Lament for the Injured, Pt. 2

Riyas Komu, from exhibit "Safe to Fight" (Azad Art Gallery, Tehran, 2010)

Fear of ACL injury has replaced fear of intimacy as my number one issue. Plenty of people come back from an ACL tear and still play in leagues and pick-up games. But plenty also leave the sport forever.

If I turn a cold eye on my fear, I see that I am less afraid of never playing soccer than I am of the rehabilitation that it would take to go from a torn ACL to playing again. It isn't the tear that scares me, but being off my feet, not being able to run - sinking into depression and giving up. Not having the emotional strength and discipline to take on something like that.

I called my HMO the morning after my injury and pushed to see someone that day - I was clear: "I am afraid I tore my ACL." I was determined confront my fear - or rather, I should say, my knee insisted.

I said the magic word to describe my pain ("acute") and soon gained entry to orthopedics (I had asked for Sports Medicine, but was re-routed). I am not a difficult patient, but I have something to say about what's going on with my body. Unfortunately, this doesn't always make one's journey as a patient smoother.

A detour through past medical trauma

In 1984, I was hospitalized for eight days. A couple days before I found myself in an ambulance, I had gone to the student health clinic at Rutgers College because I was afraid I had a kidney infection.

A good friend of mine became deathly ill from this when we were first-year students. I knew the symptoms, and mine were identical to hers.

An affable young male doctor saw me. He didn't seem to take my concerns seriously. I had constant, deep pain in my lower back - off to one side exactly where the kidney is located. I had a low-grade fever, symptoms of a UTI, I was starting to feel like I had a flu or something. I could feel that this back pain wasn't muscular - it was deep, and constant.

He asked if I lifted heavy things - maybe I sprained my back. I worked in a kitchen and lifted heavy things all the time - but didn't recall hurting myself. "And how would that explain the fever, anyway?" I asked.

He told me to take extra-strength Tylenol. I said I wanted to be sure I didn't have a kidney infection. Would he please run a test? Could I please pee in a cup so we could just be sure - I was really concerned because kidney infections are really serious, and if you get to the point were you need to be hospitalized, the recovery is slow. As a working student, I couldn't afford to be out of commission for a month. I peed in a cup and went home. I took the Tylenol and felt better, but the symptoms kept returning as the pills wore off.

The next day I called the clinic to ask about the test results - they said: "The test came back negative." I bought nice food for myself because I hadn't eaten a decent meal in days. I took more Tylenol - I ate cheese and crackers, some fruit, and went to bed.

That night I was violently ill. There was a reason I had no appetite: my body couldn't handle food. I soaked the sheets with sweat. My fever kept climbing, dipping, and climbing again. By the morning I couldn't keep down water. It was the last week of the semester, and I couldn't imagine not going to my feminist political theory seminar. Being young and delirious, I went to class.

I sat on the floor in the hallway with the other students and waited for the professor. My classmates (an intense collection of college activists) insisted I go directly to the nearest university health clinic (attached to the women's college, different from the one I used). I must have been a sight - gray and sweaty. Having trouble staying vertical, and having little will of my own by this point, I went. It was about three blocks away, and I remember walking there being really hard.

I more or less collapsed when I walked in the door. My fever was 104. I remember telling the staff taht I'd been to the other clinic about fearing I had a kidney infection, and that this clinic said I was fine. The doctor on duty at the women's college clinic was soon yelling into the telephone, swearing. She shouted "You did what?!" and said "What fucking assholes," or something like that when she hung up. She then ranted to her colleagues.

I later learned that the doctor I'd seen (a resident) had decided that I w as trying to manipulate him into giving me a pregnancy test, on the assumption that I was too ashamed to ask for one. So, when I called about my test results, I had gotten the result of a pregnancy test I had not asked for.  This is bad enough. But when I went to that first clinic, I had told the resident who treated me that I had my period.

The picture I should have presented to that doctor was that of an articulate young woman, who was quite frank about what was going on with her body, and who was worried that she had a kidney infection. The doctor, I guess, saw me as a dumb slut trying to manipulate him. I don't think that's too harsh a way of reading his actions.

As I was being rushed off to the hospital in an ambulance, as the school worked on locating my family, I was far too sick to care.

