Knee-deep in an age-old reality
On a Friday afternoon last October, I put my fate in the capable hands of an orthopedic surgeon. After a skiing accident, I needed a new ligament in my left knee, and he assured me that a graft from a donor cadaver would soon have me up and running again.
Back home after the operation, I stretched out on a big chair in my living room and promptly upchucked the two bites of bread I had eaten to break my 17-hour fast. I couldn’t keep down the painkillers or the anti-inflammatory pills, either.
In a world of hurt, with a dead man’s tendon in my leg, I could barely move, let alone do the straight-leg lifts and knee bends that nurses had told me to begin as soon as possible. Ahead lay months of torturous rehabilitation, presided over by a woman I came to call Connie the Barbarian.
A baby boomer accustomed to exercising, hiking and playing tennis, I now faced a battle just relearning how to walk without a limp. A red disabled placard became my most prized auto accessory. To my chagrin, I needed a cane to get around.
I felt I had suddenly, way ahead of schedule, begun a reluctant march into what Henry James called the enemy’s country -- the enemy being old age and decrepitude.
The experience provided a disturbing preview of the loss of mobility and independence that comes with advancing years. It gave me greater empathy for my once active parents, now slowed by a battery of aches and pains.
I was heading down a road that tens of thousands of my peers have traveled or will travel. We are collectively . . . well, falling apart. We have ripped our rotator cuffs, slipped our discs, pinched our nerves and felt arthritis invade our knees and hips. We are having joints replaced and ligaments repaired in record numbers.
We are entering the vestibule of geezerhood.
My journey began on a mountaintop in Chile.
You know your South American ski adventure is headed downhill when you are descending the mountain head-first in a rescue toboggan.
On a beautiful afternoon last August in Portillo, Chile, 9,300 feet up in the Andes, I was about to start an intermediate run when I spied a skier zooming my way from above. Distracted, I glided into some powder, tumbled and landed hard. My skis spiked the snow, my bindings failed to release, and I felt a twisting in my left knee.
A clinic doctor at the lodge took an X-ray, declared that nothing was broken and gingerly manipulated my knee. He concluded that I had sprained my medial collateral ligament, or MCL. He fitted me with a knee brace and a crutch.
I wept -- not so much from the pain, which was considerable, as from the realization that I would not be able to exercise, something I have done almost daily for decades to relieve stress, stay healthy and control my weight.
Back in Los Angeles, an MRI, or magnetic resonance imaging, brought worse news: In addition to spraining my MCL, I had torn my anterior cruciate ligament, a ribbon of tissue that connects the thighbone to the shinbone at the center of the knee.
The ACL is the knee’s most important stabilizer for activities involving sudden, pivoting movements. It is one of the most commonly injured parts of the knee, and tears have sidelined many a professional and collegiate football, soccer and basketball player.
I called a friend whose teenage daughter had ruptured an ACL playing soccer. It took a year of dedicated post-surgery therapy for that fit young athlete to return to competitive play.
I met a New York investment manager in his mid-40s who had an ACL reconstructed. Seven months after the operation, he felt stronger than before the injury, thanks to therapy and lots of cycling. But the recovery, he warned me, involved “pain and agony.”
A female heli-skier and cyclist told me to prepare for 18 months of rehab before I would feel secure enough with my new ACL to play tennis. My surgeon, Michael Gerhardt, of Santa Monica Orthopedic and Sports Medicine Group, predicted that it would be more like six months. Even that sounded like a very long time.
Then there was the former colleague who sobered me by describing her “disastrous” ACL reconstruction. Years later, she must still grip the railing to walk up or down stairs. Sports are out of the question. Her surgeon calls her an “outlier” who had an extremely unusual outcome. Please, I prayed, don’t let me be an outlier.
Before I could have ACL reconstruction, I had to undergo physical therapy to reduce the swelling in my knee and improve my range of motion.
Two months after the injury, I was finally ready. Because I was under general anesthesia, the two-hour surgery itself was a breeze. The aftermath was another story.
