Injuries are emotional, too!

The Words We Tell Ourselves (And Each Other)

Have you been/are you currently a patient frustrated with your rehabilitation process, feeling low on the hope meter, or feeling like you’ve reached a dead end?  Are you a physical therapist (or any healthcare provider) who is perplexed about a patient’s delayed or seemingly plateaued rehab progress?  If you can check either one or both of these boxes, read on!  The physical healing process involves far more than physiological repair.  What I believe to be even more powerful and influential in the healing process is psychological and emotional status, which is often shaped by the words that we take in and the words that we put out, both towards other people and also ourselves.

As a Doctor of Physical Therapy, I frequently catch up on the latest research to see how I can improve my clinical skills and reasoning so that I can provide my patients with the best care possible.  As I perused the one of the latest editions of the Journal of Orthopedic and Sports Physical Therapy, I came across an article that I believe all healthcare providers should read.  First and foremost, authors Michael Stewart, MCSP, SRP, MSc, Bsc and Stephen Loftus, PhD encouraged the fundamental idea that patients are not defined solely by their injury.  Rather, each patient is a human being with a unique collection of psychological and physical attributes that all play a part in the body’s pain and healing response.  From the perspective of a current patient and practicing physical therapist, I believe that the message conveyed in this article is pivotal for optimizing patient care and improving patient outlook when it comes to the injury rehabilitation process.

In their article titled “Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation,” Stewart and Loftus begin with a quote from Rudyard Kipling, saying, “Words are, of course, the most powerful drug used by mankind.”  As if that single statement wasn’t enough to draw the reader in, they expand even further to say:

“Human beings consist of muscles, bones, and tissues, but the words we use in therapy can have a profound influence on how people make sense of their bodies and how they interpret what they are experiencing.”

I am so grateful that this concept has finally made it into publication!  Words matter to every human each one of us interacts with, but they are especially crucial to those enduring pain.  From a movement expert and injury prevention perspective, research indicates that a more negative and depressed mindset effectively delays the physical healing process.  Even further, athletes attempting to return to sport after recovering from an injury are more likely to sustain re-injury if their recovery process is marked by any extent of depression.*

*Depression does not have to be clinically diagnosed in this context.

As humans, we are wired to selectively choose and invest in community, experiences, conversation, and thoughts that reinforce our perspectives.  If I am looking to experience joy, I will surround myself with people and opportunities that allow me to experience joy.  On the other hand, if I am enduring pain and/or struggle, I will likely surround myself with other people and experiences that validate and reinforce my pain and/or struggle.  Stewart and Loftus build upon this idea, saying, “When we are physically and emotionally low, we also seek information that supports our vulnerabilities.”  Long story short, we crave a sense of belonging.  We want to surround ourselves with people and spaces that validate our experiences.  As a result, we can become tunnel-visioned in the way we process information we take in from our surroundings.

From a patient standpoint, recognizing that we, as humans, are wired in such a way can bring awareness to the opportunity of restructuring our perspectives when we are suffering and in pain.  It is so easy to become overwhelmed by our pain, especially when it is chronic and nature and the light at the end of the tunnel appears to be very far off in the distance or perhaps even non-existent.  However, when we consistently acknowledge that our pain is here to stay forever (ie. “I’ll have this pain for the rest of my life”), we are actually reinforcing its existence, allowing it to keep a nice cozy home in our brains and nervous system when the body may have stopped waving red flags a long time ago.

Personally speaking, I have lived out this concept in its truest form.  I am guilty as charged, having unconsciously welcomed pain to live rent-free in my brain for an unnecessary length of time.  Most patients who recovered from a knee surgery, especially and ACL reconstruction, can acknowledge the oh-so-frustrating existence of anterior knee pain.  It is one of those aching discomforts that is constantly reminding you of its presence–sitting for long periods of time (long car rides, air travel, etc), climbing up and especially down stairs (or hills for that matter), during and after running (or any impact activity), or maybe even walking for a little longer than usual.  Gah!  So frustrating.  What’s even more frustrating is recognizing that every time i acknowledge it’s existence, I give its studio apartment in my brain a brand new renovation–for free.

Don’t get me wrong, anterior knee pain and pain in general can be totally real, especially in the acute phase.  Recognizing and staying ahead of pain during this period is crucial for symptom management and recovery.  However, when we continue to coddle our pain  long after the acute phase has passed, we invite our brain to fall victim to the chronic pain cycle.  When we allow our pain to dictate our lifestyle choices, we unconsciously give it the power to own us.  By choosing to take the proactive pain-reliever, by choosing to avoid participation in recreational activities that once gave us joy without fear, by choosing to take the elevator rather than the stairs, by choosing to stay at home rather than go for a walk with our friends, we unconsciously choose to fall victim again and again to the power of the chronic pain cycle.  This not only interferes with our physical recovery process (as pain in inhibits appropriate muscle activation and strengthening), but it also commandeers many other facets of our lives that keep our psychological and emotional health tanks full.  So how do we press the hard-reset button and pull a U-ie on what appeared to be a one-way street?  The empowering piece in all of this is that we have a choice.  We have the ability to face the trickery of our brains directly in the eye, saying, “Hello my dear pain, we’ve had a nice run.  I see what you’ve done here.  But I think it’s time we move in different directions.”

Often times we can reverse the power of pain simply by the words we tell ourselves.  Instead of saying something like, “I’m going to be stuck with this pain forever,” perhaps we can reframe our words, reminding ourselves that the current situation is only temporary and not our final destination.  Instead of opting out of opportunities due to fear of exacerbating our pain, maybe we say yes to the opportunity and participate in it to our fullest potential until the body really sends us a true red flag.  Who knows, we might end up surprising ourselves!  When we get angry about the ongoing presence of pain and feel as though our bodies have betrayed us, perhaps we reframe our perspective, saying “Body, thank you so much for being a part of this journey with me.  We’ve been through a lot, but we’re stronger than we think and there are certainly better days ahead.”  The words we tell ourselves are so powerful, especially in the pain journey.  Becoming aware of our pitfalls and acknowledging when it’s appropriate to reroute is undoubtedly the biggest step towards finally seeing that progress and hope that we didn’t think was there anymore.  How can you speak to yourself differently?

From a healthcare provider’s standpoint, much of the same ideas apply.  Have you ever reached a hard stopping point in your patient’s progress, retrospectively thinking to yourself, “Perhaps I could have done/said that differently?”  Have you been caught with a patient when he/she is having an emotional moment, often wondering what you’re supposed to say or do to rectify the situation?  Don’t be afraid to step up to the plate here–you’re in overwhelmingly great company!

I think we as physical therapists do a great job of relating to our patients the best way we know how, but when it comes to uncomfortable situations, we–like most other humans–prefer to run as fast as we can in the exact opposite direction instead of sitting with our patients through their discomfort.  Granted, our patients’ emotional turmoil is not necessarily our burden to bear, but we can certainly help to alleviate their discomfort within clear boundaries.

As mentioned previously, patients enduring pain often seek validation and reinforcement that their symptoms are justified.  Patients coping with chronic pain often demonstrate decreased self-confidence and a less positive outlook, which often exacerbate the chronic pain cycle.  One way that we can assist these patients to experience increased chances of improved recovery is helping to reframe their perspectives.  Stewart and Loftus suggest the following:

“An essential step on the road to rebuilding self-efficacy and resilience is to understand that people can often be distressed and disabled by their view of things.  There is plenty of evidence to support the claim that if we change the way we view things, the things we view can change.”

As physical therapists who generally see patients 1-2 hours per week, we are likely to be healthcare practitioners that spend the most time building relationships with our patients.  Our words are powerful, and we should choose them carefully.  Stewart and Loftus continue to build on this idea by saying:

“As the current international pain epidemic continues to escalate, it is time to conserve whether the words we use form part of people’s solution or part of their journey toward disabling vulnerability.”

