The courtroom erupted into applause on Wednesday afternoon as Larry Nassar, the former USA gymnastics team doctor and Michigan State University sports medicine physician, exited stage left to spend the rest of his life in prison for the systematic sexual abuse of athletes under his care. Survivors and their families in the gallery wept and embraced. It was a catharsis hard-won by the bravery of dozens of young women, empowered by solidarity, who stepped forward to hold the powerful to account.

The terms of Nassar’s guilty plea on seven counts of first-degree criminal sexual conduct allowed for anyone who said they were a victim to read an impact statement in court. Remarkably, the total of 88 girls and women initially scheduled to speak nearly doubled over the course of the sentencing hearing as it spilled over into a second week. One by one they faced their nightmare incarnate, from household names like six-time Olympic medalist Aly Raisman, whose scorched-earth salvo will be long remembered, and countless more who never reached the elite level, putting forth searing testimony on the pathology of a sociopath who leveraged his authority and professional heft to betray the trust of young athletes and their families.

Larry Nassar's 'death warrant': sexual abuser jailed for up to 175 years Read more

The last of the 156 survivors to testify before Nassar’s fate was sealed on Wednesday was Rachael Denhollander, a former gymnast turned Kentucky attorney who became the first woman to come forward publicly in September 2016 for the Indianapolis Star story that convinced dozens more to break their silence. “The number of sexual assault victims Larry had was plain to me,” she said in the immediate aftermath. “Whether or not anyone would feel safe to come forward, that was the wild card.”

“You do not deserve to walk outside of a prison ever again,” the judge, Rosemarie Aquilina, said before sentencing Nassar to jail for up to 175 years. “Anywhere you walk, destruction would occur to those most vulnerable. I just signed your death warrant.”

Now the real work begins.

So far culpability for Nassar’s monstrous acts has fallen almost exclusively on the disgraced physician himself. But many of the statements from the survivors and their attorneys have targeted the individuals and institutions that allegedly enabled or were negligent in preventing Nassar’s abuse for as long as two decades: Michigan State, USA Gymnastics, the United States Olympic Committee and Twistars Gymnastics Club, all of which have been named as co-defendants in civil suits that appear headed to trial.

Play Video 1:42 'Little girls don't stay little forever': abuse victims confront Larry Nassar – video

Denhollander is among the plaintiffs in a lawsuit filed against Michigan State, USA Gymnastics and Twistars, an elite-level training facility in the Lansing area which referred athletes to Nassar. Those athletes allege that complaints through the years to coaches, counselors, police and university-employed trainers were never followed up with proper investigations. Another lawsuit filed by an unnamed former US gymnastics team member accuses Bela and Martha Karolyi, the former national team coordinators widely credited with transforming the United States from outsider to the head of the sport’s new world order, with fostering a toxic environment that enabled Nassar’s abuse.

And then there’s Michigan State, where Nassar had taught and practiced medicine from 1997 until 2016. Larissa Boyce and Tiffany Thomas-Lopez are among former athletes who claim to have spoken with coaches and trainers about Nassar only for the complaints to go nowhere. He remained employed and was allowed to continue working with patients even during when Amanda Thomashow’s allegations prompted a criminal sexual conduct investigation by campus police that cleared Nassar in 2014.

Last week the Lansing university’s board of trustees called on the state’s attorney general to review the school’s handling of the complaints amid mounting pressure for the resignation of school president Lou Anna Simon. The calls had come from both the student body, including a withering front-page editorial by the independent school newspaper that cast “Simon, her appointees and cheerleaders” as “enablers”, and from the faculty, who on Tuesday called for an emergency meeting to raise a vote of no confidence in Simon. Still, the eight-member board have firmly thrown support behind Simon, with one trustee maddeningly citing her fundraising proficiency. Hours after Wednesday’s sentencing, Michigan state legislators voted overwhelmingly for a resolution calling for the president’s ouster with Simon stepping down that evening. It’s a start.

Just as problematic is the timeline around USA Gymnastics. The Indianapolis Star reported the governing body, which previously claimed to have called law enforcement “immediately” after it was first alerted to suspicions about Nassar, waited five weeks to alert the FBI while conducting their own internal review. Raisman, who brought home three golds from two Olympics, said USA Gymnastics “threatened” her to be quiet with McKayla Maroney having also revealed she was pressured to sign a non-disclosure agreement in return for a financial settlement. The unfolding scandal has led to last year’s resignation of longtime president Steve Penny and three other board members in recent weeks, followed by Wednesday’s call by the US Olympic Committee for all USA Gymnastics directors to resign en masse as the USOC launches an independent investigation into “who knew what and when” about Nassar.

These overhauls are due diligence, but the unfortunate truth underlying Wednesday’s outcome is while the institutions that oversaw Nassar failed these young women time and again, it required the external force of investigative journalists, and the public pressure their work ignited, to hold a predator to account.

“Every previous time there’d been an allegation, nothing happened,” prosecuting attorney Angela Povilaitis said in Wednesday’s closing remarks. “His lies worked. With each time that he got away, he was empowered to continue, to perfect, and to abuse even more.

“What finally started this reckoning and ended this decades-long cycle of abuse was investigative reporting. Without that first Indianapolis Star story in August 2016, without the story where Rachel came forward publicly shortly thereafter, he would still be practicing medicine, treating athletes and abusing kids.”

Only in the late stages of the grueling 16-month trial, after Olympic gold medalists Gabby Douglas, Simone Biles, Maroney and Raisman came forward as accusers, was the previously lacking national media coverage of the Nassar story commensurate with the one of the biggest sex abuse scandals in sports history. And only if we let it slip from our field of vision will those who enabled his heinous acts, whose silence made it possible, escape their reckoning.

“Inaction is an action,” Aquilina said. “Silence is indifference. Justice requires action and a voice. And that is what has happened here in this court.”

A monster has been slain, to be sure. But it’s early days in the search for justice.