A REFLECTION ON TWO RIGHT KNEES

Recovery Insights for Skiing, Business, and Life by Anna Mulock Houwer and Stephen Mansfield

We all make decisions daily, even hourly. We strive to arrange them into a logical hierarchy, hoping to maximise their impact. Yet there are moments when this orderly approach falls short, and we are forced to think and act on our feet, inventing and deploying strategies as each situation unfolds. In business settings, this is often referred to as ‘crisis management’. But what happens when a crisis arrives at your personal doorstep uninvited?

Our story explores this very question.

Anna Mulock Houwer and Stephen Mansfield live near each other with their respective families. Our children attend the same school and are in the same grade, yet we had not met until disaster struck each of us independently on the ski slopes.

Anna’s crisis hit first. A crash while skiing in the Austrian Alps on 19 February 2022 caused a cluster of severe injuries to her right knee. One year later, on 23 February 2023, it was Steve’s turn when he smashed the top of the tibial plateau of his right knee while skiing in Austria. Our paths crossed in the Austrian Alps – we just did not know it yet.

STEVE

I was grappling with a big decision, go for a coffee or another run down an uninspiring red trail before picking up the kids from ski school. The time spent considering this decision was suddenly moot as I travelled horizontally, looking at people on a ski lift. As an experienced skier, I went into crash mode, my left ski had come off, but the right one was still there. That was not good, but I was still in the air.

I hit the ground, and the right ski came off. I was relieved but then wondered why I was still travelling so fast. A large fat man flew past me as I cartwheeled to a halt. Instinctively, I knew I was injured, I was just not sure where.? He landed a few meters downhill from me, picked himself up and skied off.? I was left to arrange my own evacuation from the ski slope with the help of a good Samaritan. Ten minutes later, I was in the medical centre.

The system was flawless and clearly well-practiced. The helicopter took me to the ambulance, and less than an hour after the accident, I was in the hospital and shuttled in for an x-ray. Two minutes later, lying on a gurney, the doctor informed me that I had broken my leg and I would need an operation to fix it.? The language barrier prevented me from understanding the magnitude of the issue.

ANNA

That day in February 2022, I had a late lunch. The weather was breaking, and I sat in the winter sun to watch the skiing world go by. I was elated. It was my first day of skiing after missing two seasons because of the pandemic. After lunch, I was still high in the mountain, on a connecting road between two pistes. It was not a challenging run, so I let myself pick up some speed. Suddenly, I was flying headfirst, propelled by unexpectedly violent forces. I watched my left ski detach and fly away; the right ski stayed firmly attached, which was not good. Then I heard a loud pop, and everything stopped.

As an experienced skier, I’ve had my fair share of tumbles over the years. However this particular fall felt distinctly different. ?I tried to take a few unsteady steps, but it became clear that the damage was far more severe than usual. Soon, the rescuers arrived with their iconic red toboggan and quickly excluded major head and chest trauma. I cracked a few jokes about being ‘like in a movie’, but there were no smiles. Covered with blankets and strapped tightly in the toboggan, the mountain descent was quick. I was greeted at the hospital by a line of ski boots, 10 or 12 pairs of them, in various colours and sizes, arranged neatly against the wall. My boots joined them.

After a scan was taken, a doctor came to examine my leg. Soon it was evident that that loud pop I heard during the crash was the destruction of the anterior cruciate ligament and medial collateral ligament of my right knee. Taking those few unsteady steps without ligaments had been a bad idea and caused extensive damage to my meniscus, cartilage and tibia.? The prognosis was not optimistic. I was informed that I would require surgery to address my complex knee injury involving several crucial structures.

The ski trips to Austria were fault lines, dividing old from new. Two years have passed since Anna’s accident, and a year has passed since Steve’s. Neither is recovered. Running, jumping, playing basketball with our kids, chasing a dog, or even walking on the beach remain memories. Walking up and down stairs is a challenge, never mind the thought of skiing once again. However, we have learned invaluable lessons about processes, resiliency and recovery. This is what we would like to share with you.

