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?