Impending Sugery

Quite possibly the only good thing to come out of today is that I am marked urgent for knee surgery and will hopefully get in within 1-2 months. Everything else was kind of depressing.

My knee is essentially a mess and that mess is a result of being misdiagnosed since 2011, which is the likely time I did tear my ACL. Since I've been working with an unstable knee since then, I've been progressively damaging it more and more, until we got to now. As she described it, I effectively have the knee of a 62-year old, not a 32-year old. 

Given that I have been misdiagnosed by no less than three physios and one sports med doctor at three different clinics, you can imagine I'm not terribly impressed. Miles is literally the only one throughout this entire time that has raised ACL as a possibility. 

The first doctor I saw today figures that the flap of my meniscus that is displaced (and preventing me from getting full extension) may actually be stabilizing my knee. So essentially I'm that episode of The Simpsons where Mr. Burns has every illness known to mankind and they are all jammed in that door frame. I was pretty frustrated after he told me he highly doubted I tore my ACL in November, but likely earlier, and I expressed my concerns with respect to getting surgery and being able to recover in time to try to make team Canada. Based on my history of misdiagnosis, my sporting needs, and the fact that my knee is locked, he told me he would try to accelerate my timeline. He actually managed to get me a surgical consult today, so that was I guess a second good thing.

The surgeon I wound up seeing was the one that my physio had recommended, and she was pretty solid. The concerns with my knee are (i) repairing what can be repaired; and (ii) trying to minimize the further progression of osteoarthritis in the joint. The bad thing is that I have some bone spurs and degradation on the lateral side, I have my meniscal tears on the medial side (given my two tears, my medial meniscus is likely to be fully removed) and then I have some anterior degradation because of my lack of ACL. Hence tricompartmental arthritis. She was telling me that long term to minimize its progression I may want to consider giving up high impact sports and heavy lifting...you know, everything I love. 

So next step for me is to go get a physical signed off on, as apparently that's a requirement for surgery. And then hopefully I get a call within the next week with a date. 

And then 12 months of recovery.

Limbo

Tomorrow is my referral appointment with a sports med doctor at the Glen Sather clinic. I'm hoping to get some answers to a few questions with respect to activity and ideally get a better picture of what kind of hoops I would need to jump through in order to try and make sure I don't have a six month waiting period before surgery. With a minimum six month recovery, I pretty much need to get surgery by October if I'm going to make a run at team Canada next year. I also need a better idea of knee timelines so I can figure out the timeline for getting my ankle hardware taken out. 

Apparently they offer a functional strengthening and conditioning class for ACL patients - either pre-op or 4-6 weeks + post-op, but I'm unlikely to qualify as the requirements are full range of motion of the knee (I'm missing a significant degree of extension) and moderate effusion or less (my MRI put me at moderate to severe); so that's too bad. But I really need to know what I can do in the meantime. I'm in this awful no-man's land where I don't see the point of doing anything because (i) I'm somewhat worried about continuing to grind away my knee; and (ii) everything seems pointless because I'm just going to need to go through another recovery period.

Well, that's not great.

MRI results are back. As suspected, the actual outcome was not great, essentially one of the "worst cases" I was hoping not to hear. 

ACL shows signs of complete tear ("less likely partial severe"). PCL intact. MCL unremarkable. LCL shows mild signs of chronic sprain mainly involving the proximal third of the ligament, but is well attached.

My medial meniscus has not one but two tears - bucket handle type tear with a meniscal flap subluxated medially and then a flp-type tear involving the meniscal body and anterior horn. My laterial meniscus is fine.

And then a 12x5x5mm intra-articular loose body is hanging out in my knee. 

The summary version was "extensive medial meniscal tear as discussed with a bucket-handle type component and tricompartmental osteoarthritis. Chronic complete (less likely partial severe) ACL tear".

Given the sports that I do, it's highly unlikely I will get away without ACL surgery, which is unfortunate given that it carries a 6-12 month recovery with it. I had been hoping for a relatively minor meniscal problem that would require arthroscopic surgery and 4-6 weeks of recovery. 

My physio says it's fairly remarkable that I've been able to play football given my injuries and says that if I'm able, I might as well keep doing it until I get surgery. I have a referral to the UofAs sports medicine clinic (it was set up before my MRI), so we'll see what happens with that now that I have my MRI results. My physio is also trying to help with setting me up with a surgical consult as quickly as possible. 

