January 20, 2021. Here I was again: injured, feeling sorry for myself, trapped. Not in a serious way – and I knew it – but my mind was messed up, missing the highs it had come to rely on. Highs only brought on by adrenaline and serotonin induced running and skiing.
In my training log, which in my case is basically a “Dear Diary”, I had noted, “1/2 hr Physio: Failed ready-to-run test. That spot I spoke about (gastroc) really acted up when started Test 5 of 6. Yeah…all I could do not to cry. I am in a super low mood, even though trying every trick in the book to bring myself up. Hard to sleep, hard to focus, just a lack of joy… and tears often just under the surface.”
It had been a month since I had torn my ACL and banged up the other ligaments in my right knee. On December 19, in a backcountry skiing incident, I caught a stick in a tree chute, my binding didn’t release, and well… Hello Darkness My Old Friend….we’ve come to injury again.… (I couldn’t get Disturbed’s dark and silky version of the Sound of Silence out of my mind). My ski season was shot, I couldn’t run, and although I had been working my ass off to rehab – it was complicated, uncomfortable, and Not going my way at the moment. I had failed the ready-to-run test.
My coach (the 30 year old no-messin-around-one) had obviously read my log and, in response, blasted me a sentence or two: “Vicki – I am havin’ none of it.” Further, and I paraphrase: “This is not a race. Get up. Do the work. You will get out what you put in.” It really woke me up. I could’ve become defensive, leaned into the pity party, but I knew he was right. It was all that I needed to get back at’r.
This was not my first injury. In the past decade – since I had really stepped running & skiing up – I had a few ups and downs with injury. But…I had not lost a whole season of skiing or running to it. This was different. I loved winter: looked forward to snow, to darker moody days, slowing down my running schedule and flipping into skiing. Over the past couple of years I had even taken up backcountry skiing, finding a mentor/friend that has truly been a blessing at this stage of life. At 60, I was feeling silver and strong. I was recently retired: that dream of a 100+ days of skiing was surely going to be my reward…
From the moment I heard the POP!, felt the searing twist and breathtaking slam of my body to the snow – while my leg was hooked and caught uphill – I knew I had really done it this time. I bargained with God for a night (please, please let this be nothing…) then, inevitably, ended up in the clinic the next day.
Still thinking I could “will this away”, the young Doc (I’m noticing, these days, that there are a lot of young docs) who attended me took all of 10 seconds of gentle leg manipulation to come up with a tentative diagnosis: “at least a Cl 2 ACL tear, possibly a Cl 2 MCL tear, and your meniscus could be **cked, too.” The Xray did not find a fracture, though an MRI would be needed to confirm the diagnoses and fully rule out fracture. It kind of shocked me. I did NOT want to hear about a torn ACL. Already I had a preconceived notion that meant surgery. And since the loud “Pop” and tenderness were similar to an incident I had about 15 years earlier (which had been diagnosed as a slight MCL tear which would not require surgery, and went away with a few months for nighttime discomfort without skipping a beat or a day on the hill), I really thought (hoped) the Doc was off. I was ok with her advice to see a physiotherapist asap. “Surgery or not, your physio will be your lifeline for the next 6 months, to a year, maybe longer”. Next she sent off a referral for an MRI. $35 later, I was out the door on crutches making my way to my car where I: (1) made an appointment to see a physio later that afternoon and (2) booked a private MRI for the next day. I was NOT waiting for a phone call.
Physiotherapy. Not even 24 hours after the injury, there I was at Peak Physio. Although I am not one to seek physio, or massage, or chiro on a regular basis, I had come to learn that “they” really knew a thing or two about sports injuries. A couple of times, I had walked in to their clinic with a “niggle” complaint and, within a very short time, had a diagnosis and a plan to make the niggle go away with a few exercises. My coaches were big believers in the power of physiotherapists. I felt trust. Until…
I met my new physiotherapist. She was pretty, young (oh great, they’ve given the old lady the rookie), sure of herself with a strong Aussie accent. Taking a history, and manipulating my leg (in a creepy way: you would know if you’ve ever had your ACL checked out), she pronounced that she agreed with the Doc at the clinic: torn ACL. But she said it without wavering. Like a fact. Then, when I asked her if she thought I might need surgery, she said, GASP, “most likely not, at your age”. It was my first brush up against those words, “your age“. Bristling, I asked what she meant. “Well, generally, anyone under the age of 45 is treated with non-surgical rehabilitation.” Feeling gut kicked, I was starting to put things together. Ohhh….so that is why the young Doc at the clinic told me that – within a year or so – I would maybe be skiing again…with a brace. The picture was not pretty in my mind. And simply NOT acceptable.
