How I became another knee statistic….

Three years ago I experienced what it’s like to rupture an ACL (anterior cruciate ligament) and my left knee required a full reconstruction as a result of a netball injury. The rehabilitation back to playing was a long, drawn out and frustrating process. But after 12 months off I managed to get back to playing the sport I loved so much. I had a full season virtually pain free and was over the moon! I was ready to continue playing for as long as I could. However, fate wouldn’t allow that… The risk of injuring either the same or opposite ACL within the first 2 years post-surgery is 6 times greater for people with a knee reconstruction (Source: American Orthopaedic Society of Sports Medicine) and its even higher for women compared to men. Unfortunately this year I became part of this statistic and the timing was devastating, on and off the court!

Another netball match would lead me into becoming another statistic and being utterly devastated. It was the second last round of the 2014 home and away season and it was just like any other game day, except maybe a bit sunnier which is surprising for Ballarat! It was early in the 3rd quarter and I dodged and twisted on my right leg, much like I had done millions of times before, there was a very loud “pop” and the feeling of pain was instant. I let out a scream and landed on the court grabbing my knee knowing exactly what had happened and the memories of my past knee reconstruction came flooding back. The pain was extreme for the next few minutes, but after calming down, I thought maybe it wasn’t so bad… Oh how I was wrong! Off to hospital I went for an x-ray and the results came back normal. But due to still being unable to weight bear on my right leg I was given a referral for an MRI (magnetic resonance imaging). This scan would be able to show how much damage I had actually done to the ligaments. Frustratingly, there was a wait of 2 days for the MRI.

In the mean time I had to make a phone call that I was dreading. Two weeks earlier I had started my new job here at Rebalance Myotherapy and was loving every minute of it. But I knew with this injury that working would be impossible for at least a week and if not longer. The thought of losing my job had crossed my mind briefly, I called Monica with the unexpected bad news. After making sure I was ok, we arranged that I would have the week off. There was no pressure to return before I was fully fit so the results from the MRI would determine the date I would return to work.

Due to my minimal swelling and lack of pain on viewing my MRI results I was in complete shock. It showed I had a fully ruptured right ACL, a grade 3 tear in the MCL (medial collateral ligament), a torn lateral meniscus (cartilage inside my knee), the bone was compressed in the femur and a torn popliteus muscle behind my knee. I was absolutely devastated!

The next step was to contact my surgeon and arrange for my second knee reconstruction. His advice was to wear a hinged knee brace locked between 30-90 degrees of knee flexion. Doing this allows the MCL to partially heal prior to having surgery. With this brace I was able to start moderately weight bearing through the leg again. Feeling still relatively pain free (this can occur with complete ruptures due to all of the nerve fibres being torn), I managed the swelling with ice and NSAIDs. By the end of the first week I was fully weight bearing and also walking reasonably normally which enabled me to return to work. I was happy to be back that’s for sure!

Eight weeks after the original injury I returned to the surgeon for a review and hopefully book a date to have surgery. The advice given was that I was able to go without the brace and will be having my surgery in early 2015. Until then my job is to “prehab” the whole leg, which involves building up the strength I have lost in my calves, quads and hamstrings. There is also the tough decision on what type of graft would suit me. My options are either a hamstring graft, where they take part of my hamstring tendons, sew them together and insert that where my ACL was or have the artificial LARS implant. Both have pros and cons and neither are completely fool proof. You just need to look at the AFL footballer Daniel Menzal who at 23 years old has already had four reconstructions including both the LARS and hamstring grafts. He will be making his comeback with Geelong Cats in 2015. What a long road to recover he has experienced.

At this stage unfortunately I won’t be looking to play netball again. Which is really sad, to retire at a ripe old age of 25. My focus right now is on my strength training and looking forward to finally having the reconstruction. With a bit of luck, in 2015, I will be able to regain full strength and range with my knee, with the long term goal of even completing my first ever fun run.

www.rebalancemyotherapy.com.au

Why your Doctor Google self-diagnosis is wrong….

Working within the health industry you would think I would have known better. I have always been an advocate for listening to your body and reading the signs it’s telling you.  The body is truly an amazing thing and it does often give hints to let you know what needs some attention. To ignore these warning signs can lead to disappointment, including injuries and time away from what you love doing.

The body will tell you that you’re dehydrated by giving you a headache, it will tell you that you’re cold by making you shiver, it will even manifest pain in areas that are injured and require some attention, whether that be rest, rehab, taping, Myotherapy or stretching etc.

Last year I ran my third marathon, yes I’m crazy, I run 42.2km for fun and I’ve done it more than once so lock me up, I’m a looney!! During my training for this event it was the first time running caused a debilitating injury for me.  I made some very common mistakes that I see every day in the clinic and the result was a forced 5months off running.  As I said earlier I should have known better.

