Only You

I've always had an uncanny ability to have the unusual happen to me. Call it a curse, call it a blessing, call it downright weird. If it's strange or unheard of, chances are I can make it happen. Case in point: at the young age of 12 I managed to acquire an avulsion of my right lesser trochanter. In English, you say? My muscles, which were stronger than my bones, managed to actually rip off a small bony prominence on the inner thigh bone that connects the muscles and tendons that run down the inner thigh. The doctors at the ER all looked at the x-rays, looked at me and scratched their heads. "We've only seen this in textbooks," they said. "We've never even heard of this happening to a girl. It typically happens to 18-22 year old football players. What did you say you were doing again?" High jumping for my middle school track team.

I also seem to have a somewhat high threshold for pain. Or maybe it's just that I love skating so much I can flip a switch in my brain and ignore it. Either way, even though the nurse in me knows better, I really think that any injury can be trained through on the ice with Advil. Case number 2: My right foot started hurting in December 2011. After about three weeks, I was pretty sure that I had a stress fracture. Having had three of them in my ankles caused by skating boots that were too stiff, you learn to recognize the very distinct, sharp pain they cause. Agreeing with my suspicions given my history (and the inability to see stress fractures on x-rays), my family doctor put me in a walking boot for three weeks and kicked me off the ice. Day one back on my skates, my foot was worse in five minutes than it had been before the CAM walker. I then saw the orthopedic surgeon who had previously diagnosed my ankle stress fractures. His response after not seeing anything on the x-rays was, "You'd see stress fracture changes in an x-ray by now. There's nothing wrong with your foot. Quit being a wuss." This is the same doctor who was shocked to hear that I was still skating after he found stress fractures in my ankle the year before. So, I simply continued to train. For the next 8 months. Finally, I saw a doctor in Colorado Springs in August 2012 who, also saying there was no way I would be able to skate with a stress fracture in my foot, ordered a MRI to look for soft tissue damage. He personally called me two days later, his voice full of surprise, telling me I had not one, but two stress fractures in my foot that he was diagnosing as non-unions (fractures that have not healed after 6 months). A month or two using a bone stimulator produced great results.

I've been very lucky since moving to Colorado Springs in July 2012 and have stayed injury free. Any skater will tell you they are nearly always battling some form of acute or chronic injury. It's in the nature of what we do. No matter how beautiful, graceful or powerful skaters look, the bottom line is that the human body was NOT made to hurtle itself through the air, rotate multiple times in less than two seconds, and land on 1/8th of an inch of steel on an ice cube. Skaters land double and triple jumps with the force of up to eight times their body weight. That puts a 120 pound skater at 1,000 pounds of pressure when landing a jump.On one foot. It's even higher for quad jumps. And that's just the jumps. If you think that twisting your body into a pretzel while spinning is easy, or kicking over through the air and landing in a spin is a piece of cake, it's not. With the new IJS judging system, skaters can't just be great jumpers, they have to have the full package: jumps, spins, variation, artistry, speed and power. And we have to make it all look like Joe Somebody could strap on a pair of rental skates and do what we do.

Injuries are nothing new to us. It's just a part of our way of life. So in late July 2013 when I got up one morning and felt like I had a high hamstring pull in my left leg, I didn't think twice about it. I stretched out extra well in between sessions, and by the afternoon it wasn't impeding me in any way. I had started landing double loops and double flips in recent weeks and my double lutz was just on the brink of cooperating as well. Friday morning, however, was a completely different story. I could barely put my shoes on and had to do quite the acrobatic routine to get my skating pants on. I went to the rink and was barely able to even manage crossovers. I tried to just push through it and thanks to some good ART therapy over the next week I got some mobility back. I had a competition coming up in less than four weeks so I simply skated through the pain and stiffness. In fact, I actually felt the best after getting off the ice. I had a lot more range of motion in my hip when it was warmed up from skating. But as soon as I cooled down, it would immediately lock up again. Over the next four months, I tried to deal with some very debilitating symptoms including hamstring and piriformis spasms especially when going from sitting to standing, sharp shooting pain in my butt and hamstring, dull pain in my outer hip, a clicking sensation over the groin area when extending my foot forward or raising it up, and a louder but more diffuse snapping over the outer portion of the hip when rotating my leg outward. I couldn't do a straight legged toe touch. My leg would automatically bend and twist inward. I couldn't sit at a 90 degree angle on the floor without excruciating pain and my leg would lifelessly flop into extreme external rotation. Since July I have winced every time I dressed, held my breath while putting on shoes, and tried not to sound like a wounded dog every time I would get into or out of the car. Some mornings it was all I could do to put my skates on at the rink. I avoided anything that required forward leg extension and had trouble holding myself on top of my left hip when doing footwork. I swear I developed a severe case of butterfinger-itis since picking things up from the floor is painful and challenging! There were days I would wonder if I would ever be able to throw a death drop again or do my awesome fan kick with my left leg and as time went on those thoughts turned to wondering if I would ever be able to remember what it was like to not have constant pain in my hip and leg.