Because we have the privilege of spending so much time with our patients, we must realize how much of an influence we can have on recovery outcomes.  Most times patients will come to us having already seen a doctor or a specialist and having already received a diagnosis following a series of diagnostic tests.  Other times we may be the provider performing the primary screening.  In any case, patients often seek concrete causes for their symptoms.  In today’s world, diagnostic images are heavy with technical medical terms, which can be easily misconstrued in the absence of proper education.  Moreover, it is also easy as highly educated health professionals to speak to patients in technical medical terms, which can present the opportunity for a communication barrier or unclear communication.  Stewart and Loftus suggest that, “When communication is not clear, our interpretations are colored by our psychological state.”  For people suffering from severe or chronic pain, these fancy medical terms have the potential to negatively impact recovery outcomes.

A personal example stems from medical terminology associated with surgical findings after my first ACL surgery.  At this point, I was not educated as a physical therapist and was therefore more prone to becoming hung up on big words that seemed to be associated with life-changing consequences.  If my memory serves me correctly, my surgical findings included something along the following lines:  left knee complete ACL rupture with bone bruising and Grade II chondromalacia underneath the patella.  One of my immediate reactions… Grade II chondro-what?!!  What does this mean?  Keep in mind, I was a collegiate soccer player who recently sustained what used to be a career-ending injury.  I was already scared that I would never be able to player soccer again.  And I was also in a lot of pain after having a huge knee surgery.  My psychological and emotional health were not in their prime, and I was certainly looking for misery to keep me company.  So, after perusing WebMD like most people do, I was convinced I had advanced arthritis underneath my kneecap that would eventually lead to a total knee replacement and reduced participation or perhaps even none at all in all of the physical activities that contribute to my identity.  That’s it–life was over as I knew it.  We can all see where this is going, can’t we?

As healthcare providers, it is important to consider our patients’ education level before we disseminate fancy medical terminology.  Using my own experience as an example, it is easy for a patient to latch onto these big words and catastrophize the situation to various extremes.  More often than not, when patients are introduced to big words like “chondromalacia” or “degenerative changes”, they may be too overwhelmed to think about asking for clarification.  Even more likely, patients might be afraid to speak up out of shame derived from self-generated expectations that these big words are supposed to be understood by the average individual without 7+ years of secondary education.

On a similar note, words like chondromalacia, arthritis, and degenerative changes are often perceived as conditions associated with chronic and progressive negative life changes.  From a patient point of view, this often leads to thoughts like, “I’ll have this pain for the rest of my life,” or “I can only manage X symptom by taking this pill every day,” or “I have to stop participating in the fun things that I love so I don’t make X condition worse.”  In some situations, pathology may be severe enough that lifestyle changes have to be considered.  But in so many other situations, we jump to worst-case scenarios and make drastic life-changes that decrease our quality of life when they might not have been necessary in the first place.

So when it comes to physical injury and the rehab process, how can healthcare providers adapt their vocabulary to reinforce positive thinking and a growth mindset?  Steward and Loftus provide us with a general roadmap, stating:

“The language used with patients in diagnosis and therapy is just as important as, if not more than, the findings of such scans… By rewording and broadening the context of medical language used with patients, clinicians may begin to liberate people from a life of unnecessary worry and disability… By focusing language toward [the patient’s] hopes, and not [the patient’s] hurts, we may begin to lay the foundations for recovery.”

By taking the extra minute to explain to patients what these fancy medical terms really mean and by also encouraging them to ask questions if they do not understand, healthcare providers can help to significantly reduce the amount of stress, anxiety, and fear-oriented behavior associated with diagnostic tests.  In doing so, we can allow for opportunities for patients to digest new information with fewer questions and empower them to better manage their symptoms given improved understanding.  By focusing primarily on pathology that is symptomatic and normalizing asymptomatic findings, we may be able to help patients feel less like they’re “broken” and more like they’re normally aging humans.  Steward and Loftus suggest that we can do a better job of empowering our patients when, “There is a focus on what someone can do (or will be able to do with help) rather than on that they cannot do.”  And we can certainly dwell less on fancy medical terms that cause confusion, mental/emotional overload, and fear-avoidance behaviors that often exacerbate the chronic pain cycle.

Speaking from personal experience and with additional support from research findings, patients identities are significantly more than the physical ailments with which they consult healthcare providers or a diagnosis provided from a healthcare provider.  Patients are humans with varying life experiences, home situations, life stresses, temperaments, and mental states that all influence the way information is received and processed.  In a world with continuous medical advancements and healthcare changes, there is great opportunity for gaps in understanding of medical terminology to persist, thus continuing to endorse the chronic pain crisis.  However, patients and healthcare providers alike have the potential to approach medical situations differently by changing mindset, asking for or providing more education, and improving understanding of the body’s complex response to pain and suffering.  Steward and Loftus affirm this concept by saying, “All musculoskeletal conditions must be viewed within a ore comprehensive framework that takes account of biomedical issues and includes how patients perceive their injuries, their disabilities, their pain, and how they make sense of what is happening to them.”

In conclusion…

If you’re a patient, I encourage you to speak up when you don’t understand, ask the question you think you should already know the answer to (because chances are you’re not alone), take accountability for the ways that you can optimize your recovery and symptom management, and reframe your mindset to prevent your pain from becoming a part of your identity.  You absolutely can do all of these things.  You are strong and you are completely capable.  But you are also a human.  It won’t be a straight-line journey and there will be ups and downs.  But keep pushing.  Every step you take is one step closer to the other side.

If you’re a healthcare provider, I encourage you to reflect on and reconsider some of the ways you might approach your patients dealing with chronic pain or devastating injury.  These patients each have their own story.  Ask questions so you can better understand where they come from and what they need.  Ask questions so that you know how you can best empower each patient to be a positive driving force in their own journey.  That fancy medical terminology surely sounds sophisticated, and it is.  But sometimes–most times–simplicity can be more effective.  Sit with your patient just a little while longer to explain medical information, allowing time for questions and processing.  Your patient will thank you later–big time!  And chances are, their outcomes will likely be better too.

If this post resonates with you and you know of someone else who might benefit from reading it (whether you’re a patient or a healthcare provider), please pass it along!  One of the best ways to make an impact is to empower the people around us.  Wouldn’t it be amazing if we could create a widespread epidemic of patient education and empowerment and kick these unnecessarily ridiculous complex recovery processes to the curb?!

Interested in learning more about the chronic pain cycle?  Stay tuned for a follow-up post with more details.

 

Reference:

Stewart and Loftus. “Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation.” J Orthop Sports Phys Ther, 2018: 48 (7), p519-522.

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When the Physical Therapist Becomes a Patient

Finding Light Within The Darkness

It’s been quite a few months since my last post regarding my ACL recovery journey–just over seven months to be exact.  My mission in vocalizing my recovery journey is not to throw a pity party for myself and others.  It’s also not to draw attention to myself (because Lord knows that is asking to be drowning in discomfort).  Rather, I hope to help those walking in similar shoes to realize that we are not alone.  So thank you for being patient!  I ask that you practice your patience just a bit more.. This is a long one! The beginning of this post is legitimately real talk.  It will be sad, frustrating, and not-so-positive at times.  But keep reading!  There is a light at the end of the tunnel and it’s what I work towards each day.

Over the past 7 months, life happened and is still happening.  Sometimes I’m so busy that I’m doing my best just to find a minute to breathe.  Other times I simply just don’t feel like devoting anymore attention to my knee and my physical limitations.  It’s been over 3 years since my initial ACL injury happened and I feel like I’ve been telling the same sad story over and over again.  It’s emotionally, mentally, and physically exhausting, and I don’t want to allow this injury to consume anymore of me than it already has.  If you’ve been here, you probably know what I’m talking about.

Nevertheless, I’ve had many people reach out asking how my recovery is going (ie. How are you doing?  How’s the knee?  Are you running yet?  When can you play soccer again?)  Some days I’m feeling like I’m on a mountain top and I’m ready to take on the world, but most days thus far I find myself frustrated and discouraged, wanting to defer the question to a time when I can confidently provide a more positive and exciting answer.

