Posts Tagged ‘ACL’

Audio by Jonathan Fader with additional commentary

Foreword:  This piece was originally written and posted on January 12th, 2017, it has been updated and re-edited for 2020. Last week our editor posted about his experience with injury in the martial arts, as well as injury anxiety in the post “Once Bitten, Twice Shy: Overcoming Injury Anxiety“. As a Martial Artist and Instructor I can say, without a doubt, that fear of injury and injury anxiety are a common, if not the most common, the reason why people abandon their martial arts journey. For some students, it is a situation they experience, witness, or hear about in class that pushes them past their comfort zone, which in turn triggers this fear (or self-doubt) and they stop coming. For others, they suffer an actual injury and never come back due to this fear. Then there are those who finish our first test (which is VERY HARD) and they no longer want to continue because the fear of further challenges sets in. To me, however, getting injured and coming back stronger is the sign that you may in fact be a true martial artist or warrior. No one ever said it was going to be an easy, joyous journey, but the skills and personal development you gain from self-defence/combative practice is more than worth it. This post discusses the most disastrous injury I have ever had and my road to recovery. I believe that if you truly understand your body and become your own doctor, learning how to properly recover and become stronger (with proper research), then it will reduce the fear of injury (which may be inevitable in martial arts training for most) allowing you to continue to grow, develop, and challenge yourself. Something that is increasingly important in a world were people no longer like to be challenged. With that in mind, read on for my story of injury, pain, and recovery.

Pound for pound, the knee is the strongest offensive strike that the human body can generate. But many folks out there, whether athletic or not, find out that, with one wrong movement, or one wrong hit in the wrong way, this strong offensive weapon becomes as limp as a wet noodle.

In my case, it was the dreaded anterior cruciate ligament (ACL) injury. I am not even 30 and my knees are already going! This can easily make a person feel old. It reminds me a line in the spoken word piece, Wear Sunscreen, by Australian producer Baz Luhrmann in which the advice is given:

“Be kind to your knees, you’ll miss them when they’re gone.”

Here I am, supposedly in my prime, and my ACL is torn on one side, making me I feel like an old man as my other knee is going too. Ironically, I’m surprised they lasted this long. As a Rifleman, Light Machine Gunner, and Sniper in the IDF, I often carried far too much weight for my little legs and knees to handle. Add to that all the road running I used to do… I guess my knees had a good run (pun intended).

People are consistently shocked by how quickly I recover, post-injury and post-surgery, and get back into regular activities. I’m usually met by skepticism and rolling eyes when I tell people, “don’t worry I heal fast!” As the doctor said, “It’s people like you I worry about the most.

Don’t worry, I heal fast!

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I wish I could heal like Wolverine

I’m not Wolverine, and I don’t have a “mutant healing factor” or other superhuman resiliences. In fact, I don’t really even consider myself very athletic; one of the reasons I was drawn to Krav Maga. So why should I heal any faster than anyone else?

The truth is I don’t heal any faster than the average person. But I have a theory as to why people think and say such a thing.

Let’s begin by breaking down the injury and recovery:

First, I would like to be critical about the medical system. Even in Canada, we have a broken medical system, in my opinion. Generally, doctors are experts in acute injury diagnosis and treatment, but when it comes to post-injury recover they are almost clueless. They do not employ a holistic approach and they rarely understand, to the level that they should, aspects of medicine and healing. In Canada, though our medical care is largely covered (I say largely, since there are still costs…), there is a serious shortage of qualified professionals and equipment. In my case, when I was injured I knew it was something more serious than the “just a sprain” that the doctor assessed it as.

The day after my injury, my doctor was overbooked (it happened late at night). So I went to the ER instead, which had a long wait time, as usual, due to overcrowding. Finally, after several hours, I see a doctor, only to be told they think it’s just a sprain. They sold me crutches and prescribed me light painkillers. A week later, I finally managed to see my regular doctor and was told something similar. The idea of an MRI scan wasn’t even mentioned until I went to a physiotherapist, which was covered by WorkSafeBC. This is appalling to me because, as far as I know, the sooner a proper, accurate diagnosis can be made the faster a surgery or rehab can happen, and the faster I can heal and recover. All these things would lead to a better experience for both the patient and medical professionals, with lower cost for the medical system overall.

