Sunday, December 20, 2015

A lesson in radical acceptance

I was about a year and a half into Crossfit when I tore my ACL playing soccer.  Although soccer had been my go-to sport all of my life, I haven't had much desire to get back to it since my injury.  Yes, it would be nice to "make friends" with soccer again, as I almost feel as if it let me down.  So, kicking a ball around is probably in my future--but not likely anything competitive.  Crossfit, on the other hand, just won't seem to go away.

Its not that Crossfit is something that I was really good at.  Its that it gives me strength, confidence, and a sense of community.  Crossfit somehow manages to spill out into everything you do in life.  For those of you who have never tried it, I'm sure you think that sounds crazy.  But for whatever reason, I have stuck with it, day in and day out, and I can't see myself NOT doing it.

In August (6 months post-second surgery) I had finally been cleared by my PT to run and jump--and my insurance visits had basically run out.  So I was rehabbing on my own at my Crossfit gym.  At the time, I was hiking a lot for a job, and my strength did seem to be improving, but I still struggled with full extension and stiffness.  So I was reluctant to run.  I started out with ladder work and then short jogs at the gym--when no one was around.  Then during one of the WODs, I did my first warm up jog with the rest of the class.  They were, of course, supportive and congratulatory. But it did hurt to run.  I figured, after all the pain I had been through, that this was just part of the deal.  I didn't HAVE to run, but I felt like, I SHOULD be able to, and I could slowly work up to more and more.  I was happy, I was positive, I had a goal, and I was finally making progress.  I could see the light at the end of the tunnel.  

Still struggling with overcompensation during squats (I'd feel sore only on my good side afterwards), I attempted to talk to my Crossfit coach about how to approach squats, running, and my future in Crossfit.  She had already told me she didn't think I should be running, even though I had been cleared.  And she had some experience with PT and knee rehab--so I was often torn about who to listen to.  But when I approached her about it, instead of discussing a plan for the future, she and another PT who knew nothing about me, told me I should go back to therapy.  They determined that I was very "far behind" and should not be running and should probably not even be squatting.

In my mind, the two of them had just taken months of progress away from me in one 10 minute conversation. I was devastated.  I walked away from the conversation, back into the empty gym, and went back to one arm barbell snatches with tears streaming down my face.  It wasn't the first time I had cried in that gym.  But it was the last.  Because a few weeks later, they "encouraged" me to leave the gym all together--and to "seek proper care" for my knee.

I had no health insurance visits left, I had no more gym to do my own PT, and my heart felt more broken than my knee did.  I had been at that gym for a year and a half, was injured during the majority of it, and all I wanted to do was be able to keep doing Crossfit.  I wanted to get the strength back in my weakened leg, and to get back to my normal life. I wanted to workout with my friends.  I wanted to not be terrified to do things because I might hurt myself again.  I wanted to stop feeling like every little thing I did could be the WRONG thing to do.

In only a few days after being "kicked out", I pulled myself back together.  I did seek a second opinion for my knee from an ACL specialist, and ironically, they determined that I was not strong enough be running or jumping.  Then I scheduled an assessment at another Crossfit box in town--and I honestly thought they would "reject" me because of my limitations.  Instead, they offered me specific programming, and just like that, I was back in the gym.

In those few days between leaving one gym and starting at a new one, I realized something very important.  Ever since I had injured my knee, I had been seeking help from others to "fix" me.  Afterall, I'm not an orthopedic surgeon, an athletic trainer, a physical therapist, a personal trainer, or a Crossfit coach.  Of course I needed help.  And these people made promises they could not keep--that they would, in fact, help me get back to sport.  But, if you have been through this injury or a similar one, you know that it takes a TON of willpower to do what your team of specialists tells you to do.  It's hard to know how hard to push and when to rest.  You never know if you are doing enough or the right thing.  And you have set backs.  Most importantly, you can't predict how your body will respond to surgery.  And it's even worse when your team of specialists doesn't really give you the support you need to get "back to sport" because THEY weren't anticipating setbacks.

But, I finally realized that *I* was all that I had.  That I wanted a fully functional knee, that I wanted to keep doing Crossfit, and that no one was going to do the work for me.  I had already been busting my ass of course, and doing the best I could with what I knew, but I still wanted someone to "save me".  I wanted someone to give me a magic pill that would make it better.  I wanted someone to motivate me.  Encourage me.  To push me.  To give me advice.  To tell me what to do and how.  But in reality, all I really needed was to find that trust and fight within myself.  Because there was no one else as dedicated to me than me. I knew enough to keep moving forward, and I could still seek out new specialists for help, but I was the most important factor in everything.  Not some gym.  Not some coach.  Not some therapist.


