The Boxer As Martial Artist

Would I still be a middle-aged martial artist if I were a boxer?

I ask because now a second doctor has told me that kicking without an ACL is not a good idea--at least, kicking hard is a bad idea. And I'm finding myself drawn to the idea of taking up boxing as an amazing form of exercise, and perhaps eventually for sparring.

A week ago, I saw a physiatrist--a doctor of physical medicine and rehabilitation. My thought was that he would be less focused on surgery, more on recovery, and would be a good judge of what I can and can't do physically without an ACL.

Among other things, he tested the strength of my leg, to see if the muscles around the knee can stand in, to some extent, for a missing ACL. His judgment: "You're stronger than you look." Uh, thanks, Doc...I think....

He explained that one of the risks of kicking hard with my injured leg, even against a bag, is that without an ACL, the knee will travel too far--and in the long run, that would put me at risk of arthritis. And I know I don't want to kick while putting weight on my injured leg, which is how I got hurt in the first place.

Also not good ideas: tennis, basketball, soccer--sports involving a lot of cutting movement. Wrestling/grappling are out as well.

What activities can I do? He said running, sprinting, even sprinting up stairs are fine--as long as I don't bend my leg too far by, say, taking multiple steps in one bound.

As for martial arts, he suggested ones that don't involve kicking--wing chun, for instance.

I asked about boxing. He said that would be okay as well. I would need to be sure, when stepping to the side, that I put my foot flat on the mat. Stepping on the outside or inside of my foot would re-injure my knee (I think that's what happened when I twisted my knee again just trying to sit in a confined space). He even said he thought I could jump rope, a favorite boxing workout, if  I did so on a cushioned surface and not a hard floor.

I know that boxing workouts are amazing exercise (I once took a trial class at a cool downtown Manhattan gym called Trinity Boxing Club, but I'm too far away now to attend there). My friend Tracy Hutt swears by them.

One of the instructors at my school was saying that I could focus on boxing instead of kicking in class, and I may try that. But it's looking more and more like I will be boxing for exercise in the near future.

Why Train?

Blogger Felicia of Bushido Road asked in a recent post, "Why do you train?" She focused on the self-defense aspect of training.

One of the surprising things I've realized in this stretch, where my torn ACL has interrupted my training, is that self defense has more of a role in my motivation than I realized.

I nominally took up martial arts as a form of self-health defense, so to speak--to get into shape in an enjoyable way and avoid the health problems I was beginning to experience (weight gain, high cholesterol, etc.) in my early 40s.

But I as I have contemplated the possibility that my injury could interfere on a long-term basis with training, my thoughts were focused more than I expected on how I would defend myself without the ability to use my leg as I was taught. Interesting--that's not what I expected to be thinking about.

Friday the 13th Tale

My return visit to my orthopedic surgeon today was inauspiciously timed.

He bent my leg, shook it, made sure I realized it wasn't healthy, and rendered his verdict: If I lead an active life, eventually I'm not going to be happy with my knee and I'll come back for surgery. "You're not a potato on the couch," he said. He even said activities like running and sprinting--which don't involve cutting, pivoting or torquing the knee--would lead to knee pain, an assertion that left me, frankly, surprised and dubious.

My verdict: I'm continuing with physical therapy, and I'm going to see a physical medicine and rehab physician--a physiatrist--to see get suggestions on how to stay active without surgery.

No doubt, my body is conspiring against me. I caught a cold a week ago, which restricted my exercise and even PT; I twisted my knee again two weeks ago in an unlucky accident. (My orthopedic surgeon said a torn ACL used to be known as a "trick knee" that "went out" every once in a while. I've heard the term before.)

I take heart from a 2010 New York Times article, cited originally by in the Just A Thought blog, that cited research saying people with ACL tears who had physical therapy alone had improvements after two years comparable to people who had ACL surgery. The PT-only group had knees that were less stable, but that instability didn't seem to be a big deal. The study authors were quoted in the article:

there is no apparent downside of starting a good rehab program and waiting with the surgery decision to see if it is needed or not.

I figure that a physiatrist is much more likely to know what I can do, how much I can do, and how to do it safely with a torn ACL. My appointment is a week from tomorrow; I wish it were tomorrow.

That said, I do feel--and I sweat somewhat saying this in a martial arts blog--for the time being, I must interrupt my mixed martial arts training. I've suffered grievous injury twice to my knees from kicking or being swept in mixed martial arts, and that's a fact that looms very large at the moment.

The thought occurs to me that boxing might be a way of giving myself a similarly intense workout to mixed martial arts, but without kicking or sweeping. It might even offer me a way of continuing to spar, which has challenged and enlivened me in mixed martial arts (though I'd definitely want to talk to the physiatrist about whether and how to do that--e.g., would I need a knee brace?).

I'm facing lots of questions; I don't know where this journey will end up. The next step, when I get up from writing this entry, will be to do another set of physical therapy exercises, and to continue to be patient.

Steps Forward, Back--Sideways

On Friday, I twisted the heck out of my knee again--just trying to sit down in a confined space. My foot got caught on something so when I put my weight on my right leg, the foot wasn't under the knee--and so my missing ACL wasn't there to keep my knee from twisting. Very painful. Rest, ice, compression, elevation.