The week before Thanksgiving my hip had gotten to the point that I couldn't skate at all. I scheduled an appointment with an orthopedic doctor to have it evaluated. At this point, my ART practitioner had been telling me for two months that I needed to get a MRI but being a nurse and a skater makes for a dangerous self-diagnosing problem. Skaters, along with hockey players and football players in particular, do a LOT of what is called axial loading. This is a force that is applied to the body along an axis. In football, players have to do a lot of pivoting and cutting. In hockey, the players are constantly checking each other against the boards and change direction very quickly. And in figure skating, well obviously we have huge amounts of rotational force in our jumps and spins. Because of this axial loading, football players, hockey players and yes, figure skaters, are very prone to an injury called a labral tear and sometimes complicated by femoral acetabular impingement.

The top of the femur (thigh bone) is a ball shaped joint which allows for 360 degrees of motion. Separating this joint from the hip socket is a piece of cartilage called the labrum. This cartilage is present in both the hip and the shoulder. In the hip, this cartilage can become torn by either repetitive motions or direct impact injury. For a skater, a labrum injury could occur from years of jumping, falling, spinning, and pushing the hip's flexibility to the maximum or it could come from a single fall on a jump. While a tear in a small piece of cartilage may not sound like a big deal--after all your ears are almost entirely made of cartilage and you can throw a dozen piercings in them--this particular piece of cartilage is extremely important. It is the only buffer between the femur bone and the pelvis that keeps them from rubbing up against each other. And to complicate things, a torn labrum is often seen as a career ending injury for athletes. The pain is often excruciating, surgical repair complicated, and rehabilitation extensive. In the skating world, two recent examples are Olympic medalist Evan Lysacek and Alissa Czisny. Both have withdrawn from the US Championships in January (which will determine our Team USA skaters for the 2014 Winter Olympics) due to Evan's labral tear that has been unresponsive to conservative treatment and Alissa's unsuccessful comeback from surgical repair of hers nearly two years ago. Being a nurse, it began to become more and more clear to me this fall as my hip slowly worsened that it was most likely a labrum tear. But since this is such a scary thing for a skater, I figured I would just ignore it. Like I said previously, my motto is 'Advil can fix anything'. Obviously this wasn't the best choice as it took getting to the point that I wanted to practically scream getting out of my bed in the morning from the sharp pinching sensation was so severe in the back of my hip before I thought that it might be a good idea to get it checked out. So the day before Thanksgiving I saw an orthopedic surgeon before driving home for the holiday. He quickly agreed with my hypothesis that it was very likely a labrum tear and ordered a MR-A. This is a MRI where they inject a dye into the actual hip joint before they do the MRI which allows them to visualize the hip joint in greater detail and identify any tears in the labrum cartilage. This sounds a lot worse than it actually is. They are kind enough to numb your leg all the way down to the bone, so I only experienced a slight pinch when the doctor inserted the needle into the hip capsule, which he did under live time x-ray guidance called fluoroscopy. The worse part about the whole thing was having my legs taped together in internal rotation for the 45 minute MRI. Internal rotation has not been my friend recently. Now the doctor I saw initially had said that they would also put a cortisone injection into the joint at the same time because it is also diagnostic for a labrum tear. The MR-A has about a 91% accuracy but injecting cortisone confirms that the problem is within the joint if the cortisone significantly helps the pain. Of course, since they're injecting the dye so close to the femoral artery, I couldn't take any of my favorite miracle drug, Advil, from Thursday on. I got through it by telling myself the cortisone would take away most of the pain. Eye on the prize. Of course, it never is that simple. They told me as they were doing the dye injection that they couldn't do the cortisone at the same time because it would be fluid overload for the joint and the dye would wash out the cortisone faster. So, I would have to come back on Wednesday. And I couldn't take any more Advil until they had done the cortisone injection. UGH! But there was one very significant upside. On Wednesday, while trying to suck up the fact that the doctor doing the injection this time was not nearly as good as the previous one on Monday and had not done nearly as good of a job numbing my hip and therefore was causing me quite a bit of sharp pain, I managed to coerce him into telling me what the MR-A said. Aside from being someone who does not like to be kept waiting (my follow up appointment isn't until this coming Monday), there is virtually no point in me going to this follow up appointment. There are only about half a dozen surgeons in the world that have a strong resume of repairing labral tears in elite athletes and returning them to their level of play prior to the injry. As it so happens, one of them, if not the most qualified one, is in Vail. When I told my head coach Eddie what was going on he first exercised some restraint in not strangling me as his daughter had torn her labrum as a competitive skater and secondly immediately said that he was sending me to Dr. Philippon. In addition to having returned a few dozen professional athletes to their respective field of play, he also fixed the top US male pairs skater's labrum about 18 months ago. Thank God for Eddie because any ordinary person calling Dr. Philippon would get stuck on a 3+ month waiting list to see him. Because I train at the World Arena and with some of the top coaches in the world, their one call to Dr. Philippon is the equivalent of a first class ticket on a plane. So, Eddie thoroughly instructed me that I was to 1) not touch the ice until we had a diagnosis 2) never train on that kind of hip pain for 4+ months again without saying how bad it really was and 3) call him as soon as I had the MRI results. So, paying a $40 copay to visit with this doctor in the Springs for 5 minutes to find out the results of the MRI was virtually pointless because he wouldn't be allowed to touch my hip if it was torn. I'm sure he is a great doctor and surgeon but if you could have a doctor that does 20 of these a year or a doctor that does 1-2 a day which would you choose? So, I had to coerce the answers out of the radiologist. And while I was thinking that the worst case scenario would have been the MR-A reading everything as normal, I was gravely unprepared for what this radiologist was about to tell me.