“Ready to run next week?”

I was finishing up my most recent physical therapy session when Eric, my longtime PT, quietly and casually asked this simple and innocent question that carries a ridiculous amount of emotional weight for the post-op meniscus root repair patient who has been counting up the weeks post op as a measure of time (for the record, as of April 10, I’m finishing week 15).

“Whaaaat did you say?” I shrieked, wanting to confirm again through my hearing aids.

“Are you ready to run next week? We’ll start on the Alter G and see how things go.” Eric was laughing now, almost taunting. He knows me well, and that left to my own devices, I could easily let things get out of hand. “See how things go” is his way of saying, “don’t get too excited and stay in your (protocol) lane.”

Boom. There it was. Return to Run (or “R2R” for those not well-versed in post-op recovery speak) is finally here!

Phase 4: 12-20 Weeks Post Op

UVAHealth Post Meniscal Root Repair Protocol

What did it take to finally arrive at this point?

PT: The protocol above spells out the work of weeks 10-15: a lot of single leg balance work on the Bosu, multi-directional wobble board, and foam squares. This includes split squats, slides, single leg squats, two-legged squats with rotation, kettle bells up to #20lbs, pogo hops on one- and two-legs, side-to-side hops, and single leg press up to #110 lbs. I knew we were getting closer to R2R when Eric had me add hops on the surgical leg while in a split squat, as well as “hopping” on the single leg press at #60. I worked with Eric twice a week in the clinic and once on my own, being careful to carve out a good hour at the gym to include my other knee as much as I could, and starting this week I will go to the clinic once a week while completing two more sessions on my own.

Hiking: I don’t think I’m alone in saying that there’s nothing quite like Virginia in springtime. Temperatures in the morning are chilly, even downright cold, before warming to 50s and 60s by evening. The pear and peach trees are often among the first to bloom, before the redbuds (my favorite) and the dogwoods and the purple wisteria, and our running crew can run through a blooming peach orchard on our way to and from the Appalachian Trail and Shenandoah National Park.

Chiles Peach Orchard sits at the base of Jarmans Gap and Shenandoah National Park

Weeks 10-15 of this recovery connected late winter to early spring in the most symbolic way. Literally moving from the darkness of winter towards the promise of renewal and new beginnings, I have been able to increase my time on feet, hiking up to 20+ miles for weeks in a row with no issues. These hikes include two miles each morning on the soft farm trails near my house with my dogs, and on the weekend I venture to Mint Springs Park for a solid 1:30 four-mile loop with 871 feet of vert. In late March I drove a few hours west to the Hone Quarry 40, a race I suffered through in heat and cramping last year, to cheer and support my friends and to enjoy a gorgeous, chilly spring day at the finish line party. Another injured friend, Anna, and I rode our mountain bikes for five miles on the gravel forest roads to the mile 20 aid station, and then ditched our bikes in the forest to hike a few miles of the last section of trail on the course to see our friend Eric crushing it as the front runner. It was a perfect way to enjoy and participate in the ultra scene while being injured — moving outside on our terms, while supporting those who moved a little longer and farther.

Speaking of longer and farther, friends Bridget and Marc are deep into their training for the Hellbender 100, a Hardrock qualifier in western North Carolina in early May. Last weekend I tagged along on their 21 mile training run on the AT and Mt. Pleasant trails and enjoyed my longest hike to date, a 7.6 mile loop with 1695 feet of vert of the Old Hotel trail towards Cole Mountain (a beautiful and rare bald knob for our area) followed by a 4-mile mountain bike spin on forest roads while waiting for them to finish their run. Traversing these technical trails using poles, my knee felt great as I built up confidence covering rocky terrain. I definitely envision hiking long distance as a new part of my regular exercise routine, along with gravel biking and swimming.

Cole Mountain has 360 degree views of the Blue Ridge Mountains near Lynchburg, Virginia

Biking The Peloton bike (aka “injured runners best friend”) has been a valuable part of my physical and emotional recovery. We are fortunate to have been gifted a bike during Covid as a Christmas gift from our adult children, and I have used it on and off since 2020 while — you guessed it— injured with plantar fasciitis, a little ITBS, and now this pesky root tear. But I haven’t been a Peloton regular, the kind of user to get over 100 rides or who knows the best Power Zone workouts, until now. When I started bearing weight, the Peloton was a handy tool to help increase my knee range of motion. Now I use it for speedy leg turnover as well as to mimic the run motion while standing in the pedals for 1-2 minutes at a time. I’m going to start gravel road riding outside on the weekends now that the weather is nice, but will keep my three, 30-45 minute indoor spins during the work week as a low weight-bearing cardio option.