I only learned the full story about what happened from a nurse, just before I graduated, when for some reason I had to go back that clinic. She saw my name and pulled me into an office to give me the full breakdown on what had happened. (Until then, I thought it had been a lab error, or something like that.)

The residency program at Rutgers was overhauled as a direct result of this incident: residents were not allowed to see especially women patients without supervision. If that nurse hadn't told me what happened, I'd never have known why what happened to me happened, or that the university had cared enough to prevent it from happening again.

The whole experience left me with one rule: Never let a resident talk to you without a doctor in the room. Never trust a doctor to really understand what you are saying about your body - they have their own feelings about the body you are in, and you can't control that. You have to help them see where those feelings interfere with their ability to see and hear you, just as they are there to do the same for you.

The only branch of medicine where I've found this to be less true - where careful listening to the patient is pretty much a base-line from which the doctor works, is, as it happens, Sports Medicine.

Sadly, that wasn't where I found myself the morning after I heard that tearing sound from my right knee. I was at Orthopedics. In a room with a resident.

Lament for the Injured, Pt. 1

Yrsa Roca Fannberg, The Death of a Former Giant (watercolor on paper, 2009)

For most of my life, I've had very specific flying dreams. My sleeping self unlocks gravity with a perfect physical coordination. I'll be running, or dancing, and then somehow both at once - suddenly I feel weightless. The struggle is not how to leave the ground, but how to find it again.

The nightmare version of this: I am running, and I feel something pull my feet out from underneath me - I fall down while my feet are being pulled backwards, and wake just before my face hits the dirt.

My athletic unconscious orbits around the scene of physical freedom - its gift, its loss, its recovery.

Last spring, I played a game with that dream-like weightlessness. There was no will, no thought - just the pure physical expression of intention.

I scored, assisted, played great defense. My body knew where the ball was, all the time. I played out of my socks, and felt, for the first time, that I knew what that phrase meant.

I loved every second of that night - months later, I can recall the game in flashes, a residual sense of a perfect (for me) economy of movement.

But the morning after, I woke up with a swollen knee - I don't remember hurting it. This was not something I'd seen before. I did the things athletes do, wrapping, icing, etc. I stayed away from the field for a few while. After three or four weeks I was back in the game - but it didn't feel right. More months off the field - a glorious summer devoted to cross-country running - and my legs felt great. Then I tried playing.

My first week back, my knee felt wrong. Easing into a game, I took up a defensive position in relation to player attacking down the right wing - he faked this way and that. I tried to go with him as he cut to my left. As I pushed off with my right foot - nothing unusual - I heard a crunch, and my knee immediately went funny.

This was a loud crunch - very different from the crackles that knee has made since I was in my 20s.

The knee didn't swell up immediately (one of the big indicators of a torn ACL), and I could put a bit of weight on it. But it hurt, and it felt so wrong - like I'd tangled up all the cords. 

A sense of dread washed over me.

Walking off the pitch was really tough. I hoped that I was being stoic. But, really, I was numb with dread.

In my heart of hearts I knew that my leg hadn't been normal in months: where my age has generally manifested itself as me needing more and more time to warm up in the game, here, it was showing in a different way.

Since that amazing night in May, my right leg would actually get worse as the game wore on. It would get weaker. My knee would be unpredictable. I couldn't tell where my right foot was when receiving a pass on the floor. My right leg below the knee would feel increasingly wooden over the course of a match. It wasn't tiredness, it was something completely different - something mechanical.

That night I stood on the sideline and watched the guys play for a while. This only made me feel more sad, more alone. 

I was staring at the field but I wasn't watching the game. I was trying to look like I wasn't totally freaked out. 

The guys in that game are my friends, but our friendship lives there, on that field: What is our connection to the people we play with, when we can't play with them anymore? Even those attachments which extend beyond the field are transformed by not being practiced on it. 

It is not easy to maintain a connection built in the game beyond your ability to play it. Making that transition is not much easier than it is to maintain the intimacy of lovers, once one has declared to the other: "Let's just be friends." I know this, if only for having played in different generations of games - Saturday morning collectives dissolve and then people you've known for a decade disappear from your life.

I limped to my car and went home.

Actually, I went to a neighbor's for ibuprofen and sobbed at her kitchen table.