I took a couple of days off from PT at home, and have since resumed. I haven't trained at my school, though I've done the elliptical machine at the gym (and some of the PT is real strength training for my legs).

It's worrisome to me that I could re-injure my leg just trying to sit down.

On Friday the 13th, I'm going back to the doctor, following a month of PT, to see what he says and, I suspect, order a brace. Then I have to decide what I will do.

Physical Therapy, Exercise, Careful Training

I'm feeling a bit encouraged about my prospects of continuing to train, with modifications, post ACL tear.

I've been to three physical therapy sessions, and have been good about doing my PT exercises twice daily. Compared to working out, the PT exercises don't feel like they're doing much, but they are clearly doing something to strengthen the muscles around my knee and give me more range of motion (a limitation imposed by the meniscus tear).

I've gone on the elliptical machine at the gym at work three times. I'm using it because there's a limited motion and there's no impact, but I can still get a good cardio workout.

I have also now taken three classes in my mixed martial arts school. I have been very careful about kicks, and my knee has been fine. It's good to see my friends and instructors and to continue to get a workout.

One of those workouts was a private class with our school's Joshu, a young (20s), very skilled martial artist and a friend. We just worked on form for punches and kicks (again, being careful not to do anything that would torque my ACL-less right knee). I had developed a way of throwing round kicks that involved a lot of leaning and turning in order to avoid punches. He worked with me to move my hips independently of my shoulders, which should speed up the kick, allow me to focus more on the target, and I think put me at less risk of torque injuries to my remaining good leg. It will take time to undo prior habits.

I'm not going to spar until I get a knee brace, which I plan to order from my doctor when I see him in three weeks.

My plan continues to be that I will not get ACL reconstruction surgery. I needed ACL reconstruction four years ago to get my black belt. I don't believe I need the ACL reconstruction if I am training for fun and fitness, and if I am very careful.

There's some precedent.

There are, I realized, two women in my school who ruptured their ACLs and who continue to train wearing braces. They're both excellent athletes; they'v had mixed success training in their condition.

One is a second-degree black belt who has been without one of her ACLs for many years. She's one of those amazing Gumby-like types who's about a foot taller than me but can kick me in the head. I haven't seen her on my abbreviated training schedule, but when I do, I will definitely talk with her about how she takes care of her knee. She does some sparring; she doesn't do grappling. Mostly she takes the "core" classes that are bag workouts.

The other fellow student offers a bit of a cautionary tale. She's also a good athlete and is a former cop. However, she did injure her other knee a few months ago--I believe while sparring--and has some discomfort in her daily activities.

That's what I don't want to do.

So for now, it's PT and patience for me.

Facing Uncertainty with Patience

It's going to take patience to work through this ACL tear and figure out what I can and should do.

On Friday morning, I got the diagnosis from my doctor--complete ACL tear in my right knee, plus meniscus damage.

My leg isn't painful except when I bend it too far (meniscus) or I step in a way the knee becomes unstable (ACL). It's more my brain that's sore.

My doctor, who had performed ACL reconstruction surgery on my left knee four years ago, said Friday morning he expected that without an ACL, I could run and eventually probably even sprint--which I'd been doing lately for conditioning. The day before, I had gone on an elliptical machine for 22 minutes, and my leg felt fine at the time. It was a little sore an hour later, which a naproxen took care of. My doctor thought that activity was fine, and said the knee is still healing from the initial incident.

However, while running is okay, he thinks that martial arts would put me at risk of further damage to the knee, which is unstable without an ACL, because martial arts involves torquing the knee. A knee brace wouldn't help with torquing.

I don't want to have ACL reconstruction surgery again. I simply can't afford the time away from work and life it would require right now; in any case, the doctor said the knee needs to heal before surgery, so there's no rush.

The reason my head hurts is that, while I don't want to do ACL surgery, I also do want to continue training.

My martial arts instruction got me into shape; it taught me to face up to my fears; to face up to conflict instead of avoiding it; that getting hit just means I'm still in the fight; that I can protect myself. These are all extremely important things to me, body and soul.

I could maintain my conditioning even if I gave up martial arts. But I would be leaving behind a crucial part of my life if I had to give up my school due to my injury.

I have decided to respond with patience.

I'm going to do physical therapy for a month to strengthen the muscles around the knee to compensate for the lack of an ACL. I'm going to discuss with the therapist, or perhaps even a physiatrist, what activities I can safely do.

I'm going to very carefully try to take certain martial arts classes. On Friday evening, I took a "core" class that entails a bag workout and physical and strength conditioning, but no sparring. I was very careful; my knee was a little sore afterward but fine. Oddly, one of the most difficult things in class was some of the stretching at the beginning.

I'm going to have to leave grappling behind, which I'm fine about.

I would like to carefully, carefully try out sparring, including being selective about partners. I will probably be boxing more than kickboxing--a shame since my kicks were pretty good.

I'll see how my leg does. I'll talk about my situation to doctors and others (including a remarkable classmate who does train without an ACL).

I'll give it time.

"Complete Tear of the Proximate Anterior Cruciate Ligament...."

"MRI of the right knee demonstrates a complete tear of the proximate anterior cruciate ligament with osteochondral impaction injury of the lateral condyle and bone contusion of the lateral proximal tibia. Complex tear of the posterior horn medial meniscus involving both aeticular surfaces with associated posteromedial capsular sprain and small joint effusion"