May 12th marks the 8-month marker since my surgery, and my progress has been slow, up, down, sideways, in circles, and nothing like I expected it to be.  I typically achieve recovery milestones at least one month later than a typical ACLR patient does, and in general my body’s recovery response is SLOOOOWWWWW.  I’ve worked through all parts of the ACL journey, including physical achievements, barriers to physical success, depression, loneliness, stress related to poor body image, and a roller coaster of many other emotions.  I’ll let you in on where the mind often goes first (the negatives), and then we’ll walk through the positives together and see just how much perspective can change everything.

At over 7 months out from surgery, I am still unable to perform a 1 min:4 min on/off running progression without pain in my knee afterwards.  This is so frustrating because it is FINALLY Spring in Boston and all I want to do is throw on a pair of shorts and a tank top and go out for a run by the Charles River–yes please!  However, my knee seems to have other preferences.  In fact, whereas most ACLR patients return to running at 12-weeks or 3-months post-op, I was unable to demonstrate appropriate strength (>/= 80% quad strength relative to my unaffected leg) or perform single leg squats and double leg jumps without pain until nearly 5-months post-op.

At 4-months post-op (after I complimented myself for being so patient in waiting for the green light to begin running), I arrived at my physical therapy appointment and my PT and I decided we wanted to give quad strength index testing a try.  Keep in mind, the 3 weeks prior to this PT session I was battling knee pain that scarily resembled my pre-surgical symptoms–we’ll talk more about that later.  Was I confident that quad strength index testing was a good idea?  Not even a little bit.  Was I worried that I wouldn’t “pass”?  You bet.  I knew I still had a little bit of knee pain, but, dang it,  I was determined to finally be able to put my running shoes on!


[Learning Moment: Quad strength index testing involves straightening each leg against a handheld dynamometer (essentially a handheld force plate) as hard as you possibly can without compensating through other joints and muscles.  It’s generally not the most comfortable process, especially when the patient has had trauma to both the patellar and quadricep tendons.  Nevertheless, it is an evidence-based approach to identifying quad strength, which indicates readiness to run as well as injury risk.]


Fast-forward to the third and final trial on my right knee (injured knee), and my PT noticed I was compensating by hiking my right hip to generate force.  I had to re-do that trial (while I knew I had been hiking my hip for both legs the whole time).  I knew my numbers would be inaccurate, but I kept going anyways.  Yes, I am professionally a physical therapist and know better, but I am also a human.  And my goal-oriented tunnel vision sometimes gets the best of me.  As I finished testing, my PT looked down at the numbers and said something like, “Hey, these look pretty good.. I think you made it!”  Boost of confidence–check.  Mind already imagining all of the glory of a run along the Charles–biggest check there ever was.  My imagination was long-gone.  As I neared the end of my dynamic warm-up, I noticed my PT walking back towards me with a straight face.  Ohhhhh boy.  This doesn’t look good.  She said, “You’re going to be pissed.  You got 78%.  We need to continue focusing on your strength first and then work on jumping and running.”  That may have been the closest I’ve ever been to actually having steam blow out of my ears.  I was frustrated, disappointed, angry, sad, discouraged, and downright mad.  It had been 4 months since surgery and 7 or 8 months since my last run.  GAH!


[Learning Moment: Pain inhibits muscles from performing at their fullest extent.  When the body is pushed through pain, injury risk increases because muscles and joint receptors are inhibited, thus impairing the body’s ability to stabilize and protect itself.]


As I did my best to keep my composure in the middle of a busy Sports Physical Therapy clinic at Massachusetts General Hospital, I was slowly losing my grip on the floodgates.  I tried reminding myself that I cannot compare my journey to that of a patient with an initial ACLR, because I had a revision and the timeline is much slower.  I also tried reminding myself that the recovery journey is never a straight line and timelines are just guidelines (which is something I tell my patients all the time).  Additionally, I tried reminding myself that I was still having pain and I knew deep down I wasn’t ready to run.  But I wanted to so badly!  Some of you might be wondering why running is so gosh darn important to me.  No, I am not and never will be an elite runner.  Running is not my life and “runner” is not my first-choice word for identifying who I am.  But tying up my shoes, getting outside in the sun and in the fresh air, and exploring the world by foot while listening to my most updated playlist is one of my happy places.  I hadn’t tasted it in so long, and I needed to know so badly that I could be back there again one day soon.  I was afraid.  I was afraid that I might not ever achieve an outcome I was clinging onto so strongly.

After my PT gave me a little bit of space to process, she approached me again and I immediately lost all control of the floodgates–In the middle of a busy clinic where so many people could see me.  My PT probed about the reasons I was upset (as I outlined above) and she provided positive feedback and support in the best way she knew how.  She reaffirmed that my poor little knee has been through a lot of trauma, and it’s doing pretty darn well for having been through 4 surgeries.  She continued by acknowledging that she can see how important running is to me but logically speaking, I’m just not ready for it because of my continued pain.  She reminded me about the evidence-based strength and functional performance progression that indicates readiness to run, and pointed out in black-and-white details all of the things I had achieved so far and what I still needed to continue working towards.  She encouraged me to treat my knee and my whole self better, asking me to give myself a little more grace and to stop pushing myself so hard, expecting to achieve high standards, goals, and timelines that are not fit for my own story.  It took me a few minutes to get my head on straight and relinquish attachment to my emotions; but when I did, I began to see the light.

Yes, it has been almost 8 months since my surgery and the recovery process has been unexpectedly slow.  There is a lot I could and have complained about.  But as a busy individual working a full-time job and then some, there is even more to be excited and grateful about.  I have two very well functioning legs and a healthy body that can take me from point A to point B.  It might not be with my running shoes on, but I can ride my bike to and from work 5 days a week with no pain.  HUGE accomplishment.  I can still explore the world on my feet by walking without pain.  Also a big accomplishment.  (Walking might not be as fast as running, but I think I’m okay with that.  Sometimes when we move too fast, we miss the opportunity to see and embrace the little treasures.  My mom always tells me that good things come in small packages.  I think I’d like to find more of the little treasures in this journey.) Other major accomplishments include: achieving 92.7% on my quad strength index; practicing yoga (my other happy place) almost as much as I want; walking up and down stairs without pain (most of the time); and performing single leg squats without pain (most of the time).  Last but certainly not least, I am alive.

For those familiar with the ACL journey, it’s not uncommon to become all-consumed by the process, as the recovery is LONG (7-12 months for most initial ACLR patients) and can often include many bumps in the road.  In my experience, I’ve learned that it’s important to acknowledge and accept all parts of the journey–good and bad.  I’ve learned that I must take all the time I need to feel my emotions and work through them.  Even if that means crying in an public space. But I’ve also learned that there’s a fine line between sitting with/processing the emotions and letting them dictate my behavior and my life.  When I notice that my emotions are creeping a little too far into my inner peace, I practice gratitude.  I look back on my journey and all of the mountains I’ve climbed, and I: (1) throw a party for myself in celebration of my accomplishments and (2) remember that I am a human.  I am not perfect.  My body is not perfect.  And the recovery process certainly is not perfect.  If I extend a little more love and grace to my whole self (my knee, my body, my mind), my victories shine brighter than my road bumps.


(Note: I’m specifically avoiding using the word “failures,” because I don’t believe they exist.  Things don’t go as planned?  That’s alright.  Maybe I’m not ready to be on the top of that mountain just yet.  Perhaps I can benefit from a little more learning to grow and be better prepared to enjoy what’s at the top of that mountain even more).


The ACL journey is long and can be very slow and frustrating.  But it’s humbling and has so many silver linings that help me to navigate life as a whole with a little more grace, light, and gratitude.  While speaking about gratitude, I have to fully admit that I am not in this journey myself and cannot take sole responsibility for my growth and learning experiences.  It takes a village, of which mine includes extremely supportive family and friends, life coaches, physical therapists, and counselors.  I would not be where I am today without them, and I am grateful for my village each and every day.

