Rude awakenings can happen for people in many forms. We always hope that for us, it’s in a form that doesn’t cause too much interruption to our incredibly self-important routines (if it happens at all).
My most recent one didn’t hold back; it stuck its nose into my life during a basketball game this spring.
It had been a few months since I’d played, but as the time passed, I never had an issue hitting the track or the court to get some sport in, and a little light pick up ball with some colleagues was an inviting opportunity.
And of course, the moment I got hurt, I was cursing myself and every decision that led to that instant. As I lay on my left side on the gym floor, once my violent round of involuntary screaming and writhing began to abate, I tried between labored breaths to describe to my friends (who were huddled around me at this point) what I felt. The play was one that was – though athletic – fairly routine for me: A two handed slam, this time off of an alley-oop lob. I’d been slam dunking since I was 15, so there was no hesitation in my step. On my takeoff on this particular evening, I felt instant pain – the shocking kind that’s far too sudden and intense to cry from. All you know is that it means one thing: Injury.
I told my friends I couldn’t really feel my legs beyond the world of pain – so it was hard to specify what I did. For some reason I was afraid to look down at the damage, or try to turn over onto my back to assess my movement. Then I realized that movement wasn’t really an option.
My friend called the ambulance, and it was around then that I’d silently concluded I’d suffered a dislocation. On the way to emergency, I imagined bracing myself on the doctor’s table for the sickening “snap” back to place that needed to happen to allow tendon to slide over bone, returning everything to their rightful position. I prepared for the momentary agony but immediate relief I’d feel once it was over. I’d already thought of the accessory weight training movements I’d resolve to incorporate alongside my squats and deadlifts to edify the connective tissue and stabilizing muscles to prevent this from happening again.
All those thoughts came to a screeching halt when the ER doctor, after prodding around and taking some X-Rays, delivered his prognosis with the cavalier blasé that would warrant a punch in the face from anyone even slightly emotional. And the results weren’t pretty.
Devastatingly serious injury.
Bilateral Patellar Tendon Rupture
For those who need the explanation, a full rupture of a tendon doesn’t mean a partial tear – it means a full-scale separation, like cutting an extension cord all the way in two with a pair of heavy duty scissors. Tendons attach muscles to bones, so a full rupture usually makes the corresponding muscle that that tendon attaches, roll up like a set of venetian blinds. It also means there’s no longer a neurological connection to make the muscle do its job.
The patellar tendon is the beefy cord you feel right beneath your kneecap that connects it to your shin bone. It’s the most significant tendon in the knee joint, and one of the largest tendons in the entire body. Without it, you can’t extend your knee, use your quadriceps in any way, or stand up and support anything with that leg once your knee has been assisted into extension by a partner. You can sit there sweating for 3 straight hours telling your brain to extend your leg, and nothing will happen, because the electrical pathway has been cut off. This is a knee injury that often ends elite athletes’ careers.
And to be clear, the “bilateral” part of the injury prognosis means this had happened to both of my knees at the same time.
The image you saw on the cover page of this article is the same as the image below. That’s the actual X-Ray of my legs, the day I got injured. Circled in yellow are the spots where my kneecaps were supposed to be, and as you can see, floating far above those circles is where they were newly resting – essentially up on my thighs.
It was the first time anyone at the hospital had ever seen a case like this firsthand. Tendon ruptures happen, but not bilateral ones. The surgeon assured me that I’d be back on my feet, but the path to get there would be very difficult, and a much trickier process to relearn and readjust, since I had no chance to “try” or half-practice until both of my legs were ready for it. I was booked for a double reconstructive knee surgery to happen the following week. At 12:30 AM, I was placed in straight full-leg braces and crutches, given a wheelchair to get to the car, and had to be practically carried home by my teammates.
One of the biggest challenges of that entire evening, however, was trying to stop my mind from racing enough to actually get a wink of sleep.
Week 1: This Didn’t Happen
Within a week, I had gone from squatting hundreds of pounds and dunking basketballs to living the life of an actual disabled person. It turned my world upside down in the most jarring, aggressive way possible. There was nothing I could do without assistance, and I hadn’t had surgery yet. My knees were the size of softballs and I couldn’t come to terms with the fact that my legs were virtually useless. When you were perfectly healthy and functional the day before, you feel you can “convince” yourself that you’ll stand tall when you pop out of bed, and not crumple to the ground like a house of cards in light breeze. This was the phase where the most irrational questions began to surface, blaming myself – or even others – for the uncontrollable:
Why did I decide to play basketball that day?
Why did I play in those particular shoes?
Why didn’t I warm up for longer than I had?
Why did I go up for the alley-oop?
Why did I take off using 2 legs? If I jumped off 1 leg, at least I’d have only injured my takeoff leg.
