After Iraq: Jessica Lynch's story of recovery: physical therapy, determination, and courage have helped former Pfc Jessica Lynch fight back from devastating injuries.

Jessica Lynch's experiences in and her dramatic rescue captured America's attention. However, she says, her real battle--marked by courage, pain, determination, and even fear--came during her rehabilitation and her struggle for recovery. And that fight is continuing even today.

In the spring of 2003, Pfc Jessica Lynch, 19--a recent high school graduate from West Virginia--was a supply clerk with the Army's 507th Maintenance Company in Iraq. On March 23, a convoy of the 507th took a wrong turn in the desert and was ambushed in Nasiriyah, a city in southeastern Iraq. When her vehicle stalled, Lynch jumped into a nearby Humvee. That vehicle was hit by a rocket-propelled grenade and crashed. Eleven American soldiers were killed in the ambush. Lynch was severely injured. About 3 hours later, the Iraqis delivered Lynch, now a prisoner of war, to nearby Saddam Hospital.

Lynch's biography, I Am a Soldier Too: The Jessica Lynch Story, describes her injuries. Her right arm was shattered between her shoulder and her elbow. The compound fracture shoved slivers of bone through muscles, nerves, and skin, leaving her right hand virtually useless. Her spine was fractured in two places, causing substantial nerve damage. Her left leg was broken both above and below the knee, and the broken bone had damaged her nerves there, too. Her right foot was crushed. Those injuries later would lead to her discharge from the military with an 80% disability.

On the night of April 1, US forces raided the hospital and rescued Lynch. She first was taken to Landstuhl Regional Medical Center in Germany, where she underwent several surgeries to stabilize her injuries. She then was flown to Walter Reed Army Medical Center in Washington, DC, where she spent more than 3 months in recovery and rehabilitation. [See "Physical Therapy at Walter Reed Army Medical Center" on page 40 for more information about services provided to returning members of the military.] From there, she returned to her home in rural Palestine, West Virginia.

Lynch doesn't remember the 3 hours between the ambush and her arrival at the Iraqi hospital. And she prefers not to talk about what she can recall of that entire experience. However, she is willing--even eager--to describe her rehabilitation and the role that physical therapy has played in it.

"When I got to Germany, I wasn't able to do much of anything. I was just in bed. Even when I arrived at Walter Reed, I couldn't sit up. it took five people to get me out of the bed and move me to a chair," Lynch says. Her weight had dropped to 70 lbs and she was severely dehydrated.

While at Walter Reed, Lynch underwent 5 hours of physical therapy 7 days a week. She admits the process was painful and says that she was motivated in part by fear. "One of my biggest fears was that I'd have to remain in a wheelchair. That's what gave me the courage.

"At the beginning, there were three physical therapists (PTs). They especially worked with my knee, getting it to bend. Then it got to the point I could go to the physical therapy room," Lynch says.

By the time she left Walter Reed, Lynch had made substantial progress. Nevertheless, she still was using a wheelchair 90% of the time and a walker the remainder, recalls Burt Reed, PT. Reed, the owner of Mountain River Physical Therapy in Mineral Wells, West Virginia, is the physical therapist who has worked with Lynch following her discharge from Walter Reed. Reed also operates a clinic in Ellenboro, West Virginia.

Lynch says, "I was still in the wheelchair when I started with Burt in July. He got me out of that, working with me each day until I no longer even used the walker." It was a long and arduous process--averaging 2 hours a day, 5 days a week, plus additional exercises to perform at home. After 7 months, due to her steady progress, Reed reduced Lynch's sessions to 3 times a week. Reed says, "Much of what we do now is more advanced than when we started. And much of what she does now does not require my assistance or cueing."

In the Clinic

Reed says, "We have maintained a comprehensive approach, requiring work of the trunk and extremities. Mostly we've worked on her strength and improving her ability to walk."

During one session, Reed helps position Lynch to push an inflated ball against a wall to strengthen her hip muscles. After a while, Lynch, grimacing, says, "It burns." Reed comments, "This exercise is tough even for the general population." Later, Lynch practices standing on one foot in order to help her improve her balance. She says, "When I first was able to stand, I'd lock my knee because it would keep me more stable." Reed adds, "We don't want her locking her knees. We want her to rely on her muscles and not stretch her capsule."

While taking a brief break, Lynch points out her injuries. She has no feeling in or control of, her left foot and so must wear a 90[degree] ankle brace. Her right foot was badly injured. She walks with a noticeable limp and has scars on her arms, legs, and forehead. She also mentions the spinal injury and the metal rods in her leg and arm, as well as pain while sleeping. "Most nights, my back and legs bother me," she says.

Resuming their session, Lynch and Reed move through other procedures--including forward and backward walking, a lumbar stabilization exercise program, balance activities, and more--all designed to address her arms, legs, and trunk strength. In addition to her scheduled physical therapy sessions, Lynch also exercises at home with a treadmill and a bicycle.

When lynch returned from Walter Reed, her house was fitted with ramps for her wheelchair. She still uses the ramps occasionally but says, "I'm trying to walk up the stairs, rather than take the easy route."

Reed is continuing Lynch's strength and endurance work, while placing more emphasis on her gait, balance, and proprioception deficits. In addition to the physical therapy sessions 3 times a week, Lynch also visits Reed's facility twice a week for an independent gym program. "I felt she still needed to continue the strengthening, but that she could do it on her own," Reed says.

Although Reed has pushed her hard, Lynch is pushing herself even harder. Her physicians at Walter Reed told her that most of her physical improvement would come in the first 2 years, so she's determined to make the most of that time. Beyond her physical recovery, Lynch has other plans, including becoming a kindergarten teacher. "It would be too hectic to go to school now. But I'd like to as soon as I'm able to walk to all the classes without having to rest, she says. Another goal is travel. Lynch especially wants to visit Hawaii. She expects to achieve those objectives, just as she's regained her ability to walk. Lynch is grateful for the assistance she's received from others. "The support from other people, their belief, has helped." And she advises others facing adversity: "Don't give up hope."

Describing physical therapy, she says, "I still think back to when I was lying in the hospital in Iraq and all I could move was my left arm. it's been rough, but I needed this. It's great to be able to get around on my own."

Questions & Answers

After Jessica Lynch was released from Walter Reed Army Medical Center, she and her family met with and interviewed Burt Reed, PT, before deciding to continue her physical therapy at Mountain River Physical Therapy. Conducting an initial interview is a valuable process far both physical therapist (PT) and patient, Reed says. He recalls, "She told me that she was very pleased with the services she had received at Walter Reed and she wanted to find a practice with a similar approach. She said that she had goals and she wanted to be pushed. She also wanted to know whether I had experience with patients with multiple injuries and surgeries." Reed did. Throughout his career, he has been exposed to work injuries and automobile and other accidents causing multiple injuries.

Reed recommends that anyone seeking physical therapy ask whether the PT is familiar with the patient's diagnosis. He also suggests asking the PT to describe the proposed course of treatment.

The physical therapist and patient also should discuss goals. The PT should ask, "What do you want to get out of physical therapy? What in your mind will make this experience successful?" Reed says, "That way, we're both on the same page."

Donald E Tepper is editor of PT Magazine.