If you’re moving through your own ACL journey or something similar, including any situation that threatens your identity and tests your patience (and so much more), my challenge to you is this:  make a list of everything you are frustrated with and then make a list about everything and everyone you are grateful for.  What can you do to better see the light in your journey?

 

 

 

 

When the Physical Therapist Becomes a Patient

Start Where You Are.

Click here to donate towards Jen’s medical expenses accrued from surgery and post-operative care!

This past Tuesday (9/26) marked two weeks since surgery day!  I think most surgical patients would admit that this block of time is the worst part of the whole surgery process, so I sure am glad that I’m finally over the hump!  Frankly, to say that these last two weeks have been a rocking roller coaster of both physical and emotional manifestations is quite the understatement.  I remember my last 2 ACL reconstructions having their ups and downs, but I don’t remember the beginning being so rocky.  Some say that the brain blocks out painful experiences.  I think there may be some truth to this!

For the past two weeks, I’ve had the luxury and convenience of staying at home with my wonderfully loving and caring parents who have catered to my every need and put aside their own priorities and self-care to make sure my needs are met first.  For this, there are no real words that truly and accurately express my gratitude.  One of my sisters, who is a Registered Nurse, also flew in from North Carolina for a few days (not specifically to help me) and spent a very large part of her vacation making sure that I was comfortable, that my leg was positioned in precisely the right way to allow for optimal healing and pain relief, that I was being nourished, that I was taking my pain medications on time, that I could make it to the bathroom safely and in a timely manner to relieve myself, that I could take a shower and wash days worth of filth from sitting and sleeping in the same clothes, that I knew I was loved and that she would go to the ends of this earth to make me feel safe and cared for.  I have a wonderfully supportive roommate who sat in Boston traffic 30-40 minutes each way traveling 5 miles to pick me up from physical therapy.  I have a physical therapist who makes it her mission to put a smile on my face before I leave her each day.  I’ve had so many people–family, friends, acquaintances, patients–reach out to me and wish me a smooth and speedy recovery or let me know that they are here for me when I need them and they would love to know how they can assist me to help my post-op journey be as stress-free as possible.  Yes, these past two weeks have felt like one of those really old wooden roller coasters that knock you from side to side and bring you to great heights only to drop you back to an equidistant low.  But these past two weeks certainly have been filled with more love and support than I could have ever imagined.  **See later post for importance of social support during the recovery process.

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My Momma and Me
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Me and my loving sis 9 days post-op!

As mentioned in my previous post, my first few days after surgery went relatively smoothly, as I was pumped up with lots of nerve blocks and therefore could feel nothing at all in my leg–not even my toes.  I was tired from a really long day of surgery and the anesthesia was taking it’s sweet, slow time moving through my petite body.  I was sleeping a lot.  Well, my eyes were closed at least.  Getting truly restful sleep after surgery  is somewhat magical and rather rare.  Sleeping positions are extremely limited and frequent and intermittent waves of pain don’t make for ideal sleeping conditions.  But when you’re so sleepy from the anesthesia, the pain meds, and from the body being in overdrive after being assaulted by surgical tools, sleep finds a way to take up most of the day.  Long story short, I was pumped with meds, had minimal pain, and was feeling like a rockstar.  I even was feeling well enough to eat whole foods and full meals.  Life was good.  Then the nerve blocks started to wear off, and the pain came at me full throttle like a freight train.  Rockstar spirits effectively squashed.  Floodgates effectively lifted.  Bring on the tears. I pushed through some of the worst pain I’ve endured in my entire life the second day after surgery.  I’m not-so-secretly hoping that childbirth will be slightly better than this post-surgical pain, but we’ll cross that bridge when we get there.

It is amazing what pain can do to the body–how it can affect emotions, appetite, sleep cycles, desire to be social, and overall well-being.  As I worked through each day from 2nd day post-op forward, the pain was real.  Even while taking pain medications regularly and on time, my knee was still finding ways to tell me how angry it was.  Sometimes I was wiggling every which way on the couch in unsuccessful attempts to find even just one position that slightly reduced my pain.  Other times I successfully found a little bit of a happy place, at which point it became my mission to not move a hair so that maybe, just maybe, I might be able to squeeze in a 20-minute power nap before my knee demanded a change in position.  Most of my pain was the throbbing and aching kind–the kind where my knee felt like it developed it’s own heartbeat and grew to be the size of a small bowling ball because of the swelling.  My surgeon requested that I avoid taking anti-inflammatory medications because they interfere with the body’s natural healing process.  Logically, this makes complete sense.  But when the strong pain medication you’re prescribed helps minimally with pain as a result of swelling and inflammation, NSAIDS sound like the best thing on this planet.  No worries–I remained obedient with the surgeon’s orders.  But the pain–boy was the pain really something special.

 

As the pain began to slowly improve, I started to do more for myself.  I walked upstairs in attempt to make breakfast or lunch with the overall intention of lightening the burden on my parents.  I was feeling pretty good after a few days, but my body once again had a way of telling me that I was moving too quickly.  While attempting to make a smoothie for breakfast 6 days after surgery, my leg was throbbing like crazy, making sure to let me know that I needed to tend to it.  Instead, I was on a mission to make this smoothie and demonstrate my independence.  I made smoothies for the past 2 days.  I could certainly do it today.  The throbbing got worse, my ears began to ring, my hearing and vision started to get a little fuzzy, and my heart started racing.  From past experience, these were all tell-tale signs that I was just about to pass out.  I made my way to a chair, made sure my leg was propped up and taken care of, let my mom know that I wasn’t feeling good, and then indeed passed out.  I awoke to my mom holding and ice pack on my head and my dad holding my leg, making sure it wasn’t going anywhere.  Jen’s knee = 1.  Jen (and her pride) = 0.  Just when I thought I was on the up-and-up, my body had other plans–plans that differed from the ones I had.  Under these circumstances, it is so easy to become frustrated and discouraged.  It’s so easy to think poorly and begin to fall into the emotional ditch.  Admittedly I did, but only for a short time.  Fortunately I have amazing people surrounding me who were there to pull me out.  Instead of being mad at my knee, my body, or the circumstances, I learned to accept the situation and practice positive self-talk.  Instead, I learned to tell my knee that it’s okay.  It’s been a tough journey.  We’ve had a lot thrown our way.  But we made a good effort and we’ll try again next time.

There is something to be said about the emotional part of this whole process, how sometimes you feel things and you don’t even know why.  For instance, one day when I was doing well with accepting my limitations, I asked my dad if he could make a smoothie for me for breakfast.  He did a great job the previous days feeding me bone broth and crackers and making me a berry smoothie.  But that day I wanted a different smoothie–one with greens, chia, and flax seeds to help with my GI mobility.  After I asked, my dad responded by requesting that we stick with the simple berry smoothie.  Maybe we could try the green smoothie tomorrow.  I suggested that I could go upstairs to make it myself, letting him know that I had successfully made a smoothie earlier that morning.  He was still hesitant, though, and he suggested that he make it (now recognizing that this was for my own safety).  Out of respect for his effort in helping me, I compromised with the berry smoothie.  But as soon as he left the room, I started crying.  I couldn’t make any sense of this while it was happening, but looking back on it, I think I was dealing with overwhelming feelings of helplessness, frustration and anger (not towards my dad but towards the circumstances), and pure defeat.  All I wanted to do was make a smoothie by myself.  I wanted to stop being a burden.  I wanted to stop having to ask for help.  A note to parents caring for a child after surgery, meet him/her where he/she is.  And a note to children working with parents who care for them after surgery, meet them where they are.  Nobody knows how to be a patient or a caring parent perfectly.  Work as a team and make compromises.  After all, we’re all in this together.

