A year ago today a found myself the center of attention at a 4rth of July party. Not because of some witty dialogue or interesting feat of athleticism, but because of the ambulance pulling up to the lawn to whisk me away to the hospital. Certainly not my favorite way to exit a party. As some of you may remember, I completely ruptured my patella tendon literally in half, as well as my entire retinaculum, leaving nothing capable of extending my knee intact. This happened during a “grueling” game of horse (the basketball variety). I described a bit more about the ordeal when I returned from the hospital here. It is a rare type of a rare injury – not really similar to a more common ACL or total knee replacement. So it is a year later, and I feel like I should show how I progressed towards my goals. I really don’t enjoy writing about this, to be honest, because although I did learn some valuable lessons, the entire rehab process was miserable. Also, I’m not much a fan about talking about my own plights. But I am compelled to share what happened at this point because it may provide a lesson, or at least a story about the successes and failures while chasing goals. Also, my job as a therapist, trainer, and educator is to ask people to pursue their goals, even when they are in pain, frustrated, or scared and be held accountable. So I think it’s important that I apply those same standards to myself and reveal some personal accounts to you. Time for me to walk to walk! If I’ve stretched your knee after a knee replacement, asked you for a food log, applied the skin fold calipers to your abdomen, or pushed you through a grueling set of walking lunges, you might find this particularly interesting. To be clear, my ordeal does not compare with some of the grave struggles and successes that many have experienced due to injury and disease. So this isn’t about “Hey look at me, how hard it was and what I did”. Not at all, because my experience wasn’t really that physically hard. I’m no stranger to working hard. However, it was draining, irritating, frustrating and to be blunt a serious pain in my ass. This is simply a story of chasing goals and holding myself accountable much in the same why I ask my clients to do so. I’ll explain recount some key experiences of my rehab one year removed, and hopefully you’ll glean some insights that might help you with your goals, big or small. Ok – here it goes…:
Guilt and Amazement
While I was laying on the coach this time last year, not able to bear weight or even move my leg, my thoughts were mostly occupied by a mixture of guilt and amazement. I felt guilty that I pretty much ruined my wife’s summer. Being three months pregnant after dealing with medical complications earlier in the year, she was left to take care of the house and our 2 girls by herself, and now me and my feeble damn leg. I felt bad for my girls because I couldn’t put them to bed, pick them up, or play with them outside. But that disappeared quickly – being grounded to the couch for weeks and home all the time made me a prime target for cuddling, playing dolls (which I had no problem doing because it was about the only thing I could do), and reading stories. Plus they absolutely loved taking care of me. Kids are amazing. But I still felt bad for Danielle. That really sucked. The kiddos amazed me, and so did the friends and family who brought me dinner, came over to check on me, and picked me up to take me to and from work a few days a week (I live 50 minutes from work). From the people at the hospital, to the random people at the airport or store that bent over backwards to help me when I could barely walk – it was simply amazing. The other thing that was amazing was how much pain I was in – and how little it bothered me. Although it felt like my leg was going to explode and took a lot out of me, it rarely worried me. I have studied pain extensively, and know fear and anxiety are major drivers of the pain experience but I found this website https://www.laweekly.com/best-cbd-vape-cartridges/ that have the best CBD oil and it helps a lot with the pain. I had complete confidence that, although I hurt, I was not in danger, and that my leg would be 100% pain free one day if I cared for it properly. I expected pain and knew that it was part of the consequences of the surgery I underwent.
Those who know and understand pain will never ever suffer that much as those who do not use FluxxLab™ tincture CBD to deal with the pain. Finally, I was astounded at how my body wasted away in front of my eyes. My joints ached all over, my energy was zapped, and my muscle vanished. In 4 weeks I had lost 24lbs of muscle. Even when I resumed walking and rehab, I needed at least 10 hours of sleep every night. I had lost so much strength everywhere. Yes, this was somewhat expected, but to this degree to me seemed unworldly. I was a bit in shock. I had to buy new clothes, and my family who came to visit my from Chicago were equally surprised. Inactivity has crippling effects, and they show up quickly.