So between now and surgery, whenever it may happen, I will just keep trying to strengthen my quads and hamstrings as much as possible to go into surgery as strong as possible. And you know, accept the reality that I am trying to regain my strength in the present for no actual short term pay-off. I won't be competing in either strongman or powerlifting this year. I am looking at competing bench-only in the fall, as I could likely take the record provincially. And by likely I mean "I bench the current record for multiple reps" but I'd like to be able to take it into the 200s. We'll see. I'm working on putting together a program where I bench 2x a week instead of just once, since it's the only lift I have not really hampered by injury.

MRI

Had my MRI yesterday. Panic was low, so that was positive. The worst was when they were positioning me in the machine, as I was waiting for them to be like "HAHA!" and shove me all the way in. I had to be positioned and then re-positioned, as my knee wasn't quite far enough in, and the second time I panicked. The techs were very nice ("it's ok! Open your eyes! I promise you're not all the way in") and the whole thing took about 20 minutes, so it wasn't terrible. If I ever need an MRI pelvis or higher though, there's going to be issues.

My results are back with my physio already and he wants to see me to discuss tomorrow at 9:30. So I essentially have 17 hours to worst-case scenario and panic. Part of me is happy that I'll know either way what's up, but part of me is pretty worried as obviously something came back as this is the first time he hasn't given me results via email (my ultrasound in November came back negative; my x-ray in mid-April confirmed that I was healing properly). I can think of a couple "worst cases" that I really don't want. I guess we'll see tomorrow.

Still Going

After about five months of encouragement and prodding, Marlies is seeing the same person I am for meal planning/consulting. This is great on several levels, not least of which being that it makes it infinitely easier for me to follow my plan if she's on one as well. I can deal with the requests for McDriveThru easier than the chips/chocolate/etc. that populate the pantry. Or the "hey let's go out for dinner". Today has also been entertaining, as I'm getting a play-by-play of her eating like it's a job. The difference between me cutting and her trying to gain is about 1,200 calories a day. I packed her first four meals of the day last night and was like "ok, you need to look at this and kind of visualize eating it". I also told her to set alarms for her two "snacks" (her snacks have more calories than my meals!) because if she doesn't and falls behind on eating, she's going to puke trying to catch up.

This is the push I needed to get back on following my plan stringently. Rehabbing my ankle has been really draining mentally and my motivation hasn't been where it needs to be. I'm also really tired of GI distress brought on by eating more bread in particular, so yeah, bring the meal plan back on. 

Steadily reloading on the ankle front. Our football jamboree took a hit this week-end when one of the teams that was supposed to come folded the day before. It left us with three teams, and somehow missing the abbreviated jamboree was easier to take. We are currently awaiting a revised schedule, which will hopefully arrive early this week (and be done properly). While annoying for everyone else, this has worked out really well for me as it gives me an extra week of rehab before we play. I've been more than a little trepidatious with respect to my ability to be able to be productive on a football field this week-end. 

One of the biggest things I need to keep working on is getting over my fear of going to the ground. My bones are fully healed (and in the case of my fibula, medically enhanced) and I need to get over my injury mentally. The image of being on my knees and having a body go overtop of me is still very fresh in my mind, and I need to reinforce how statistically unlikely it is that it happens again with the same result. Marlies and I did a couple sessions this week-end where I would lay prone and she would fall onto me in various positions (injured leg up, down, etc.) and with varying intensity. She also kicked my leg at various points (stepping over, etc.). While this sounds ridiculous and probably humorous, it was really necessary for me. It went ok, and so I need to figure out the best way to progress to actual contact. One of my good friends is game for helping, but I think I need to start with someone smaller and progress upwards. It seems less daunting to be hit by a 100# person than one my size. ;)

Sitting in the bottom of a squat is getting better. I was able to power up a 95# snatch this week-end, so that made me happy. I need to fix my technique yet again so that I'm recruiting legs instead of just beasting it up, but I was happy that I was able to extend, get on my toes, and then re-bend to catch. 

My biggest goal this week is to be able to do at least 5 straight single leg hops with proper take off and landing.

Just one of Those Days...

