Why I Understand
A guy’s walking down the street when he falls in a hole. A doctor passes by, and the guy shouts, “Hey, you, can you help me out?” The doctor writes a prescription, throws it down in the hole, and moves on. Then a priest comes along, and the guy shouts, “Father, I’m down in this hole. Can you help me out?” The priest writes a prayer, throws it down in the hole, and moves on. Then a friend walks by. “Hey, Joe, it’s me. Can you help me out?” And the friend jumps into the hole. The guy says, “Are you nuts? Now we’re both down here.” The friend says, “Yeah, but I’ve been down here before, and I know the way out.”
Inspired by The West Wing

I’ve…
had a total of 10 surgeries due to injury
spent more than a decade recovering from injuries
spent more than a year on my back
spent more than four-and-a-half years on crutches
perfected a full repertoire of crutch stunts, and
learned to walk again four times.

It takes less time to earn a PhD.

I’ve studied for way too long at the University of Injury (U of I). Forget about the five-year plan; I’m on the decade-plus plan. I know intimately what it takes to ward off frustration, impatience, and anger. I’ve learned and researched the most important mental tools you’ll need on your recovery journey—tools I’ll teach you when we work together.

These tools enabled me to preserve my sanity during more than 10 years of injury recovery, but particularly in 2012, also known as The Year I Spent on my Back.

Note: It’s likely you’ve not enrolled in the U of I for nearly as long. I hope not, anyway. Regardless, what we talk about here applies to twisted ankles as well as chronic, life-changing injuries, and everything in between.

Injury came knocking for the first time in the summer of 1999 following a spectacular crash at a National Championship Series mountain bike race in a Pennsylvania ski resort, Seven Springs.

Riding and racing my mountain bike begets connection—to nature, to myself, and to my friends. It fulfills my intense desire to continually explore. After a ten-minute pedal I’ve seen magnificent nature that most people will never see in a lifetime. Mountain biking challenges me to face and overcome fears of scary, technical obstacles on the trail, and that translates into more confidence in life.

Piney Lake

Mountain biking serves as my favorite metaphor for life. Want to know the fastest way to crash on a mountain bike? Look behind you, look at the scary tree leaning just into the trail, or look over the precipitous drop to the right. Before my first adventure, I learned the most important rule of mountain biking. My friend Ed told me, “Look where you want to go. Don’t look where you don’t want to go.” Flowing through life’s sinuous trail demands that you look you look where you want to go.

Indeed, that’s exactly what I did on the technical but outrageously fun race course in Seven Springs. To avoid surprises on race day, my friends and I did a reconnaissance ride of the course. Following a flat, grassy start, the trail climbed into the forest where the tricky bits commenced. Moss took up residence upon the perpetually damp embedded boulders and countless roots. Over and over, I repeated aloud one of the first rules I learned mountain biking, “If the trail is damp, don’t hit an obstacle anything other than head on.” Failure to approach a wet root at a 90-degree angle equals instant crashing.

Riding the technical forest trail reminded me of a high-speed game of chess as I looked three or four obstacles down the trail, calculating my approach and speed accordingly. While exhilarating, this section of trail exhausted my brain.

Thankful to have made it out of the woods unscathed, I let my guard down and exhaled just a little as the trail widened into warm sunshine and smooth grass.

In mountain bike racing, a sign alongside the trail with one arrow pointing down warns of an impending gnarly downhill; two arrows down warns of a steeper downhill—one where a crash means bodily damage; three arrows down implores racers to seriously consider walking. Until my crash, I had never seen a sign with three arrows down and a skull and crossbones.

It came out of nowhere, following a long gentle descent down an easy ski run. Just out of sight, the trail narrowed to a goat path and unpredictably made a sharp left and instantly fell off the face of the earth. I had no time to slow down before my bike was pointed straight down a hill far too steep to even walk.

Time stood still. I thought, “OK, Heidi. You have two choices. You can fall now and tumble down the entire hill, or you can try to ride it out.” Falling’s obvious consequences didn’t seem appealing, so I shifted my weight so far back my bum was almost touching my rear wheel. Any hope of making it to the bottom without crashing rested on resisting an overwhelming reflex—grabbing my brakes. Otherwise, I would have skidded and crashed instantly.

I made it all the way to the bottom of the hill carrying an overabundance of momentum through a bumpy minefield of palm-sized rocks. The second I thought I was safe, I felt my front wheel nose dive into fine silt. I went from trundling downhill at 30-plus miles per hour to an instant full stop. As I remained clipped into my pedals with one leg, my bike went one way and my body another.

I sat up holding my knee, rocking back and forth in agony trailside. Denial compelled me to ignore the pain, so, after the initial shock, I gingerly stood up as my friends waited. Then I rode on like nothing had happened.

The next day I raced well, despite distressing pain and swelling. I figured nothing was torn, and it had been a trek to Pennsylvania, so I might as well race.

Aspen leaf rainbow

Aspen leaf rainbow…Dan and I gathered and arranged these leaves on one of the first hikes I was able to do in Vail.

For the next six months a familiar injury cycle sucked me in: work out→hurt→rest until the pain goes away. The cycle repeated ad nauseam. I finally faced my denial and saw a doctor.

Following my first surgery, with an abundance of enthusiasm and confidence, my first doctor claimed I’d never race my mountain bike again. The chunks of cartilage and bone that broke off the backside of my kneecap would never heal completely, he said. I built up a fierce resentment of my injury and my doctor.

I worked through it by surrounding myself with supportive friends—who are more like family—performing each physical therapy session without fail, and not obsessing over my situation. I lived my life as fully as I was physically able. I trained my mind daily using nearly every tool I’ll teach you as your injury recovery coach.

