The Strange State of Injury
Edited by Joanna Bowen
I was moping about in a moon boot with a couple of ruptured ankle ligaments, acquired during a recent fight in Sydney. Before the fight, I’d already had 12 months without a fight – there didn’t seem to be any takers – and now I was grappling with a prognosis of another 12 months out of the ring. So I decided to find out how other people manage injury and setback. It’s one thing to have the advice and opinions of doctors and physios, but how have the countless other fighters out there managed significant injury?
What I learned interviewing the 50kg Lionfight World Title and Muay Thai Grand Prix World Title holder, Lisa Brierley, and amateur fighter, Andrew Prentice, was that the key to recovery is accepting many lessons in patience, being persistent, and taking hold of one’s destiny.
Lisa Brierley Wat Santai from the UK (34 fights) was fighting the famous Thananchanok Kaewsamrit for the 112lbs WPMF World Title in Bangkok, Thailand, when suddenly, her body failed her. In the first round she went to kick left, and felt something pop in her right knee. That pop, she learned afterwards, was her anterior cruciate ligament rupturing. She fought on, trying to hide the injury. Moving forwards towards her opponent, her leg collapsed under her. Her opponent spotted it and attacked. Lisa fights south paw, so she changed guard to protect her injured leg. In the second round, Thananchanok landed a kick, and when Lisa tried to kick back to even the point score, her leg collapsed, and she fell over. She was dismayed to incur an eight count and lose the round. In the third round, hunting down her opponent on right guard, she felt a second pop. That was probably her medial collateral ligament tearing. Unbelievably, she finished the fight, incurring as well, a bucket handle tear to the meniscus cartilage in the same knee, rendering it an emergency situation.
Lisa sought out multiple medical opinions, both in the UK and in Thailand, before having surgery. Now 7 months post-surgery (and 11 months post injury) Lisa describes her biggest challenge as patience. “I’ve learned to be patient with my body as it recovers and heals. I still get a lot of pain.” Of all her physiotherapy exercises, step-downs were initially extremely painful. “I hated doing them,” she tells me, “and not just because of the pain, but because I couldn’t do them.” Lisa says it was difficult to be patient with the things she couldn’t do, especially those exercises which showed her the vulnerability of her knee: “I didn’t want to see that vulnerability,” she reflects, and her eyes cloud over for a moment.
Lisa is a full-time professional fighter in Thailand. 11 months out is a long time for any fighter; it’s surely even longer when fighting is your job as well as your passion. I ask her how she’s coping with not training and fighting. Lisa has reframed the situation as an opportunity to rest and make her body healthy and strong “I’ve got hypermobile joints, and I’m focusing on learning control through range of motion.” In reframing the situation, she’s created an opportunity to work on some fundamental components of her movement and physicality.
I ask her what the prognosis is for her injury. She tells me that her doctors anticipate that she’ll have compromised function in her knee. “But that’s no problem,” she tells me with a smile, “I’ll adapt!” She’ll modify her training – no more long runs – and, she anticipates developing a new kicking style. I reflect that Lisa has already demonstrated a high level of adaptability in changing from conventional stance to southpaw. “Fighting is all about being adaptable,” she agrees.
Andrew Prentice (2 amateur fights) from Australia, lost 4cm of his right tibia bone in a motorcycle accident. ““Bike vs tree” is the official description on his medical report. The official diagnosis is “double open fracture of right tibiofibular.” The surgeon had to cut clean the exit wound, cutting away most of the muscle that allows dorsi flexion of the foot. Andrew rolls up his trouser leg. I see a long, purple scar on his lower limb, and slabs of smooth flesh behind which muscles no longer exist. “I still remember the first time, months after the accident, when I managed to move my big toe. That was very good news: it meant I’d be able to walk without dragging my foot.”
The orthopaedic surgeon took bone-grafts from Andrew’s iliac crest and from his femur. Then he hammered a temporary, non-weight bearing titanium rod though Andrew’s tibia, from his knee to ankle, to help the bone regrow from each end. Unfortunately, the leg became infected during the second bone graft, setting Andrew’s rehabilitation back for a further 11 months, keeping him on crutches for 18 months. “It could have been worse, though, I might have lost my leg,” says Andrew.