The idea of an MRI scan wasn’t even mentioned until I went to a physiotherapist.

So why didn’t I get sent for an MRI right away? Well, if you are unaware, the whole nation of Canada has fewer MRI machines than some individual cities in America. This results in a long wait list, and even when you can get bumped to the front of the line through WorksafeBC, there is still a resistance to sending you.

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ACL Injury

If I had been sent for an  MRI within 2 weeks of my injury, as should have happened, they would have discovered that I had a seriously torn ACL and meniscus. But since it took about 2 months to get the MRI, albeit it was faster than the normal 6-9 month wait, they would have discovered it sooner and not wasted time thinking it was something less serious.

This means that, even in a country like Canada with a so-called advanced medical system, there are serious problems and you really cannot rely on the advice of just one so-called medical professional. A lot of times, these people are tired, overworked, and too accustomed to patients who exaggerate their symptoms. Although in my case, I was under-exaggerating my injury since I have a high pain tolerance; so they assumed it was nothing despite the details I was verbally indicating.

When I finally had the MRI, I was referred to a specialist. Once I saw the specialist, things moved forward rather quickly. Her question was basically, “so when do you want the surgery?” Great, right?

Back to the main topic about my not-Wolverine healing abilities:

Here is my theory as to why people have the perception that I heal faster than average; One of the biggest problems in the medical system is the over-prescription of pain killers. In my opinion, this is one of the main hindrances to how fast a person can get back to their normal activities.

When I am teaching my kids’ Krav Maga classes, often every little bump and every little scrape becomes a big deal. I always teach these children the same simple lesson:

There is a difference between pain and injury.

Pain is your body’s natural way of giving you feedback to assess whether something is a possible threat. However, it is a very simplistic system and doesn’t always know the difference between something that is actually harmful and something that is not. As a reasonably developed species, we should be able to use our conscious mind, based on our experience and the mechanism of the pain, to know if it just hurts or is an actually injury. I always tell my students that “pain is good and injury is not.” You should fight through pain when it is just pain, but stop when pain is related to an injury and take the care of injuries seriously.

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Pain is your body’s natural way of telling you there is possible danger. (Image source)

Thus, I am not a fan of pain killers prescribed by doctors. Generally, medication should only be used when necessary; such as taking acetaminophen for a fever, or NyQuil and DayQuil for a serious cold. It should also only be used a long as needed, which is usually a day or two. Yet, doctors often prescribe 2 weeks to a month, or more, of serious, heavy-duty painkillers, which can be highly addictive to a lot of people. They tell you the maximum you should take and for how long, which means that you should not take all the pills you are given, but people still do. Which leads us to…

The issue with painkillers and other meds

By taking painkillers for longer than you need just because you were prescribed them, it dulls your body’s natural pain responses and you can no longer “hear” your body’s feedback. Eventually, if you take them too long, your body’s pain threshold will have shifted and your overall tolerance to pain without painkillers will have been reduced. By the way, this is the start of addiction when it comes to painkillers, as you will constantly be trying to maintain your new pain baseline, which is now only achievable through the pills themselves. This is why heroin, when medically supervised by doctors in hospitals, is a better pain alternative than morphine and is less addictive. Yes, you read that right, but I won’t get too science-y. The fact remains that the layperson’s understanding of painkillers and other meds is dramatically limited.

Addiction issues aside, there are two main problems: Either, you diminish you ability to feel when pain becomes injury, then you push yourself too hard, or, you become docile and don’t know when your injury is ready to begin rehab because you no longer know the difference.

This is why post-injury and post-surgery, I rarely take painkillers for more than 2-3 days. I typically only use them to help me sleep and overcome the initial acute pain, which is often a bit more than I would like to deal with. However, even if I have to walk with a limp, I would rather get rid of the medication as soon as reasonably possible, than to rely on it like crutches and lose my body’s natural senses and abilities.