How did I go from elite athlete to a cripple? The one thing I could always depend on, my well-trained athletic body, let me down. Injury left me angry, impatient, frustrated, hopeless, and trapped. It yanked me out of my sport and my social network. It held me at gunpoint and fled with my identity and self-worth.

Fueled by rage, anger, denial, and resentment, I forced my way through surgery and year one post-op. I grew increasingly bitter and moody, highly unlike my normal temperament. Without my sport I felt as if I had no purpose, no worth, and no identity. Nothing had brought me more joy than racing my bike. I identified as a mountain bike racer first.

Late into my first year of injury and before my second surgery, my best friend and roommate, Christine, intervened. I was instructed to spend all day with my leg elevated above my heart to alleviate swelling. However, the longer I rested my body, the more my anger and frustration overflowed, until I began doing what every self-respecting injured athlete with a knee the size of a cantaloupe would do—compulsive cleaning. Goodness only knows why, but in 2000 I still had a righteous cassette tape collection, and it needed to be cleaned, damnit. I sat for hours on the floor with a bottle of Windex and a roll of paper towels polishing each tape to within an inch of its life. The party ended when Christine, a physical therapist (!!) walked in the door. “Um, what in the bloody hell is going on here?” she asked. “I’m cleaning the cassette tapes,” I said flippantly. “Aren’t you supposed to be on the sofa with your leg above your heart to ease some of the swelling?” she asked. “Well, if I don’t clean these cassette tapes, who will?” I quipped angrily. “Well, okay. I’m going to go in my room for 10 minutes, and when I come out, we’re going to talk,” Christine said. “Fine,” I said.

best friend

Me with my best friend, Christine. People often ask if we are sisters or even twins! She’s on the left; I’m on the right.

As promised, ten minutes later, Christine emerged to find me still cleaning away. She looked intently into my eyes and said, “I know you’re struggling, but this (pointing to my piles of paper towels, bottle of Windex, and crates of obsolete cassette tapes) cannot continue. You need to find another way to deal with this injury.” For a second I was pissed. Then I considered how much bravery she’d mustered up to intervene and thought, “OK. If she loves me enough to say something, I need to find a different way to deal with this injury.”

The feeling of aloneness paralyzed me. I wished for another chronically injured athlete to connect with, but I couldn’t find one. Everyone else’s injury came and left in revolving door fashion. Mine burst in like a couch-surfing relative who refused to leave. Nobody understood what I was really going through emotionally.

Following Christine’s fortuitous intervention, I recognized the importance of adopting some new tools to assist on the road to recovery. They say if all you have is a hammer, then everything looks like a nail. For me, the hammer wasn’t working. I needed pliers. I needed a box wrench. I didn’t always need force. I needed grace. I needed to forego my denial and surrender to what was. I needed balance, resilience, guidance, and optimism. I needed to find strength and the voice lost inside me. The voice that told me to change my attitude but to never give up—the voice that told me I would walk again and that somehow, by some miracle, my swelling would dissipate. The voice that told me one day I would sit on my mountain bike and race again.

I realized the only way out of hammerville required assembling a small army of gifted practitioners.

I found a Licensed Professional Counselor to penetrate my anger and frustration and help unravel my real issues, which snuck up with the subtlety of a bomb when I could no longer train for hours a day. I wanted to run like hell from my real issues, but I knew Christine would toss me over our third story balcony if I didn’t face the challenge of figuring out exactly why I had fallen so far emotionally after my injury. After all, my real issues caused my insufferable attitude.

What were my real issues? Remember when you were a kid playing with a beach ball in the pool? You’d try to hold the ball under water for as long as possible. Eventually, you’d get worn out, and the ball would launch sky high, usually hitting you in the face. My beach ball was “childhood issues,” and bike racing held the ball underwater. When injury struck and I couldn’t race anymore, guess what happened?

My parents did a bang-up job of making me feel unworthy of unconditional love, emotionally unsafe, and as if I were a burden. We all have our wounds from childhood, and my wounds led to anxiety and chronic over-achieving, particularly in sports. I found worthiness, love, and acceptance in sports. I found physical and emotional strength. Sports allowed me to escape bad energy at home and connect with teammates who had become more like family. I didn’t have a voice or identity inside the walls of my house; sports gave me both.

Though the seeds of my issues were planted when I was pre-verbal, they still produced a bumper crop of pain into adulthood. Injury was my life pause button and an opportunity to unravel the trauma from years of emotional neglect and abuse, aka my real issues.

I didn’t stop there though. I also found a new orthopedic surgeon and a new physical therapist with experience relevant to my injury. I found a chiropractor specializing in Active Release Therapy to address years of dysfunctional movement that accompanies injury. I found an intuitive and loving acupuncturist. Recovery necessitates help from a diverse care team. Over the months and years, I inefficiently but inexorably cobbled together a group of practitioners to help me get better and simultaneously (re)build a positive attitude.

Kelsey, my physical therapist turned dear friend, proposed that rebuilding my mental game required using my cobweb-covered right brain. He suggested photography to begin a journey of tapping my creativity and inner strength. Photography created a bridge between my right (grace and acceptance) and left brain (force and frustration). It allowed me to see the beauty in my environment, color, life, vibrance…and it made me grateful to focus, literally and metaphorically, on what was in front of me. Kelsey also insisted I start a gratitude journal. On days when I was in so much pain I couldn’t focus…when my voice shook because I was too devastated to admit my fear of never racing again…when I felt abandoned by the whole world…I looked back at my gratitude journal to revisit a thought, moment, or person who made my soul smile on the darkest days.