INSIGHT 1: YOU ARE RESPONSIBLE, THE OUTCOME IS YOURS, OWN IT

Recovering from a serious skiing accident necessitates a robust and diverse support network. The medical professionals are obvious, but family and friends are critical too. Regardless of each person's service, we both discovered - the hard way - that the responsibility for recovery is ours.

Navigating the complexities of detailed medical jargon can be overwhelming.? The temptation is to abdicate control to the professionals. Our advice is to fight this reflex and assume the responsibility for coordinating your own recovery. Both of us fell into the ‘abdication of responsibility’? trap, and both of us paid for it dearly, with more surgery, more physiotherapy, longer recovery times and more frustration.

The support network acts as a pillar, but the individual's determination, vision and active management will chart a course for successful recovery. Too late, we discovered that no matter how good your team is, coordinating that team is key to ensuring nothing falls through the gaps. Lying in your hospital bed, it is tempting to become a victim, yet, if you want the best and quickest result, remain in the leader mindset, probing and questioning. Wounded, tired, and overwhelmed, you are nevertheless in the driver’s seat of your own recovery; you must collect your strength and dare to lead.

STEVE:

?Six weeks after the operation, I sat in front of my surgeon. All he said was, “I am not happy.” If he was not happy, then it was not good for me. The surgery had failed, my tibial plateau had collapsed, and my knee was 5 degrees out of alignment. He painted a very dark prognosis - a complete knee replacement.

The physiotherapy report indicated that too much weight had been put on it too soon. I was perplexed because he was in direct contact with the physiotherapist and provided instructions directly. The trouble was, I was now stuck with the consequences of whatever the communication had, or had not, been. My confidence in them as skilled professionals capable of delivering a successful outcome was high. The issue was I assumed there was good communication between the surgeon and physiotherapist. Whether there had been or not, I do not know; I was never a party to their communication. Yet, I had to live with the consequences. What went wrong?

I had absolved my responsibility for the outcome; it was that simple. My premise was that they knew what they were doing and communicating regularly, and I should follow along. I never tested or challenged this, yet I should have been the most critical as I had the most to lose. The failure of clear communication had landed me with potentially life-altering consequences. My inability to coordinate the team is where the failure happened, a detail that fell into the gap, and the consequences were severe.

ANNA

After eight months of exemplary post-surgery rehabilitation, I was ready to restart some athletic pursuits. Weary of the repetitive five-times-a-week physiotherapy sessions and fed up with being a patient, I was ready for the ‘real thing’ and so I hit the gym.

I hired a personal trainer to help ease my way back into more strenuous physical activity. My new personal trainer was with a reputable gym; his fun, positive, can-do attitude induced my trust. He seemed unperturbed by my surgery and exuded confidence in his ability to help. I completed a single training session with him. That was the first and last time we met.

This one hour of training caused extensive damage to my knee.? It was so bad that I only narrowly avoided a second surgery. I had abdicated my responsibility for my leg to a personal trainer based on his airy, can-do attitude. My judgement failure led to being immobilised at home for an additional seven months and caused a host of new issues, including muscle atrophy and bone loss. The mental and emotional toll of this setback was huge on me, my family, and my ability to work and travel.

INSIGHT 2: STAY? OPEN, FLEXIBLE AND READY TO PIVOT

One of the most crucial lessons is the importance of staying open-minded and ready to pivot as unforeseen challenges and setbacks occur, derailing even the most carefully crafted recovery plan. Whether it is a sudden increase in pain, a plateau in progress, or encountering new limitations, the ability to adapt ensures that the recovery journey continues moving forward.

We both experienced firsthand serious setbacks, which essentially took us ‘back to Square One.’ These challenged our resilience to the core and highlighted that rigid adherence to a predetermined path leads to frustration and disappointment. Instead, it is crucial to embrace flexibility, remaining open to adjusting the plan as new information arrives.

Recovery is not a linear process; it is a journey filled with peaks and valleys that can not be planned according to a meticulous schedule. Being open to new approaches, therapies, or exercises can sometimes yield unexpected breakthroughs. Similarly, being flexible means being willing to modify goals and expectations based on the circumstances.

