Back in early September 2017, I was playing basketball on the courts at Cal State Long Beach along with some classmates from my PT program. This was a common ritual for us as it allowed us to take some time and blow off steam after a long day of classes. However, on this particular day, I was in for something that I had never experienced before. During one of the games, I was defending another player who started driving to the basket from the perimeter. In an attempt to cut him off and block his lay-up, I began back-pedaling towards the basket, but in my haste, forgot to set my feet properly only for my opponent to have him step on my left foot. At this same moment, he threw his shoulder into me causing me to spin rapidly to my left and fall backwards. In that moment, I experienced heard two pops and felt an instant rush of pain en route to the gym floor. Lying on the floor, I suddenly became very fearful because all the thoughts began to flash through my mind about what I had learned in great detail about knee injuries in PT school…the “pop” that could signal a potential ACL tear, the forced rotation on the planted foot that could be a sign of a meniscus tear, what if it were both? These thoughts raced through my mind as I lay there on the floor, unable to get up without help from my friends. These fearful thoughts continued the next day as I walked around campus on a pair of crutches…what was I supposed to do? The first of my two clinical rotations was supposed to start in eight weeks, and I might end up needing surgery if the worst of my fears were to come true. The thought of surgery chilled me to the bone because it might mean having to be held back another year in PT school because I wouldn’t be in sufficient condition to participate in my clinical rotation, but at the same time, I was afraid of the chronic knee instability and early arthritis that could develop in my knee if I chose not to go under the knife. I knew that I didn’t want that to happen because that meant medical bills that me and my family would be struggling to pay, not being able to get a paying job in my profession while my classmates moved on.
Thankfully, I was fortunate in my circumstances for two reasons…first of all, we had a physical therapy clinic on campus which I was able to go to have my knee evaluated. Second, I was a physical therapy student who had the expert opinions of both physical therapists as well as an orthopedic surgeon readily available to him. When I first went into the PT clinic on campus, it was difficult for the therapists to get a definitive diagnosis because of the swelling that remained in my knee. That fact aside, they were able to give me valuable information.. 1) I had poor hip strength..my PT was able to break me (a 6’3” 250 pound guy) using minimal pressure and 2) regardless of the specific pathology, I could start work on strengthening my hips and knee right away to get me back faster. On my next visit, my PT was able to rule out damage to the ACL and concluded based on her physical exam that I had a tear in my medial meniscus.
Despite the progress we had made in just two visits, the thought still lingered in my mind that I needed to obtain an MRI and undergo surgery to clean up the injury. Throughout my first week after injury, I was able to return to weight-bearing on my left knee, but when I did I experienced a clicking sensation in my knee that remained consistent the whole time I was walking. On top of this, I would feel my knee give out if I made any movements that I required me to extend my leg or to twist it at all. I felt guilty for having these fear-mongering thoughts. All of my training in PT school told me that just because I had a tear that wasn’t an indication that I needed to undergo surgery but the mental image of the potential damage and deformity in my knee caused me to continue thinking that I really needed to get it looked at surgically. These thoughts continued until one of my professors challenged me with this question… “James, if you’re function is improving and you’re aren’t experiencing any big issues, is it really necessary for you to undergo surgery?” What he said had been true, I was indeed getting better…I was doing challenging exercises in the clinic that were pushing me in ways I hadn’t been pushed before, I was experiencing less and less pain each day and I had been experiencing much less clicking, all in a matter of a couple weeks. I was letting that image of damage in my knee hold me back even though everything that I had been doing in PT was making me not only stronger but helping me to improve even in comparison to my condition pre-injury. Now, although I am able to run short distances and have been able to return to swimming at the pool and work as a lifeguard, I still have room to continue to improve because I want to be able to start conditioning for a half-marathon later this year and I still am working on returning to my swimming to its previous form and speed. But what physical therapy has given me is the ability to appreciate function for what it really means, the ability to accomplish. I say this, not merely as a prop for my profession, but earnestly and seriously as a reminder that we all have mental barriers that may be preventing us from getting back to what we love doing most. This I say, as a student who has been nearly a third of his life dedicated to the study of physical therapy. Appreciate function for what it is and don’t let a state of mind prevent you from reaching the goals that you have set for yourself.