Anyway, no use arguing now, especially with those youngsters. I would have that MRI soon. The results would either vindicate – or screw – me. I would do what I could, become an informed patient, and follow orders to get better. I had almost cocky confidence in my ability to heal quickly, and to use grit (aka stubbornness) to my advantage. It would be ok. I was strong. No feebleness here. Hah! Just you wait…
Of course the MRI confirmed the worst: Complete ACL tear. Partial-thickness injuries to the lateral structures including the lateral gastrocnemius tendon, distal biceps femoris tendon, iliotibial band and LCL. Small undisplaced tear in the posterior horn of the medial meniscus. I guess those kids knew a thing or two after all...damn it!!!
And so it began.
I watched my family and friends head out the door, every day, for holiday skiing while the fluff kept piling up and up. I pulled up my big girl underpants and dug into the fact that – for once – I was going to have lots of time to fuss over the holidays rather than heading out to the mountain every single day (I can barely get a tree up most years). I knew I could not let my head get into FOMO. I forced a smile, “Have Fun!”, and a good attitude (most) every day.
I did “some” research: perused online chats, articles, studies on ruptured ACL treatment and rehab. Although I did not recognize it at the time, I was unwittingly forming a bias: a bias towards surgery. Coming from a medical/dental background, I generally trusted main stream professionals and the power of a good reparative surgery. There were no shortage of folks to talk to in this part of the world: ACL tears (and “shoulders”) were as common as root canals. “Everyone” said, “Do It!” But, then came in the insidious…”Don’t let them hold you back…and they likely will because of your age“. Seriously, I was ready for that fight!! I had accepted my age, hell, gone silver (which is a major move for many women, and men actually), accepted my wrinkles as badges of experience, and refused to use it as an excuse. I had never brushed up against this before: surely they jest.
Indignant, I didn’t think it reasonable that anyone should think I would be able to fully get back at’r with 3/4 of a knee. I’m strong, but…. I also felt it was asking for trouble. Sure, I may be able to rehab, but throughout the research articles (which made total sense to me) was the thread, “success through dialling it back”. In other words, as an older athlete, or in non-athletes, dialling back your sport was the key to non-surgical rehab. And, more unsettling to me was the realization that in every case of folks I spoke with, they had dialled it back…even with surgery.
Anyway, a chance meeting with a para-olympian friend really smartened me up. Think about that! Here I was, embarrassed to even mention that I wasn’t skiing that day because I had buggered up my knee temporarily. Really. One has to give themselves a kick in the ass once in a while.
I had great allies: Eric & Gary had my back (Gary, the Soother in Chief, and Eric the No Nonsenser) , but basically they backed away, insisting I follow the professionals’ advice while encouraging patience. My new Physiotherapist took the cranky old bull by the horns immediately: she put me into a temporary brace (while encouraging me to get a custom HUGE one – one I was sure I would leave dust covered in the closet by week 3), and started me on physio exercises right away. She saw me 3 times a week, sent physio homework with me, and said I could walk – with a brace – for as long as I could tolerate.
The UBC Sports Doc appointment was set for January 8, 2021. 5 years ago, I had visited that office with a stress fracture five years ago. 11 weeks later I was up and running and 6 weeks after that, taking part in the 120 Mile Fat Dog. It had gone well, and I was confident it would again. I just needed that surgery.
All my chatting with folks who had torn their ACLs, and who had the surgery to replace it, convinced me that I had to have this surgery. This confirmed my research and natural bias. Soon, I threw down a gauntlet: while speaking with a runner/physiotherapist friend, I mentioned that many thought my age would be a factor. I laughed out loud, relaying that my trainer said I should cry crocodile tears and beg for the surgery! Haha. As we laughed over messenger, I only half jokingly said I would use subtler methods: flirt and arrive at office bearing fine cognac. “He” would see the light.