Rehab goals and new insights
I had the standard rehab goals, like full ROM, normal gait, and strength. I achieved those goals (well, still working on the strength) mostly because of the invaluable help of my PT rehab team consisting of Dr. Tim Ehle and Rob Herron (also a trainer at Spectrum) at Orthopaedics Plus. These guys are gifted Physical Therapists, who know people as well as they know the science and skill of rehab. My understanding of the role of very gentle soft tissue mobilization, gait training, deloaded exercise, strengthening, & transfers for the severely weak or disabled has drastically improved. I’ll share a couple of observations about this. The Soft Tissue Issue Soft tissue work (aka massage) is often regarded as fluff- having no value other than feeling good. Oddly enough many of the massage therapists perpetuate the notion that soft tissue work is fluff or unskilled unless there is some intense deep pressure and “lengthening” designed to manipulate soft tissue in some complex physiological way that is yet to be understood by anyone. Having immersed myself in the neurophysiology of pain and recently serving (again)as a test subject for experiencing pain, I can tell you that the rationale and outcomes of very light touch, gentle soft tissue work is strong. If you consider that skin has is the most densely innervated organ in the human body, and positive afferent stimuli from gently touch can reduce hyperactivity of sensitized tissues, it makes a lot of sense that simple touch can help. I was stunned by how much range of motion my knee would acutely achieve following a brief 10-15 minute episode of light soft tissue mobilization, compared to times in which we skipped it. Simple stuff, no side effect, sound research, great outcomes. A Novel approach to walking and squatting again: Deloading & technique Now onto learning to walk again. The chasm to cross from using a massively atrophied non-weight bearing leg to all of the sudden resuming normal fully weight bearing gait is vast. You cannot just tell yourself to walk normally. You can know gait back and forth (which I’m quite proficient in) and it matters little. Use mirrors, verbal cues, and still it seems next to impossible. This freaked me out. I wasn’t in pain, but I simply could not will my leg to do what I was asking it to do – for several weeks. Then it dawned on me. Everything that connected the front of my thigh to my lower leg had been cut in half, and then precariously re-sutured together. My thigh was a toothpick. I was like a race car driver on a moped. I simply did not have the strength, the horsepower, to hold myself on one leg while the other swung forward. I could not execute the stance phase of gait because I did not have the necessary strength. Based on my post surgery protocol and risk of re-rupture, I knew getting my strength back quickly was not in the cards. I realized this was no different than asking my 6 year old to do calculus, or having a little kid try to bench press 250lbs. How would I approach those cases? Easy – start with less difficult things, but still challenging, and gradually progress. So how do we do this with someone who is too weak to support their own weight? The light switch went on – I’ve done this hundreds of times for patients, but never thought of applying this to myself. The answer is to make myself lighter. No, not by losing more weight – that would be counter-productive – and as you’ll see in a minute I couldn’t afford to lose any more weight. Instead, I could deload my body weight. I’ve set up elaborate scales to do this with patients, but in my case I used something much simpler. I held onto a high pulley for support, and practiced stepping until I found a weight heavy enough that supported me, allowing me to execute a perfect stance phase, but light enough to challenge me. Essentially, when I found a weight that no longer supported me enough to allow proper gait, I increased the assistance, and performed by reps at this level of assistance for days to weeks. I would gradually lighten the assistance until I no longer needed assistance. then end result – perfect gait restored. You might wonder why I couldn’t just use crutches as a form of deloading to address my gait issues. The problem is that it violates the law of maximal assistance (I just made that up but let’s just roll with it for now) which states that a person who needs assistance will always use near the maximal assistance afforded by the integrity of the structure providing the resistance. If it is a heavy railing, they will lean all of their weight on it. If it is someone’s helping hand, they will press down proportionate to how strong they think the person is. The other issue is that it is almost impossible to perceive how much weight