Generally, in both studies and anecdotes, evidence shows that the faster you get back to regular movement (within reason) the faster you can heal yourself. The body is both an inefficient piece of junk and an amazing machine. If you take painkillers longer than you need to and cannot receive the appropriate pain feedback, then you cannot properly heal yourself. Many also go wrong by using painkillers to “push through” pain, which is not advisable because then you cannot know when the body moves from pain to injury, and this is a crippling mistake for many athletes.

Listen to your body

If that means you don’t do anything that day, then you don’t. If you can push another day, then you do. But the sooner you get back into simple things, like moving, walking, and doing regular day-to-day activities, the better.

Have you heard of those people who work their entire lives, and then in their late-70s or 80s, they just stop or are forced to retire and then die? I think this is a great analogy for muscle atrophy.

If you don’t use it, you lose it.

Have you heard of that? Surprisingly, muscle atrophy can kick in very quickly, usually at around 72 hours of non-use. Which means if you take most doctors advice and rest up to six weeks, you will see major muscle loss and the recovery will be much harder. Often, doctors and physiotherapists hesitate to push people, and thus continue prescribing fairly basic exercises, which may be great for office workers, but not for the athlete.

As an athlete, sometimes safe, yet serious, strength training is required. For me, the results of my post-injury recovery were not happening as fast as I would have liked. It was my first experience going to physio, and I did everything they said. However, my impatience comes from being told to do very boring exercises with minimal results. What’s more, I would have to stop what I was doing 4 times a day, for 20-30 minutes, to do the exercises. It became a hindrance to my work with no benefit to my recovery.

So I started doing my own exercises, which limiting myself to light squats and deadlifts. Two months after my initial injury, I was doing 200lb deadlifts, no problem. Of course, I was wearing my knee brace and would end a set if there was any discomfort. However, with this approach I saw far quicker recovery than when I had just listened to the so-called experts.

I am not trying to discredit medical professionals, this is not at all what I am trying to say. The problem is that, due to the system, or lack of experience, or scarce resources, there is often a disconnect between injury and recovery. The sooner rehab starts, the faster people can get back to normal activities, the faster and better the overall recovery.

How do I know when my doctor is right or wrong?

Sometimes, of course, you should listen to professional advice when it is legitimate. In my case, I listened when the doctor specifically asked me not to bend my knee more than 90 degrees for 6 weeks, regardless of pain. This is to allow the fixed areas, specifically the meniscus, time to properly heal and become as strong as required. However, all that it means is simply that I should be careful and modify my exercise to adhere to that specific limitation. I can still attempt light squats with limited range of motion, despite what the doc might think.

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How I’ll feel when I finally get to do BJJ after all these months…

Healing and returning to normal happens faster when I listen to both my body and the advice of the doctor and physiotherapist. Your body knows itself best. As long as you are fairly self-aware and attuned to your body’s messages, you should let your body guide you. And, seriously, don’t rush. As an athlete, I know that pushing too much too quickly because you want to get back in the game and prove yourself, is not a good idea. For me, this has meant no Krav Maga or BJJ for at least 2 months, and no rolling or sparring for 3-4 months.

There is still a dispute as to whether it makes more of a difference to get surgery ASAP and then do physio, or vice versa. It is my opinion, as an athlete, that surgery should happen as soon as possible, and you should do physio before and after surgery. It is fairly conclusive that doing physio and rehab to get back to regular activities ASAP means a better recovery. In my case, the longer I had to wait for my surgery, the worse my other (uninjured) knee got. Having a surgery done ASAP means your body will not have to go through multiple healing processes and can get back to what you love to do with less risk of degradation of your other areas of the body due to compensation.

So stay off the painkillers when you don’t actually need them. Get moving and get healing. When it comes to injury recovery, push when there is no pain, and rest or stop when you feel pain. Through time, you will know if the pain is related to the injury or whether it just hurts. Remember…

Pain is fine. Injury is not.

This is my secret. Simple, really!

Written: by Jonathan Fader