Now I’m the first to tell anyone one that running hurts, you’re short of breath and the body pulls out every trick to try and make you stop.  There is always a little niggle here and some tightness there that reminds you that you’re running and then you start to questions WHY you are doing such a silly activity. Now there is a big difference between these sensations and pain.  Pain is a warning sign! It’s your body’s way of telling you, that something isn’t right. I ran through pain while training for this marathon. Why?? Well given my background of three years at University I self-diagnosed my symptoms to be classic plantar fasciitis. I had seen it a million times on my treatment table, how could it be anything different?

There was more pain upon waking in the mornings and it was present in my heal region. I have flat feet that pronate (roll in) and I would limb after prolonged periods of standing or sitting.  It was extremely painful to weight bear on the area and even worse after exercise.  Plus my painful area was in my plantar fascia muscle.  So I ran through it, call it the plumber’s shoddy pipes or the builder’s unfinished home self-renovation.  I knew this “self-diagnosed planta fasciitis” was only going to get better with complete rest and I could do that after the marathon. So I pushed through.

I would run week in, week out clocking up the kms all the while the foot kept deteriorating, even though I was self-treating. This self-treatment included icing the area, self-massaging through my calf (gastrocnemius and soleus) and always making sure I was wearing correct supportive footwear. Anyone who has ran a marathon knows that they are mentally challenging and once you’ve run one you know what’s required for the next. In short it’s what you put in before the start line that dictates how your race will pan out on the day. So I was mentally aware my foot hurt and would continue to cause me grief until I decreased my running.

I ran my marathon, finished and clocked a PB but ran the whole distance in pain. Ecstatic and caught up in the hype of completing such an achievement I continued to run.  I was on a runner’s high, but still had a sore foot. Decreasing the amount of runs and kms I was doing had made no difference. I was still hobbling around like a 90 year old grandma that had misplace her walking frame.  Time to get a second opinion…

Heading to a local podiatrists describing my symptoms and being examinated he too came to the same conclusion as me, plantar fasciitis. He sent me off for an ultrasound to see how bad it was. How much extra damage had I caused myself by not stopping running? In the meantime we upgraded my orthotics and he advised me to keep running as normal. So with this green light I did, albeit decreased distance and frequency but still in pain!

Results day…  On reading my results I was shocked to find out that in fact I didn’t have planta fasciitis but a very rare condition called fibromatosis. What is this? It’s when a fibrous growth develops that results from repetitive microtrauma and overuse. It leads to chronic inflammation with the development of adhesions in muscle fibers and the fascia. The more stress that area experiences the more fibrous growth is laid down. My ultrasound showed the fibromatosis to be 14mm long by 6mm wide by 4mm deep, significantly big in comparison to the space available in your foot.  Treatment is immediate rest, trial of steroid and local anaesthetic to the area and possible surgery. The foot is a complex structure with many nerve endings, which would make surgery very difficult and possibly not solve anything. Also the steroid injection could also flare the fibromatosis as well. I opted not to head down either of these paths.

My treatment plan consisted of numerous taping trials before we decided a doughnut pad, attached to my orthotic, around the effect area was best action to stop the day to day load bearing. My first rehabilitation goal was to get through a day pain free.  To achieve this, not only was my orthotic adjusted but I completely stopped running and iced like a mad woman. How long did this take? Not two weeks, not one month or two but five long (running free) months…..  

I couldn’t believe it took five months for me to have one pain free day, talk about frustrating! During these months of not being able to run I was encourage to try cycling by my boyfriend and it did help short term but it all came to an abrupt stop. A leisurely mountain bike ride turned into an emergency room trip with a couple of broken ribs, numerous grazes and a hematoma the size of a Sherrin footy on my thigh (but that’s another blog).  So I could now add not being able to cycling, swim or in fact do anything physical, including walking the dog, while all my war wounds healed.

I’d gone from being a long distance social runner, too craving being able to just run 5kms! After my first pain free day I gave it another 2 pain free weeks before pulling the joggers on. I still remember that run the breathlessness, the freedom and the endorphins.  On finishing the run the foot was sore! Would I ever be able to run again? The symptoms were back but not to the same extent, so after another two weeks rest I again tried my hand at running.  It was very much a slowly, slowly approach back into running. I now have such a greater appreciation of the frustration clients feel while they are recovering from injuries. For the next three months I only ran once a week anymore and the foot would flare. It is only now over 12months since symptoms first appeared that I am running more than once a week.

What have I learned from all of this? No matter what your background is DO NOT self-diagnose. Getting a second opinion and reading the warning signs that your body is screaming at you can save a lot of heartache down the track. Every day I have patients that come in and ‘doctor google’ has given them a prognosis and I can tell you now that the majority of these clients have it wrong.  We live in an age where resources are at our fingertips but this information caneasily be misused and presented incorrectly.  My advice is seek guidance and information from your local experts within that field, as it’s money well spent and their advice is directed particularly at your condition and circumstances.

www.rebalancemyotherapy.com.au