Frisbee Bella

Once I implemented Kelsey’s suggestions, I began to feel better—more patient, less angry. I wanted to access those healing feelings more and more. I realized instead of going crazy with all the extra time I had on my hands, I could use it to continue to explore other enjoyable activities that provided solace from anger and frustration. I created a structured mental training plan for myself incorporating many different creative activities, journaling, and alternative movement, since I couldn’t ride my bike outside. Then, I adhered to that training plan like Velcro. My sanity and life depended on it. Little by little, I climbed out of my hole of despair.

Kelsey was a guardian angel to me in more ways than I can express. For example, I developed a severe complication, Reflex Sympathetic Dystrophy (RSD), which caused unrelenting knee swelling, pain, and mental exhaustion. No matter how carefully I followed my restrictions, swelling and pain persisted. There’s no cure for RSD either. Some people get better and others don’t; the randomness of who improves is utterly maddening. Note: RSD is not called complex regional pain syndrome (CRPS). Kelsey accounted for my RSD in his treatment approach, but we didn’t call it RSD when we talked. We called it swelling and we talked about controlling the load on my knee to ameliorate the swelling. We put no wind in RSD’s sails.

I worked through the mental pain by surrounding myself with supportive friends—who are more like family—performing each physical therapy session without fail, and not obsessing over my situation. I lived my life as fully as I was physically able. I trained my mind daily using nearly every tool I’ll teach you as your injury recovery coach.

Ultimately, I created a toolbox containing every mental training tool necessary. The tools helped to ameliorate pain, survive setbacks, and manage relationships that went sideways—a common occurrence for the chronically injured. Injured Athlete’s Toolbox is about sharing those tools with you.

The people who helped me took note of my complete mental turnaround, and I started receiving phone calls from practitioners. “Heidi, I have a patient who is an injured athlete. He doesn’t need psychotherapy; he needs to talk to someone else who has been in the hole and knows the way out.” “Send ‘em my way,” I’d reply. Since the first phone call 17 years ago, I’ve worked with athletes helping them to navigate the emotional maze of injury.

One of my favorite quotes from Maya Angelou is: When you learn, teach. I soon discovered in helping others, I helped myself. It’s a good thing, because I was far from finished with this recovery.

My next stop on the journey following surgery number two was a six month sentence in activity jail. I was allowed to do zero. And I mean *nothing*! No cooking, no cleaning, no grocery shopping, no walking the dog, no social life, no walking to the mailbox. N. O. T. H. I. N. G. I had to depend on Christine for absolutely everything. From athlete to invalid, my brain fought magnificent internal arguments to accept such complete assistance from her. Mentally, I thrashed about spectacularly until I finally relented and realized if she was in my condition I’d do the exact same thing for her.

I was allowed to walk down the stairs, go to work (at my desk), go to physical therapy, and come home. Not one thing more. For six months. If I wanted to go out more than once I called my firefighter friend Erick to carry me down the stairs. He’s 6’5” and I’m 5’11”. We were a planet of arms and legs traveling down the stairs, me thrown over his shoulder in a fireman’s carry.

Fireman's carry

My good friend, Erick, and me reliving the months when I could barely go up and down stairs

One day, after almost two years on crutches and two surgeries, my leg began to work again. I could do a leg lift! Kelsey provided one finger’s resistance to my lifting, then two fingers, then a hand, then an arm. And then I needed real weights. Then I lost a crutch. And then I ditched the last crutch, but I gained a cane. I walked proudly with my cane. When the world wondered why I needed one in the first place, I smiled with the knowledge I was getting closer. Closer to walking again. Closer to living again.

I spent four and one-half years in physical therapy, three days a week. Every day, without fail, I woke and told myself, “Two feet on the ground. Here we go.”

My injury became a gift. I had an opportunity to deal with my real issues from childhood. We all have issues, but few of us have a major life pause that allows us the opportunity to truly heal from and process our past trauma. Moreover, most of us just don’t want to; it’s too painful and scary to open up the closet of rabid skeletons. I didn’t want to, but I was more or less forced to, thanks to Christine.

And, you know what? I came out the other side alive. The skeletons didn’t get me. After I decided to wrestle with my real issues I had peace, strength, and a voice. I realized I could be my own saving grace; I didn’t continue expecting emotional support from my parents in the absence of evidence I’d ever receive it. I reached a point of acceptance and peace. I began to appreciate the time injury gave me to grow and evolve. I realized I was okay just being. I learned how to feel all kinds of different emotions instead of perpetual anger and frustration. I lived with grace instead of force. My worth wasn’t solely defined by my last race finish or schooling boys on training rides.

I grew from the inside, redefining myself as a creative, intuitive, resilient woman. As human beings, we are vessels with infinite dimensions, but as athletes we really only realize one dimension—the athletic one. That’s not sustainable for a lifetime.

Ultimately, I rode my bike again. In fact, I even raced again and I had a great time.

15 weeks before my accident, in August 2010, I was one of 66 women (out of 1000+ co-ed starters) to finish the Leadville Trail 100 (world’s most difficult 1-day mountain bike race: 100+ miles; 10,000+ ft in elevation; 14,000+ ft of climbing).

Leadville Trail 100 MTB

Crossing the line at the 2010 Leadville Trail 100, 15 weeks before my accident

And then came another test. But this time I was better prepared. I had more than a hammer.

In November 2010, I crashed while cross country skiing. You may be thinking, “Cross country skiing? That’s supposed to be safe!” Lots of folks have said those exact words to me. The fact is, it is safe. Unfortunately, that day there was a spot on the far end of the orthopedic injury bell curve that had my name all over it.