Nurses outfitted my leg with an ugly compression sock to reduce swelling and sent me on my way with crutches. I was groggy and woozy, and my knee throbbed as friends drove me home. I had a new ACL crafted from the tendon of a 44-year-old male donor from Pennsylvania. It was provided by the Musculoskeletal Transplant Foundation, a nonprofit organization that is the nation’s largest tissue bank.
As I practiced the golden rule of surgical recovery -- RICE, for rest, ice, compress, elevate -- friends brought meals and ran errands. That period was short-lived. I’m a single, working mother with a teenage daughter. Four days into my recovery, I was driving. By the sixth day, I was working from home.
I was in pain and sleep-deprived but determined not to put life on hold. Leaning on cane or crutches, I sang in a concert and attended a party. I dined out and took an architecture tour. I shopped for groceries, newly conscious of the many other people with canes in their carts. I did not like being one of them!
Gerhardt had told me to aim for full range of motion within a few weeks. That seemed like mission impossible. I would have settled for a good night’s sleep, but rest proved elusive because of the dressing on my incision, the tight sock, the bulky, ill-fitting brace I wore to immobilize my leg and the fact that I had to prop my leg on two thick pillows and lie on my back. Any stray moves caused darting pains.
At last, 10 days after surgery, a nurse removed the stitches, discarded the compression sock and told me everything looked good. I resumed physical therapy at Gail Wehner & Associates in Santa Monica.
Connie, my terrific therapist (who asked that I not reveal her last name), had several goals. One was to break up the scar tissue that my body was producing as a “cast” for my injured knee. Although scarring is a natural response, the lumpy tissue inhibited movement, and I needed to begin work immediately on “extension” (fully straightening my left leg) and “flexion” (bending my knee with as much comfort and range as my right knee). I also had to start strengthening my quadriceps and hamstring muscles so that they could protect the graft.
One of the best forms of post-surgery therapy is cycling, and Connie put me on an exercise bike. I could not make a full circuit, so she had me pedal forward and back, forward and back. Even that was excruciating.
Psychologists say pain is intimately associated with depression and anger, and I felt like a textbook case.
On Nov. 2, three weeks after the operation, I sobbed as Connie pushed my knee to 103 degrees of “flexion,” well shy of the 110 degrees that my post-surgery “protocol” indicated I should have managed. As for the other objective, the protocol said I should, within two weeks, “gain full knee extension so patient can ambulate with normal gait.” My knee remained stubbornly bent at a slight angle, and I hobbled along for weeks.
The protocol’s goals seemed cruelly unachievable. I felt inadequate. After I complained to Gerhardt that I couldn’t keep up, he told me the regimen was probably “one of the most accelerated in the nation,” designed as a best-case scenario for professional or collegiate athletes. “You need to tell people that,” I chided him.
The Pedlar, a low-to-the-ground pedaling device, was a key piece of equipment, but it proved devilish. To keep it from scooting all over the floor, I had to shove it against a wall and pile weights on it.
I had nightmares about range-of-motion exercises. Connie vigorously massaged the scars that had built up under the incision. My knee felt like a coiled rubber band that she gradually stretched during each hour of therapy. As soon as she was done, the band seemed to snap back to where it had been.
The pain released years of accumulated sadness and disappointment -- about work, parenting, romantic relationships. Emotions gushed out. I felt depleted. My poor daughter bore the brunt of my short temper. Each time I lashed out, I felt guilty.
I felt sorry for myself, and felt guilty about that, too. As my pity party got into full swing, I had to keep telling myself that by any rational measure, life was fine. My injury was manageable, and I could hope for a full recovery. A psychiatrist reminded me that my leg hadn’t been shot off in Iraq and my house hadn’t burned in a wildfire. I found that faint comfort.
My reflection in the mirror each morning revealed a spider web of new wrinkles etched by the steady discomfort. I was 56 when I had the surgery, and for the first time in my life I really felt my age -- or older, truth be told. Adding insult to injury, a man I liked, with whom I’d often played tennis, stopped calling, leaving me to conclude I was damaged goods.
