Arvind Ashok: Fitness & Nutrition Simplified

A bit back, I injured my knee rather seri­ously while play­ing Ulti­mate. We were in Ban­ga­lore, play­ing a tour­na­ment, and it was the last point of the last game, and I was tired, ended up land­ing rather hard and tried to turn while my ankle was still planted, and heard a pop in my knee, fol­lowed by pain.

It has been a hard time, and am while am still not done with my recov­ery, I’ve learned quite a bit from this episode and wanted to write about it. This is not about what to do if you injure your ACL etc, but rather about how sur­pris­ingly dif­fi­cult and con­fus­ing this entire process was. While I am not an expert on injuries and phys­io­ther­apy, I am rea­son­ably clued in about it. And yet, there were a lot of doubts and road­blocks that I went through.

Right after the injury

I was in no posi­tion to go any­where. So, I was moved out of the way to the side­line, until the game and the spirit cir­cle fin­ished. After that, I man­aged to hob­ble along with lots of help, and we went directly to the best ortho (Doc 1) around nearby. My knee was pretty swollen, as is nor­mal in this sce­nario. After get­ting an x-ray done to see if there was a frac­ture, the ortho swung by and did a few stan­dard tests to see if my lig­a­ments held. He seemed pretty sat­is­fied, told me that my bones were con­tused (bruised) from the fall and that I needed to rest. No torn lig­a­ments or any­thing like that — which was my ini­tial fear.

My research

While I was rest­ing, I did my research on knee injuries, trauma, bone bruis­ing, and ACL tears as well. Just some back­ground on the ante­rior cru­ci­ate lig­a­ment (ACL). A lig­a­ment is tis­sue that con­nects two bones, and the ACL is one of four lig­a­ments that con­nect the thigh to the shin (femur to tibia). The knee joint’s main func­tion is sta­bil­ity, rather than mobil­ity. It is not built for rota­tion or for too much for­ward move­ment. So, when my ankle got stuck and I still tried to pivot, rota­tion is exactly what my knee did. Every­thing that hap­pened to me was indica­tive of ACL and menis­cal tears. So, I wanted to be careful.

My goal out of this was pretty straight­for­ward — I wanted to get back to doing what­ever I nor­mally do — train and play Ulti­mate. Nor­mally, I rush things. I fig­ure out what the best thing to do is, and do it. But I was not going to rush it, but be patient, lis­ten to the experts (rather than lead with my research) and do what was required. If only it was that straightforward!

Most of my research indi­cated that I would need surgery if I had torn a lig­a­ment. I was young enough, and my activ­i­ties required it as well. But one resound­ing thing was to get the knee as good as pos­si­ble, before surgery. This would improve chances of the knee get­ting health­ier, and back near its best. And this was what I used as a guid­ing tool, through­out this process.

More Rest?!

I was told that if I did any kind of physio work, I would be delay­ing the heal­ing process. My knee would func­tion nor­mally once the bruis­ing went away. And rest was the best thing.

Once I got back to Madras, I wanted to seek another opin­ion, and went to an ortho (Doc 2). I was advised more rest and told to come back with an MRI. He said that the bruis­ing had not sub­sided yet, and hinted at lig­a­ment dam­age as well. I went and got the MRI done, which indi­cated a fully torn ACL, in addi­tion to bone contusion. I was men­tally ready for what­ever, and it didn’t really affect me too much. I had def­i­nitely done some­thing to my knee, and I was just ready to find the right way to move for­ward and get on with it.

I was not too com­fort­able with Doc 2, and so fixed up an appoint­ment with a spe­cial­ist (Doc 3) in sports injuries, as well as another well-reputed ortho (Doc 4). Doc 3 did not want me to bring in the MRI as he was of the opin­ion that a phys­i­cal exam­i­na­tion will reveal more. I can def­i­nitely under­stand this atti­tude as an MRI is not 100% indica­tive of any­thing, and is just one part of the diag­nos­tic process. Doc 3’s diag­no­sis was a torn ACL and menis­cus, and for me to have surgery imme­di­ately. Doc 4 told me to rest some more, wait for the swelling and con­tu­sion to sub­side, and then get surgery.

Did I rest too much?