I suffered an extremely obscure knee fracture and a completely torn Medial Collateral Ligament, which nobody seemed to care about because they were so alarmed by the fracture. When left unbraced, my lower leg looked as if it were being held together by only skin.

I flew back to Austin from West Yellowstone (where it all went down) and moved in with Christine (yup…same best friend!). She had a sofa that needed holding down and I was the perfect one for the job. I was completely incapacitated and could barely make it to the bathroom and back to the sofa alone. I needed help with everything. Again.

As I was lying on the sofa one afternoon, she sat down next to me. “Heidi, I’m worried about you. I know what you went through last time. I just want you to know you are so much more than an athlete. I don’t want you to go through what you went through with your first injury.” I appreciated her earnest concern. She didn’t want to deal with Heidi v1.0 again—that girl she wanted to toss off the third-floor balcony.

I told her (in the most confident sounding voice I could muster): “This time will be different. Last time, at least for the first year, I felt like I was emotionally wrestling with pigs. We both got dirty and the pigs liked it. I know I am fulfilled and whole without my mountain bike. I’m not saying this is going to be easy. It will be different now because I have tools to cope.”

I called the best orthopedic surgeons in Austin and got responses like, “Oh, I saw one of those fractures in residency.” I ultimately settled on an Austin-based orthopedic trauma surgeon and scheduled what was supposed to be a complex ACL reconstruction for December 2010. I woke up to a nurse telling me I hadn’t needed ACL reconstruction after all. It was the first of an infinite number of Chinese stars I’ve had to dodge for the past (at the time of this writing) almost-nine years.

In the midst of darkness I re-met an individual who is a very bright light, so I’m going to take a timeout and share the story…

Dan and I raced together at the University of Texas while I was finishing my undergraduate work and he was beginning his graduate work. We got to know each other on group rides and he was always kind and considerate of everyone on the team, no matter how fast or slow they rode. Unlike most fast racers, he made sure slower riders didn’t get lost or left behind on rides.

After I graduated, we’d see each other from time to time out on the road or at a race.

In January of 2011, after going stir crazy staring at the walls of my living room, I packed up my journal and my beloved red dog, Bella, and headed downtown to a bike shop with a coffee shop inside. A few friends worked there, but none knew I was injured. I sat in my car for 20 minutes doing mental gymnastics with myself, repeatedly questioning my next steps. Which entrance do I use? The coffee shop side or the bike shop side? Was I going to swiftly crutch into the coffee shop and avoid my friends so I didn’t have to explain what happened? Or was I going to face my friends and explain?

About my mental gymnastics routine in the car… Crafty as ever, our language has a word for that: perseveration. It means repeating something insistently or redundantly. In the case of injured athletes, “something” typically equals a particularly grim or anxious thought; such thoughts breed more of the same thoughts ad infinitim. The thoughts rapidly accumulate into a venomous negative mantra. What each individual perseverates over is different, but a representative round of injury perseveration sounds like this: I hate this. I want my life back. I’m sick and tired of being in pain. I miss my friends. I hate asking for help. I feel like a burden. Repeat over and over. See where this leads? Nowhere productive or healthy. Unfortunately, injured athletes master perseveration quickly. Fortunately, I can guide you to stop such thinking.

Now back to the bike shop… I chose the bike shop side, and as I rounded the corner to say hi to my friends, I ran into Dan. He had been out on a ride, had a flat, and discovered his spare tube had a hole in it. We both lit up and chatted like teenage girls. After I could no longer stand on one leg, I said, “This has been just wonderful! I’d love to talk more, but I can’t stand anymore. Maybe we can take the dogs to a park so I can sit and we can catch up more.”

A couple of weeks later, we met, with our dogs, and continued chatting like teenage girls. Dan asked me out to dinner, but I didn’t know if it was as friend or a date. I consulted with Christine, and she asked, “Is he picking you up?” I said, “Yes.” She said, “That’s a date.” Fair enough…

We dated for a bit more than a year, got engaged in 2012, and were married in 2013. For his patience, (For example: After eight weeks of dating, he took me to the hospital for my second surgery at 5:30am for a supposed-7:00am surgery that didn’t happen until 4:30pm. Without an ounce of resentment, he patiently sat with me and we talked the afternoon away.) his unconditional love, his genuine kindness, his sense of humor, and his generosity, I’m going to nominate Dan for sainthood. I’m positive my nomination won’t be contested.

wedding

Dan and I at our wedding. Though I walked down the aisle (to the Rocky theme song played by my friends on violin and sax), I needed a stool to sit for most of the ceremony.

Now back to the story of my knee…

In March of 2011 I had a second surgery in Austin to remove extensive scar tissue and relieve a terrible pressure and pulling sensation under my patellar tendon. The surgery was declared bloody by virtue of the fact that the surgeon had to tourniquet my leg…never a good sign.

I was told to slowly return to my activities. I had about three quasi-functional months, then the pulling, pain, and pressure returned. Walking was possible only through creative usage of a patellar tendonitis strap. Instead of placing it over my tendon, I placed it above my knee. I lived with unrelenting burning pain, so I went back to my Austin-based doctor, insisting on another MRI. It revealed my scar, only bigger and stronger. He wanted to remove it once again. I decided it was time to see the best.

