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Feature - Beyond the comfort zone

Getting back to game after injury

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When you’re in the comfort zone, life is easy. The boat isn’t rocking, you’re not pushing your limits, everything flows.

Somewhere out beyond the comfort zone is a little room. A room you don’t want to be in. This room is peopled with men in white coats, women wielding ultrasounds, supersized bottles of Ibuprofen, Crayola-coloured physio balls. Oprah Winfrey is there, along with your mother’s chicken soup, the remote control, a pile of unintelligible WCB paperwork. This room is one of your possible destinations when you push yourself past the comfort zone – the possible future that comes into existence when you mess up and get hurt. An injury is your passport to this place – it’s Recovery and Rehabilitation Central.

Dr. Hugh Fisher, Pemberton-based physician, and an athlete and coach in his own right, explains why the Sea to Sky corridor might be ground zero for sports-related injuries.

"It’s the direct goal of many sports to push you outside the comfort zone because that’s where the thrill is. And that’s where people get injured."

Recognize the profile? Check your garage/storage locker/entryway. Are you tripping over skis/boards, bikes, clubs, to get into your house? Do you have a diluted S&M-style crush on your physiotherapist? Do you buy bottles of Ibuprofen in the super-sized version?

One in five of my work colleagues is currently undergoing treatment for injury. They randomly encounter each other on the tables at the physiotherapist, for a brutal session of back-cracking, rib-popping, and shoulder-rotating, before limping off to work. Granted, the season takes its toll on your body, but they definitely fit the profile of frequent venturers beyond the comfort zone.

So too does local athlete and ski guide, Lee Anne Patterson. Patterson has suffered her share of injuries in a ski career that has seen her making first ski descents of numerous peaks around the world and ascending the ranks of the international freeskiing circuit – concussions, several torn knee ligaments, a broken nose, a busted shoulder. Getting injured is par for the course when you’re shooting to be the best in the game. Staying in that game for an extended period of time means dealing with your injuries intelligently.

"I have a very strong opinion about rehabilitation," says Patterson when I corner her for the inside scoop on recovering from injury and getting back to game. "I think the most important thing in getting better is sleep, because your body does the most healing and repairing when you sleep. I’ve always been able to recover from my injuries super fast and strong, but in the first phase, those first couple of weeks, I’ve spent on average 16 hours a day sleeping."

Like the five stages of grief, there’s a healing process to go through. Before you gain access to the R&R room, and settle into the couch for some hardcore napping, you need to pass through the first phase – denial. Injuries tend to announce themselves without shame. As soon as the deed is done – ankle rolled, shoulder popped, ribs crushed, bone snapped; you know you’re there. You don’t need a deck of tarot cards to know what lies ahead. But like a kid getting dragged off to bed just as the party’s warming up, you kick and scream and resist.

Dr. Fisher has seen it.

"So, doc, can I get back on my bike tomorrow?"

Ah? No.

"Doc, I rolled my ankle on the weekend, I’ve rested it for two days, can I play pick-up basketball tonight?"

Ah? No.

Combine our general reluctance to leave the party with the fact that most sports-related injuries are invisible, and you have a recipe for denial.

"Usually, when I consult with someone after an injury, the first thing I do is start drawing," says Dr. Fisher. "I do a diagram, or show them a model. Part of my function as a physician is to give some basic anatomy lessons."

As with any good basement meeting, the password to recovery is admitting that you’re injured. "Hi, my name is Dave and I have three dislocated ribs." "Hi, my name is Lee Anne, and I have a concussion, a broken shoulder and a torn MCL." To get out of that room, and back to life, as soon as possible, you need to get your head around the injury. Find out what it is, what’s going on inside, what it takes to mend. Grab a pile of magazines, flick Oprah on and wait. There’s healing that needs to happen. Torn tissue needs to knit together.

"A good couch and a sympathetic dog to hang out with is key," says Patterson. "Because none of your buddies will be hanging around. They’ll all be out trying to injure themselves."

Dr. Fisher cautions on the art of finding the balance. "It’s important to get back soon, but not too soon, or you’ll re-injure yourself."

The Zen-masters would say, Listen to your body, grasshopper. If it’s saying Slow Down! then slow down. If it’s saying, Ow! Don’t touch me there! then investigate.

After the third time in as many minutes that his therapist had rolled his body over, jumped her full weight on him and still not relocated his ribs, skier Dave Hobson was about to give up on physiotherapy. His initial response to an injury sustained in a ski collision was inspired by the "ignore it and it will go away" school of medicine. Unfortunately for Hobson, three dislocated ribs don’t go away. The muscles around them do adjust to the ribs’ new location and that’s been the problem.