Swimming The pool continues to be my happy place. I usually swim twice a week after a PT session, to loosen up, “run” without loading my knee, and to use my upper body. I also love the sauna and the hot tub, which are adjacent to the pool deck, so my Strava swim title is always some version of “Sauna/Swim/Hot tub” with the actual “swimming” being more like 500 yards of pull buoy work around a few laps of pool running with a belt. In the early days of weight bearing, I would walk up and down in chest deep water to gain confidence, and now I’m in the deep end enjoying my easy “runs” (and my waterproof headphones).

Emotional capacity In addition to my husband, family, students, and colleagues, the support I’ve received from my running friends (some who have had this injury) as well as new ones has been essential to building my emotional capacity. I started following fellow endurance athletes Jill Homer and Scotty Kumar as they write and podcast about their own recovery journeys. Scotty interviewed me on his podcast last week, and we had a fun discussion comparing our root repair journeys as well as the ultra scene. The meniscal root repair Facebook group has been very helpful in sharing logistical intel, as well as success stories, although I need to check myself from going to down the rabbit hole of posts about unsuccessful repairs, and to prevent the comparison trap, as everyone’s repair journey is unique.

One book I’m enjoying right now is Brad Stulberg’s The Way of Excellence. As a coach and teacher of young people, I find his writing inspiring and practical as he talks about excellence being not about striving to be perfect and elite, but more about gaining mastery and meaning. The concept of “building capacity” while working through difficult times has resonated with me during this recovery journey, while at the same time I also relate to this piece (gift article) he wrote for the New York Times that emphasizes that not everything hard in life has to have some deeper meaning attached to it. Sometimes life just sucks, and trying to create meaning can backfire. Sometimes, Stulberg writes, “the most important thing to do when in the midst of a life upheaval is to release yourself from any expectations altogether. Be patient and be kind to yourself. Seek help and social support. Do what you can to hold onto the fact that what feels like forever now probably won’t in the future. If you find immediate meaning and growth in your experience, that’s great. But if not, that’s OK, too. Sometimes simply showing up and getting through is plenty. Perhaps the real growth is learning to let it be enough.”

And when magic words like “ready to run” come seemingly out of the blue, I can see that one part of the journey may be over, but another one is just beginning. And that is enough.

If there is one big takeaway after the past ten weeks since surgery, it’s that the meniscus root tear repair protocol is rigid with very little room for compromise, and that’s for a reason. From what I have read, unlike other knee surgeries where the risk of re-tearing is mainly due to torque and/or impact, the root repair re-tear can happen with a random step up the stairs, or off the curb, or just walking in a straight line. The tear can fail because of poor tissue quality, extreme knee angles, a trip or fall, or because the root couldn’t hold the stitches. The timeframe for most re-tears is about 4-5 months post op, which also coincides with the protocol’s allowing of full return to activity. I unfortunately find myself going down this rabbit hole of negative thinking as we ramp up the PT and enter month 3 post op.

UVAHealth Meniscus Root Repair Protocol

It’s been four weeks since I gingerly walked out of Dr. Matt Deasey’s office without crutches. At his suggestion, I went directly from his office at UVA Orthopedics to the UVA rec pool to walk in chest-deep water (which is 50% bodyweight) and return to swimming with a pull buoy. It was glorious! I wore the brace on the pool deck out of caution, but after a few days, I ditched it in favor of an Incrediwear bamboo knee sleeve (which I highly recommend) that I wear nearly 24/7 . The following days were a mix of elation from being sprung from “brace and crutch jail” and anxiety about every weird niggle or wrong step being “the one” that ruins everything. At my first PT appointment in this phase, Eric outlined the recovery plan: “Hurry up and Wait.” I would move ahead on all the protocol-approved exercises, continue stationary biking while gradually adding resistance, swim as much as I wanted, and start walking outside on a flat road for 10-20 minutes. But we were going to stay within the recommended protocols no matter how good I felt.