they are applying to the assistive device versus the limb, making grading the assistance quite difficult. This leads me to the final observation about my rehab experience – strength is vital, and many people as so weak that moving their own body weight through daily activities like getting in and out of bed and on and off a chair, or the floor is exceedingly difficult or impossible. The solution again here is deloading. Think about it. A skinny kid gets pancaked by 300 pounds doing a bench press. What’s our strategy? Keep benching 300? Of course not. Start lower, then gradually go up. Deloading someone so they are lifting a percentage of their bodyweight in the context of the movement they are trying to improve, like sit to stand, is the answer. Again, I’ve been doing this for years but I’m an even more fervent advocate of it in light of my own experience. This has massive implications for the severely deconditioned. People throw their hands up with this population. They can’t even get out of a chair? Ugh! Instead, try a different tactic. So they can’t lift 220 lbs (their body weight), so let’s start with 150 and see how that goes. Viola – they can squat now! It’s a miracle!! Well – no, just physics, very basic physics. The other part of this is technique. Let’s stay with the sit to stand example. I amazed my Dr when I showed him that I could squat with little effort from a low chair just about 3-4 months following surgery, yet I could not actively straighten my own leg in the air while seated. How could this be? Because I knew how to manipulate my mechanics to transfer weight to my more robust hip joints. This is a tactic I’ve used to get people to perform those evil – gasp – squats pain free that supposedly destroy so many knees (even though you can’t expect to go to the bathroom without them). OK enough with rehab goals. I could go on forever, but let’s transition to my fitness goals and the lessons from pursuing them.
I love being strong and looking like it. I feel great around 190-194lbs, and have always been able to get there without going past 10% bodyfat. If stress and sleep are good, I can hangout around 8% most of the time very comfortably (which means spontaneous beers and pizza are no problem). 4 weeks after my surgery I found myself hardly being able to fit in my clothes. I was down to 169lbs, and felt horrible physically. I wasn’t concerned about how I looked – that was the furthest from my mind. I just felt unbelievably weak. My appetite was low, so I choked down smoothies to supplement regular meals to get the nutrients my body needed to heal. I returned to the gym just a few days out of surgery, but getting into position to lift anything was a major obstacle. Lifting or doing much of anything is a big problem when you have your leg in an immobilizer and lifting it is impossible. So it really limited what I could do to strengthen the rest of me. But I did the best I could. Before I go on, I want to clarify my pursuit of muscle gain. I realize that getting to my muscular goal is in stark contrast to what many people would deem important or relevant. For those having difficulty relating, I think it’s important to consider three points. First, gaining muscle is just my thing – some work hard to get a nice car, others a beautiful garden, and others run marathons or sail. This is just my thing – that’s all. Second, I’ve been blessed with a healthy body and above average abilities. I’ve worked with hundreds of people that have had their healthy bodies stolen from them at the hands of disease and crippling trauma leaving permanent disability in their wake. I’ve been given a gift, and I’ll be damned if I take it for granted, so I’m doing all I can with it within reason (which admittedly can be difficult to determine). And finally, my purpose of sharing this is about the pursuit of goals, and the lessons learned, rather than what exactly the goal is. So here are my before and after pics. The first pic was taken in early to mid August when I was on “vacation”. I was 169 pounds, and very low body fat. The second was taken by my daughter the morning of the 4rth of July, exactly 1 year from my surgery, 194lbs at 10% bodyfat.
Here’s what I learned about my muscle gaining pursuit:
- Pictures hold you more accountable than anything if you aspire to gain or lose weight, or are seeking body recomposition. They are raw, sometimes hurtful, but they do give you priceless perspective. You have to have some guts to take one. You will feel like a total tool. But your goal is more important than that crap. Get over the head trash, take a pic, look at it often, and retake during various points of your journey. I’m not thrilled about sharing these pics. But I need to walk the walk. And they simply are critical for success.