Doc 2. I call him Doc 2, because little did I know that time, the young doc I saw in the Whistler ER was Doc 1. Actually turns out that she was an orthopaedic surgeon. More on that later.
Doc 2 was not much older than my 21 year old daughter. I swear. A lot more swagger. Certainly not the type I would ever offer cognac to. No, this kid was likely still drinking frat beer. In less than 2 minutes, I recognized that he recognized me as a silver-haired-person. He flat out – without any explanation – said surgery was not an option for me. Why? Well, although he did see in my history that I skied and ran (slowly and infrequently with my old lady friends, no doubt), my chance of full recovery from surgery would likely not be great. I would be left stiff and in worse shape then when I started. I honestly think he didn’t have a clue what he was saying – and how he was saying it; Having taught at UBC, I would have given him a score of “2” – flat out Fail – for his bedside manner and professional communication. Inexperience. Ageism. You could hear the mic drip when he stated, “If you were a 23 year old soccer player, we’d have you right in…” This was my first REAL brush with ageism, and I did NOT like it. Let me the hell outta here. I’m going to find a grown up doctor.
Doc 3. One week later, after blubbering my indignant eyes out on my coach, Gary, I landed in the office of the Amazing Dr. B. An ultra runner and backcountry skier himself with (silvering good looks and) superb bedside manner, Gary absolutely knew what I was in need of. Of course he also outlined that there would be no more doctor shopping. This Doc was experienced, dealt with athletes of all ages, and Coaches really trusted him. They were more wary of surgery than I was, having seen complications with previous athletes. Either way, I think we all needed Dr. B’s opinion.
Now, this time around, the Doc delivered the same news but with sublime expertise (yep – a 10 out of 10 for professionalism). He spent time actually looking at – and manipulating – my knee. He explained the, “if you were a 23 yr old soccer player, we’d have you right in for surgery”. Turns out that, “Yes, if you were a 23 year old soccer, or hockey, or football player with a million dollar contract (or the olympics on the line) we would get you in for that surgery. But just because we can, doesn’t mean we should. There would be a big push to DO SOMETHING! Again, “doing something” is often not the right thing.”
He then went on to say, “these days, the trend is towards non-surgical rehabilitation“. “Studies have shown that treatment with surgery is no more successful than without.” I left his office feeling fully informed. I still had some doubt because of the overwhelming number of people who had ACL surgery (not hard to find in Whistler) and encouraged me to have it. And I still wanted to do some more “research”, but my heart rate was down and the beast soothed.
Here’s where things got twisted up: this time I researched “non surgical treatment of ruptured ACL”. Sure enough, the studies started popping up. They were not quite as favourable as Dr. B may have suggested they were, but he had placed the caveat, “you won’t really know until you are fully back at it. Late into a long mountain run in difficult terrain and you are tired”. He strongly encouraged me to go for the non-surgical rehab. If things didn’t go well, I could always go for the surgery later on. So, hell’s bells, although I felt fully confident in his advice, I was going to have to make a difficult decision. One that no one else could make for me. The more I looked into it, the more torn I became. You can always find a study to agree – or contradict – with your point of view. But I made a promise: no more doctor searching. I would take a stand, make the non-surgical rehab my job for the next 6 – 9 months. And if I needed surgery (after all that), and in essence had to double this time – well – too bad, so sad. Life’s a bitch sometimes…
Best damed rehab EVER. Fully diving in, my physiotherapist passed me a snorkel and showed us the way. Gary and Eric stood back while she steered the whole process. I met with her 3 times per week to start; after a few weeks, 2X per week.
Almost from the beginning, physio said “walk all you want“. I would start out before anyone even left for skiing. Fully wintered up, with ispikes from Salming (an amazing running/walking shoe for winter icy/snowy conditions) and running poles, I started walking the Valley Trail. Soon these became hikes up snowy trails: following snowmobile and ski/skin tracks.