I had been doing physical therapy with Kelsey again, and he suggested I see Dr. Richard Steadman at The Steadman Clinic in Vail, Colorado. That brought up memories of squirreling away in the Life Sciences library at the University of Texas at Austin reading sports medicine journals for research projects. I’d read many articles authored by Dr. Richard Steadman, and I was fascinated by his progressive and unconventional approach to knee surgery. For instance, he questioned ages-old ACL reconstruction methodology and researched new and better ways to conduct the procedure, ultimately with much better outcomes. Maybe he knew something about arthrofibrosis…

I also remembered a fellow patient I got to know at the PT clinic while rehabilitating from my first knee injury. I recalled he had a similar fracture and subsequently developed arthrofibrosis.

I called Dr. Steadman’s office and learned he was indeed an arthrofibrosis expert. “Thank you, God and universe,” I repeated to myself.

In October 2011 I made my first trip to The Steadman Clinic in Vail, Colorado. I realized that the surgeon who performed my first two surgeries dug me a very deep hole, botching my surgeries by using the wrong tool to address the scarring in my knee. As a result, my patellar tendon was scarred down to my tibia and my patella was stuck like concrete. I was lacking 22 degrees of extension. That means my leg was dramatically and permanently bent. I could not straighten it. Dr. Steadman diagnosed me with a severe case of arthrofibrosis, a chronic, rare, and debilitating scarring condition. Of all knee pathologies, arthrofibrosis is arguably the most difficult to treat surgically. It requires the surgeon to have the hands of a jeweler, not a lumberjack.

My third surgery (and first at The Steadman Clinic) was December 7, 2011, which I now consider to be my knee’s birthday. Without my effort to reach out to a new care team, I would have been crippled my entire life, but I wasn’t willing to accept being injured as my destiny.

Chris Watts, ATC, me, and Dr. Steadman

Chris Watts, ATC, me, and Dr. Steadman

During rehabilitation I connected with other athletes whose journeys have been as convoluted as mine. They became my friends and Vail family. We all shared one thing in common—that far end of the orthopedic injury bell curve. Rehab became ground zero for swapping stories, empathy, compassion, support, and injury jokes only we could understand. Each of my friends has given up their lives to heal; some have been fired from their jobs, others have likely lost what they used to dream about. Our stories overlapped so much that we ended up completing one another’s sentences, and many conversations involved more head nods than words. Best of all, nobody got impatient if one of us wasn’t healed yet. Throughout my first recovery I longed to talk to another athlete who really got it. Now I have connection to a whole group of friends who aren’t willing to accept being injured as their destiny either.

Krause Springs

Knitting remains a source of comfort and meditation. Here I am in the spring of 2019 recovering after a three-hour hilly bike ride: swimming in cold springs and knitting against a 16-foot wide Cypress tree

Leaving my care team and support system in Vail that first time was terrifying. Back home, I was reminded of all the normal trappings of life in which I couldn’t participate. I learned the fickle nature of arthrofibrosis and acquiesced to forgoing my normal life once again. It was like Groundhog Day, only this time I didn’t fight.

I accepted what was, so I suffered magnitudes less. I used every tool I acquired from my first injury. I accepted help. I allowed my friends and husband to cook and clean for me. I focused all of my energy on staying positive and hopeful. My friends asked, “How in the hell can you spend eight hours a day on your back in a CPM (constant passive motion machine—a machine that slowly bends and straightens the knee to keep scarring to a minimum)?” I went right back and picked up my creativity tool. Creativity was my solace. I learned to knit. I did beadwork. I wrote a ton. I wrote real, hand-written thank you notes to everyone who helped me. I spent five hours a day doing physical therapy. I slept as much as my body needed. I learned how to strength train on my back or sitting in a chair.

I shocked myself after a 19-year swimming hiatus and returned to the pool for aerobic exercise, something I swore I’d never do after way too many years of pre-dawn workouts. Many years of coaches yelling and screaming from a pool deck for hours a day made me allergic to the stripe on the bottom of a pool. In the ocean I’ll swim all day, but if I see a stripe all bets are off.

My pool return happened unexpectedly. Dr. Steadman prescribed aqua jogging after my December 2011 surgery. Dan joined me for the first time and, after I had finished jogging, he suggested I swim a few laps. I rolled my eyes and sighed.

Lake George Open Water Swim 10K

I’m all smiles having just crossed the finish line at the Lake George Open Water Swim 10K race

Then, in a moment of clarity, I thought, “Huh, maybe he’s onto something. I’m taking things hour by hour, but he sees the big picture. He sees this recovery taking years, so he’s suggesting swimming as an alternative to cycling.” Begrudgingly, I swam 8 laps and had an epiphany. I realized that my disability disappeared in the swimming pool, and I was hooked, but that didn’t change my hate of stripes underwater. So, I explored and fell in love with open water marathon swimming. The longer I swam, the better my mind and body felt. Plus, no two swims in the same water body are ever alike; open water swimming is never boring and predictable.

CPM

This is a CPM, or constant passive motion machine. I spent hundreds of days and tens of thousands of hours flat on my back with my leg placed in this machine as it slowly bent and straightened my knee. The constant, almost imperceptible motion prevented much of the re-scarring of my knee post-operatively. I used my CPM for months and years longer than most doctors recommend because it was still helping ameliorate stiffness. For me, this tool was my secret weapon to ward off scarring and stiffness, two hallmarks of arthrofibrosis

PS–I earned a new title in 2012: CPM whisperer. The beast is often restive at 1:00am, clunking, shrieking, grinding, and squeaking so its captive cannot rest. WD-40, straps, bungee cords, bicycle chain lube, dental floss, tape, towels, and a flash light are the tools of my trade. When one becomes insufferable, it gets replaced without remorse. No black veils are necessary. The CPM rep and I are on a first-name basis. I have also learned that ice machines can give you frostbite, crutches in Vail need crampons, and all of this paraphernalia sticks around too long and unexpectedly returns, just like bad relatives.