Week 7:

PT ramped up from the basics of heel slides, quad sets, and single leg raises while lying down to 3 x 15 reps of banded quad sets while standing, mini-squats off the Bosu ball and balance board in different directions, Bosu and TRX squats (no more than 90 degrees), and single leg presses at 50 pounds. Eric did a lot of knee massage and manipulation to break up scar tissue while working to get my range of motion (ROM) closer to 120 degrees.

I began adding two clipped-in peddling legs to the Peloton, which really helped increase ROM, and went to the pool 3-4 days to walk in the water and start kicking without a pool buoy. I walked outside for the first time at the end of week seven, slow and deliberate without my dogs. Our area was still covered in “snowcrete” from the recent storms, so I didn’t have any FOMO about missing trail time, and I just enjoyed each and every unassisted step.

At work, it was gratifying to see the excited faces of my students when they saw I was walking without a brace or crutches. “You’re walking!!” was a typical reaction as I passed by in the hallway. Oh, how I love teenagers. Despite how they may be portrayed by the media, teens are (mostly) empathetic, genuine, and authentic. My students are especially so, and since we have a cell phone ban during the school day, their eyes are up and they greet people by name when we pass. Many stopped to ask about my knee, and because we are in a college town with excellent orthopedic care, a lot of our student athletes also work with Eric when they have injuries. It’s been fun to compare PT notes with them, as we all agree, in the words of one student, that “Eric is the BOSS” – no-nonsense, experienced, and always keeping the bar high enough for each session to feel challenging but also within the protocol limits.

Week 8:

PT: 5:00 leg press: 3:00 with two legs, then 2:00 one leg; 3 x 15 reps each of TRX squats, lunges, banded quad sets, single leg Bosu mini-squats, slider squats in three directions, step-to-stand from seated on two legs, 50# one legged seated press.

Cycle: 2-3 times with increased resistance on the Peloton (still staying in Zone 2 during Power Zone classes) and maxing out at 45 minutes. The 30 minute HIIT/Hills rides are a fun distraction and help with building my turnover again.

Swim/Pool walk: 2-3 times with pull buoy gradually adding one beat kicking without (and no breast stroke – I’m not sure if I’ll ever do that again, to be honest).

Upper body strength and core: I’ve been incorporating these workouts since the first week post-op, but now I can add single leg RDLs with weight (30#), side planks, bear planks, and quad strength exercises for my right (non-surgical) knee.*

**On the Facebook page for meniscus root tear repair support, there is a lot of chatter about the need to take care of the non-surgical knee throughout and beyond the NWB recovery. My right (non-surgical) knee has a bit more osteoarthritis than the left, and is definitely at risk for a root tear because I’m more bowlegged on the right than the left. So I try to work out the right leg with the same PT exercises as the left for this reason.**

Walking: I walked slowly for 30-40 minutes a few times this week, never on consecutive days. Everything feels good but the quad insertion on the medial side is tight. I have no pain in the meniscus – it’s the right knee that feels more creaky!

Lacrosse season has started, and I am the coach of the JV girls team. I bring a three-legged golf stool to sit on during practice, and ask my assistant coach to demonstrate all drills – I’m not allowed to hop, jump, run, or pivot and it’s definitely a mind game to remember this while coaching.

Week 9:

PT: More of the same (yep, “Hurry Up and Wait”) with the addition of 3 x 10 Bulgarian split squats at body weight, single leg mini squats off a step in three directions, and 60# single leg press. My left glute and quads are (happily) whipped after PT.

Cycle: Peloton up to 45 minutes with Power Zone Endurance rides where I am now going to Zones 3, 4 and 5 with resistance and cadence. This feels like a huge step forward towards reclaiming my pre-injury cardio fitness (which I realize will take the rest of the year to happen, if at all). My knees really love cycling. Going forward, if all goes well, the OG days of 5-6 days of running, 2-3 days of swimming, and 1 day of cycling will be replaced with 2-3 days cycling, 2-3 days of swimming, and 3-4 days max of running, all on non-consecutive days.

Swim: 3 days of 1000+ yards including chest-deep walking and pool “running” in the deep end. I did not grow up swimming competitively but I am a former triathlete, so I’m comfortable in the pool, but not for long periods! In anticipation of more pool time post-op, I asked Santa to bring me waterproof headphones by Shokz for Christmas, and the music entertains me enough to get close to 30 minutes of swimming, a huge milestone for me!

