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When an Injury Forces you off the Water

If you do a sport long enough, no matter how proficient you are at it and no matter how well trained you are, you’re eventually going to be benched.  No one can avoid the Injured Reserve List.  Sure, you can do all the things, take all the potions and wear all the wearables to help you delay or maybe mitigate the inevitable. But really, as you push yourself to grow and improve, it’s a matter of when, not if.  This gets more likely as we age. How you approach recovery from an injury or an illness can make or break  your return to the water and it can have a tremendous affect on how fast you get back out there. Much of it, believe it or not, is mental not physical.

My Backstory

I should know. On September 27, 2021, I had to have a completely unexpected total replacement of my right knee.  It came out of nowhere.  I went from having the knee of a 25 year old to having zero cartillage in about that fast.  I had no issues with my knee until I did.
I thought I had simply torn my meniscus.
“Yeah, your meniscus is torn,” my orthopedic surgeon told me after looking at my MRI. “But the bad news is that it is torn because you are bone on bone.”
Most people in that condition have been dealing with knee pain for years and have put off the inevitable TKR.  Nope.  Not me.  I likely didn’t feel anything because of my level of activity and fitness. The meniscus likely tore because my knee was already shot, according to two doctors who offered me opinions on what to do.
Surgery went well. Everything was going great - I was back sup surfing  and downwinding in three months time, after having completed a cross country transpacific move at the same time.
I worked hard with paddle trainer Suzie Cooney to get the knee and the rest of me stronger, both physically and mentally. And I am so glad I did.  I would need that training more than I could ever know.
All was going well a year after the surgery and I felt almost back to normal, except for some occasional pain and persistent swelling.  I started to feel a  little instability going down stairs.  Riding the bike was starting to not feel as good on the knee as it had.  I dismissed it. After all, it can take over a year sometimes to fully recover from the highly invasive TKR surgery.
Then, one morning at a surf break near Lahaina, I was waiting for an incoming set.  They were quite a ways apart.  The waves weren’t huge, but I was having fun with Suzie and our friend Donna.  A set started to come in and as I moved to stand up, I felt three pops and then the worst pain I’d ever experienced.  I could not extend the leg.  I suspected it was dislocated. Indeed it was.  The femur had jumped the prosthetic post.
Suzie, Donna and two surf instructors got me off the water and my recovery began. Again.

A week of darkness

The first week following the dislocation was horrible. Fear, uncertainty, and worry hit me like a wave at Pe'ahi. There were too many questions and not enough answers.  Knee dislocations are very uncommon; even more so when it’s a replaced knee that dislocates.  .005 percent of all TKRs dislocate. There is little scientific data on outcomes and the studies that do exist pretty much do not apply to someone my age who has my activity level.
Not helping matters was the comment made by the emergency room doctor who “reduced” (the technical term for popping a dislocated joint back in) my knee.
“Oh, you won’t be able to surf anymore.”
I burst into tears.
Michael, the amazing nurse who helped my through that whole event, leaned over and whispered in my ear.
“Do not listen to him!”
My "Don't Tell Me I Can't Surf" face in the ER

Decisions, Decisions

I had to make a decision.  I could either believe the ER doctor, and just give up everything I love. Or, I could make educated choices about what to do next in order to give me and my knee the best shot at resuming my lifestyle.
That meant a TKR revision and replacement of the two original implants with a more robust ones that would have a thicker post, less likely to dislocate.
It would mean another 12-14 weeks of rehab that could be more painful and have more consequences.
I quickly realized that focusing on the possible negative consequences was not helpful.  Listening to others tell me what I could and could not do or shouldn’t do was also not useful. It made the future seem darker.

Building a Positivity Zone

My plan of attack included creating a “positivity zone” around me and my thinking.  I had to focus on the advantages I had going into post injury rehab and the second surgery. I had to focus on modifications I could make so that I could continue my paddling.  Focus on each day one at a time and how far I had come during rehab instead of how much was left to go.
I told myself I had no other choice.
Because I didn't.
I had to realize - and believe - that my case, my knee was unique.  There was no data, no rules, no guaranteed outcomes.  I could write my own script.  I chose accept that not paddling, not surfing, was NOT an option and that I would make it happen, no matter what.
By the time my surgery date arrived, I had over two months of physical therapy designed to help strengthen the knee after the dislocation and get it ready for surgery. I had spent that time in a brace that limited my flexion to 90 degrees. Bend the knee past that point and there was a 50-80 percent chance it would dislocate again on its own.
Some friends intimated that another surgery was too big a risk to take but with percentages like that, not having it would mean not being active at all.  Living with the fear of another dislocation was just not something I was willing to do.  That isn’t life.
Like I said, I had no choice.