- Determine if you are process or results driven when establishing goals. For example, I never set forth to get to 194lbs at 10%. I never had a hard time getting results with exercise. But I had a hard time getting a 4rth workout in a week (for years I only did 3 workouts) and have an even harder time getting more than 7 hours of sleep (I averaged about 5 for most of my adult life). At 37, I need to focus on the process more, because I can’t afford to mess around anymore. So my goals were to always get 4 workouts a week (except for planned breaks) and get 7 hours a sleep every night. I am on the CARES plan for that, just like many of our clients and all of the Spectrum trainers. I knew that if I focused on those 2 things, everything else would fall in place. Now I still tracked results, but that wasn’t the primary focus for me.
Others are more results focused with their goals. In this case 194 at 10% would be the focus. One is not better than the other, but many times people ignore the process driven goals, and these can be powerful. Here are a couple more pics, taken around the exact same time as the above before and after pictures, respectively, featuring my left quads. I still have a ways to go here, but I’m happy with the progress thus far.
Time to Run and Get Strong
My prognosis was quite bleak for a full return of function to my knee. I have always been able to jump high and run very fast, and pretty strong as well. My doctor, who had worked with many pro-athletes, had told me to forget a 450lb squat or 36 inch vertical. Pain-free stairs and jogging with the kids would be a success. He explained that the bottom half of the patella tendon was obliterated and the retinaculum was completely reconstructed. Both of those things made prediction of the length of my tendon, and thus orientation of where my kneecap would end up aligning, quite precarious. As it turned out, my knee cap ended up quite a distance away from optimal, throwing the leverage of my quad way out of whack. That didn’t bother me really until a few months ago. Initially I just needed to focus on the next step. First, move around independently. Next walk. Next, get range of motion, then squat, stairs, add muscle and strength. When the dust settled, my functional goals became clearer: run fast enough to help Bella ride her bike, do a single leg squat, and deadlift over 400lbs. These last few I’ll talk about briefly, then finish up with where I go from here.
My oldest girl, Bella, was very excited to learn to ride the new bike she received for Christmas. She had her heart set on having me teach her to ride a big girl bike without training wheels. Danielle could do a fine job, but given that she was 8 months pregnant around that time, I guess Bella didn’t think of mommy when it came to running after her when riding a bike. What Bella didn’t realize is that Danielle could have easily beaten me in a race then, even with a belly full of baby. Although hard to imagine around Christmas time, I promised Bella that I would be able to run at some point this summer to help her ride her bike. She is a cautious kid, and wanted the assurance that I could run along side her until she could go on her own. I was flattered that the person she wanted for this job was me. I wasn’t going to let her down. It was time to get some track work in. Even with all of the incentive of a prideful dad helping a child ride their bike, starting to run again was the hardest part of rehab. The random twinges of knee buckling pain and the occasional thoughts of my knee exploding were minor obstacles. The big obstacle was the massive disappointment when I realized how pathetic my running was. It was 7 months after my surgery. I had been walking normally, negotiating stairs, had full range of motion and balance, and as well into a good strengthening routine. When I hit the track for the first time, I felt like some had replaced my leg with a frail, elderly leg. My feet smacked the ground like they were made of lead. I was passed on the track by a group of power walkers. I lasted for 4 x 20 foot “sprints” and had to stop. My knee swelled up the next day and sent my rehab back a couple weeks. I was demoralized. This was the real hard part. Grinding my knee from 6 degrees flexion to full in 4 months was nothing. Even learning to walk was not nearly as frustrating or challenging. When I returned to the gym in my brace and a wheel chair, everyone offered words of encouragement. I was happy to be out, motivated as hell, and saw improvements every day. But now, I was a seemingly healthy guy running like I had just been shot in the leg. I learned that the hard part of the goal process isn’t just starting out, when progress comes quick and support is abound. Rather, it’s several months later, when seeing results is like watching grass grow, support fades, and your mind starts wondering things like “is