Walking/hiking: I’m moving closer to 2.7/2.8 miles an hour on my walks, so on Strava I am now using the ‘Hike” mode. Little victories! Eric gave me permission to add 10-15 minutes at a time to each hike as long as there was no swelling or pain that lingered the day after. So far so good. I’m also allowed to hike on grassy trails in addition to the uphill treadmill at 8% grade.

Other milestones this week: I took my first walk with our Aussies Blue and Cooper together, and it went off without a hitch. I’m very wary of being pulled off-balance and have made a conscious plan to drop the leash at the first sign of a pull towards a critter or a runner. We like to go hiking in the pre-dawn darkness to avoid others and to enjoy the sunrise, something I’ve missed so much since surgery.

Blue and Cooper are so happy to resume their sunrise hikes. I am too.

I also hiked with friends for the first time this week! C and K are both struggling with knee issues, and K is having a significant surgery (not a meniscus root tear) with an 8 week non weight-bearing recovery in the near future, so we talked a lot about what to plan for, what to expect, and the reality of the NWB phase. It was so good to be moving outside again with friends, and I was happy to pass on the lessons of these past weeks while also being reminded that I am still very much in the midst of it all.

Week 10:

PT: Same as last week, but now all on unstable surfaces like the flat side of the Bosu and the big wooden wobble board (which is the same one they’ve had in this PT office since I first came for treatment of ITBS in 2004. It’s like an old friend to me!). New additions this week are Bulgarian split squats with rotation, hip belt slides with rotation, step ups onto the blue Bosu side, “smooth and soft” side-to-side hops (!) across the Bosu blue side, sit-to-standing on two legs, then one leg, and 70# single leg press.

Cycle: Peloton 3 x for 30-45 minutes, using Power Zone endurance and HIIT/Hills classes going to zones 3-4-5. The weather is looking good for my first permitted (and very easy) outdoor ride around the neighborhood on my mountain bike this weekend.

Swim: 3x for 25-30 minutes, using pull buoy for half, as well as chest-deep walking. Pool running in the deep end with a hip belt still feels awkward and a little stressful to the surgical knee, so I’m staying safe in the shallows.

Hiking: Before my injury, it was my tradition to run/hike up our local mountain every month a few days after the full moon, to admire the sunrise and the moonset from the open ridge line. With the exception being away on vacation, I hadn’t missed a sunrise up there since 2018, so having missed the past five full moons, I was hell bent on getting up there to see the Worm Moon this month. I gathered my friends, stayed on low-vert gravel, used my poles, and felt fantastic to be back to one of my favorite ways to start the day. It was a much-needed celebration of spring, sunshine, health, and friendship.

Celebrating the Worm Moonset, the onset of spring in Virginia, and the return to my happy place with friends.

Looking ahead, it’s hard to believe there are 6 weeks to go before starting the return to run protocol, which is going to be an entirely different “Hurry Up and Wait” experience. I am feeling grateful that my body is responding so well to all the loading, and to be healthy, strong, and able to move in the mountains as our Virginia springtime begins its blooming season. My mindset is still a work in progress, as it would be easy to wallow in the worry of a re-tear, so instead I’m determined to enjoy each and every moment of movement without fear, one step at a time. A perfect mantra for living life!

The view from my couch, where I have slept for the past six weeks.

On December 29 I woke up in my recovery room to see the tired but smiling face of my husband, Rusty. At least, I think he was smiling behind the mask he was wearing, since he had been dealing with flu-like symptoms for the past few days. My surgeon, Matt Deasey, came into the room to say that all went well with the repair, despite the fact that when he tested the suture before closing up, it failed. And the room they were using for my surgery was scheduled for another patient at that time, so they had to wheel me into the pediatric surgery room next door to finish the job, with a bunch of pediatric surgeons watching. Matt assured me the second round of repair held beautifully, that the rest of my knee looked “pristine,” and that he would see me in two weeks to get the sutures removed. Still groggy from anesthesia, I was discharged with my left knee wrapped in a full locked brace, with post- op instructions and a handful of medications.

