Personal Injury Recovery

CW: Accounts of a personal injury, recovery, and some potentially disturbing images

If you are reading this, there is a good chance that you already know my alter ego as Thom Alman of the professional wrestling tag team The Academy, what you may not know is the road to recovery I faced following a traumatic injury in December 2019.

During a match for Seattle's Lucha Libre Volcanica, I landed awkwardly on my knees following the execution of a move I've done hundreds of times. As I landed, my right knee rolled slightly under my body and the joint absorbed the full impact of my 280lbs frame.

At the time of the impact, I didn't feel anything that would lead me to believe I had sustained an injury and I finished the match with no limitations. Getting to the backstage area and still running on the adrenaline high from performing in front of a crowd, I undressed, put on my normal attire and peaked out of the curtain to watch the next match.

As the night progressed, I began to feel some stiffness in my knee but never any pain. In fact throughout the following 24 month journey, pain was never a symptom.

During December 2019 and January 2020, I was training at a gym with a personal trainer and he began to notice that my squats were off. I was moving less weight and favoring my right leg. I told him that I was experiencing some swelling and bruising from an injury during a match but it wasn't a big deal. He asked to examine the knee and was immediately concerned about the amount of swelling in the joint.

Due to the physical nature of wrestling, I had a good sports medicine doctor on my team so I scheduled an appointment. I saw him on January 15th, 2020 and this was the view he was greeted with:

Given the level of bruising and swelling after nearly a month, my doctor ran a variety of tests including x-rays and removal of fluid from the knee for analysis. The x-rays did not reveal any damage to the joint and the fluid analysis was clean with the exception of a large volume of blood in the joint. There was evidence of a torn hamstring however and that was the diagnosis we stuck with. I was asked to remain active but stay off the leg (so of course I wrestled and trained) but was given little by way of actual restrictions. In fact, the doctor thought this was the best case scenario as damage to the joint would take much longer to heal.

The bruising cleared up over the course of the following month but the swelling in the knee persisted. I sent a follow-up message to my doctor who said it can take a long time for the body to reabsorb the fluid and blood that has pooled in a joint and it can be even worse in the knee. Fluid collection in the legs is common in individuals who cannot fully extend or bend their legs as this movement actually provides the required force to push the fluid back towards the heart.

In March of 2020, COVID exploded, wrestling stopped, and my gym closed. I took some time off to allow the joint to heal and then began to jog. By summer of 2020, I was routinely doing 5 miles a day but my pace was always hindered by the knee. It didn't hurt or respond negatively to the impact, but had a baseline level of discomfort and swelling.

Fast forward to September 2020 and I installed a gym in the garage of my new home. I was surprised to see how much strength I had retained in my deadlift and bench press but was shocked at how weak my squats were. Prior to the injury, I was never a guy with a huge squat, mostly due to less-than-perfect form and previous knee injuries, but my ability to move weight was dramatically reduced.

Through the winter and into the spring of 2021, I noticed the swelling on the knee was getting progressively worse and despite being concerned about COVID, I made a follow-up appointment with my sports medicine doctor.

He ordered a second set of x-rays that again came back with no visible damage but lacking conclusive evidence about the cause of my swelling and discomfort he also ordered an MRI. This finally revealed a root for the symptoms and lack of improvement we were seeing.

This is not my x-ray, but a representation of the injury I was diagnosed with. I had a subchondral fracture of the tibia plateau. Essentially, there was a fracture of the portion of the tibia that fits into the knee joint, but thankfully it was simply a type-I fracture. More pronounced fractures can lead to the entire tip of the bone breaking free of the tibia.

In addition to this fracture, the constant swelling in my knee had caused post-traumatic osteoarthritis and damage to the underside of the patella. Recovery time was estimated to be 6-8 weeks and I was put on crutches.

This should have been the end of the sage, however the long term swelling and the time on crutches combined to cause a new condition to arise, called quadriceps activation failure. I was no longer able to contract the quadriceps muscles of my right leg and over time, this led to a difference in circumference of more than 2 inches between my legs.

Quadriceps activation failure is interesting as its a defense mechanism the body uses to protect the knee joint. By reducing the ability for the quadriceps to contract, the knee is actually subjected to less stress. I may revisit this for an article review but it appears longterm knee injuries that have large effusions in the joint actually reduce the ability for the neurons to fire in response to voluntary stimulus.

We were now in a vicious circle, where the knee could not support the quad and the quad could not support the knee. I came off the crutches but nothing improved so back to the doctor again. In August 2021, my doctor removed more than 100ml of fluid from the joint (this is more than 25% of the volume in a soda can) and I instantly felt better. He then advised me to "wait and see" and not go to physical therapy yet.

Finally, I became fed up with the lack of concrete facts with regards to healing both the quad and the knee. I decided to see an orthopedic surgeon who specializes in knee injuries and he immediately diagnosed a small tear in the cartilage behind my patella (in addition to the previous documented injuries). He believed I would need an experimental surgery known as a MACI surgery where cartilage is removed from the knee, sent to a lab in Boston who would grow new cartilage and then it would be grafted back into the joint to repair the tear. "Don't worry," he said, "you'll only be out nine to twelve months." Subsequent research showed that this surgery has about a 75% success rate which was too low for giving up a year of my career.

I went back to the drawing board and this time consulted a sports medicine doctor at the University of Washington. His diagnosis was the fracture was healed, the tear in the cartilage is not a current major concern and the biggest factor in my inability to heal was the fluid in the joint. Apparently this fluid is acidic and over time can cause longterm damage to the joint. I was advised to try a platelet-rich-plasma injection, where my blood would be spun in a centrifuge and the platelets injected into the joint to promote healing.

This kept me out for the month of October 2021, as the joint needs to be minimally impacted to allow the platelets to bond and heal the joint. After the injection and healing period, I was finally cleared to return to activity and start physical therapy. At physical therapy, I actually needed to have electrical stimulation to convince the quadriceps to contract. Over numerous sessions, I was able to finally engage the quad and running, jumping, and squatting became much less scary.

Now it has been a couple months since regaining full function of my quad. The knee is still slightly swollen and I will likely always have arthritis in the knee, but I've been able to fully participate in the ring and the weight room without any concern for additional injury and I've managed to avoid major surgery.

I recognize the privilege I have had to be able to seek additional opinions on the knee, but it was frustrating to go through numerous doctors to find something that helped. I also think the surgeon was much too quick to suggest risky, experimental surgery.

I'm sure the knee will have its ups and downs going forward, but having trust in your legs is a big key to being a successful wrestler.