On Setbacks

You may recall from a previous blog post that I’ve had some knee surgeries: three of them, to be exact. I first tore my right ACL in November of 2007, with surgery happening early the next year. That first repair failed six months later, and I had a second ACL reconstruction – or ACL “revision” – in the summer of 2008. Then I had another revision in August of 2013.

Right knee, post third ACL reconstruction, August 2013.
Right knee, post third ACL reconstruction, August 2013.

So, as I’ve been preparing for Denali, I’ve also been rehabilitating from a significant knee injury and resulting surgery. This has been a blessing and a curse.

On the curse side, there are the obvious issues: First, it really hurts. You are breaking through scar tissue, healing significant bone trauma, building up muscle that isn’t there, and dealing with cartilage pain and the ensuing arthritis. Second, it is impossible to climb while going through most of the stages of the rehabilitation. Climbing is movement on unstable surfaces, requiring your leg muscles to constantly adjust and contract to avoid putting undue stress on your bones and ligaments. You need to have enough muscle mass restored to allow yourself to function on unstable surfaces. That doesn’t happen until about nine months to one year after your surgery. Finally, there is the significant emotional toll. You are an active person (most likely, or how did you hurt your knee in the first place) who now cannot walk without assistance. You don’t have free hands (due to crutches) to carry a plate or a water glass. You are suddenly very dependent upon others, and that lasts for months.

On the blessing side, however, I got to focus almost exclusively on my physical fitness, aimed at a long-term goal. When you climb all the time (and I’ve had years when I’m out almost every single weekend), you never really get to push your fitness in as purposeful of way; you are too busy climbing to keep to a regimented schedule dedicated to targeted improvements in strength, cardiovascular fitness, VO2 max, or the like.

Training isn’t always supposed to be “fun,” or you aren’t pushing yourself to the edge of your fitness. And pushing yourself to the edge of fitness every time you climb would be a good way to die young. So, almost by definition, climbing can only be a part of your “training to climb,” as it cannot be the totality of that training.

I got to spend 16 months focused almost entirely on getting more fit. I can say – without hesitation – that I got to the best physical condition of my life… even better than when I was a nationally competitive soccer player at the peak of my late teenage powers and youthful vigor.

…until this last Thanksgiving.

Routine morning workout. A conservative one, at that. No explosive movements. No lateral strain on the knee. Just walking up an incline treadmill with a heavy pack, lunges… straight forward stuff, literally; all the movements are designed to keep the knee in its forward bending plane without significant lateral forces.

And then my knee swelled up.

I could feel it swelling a bit during the day. By Friday morning, I could feel significant swelling behind my knee. I went to see my family doctor. He tested it out and thought it felt “okay.” I wasn’t so sure. I’m now fairly well paranoid about this knee.

The swelling got worse; so bad that the joint seized up. I couldn’t move. Out came the crutches, again. I knew something was damaged. I couldn’t point to any *pop* sound that would suggest another ACL injury. Besides, I wasn’t doing anything that would put torque on my knee. However, I do have arthritis in that knee, and over time, that can wear away at the meniscus. As the symptoms got worse and worse, I became convinced that I had a meniscus tear. I could feel the knee joint grinding over material inside of it like you feel your car running over the rumble strips on the side of the freeway.

Great. Six and a half months out from Denali, and I’ve damaged my knee by doing – well – nothing.

I’ll admit that I went through a grieving process. It took me about three days, and it ran the full gamut. First I was convinced, as the swelling went down, that it was just a temporary thing: maybe my first true arthritis flair up? (Denial) Then I was pissed off. I had been working so damn hard, diligently following my recovery and rehabilitation protocol. What the hell was this all about?! (Anger) Then I was “bargaining”: if only I could get through this without a serious injury, I would cut this and that out of my workout. Maybe I had been pushing myself too hard? Then onto “depression,” which looked a lot like “anger,” but with a full measure of self-pity thrown in: I had been working so damn hard, diligently following my recovery and rehabilitation protocol. *Sigh* What the hell was this all about?

Finally, onto “acceptance.” I was staring down the barrel of something difficult. It could mean early knee replacement (which would mean multiple knee replacements in my life, as they last 10-15 years). It could be another ACL reconstruction. It could be a meniscus repair – meaning three months of rehab and then a struggle to get my fitness up to snuff in time to take on Denali. It could be removal of some meniscus – a simpler three week recovery and not too impactful on my training plans.

Regardless of what it proved to be, however, I could choose to be a victim – concerned about never climbing again, and missing out on some pretty audacious dreams, or I could choose to not let the outcome define me. Maybe I’d have to curb my climbing. Maybe I’d need to learn to climb with a brace. This would require that I create an “11th essential system” around knee care: a custom fit brace, anti-migration system (knee braces slowly slide down your leg over prolonged activity), a whole new set of –slightly heavier – pants that all have full side zips so that I can adjust my brace as needed, the right set of anti-inflammatory drugs taken at the right times, etc. I’d need to find new ways to cope with new limitations.