Screenshot of the UVAHealth Meniscal Root Repair Weeks 2-6 protocol

Takeaways/highlights/struggles from Weeks 1 and 2:

• Staying ahead of the pain: They sent me home with 30 days of Oxycontin (opioid for pain), Toradol (NSAID), and Eliquis (to prevent deep vein thrombosis or DVT). I took one Oxycontin at the hospital, then started on a regular regimen of extra strength Tylenol and Toradol every six hours for pain. This worked well and my pain levels were mild, and I stopped all except Eliquis after five days.

• I wasn’t allowed to shower or bathe for the first five days. I slept on the couch downstairs to minimize using the stairs to the bedroom, and kept a rotating backpack of clean clothes (and deodorant!) with me. When I was finally able to shower, I used a shower chair (clutch) which worked well in our walk-in shower. Showering was stressful and exhausting the first few times trying to keep my knee extended without the brace, and figuring out how to safely transfer in and out of the shower chair without falling.

Rusty was dealing with the after effects of the flu, so I tried to do as much as I could despite being limited to crutches: feeding the dogs (using ziplock bags and dumping them into their bowls), emptying the dishwasher, making a basic breakfast and morning tea. The rest of the day I would spend on the couch with my knee elevated and being iced regularly with an automatic ice sleeve. I also read, watched the birds outside our windows, wrote in my journal, and re-watched The Pitt season 1 and Taylor Swift’s Eras Tour docuseries (so freaking good!).

• PT began on day two after surgery. Eric was pleased that I had almost a 90 degree range of motion (the goal is 90 degrees and no more for these first six weeks), and with my hip flexor strength, a by-product of all the strength work done before surgery. The daily PT exercises were 3 x 5 heel slides, 3 x 30 quad sets (contract, hold, and release), 2 x 15 side leg raises, 2 x 15 supine leg raises. I did this morning and evening, along with a light core in between sets during these early days. I learned quickly that quad firing can be impacted by surgery and nerve blocks, so it was good news that my quads were working nicely – especially on the “good knee” side, since it was taking a lot of impact with my non weight-bearing (NWB) status. I was also allowed to “toe touch” for the 25% weight bearing protocol, but found myself holding off on any weight bearing, out of fear of impacting the repair.

• Sleep was in fits and starts. It was important this week to rest my body as well as my mind, so I napped a lot and this disrupted my nighttime sleep, but by the second week I was able to find a good rhythm.

Connection with others was key. Rusty and I ventured out three days post-op to a New Year’s Day brunch with my running crew, and that really helped my mood, as well as confidence getting in and out of the car (I could drive since this injury was on was my left knee, but waited until I felt all the groggy effects disappear around day 4). I started following a “Meniscal Root Tear Repair” group on Facebook that has proven to be very helpful. I met Michelle for coffee, English delivered homemade chicken noodle soup, and I started texting other women (Clea, Sara, Alyssa, Nicola, Pam) who have come through the repair experience, given me wonderful advice, and provided optimism and hope. Thank you, dear friends!

Takeaways/highlights/struggles from Week 3:

• Getting creative with cardio: Week 3 I started cycling on the Peloton bike with no resistance, using the good leg to cycle and placing the locked knee on top of a high chair, working up to 45 minutes at a time. I have also seen people using the rowing machine in this way, with the locked knee/foot sliding back and forth on the floor using a paper plate. Whatever works!

• Routines matter. Prior to my injury, I was up each morning at 5:00am to feed and walk the dogs before working out; now, I’m still up at 5:00 with the dogs, but I make myself a mug of tea and settle in for journaling, reading, and (sometimes) back to sleep. Then it’s time for a PT and upper body strength sequence all before leaving for work.

• I am fortunate to be a high school counselor and teacher, so my back-to-work routine was easier than most. Our school is fairly accessible for someone on crutches, so I was able to park in the handicapped parking and crutch to my classroom on the ground floor (and use an elevator to get to my office on the second floor). Rolling office chairs FTW! Ease of accessibility (and lack there-of) is a huge takeaway from this injury experience for me. The two sets of stairs in my home dictated a lot of my decisions around shower time and PT, as I wanted to minimize trips upstairs (shower) and downstairs (home gym for PT, and the entrance to the garage).