Crutch cramponsDuring a follow-up appointment at the physical therapy clinic (think Cheers, the TV show) I met two men who made me ask two questions that changed the course of my life. I’m going to interrupt my injury story to introduce the story (which happened within my injury recovery) of how I started Injured Athlete’s Toolbox.

The three of us were side by side on exercise bikes taking a slow and scenic ride to nowhere. One was an active Dallas Cowboys player recovering from hip surgery; the other was a gentleman in his late 60s who has no recollection of learning how to ski because he was a toddler when he learned. We were chatting when I realized that these two men—who could not be more different—were using the same words to describe their injury challenges.

“Huh,” I thought, “I wonder why this is. I think this is something I’d like to research. I’m about to spend many months on my back. I may as well do something productive and stimulating with my time.”

So, I embarked on a year of research to determine two things: First, what were the common words injured athletes use to describe their suffering? Second, I wanted to talk with athletes who said things like, “My injury was the best thing that ever happened to me,” or “My injury made me a better person,” I wanted to uncover what different habits or attitudes they practiced.

Very quickly, I redefined athlete. I realized no matter the person’s age, sex, sport, or level within a sport, the words people used to describe their suffering were universal. So, to me, an athlete is anyone who gets enjoyment out of movement.

I used the results of my research, my own 10+ years of injury experience, and more than a decade of informally guiding injured athletes to create Injured Athlete’s Toolbox. I help injured athletes move from feeling frustrated, impatient, and angry to feeling optimistic, patient, and motivated by teaching them the essential tools for injury recovery.

Back to the arthrofibrosis recovery story…

Arthrofibrosis isn’t a one-and-done pathology. I had a fourth and fifth surgery (at The Steadman Clinic) in March and May 2012. These two interventions were relatively minor, but carried all the restrictions of major surgery.

I had a tiny window of semi-normalcy during June 2012. I began a walking progression and did a few 30-minute bike rides outside. Ah, sunshine!! Alas, it was another false dawn. Around August I could tell the scar was growing back, restricting my movement. I had a sixth surgery (also a more minor intervention) in September 2012 in an attempt to avoid a major surgery.

In November 2012, during a follow-up visit, I traveled even further into that teeny tiny corner of the bell curve. Nine months post-op, part of my scar had organized itself to look like an extra ligament in my knee, something Dr. Steadman told me he had never seen before. Most of his patients are short a ligament or two. I had an “extra” that sorely needed to go. I had my seventh surgery on November 7, 2012.

2013 was a year of polar opposites–huge progress and setbacks. I recovered slowly and smoothly from surgery number seven and accomplished three important goals: 1) walk down the aisle at my wedding; 2) stand up off the toilet unassisted–no pushing on the counter for assistance (I’m serious!); 3) conquer grocery shopping. Everything was going well until nine months post-op when I began to experience locking and tugging caused by the scar. Most arthrofibrosis patients risk scar regrowth within the first 12 weeks post-op but twice now I’ve had scar regrowth at nine months. In the fall of 2013, my care team and I decided to determine if the locking and tugging was caused by muscle weakness. I got stronger and stronger, but my symptoms remained. In lieu of an immediate eighth surgery, I made a proposal to my PT Luke: within my limitations, I would “do life” for the next few months. I could take short walks, go for easy hikes, and have a [measured] mountain bike adventure in west Texas. I could even try an easy Nordic ski on flat, groomed terrain. If my symptoms remained, I would still have surgery #8, but at least I would have a mental and emotional break first.

West Texas mountain biking 1 week before surgery in 2014

I savored every second of “doing life.” I still had limitations and constant pain, but it had been three years since I had experienced a remotely normal life. The goods news is my knee didn’t get worse during my period of relative normality, but it didn’t get better either. Apparently it had finally stabilized. Surgery #8 beckoned. Now for the bad news: the man I had come to love and trust had unexpectedly retired.

Dr. Steadman is one-of-a-kind. He’s without ego and overflowing with wicked intuition and compassion. His kind smile and warmth put me at ease. He listened. And then he listened some more. I knew as long as I didn’t give up on myself, he would never give up on me. His mind could imagine the location of a scar without even peering at MRI images. When I closed my eyes on the operating room table, I never, ever worried. I can walk today because of him, and my gratitude for his care and encouraging hugs is without end.

My case was gracefully transitioned to Dr. Steven Singleton, who studied with Dr. Steadman in the 90s. Dr. Steadman’s practice coordinator, Cristal, described Dr. Singleton “as close as we will ever get to Dr. Steadman.” I thought she was smoking crack. Turns out, she was spot on.

In February 2014 (after a 16-month break from the operating room), Dr. Singleton addressed the scar that had been causing my symptoms in surgery number 8. It originated on one side of my patellar tendon, snuck underneath the tendon, and attached to my medial meniscus. No wonder my knee sounded like a bowl of Rice Krispies, and walking caused constant pain.

I celebrated a huge milestone in the spring of 2015. When tested in isolation, my muscles (quadriceps, hamstrings, external and internal rotators, gluteus minimus, gluteus medius, and gluteus maximus) in both my affected and unaffected sides were the same strength–a monumental victory! There were lots of high fives and hugs at the Steadman Clinic and at the PT clinic downstairs.

With Dr. Singleton a few hours after my surgery in February 2014

I diligently followed restrictions and completed daily physical therapy without expecting or knowing when I’d reach this milestone; I just knew one day I’d get there. Imagine my smile when “one day” finally came. To put this in perspective, when I arrived at the Steadman Clinic, my affected quadriceps muscles were 11 centimeters smaller in circumference than my unaffected quadriceps. Talk about lack of muscle strength! I frankly needed a custom tailor to make pants for me—one side for a super model and one side for a mountain bike racer.