Even when the physiotherapist pops the ribs back in (one two three, everybody jump on the man), the compensating muscles kick up such a protest that eventually the rib gives in and goes back to its out-of-whack place. Now he’s murmuring about chiropractors, X-rays, acupuncture. Stands against the wall with two tennis balls in a sock, rubbing his back like a dog with an itch. Eats ibuprofen for breakfast. Sucks it up and keeps on working, because, like most employees in this town, if you don’t work, you don’t eat.

Still, Dr. Fisher says this could be a good thing.

"There’s a huge overlap between sports injuries and industrial injuries. It’s a similar population in terms of injury, so information on workers can be applied to athletes. A lot of studies have been done on industrial injuries – primarily, they’re funded by the insurance companies so they tend to favour early return to work, but despite that bias, there’s good evidence to support early return to work, as opposed to encouraging people to rest, to wait until they’re 100 per cent. When you look at the markers of healing at two-three weeks, at three months, at six months, and one year, almost always those that get back to work earlier will have higher function at each of those markers.

"The days of saying just rest are long gone. The body is pretty good at healing itself, but there are things to do to help return a joint’s function, like physiotherapy."

Which is to say, once you get through the waiting room, the lie-on-the-couch-and-nap-zone, and into the inner chamber of rehabilitation, it’s time to give ’er.

For Blackcomb pro-patroller, Mike Wilson, that’s been the most satisfying phase. This winter, all the stars aligned (a slot in the specialist’s calendar two years after the initial referral, employee benefits available) for Wilson to schedule shoulder reconstruction surgery. Painkillers were the key to getting through those first few days.

"It was really painful. The first night, I don’t think I slept at all. You get exhausted from the constant pain. I hit rock-bottom when I watched a full episode of Fear Factor."

Doctor’s orders were only to totally immobilize the joint for the first day. As early as the day after surgery, Wilson was letting his arm hang and gently rolling his shoulder. After a week or so, he started physiotherapy.

"The physiotherapists know the progression of how the tissues are healing and how to get mobility and strength back," says Wilson. "I really think that physios know more than doctors about the actual rehabilitation."

Dr. Fisher articulates the physiotherapist’s role, particularly for athletes.

"I think the best physios have a good idea of the range of motion required for the athletes they’re treating to do their sports. They know how to increase the range of motion and allow the athletes to get back sooner. Part of the role of the physiotherapist is to be a coach. To say, ‘I know you have pain, and a limited range of motion, but it’s okay to feel hurt.’ But there’s a big difference between hurt and harm. So they can coach you through the pain, just like a coach of an athlete will say, ‘Run this lap at 59 seconds, instead of 1:01. I know it’s going to hurt, but it won’t be harmful.’"

Wilson agrees.

"The rehabilitation I’ve been doing and the physiotherapy visits especially are an exercise in pain, just moving the limb to the far edge of your range of motion and stretching the tissues to regain mobility. My physiotherapist always says she’s sorry, but I know she secretly loves it."

Still, like the runner pushing through the pain to achieve his goal, Wilson had his eye fixed firmly on the prize.

"I was motivated to get back to skiing. And I didn’t question at all what my physiotherapist was doing. I’m happy with the timeline of my recovery, and in a large part it’s due to the surgeon and the physiotherapist."

Healed tissue is scar tissue, and this scar tissue is dense, fibrous, inflexible. The primary goal of rehabilitation is to recover the pre-existing function of the joint, by treating that scar tissue, by stretching it, increasing the range of motion. In a word, by suffering.

Getting back to game doesn’t necessarily mean recovering full range of motion or normal function. Optimum recovery simply means you can still practice your sport. Downhill skiing, fortunately for Dave Hobson, Mike Wilson and the rest of my creaky colleagues, involves a fixed, tight posture, which enables a skier to get away with certain weaknesses, dodgy knees, a reconstructed shoulder, some insolent ribs, a certain lack of flexibility.

"The worst is head injuries," says Dr. Fisher, "because we don’t have good rehabilitation for head injuries. The sport’s specific requirement for brain function is 100 per cent. You can’t get away with any less motor control. So in sports associated with a high risk of head injury, an athlete really needs to wear protective gear and consider whether the risk is worth it."

Dancing in and out of the comfort zone is a delicate act. And maybe we play too hard. For some injuries, prevention might be the only cure. But as a community of thrill-seekers, there’s no sign of people easing off the throttle.

Dr. Fisher counsels: "I think what injuries do is age your joints and muscles faster than the normal rate of aging. We’re given a full complement of muscles and joints; and maybe we’re just not meant to hurtle ourselves off cliffs and down mountains."

I guess there’s always golf. But where’s the thrill in that?

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