Maybe my climbing would be more painful. Maybe multiple knee replacements would have to come to pass. It really didn’t matter. What did matter was the choice I had: let my circumstances define me and impose themselves upon my goals, or figure out how to work within new constraints. Climbing is all about dealing with tradeoffs and constraints. What’s one more set of tradeoffs? As long as I was still capable, as long as I could climb safely, I could will myself through the pain and do what was required again… now and in the future.

Waiting for a definitive diagnosis, I modified my training. I may not have been able to carry heavy packs, but I was able to keep up cardiovascular fitness. 90 minutes every day of a sustained heartrate of around 150. I could do it on the elliptical. It wasn’t the best preparation, but it wasn’t nothing. It wasn’t giving up. Rather, I was going to do what was within my power given my new constraints. I was going to move towards my desired outcome of being ready for Denali, even if my current point on that continuum of progress was now further back than I would like. Doing nothing, leaving it to chance, luck, or inactive hope, that is not in my nature.

So, this is how I had been dealing with my latest setback, mentally, emotionally, and physically.

It turns out, as per an MRI, that I have an articular cartilage lesion. There are two types of cartilage in the knee, the meniscus, which sits between bones and the articular cartilage which is attached to bone as a sort of outer shell. I basically have a hole in this outer shell that allows my bone to be exposed, impacted by other bones, and bruised when I weight my knee wrongly.

The non-surgical means of treatment are to learn to make movements that avoid creating impact on the exposed area and wearing a brace (the exoskeleton of the brace absorbs some of the impact of movement). The surgical option involves taking a “plug” of bone and cartilage from a part of the leg bone that doesn’t get impacted during movement, and using that plug to fill the lesion. It’s basically like taking the aeration core from your lawn and putting it in a different aeration hole than the one it came from. Rehabilitation looks a lot like that from an ACL reconstruction, with the same phases in the protocol. However, the initial phases take longer (e.g. getting to weight bearing) and the latter phases (e.g. running and jumping) come quicker. It’s eight months to full functionality rather than the year to fifteen months for an ACL (which is dependent upon your new ACL “reweaving” itself into blood flow and the like).

So, after talking it over with my surgeon, I’m trying the non-surgical option, first. I have some braces from my original knee injury eight years ago. Wearing them has really helped the knee pain. However, they fit a leg shape that I no longer have, so I get some aches and pains elsewhere (such as my shin). It may be that a new custom brace could make a significant difference.

If the non-surgical options don’t work, well…

This likely means that as I get ready for Denali, I will be learning how to manage this “11th system” of knee health. It could be that I won’t be able to sustain the activity I need to prepare for the climb and will need to have surgery. (and thus, miss the climb). However, it could be that it all works out. Right now, I’m encouraged by the level of activity I’ve been able to undertake using a brace. I’m optimistic. Regardless, I certainly will need to know if the brace will work – will need to get out in field and test the the brace and the knee – before traveling to Alaska. I had done this field testing before, trying the new ACL revision on climbing routes of gradually increasing difficulty.

Making my way up the final summit pyramid on Fletcher Mountain’s (13,951’) Southeast ridge as my first test of the new ACL. April 19th, 2014. Photo by Matt Klimock.
Making my way up the final summit pyramid on Fletcher Mountain’s (13,951’) Southeast ridge as my first test of the new ACL. April 19th, 2014. Photo by Matt Klimock.

In the meantime, I’ll be going back to some of “my old friends” in terms of rehabilitation and strengthening exercises while building up the strength to carry the heavy loads that Denali demands.

Some Phase II exercises for ACL reconstruction recovery: working on graft and surrounding muscle strength and coordination.
Some Phase II exercises for ACL reconstruction recovery: working on graft and surrounding muscle strength and coordination.

If I’m honest, I’m disappointed by the setback. I really was well ahead of schedule in preparation, having routinely (daily) carried 90 pound packs on my inclined treadmill and having already made an ascent of Mount Bierstadt (14,060’) carrying up and bringing down 50 pounds. I was well on my way. Now, while certainly not starting over, I am starting from back a few phases in my preparation.

But, while it’s a setback, I refuse to let it be my final destination.

Confucius said, “The man of virtue makes the difficulty to be overcome his first business, and success only a subsequent consideration.” The obstacle in front of me is a knee injury. It is here, and it is now. If I spend my time thinking only of lost time and lost opportunity, I’ll never achieve the level of focus I need to overcome that obstacle.

I have dreams. And, right now, something is in the way of those dreams. I still long to gaze out from my tent window from high upon some glaciated peak, sitting well above the clouds, finding that grain of courage in myself that pushes me ever higher.

Maybe, just maybe, I am still to find that grain of courage while moving towards the roof of North America.

The view from just below Camp Hazard on the rock rib between the Wilson and Kautz Glaciers on Mount Rainier (14,410’). June 18th, 2013.
The view from just below Camp Hazard on the rock rib between the Wilson and Kautz Glaciers on Mount Rainier (14,410’). June 18th, 2013.

Until next time, climb high and climb safely,

Jason

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