Speaking of…In the fall of 2015, I celebrated my first true Colorado mountain bike ride with my husband, Dan, and my physical therapist, Brooke, who has been with me since my very first surgery at the Steadman Clinic.

mountain biking

One of my wonderful PTs, Brooke, and me striking our best Glamour Shots pose in the middle of a mountain bike adventure

Of course, setbacks happen on a recovery this long, but they’ve all been manageable. On separate occasions, I’ve taken three doses of oral steroids to address two small and one terrifyingly-big flareups. I’ve never been considered dainty or graceful, so no matter how careful I am, I’m prone to whack my knee into something. Fortunately, most inanimate objects are fairly forgiving. Unfortunately, kitchen cabinet door pulls are not. Ouch. Luckily, all the flareups responded to steroids, because, had they not, I would have had another less than fortuitous date with the operating room table. Luckily, I’ve been able to manage most flare-ups with rest and a prescription compounded lotion that targets inflammation and inhibits scar formation.

In the fall of 2017 my recovery plateaued. I began feeling a painful snap with each step over my previously torn medial collateral ligament (MCL). Coincidentally, my chiropractor-friend, Kyler Brown, had just received a Piezo Wave 2 machine (an acoustic wave device like a lithotripsy machine used to break up kidney stones, but this machine is used for orthopedic applications) on evaluation. He asked if I wanted to test it out. “It can’t hurt,” I responded. After three treatments the painful snapping and pain disappeared and hasn’t returned. It’s obvious the Piezo Waves were able to break up the scarring over my MCL.

The next conundrum was a pervasive feeling that my body from the waist down was not communicating with my body from the waist up. I felt like two different people glued together at the waist. My gait felt awkward. Swimming made my right shoulder (opposite my affected leg) ache badly because instead of using large core muscles to drive my swimming stroke, I used small arm and shoulders muscles.

I felt scared and discouraged because my recovery was going backward. I had worked for years to regain capacity and quad muscles. Over the course of a few months it slipped away…and nobody could figure out why.

Most physical therapists are trained to notice obvious and objective deficiencies. My best friend, Christine (yep, same friend from the cassette tape incident) notices and knows how to fix subtle and subjective deficiencies.

I knew this about her, but hesitated asking for her help because mixing PT and friendship didn’t feel right. Ultimately, in the summer of 2017, frustration broke me. My quadriceps muscle going on vacation, combined with all the other issues, pushed me over the edge. I shamelessly asked if I could visit with “PT Christine” while she was in town.

Not surprisingly, Christine identified seven dysfunctions, all of which explained my waning capacity and janky gait. She created three physical therapy routines for me to alternate on Monday, Wednesday, and Friday.

Chronic injuries beget dysfunctional movement patterns and neuromuscular disconnection. I worked with Christine to identify and learn how to fix one disconnection, then another, then another. Arthrofibrosis is chronic, therefore, so is my physical therapy and training. I’ve adopted rehabilitation as a practice and a gift—because I can still affect change in my recovery. I can still make progress. I have no attachment to when or how much I’ll improve; I just know I will.

Big Bend Ranch State Park

Eden…a spring-fed waterfall up a remote canyon in the middle of the desert in Big Bend Ranch State Park

So, back to physical therapy I went for three days a week for about six months while I learned proper form and control for each exercise. I had little proprioception (awareness of the position and movement of the body) and my body attempted to cheat most exercises. My Austin PT, Brenda, taught me to execute each exercise with perfect form, which created a foundation for progress.

Most people would have processed such a regression as a depressing backward slide. I didn’t. I saw an opportunity for improvement. I knew that diligently following Christine’s specific and targeted program would improve my capacity, but I had no idea how much…until February 2018.

Dan an I attended an annual weekend mountain bike festival in February 2018. On Friday, we rode for three hours in the middle of nowhere West Texas desert on technical singletrack to a creek drainage. There we stashed our bikes, put on tennis shoes, scrambled and bushwhacked up an overgrown canyon to Eden—a spring-fed hanging waterfall in the middle of the desert. Ferns and Columbines surrounded us. We soaked in the frigid spring water shower, enjoyed lunch, then scrambled back down the canyon, switched shoes, got on our bikes, and rode two-and-a-half hours back to our campsite. My knee felt better than it ever had post-adventure that evening. It even felt great the next day on an easy ride.

Two days later, I went on another mountain bike adventure, this time with a group—something I’d avoided for years because I can’t govern my speed riding with others. My knee felt great, and I found someone my speed. We pushed each other to the point of drooling for hours…and my knee felt solid.

I called Christine on the long drive home and told her the weekend felt like a friend coming back from the dead. Never in my wildest dreams could I have imagined again experiencing such adventures. In fact, I’d long since accepted my pre-working-with-Christine capacity. After all, I’m lucky just to be able to walk properly and doing activities of daily living, yet over the course of the weekend I experienced glimpses of my former ability and speed.

Big Bend Ranch State Park

Scrambling up the canyon on our way to a glorious spring-fed water fall (note: there’s no trail…this was all bushwhacking)

After about eight months of patience and persistence, I’d progressed through the first set of routines, and Christine assigned new fun and torturous routines. I’m currently working through my third progression and feeling more strength and coordination than ever, but I have to keep up with my training. If I decide I’m above doing my routines, my knee and body squawk back.

My capacity has improved beyond measure since I began working with Christine in the summer of 2017.

It’s summer 2019 now. I’ve made it longer without surgery than I have since 2010—5.5 years.