Lame Journalism: Observer Story on Injury and "'Warrior' Girls"

Because newspapers are lazy, Observer readers this weekend are being served recycled slop originally dished out a few weeks ago in the New York Times ("'Warrior' Girls Run the Risk of Injury"). Like the NYT story ("The Uneven Playing Field") the Observer spins a scary - and condescending - headline from the most regressive aspects of Michael Sokolove’s book on the “injury epidemic” in women athletes.

This story is short, and so doesn’t even have the complexity of the NYT Sunday Magazine piece – its whole attitude stinks with the totally unexamined sexism of UK culture when it comes to women athletes.

For example, the story makes news of the fact that when women athletes ignore their injuries, it has a drastic effect on their health. RRRReally?! Anyone tell Wayne Rooney – hey, with all those metatarsal fractures, think you should keep playing? He's hardly alone - it's a very common injury for footballers. Man, Thierry Henry’s back wouldn’t hurt so much if he just stopped playing. Think Eduardo de Silva plans to retire from football just because Taylor broke his leg? And: Let’s remember that Ronaldo’s most recent knee injury wasn’t his first. Any stories in the sports section in which journalists breath the slightest suggestion that football is too rough to play because men get hurt??? And what's with the scare quotes around 'Warrior', and what's with the word "girl"? The Observer article doesn't focus on girls, but on adult women playing at the highest levels.

I’ve covered the ground regarding ACL/cruciate injuries and women athletes before ("Sexism Hurts"). And I agree – there is a story in the subject. Just not the story people want to tell.

But here I will just say this: Things are worse in England than in the U.S. Sure, there are people out there who support women’s sports, but the generic cultural attitude is still in the dark ages. Just look at the amount of space The Guardian/Observer gives to women’s sports, for example. Next to nothing. There shouldn’t be a single day in which their sports section excludes coverage of women’s sports. And we should not have to wait for people like David James to use his column for perspectives on women’s football (he’s the only one who does so with any intelligence). Why doesn’t the Guardian or Observer (or any other paper) have a woman columnist (and I mean a serious writer) invested in the women’s game??? (Please tell me I'm wrong and give me a link to a monthly column on women's football written by a woman in a national paper.) Is it only acceptable to write as a feminist when it comes from a Premiership and national men's team player?

An alternative view of sorts concludes the article:

Others, however, are concerned that drawing attention to the issue will backfire. 'Sex differences can easily be perceived as weakness,' said Mary Kane, director of the Tucker Centre for Research on Girls and Women in Sport. 'We need to do everything we can to prevent injuries. But it does seem that there is a disproportionate emphasis on things that are presented as signs of women's biological difference or inferiority.'

But this isn't, in my view, enough of a portrait of the concern many of us have about the presentation of the issue. Why doesn't Kane's concern lead the article? Why present it as an afterthought? Again, see "Sexism Hurts". It isn't that we don't want to discuss the issue - far from it. We want it presented in the same way that we present issues regarding male athletes. Taylor's tackle on Eduardo de Silva, for example, sparked an important conversation about the complexity of the physical side of the game. Let's allow ourselves to have that kind of conversation about women athletes, injury, injury prevention, and recovery.

That story about women athletes and injuries should be a big story in the sports section.

Why don’t journalists track down the members of the English women’s national team who’ve suffered from these injuries and talk to the doctors and physiotherapists who treat them? How about stories about how hard these women have fought to come back from these injuries? OR – perhaps more compelling: what happens to them when they can’t play? Where do they go with all that passion for and knowledge of the game?

Ask top athletes who’ve suffered career ending injuries if they regret it (who among them would say they’d rather never have played??). (The only athlete they interview is Katharine Merry - a sprinter – and runners don’t suffer the kind of knee injury that is the subject of discussion! The injuries sustained by Merry are absolutely identical to all athletes of any gender who train and compete at very high intensity from a young age.)

Cover the advances in training – I think people would be interested in learning exactly what the differences are between men & women athletes. I mean, we get stories about differences in how men and women talk, how they think about sex, how they approach raising kids and managing colleagues in the workplace. How about how men and women play the game? Like: Do women dive as much as men? Do they give referees attitude like the men do? Do women play dirty? What kind of reputation do the women’s teams have?

