to get back for her senior year.”
Experiencing normal post-operative pain and swelling, Bramhall wore a knee immobilizer for four weeks before transitioning to a hinged knee brace. Early on, her rehab consisted of electric muscle stimulation and general straight-leg strengthening exercises.
By Feb. 12, 2010, the hinged knee brace Bramhall wore was released to 90 degrees and she was off crutches and healing well. During this stage of rehab, Mead had her performing quad sets and four-way straight-leg raises–side, middle, hip extensions, and terminal knee extensions–and did manual therapy to improve range of motion. “We just wanted to get the tone of the muscles back and build them up to get the kneecap stabilized,” says Mead. “The progressions were mostly based on her symptoms and how she tolerated the work.”
Six weeks into the rehab, Mead began slowly introducing functional activities. “A lot of that involved dealing with the motion requirements of gymnastics,” he says. “There’s probably no one as difficult to design exercises for than gymnasts because of all the different movements they perform.”
For Bramhall, functional work included performing movements on a trampoline, such as single-leg balancing. She also did a lot of lateral ramp jumps and running drills with a resistance cord wrapped around her waist.
Other exercises incorporated a balance board. For example, as she progressed, Mead would have her roll back and forth on a balance board while throwing a 10-pound medicine ball against an angled trampoline and catching it on the rebound.
Improvement was slow but steady, and by the end of May, Bramhall’s knee could tolerate 142 degrees of bend (her pre-injury level was 150). Still, an isokinetic strength test revealed a 40 percent strength discrepancy between her right and left legs. At that point, Mead considered the difference to be normal based on the severe muscle atrophy associated with such a long-standing injury situation. Bramhall, however, saw it differently.
“She was mad,” Mead recalls. “She thought she should be further along at that point. I explained how long muscle takes to develop and told her she just needed to keep working hard.”
Bramhall’s anger fueled her determination and she attacked her rehab with even more vigor. Mead says she worked out incessantly on the clinic’s Cybex machine, which helped her build girth and develop power in her leg muscles. Bramhall was also working out on her own at a local gym, performing a lot of the functional exercises she had learned from Mead.
Two months after her first isokinetic strength exam, Bramhall was re-tested. Her right leg was now 90 percent as strong as her left leg. As the calendar moved toward November and the start of the gymnastics season, Bramhall still carried some doubts about her ability to remain injury-free. She had been cleared to practice and compete, but was restricted from doing moves that involved twisting or hard landings.
After about a month of competing with what she termed a “watered-down routine,” Bramhall was given the go-ahead to add twists and more difficult moves back to her repertoire. She didn’t have any setbacks–other than the frustration of not reaching her pre-injury levels right away. Then, finally, at a meet in January, she felt she was returning to full strength.
“At that meet I got my first nine in an event since returning, and to get a nine in high school is kind of a big deal and something you strive for,” Bramhall says. “I had been getting nines prior to my injury during my junior year, so that was my big comeback goal. After I got it, I thought, ‘I can get nines again, I’m back in business.'”
By February, her return to form carried Bramhall to the regional championships, which were held at her home gym at Loudoun Valley. In front of teammates and a crowd that cheered her every move, Bramhall ripped off a 9.7 in the floor exercise–just 0.1 off the school record. “When they put my score up, I was in shock and my whole team was so happy for me,” she says.
After the four remaining competitors finished their final runs, Bramhall was announced as the winner. “Once I saw that I had won, I let out a huge sigh of relief and couldn’t believe that I had just won the floor event at regionals,” she says. “Coming off the injury, it was so satisfying to simply make it there, let alone win.
“There were a lot of club-level gymnasts at that meet who compete in national events as well,” she adds. “I proved to myself that I could make it all the way back, and beating those high-caliber gymnasts was icing on the cake.”
Gordon was also there to share Bramhall’s moment. “It was a perfect example of how hard work pays off,” he says. “Kids at this level often get down when the going gets tough and don’t think they’ll ever recover. When that happens now, I’ll be able to tell them Jess’s story.”
When Bramhall tells the story from her perspective, she talks about the people who helped make her comeback possible. “Andy wasn’t just an athletic trainer, but a friend,” she says. “I would go see him to do swelling reduction and stuff like that during the school day and after school he was someone I could talk to about what to do following an injury. He was always encouraging me to stay positive.
“Rick was the one who kicked my butt on days when I wasn’t feeling up to working hard,” she adds. “He influenced my rehab. I felt like I owed him the hard work it took to be successful because he gave me so much.”
Bramhall, who graduated in the top five percent of her class, is headed to Virginia Tech in the fall, where she will take the experiences of her years of rehab and apply them to her studies. “I’ve thought about majoring in physical therapy, but I also started looking into biomedical engineering. I think it would be cool to make prosthetics–maybe have a prosthetic clinic where I teach people how to use them,” she says. “I’m really into math and science, and I’d like to find a way to use those interests to give back to a field that has helped me so much.”
FEEDBACK: Wonderful article that should be an inspiration to other high school athletes. -Marty Cooper