Along with the bi (and tri) weekly visits to Physio’s office, I went to the gym daily (thank God our gym was open in spite of COVID), walked – then hiked – for hours and started stationary cycling. Everything was measured by time, and itty bitty at first, but increased quickly. My only rule was “stop if there is pain”. Within 6 weeks I was putting in 28 hrs per week. Being a retired old folk has it’s benefits, and this is definitely one of them. I was putting in professional athlete hours to my rehab, and was surrounded by a team of pros (Sports Doc, Physio, Coaches, and eventually a gym trainer). Gary laughed: “Tell an ultra runner they can walk all they want and bingo: 7 hr strolls”. There was some pain, there was discomfort, there was some swearing, some doubt, some knee buckling: you know…like a typical 100 Miler.
Of course, as mentioned at the beginning, it was not all smiles & giggles. At week 4, I had enough success to have convinced myself I was “ready to run”. Half a week later, I failed the “ready-to-run” test, and crumpled up for a few days. The loss of my winter – my beautiful fluffy ski season – coupled with some fatigue from probably trying too hard, weighed on me more than I let on…
Never mind: Eric righted my attitude. By week 7, I passed that “ready-to-run” and added it to my daily routine of walking/hiking/physio/strength/biking which brought me up to 36 hours per week by week 8. I even threw in a couple of careful snowshoes up to Journeyman’s Lodge in the Callaghan Valley. Running was kept on a tight leash: precisely 22 mins per day, with 10% added per week.
At 8 weeks, Physio added ski exercises. This was going at near lightning speed. The exercises were HARD. Like everything-I-had-HARD. But…they were exactly what I needed. And I could see – with each and every one of them – as I returned to the actual movements (running, skiing) why she chose them specifically for me. I was in awe of her expertise: not only her knowledge, but her bedside manners and her specificity as we moved along. I really looked forward to her appointments!! She was more than a nice kid, that’s for sure 😉
By the beginning of March, she let me out on the mountain with skis. My restrictions were: 1) stop if it hurts. 2) stay “on piste, aka groomed runs” 3) wear your brace. 4) skinning is ok, but backcountry is not. This was about when her next two weeks were cancelled due to COVID. The timing was perfect: I added skiing to my list and got out there, able to report back in 3 weeks time.
As I discovered very quickly, it was fairly easy to get fully back on groomed runs. Of course, I did deek into some tree runs (against orders), and there, met my match. I discovered a frustrating (and dangerous) disconnect between my brain and my knee. To try to describe it to non-skiers, it was very much like being an experienced driver. We just drive, and react naturally. Our experience has laid down paths in our brain that drive our physical reactions (and vice versa). It becomes automatic. Now, imagine you are flying down a fluffy hill with trees randomly here and there, terrain uneven and unfamiliar. An experienced skier is able to steer through without much thought to what specifically his or her legs/arms/position in space is. Now that was broken for me. It was a crazy experience: walking, running, exercises, strength training did not bring this on. Speed, unfamiliarity with terrain (which is the essence of tree and backcountry skiing), and the inability to react quickly enough, were a danger.
When I mentioned this to Physio upon her return, she was not surprised at all. She didn’t want to plant doubt in my mind, but wanted to see how things went. And after all, she was away for a few weeks, unexpectedly. So…we worked on that: more physio exercises to challenge that part of my brain.
Long and short…at 15 weeks, my most amazing physiotherapist released me from her care. She sent a letter to my coaches to confirm this, because we both thought they would not believe it. Fifteen weeks: the shortest rehab she had ever seen with a complete tear of an ACL (and banged up other ligaments), even with her young pro athletes.
So…Hah. I said this was going to be The Best Damned Rehab. EVER. Lil’ol ladies Rock, Right?? ;D
As I write this, Dear Diary, it is April 22, 2021. 4 months after the crash on December 19, 2020. I am back at the beginning, so to say. Starting the slow build up to an anticipated ultrarun event (maybe? who knows with the way COVID numbers are rising, in spite of the vaccines). My ski season is over but did get a few days on the mountain before it was closed due to government COVID restrictions. Did get out a few days – after the closure – for easy skins/ski up the mountain. Had to turn down backcountry days with my touring partner. Although my heart is there with her, and during my few days skinning I noticed an improvement each and every time, I figure I’ve pushed my luck enough for this ski season. I am sooo grateful for what I can do! We can push it again for the 2021/22 season: next winter!!