While Andrew was never a full-time fighter, he’d made muay thai a central part of his life, training 6 days a week for 2-3 hours, and working his way up through the gym grading system, and accepting amateur fights. It wasn’t his profession, but it was clearly his passion. He was back in the gym as soon as he was out of hospital. He’d arrive on crutches, push a Swiss ball in front of one of the long bags, sit on the ball, and do bag work which paralleled what his able bodied counterparts were doing in the evening muay thai classes.
Andrew talks about the importance of both working with his rehabilitation team, and, conversely, knowing when to take things into his own hands. Physiotherapy, says Andrew, was great during the initial stages of recovery, where he made slow, steady progress: “I learned to walk again.”
“There comes a time, though, when you have to stop listening, and you have to take control.” Against the advice of his medical team, Andrew quit physiotherapy, and made a bid to return to the ring. “My leg wasn’t much good; I couldn’t kick but I could still box, so I settled for a boxing bout.” So, 2 years and 4 months after the “bike vs tree” accident, Andrew got back into the ring. He didn’t win the fight, but I think he’d been winning the moment he sat on that Swiss ball and joined the class. It was being in the ring that counted.
I asked Andrew what helped him keep his body and mind together during the 18 months he was on crutches. Andrew says returning to the gym ASAP was crucial. “It was really important for me to be around positive people. The people in the gym rallied around and helped me with accommodation and training.” Andrew couldn’t fight for the gym, so he found other ways to contribute, taking on administration and promotion work. “Later on, preparing for the fight was itself recovery. You can either sit around and vegetate, or you can do something.”
I draw inspiration from both Lisa and Andrew. Hearing their stories, what they’ve overcome and how, helped put things into perspective for me, and it helped me find motivation within myself.
I decided to manage my own rehabilitation. I consulted doctors and physiotherapists. Overall, the advice wasn’t always consistent: one doctor would put me in a moonboot, another would take me out of it, and then the original doctor would put me back in it. Some told me I’d get close to full recovery, others warned that I’d have to learn to kick on a flat foot because I’d never have good ankle stability. Some advocated Platelet Rich Plasma Therapy (PRP); others said there was little evidence for PRP therapy’s efficacy for healing, although they all agreed it would likely have therapeutic benefit.
In the end, I did two rounds of PRP therapy, consulted a physiotherapist for a bit, took the moonboot off in my own time, and developed my own progressive rehabilitation program alongside a modified training program. My first run at 7 weeks post injury consisted of 4 x 100m shuffles at walking pace on the back straight of an athletics track. 12 weeks post injury, and I can now run 10km on unpaved ground. I notice a difference in my ability to balance on one leg compared with the other, but I’m working on that daily, and I’m seeing progress in flexibility, strength and balance.
I haven’t put on a pair of gloves since 23rd March, because muay thai training is not the priority at the moment – there’s just too many twisting motions that I can’t yet do – rehab is. They say rehab is boring, but I’m okay with boring. Frustration, despair and loss of motivation are the real challenges. That’s why, in the first few months, I focused on strength training: weighted pull ups and push ups. This allowed me to focus on what I could do, and to experience the familiar sensation of pushing myself in training. I achieved PBs, and this was enormously important from a psychological point of view. As soon as I could, I strapped on an ankle brace and made my Sunday hobbie – rock climbing – into a daily pursuit. Psychologically, this substitute sport is crucial; it provides daily training, fatigue, challenge, skill development, human connection, and a sense of progress.
Sometimes we just need to take time out to heal: the trick is discovering ways to keep oneself physically and mentally challenged while we are healing. Andrew and Lisa showed me that injury is common, and people do overcome injury and setback in creative ways. They also showed me that people can come out the other side with increased awareness of their bodies, and maybe even of life itself.
I needed to hear their stories, in the midst of the struggle myself. It’s early days for me, but I’ve moved from feeling powerless to taking control, a vital step. I’m letting recovery be a discovery of other interests, other pursuits – I’ll know when I’m ready for muay thai again. And I’m allowing my current limitations to help me focus on what I can do.
Editor’s note: Claire Baxter is a three time Muay Thai World Champion. She is a practicing psychologist with a degree in sport and exercise psychology.