Mental Tools

During rehab, I discovered the importance of using specific “tools” to keep that positivity zone strong and capable of  warding off unhelpful opinions.
1. Gratitude
I have always kept a gratitude journal but maintaining that practice was  key to maintaining a positive outlook after my injury.  Every morning, I list at least three things I am grateful for, three things I am going to do to make the day great, and I add a positive affirmation.   It is amazing how this practice, over time, can change your outlook on any situation, not just an injury.  I also journal three things that are currently going well and three things I am looking forward to.  I end the day with noting three things that made the day great, along with at least one thing that could have made the day better.
There is plenty of documented info out there on the value of gratitude.  Keeping a journal like this is used by many professional athletes, including waterman Zane Schweitzer  who talks about it in his book, Beneath the Surface.
Gratitude helps us focus on what we can do, and what we have done, rather that what we can’t do and how far we may have to go.
2. Meditation
I ramped up my meditation practice during this time.  Andy Puddicombe’s Headspace app has a fantastic collection of meditations for sport, including  a ten-day program on rehab.  I put that series on repeat. It taught me a useful creative visualization I could use whenever worry, doubt or stress about my knee crept in.  It was especially useful the first time my physical therapist/physio took my brace off and moved my knee passed 90 degrees! And the first time I rode the stationary bike brace free.
I also found a knee surgery specific guided visualization program  which I used several times during rehab and then right before and the day of my procedure. The Images of Wellness program also includes a meditation for after surgery.
3. Fear Setting
Fear setting is an exercise I learned from Tim Ferris.
Like Gratitude, and meditation, it is useful for dealing with anything that scares us, especially when that fear is debilitating. Fear setting is basically a journaling exercise in which you confront whatever it is you're afraid of - name it - and then consider all what you can do to prevent your worst fears from coming true, or the real outcomes should they come true and how you would deal with them. It takes away the uncertainty. It gives you a plan. It helps you believe you can deal with whatever it is you are afraid of. It makes things not seem so scary.
There are any number of downloadable templates to use, and some apps.  My favorite is the Stoic. app.
4. PT is Training
Many people struggle with doing PT after surgery or recovering from injuries because it seems like work, or is painful, or is a reminder that you had to stop training and/or doing the sport you love.  One way to overcome that is to approach PT as if it IS your training. That is because it is.  It is what you have to do to get yourself back on the water, doing what you love as quickly as possible and a strongly as possible. No, you might not be getting your heart rate up to Level Four, or you might not be doing the miles, but it is just as essential. It is what you have to do, in this moment of injury, to continue your progress. You get to focus on a very  specific set of exercises that work specific muscles that now need all of your attention. PT IS training and training works.
While focusing on my knee exercises, I also kept up with upper body work. That was important as well.
Training buddies!
5. Embracing Pain 
Changing my opinion of pain made a huge difference. Instead of fighting the pain, I chose to acknowledge it and its role in my recovery. That Headspace meditation series I mention above was instrumental in that. Pain isn’t something that is negative, or that we should put aside or fear. It can help guide us on our way back to our activities. It is part of the healing process.
6. Give Yourself Permission
It’s easy to get  wrapped up in the things you cannot do, the workouts you are missing, the fitness you are losing or the events you have to drop out of when you have an injury. During my rehab time, I worked hard to let all that go.  I gave myself permission to not  worry about it. To do other activities - like drawing, star gazing and yes, even gaming. When you make rehab your number one goal, none of those things you think you are missing out on matter. There will be other races, there will be another whale watching season to paddle out in, and there will always be more waves to catch. It will all wait for you. Don’t let FOMO and your perceived judgement from others encroach on your “positivity zone!”
7. Take off the Wearables
Anyone who knows me well knows I love my Garmin devices, and my Whoop and Oura sleep trackers and my other fitness-related electronics. I love the data!  This time around, I found that seeing the declines in my fitness data as a result of my injury was not useful. It was too much of a reminder what I wasn’t doing, instead of what I was.  It created too much pressure, too much angst.  So, I took them off. I started using my Apple Watch with just basic functions. I can still track sleep and how much I am moving, which is important now that I am post-operative. The Oura ring also has an “injury” setting which restricts collection of some data  during the day.  I’ll go back to using the Garmin when I am ready to resume  regular training, Maybe.
8. Get Outside/Be Creative
I found it extremely helpful to spend at least an hour a day outside. I didn’t have to be doing anything - simply sitting on my lanai and listening to the birds, watching clouds, watching the sunset helped me stay grounded.  Even going to the beach.  If you live in a warm climate, or if your injury happens in the warmer months, definitely take advantage of the opportunity.
Outside time!
I also made sure I did at least one thing that involved creativity each day.  Maybe I made a sketch of my back yard. Maybe I colored. I started writing a haiku every morning.  That has now become a part of my journaling process.  Being creative makes you feel productive, gives you a sense of purpose, reduces stress and anxiety and it promotes problem solving.  All good things to have when you are rehabbing.
Haiku and stargazing combined
All of these tools or strategies set me up for really being ready mentally as well as physically for my surgery on December 12.  I was ready to move on to the next phase. Rather than thinking that I would be starting all over, I considered that I had already come half way.  I was ready to get the brace off and start the next set of work that would get me back in the canoe and on the board.

Post Surgery

Turns out the surgery was not what  my surgeon and I expected.  When he got into my knee, he discovered that the liner or spacer between the upper and lower knee implants was the wrong size. It was too small, and thus it was not able to do its job- keep the femur from jumping the post. That's why my swelling persisted.  That's why I felt instability on the stairs. That is what caused the dislocation.  It was not anything I did.  I did not exceed the limit of my TKR.
The plastic liner shown between the two implants. Mine was loose and unable to keep the femur in place.
It could have happened at any time.
He replaced the liner and that was it.  No replacement of the two implants - so no trauma to my bones.
That means my recovery time will be cut in half. If even.
As the time of this posting, I will be almost three weeks out of surgery.  One week out, I was walking without any kind of aid. Two weeks out, I was back to driving,  I can ride the stationary bike for as much as 30 minutes a day. I can walk as much as I want.  My surgeon and PT say there will be no impact to my surfing or canoeing. Or yoga. I will be able to go back to all those things. No problem. The pain is minimal and of course there more of it as my activity ramps up. Next week, my incision will be healed enough to permit me to get back in the water swimming.  I’ll return to paddling first in the canoe, then with small waves.  I will continue to use all the tools I’ve discussed here as I move forward, adding in patience. I need to give my tissues time to heal. That means listening to my body and backing off when it feels like I have done too much.  Not rushing.
The bike is my best friend!
And it means continuing to realize it will all be waiting for me when the time is right.
Dealing with injury is mostly mental.  Win the mental game first, then dealing with the physical piece is that much easier!

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