Second case in point was when my sister brought me back to Boston after my two-week stay at home with my parents.  The entire 90-minute car ride there, I could feel something boiling in my gut.  A sense of fear, anxiety, and perhaps some sadness.  This was the first time in all of my surgical recoveries that I felt like I wasn’t ready to do this by myself.  I was surrounded by my family who took such great care of me and showed me how much they loved me for the past two weeks.  Once I got to Boston, I would pretty much be on my own.  Me, my kitty, and the bare white walls of my apartment.  I’m not ready for this.  My sister spent the night with me and left the next morning to go back to Charlotte. She asked me what was wrong, and I said, “Nothing, I’m just tired.”  Inside, though, my heart was screaming, “I’m scared.  I’m not ready to do this by myself.  I’m not ready to be lonely.  I don’t want you to leave.  Thank you.  I love you.  I miss you already.  Don’t leave.  Can you please stay?”  As she dropped me off at the nearest Starbucks so that I could spend a little bit of time outside of the apartment, I cried when she hugged me goodbye.  And then I kept crying as I sat in the middle of Starbucks, wondering and worrying about what the rest of this process is going to look like.  I sat and wrote thank-you notes to many of the people who have supported me thus far.  I sat, and I wrote, and I cried.  There were certainly tears of fear, but mostly (I think), there were tears of gratitude.  So what to do when your emotions creep up behind you and engulf you like quicksand? Start where you are.  Acknowledge them.  Feel them.  Honor them.  And then keep moving forward.

As I did my exercises at home and started physical therapy, I continued to encounter achievements and also setbacks.  At my first follow-up appointment with my surgeon, his Physician Assistant was excited about my progress and suggested that I could finally unlock my brace to allow movement in my knee.  Yay for better sleep!  He also wanted me to ditch my crutches.  Woo hoo!  Independence here we come!  However, my physical therapist wanted to make sure we were taking this rehab process slowly and carefully to ensure optimal healing given that this was my second ACL reconstruction on the same knee.  She preferred me to keep the crutches and walk with a locked brace.  Womp womp.  Goodbye feel-good feelings.  Welcome defeat, discouragement, and frustration.  Some people have a tough time recovering from these setbacks.  I personally use them as greater motivation to do my exercises exactly as instructed and to give them my best effort each and every time.  Every. Single. Day.  They say that hard work pays off, right?  As a Physical Therapist myself, I know the recovery journey is never a straight line.  It moves up, down, forwards, backwards, sideways, diagonally, in circles, and every which way you don’t want it to go sometimes.  But even the littlest bit of progress is progress.  And progress means moving forward.  And moving forward means gaining one more step to the overall goal.  This week I gained 14 more degrees of knee flexion than I had last week.  My swelling has gone down considerably and I’m walking more and more like non-injured Jen every day.  I’m moving forward, and that is a wonderful thing.

In all surgeries, there are unique nuances and frustrations.  No two surgeries and recovery processes are the same, whether it’s two different people having the same surgery or one person having the same surgery two different times.  This time around for me, a particular nerve in my low leg, foot, and toes, seems to be acting up.  My toes don’t have their full sensation and I experience intermittent twinges of pain along the nerve pathway.  Additionally, my kneecap has a mind of its own and continues to make it difficult for me to bend my knee without pain.  If bending my knee hurts, then walking and performing some of my exercises also hurts.  Focusing on nuances like these makes it really easy to see setbacks and frustrations before progress.  Somedays the body feels good, and other days the body might need more time to heal.  With each day that passes, I know that it’s important to meet myself where I am–to start where I am.  I can only move forward if I start where and when I’m ready.  Nothing more, nothing less.  That’s one thing I’m more confident about after #aclsurgerytake3.  I only have this one body, as broken and beautiful as it is.  If I start where I am, I give myself the best chance to move forward in the healthiest, most loving and most successful way possible.

I’m excited to see what comes of this #littlekneebigstory!  Thank you for continuing to follow me during my recovery process.  I appreciate every bit of love and support that comes my way, of which there has certainly been no shortage.  If you are interested in donating towards my upcoming medical expenses while I am out of work, click here.  Thank you in advance!

 

When the Physical Therapist Becomes a Patient

On the road [to recovery] again!

Donate to my GoFundMe page at https://www.gofundme.com/lendjenaknee.

Hello everyone!  It is day 2 after my surgery and I am doing well!  It has been a long 3 days, including surgery day, but what matters most is that with each second that passes I am continuing to move forward in this journey towards great things.

My wonderful mother and I arrived at the surgery center at 7am on Tuesday morning and did not leave until nearly 1pm.  Surgery took a little bit longer than expected, as there was more damage inside my knee than the surgeon anticipated.  I did undergo all of the anticipated procedures, including an ACL reconstruction with a patellar tendon autograft, a medial meniscectomy, and a quad tendon repair.  It turns out that I did indeed have another cyclops lesion with substantial scar tissue buildup all along my previous ACL.  What’s the most alarming is that my ACL was nearly 60% torn without me even knowing it.  The surgeon confirmed that the cyclops lesion was at the bottom end of my ACL because of impingement happening to the graft at that location.  However, my ACL was torn at the top end because of additional impingement in that area as well.  So–HUGE blessing in disguise–I would have needed another ACL at some point in the very near future, even if I avoided any strenuous activity.  For those of you who might not understand anything I just said, let’s break it down.  The ACL lives in a tunnel between the thigh bone and the shin bone that moves each time the knee bends and straightens. If these bones interfere with the ACL in any way, the ACL becomes “impinged”, meaning it is compressed by the bones.  Even with a task as simple as walking, the bending and straightening associated with each step shreds the fibers of the ACL, compromising its overall integrity, eventually leading to tearing over time.  In my case, it was only a matter of time before I had no more ACL left at all.  Holy moly.

After learning about this while sitting in post-op eating crackers and drinking water, I could not have been anymore grateful that I decided to get this surgery done now.  Although I know the recovery process will be long, I’m excited to be working from a fresh slate that is hopefully free of anymore complications.  I’m excited to essentially have a new knee that will be able to take me to new places with far less pain, discomfort, and limitations.

A lot of people have spoken about my positivity and hopeful mindset, which I cannot speak about without thanking everyone who has reached out to me in this journey so far.  The amount of love and support I have received is incredible, and there are no words that justify the amount of gratitude in my heart.  I brought this love and support with me all the way into pre-op, where I received even more support and compassion from the surgical staff who did their best to lighten the tension and anxiety that can so easily invade a room right before major surgery is about to happen.  We joked around and made small talk, which served to be a great distraction until it was actually game time.  Before I knew it, my surgeon gave the anesthesia team the go-ahead to get me prepped with nerve blocks in my leg that would help with pain management during and after surgery.  Up until this point, I was secretly proud of my strength so far, not having shed any tears or make any of my anxieties too obvious.  Then all of a sudden, I couldn’t contain it anymore and the floodgates opened.  As I lay on my gurney while the anesthesia team did their work, I was trying so hard to muffle my breakdown, but there was no stopping.  Is this really happening?  What is happening?  Is this real life?  Why is this happening?  Is this real life?  Is it too late to bail?  Is this real life?  It was indeed real life.  And there was no turning back.

With the help of the surgical team, I got myself back together and tried to put my superwoman uniform back on.  I’m ready!  Let’s do this.  Wait–I’m not actually ready.  Breakdown #2 happened while I was transferred to the operating table in the OR and the entire surgical team qA making sure everything was in place for a victorious surgery to soon take place.  The anesthesiologist tells me she’s going to put me to sleep, and as I succumb to the last bit of hot tears running down mcheeks, I fall asleep.

We all knew a breakdown was bound to ensue at some point.  It was really a question of when.  I don’t share the nature of my breakdown(s) in such great detail to make others feel sorry for me or to gain support from others out of pity, because–believe me–this is the very last thing I desire.  Instead I share this part of my story to show those in similar circumstances as me that it’s okay not to have it together all the time.  It’s okay to be weak and to cry and to sometimes not even know why you are crying.  It’s okay to be sad and to mourn circumstances that once were.  It’s okay to be vulnerable.  Actually, being vulnerable is one of the bravest and strongest things you can do.  Embrace your feelings. Address your emotions.  Figure out why you feel the way you do.  This part of the journey is important.  What’s even more important, though, is deciding how you’re going to move forward.  Are you going to let the weight of unfortunate circumstances cloud your hope, your positivity, and your motivation in growing into a newer, greater version of yourself?  Or are you going to accept that the circumstances stink and fight back against them with a “Bring. It. On.” attitude?