I can't tell you how many times people have told me that I "should be further along" or "should have done A, B, and C".  I had enough trouble keeping those thoughts out of my own head, I certainly didn't need doctors telling me the same thing.  It wasn't helpful. I felt like the person in the little cartoon to the left.

Radical acceptance is about accepting life on life’s terms and not resisting what you cannot or choose not to change. Radical acceptance is about saying yes to life, just as it is.  I can keep working on my ROM and my strength.  And I can keep doing Crossfit as best I can.  I cannot change anything from the past.  I cannot change the fact that my knee is not what it used to be.  I cannot force people to help me when they don't want to, or don't know how.  But I can keep moving forward, step by step, in the direction that I want to go in.  

Monday, November 23, 2015

5 Things That Get in the Way of Injury Recovery

*This article was written for and published in the Tabata Times. http://www.tabatatimes.com/5-things-get-way-injury-recovery/

It’s an athlete’s worst nightmare — an injury that requires surgery. Many articles will tell you how to decrease swelling, how to regain range of motion, and even how to utilize a detailed exercise regimen for the various stages of recovery. But most don’t talk about how surgery can cause depression, that setbacks do occur, or how hard it will be to stay motivated during a long term recovery.

I tore my right ACL in July 2014. And a year later, I was still struggling to find my way “back to sport.” Although an ACL tear can be devastating to an athlete and it is one of the longest surgeries to recovery from, most people will be back to “normal” after 6 months to a year. It is not uncommon for athletes to have a physical therapist who specializes in getting you back to the basics (daily function), but not back to full strength (sport). It is also common for insurance companies to stop covering physical therapy for the duration of such a long recovery. This can leave athletes feeling a little like they are stuck in limbo and even abandoned.

In my case, I lacked range of motion and extension before and after the reconstruction and had a second surgery a few months later. As an avid soccer player, CrossFitter, and hiker, this was extremely difficult to cope with. The surgeries left me with a severe strength imbalance between my two legs and a significant worry about whether or not I’d ever be able to participate in the things I previously enjoyed.

I am still in the recovery process, 15 months post-injury, and one year from ACL reconstruction. But I have been doing CrossFit in one way or another throughout the entire process. I have had my ups and downs throughout my recovery and have learned a few things that I’m hoping might help others. CrossFit is modifiable and has enough variety that it can keep you interested and focused on what you CAN do, instead of what you can’t. It is probably one of the few active things you can keep doing as you “work around” a significant injury. I am not a doctor, physical therapist or even a trainer — but I have struggled to find information about recovery for athletes, so I want to share as much as I can, as I suspect there are others out there in a similar situation.

Here are 5 things that get in the way of an athlete’s recovery from surgery and a few tips on how to deal with them:

1. High Expectations

You can read thousands of online accounts of people rehabbing and being “ahead” of schedule -- for example, returning to sport in three months when it should take six. A positive outlook is particularly important, but keep in mind that everyone is different. Do not fall into the trap of feeling like you are behind. Focus on you. Do whatever it is that you need to do, and stick with it. It is great to have goals and to push yourself, but don’t get caught up in “shoulds.” “I should be further along” will not help you; however, if you truly believe you could be doing more or taking physical therapy more seriously, then do it. But remember that the further you are away from a surgery, the better your body has healed. Rushing things could cause new problems or re-injury.

2. Other people’s opinions

You will need a lot of help and support from doctors, therapists, trainers, family, and friends. But some people won’t understand what you are going through and will have trouble relating. Some will think you are crazy for being back in the gym a couple weeks after surgery. What matters is what you think. You will know your limits. You know your body best. You will have to work through some pain and a lot of discomfort, but don’t let anyone else push you beyond what you are comfortable with.

3. Negative Thoughts

Last night, while I lay thinking here,
some Whatifs crawled inside my ear
and pranced and partied all night long
and sang their same old Whatif song
--Shel Silverstein

What if I can never squat again? What if I can never play soccer again? What if I never run again? Beat them back with a baseball bat if you have to. Change them. Challenge them. Focus on what you can do. Being sad or scared are normal feelings that come with these experiences. Just don’t set up camp and live in those places.

