My mindset has always been proactive, asking myself and others “what more can I do?” and my overall context has been that putting in more effort, doing more and working […]
My mindset has always been proactive, asking myself and others “what more can I do?” and my overall context has been that putting in more effort, doing more and working harder and/or faster will yield better results.
It’s gotten me where I am today: a happy, healthy, successful human being.
But it’s also gotten me where I am today: recovering from my 3rd knee surgery.
Yeah, the third one. Gee Hannah, maybe it’s time to reconnoiter: how did I get here, AGAIN?
So I’ve been using the time pre-op (what I call “pre-hab”) and post-op (re-hab) to re-boot my brain as well as my knee by asking myself how well my “what more can I do?” mindset has been working for me, including what about it is working, as well as what isn’t working. Then taking forward what is, and leaving behind the rest.
In order to create my new mental model, I’m integrating Greg McKeown’s “less, but better”, Seth Godin’s “minimum viable audience”, and Maria Brophy’s “most important thing”. In Essentialism, McKeown makes a compelling case for achieving far more by doing far less, but better. In This is Marketing, Godin asserts staking out the smallest imaginable market that can sustain us is the simplest way to matter. Maria Brophy contends that choosing one – just one! – “most important thing” to focus on each month is the best way to outstanding accomplishment.
Their solutions are simple but counterintuitive; easy to grasp but challenging to implement.
But first I’ll step back a bit for context so you know what the heck is going on: by knee surgery, I mean that I had my anterior cruciate ligament (ACL) reconstructed.
The ACL is a critical knee ligament running diagonally behind the patella, connecting the lateral femur with the medial tibia. It’s essential for holding the femur securely in place directly above the lower leg, and the ability to pivot your knee. Pretty clearly a key component for daily life, as well as some sports such as basketball where pivoting and cutting occur frequently.
Without an ACL, you can still flex and rotate your knee, but can sometimes find yourself suddenly laying flat on the ground because the missing ACL wasn’t there to support you.
This is not an exaggeration: I speak from experience. And can say that it’s seriously disconcerting to not be able to count on your own limb to support you even just in regular daily life, let alone in sports.
I naturally wanted to get back to full wellness as fast as possible, so visited my orthopaedic surgeon, Dr. Craig H. Bennett right away, who referred me same day to get an MRI and confirm what his Lachman test suggested: my ACL was gone. The image showed only fragments remaining, waving about like bits of seaweed. Yikes.
Good news though, the meniscus looked fine. While it wouldn’t be possible to tell for sure until Dr. Bennett could actually put his eyeballs on it in the OR, this was a relief (and seconded my experience: torn meniscus can be very painful which I was not feeling; only the swelling, stiffness and instability due to my shredded ACL).
But now it was time to plan for surgery. Optimal ACL reconstruction (ACLR) outcome is achieved when the knee is not swollen and has normal range of motion (ROM). Mine had very limited ROM, and was so swollen it was difficult to tell I had a knee joint at all. Pretty funny looking; but very uncomfortable. So we needed to wait at least a few weeks. And then another few weeks due to my work travel schedule.
At this point I wasn’t even yet consciously aware my new mental model was under construction. I was intutitively experimenting by just going with what felt right, but not rushed. Often it comes to me like this: inspiration –> action –> understanding (thou not always the understanding part; sometimes it just feels right).
Back to the knee: with a month to prepare for surgery, I asked Dr. Bennett and his team what I could do (or avoid) to reduce swelling and increase flexion for optimal ACLR outcome. Their answers:
*60 minutes daily biking or swimming
*continue all strength training, including legs but modified to include lighter weights for higher reps and specific exercises only such as straight-leg deadlift, hip thrust, abductor, adductor, good morning, extensions and curls)
*elevate knee when possible during the day
*ice it off and on daily
*take OTC anti-inflammatories
People who knew my injury situation or saw me limping around the gym (and taking the elevator, so embarrassing!) called me crazy for being in the gym at all. “Why are you even here?!” they asked, “I’d just be at home resting on the couch!”
I let them laugh, even grinned along with them, and asserted that my aggressive attitude about my daily “pre-hab” regimen was going to stand me in good stead during and after surgery.
Besides, Dr. Bennett actually wanted me in the gym strength training so my whole body would be as strong and healthy as possible going into surgery, so if I’m crazy being there that makes him crazy too right?