In spite of all of this, I am still not 100% certain I won’t need that surgery. As Dr. B said, “you won’t know until...” So in the meantime, I will follow orders and am happily back with my run coaches and gym trainer. I’ve built up leg/hip strength with this experience, stationary biked more than I have ever before (and didn’t lose my mind too badly), and have even grown some arm muscles (check these guns out). Maybe someday I will need that brace, but for now…no damn way.
Doc 1. Oh yes. I said there would be more on her later. Doc 1 was the youngster who attended to me at the clinic. The one who wrote an MRI referral and sent me out the door with crutches to the physiotherapist. The one who said she had torn her ACLs a couple of times and was back at it. Turns out she is an orthopaedic surgeon. Young, pretty, athletic and low key. Playing ball with the big boys: the medical world was a macho place, but apparently not so much anymore. Her office did call me for an appointment, but in a twist of fate, it didn’t go well. Since I already had an appointment with Doc 2, her office could not/would not simultaneously book in their’s. Since I already had an appointment – within 3 weeks – and their office might not be able to get me in for six weeks or longer…I chose the UBC route.
Something didn’t feel right, and in hindsight, I wonder how things would have gone had I cancelled Doc 2 and gone with Doc 1, at least for a Consult. As it stands, I now am on a waiting list for a surgical consult with Doc 1. It’s been 4 months, I check regularly, and yes…still on the list. I still want to talk with her: it is my belief and background that patients need to inform themselves, and that includes talking to an actual surgeon. So, I rehab and wait. Fortunately, even Dr. B agrees with that route: “get on the surgical list, then if you need it, you have the appointment”. Suspiciously, I kind of wonder if her Orthopod office took me off the list – or keeps flipping me to the bottom… That is beyond my control. Ageism is real. And until a larger swell of older athletes starts to dominate the scene, I suspect I won’t be the last to walk this way.
Private clinic, you may ask? Well, I did look into that. And it turns out that – with a new and recent ruling after a long standing court case – private clinics cannot accept you (even for a consult) until you have a diagnosis from a mainstream BC Medical specialist. Hands tied. I won’t get into that philosophical or political hornet’s nest in this blog.
I grew up a little more this year. Discovered another “ism”, which I wasn’t even aware of. From my writings you will notice I had started to pepper my thoughts with “young/kid/rookie”. Why should I be surprised then, when others notice “old”. We all have our “isms”: sexism, racism, ageism. They can all be harmful and unfair and hold us back: as a society, as a people, as a sex, as an individual. For me, again, I have been spoiled. A little indignation and humbling is good for the soul. May I strive to do better…and be thankful.
I also confirmed that gut feelings are important – but should not completely over-ride sound scientific/medical advice. It’s all too easy these days to find data that will support your biased point of view. Listen, look, and seek advice from experts…then Trust. My patients (when I was practicing) gave it to me, now it’s my turn to give it back.
Honestly, I could not have imagined a winter season and living in Whistler without skiing dozens & dozens of days. But having just lived it, yeah, again I was just spoiled. Feeling super grateful.
Finally, and with regret, I should note I was not the only person hurt this year: in a crazy twist of fate, I saw friends around me, also, get injured (collarbone, ankle, shoulder, leg/knee), saw friends/family lose their loved ones and, more recently, a super athletic dad/husband/friend suffered a stroke. Then there is COVID and the havoc it is reigning on the world. 2021 is proving to be as challenging as 2020, and it’s still early. My heart goes out to all.
Many thanks to my coaches Gary & Eric, of Ridgeline Athletics, physiotherapist, Sharni, from Peak Physio in Whistler, trainer Mandy, from Whistler Creek Athletics, Dr. B, my touring partner, J (who saved my life on Dec. 19 and who I want to be when I grow up), and of course my ever-patient and encouraging (silver fox) husband, Michael. Yes…I Luv you All!!!!
Thanks for reading my blog.