I choose the “Bring. It. On.” attitude.  I’m ready for a knee that feels better and works better.  I’m ready for a knee that helps me to participate in the things I love and the things that help me to bring the best version of myself to this world.  All this being said, it is important for me to recognize that recovery is not a straight line journey.  Not even close.  Having been through this surgery twice before, I should know more than anyone that there will be ups and downs, and sometimes there may be more downs than ups.  But again, it’s the attitude with which I approach these twists and turns that will help me to be the most successful on the other side.

After a rough second day after surgery that was way more painful than anything I could ever imagine, I’m feeling miles better on post-op day 3!  I’m sticking to my surgeon’s post-op protocol as best as possible, hoping and praying for the world’s strongest knee to come from this.  And…… I may even get to take a shower tonight!!  Yes–life is getting wild in the Wardyga household these days.

Thank you for continuing to follow my story!  I appreciate your support more than you’ll ever know.  If you’d like to donate to a fund established to help decrease my financial burden from this very expensive surgery, use this link: https://www.gofundme.com/lendjenaknee.

Stay tuned for more updates on my recovery!

When the Physical Therapist Becomes a Patient

When Reality Hits–Like a Ton of Bricks

If you have not donated to my gofundme page and wish to do so, donate here: https://www.gofundme.com/lendjenaknee.

Today is Thursday, September 7th, which means that surgery is less than 1 week away!  For the past couple of weeks, I’ve been working hard to micromanage my schedule for the upcoming month or so, making sure to schedule important doctor’s appointments, physical therapy, and establish some type of to-do list that might help to keep me occupied during the long, slow recovery process following my biggest surgery yet.  With a ginormous to-do list staring me in the face as I try to make sure all of my ducks are in a row before the big day happens, I have fortunately been quite distracted from quiet time and silence.  It is this quiet time and silence during which I often drift towards thoughts of surgery day (Tuesday) and what it’s going to be like waking up in the post-op room with my knee all braced up and hot, swollen, and painful.  Then I think about getting back to work, managing finances while I’m out of work, and wondering where exactly I’m supposed to start so that I can keep my mind in the best of places during this long journey.  My life as a PT has finally become busy and crazy again, and my evenings are often filled with so many supportive and loving patients wishing me the best of luck and reminding me how strong I am, encouraging me that if anyone can do this, it’s me.  How lucky am I to be blessed with a life like this?

I can’t thank everyone around me enough for providing me with all of this support, encouragement, and love before the hardest days have even begun.  I’ve decided to make a scrapbook of all of the well wishes and encouraging statements so that I can look back on tough days and remind myself how many people are cheering me on and routing for me to walk through this journey as a rockstar and be a superwoman always.  Small life lesson–never underestimate the power of love in all of its forms.

During the small glimpses of slow time amidst all of this chaos, I’m realizing that another reason I’m grateful for all of this love and distraction is because it helps me to avoid a really important part of this journey–accepting it in its entirety.  Acceptance–that’s often the first step towards making a positive change.  It also tends to be the most difficult, and for some people it doesn’t happen until a not so subtle reminder hits them like a ton of bricks.  Yesterday, the bricks hit me.  After I finished my pre-op quad strengthening workout and subsequently feeling like a very sore rockstar, a kind gentleman delivered a continuous passive motion machine to my apartment.  This device is used post-operatively to passively help the knee bend and straighten in order to prevent scar-tissue buildup and also minimize pain.  Using this device is a new experience to me, so when I saw how large and in charge this machine is, I literally blurted out, “that looks like a torture device.”  Oops.  This is my unfiltered mind in all of its fears and anxieties, running faster and faster and becoming slightly more unfiltered as surgery day approaches.  As the kind gentleman proceeded to fit me for this device and teach me how to use it, reality settled in–fast.  This is real life.  This is really happening.  Am I ready for this?  I don’t think I’m ready for this.

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Continuous Passive Motion Machine

For the past 2 weeks, I’ve been working incredibly hard to be my strongest self, both physically and emotionally, though I will admit the physical effort is currently outweighing the emotional effort at this stage in the game.  I’ve taken on my own pre-surgical rehab, trying to strengthen my leg as much as I can with electrical stimulation and demanding exercises that will help my quad to be as strong as possible going into surgery.  As each day passes, I recognize that I have one less day with 2 reasonably functioning legs that still allow me to walk, run, ride a bike, climb stairs, shop for food, take a shower, and cook meals independently without the help of anyone else.  Oh boy.  There it is again.  Asking for help.  It’s SO hard. Soon I will be asking for help more than I ever wanted or ever expected to and I will be restrained to the restrictions of a post-surgical protocol and the needs of my body, preventing me from being physically active at my discretion.  Even more, I realize I’ll be asking others to sacrifice parts of their own life to meet my needs.  Real life is happening.  It’s here.  And as hard as I try to run away from it, it’s chasing me faster, stronger, and harder.  Acceptance.  That’s where I’m at.

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Neuromuscular re-education with electrical stimulation for quad strengthening

 

Thank you so much to everyone who has reached out to me and helped to support me emotionally, physically, and financially throughout this journey.  Words cannot explain how grateful I am for all of the blessings that have been placed before me.  As surgery day quickly approaches, the reality of financial hardship continues to be a large burden on my plate.  With the help of family, friends, and acquaintances of friends, I’ve raised $700 to use towards my medical expenses, which will be upwards of $5000 after insurance coverage.  Given this large number, I’m continuing to be brave and ask for help.  If you are interested in supporting me with any sized gift, please donate here: https://www.gofundme.com/lendjenaknee.

I will continue to produce new posts throughout my recovery, hoping to further my mission in educating others about the real association between mental/emotional well-being and physical recovery during injury.

Thank you again for all of your support in this journey!

 

When the Physical Therapist Becomes a Patient

What to do when you get thrown a curveball–breathe.

Donate to my GoFundMe page here: https://www.gofundme.com/lendjenaknee

Want to know more before you donate?  Read below!

If you’re reading this post, you’ve probably learned through some social media venue that I’ve been thrown yet another curveball after I thought my journey with my last ACL reconstruction should have been long over.  Sharing my story publicly was a tough decision for me.  Those of you who know me well know that I like to keep a lot of my personal life closed within the walls of my family and friends closest to me.  I don’t like to be the center of attention–especially when the attention comes in the form of people feeling sorry for me.  What’s even more difficult for me is asking for help.  Yes–it’s a real thing.  I want to be a strong and independent role model that other people look up to.  But I am human after all, and through many humbling experiences, I’ve learned that showing weakness and asking for help is indeed an indication of strength.  So I choose to share my story not to throw a pity party or to call attention to my circumstances; I recognize that we all have unique challenges of our own and my story is no more special than anyone else’s.  Instead, I choose to share my story so that others may learn from my experience.  I choose to share my story so that maybe I can make an impact in even one other person’s life.  That is my mission.

The first practice after the third game of my junior year varsity soccer season at Skidmore College, I tore my left ACL.  I overcame setbacks associated with exertional compartment syndrome as a freshman and worked my tail off through my second year to earn even just a glimpse of playing time.  After a coaching change and a fresh start at the beginning of my junior year, I proved myself as a player capable of making an impact on the field.  The third game into the season, I earned my first starting spot and was elated that finally all of my work had paid off.  However, it wasn’t smooth sailing.  I started the game, played 15 minutes, and sat the bench the rest of the game without any explanation from my coach.  Frustrated and confused, I walked into my coach’s office before practice the following Monday and asked for some details.  I was told that I wasn’t fast enough and my sub was a better candidate for that particular game.  In my head, all I could think about was how my sub did not appear to be any faster than me.  So I had some work to do that day at practice.  I put a lot of pressure on myself to show up, be present, and prove myself once again.  Towards the end of the practice, we ran a drill that involved transitioning the ball from one side of the field to other as quickly as possible while under pressure.  This was my time to show my speed.  I was on the opposing team and it was my job to chase the ball from side to side.  Running as fast as I possibly could, I turned to chase the ball the other way.  My knee went one way, my body went the other, I heard a pop, and I knew it was bad.  MRI confirmed a torn ACL and I was under the knife in 3 weeks for an ACL reconstruction using my hamstring tendons.  My recovery went as smoothly as one after an ACL reconstruction could, and I was back for my last year, having my best season ever.