Anyway, I’m ok with being “crazy”, and not just at the gym.
In addition to the physical preparation of my body, I added daily meditation and mental imagery. This included visualizing myself in the OR where Dr. Bennett saw my meniscus looking just fine, reconstructing my ACL quickly, and my post-op rehab going smoothly.
It’s my belief that the inner work is just as important (perhaps more so) than the outer work. Our own self-image always wins out, so making sure all our actions align with how we see ourselves is essential; efforting against our own self-image is just wasted energy!
On top of all that, because I’m still a science geek, I also dove into the medical science behind the surgery, both out of curiosity as to what Dr. Bennett would be doing to my knee, and to relax my mind from possibly worrying about what I’m getting myself into (rather, using it for positive worry; another way of saying visualization or mental imagery). Afterwards I even created some oil paint studies of the ACL grafts based on my surgery photos.
So far this may not sound like less is better, but it was already in play even though not yet fully crystalized as a mental model in my mind.
My original brain pattern went something like “if 1 hr on the bike is good, maybe 1hr in the am + 1hr in the pm is better, right?!”
Thus, keeping myself to the minimum viable effort (1hr daily bike) ONLY that would produce the desired results (reduce swelling, increase flexion) during my month of pre-hab, while also making my daily visualizations was already setting my new model in place.
Looking back, I can now see that my inner alignment with the outer world, coming from a place of relaxed certainty, was the foundation of my new model.
Proactively organizing all aspects of my life around effective pre-hab for the ~1 month pre-op made it easy to prioritize all the other parts of my life because pre-hab was (obviously) my Most Important Thing (MIT).
This single-focus approach recommended by Maria Brophy made it much easier to identify and handle key logistics like pre-op bloodwork, arranging transport, even stocking up on groceries while doing my daily pre-op PT / pre-hab and wrapping up any outstanding work projects. Everything else in my life was nice to have, but not essential. I’ve read Maria Brophy’s posts about choosing a MIT for awhile now; but this is the first time I’ve truly put it into practice!
And ditto for re-hab as my current MIT; but first, the surgery itself.
Apparently I was so successful at making my pre-hab my MIT that I fell fast asleep in the PACU (pre-/post-acute care unit) awaiting my turn in the OR (to the surprise of all the nurses, who commented on how relaxed I was).
Dr. Bennett arrived and talked thru my ACLR surgery options. You surely won’t be surprised to hear that I chose the one with the most aggressive recovery schedule, haha. Meaning, assuming I was aggressive about my post-op rehab (duh!), I could be back to 100% by 8 months post-op.
Being already aware of my proactive attitude, Dr. Bennett concurred with the surgical approach, and we all headed into the OR (there are a surprising number of people involved! Also, it’s very cold in there.)
Seemingly a few minutes later I was waking up back in the PACU. Got the great news from Dr. Bennett that he’d easily accomplished our first choice for ACLR procedure, and that my meniscus “looked beautiful” = yay: just exactly how I’d imagined it so very many times in my mind’s eye!
Relieved, I promptly fell asleep. And a few hours later, heard Dr. Bennett commenting on my relaxed state, just as the nurses had earlier. I remember smiling to myself and thinking, “oh yes, it’s working! Should I tell them what I’m doing?” Then drifting off again. It’s kind of a funny, fuzzy world when you’re on the high-test pain-killers, especially being opiate-naive.
When the anaesthesia was sufficiently worn off later that evening, I was ready to depart: feeling strong, healthy, relaxed, alert. Made it home, up 3 flights of stairs (no elevator, strangely reminiscent of my 1st knee surgery), and happily into my own bed again, feeling the shift: it’s strange how so much and so little can happen in just 24 hours.
And part of that shift is that now my MIT is re-hab.
The first few days post-op were the most challenging: the pain meds made me very disoriented but I was definitely glad to have them on board. By the way, make sure you leave the hospital with ALL your pain meds in hand, including a script for a refill if they won’t give you the whole dose, and really do stay ahead of the pain. This was one of those examples where toughing it out didn’t work out that well for me: I could’ve been more proactive about titrating my dose up over the first 24 hrs post-op when pain is the worst. Great opportunity to practice my deep breathing (with surprising effectiveness) and when that sometimes failed, I just punched myself in the other leg and got thru it!