STEVE:

I was back in front of my surgeon. The last time I was here, we had the “I am not happy” conversation.? Thankfully, since then, he had found a new solution; I now had another option over a prosthetic knee.? Revision surgery was what he called it, but that masked the true horror of what he was suggesting. Bone harvesting was just the beginning; then there was breaking, pushing and all sorts of verbs that should not be associated with anyone’s knee. I had only one question, “Have you done this surgery before?”? There was no pause, “No, I have never done this before.” That was not good enough for me, I wanted someone with experience, preferably a lot of experience.

A few internet searches later, it was clear my surgeon was offering the commonly accepted solution to my problem. As one can imagine, all the experience in this surgery was in the ski centres of Europe, in particular, Vienna.? By now, Anna and I were in regular contact, trading war stories to keep ourselves sane.? I was lamenting finding an experienced surgeon necessitated a trip back to Austria. Anna replied in a flash, drunk texting from a party in southern France; she had another solution for me in Portugal.?

Two days later, I was in a clinic in Porto to see a surgeon. He barely gave me the time of day, but things changed when he saw the 3D scans of my knee on his screen. As he rotated the scans on the screen of his computer, he became visibly engaged and laid out the surgery as he motioned at the screen.

First, open the scar and remove all the hardware. Enter the knee arthroscopically through incisions on each side of the kneecap. With a mallet and chisel, slowly elevate the tibial plateau and glue it into position.?

He looked up and smiled.? My question, “Have you done this before?” was answered by referring me to multiple more complex and difficult operations he performed regularly. Indeed, a scan of his resume indicated that he was the head of every medical knee, sports, orthopaedic, and arthroscopic society in Europe - perhaps the world. Not to mention responsible for the knees of some very expensive footballers.? There was a calm confidence in what he was proposing, infinitely less invasive, quicker recovery time and geographically convenient.? This was the solution for me, but why was no one else offering this? There was not even a research paper referring to this technique.? That is another story.

ANNA

By September 2023, it was becoming clear that my recovery was going nowhere. A new MRI confirmed osteopenia, a type of bone loss astronauts experience when in space for long periods of time. There was also significant muscle atrophy in my right quad and hamstring; they had lost half their volume. My body was adjusting to this new state by constantly compensating, which resulted in persistent pain in my feet, lower back, neck and head.? I was getting worse, not better. I exercised, ate well, and took supplements, yet my muscles were not growing. The September video I took for Steve and his wife shocks me today. In it, you see a tall woman wearing shorts with one thin leg and the other leg that is simply withered.

I saw visible frustration and impatience in my surgeon’s face when I showed up for the next control visit. He said my knee structures were bulletproof, but now it really was time to put on some muscle. I was in a vicious cycle of recovery where pain and incorrect exercise led to disuse, which in turn led to further degeneration and more problems. It was time to change the script.

Nearly two years into my recovery process, I was back to the physiotherapist’s office three times a week. This new physiotherapist was far away, but it was someone my surgeon trusted, and she was used to the targeted and efficient athletic knee recovery. Soon, it turned out that material mistakes had been made in my initial physiotherapy plan. I had no full knee extension, and my patella was stuck in a fixed position due to scarring and hard fascia. The setback with a personal trainer a year before was at least partly due to the grossly inadequate initial post-op physiotherapy. The bottom line was that I lost a year and was now far behind what was usual for this stage of the recovery process. There was no use crying over the spilt milk. Swallowing my disappointment I quickly re-oriented my life to accommodate intensive physiotherapy nearly two years after my accident. This is where I am today.

INSIGHT 3: IT IS BOTH A MENTAL AND PHYSICAL CHALLENGE

Recovering from a serious skiing accident is a profound journey of mental mastery that extends far beyond the initial courage and focus required for the immediate challenges.

While short-term resilience is essential, the transition from days to months of physical disability and suffering exposes the true depth of the mental game involved. It becomes a nuanced practice of mental management, demanding a sustained and resilient effort. The unpredictability of the healing process and the gradual pace of recovery necessitate a complete commitment to maintaining a positive outlook, patience, and adapting to inevitable setbacks. In this extended timeline, the mental game proves crucial as one navigates not only the physical rehabilitation but also the emotional, social, financial and other challenges.