4. Poor Nutrition

“Let food be thy medicine and medicine be thy food.”
― Hippocrates


Nutrition is important to any athlete, but it is even more important to someone who is recovering from surgical trauma. Sometimes doctors make things seem simple. But it is TRAUMA. Surgery is really hard on the body. One of the best things you can do for yourself is eat well. Some experts suggest taking supplements such as Vitamin C, Zinc, B complex, and Omega-3. Probiotics can help counteract antibiotics. And of course, consuming enough protein is also important for re-building. Supplements can be taken a few weeks before and after surgery, but make sure you talk with your doctor about what you take. Several supplements can’t be taken in the days leading up to and on the surgery day because they could lead to blood clots or other complications. But many people believe they can help increase healing and minimize inflammation and scar formation.

5. Self Esteem

"We must see all scars as beauty. Okay? This will be our secret. Because take it from me, a scar does not form on the dying. A scar means, I survived.”
― Chris Cleave, Little Bee

Scars will remind you that your surgical limb isn’t quite the same as it once was. One leg might be visibly smaller than the other. With an injury, you will be off your game. What was once easy is now difficult. You’ll have to start squatting with a PVC pipe while everyone else hits PRs. Your burpees make you look like a fish out of water. Walking correctly might be difficult for a while. You will likely have to use one-pound weights at some point during physical therapy. All of these things can be frustrating and a punch to the ego. Luckily, you will learn more about your own personal strengths during the times that you feel weakest.

Are you a CrossFit athlete with an upcoming surgery? Here are my top 3 tips.
1. Don’t give up what you love doing if you don’t want to. Talk to your surgeon about the recovery timeline and about working around the injury in a safe manner. Make sure all the coaches know about your limitations and understand how you plan to train while recovering.

2. Sit down with your trainers and coaches and talk to them about expectations, theirs and yours. Ask them what their limits are in terms of helping you recover. Ask them about how they want you to modify things and how much time they want you to take off. Make sure all the coaches know about your limitations and understand how you plan to train while recovering. Set measurable and attainable goals for things you CAN do (i.e. pull-ups if your leg is injured, squats if your shoulder is).

3. Find support. Not everyone will have a significant other or nearby family or close friends to help them. And even so, those people may not really understand what you are going through. A psychologist can provide an outlet for concerns and fears. Even if it is through social media, it is good to talk to people who have been in your situation. I found that Instagram was very helpful and motivating.

Injuries are difficult for most people. But they give you a chance to see what you are really made of. They challenge you and make you stronger in the long run. They give you a chance to rebuild, from the ground up, not just physically, but mentally and emotionally as well. It’s a process. Trust the process and keep moving forward.

Sunday, August 2, 2015

ACL Warrior: Getting back to "normal"

Oddly enough, it has been almost exactly a year since my last blog post.  I've been busy with ACL reconstruction surgery, my first Michigan winter, a second knee surgery (scar tissue removal), losing my job, finding a new job, and a whole lot of knee rehab and physical therapy.  

Since I'm a fitness nut (although I have no formal education or certifications on the topic), and still recovering from an ACL reconstruction, I'd like to focus this entry on KNEE REHAB.  I searched the internet high and low for information about getting strength back after ACL reconstruction.  I've read a ton of articles and followed people on Instagram.  This doesn't make me an expert--and everyone should check with their physical therapists and surgeons before trying any of this.  But I wanted to share with you what worked and what didn't.

I found lots of articles and blogs about success stories--young people who torn their ACLs, had the surgery, and were back to running in 3 months or less, back to sports in 6 months.  I WAS NOT ONE OF THOSE CASES.  This isn't meant to scare anyone, its meant to be a realistic story about someone who struggled.  Because when I struggled, I felt alone.  I felt like I was the only one on the planet who's surgery didn't go exactly as planned.  So if your surgery was similar, know that you are not alone.  Everyone responds differently.

I also don't want to focus on the surgery itself or the couple of weeks after it.  For the most part many doctors and PTs have different protocols.  And so you should follow that.  And a lot of that is pretty straight forward--heel slides, prone hangs, quad sets, and other simple exercises will become your life for at least a few weeks.  Where I ran into trouble was when I couldn't get my extension and flexion back, so I had a second surgery or "clean up" to remove scar tissue.  By the time all of this had happened (4 months post-reconstruction) I had lost so much strength in my injured leg, I had no idea how I would ever get it back.  This is where I found a lack of information on the internet and had to pull things together on my own.  Keep in mind that I'm a female, 32 years old, and have been Crossfitting for over 2 years.  My main goal was to work on leg muscle imbalances and get back to Crossfit.  