Given my laundry list of personal experience as a patient in physical therapy, I decided I wanted to go to physical therapy school and make an impact on patients the same way my physical therapists impacted me.  I was lucky enough to attend Emory University where I later graduated with my Doctorate of Physical Therapy.  In April of my first year after moving 1,100 miles away from my family and life as I knew it, I finally established a routine amidst the chaos of a highly demanding academic program.  Part of that routine included playing on an adult co-ed soccer team a couple nights a week.  It was the perfect opportunity–I got to play the sport I loved, get a workout in, and meet new people all in one place at one time.  On a Saturday morning 3 minutes after the game would be over, I jumped up to receive a ball on my chest.  On my descent, I stepped on the opponent’s foot.  Once again, my knee went one way and my body went the other, I heard a pop, and knew exactly what I was in for.  MRI confirmed a torn ACL and medial meniscus and I was under the knife again within 3 weeks for an ACL reconstruction with a quadriceps tendon graft.  Side note: my hamstring tendon graft had been so successful for me that I requested for a hamstring graft to be used on my right knee as well.  However, my new surgeon suggested that my hamstring tendon was too short.  He had some respectable research under his belt regarding use of the quad tendon, demonstrating that it is more reliable than other graft choices because of the thickness of the quad tendon and orientation of soft tissue fibers that mimic a native ACL.  He is a surgeon with a phenomenal reputation, so I trusted his perspective and bought into it full steam ahead.  I came back strong from one ACL reconstruction already.  I thought I would do even better with the second one.  The real question was, “Will I ever play soccer again?”

Initial response–ABSOLUTELY!  I’m strong, I’m a super woman, I got this.  Buuuuutttttt, maybe not.  After a few weeks of receiving wisdom from family, professors, and other medical professionals, I began to doubt my return to sport.  During my first ACL recovery I learned a lot about ACLs, recovery, and re-injury.  Of great importance, I knew that tearing one ACL automatically increases risk of tearing the other ACL.  Mission accomplished–I already did that.  That means my injury risk is through the roof.  Given my rising career as a PT and the realization that I wouldn’t be able to take 8-12 months off from work to possibly accommodate re-injury, I made the logical decision to end my soccer playing days.  Little did I know how much the loss of this part of my identity would affect my well-being and my recovery process until long after I was physically healed.

On top of coming to terms with the end of my days as a soccer player, I was also dealing with some physical delays in my recovery.  Three months after reconstruction when most patients with an ACL reconstruction finally get to run, I was not in any condition to run.  My knee was constantly swollen, I had consistent pain underneath my knee cap, and I could not achieve full knee extension regardless of how much I did my home exercises and how much my physical therapist cranked on my motion.  My PT at the time suggested that I might have something called a cyclops lesion, and she asked that I return to my surgeon.  First, what in the world is a cyclops lesion? Second, what does this mean for my recovery?  Desperate for answers, I returned to my surgeon who suggested that the chances of a cyclops lesion were slim and it was likely that I probably had a tight posterior capsule.  Either way, the best way to identify the problem was to get another surgery and clean up the joint.  So that’s what we did.  My surgeon did in fact find a ball of scar tissue growing off of my new ACL that was causing my symptoms.  After the cyclops lesion was removed, my knee felt magical and I thought I was over the hump.  I knew I had to work hard in my recovery for another few months, and then I would be back to myself.

Easy there, tiger; not so fast.  The loss of my soccer identity hit me harder than I thought imaginable and affected me in nearly all categories of my life.  I was sad, frustrated, angry, tired, in constant pain, and felt like nobody was understanding what I was going through.  I was working hard enough academically to pass my classes, but I definitely wasn’t giving my best performance.  Most importantly, I was so consumed by my emotions as well as circumstances that I could not control that I failed to bring the best version of myself to relationships with my friends and family.  Amidst it all, I was chugging along and getting by.  But I lost relationships that were important to me, and I lost myself.  Thankfully, I had wonderful people surrounding me who helped me to climb out of the ditch.  Eight months after the initial reconstruction and after a lot of inwards work and work in the areas of life that I needed to refine, I did indeed evolve into the best version of myself.  At the time, I was on a clinical rotation in pediatric sports medicine and I wanted to help my patients learn from my experience.  I spoke to various sports medicine clinics at the Children’s Hospital of Atlanta to help physical therapists learn about cyclops lesions.  I wanted to increase awareness and further improve ACL patient care.

A few months later (August 2016), I was in my last clinical rotation in the acute care hospital setting in Boston, MA.  I began to have similar symptoms as my first cyclops lesion, including a constantly swollen knee, pain deep in the knee joint with weight bearing, and clicking/popping within the knee joint.  Transferring patients and walking up stairs was becoming progressively more painful, and I knew I had to see a doctor again.  After X-rays and another MRI were performed, the results came back as a sprained ACL (increased signal on the ACL), a torn medial meniscus, and increased signaling at the intercondylar notch.  The surgeon I saw at the time in Boston was convinced I had meniscal pathology, but my gut was telling me something else.  Based on my past research, I knew that cyclops lesions typically live in the intercondylar notch, or the tunnel between the tibia and femur.  I also knew that in the rare occasion that cyclops lesions could be identified via imaging, there would be some indication around the intercondylar notch.  Putting this together with recurring symptoms of a past cyclops lesion, I was pretty sure I was housing my second cyclops friend.

My suspicions were high and I began to think that this could potentially become a yearly trend.  From past research, I learned that cyclops lesions are rare and can be caused by a variety of reasons.  Sometimes there can be surgical debris floating in the knee joint that can form scar tissue.  More commonly, the ACL graft can become impinged in the intercondylar notch potentially because the notch is too narrow to house the graft.  The worse possible scenario is surgical error, whereby the ACL graft is placed too far forward on the tibia during reconstruction, which causes the graft to continuously become impinged.  I knew from an inside source that my surgeon was really excited about the thickness of my quad tendon because it would make for a really strong graft.  So my theory was that my graft was too big for my intercondylar notch, leading to cyclops lesion recurrence.  If this was in fact the case, what were my options?  Do I get another surgery and hope that it’s the final one, knowing there is a possibility of recurrence?  Or do I get a new ACL?  I had this conversation with the surgeon in Boston, who immediately turned down any possibility of ACL reconstruction without hesitation.  He felt strongly that failure rates of a revised ACL are 30% higher than an initial reconstruction, and he did not want to be caught up in that mess.  So the plan moving forward was to address meniscal pathology.

Because of timing within my PT school academic schedule, I chose to get surgery back in Atlanta with the same surgeon who did my initial reconstruction.  He was well established and had good results, so I felt like I was in good hands.  Again, he thought the chances of another cyclops lesion were slim-to-none and was intending on performing a meniscectomy.  To his surprise, my meniscus looked squeaky clean with no tears, but there was in fact another cyclops lesion, which he removed.  He also expanded the width of my intercondylar notch in hopes of creating more space for my ACL.  Once again, my knee felt better than ever, and I thought for sure I was in the clear.

At the time, it was my last year of PT school and I had the wonderful opportunity of carrying out a directed study project that allowed me to pursue a unique topic that I am passionate about but do not get much exposure to in the general PT school curriculum.  Given my personal experience with ACL injury and recovery as a patient in conjunction with my experience treating these patients as a physical therapist, I wanted to blaze a new trail in the world of physical therapy.  It was my goal to improve physical therapist education about both components of injury–physical AND mental/emotional.  I did TONS of research rooted in sports psychology and adapted it to fit within the scope of physical therapy practice, ultimately developing an unofficial thesis about the emotional component of injury and how it relates to physical recovery.  Having learned lots of new approaches to my physical therapy practice that may help to serve patients with significant injury more optimally, I also learned a lot about myself.  I began to put together some of the reasons why I felt the way I felt when I struggled through my recovery process, and I wanted more than anything to prevent patients from experiencing the deep, dark hole that I did.