I can walk or hike for about two hours. I can ride my bike on rolling hills, steep hills (my favorite), and moderate trails for more than three hours.

I’m accomplishing a long-term recovery goal: taking adult ballet classes beginning in November 2018. Intuition led me to ballet. I had a hunch it would contribute to properly timed muscle engagement. Turns out, the body awareness and muscular control necessary for ballet overlaps with the work I’m doing with Christine. Plus, I’ve met several new friends with whom I’ve really clicked and I have a whole new community.

Most importantly, I can do many normal life activities like going to the grocery store, some chores, and gardening, aka dirt therapy. I no longer have to worry about going grocery shopping obnoxiously early to avoid lines (I’ve abandoned more than my fair share of grocery carts in the last five years because my knee permitted only minutes of standing.). I can participate in obedience classes and competitions with my dog and make weekly therapy dog visits with her to see patients in the hospital. I’m Italian; I’ll never shed of my cleaning tendencies (my compulsions have vanished–another gift from my injury!). Now, as my knee permits, I can once again wield the Windex bottle and paper towels.

I’ve begun to say yes to most social invites. My introversion limits my social life more than my knee now. I really feel like I’m able to plug back into life, but sometimes I feel pressure to make up for years of lost time. Sometimes I overdo it. Dan likens my knee to a freshman in college. I have more freedom now, but sometimes my knee and I go out and party a little too much.

Twin Sisters

Climbing a wall of a hill (perspective on steepness is nearly impossible to photograph) on one of my favorite Hill Country bike routes…Eight years post-injury, I’m beyond grateful for all the love and support it took to regain the strength to do this ride again.

After having them glued to my underarms for nearly four-and-a-half years, my crutches are a distant memory (as I type this, they’re in Virginia with Christine as she recovers from ankle reconstruction). I considered smashing them into oblivion, but that’s just bad karma. If you ever want to see crutch stunts, just give me a call. I have a whole repertoire that makes my physical therapists gasp in horror.Crutch stunts

My CPM—that I now own because insurance paid for it for so long—sits boxed up in the garage. I’ve loaned it to two friends so far.

Life for most of the past almost-nine years has been like driving around a traffic circle stuck in the inner lane. Every once in a while, I merge to the outside, put my blinker on to exit, and another car dives into the circle pushing me back into the inner lane. But…I think I’m working my way to a more permanent spot on the outside lane.

The financial strain of the last almost-nine years has been almost unbearable at times. Not being physically able to have a traditional job with a steady income occasionally breeds intense feelings of inadequacy, shame, and being a burden to Dan. Money stress triggers my worst days. Even with insurance, we’ve had significant expenses, especially since receiving proper treatment necessitated traveling to Vail, Colorado, from Austin, Texas. We’re not independently wealthy, and nobody has helped us financially.

There have been long periods of time where my view literally hasn’t changed much. I’ve spent thousands of hours lying on the couch, and I still cannot sit for more than about an hour without my knee getting painfully stiff.

Wonder Woman

To celebrate my first ride back on the road after my last surgery in 2014, a friend sent me a Wonder Woman t-shirt and socks, with their own little capes!!!

There were years of crutches and wheelchairs. I’ve had extensive driving restrictions. I spent 2012—more than 365 days in a row—on my back in a CPM for eight hours a day and all night long. Physical therapy was my full-time job for years and it didn’t pay well. I have had to say no to nearly every social invite. I have had to endure friends and family judging me, blaming me, and armchair quarterbacking my decisions. People make the darndest rude comments—You’re still on crutches? Another surgery? My gosh, when are you going to be done with all of this? Don’t you need to get a new doctor? Why aren’t you better yet? Having a debilitating and chronic injury that’s invisible to others leaves me open to questioning and judgment. I look normal; why can’t I be normal?

Even as far as I have come, sometimes it seems as if I’m walking at a standstill on a treadmill, because the scenery in front of me doesn’t change drastically. Getting better from arthrofibrosis is a glacially slow, all-encompassing process. But if I take time to look behind me, I realize just how far I have come (emotionally and physically)—much further than most people would have thought possible, and they are right, but only regarding people who have accepted their fate.

Martha Beck says, “A lot of people tell me, ’I need to find my passion.’ They rarely realize that the word ’passion‘ is from the Latin pati, ‘to suffer,’ or that passion originally meant ‘pain’ (as in The Passion of the Christ). Knowing that, it becomes much easier to track your passions; even if you feel no interest in anything, odds are you have suffered. Wayfinders of all cultures know that healing the self from any kind of torment is the groundwork for healing others, for creating a positive change in the world of Form and thereby establishing your career, your life’s work. Let’s track your true nature along this path of passion.”

My injury led me to my passion. During the last 17 years I have helped many athletes navigate the maze of injury—the impatience, frustration, loss of identity, and lots of other challenges. People ask me how I measure success. I respond, “To me, success is when a client comes back to me and says, ‘Heidi, you were right. My injury was one of the most difficult challenges of my life, but also one of the best things that has happened to me. My injury made me a better, stronger version of myself.’

My favorite Austin graffiti

A few fun tidbits about me

I like pink polka dot PJs and fleece socks.

I like snow falling and dark rainy days.

I like the sound of my skate skis pushing snow and poles digging in.

Coffee is my favorite comfort food.

I love nerdy chemistry jokes. I’m like Good Will Hunting when it comes to organic chemistry.

I grew up on the back of a horse. Horses were my first teachers.

I have a wise red dog.

I love elephants and owls.

My favorite book is Flow.

I like the inspirational graffiti around Austin. This little critter is my favorite.