Here is the run down on my surgeries:
July 16, 2014 -- tore ACL in right knee while playing soccer
Octoer 2014 -- started "prehab"
November 11, 2014 - ACL reconstruction, hamstring graft, hybrid with my tissue and cadaver (I have never met anyone with this method!)
March 17, 2015 -- second surgery to remove scar tissue (gained better extention, but not equal to my uninjured knee).

Now I'll talk briefly about the exercises that worked for me and what I gleaned from here and there.  I had some help from my physical therapists but I really had to figure things out on my own in terms of getting back to Crossfit and evening out my imbalances.  My general advice is to 1) take things slow and don't overdo it, 2) focus on  hitting every part of the leg during a workout (calves, quads, glutes, hamstrings), and 3) remember that it will take a while to get the injured leg's strength back if you were like me and were unable to use it for months.  

Biking.  After the second "clean up" surgery, I had a mini pedal bike that I could use right after surgery in the comfort of my own home.  I also used a passive motion machine, but sometimes insurance doesn't cover that, so the mini bike is a good one to keep in mind.  I tried to use it a few times a day--there's probably no limit to that, and you can adjust how much your knee bends by moving it closer to you.  After the mini bike got too easy, I moved to an Airdyne, but any bike would do.  It's low impact, and great for working on range of motion.  About 3 months after my "clean up" surgery I went to a spin class--45 minutes, was able to pedal with my butt off the seat with fairly strong resistance.  I also started using an outdoor bike.  I replaced all running at the gym with biking or rowing.  I've also done a lot of single leg biking--which is kind of awkward if you don't have a place to put your unused leg.  (Don't try this outdoors, haha!)

Rowing.  Low impact as well, and early on I used it just to work on range of motion.  I also found that one leg rowing worked well--put your unused leg on a small skateboard or other wheels so it can move along with you.  Most Crossfitter's know correct rowing form, but if you have never used an ergometer, make sure to watch a video first.

Squats.  Correct form deep (below parallel) squats were my goal, but I started with squats to parallel. Then I squatted to a box just below parallel, and then to a medicine ball a little lower than that.  Try squats while standing close to a wall to work on form (there are YouTube videos for this).  Then you can start adding variety--dumbbells, kettlebells, using a PVC pipe or band overhead.   After about 2 months post-clean up  surgery I was back to barbell squats at low weights (back, front, overhead). Still working on these since my ROM is a little off.

Sled drags.  When I couldn't quite hit my quads that well with squats because of poor range of motion, I used a weighted sled and dragged it while walking backwards.  Great for the VMO (vastus medialis oblique).  This muscle has likely atrophied, and it is located above the knee on the front inner part of your quad.

Backwards farmer's carry.  Yes, backwards.  This helped me focus on getting my leg extension back.  I usually held a 20 pound dumbbell in each hand and walked down and back for as long as I could hold them.  Also helps with grip strength and just plain learning walking mechanics again (I had a limp for a few months when my extension was still bad).  Forward walking is probably helpful as well.

Single leg deadlifts.  I used a kettlebell to do a Romanian deadlift or stiff leg deadlift, and the injured side got more rounds and reps than the uninjured side.  This works the hamstrings and glutes, as well as helps with balance.  Make sure you watch some videos to make sure you are doing it correctly.

Bulgarian split squats.  Another one to google and watch on video first.  Great way to isolate one leg if the injured one is a lot weaker than the other like mine was.  You can put one foot on a box behind you and hold onto something for support if needed.  Just make sure that your knee stays over your ankle as you squat down.  Works the quad and glute.

Step ups.  Grab a box and some dumbbells and step up with one leg.  Simple, straightforward, and you can increase the height of the box, the weight you use, and you can also do lateral step ups.  Works the quads when squatting isn't quite working yet.  Really focus on firing that VMO muscle and make sure that your knee doesn't cave inward (push it out!).  Don't use your other leg or other muscles to get yourself up there--focus on that quad doing the work.

Hamstring curls. My hamstrings were extremely weak.  Some people may use a gym that has machines that would work for this, but I was at a Crossfit gym.  I used a 10 pound ankle weight and did curls either lying face down, or standing up.  