this even possible?, Is it even good for me?, is it really worth it?, is this supposed to be some damn agonizing?, what am I doing wrong?, etc” I’ve learned that these are normal thoughts, whether you are trying to start a business, finish school, fight for your life, lose weight, or rehab from an injury. Big or small, goals have a way of always questioning your mettle, not only when you are starting out, but mostly further along the path. The challenge to me was to avoid compounding these negative by subscribing to the notion that I was weak for having them. Instead I had to counter them with affirmations from my own past victories, my objective knowledge about the process, and social support from family, friends, and the rehab team. At most times, these voices were louder than the negative sentiments, which drove me and kept me focused. The occasional questions from my Bella, asking me if I was sure I’d be able to run fast enough to stay with her as she rode her bike were particularly powerful. After many weeks on the track, I quickly learned that I needed to push myself according to a different standard, as opposed to reflecting on my pre-injury glory days of being the fastest guy on the court. It was not too long ago that I could barely walk, and this knee is going to have to last me for many years to come. I needed to steadily push, but I’m starting from the base of the mountain, not a few ledges from the peak. I also had to learn that pushing hard was not measured by how my muscles or heart felt. It was measured by my knee joint. I needed to remind myself that no reconstructed knee will spontaneously rupture while jogging, and I will be able to run again. Others have done it before with even worse injuries, so I’ll do the same. Finally, I needed to push to make gains, but not so much that it set my rehab back a week or two. Seems obvious, but it took several weeks for that to sink in. That is the delicate balance of the art and science of rehabilitation. Two months later, when the weather cleared around April, Bella and I headed outside with her new big girl bike that she was dying to ride. She was very nervous. I told her that she is tough, and she wouldn’t get hurt. The worse thing would be a couple bumps and bruises, but she’s done that before. Besides, I’d be running alongside her, so I would catch her. That’s when I realized she was more nervous because she didn’t think I could do that! I made a deal with her: “Bella, If I can beat you in a race, then that means I’m fast enough to stay with you on the bike. Would that convince you?” “Absolutely” she said, and we were off… …and I toasted her! Never had any adult been more proud about beating a 6 year old in a race. She was impressed. “Alright Daddy – you’re ready. Let’s do this!” Much to my delight, she picked it up on her first try amidst the cheers of her buddies in the neighborhood. She needed me next to her for a few weeks until she gained her confidence. My knee handled it well. Big victory for both Bella and I.
I lift things up and put them down
The dead lift was the first lift I could resume without any pain. It was the only thing I did with my legs that didn’t remind me of my injury. I almost felt normal, although significantly weaker. So I picked this as another functional goal. It felt good to have at least one goal I absolutely knew I would reach. 400 lbs isn’t a herculean feat by any means, but it is a good lift that many non-impaired athletes would be happy with, so I set my sights on that. I tested myself on 7/3 almost exactly 1 year to the hour when my knee blew out. 405 went up pretty easy, as you’ll see here:
A Test of Leg Strength
A common test we use at Spectrum and OP to look at single leg strength is the one leg squat. The way we do it looks more like a backward lunge. I prefer this version as it is not confounded by the extreme hamstring flexibility and lumbar spinal flexion tolerance required by the “pistol” variety. Plus, by requiring a lift of the non-stance foot at the foot at the bottom of decent, it can reduce assistance and focus on a more pure assessment of single limb strength. I thought a full 1 leg squat would be a great goal which made more sense that a double leg squat, as compensation with the uninvolved leg is so strong. This exercise scared the hell out me at first, and if my technique was off, it was brutally painful. So I started this exercise deloaded. This first video shows the deloaed variety. I was about 185 there with 70lbs of deload from the harness, making that a 115lb 1 leg squat. The second video is at 194lbs with no deload, which I record as a 194 lbs 1 leg squat. The main lesson here is that deloading makes a huge difference, whether it is rehabbing from an injury, trying to reduce pain, perfect technique, and gradually progress strength. It bridges the monstrous gap between “ I can’t do this” to “no problem”.