A few days post-op, my continuous passive motion (CPM) machine showed up. Its purpose is to assist with achieving flexion (increasing range of motion, ROM) during the first phase of knee surgery re-hab. It constantly moves the joint thru a controlled ROM, which is increased over time, starting at 30 degrees of flexion, and increasing ~10 degrees per day.
By moving my whole leg, a CPM machine also helps with the flow of nutrients in and metabolic waste products out, which is diminished while we’re laying around in the first week post-op. Even if your insurance doesn’t cover it, I highly recommend paying the few hundred $ out of pocket for this machine.
Apparently only a few hours a day are needed for good results with the CPM, but I found the motion actually mitigated my post-op pain quite a bit, and even when it didn’t, it was far better to work thru the pain in my CPM than just lay there feeling terrible.
At my day 10 post-op checkup visit, when Dr. Bennett heard that I’d practically lived in that CPM (really, I spent like 20 of every 24 hours in it), he laughed and said in this case, more was apparently better (or at least not detrimental): I was already at 90 degrees of flexion by 10 days post-op. As you see in the video, I also used an electrical muscle stimulator (EMS) to help fire my quad muscles while in the CPM.
Dr. Bennett was surprised (but also not surprised) to see me meeting all his 4-6 week ACLR rehab milestones (90 degrees flexion, straight-leg raise, quad firing, etc) by just 10 days post-op.
My reward for over-achieving? More work! I was referred to PT immediately, given the choice to skip our wk 6 post-op, and to keep up with that blessed CPM until achieving 120 degrees flexion.
I’m now aggressively yet patiently moving thru re-hab at Rehab2Perform where physical therapists Dr. Caleb Fatzinger and Dr. Anthony Iannarino push me hard but smart (only to tears once, when I was accused of possibly having unrealistic expectations; who me?!)
Aggressively by attacking re-hab the same way I did pre-hab, and patiently by making sure I always push to and thru edges of my body’s comfort zone but not over the edge into acute pain.
For me the hardest part is not the actions, it’s having the patience and restraint to be doing just enough daily PT (the minimum viable effort, MVE) to heal my knee joint and strengthen my leg musculature without stressing the new ACL graft or donor sites.
But now living inside of my new mental model, it’s becoming easier to be doing less, but better with achieving my MIT as the sole focus.
I’ve noticed this mindset spreading into other areas of life as well. In my relationships, my business, my hobbies, etc. I’m regularly asking myself “what are the most important things / people / activities to attend to right now?”, focusing on those and letting the rest fall away.
This way of approaching each moment has shifted everything in my life: my knee re-hab, all my relationships, diet, training, sleep-wake cycle, work-play time, bank account, business model, even how I paint my finger nails!
Doing less, but better requires me to check-in and listen to my own body (gut, heart, intuition) from a new frame of reference: “what is our MVE here (instead of how much effort can we exert here)?”
This means being fully present in what I’m doing now, in this moment. Not thinking about the next rep or exercise or if anyone is watching or what’s the weather like or what else I need to do that day or…anything else but this rep of this PT exercise, focusing on firing these proper leg muscles, my whole body having the proper form, and the feeling of my knee joint working.
Tightness or soreness in my knee just means to stop for now, that’s enough. The voices in my head now sound something like what my PT guys say “Good work today, Hannah. Stretch, rest, and we’ll try again tomorrow. Be patient and let the joint heal and muscles strengthen.”
I’m finally learning to listen to this little voice. It’s about time!
In fact, I’ve read that there is often a little whisper in our heads right before an injury or accident. It may be even more subtle, such as just a vague sense of unease. And yes, there was that message from my body to me which I now recall (and ignored) that day on the court when I originally tore my ACL a few months back.
But now, armed with my new mental construct of doing less, but better by focusing on identifying and exerting my MVE in order to fulfill on my MIT, I’m finally being quiet enough to both hear and then act on those whispers (which usually for me means stop, enough).
It’s sometimes challenging to balance this less but better mindset with being aggressive (aka crazy): it takes being fully present, which needs to be deliberately cultivated every moment. But it comes easier with practice, and quite frankly I’m now finding that I’d rather be fully present. To enjoy being in this place and time, whatever is going on.
How does all this land with you?
Could you be doing less, but better too?
Maybe achieving better results exerting your minimum vs maximum viable effort?
Share your stories of when you were doing more or less, and what happened as a result in a blog comment below!
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