The journey from injury to recovery is the intricate interplay of the body and the mind. Still, it needs to be emphasisedthat mental mastery is the linchpin holding the pieces together during the entire process.

STEVE:

Then, the doubts set in.? The spiral was very real, very dark and arrived overnight.? I call it the “what if” spiral.? The problem was that the plan for the remedial surgery was in place. All I had to do was wait.? I was waiting for the insurance company and doctors to resolve their issues.? I had time to ponder and review; this was dangerous.? Had I chosen the correct course?

One morning, I woke up and spent the day going over the plan. It seemed solid, but there was a niggle in the back of my mind - what if I had missed something. I was responsible for the outcome, that was clear and I was not going to make the same mistake twice. But had I made the best decision, I was dealing with a binary outcome here, a bad outcome would be really bad. I started reviewing every decision and then doubting each one. Should I start again and review all my options?? Should I just take the standard route for the revision surgery?? What if there was some information out there I had not even found? I took myself off to calm down with some breathing exercises.?

The swirling doubts were back each day, and I could do nothing to settle them. Reading medical papers made things worse.? The spiral of free-floating anxiety ratcheted down one more turn. I was becoming withdrawn, tense and disenchanted with everyone and everything.? Days of this were turning into weeks.

My wife could see what was happening, but I could not explain the problem. I did not want to speak about the potentially life-changing results if the surgery went wrong; it would make it all too real and pose too many questions for our family I did not want or need to address at this time.

Out of the blue, my wife suggested I discuss it with a close friend. There was no downside to this, and I would be able to speak about it in a more detached manner. As the conversation evolved, it became evident what a mess I was in mentally.? There were only questions with no answers, and the result was a huge overburden of free-floating anxiety.? A couple of hours later, there was resolve to see it through; something had shifted. I had no idea what, but there was a change.?

I went to bed that night and slept, the first proper night’s sleep I had had in two weeks. I had an inner calm and confidence in my decisions. Looking back on this episode, there was no way to know which route would be successful, perhaps both?? Predicting the future was a fool's errand; I found that the key was to work hard to find a path where you are at peace with the outcome, whatever it may be.

ANNA

Confronted with the constraints of long days of disability at home and unable to move, I discovered an unexpected relief in writing poetry. The desperation of immobility became the catalyst for creating a parallel reality of sorts. In the quiet spaces between therapy sessions and daily routines, I wrote and wrote, cultivating a rich inner world that gave me some solace and satisfaction. This newfound creative endeavour has also opened unexpected doors of connection with others.

Another silver lining was that I became a source of support for others undergoing similar ordeals. I found sense in the opportunity to extend a helping hand and build understanding around the shared complexities of recovery and resilience with Steve and others.

Last but not least, I developed and perfected self-discipline, accountability and resilience. Paradoxically, I am getting in great shape because I exercise all the time. I am also mentally stronger and vastly more able to enjoy the moment.

IN CONCLUSION

Dealing with a long-term injury is about acceptance, integration and making the best of every single day. This sounds simple, but it is not easy, especially as your family's lives continue undisturbed around you. Trusting that the spirit is stronger than the body's limitations and never giving up is paramount. Your brain may start to play games with you, your leg may have forgotten how to walk, and you may wake up immobile for the 100th day in a row. Yet your spirit is there to sustain you and lead you back to life. Every day must start with the acceptance of where you are. The work starts there and it’s one day at a time.

Predictably, in the face of adversity, we discovered the remarkable resilience of the human spirit. Despite the challenges posed by our injuries, we have persevered, adapting to new circumstances, and embracing the journey of recovery with some courage and determination.

Our story is just another reminder that setbacks are not an end but an opportunity for growth and transformation. In the world of business, as in life, unforeseen challenges are inevitable. Just as we have learned to navigate the twists and turns of our respective recoveries, so too, as professionals, we must cultivate resilience and embrace flexibility and mental mastery to weather the storms and emerge stronger than ever before. That is leadership.