But jeese. Don’t give us stories about how fragile women are! I’m sorry – but I took some hard, clean tackles that sent me ass over tea-kettle in the mud last week, and it felt GREAT! There’s nothing like knowing your opponent feels you as a threat. There’s nothing quite like getting up and playing on, not just because you want to show that you can’t be scared off the field, but because they’ve just upped the ante, and you plan to take that ball back come hell or high water.

Don’t pander to the sexist attitudes of the lowest common denominator. Some people here in England have their heads really far up their asses. Many would rather their women drink until they are falling over, fatten up, and breed than get in their kit and take the field. And no one is going to change those attitudes by pandering to them! So OBSERVER: SHAME ON YOU! You made me so mad I blew off my Sunday kickabout so I could rant!!!

Sexism Hurts: ACL Injuries & Women Athletes

Sexism can be simple and obvious (e.g. the FA ban on the women's game, or Man U's Christmas 'Rape' party). More often, it's subtle, complex, and really hard to tackle. Take, for example, the impact of poor medical understanding of women in general on women athletes in particular.

We see this in the alarming frequency with which women athletes who play especially soccer and basketball suffer ACL tears. The ACL tear is a very serious knee injury, requiring complex surgery and a lot of recovery time. (Pictured, right: Danielle Fotopolous, USNWT retired in 2007 after tearing her ACL for the third time in 2006.)

The New York Times Sunday magazine just published a long, in-depth story about young women soccer players, the injuries they sustain, and the difficulty we have in dealing with them (The Uneven Playing Field). The article is adapted from Michael Sokolove's forthcoming book Warrior Girls: Protecting Our Daughters Against the Injury Epidemic in Women’s Sports. (Can I just say: I hate that title. It's so paternalistic! And aimed at the parent-reader, not at the female athlete. How about - Match Fit: Injury Prevention for Young Women Athletes?)

This interesting article is unfortunately wrapped in a sensationalist package. Problematically, Sokolove makes news of the fact that more women are injured as more women play (really?!). The following rhetoric, for example, makes it seem like Title IX is the cause for the increase in 17 year olds needing knee surgery - and as if this were in itself the problem:

This casualty rate [JD: no statistic here, the author just means the number of injuries suffered by a couple of high school teams] was not due to some random spike in South Florida. It is part of a national trend in the wake of Title IX and the explosion of sports participation among girls and young women [No soccer teams = No ACL tears]. From travel teams [these are the club teams not based in the school system] up through some of the signature programs in women’s college sports, women are suffering injuries that take them off the field for weeks or seasons at a time, or sometimes forever. [Unlike men? I mean, of course women suffer career-ending injuries! At least they don't break each other's legs!]

The author then goes on the explain how girls develop differently - e.g. boys get more muscle, but less flexible; girls get more fat but more flexibility. The author's language flirts dangerously close to naturalizing girls and women as weaker, more delicate etc. I'm not the only one to spot this slant.

The main issue in this article, however, is women athletes' specific vulnerability to the ACL tear and the lack of understanding of the specific needs of female athletes - a failure caused not by Title IX, but by the ingrained sexism of medicine and sports culture.

Towards the end of the article, the author interviews Holly Silver, a physical therapist who has developed a knee injury prevention program that should be adopted by all footballers and their trainers.

Silver touches on some possible reasons for the high rate of ACL tears in women athletes: Girls are taught to walk and stand and move through the world differently. We curl around our chests - our bodies become shells, in a way, protecting/hiding everything 'feminine' - those bits are sources of shame, abuse, negative attention. [Ed: Found this note on Kickster, about the reception of the first women's game in 1894: "The British Medical Journal offered its professional opinion that 'we can in no way sanction the reckless exposure to violence, of organs which the common experience of women had led them in every way to protect'."]

One of the beautiful things about playing football is that it forces women to free their bodies from this shell: You can't trap the ball with your chest if you are hiding it from the world. You can't make a good play if your eyes are trained on your feet. You won't have much touch or footwork if your hips are locked.

Pointing to a player with good form, Silver explains

'She moves like a boy....Believe me, that's a good thing.'