Injury rehab is so emotionally draining, and this is by far the biggest one and the longest timeline I've had to battle with. I lost it last night because shit just wasn't going well at football practice. Any sort of resistance - be it hands or a push back - and I just couldn't hold a drive block to save my life. It's so humbling and frustrating and embarrassing - I used to be good at this sport and now I feel so far from where I was. Forget improving this season - I will be lucky if I am the same player I was last year. That is a difficult feeling to come to terms with and as the first game looms every closer (10 days today) the reality eats at me all the more. I'm about 50/50 to even play in that game and that 50% requires a whole lot of improvement to come in the next week as it relates to driving out off my toes. Some days I just get really tired of always being in some kind of pain. I'm transitioning more from joint-specific pain to stabilizer pain, which is good news in terms of making progress but sucks in terms of feeling general muscle fatigue all the time. I'm taking a forced rest day today because I need to let the muscles in my calf and foot simmer down. My foot sweats non-stop. It's kind of gross. If I have my socks off because I'm doing stabilization or mobilization or whatever, I leave sweat footprints in the carpet. Pretty hot, I know. I did back squat 135 for 5 last night - my depth (in oly shoes) was actually rock bottom, so that was cool. I noticed today that my talus is tracking way better and I am getting some calf strength back, such that I can get up on my toes both easier and higher than last week. So I mean, progress, just never the progress that I want. Skipping is truly terrible. I favour my left leg over my right and can't string together more than like five jumps. Embarrassing. Lateral hurdle jumps are better than forward, but neither are great. I can't successfully jump backwards over a 6" hurdle (which is a huge piss off).

Squats! Squats! Squats!

I've been eyeing up my olympic weightlifting shoes for the last little while and wondering if they could push me over the edge in terms of being able to hold the bottom position of a squat. As we approach six months of injuries that have kept me from being able to do full squats (with my hamstring/meniscus/whatever injury in November, and then my ankle in January), my hips are definitely feeling it. Waiting on my ankle mobility to allow me to hold the bottom barefoot has become, IMO, counter-productive. With that in mind I threw them on and stuck the bottom of a squat. And then accumulated 10 minutes in the bottom. Which took...more than 10 minutes.

My hips, adductors and anterior shin were definitely the tightest, with the anterior shin being the one that surprised me (though it makes sense given my ankle injury and mobility issues). I've added the 10 minute squat accumulation to my goals for the week and I think it's really going to make a difference for me.

Having held the bottom of an air squat, the next big milestone to tick off the list was an actual, weighted squat. I started with a front squat with just the bar, and that worked out well enough. From there I went to back squat with a safety squat bar (side note: I am the only person at CFSP that uses the SSB...guys, you are missing out). I finished off with old reliable, the back squat. I didn't go heavy (stopped at 105), but it felt good. I'm happy with my positioning in the bottom, and I'm activating pretty well out of my bottom. And...I get to squat again!

Yesterday was day 99 post-injury, so I kind of wanted to do something pseudo-special to commemorate. I settled on my favorite CrossFit workout, Grace, which is 30 95-pound clean and jerks for time. My (incredibly old) PR was 3:10 and I finished it yesterday in 3:15. I hadn't actually done this WOD since 2011 and healthy I should easily be able to do this in 2:30 or so (my PR for 30 95-pound snatches is 2:55 and the snatch is a more challenging movement). But I was happy as (i) I had just finished press work immediately before doing the workout; and (ii) my ability to drive through my toes to push the bar overhead improved as the workout went on. 

After we got home, I was watching hockey and trying to decide whether I was at a point where I should start trying to run again. My ankle felt pretty rough on Friday after football practice (I suspect the primary culprit was actually jumping ladders before football) and I was swollen both Friday and Saturday before returning to my normal swelling size on Sunday. I finally decided fuck it, and went downstairs to hit the treadmill and see where things were at. I started by doing a couple intervals at slower jogs (4mph, 4.5mph, 5mph, 5.5mph) at minute on/minute off, before getting to 6, which is pretty much your standard average everyday speed for a 5k. (6mph = essentially a 30 minute 5k). I did a minute on, sucked wind, and called Marlies downstairs to check how limpy I looked. She watched my next interval and said I looked pretty good (some favouring, but not enough to be like HOLY SHIT STOP), so with that I decided that it was time to buck up and start trying to get my legs back. It was very humbling to do Day 1 of a 5k program - which is 9 1:00 running intervals with 90 seconds walking in between) and have my legs be burning at the end of each interval. It's not like I've ever been the greatest runner to begin with, but this is a new low. :P But on the bright side - I completed all the intervals, my ankle didn't feel terrible, and I don't feel awful this morning.