By this time, I was wor­ried and con­fused. I was not sure what the right thing to do was — rest or phys­io­ther­apy. My bones were still con­tused, but my knee func­tion­al­ity kept dimin­ish­ing. I had been rest­ing my knee, just as rec­om­mended, and it wasn’t get­ting any bet­ter. And while I was rec­om­mended surgery, that just did not sound or feel right at all, at this point of time. Would I undo all the rest, hurt myself more if I did phys­io­ther­apy? I was not helped by a train­ing acci­dent a cou­ple of weeks ear­lier, when my home pullup bar fell down. I had restricted my train­ing to upper body work alone, coz it is impor­tant not to be active and not gain weight in a sit­u­a­tion like this. Pretty straight­for­ward, but acci­dents hap­pen. While not much hap­pened to my leg, it just made me real­ize how vul­ner­a­ble my knee was, and how small things like tripping/slipping would be cat­a­strophic. So, I stopped train­ing after the acci­dent, and just focused on what I needed to do.

Against doctor’s orders, I started doing some band work on my knee. And started to feel bet­ter day within a few days. I real­ized it was time to find a good phys­io­ther­a­pist, as in hind­sight, it looks like I rested my knee for too long. Maybe, if I had started phys­io­ther­apy ear­lier, this prob­lem could’ve been a bit eas­ier to solve pos­si­bly. Too late to think about that, I had a knee to fix.

This is how much I could bend my knee in the early days of phys­io­ther­apy. Yes, I could not bring my heel closer to my butt.

And I couldn’t sit on my heels as well, some­thing I’ve always done. In fact, I’ve never had to con­tem­plate not being able to do some­thing as mun­dane as this.

Can’t sit down on my heel.

A Con­fus­ing Process

This was def­i­nitely a very con­fus­ing process. I have not had that much expo­sure to injuries per­son­ally, and learn­ing to han­dle an injury is one thing. Learn­ing what to do is another. Eval­u­at­ing con­flict­ing advice, fig­ur­ing out the best way to go ahead — stress­ful, let me tell you! Every­one has their own prej­u­dices, their own skew. It becomes vital to fig­ure out what is impor­tant for you, a totem if you may, and guide your­self through the process based on that. For me, I broke it down as such,

1. Uhh, this hurts. A lot. I need to see a doc­tor (Doc 1). Shut up and do what he says, it just hurts too much.
2. Find a doc in Madras, as it is a lot more con­ve­nient. Diag­nose the problem.
3. Do my research, fig­ure out what is nego­tiable, and what is not. I wanted to get back to full fit­ness, get back to what is “nor­mal” which is do a bunch of stuff — play, lift weights etc. Surgery might be nec­es­sary, but is still an elec­tive surgery. And that I should get my knee as func­tional as pos­si­ble, before surgery.
4. Set­tle on a doc that I liked. This took a while, but I finally did. Lis­ten to them, see how I respond.
5. While I did what was rec­om­mended, it didn’t seem to help. After giv­ing it an hon­est shot, I real­ized that this approach might be right for some folks but was not right for me.
6. Tried the alter­nate approach, real­ized it felt bet­ter. And found an expert on the same wave­length as me. And pro­ceeded to lis­ten to him.
7. Am I get­ting bet­ter? If so, con­tinue doing what am doing. If not, well, that’s for the sec­ond part.

I will fin­ish up this story next week. I want to leave you with a thought, a digres­sion. Con­flict­ing pieces of advice is com­mon, espe­cially in the world of health and fit­ness. From where I stand, my advice and rec­om­men­da­tions on nutri­tion and train­ing are more on the “right” side of the scale than the “wrong” side. Some things I rec­om­mend seem bla­tantly wrong — eat egg yolks, good fats, rice over wheat etc. Even though these things are based on solid sci­ence, since it goes against what we’ve heard all our lives, it is hard for folks to accept. Maybe to the surgeon(s) and my physio, what I should’ve done was straight­for­ward. But it was not at all, to me. I had to come up with a sys­tem for me to nav­i­gate through this process. And that’s what you need to do too, to fig­ure out sim­i­lar conun­drums that you face. For my part, I will redou­ble my efforts to be elu­ci­date my stance fur­ther to aid you on your fit­ness journey.

Again, this is by no means a guide for you through your ACL injury (or any injury). At the end of the day, you got to take the call. And maybe read­ing my account will help you fig­ure out what frame­work to use to make that call.