Amidst all of this, I committed to a 12-week training program to run a half-marathon in March 2017.  I completed the training program and the half-marathon in my best running shape and with no knee difficulties, running a new personal best.  After completing the half-marathon, I became a newly committed yogi and recognized how emotionally and mentally transformational the practice is, especially when working through challenges.  This was PERFECT–if only I bought into the whole yoga thing when I was injured.  Yoga began to resonate so much with me that it became my dream to bring yoga into my physical therapy practice and eventually help people with chronic injury and emotional challenges associated with injury.  Before graduation, I was lucky enough to be brought onto the team at an amazing private PT clinic in Newton, MA, where our mission is to treat female athletes and empower them to overcome and prevent injury.  I shared my dream of becoming a yoga instructor with my amazing and generous boss, who fully supported me in this journey and helped me to enroll in yoga teacher training starting September 2017.  WHAT?!  How in the world did I land my first job as a new grad with such a cool company?  And how in the world do I have a boss that is willing to bend over backwards and help me achieve my dreams?

Mountain-top moment for sure.  But as we all know, there are mountain tops and there are also valleys.  Unfortunately, I didn’t have much time before hitting my next valley.  In June 2017, a couple of months after beginning my career as a physical therapist, I began to have pain in my right knee again, thinking it was hamstring tendinitis.  I tried to be a good patient and dialed back my running and my yoga, thinking that a conservative lifestyle would get me back in no time.  After a couple of weeks of no running, I decided to give it another go.  I thought I was going for an easy 3 miles, but my body had other plans.  I barely made it 1 mile before my knee called it quits.  The next week, my knee felt swollen and I felt like my knee cap was floating.  I had pain in the same place as I typically do with a cyclops lesion and my suspicions started to rise.  Please, God.  Not again.  I continued to treat my knee conservatively, still hoping that it was a really bad case of hamstring tendinitis.  My pain started to move deeper into the knee joint and further away from the hamstring tendon, and I started developing clicking and popping.  Not good–time to see a doctor.

I had a consultation with a very well-established orthopedic surgeon in Boston, MA, who did some imaging and performed a quick manual assessment.  As I remember, his first words were, “There’s a lot going on here.”  In conjunction with his manual assessment and his interpretation of my x-rays,  he suggested that my ACL is placed too far forward on my tibia, which is causing me to have re-curring cyclops lesions.  He is also suspecting that there may indeed be meniscal pathology.  Further, there is possibility for a quad tendon repair given my constant discomfort, pain, crunchiness, and overall yuckiness where the quad tendon is located just above my knee cap.  He suggested that I be out of work for 6 weeks to optimize recovery.  Putting up a great fight to hold back tears on the treatment table, my flood gates lost the battle as I was struggling to accept the circumstances.  Why was this happening?  Why didn’t the other surgeons pick up on this a year, even two years ago?  What about my job?  What do I tell my boss?  I am newly employed, living in an outrageously expensive city, and am about to have college loans hit me like a ton of bricks.  This is at least a $25,000 surgery.  How am I going to afford this?  Can I put off surgery for a few months to save some money and earn vacation time?  And what about my plan?  Can I still chase my dream and make it through yoga teacher training?  How am I more than 2 years out of my initial surgery and I’m just now finding out that my ACL is in the wrong place?  What do I do?

Obviously, I was processing–more like drowning in–a lot of different emotions.  My surgeon confirmed that I would be okay to put surgery off until February, which would allow me to establish myself in my career, save some money, earn some income to support my boss in the fabulous company she has created, and still be able to go through yoga teacher training.  Phew.  Plan B doesn’t sound so bad given the circumstances.

Easy there, tiger; not so fast.  My knee had other plans yet again.  Since June, my symptoms have progressively gotten worse.  I am in pain every day, whether I’m being physically active or not, and my pain is beginning to interfere with my mental and emotional well-being.  Given these circumstances, I made the difficult decision to withdraw from yoga teacher training and undergo surgery as soon as possible for the greater good of my overall well-being, my patients, and my professional development.

This has not been an easy road and there are days when I look up, shake my fist at the sky, and wonder with desperate eyes why this is my journey.  However, I know that there will be some amazing experiences that come from this, and I am excited to see how I will grow even more and be able to impact others in ways that I could never imagine.  So, you ask, what do you do now?  I breathe.  And I put one foot in front of the other, remaining hopeful about the awesome things that are ahead.  Surgery is scheduled for September 12th.

Unfortunately, my circumstances do not enable me to qualify for short-term disability insurance given that the cyclops lesion is considered a “pre-existing condition.”  As such, I’m putting on my brave pants and asking for help.  If you are moved by my story and want to help with the financial burden associated with upcoming medical and living expenses, please donate here: https://www.gofundme.com/lendjenaknee.  I cannot THANK YOU enough ahead of time for your generosity.

If you have any questions or would like to reach out to me personally, you can email me at headinthegameweb@gmail.com.

 

 

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Alert: Sports injuries are more than just physical—they’re EMOTIONAL too!

I have been an athlete all my life, sprinting up and down soccer fields as a varsity soccer collegiate athlete, running in circles around a track through high school, and have most recently become a yogi as I practice finding my physical edge in conjunction with my mental edge. I have a laundry list of injuries underneath my belt—some as serious as multiple ACL tears and others a little less serious,* like ankle sprains and tendinitis. I am one of the most competitive athletes I know, and I love being able to participate. So when I’m trying my very best to be a good patient while I rest and rehab my injuries, I often come across this one thought: “I know my body hurts, but I’m also having all of these feelings that make me feel like I’m just not myself right now.” Chances are that if you’ve been injured or are currently working through an injury, this same thought might have or may currently be running through your mind too. Why?

Research suggests that a sports injury doesn’t only affect muscles, bones, and other tissues in your body. It affects your brain too! As athletes, just about all of us have some level of an athletic identity—the extent to which we identify ourselves based on our athletic endeavors and the extent to which we value ourselves based on athletic success. So when we are working through an injury that limits our ability to participate in our typical athletic routine or impacts our sports performance, our athletic identities are threatened. For me, this makes me feel less worthy, less competent, less confident, more of an outsider, and less like me. Sometimes these thoughts and feelings can become the forefront of an individual’s emotional state. When this happens, the individual may feel like they’ve lost their sense of self, essentially experiencing an identity crisis.

As a patient, I’ve been here—more than once. I know what it is like to not know who I am anymore because I feel like my injury has taken away my sport—the love of my life and the thing that makes me who I am. It is scary, it is saddening, it is overwhelming, and it is emotionally exhausting. Additionally, evolving research suggests that being in a state of emotional distress like this limits physical rehab success and increases the risk of re-injury when returning to sport. Even further, research suggests that emotional/psychological recovery can take longer than physical recovery, and only when both components are successfully recovered can an individual return to sport with the lowest risk for re-injury. Woah—this is scary on all accounts.   However, take courage! There is good news!

As physical therapists, it is within our scope of practice to address BOTH components of injury. As mentioned before, we are experts in addressing the physical impairments and fortunately we are learning more and more each day about how to address the emotional component just as effectively.   In my last year of physical therapy school, I directed my own literature review in an attempt to promote both a physical and mental approach to physical therapy services when working with injured athletes.

If you are interested in learning more information about the various factors that can impact athletic identity and emotional state when coping with a sports injury, be on the lookout for future blog posts at! Topics include but are not limited to the following:

  • Athletic Identity
  • Mental Toughness
  • Social Support
  • Coping Strategies
  • Rehab Adherence

*Note: ankle sprains and tendinitis are still serious injuries that should be treated with as much attention as an ACL injury. Although these injuries might be small in comparison, they have the potential to affect other muscles and joints in the body, which can increase injury risk in other places.