Why did I train legs earlier that week? Maybe that had something to do with this.
Why did it all have to happen to ME?
It’s easy to fall into a morass of darkness and negativity, thinking your current state is the way things are going to be for life. From firsthand experience, I can say that it’s extremely hard to see yourself getting better beyond a present situation where major injuries are concerned. When you need assistance getting to the bathroom, bathing, and doing other basic tasks, it’s hard to wrap your mind around the fact that this state is actually your reality.
Weeks 2-4: Ouch
After a successful surgery, I spent an additional 6 days in hospital; I couldn’t be cleared to leave the premises given I didn’t have a good leg to rely on. The surgery itself required two surgeons –each simultaneously working on each of my knees, and I woke up out of anesthetic in agony from the extremely invasive procedure. My knees felt like they had twisting knives stabbing them, and there was no position of comfort or relief. There were holes drilled into my kneecaps and shins, to house the foreign wires that were now stringing my frayed and damaged tendons back together, and there were about 30 staples embedded into each of my legs holding all of this work shut. I couldn’t bend my legs at all, and just trying to do so summoned a world of pain. I had hydromorphone intravenously tempering the storm 24 hours per day, most all of which were spent on my back in the hospital bed.
I would have been kept there longer than the 6 days, but I was granted discharge for one reason: I was young and strong. I was able to demonstrate to the on-site nurses and physiotherapists that I could maneuver a bathroom by wheeling myself to the bathroom entrance, then using my upper body to carry all the weight of my legs on crutches (or on the floor), and then essentially do a straight dip to the edge of the bathtub, and then pull myself over to the toilet seat.
The main lesson I learned: Train. As grim as the above scenario sounds, I don’t know what I would have done if I was the same 260 pounds, but lacking the upper body strength to be at least semi-functional while disabled. By the end of the week, I could bend my knees a labored 10 or so degrees, and couldn’t dream of putting unsupported pressure on them via standing. The on-site physiotherapists insisted I use a high walker while still in hospital to experience being close to vertical again, and those were some of the most painful few moments of my entire stay. We train well for hobby or for everyday life, but we shouldn’t forget about how important it becomes in the event of an unexpected setback.
Back at home, along with my hydromorphone and Tylenol pills, I had to swallow the very bittersweet pill of the NBA playoffs being on TV.
Week 5: Healing is Incredible
At 6 weeks post injury (which was 5 post-surgery), I could bend my legs to about 25 degrees – 30 if I tried hard. I was still wearing unforgiving straight full-leg braces and not taking them off unless it was to gauge my range of motion while lying down. I was finally out of the wheelchair and able to bear supported load on my legs. I was becoming more dexterous with crutches. It was definitely an interesting walking technique I adopted since crutches are usually supposed to “replace” one bad leg, and not two.
The atrophy had set in, full force. The size of my legs was laughable; I looked like Gru from Despicable Me. My enormous braces were actually doing a doubly serviceable role in balancing out my frame from the visual side of things.
All humor aside, I had to admit one thing: I didn’t care about the muscle atrophy as much as I cared about the function. The fact that I had an injury that disallowed me to move my feet even an inch forward or upward, and then surgeons cut my knees open, pulled my kneecaps back down and strung the tendons back together to connect them back to the shin, then stapled everything shut all while I had no idea any of this was happening – and now I could use my legs again for the simple fact that the body simply “remembers” to restore nerve pathways and start the healing process, was as awe-inspiring as it was nauseating.
My right knee was lagging behind my left knee in terms of progress. It’s funny – no one ever injures two limbs at the same time, so when it happens, you irrationally expect an even recovery process, which is completely foolish to think.
Weeks 6 – 8: Embrace the Reality
When I had my first follow-up appointment 7 weeks after the injury (and 6 weeks after the surgery), it was the first time I’d been able to leave my home to see outside since it happened. Fitting a 6’4” frame into the fully reclined passenger seat of a sedan while straight legged was no simple task, and despite being hypersensitive to any bumps or aggressive braking on the road, it felt like the escape scene from Shawshank to be in fresh air.
At the follow-up, my surgeon switched my straight braces to range of motion braces. These had a dial at the axis point to adjust the degree of allowable movement, but fully blocked anything past that selected range. He set my dial to 30 degrees. The surgeon explained that my right knee was much more seriously injured than the left and was a bigger job to repair in the operating room, hence the slower progress. He also hit me with the reality that I shouldn’t expect a true reassessment of what I could do relative to what I used to do, for at least a year and a half.
I learned that perspective is most important with stuff like this. Hearing that huge timeline in my head can completely negate the positive aspect of realizing that progress was ahead of schedule, that the procedure was a success, and that I’m cleared to begin physiotherapy – all of which he told me during that same visit. Staying focused on how far you’ve come when compared to the day you got hurt is a smart thing to do, and it makes you eagerly anticipate further progress. But if you stay focused on what you can’t yet do, it’ll lead to more darkness. Your mindset matters.
