I’m two months into my ACL injury now, and I’ve been pretty lucky – I’ve had some successes, and I’ve learned a lot. In my last injury post, I talked about Doing Nothing and the importance of not re-injuring while rehabbing (or while waiting for a diagnosis). I talked about how it’s important to advocate for yourself, track all of the information you can, and learn through the process.
Well, I think I have.
I was able to get my MRI a month ahead of schedule (and not at 3:30 am, which was my original appointment time), by calling the imaging clinic on a regular schedule. I returned any and all calls from my medical professionals and it paid off.
The MRI itself was mostly just loud. It didn’t take too long and wasn’t too uncomfortable. The best part was that even though I had my MRI the Thursday before Canadian Thanksgiving, my GP still had my results by Tuesday the following week – efficient! So, the results are that I have a low-grade ACL tear (which should fix itself with time and proper rehab), and that (likely) the initial impact also formed a cyst on the back of my knee, which partially ruptured about 2 weeks after the first injury. Some advice – don’t rupture your cysts, it hurts like heck.
My doc called with the results, I picked up an extra copy for my physio, and we were off to the races.
I mentioned before that this injury is teaching me things that I didn’t know before about the health care system. And being a bit naive, I said not to shop for a diagnosis and action plan. That’s still true – but be wary, too. Pain management, physiotherapy, and the like are still businesses. And while pretty much all practitioners do care about your well-being, their goals might not align with yours. Their skills might not match the skills that you need for your recovery.
Even the very best doctor might not be the best doctor for you.
In the most acute phases of my injury, my physio clinic was awesome at dealing with my pain. Now that I can manage the pain, and need more movement coaching and help dealing with the protective compensations my brain and body have put in place, this clinic might not be up to the task. And that’s okay – not everyone can be good at everything.
Here’s what I think you need to do as your recovery goes on:
Know your options.
I highly recommend knowing enough about your injury that you can speak confidently about the usual treatments and courses of action. Know a little bit about the anatomy, so that you can ask the right questions. Talk to other people who’ve injured themselves – see what their recovery was like and what they did or didn’t do. Every injury follows a different path – some of us need more pain management, some need more active movement re-patterning, some need more psychological coaching. All of these elements come into play in your rehab – and it’s key for you to think about what you need. If your practitioner is great at one aspect, but doesn’t acknowledge the need for another, maybe it’s time to look elsewhere.
Know your priorities.
This isn’t just a matter of knowing which aspect of recovery is impacting you the most at the given time. It’s also about knowing what’s important to you down the road. Do you want to return to skates? When? In what capacity? Do you have a physical job or need for restored movement outside of derby? While your plan for recovery might not follow the exact timeline you would like it to, it’s good to have an idea of your ideal so that you and your doc are on the same page.
Know your limits.
How much time and energy do you have to dedicate to rehab? Will you do everything you are told, even when it’s difficult? Be honest about this stuff with your medical pros. It’s like when you go to the hairdresser and you’re like, “I want this really involved cut that needs lots of upkeep” and they’re like, “How much time do you spend on your hair?” and you’re like, “0-30 seconds” and they’re like, “Laura, don’t get bangs” (not that this ever, ever happens to me. Certainly not on a quarterly basis). My point is – tell the truth about what you’re willing to put in so that you can craft a plan that will give you the results you want. Tied into your limitations is how much money you have to spend. When does your insurance run out? What is covered? While a brace might put your mind at ease, can you afford it? What exactly are you paying for, and is it something you can do on your own?
This list from choosingwisely.org includes a list compiled by the American Physical Therapy Association of things to question at your physiotherapist’s office. The aspect that really resonated with me was the move past passive therapies. To quote,
There is emerging evidence that passive physical agents can harm patients. Communicating to patients that passive, instead of active, management strategies are advisable exacerbates fears and anxiety that many patients have about being physically active when in pain, which can prolong recovery, increase costs and increase the risk of exposure to invasive and costly interventions such as injections or surgery.
If all your physio is doing is putting on the e-stim, ultrasound, or ice pack, maybe it’s time to explore your options.
No injury is exactly the same as another. There’s no one right or wrong. Be wary, stand up for yourself and your needs, and find the best path back to normal that you can.