In other words, that girl carries herself like an athlete. Girls are not encouraged to adopt this stance (knees bent, butt low to the ground). And so that posture has become synonymous with 'boy'. Boys of course aren't born moving this way - and lots of boys don't carry themselves that way (and are therefore terrorized for 'walking/throwing like a girl'). The point here is that the social inscription of gender is deep: it may be culturally produced, but it is carved into our spines, and worked into our joints. Girls need to unlearn that stuff - as athletes, they sometimes literally need to learn to walk, and run. (FYI: Philosopher Iris Marion Young writes about these issues in her collection of essays, On Female Body Experience: 'Throwing Like a Girl' and Other Essays.)

Silver describes the extraordinary consequence of the way that girls inhabit their bodies as they play sports - if you run with poor posture, your running is not only inefficient, it harms your back, hips, all your joints in fact. As any yoga practitioner will tell you, holding tension in your joints not only makes you less flexible and responsive (slowing your reflexes), it makes you more prone to aches and pains.

My sister coaches girls cross-country and track at Voorhees High School in New Jersey. Her teams have been very succesfull. Injury prevention is a big part of her program. They work on building up their strength in the gym, on minimizing strain to their muscles, on overall health and well-being. For example, she has the girls keep an eye on their iron levels - anemia is a big problem for teenage girls and young women, and can have a big impact on your development as an athlete. She's always looking for the latest information on issues like these, and keys these insights to the specifics of her sport and the people she coaches (teenage girls). Not all coaches approach their work this way.

One must recognize gender differences in order to coach/train/treat athletes well. Those differences may be physiological, metabolic, social and psychological.

For example, athletes in general are loathe to report injuries. Reporting injury or medical problems can be even harder for some girls and women. Here are some reasons why:

*We don't want to seem weak. In a world that reads all physical signs of womanliness as symptoms of the weakness of your sex, getting an injury makes you feel like your body has betrayed you, again.

*Women athletes can be reluctant to own up to the differences gender makes, because admitting to those differences has meant admitting to belonging to the 'weaker sex.' Remember: every girl - even today - will be told at some point that girls can't or shouldn't play or compete. Every girl hears that girls are weak, that they aren't tough. Or that playing a sport makes them mannish - i.e. repugnant. To all of this, players say: Fuck That, and get on with it. So, not only do we not want to seem weak - sometimes we don't want to seem like 'girls'.

*Doctors treat us differently. They don't listen to what we say about our bodies. They read everything through their ideas about our reproductive system. Our experiences with doctors tend to start off bad, and get worse. We have little reason to trust them.

*We are taught to accept certain physical symptoms as 'natural': tiredness (symptom no. 1 of anemia), especially.

*We are reluctant to talk about our bodies - sport is often the only avenue through which we get to talk about our bodies in a way that is neutral, matter-of-fact and empowering. I'll never forget listening to my sisters talk about pre-race bowel-clearing nerves and the humiliating but often hilarious situations that puts you in. As much as their stories made me laugh, I didn't really 'get' it until I started playing football and found myself at Hackney Marshes trying to act cool as we waited for the mens' teams to clear out of the damn bathrooms. Never, ever, go to Hackney, ladies, without a roll. Somehow, I associate that kind of frank and humorous talk about the body with 'jock'-culture. Some of us need encouragement to adopt this kind of attitude.

*Girls aren't always used to thinking of their bodies as something they can control. Except by starving themselves.

Add onto the above the following:

*Many girls and women play team sports on bad fields/in poor facilities.

*98% of sports stores don't carry football boots made for women - and that 2 % will carry maybe two kinds. The overwhelming majority of women wear men's boots, in other words.

*Because women were prevented from playing for so long, coaching/training is modeled after the boys/mens game, and a lot of coaches are not aware of things like the frequency of ACL tears in young women footballers and the conditioning programs which might prevent those injuries.

*We accept the differences in the way that men and women move as 'natural', and so do nothing to raise girl athlete's awareness of poor posture on the field, poor running technique, the importance of being relaxed and having a good stance.

*And, most problematic of all: we don't listen to girls. We don't take their complaints seriously. We dismiss their complaints as teenage melodrama or psychosomatic weakness.

That's a lot of crap to deal with. It's why teaching/coaching/advising girls and women can be harder - but it's also why it's so absolutely rewarding. The things we learn in such settings not only change how we play - they in fact change how we live.