Week 12: The Way to Be a Hero
For the six weeks that transpired after receiving my new braces, on doctors’ orders, I gradually set the dial to allow greater range of motion, until I was allowed to set them to 90 degrees of available range (which is bottom of the thigh ‘parallel’ – not upper thigh – which translates to a shallow squat in the lifting world). In the interim, I was doing banded terminal knee extensions, ankle pumps, and calf raises at home, and was down to one crutch for support, most of the time. On my second follow-up at the hospital 12 weeks after surgery (13 after the injury), I finally got the green light to take a few steps in hospital without braces at all. It was my first time free-standing on my feet with my newly repaired knees. Nothing felt like it was my own. I was wobbly and unstable, and moving too aggressively was painful. I was constantly framing my body and scanning my surroundings for stable things in arms’ reach to bail me out, just in case. And at times, I needed them. I had no good leg, and any misstep could mean re-rupturing. Really. But it felt great. On the way home I picked up a couple of tensor knee sleeves for compression, feedback, and a little extra stability. They helped.
And the very next morning, I went to the gym.
I was down close to 20 pounds due to muscle atrophy. My knees ached and I could hardly bend them to 90 degrees, but I was at the gym and about to attempt actual exercise for the first time in almost three months. My first workout consisted of seated rows, a 135 pound bench press, and a very shallow bodyweight box squat, which proved extremely difficult. I was on a long waiting list for my physio clinic of choice, so I decided I was going to do my own physio instead.
This is the part of the story where most people would boast about sending the doctor’s recommendations to hell, while chronicling their comeback story and lightning-quick recovery that they made happen all by themselves – but I’m coming at this from a different angle.
Many movements were painful. Anything load-bearing for the lower body was very difficult, especially with my insufficient range of motion. I couldn’t hold a plank or push up position because it placed unbearable amounts of pressure in my knee capsules due to gravity. I had no eccentric control of anything requiring knee flexion. Standing tall with a significant load placed anywhere on the body also had its own time limit, and my first experience learning that was made clear in that my new 6 rep max for the trap bar deadlift was most literally the empty cradle.
Getting back in the gym the moment I could was one of the best things that I could have done – especially for the mental aspect of things. Exercise works wonders for improving one’s mood and feeling better while performing activities – and this was one of the rare instances where I could feel myself getting stronger.
I titled this subheading what I did to distinguish between busting timelines to set recovery records, and listening closely to the recommendations of the practitioner while knowing how to listen to your body. No one should be trying to be a hero. There will be pain to push through, and that’s expected and required (and that may even be something the doctors avoid telling you due to fitness training inexperience), but staying the course, knowing your limitations, auto-regulating your workouts, and ending all workouts on a high note to bolster your confidence is quintessential for success and forward movement towards a full recovery.
And this may be cliché, but it’s true: on some days, just being there can be all it takes.
Week 16: Setbacks
I’d be lying if I warned an injured person not to expect any of these. Setbacks don’t have to be complete re-injuries, but they can definitely come in the form of smaller hiccups that disrupt your linear path to better health. It may come across as jaded, but it’s definitely more realistic to anticipate something and even be wrong about it, than to have blind confidence that your wounded body is invincible just because you’re doing the right things when you remember to think about it.
In my case, I seriously aggravated my already swollen, stiff, vulnerable and tender left patellar tendon by simply standing up from a seat that was too deep, without using assistance. That stupid decision put me back a couple of solid weeks, and at the same time it refocused my thinking to taking things slow and easy. Sometimes people who may have the strongest deadlifts in the city, throw their backs out when they’re picking up a pencil or tying their shoes. What we do in the gym matters not at all if we’re completely emasculated by a basic life movement.
Week 20: I’ll Never Be the Same – Time to Own it
I don’t compete in a sport, and I’m not paid to train. I’m a 30 year old generalist trainer whose work indirectly depends on my ability to be competent at movement. As such, a smidge more was riding on my recovery being a coach and not an accountant. With that said, it’s humbling to remind myself that my knees are no longer the natural-born thing they were; they’re now a giant patch job – a doctor’s best attempt at falsely recreating what they used to be. It’s a humbling thought that only strengthens my resolve to put an end to following empty strength “standards” and dogmatized patterns or methods usually reserved for athletes or competitors. Maybe I won’t ever cover 40 yards in 4.5 again, but really – was that incredibly important?
Respect the Disabled
By 24 weeks, I had regained plenty of leg musculature (not all!), and after a long warmup, was able to perform unassisted bodyweight squats to a below-parallel depth, and make them look fairly clean and respectable.