Each morning, I did the leg lifts, wall squats and other exercises that Connie kept adding to my repertoire. She started prodding me to fully straighten my leg. “You really have to start doing it now,” she said. “Otherwise, it will be tough to get it back to normal.” She continued to knead the built-up scar tissue, creating the sensation that she was rubbing raw nerves. Instead of Kleenex, she gave me a terry-cloth towel to dab my tears.
Here’s one of the techniques that earned her the nickname Connie the Barbarian: She would prop my left ankle on a rolled-up towel while I lay on my back on a cushioned table, and then press with both hands on my knee. To get that last degree or two of extension, she would stand on a stool (for extra leverage) and bear down with both hands for minutes at a time. It occurred to me that her methods would be an excellent substitute for waterboarding.
Each session was a battle to see which would hurt more: straightening or bending. Connie wanted to bend my knee to 125 degrees, which she managed with much pressing and pushing a few days after Thanksgiving. The pain was piercing.
Improvement was so gradual that it seemed I wasn’t making any. But I began walking for half an hour on the treadmill and pedaling my exercise bike for an hour each day, crying out in pain as each morning’s first few revolutions loosened my stiffened knee. I did heel slides, wall slides, quad sets, straight leg raises and heel raises. I iced my knee twice a day.
My hours at home before and after work were consumed with my recovery. To my daughter’s extreme exasperation, I refused to buy a Christmas tree. She called me the Grinch who stole Christmas. But the persistent pain had squelched any holiday spirit. After all, my daily endorphin rush had been replaced by disability and the grind of rehab.
Edie Thys Morgan, a two-time Olympic ski racer who grew up in California and now lives in New Hampshire, has endured three ACL surgeries. Recovery should not be rushed, she said.
“The key to rehab is that it’s boring and you just have to accept that it’s boring and just do it,” she said. “ . . . It’s an ugly place. You’re not doing any of the things that keep you vital, and you feel like you don’t have your mojo at all. If you could induce a coma and just come out of it in six months, you’d feel so much better.”
Gerhardt, 37, the U.S. Olympic soccer team surgeon, said his job is to remind patients that they are “making progress and that this is not a permanent deficit.” Collegiate and professional athletes can commit four to six hours a day to rehab, but “the rest of us have to go back to work and our lives,” he said.
Sandra Kulli, 60, a cheery Malibu resident who got a new ACL a year ago, found a silver lining in the rehab process. Connie, our mutual therapist, identified a weakness in Kulli’s ankles, and Kulli has worked to strengthen them -- an effort that benefited her on a recent ski trip. “There are some unexpected gifts in the rehab,” she said. “It’s a real journey of self-discovery.”
It’s a bit early to look at this experience as a gift. I still tamp down feelings of discouragement and the fear that I’ll never be the same. I worry that I won’t be able to muster the courage to ski again. And I am terrified of reinjuring myself if I do. Once you’ve torn one ACL, I learned, you’re at higher risk for tearing your other ACL or your ACL graft.
In mid-December, I took my first hike since the injury, a gentle climb to Inspiration Point at Will Rogers State Historic Park. My knee felt tender, but the view was breathtaking.
One day in mid-January, I noticed that I was no longer feeling lumps of new scar tissue. By February, the redness around my incision had disappeared, and the inch-long scar was hardly noticeable. I could climb up and down stairs without wincing. I was pedaling furiously on the exercise bike. I could straighten my leg and I had decent, if not quite full, range of motion.
The other day, my surgeon high-fived me and said: “I know it’s been hard work, but you’ve done fabulously.”
I know I’ve got a long way to go. My knee still stiffens if I sit or stand for too long. It pops and clicks with alarming frequency. I realize I’m in for the long haul on rehab and conditioning, and I’m determined to recover as completely as possible. I do knee-strengthening exercises in the grocery line, and I’ll soon start yoga classes and enlist a personal trainer. With any luck, a few months from now I’ll be asking: “Tennis, anyone?”
But this trial has made me well aware that I have begun my inexorable march into the enemy’s country. I intend to make it a slow march, conducted to the extent feasible on my own terms. If I have to be on the slippery downhill slope, let it be on a snowy mountain in Chile.