Reverse hyper.  Our gym has a machine for this, but before we got it I used the GHD machine. There's some discussion about whether or not these are safe (as there is with almost every exercise out there), but they were good for helping me work on the posterior chain without bending my knee.  My advice would be keep the weight low, don't do them every day, and make sure you do them correctly.

Calf raises.  Pretty simple.  I can visibly see a size difference between my two calves.  And when I couldn't do much jumping I did calf raises from the floor or on a step.

It's been hard for me to get back to jumping and running--in fact, I haven't actually tried running yet. For jumping I used jumping rope, low boxes, and agility ladders.  I'd have to say the agility ladder is a great tool to have.  At almost 4 months post clean up, I can finally hop on one leg again.

It's ok to get frustrated and feel discouraged!  I frequently did.  But just know that it will get better--it just takes time and it feels like forever.  It helped me to make small goals and write down when I achieved them.  And I made myself focus on the new things I could do, rather than what I used to be able to do.  My first squat, my first 20 inch box jump, my first double under, my first single leg hop through the agility ladder--all new PRs!

I hope this helps someone out there.  Feel free to ask me questions if you have them.  Good luck!

Tuesday, August 12, 2014

The mind of an injured athlete

“You've done it before and you can do it now. See the positive possibilities. Redirect the substantial energy of your frustration and turn it into positive, effective, unstoppable determination.” -- Ralph Marston


I started playing soccer when I was 8 years old, after a friend introduced me to it. And I kept playing it for another 10 years. I wasn't amazing, but I played on varsity all four years of high school. It was pretty much the one thing that I could do that took me into "the zone". Where you are operating without thinking. In fact, even when I play today and people ask me to do a certain "move" again, I have trouble. I don't think about it. I just do it in the moment.


Like most kids, I had a dominate leg that I kicked with. My right leg. But during my senior year, I pulled my right quad. The pain would come and go and I tried physical therapy but nothing seemed to help. Like most high school athletes, I kept playing--because it was a huge part of my life. It was my last year. I wasn't going to sit on the bench and give up. So, I started using my left leg to shoot with. I even played in the final tournament game with my right quad tightly bandaged.


Today, I play with both legs. I can shoot with my right or left leg. I can play on either side of the field (I usually play center). My left leg certainly isn't as accurate as my right--but that injury in high school was a blessing in disguise. I learned to do what most people (except the pros) don't--how to shoot with either leg.


When athletes get injured they tend to lose their sense of identity, their self esteem, and their stress coping mechanism. Not being able to do what they do best, feeling weak, and becoming frustrated and bored are all common. I haven't really been injured since high school--because I haven't really been an "athlete" since then. Until I started Crossfit. And then I recently injured my knee playing recreational soccer.


I've been struggling a lot with this injury. For those of you who know what Crossfit is like (or really any sport)--you probably also know what its like to suddenly lose the opportunity to do what you love doing. Yes, I'm still working out as best I can. But my goals of hitting a 175# back squat went out the window when I hurt my knee. And although Crossfit gives you a great sense of community (like other team sports), I can't do the same workout as every one else. Which leaves me feeling left out of that community--even if I'm still in the same room.


Crossfit is not my identity. It is just something I do for "fun". Or is it? It is also my way of coping with stress. It is my social outlet. It is something I do at least 4 times a week, and have been doing for over a year and a half. It is a lifestyle. Its my reason for eating healthy. And feeling good. And I think mostly importantly, for me, it is my sense of strength. It is my physical strength--but that radiates out into all aspects of my life. When I'm feeling weak, down, or vulnerable--Crossfit reminds me of my inner strength. So the loss of my right knee--is a bit of a blow to my sense of self.


But when I think back to what I gained from my high school injury--I have to remind myself that I can still come out on top from this. In fact, I started Crossfit for a reason--I wanted upper body strength. I was tired of feeling weak and not being able to "keep up with the guys". I couldn't do a push up. And, one of my major goals has been to get strict pull ups. So here it is--my chance to focus everything I've got on upper body and core strength. Does it suck that I can't do deadlifts? Yes. Do I feel like all of my hard work is going down the drain? Yes. Does it terrify me that maybe I'll never get to play soccer again? Yes.


But for right now--all I have is the chance to make the best out of a shitty situation. All I can do is try to turn my frustration and turn it into positive, effective, unstoppable determination. Strength comes in many forms, and if I have learned anything from Crossfit-- it is that mental strength concurs all.


For more on the mental state of injured athletes check out this great page that I found very helpful:

https://www.competitivedge.com/rebounding-injuries-0