Of course, these significant victories came with a reminder, in the form of a paraplegic who would come to my gym on a regular basis.
My amazement at my own healing was (and will continue to be) juxtaposed by the fact that for some people, this is what they’ve got, for good. I spent a month in a wheelchair living the life that certain people live year in, and year out, without complaining. The amount of time it now took me to get my things, drive to my gym and complete my warm-up, was probably the same amount of time it took many truly disabled people to just get dressed and ready to start their morning. Knowing this is a small part of the reason it took me so long to write this.
There were times the guy I’m thinking of in particular would ask me for help with moving equipment or plates off of machines for him. Once, he even asked me to tie his shoe for him. More than ever before, I’ve been happy to oblige, for obvious reasons. It also conveniently shifts my mindset concerning the fact that I can’t dunk, to a more realistic one instead.
How do I Train Old People?
At 32 weeks – which is approaching the current day, I’ve come to realize I’m capable of a lot of gym stuff – if I’m prepared to do them. It’s just another reality to swallow: Like any mature adult alive, my body doesn’t have the resilience it did when I was 18, and to add to that, it’s now been through extreme trauma. If I want to “perform” in the gym, I have to give myself the necessary prep time to do so. It may also mean breaking many rules to perform irrationally stigmatized variations of movements, simply because they serve me better. I’m probably going to use a trap bar most of the time to deadlift. And a belt. I’m also going to squat to targets way more often than I squat free. At age 30, I have nothing to prove to anyone, and the key to lasting the test of time is to find safe ways to reap all the benefits of a movement.
And that brings me to my point of this subheading: It’s easy to force-feed “proper movement” to a new client who hasn’t been taught it. But when Deborah from Finance hasn’t been active the last 15 years, or has sustained an injury, or suffers chronic pain, how patient are we with creating more mobility from program phase to program phase, or from workout to workout, or even from early to later in the same workout? Like I implied above, older bodies have more “mileage”, and need more preparation to do athletic things. We can act like that’s completely reversible, but it’s not. At best, it can be tempered – but not prevented. Dealing with injuries of our own can sometimes open our eyes to being more patient and attentive to the needs of client X, Y, or Z who’s no spring chicken.
I kept this off of social media until this point, 7 months later (almost to the day), partially for privacy, but partially as an experiment. I was still focused on returning to my regular work. Though it didn’t involve 1 on 1 coaching for about 5 of those months, it did involve writing, making training videos, and doing online coaching. I didn’t make anyone who wasn’t a direct colleague, family member, or otherwise close to me privy to the bad news. If you know me well (or even if you read enough of my work), you’d know I’m not the type to take to the interwebs to garner commiseration the moment anything happens. It may work for some people, but the hackneyed “thoughts and prayers” line that rolls off the tongues – and fingers – of many a millennial has always been something I’ve been a bit divided on.
With that said, when fun was made of the knee wraps I wear to cover enormous scars and compress swelling, or nasty lines about my “poor leg development” came rolling into the comment threads upon the release of new training videos early in my recovery, it served as a reminder to behoove me into thinking twice before posting negativity on someone’s work online. ‘Cause chances are, you don’t know the whole story.
On a related note, you do only realize who your friends are once stuff goes wrong and tough times come ’round. I received regular check-ins and encouragement from many of my clients and friends who were aware during the process. Sadly, others disappeared – despite being in the loop.
At the same time, in my books, a good friend, though concerned, also respects your desire to be left alone – which, interestingly, was something I requested quite often, especially at the beginning of the ordeal.
Today, I’ve got nearly a full range of motion in both knees. When I’m warm, I can squat to almost my old full depth, and I’ve been able to deadlift significant loads with no problems. My single leg work is getting stronger, and I’ve slowly been becoming more agile.
Gradually regaining the ability to jog is the next step in progress, which should come soon. For a timeline that hasn’t even met the halfway point of the doctors’ recovery forecast, I’m not complaining. There’s still a long road ahead, but every mini-milestone counts huge for the psyche.
My word count is at 4000 right now, and I’ve covered about one third of what I have to say about this ordeal. This isn’t meant to inspire, as I consider myself far from inspirational. In fact, I wouldn’t wish this on my worst enemy. If anything from the above experiences can help a trainer, coach or lifter improve his or his clients’ training, then it was worth the overshare. If you have any questions, drop a line to my email or using the comment thread by hitting the corresponding tab below. If you’ve read this far, it may mean you’ve indeed experienced something similar and can relate – or might be doing so as we speak. If that’s you, then take this trite statement to heart from probably the least sentimental person you’ll ever read:
Stay the course, always consider the bright side, and celebrate the little victories. It’ll get better.
Train with Lee Boyce, 1-on-1
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