Takeaways/highlights/struggles from Weeks 4 and 5:

• 90 degrees range of motion started feeling comfortable at week 4, and on week 5 I could slowly cycle with two legs on a very (uncomfortable) elevated seat with no resistance for about 5 minutes. PT routines remained the same and steady (as is the protocol, but Eric added planks and pushups for variety).

• Snow and ice present their own issues while one is NWB and on crutches. We had a significant ice and snowstorm at the start of week 4, which meant I was homebound for five days until Rusty could dig through the “snowcrete” to make a clear path to my car. We also had four snow days off from work, which was convenient and luxurious!

• I love running in the snow and cold temperatures, especially making first tracks with my dogs at sunrise. Because of this recovery, we will have missed an entire winter of snow hikes and runs together, which makes me sad. And the dogs are confused by the crutches, their lack of exercise, and why I’m sleeping on the couch every night. But this, too, shall pass.

• When a friend asked me how my mental health was doing, I promptly burst into tears. The lack of exercise, connection, and the reality that my running future is unknown has been a doozy of a mental health challenge. I am putting to work all the coping strategies I teach my students: self care in the form of napping, writing in my journal, talking about how much this sucks with my family and friends, asking for help with chores, saying “no” when needed, staying in a daily exercise routine, eliminating alcohol, prioritizing good food and sleep, and making sure I get at least 15 minutes each day outside, no matter the temperature, to get sun in my face and Vitamin D in my bones.

My knees at the end of week five.

Takeaways/highlights/struggles from Week 6:

• Week 6! I had been looking forward to this milestone well before surgery. I was told that this is the hardest part of the entire injury journey, and as I crutched into my six week appointment with Matt, I prepared myself for anything he might tell me. Eric was confident that he would give me the green light to start full weight bearing without the brace, and that’s exactly what he did, once he looked at my knees. There was almost zero swelling, and after I shared my anxiety about walking on the surgical knee after six weeks of trying to protect the repair, he encouraged me by saying, “Sophie, you are a runner and not an old lady. It’s totally fine to start loading your knee. Just don’t go from zero to 100.” Yessir. I am NOT an old lady!

• The first few days of freedom from “brace and crutches jail” took some getting used to. It’s such a mind game to convince your brain that actual walking is “safe.” I still wear the brace while walking around crowds, more as a mental support but also a reminder to others. Each day feels better, and my mantra for this next phase is “slow and steady” as there is absolutely no rush.

• After my appointment, I went directly to the pool. Matt instructed me to walk back and forth in the shallow end of the pool and swim a few laps with the pull buoy (no breast stroke or regular kicking), which felt great. I then got in the sauna, which is on the pool deck, and did my PT exercises. I can tell that the pool is going to be my happy place as we thaw out of this nasty ice and snow.

• Matt also gave me the OK to start slow, no resistance spinning on the stationary bike, keeping my knee at the 90 degree mark. I’m still cycling up to 45 minutes with the other leg, to get my heart rate moving and blood flowing.

This morning, I watched with dismay as Lindsey Vonn crashed on her final Olympic downhill run. I immediately thought about how much patience, hard work, and determination she had put in to come back from all her injuries, especially her partial knee replacement, only to have such a disappointing outcome. Alas, this is the price we pay as athletes when we dream big and go for it. There were a lot of armchair quarterbacks questioning Lindsey’s decision to ski with a torn ACL (and after watching the replay of her crash, I have a hard time thinking it was her ACL that caused it – rather a snagged gate, ridiculous speed while going airborne, and being off balance while landing). I was NOT one of the doubters. I’ve set big, hairy, audacious athletic goals and know the pull, the power, and the satisfaction of working towards them. Six weeks into the pull for my next one – to run pain free – I salute Lindsey for ignoring the naysayers, as well as my surgeon Matt Deasey, for respectfully ignoring me when I told him back in December that I was satisfied with hiking and biking, and didn’t need surgery. He recognized my fear and denial, validated it, and urged me to think again. And I’m incredibly grateful.

Onward to Phase 3!

Welcome to my Substack. For the next year, I will post reflections on my recovery journey from a medial meniscus root tear. I’m thinking part-journal, part-“what others might want to know” about this injury and rehab. Most importantly, I’m hoping it will be helpful to anyone in the process of healing — physically and emotionally — from a significant injury..

Up until now, any injuries acquired from running had been mostly the soft tissue kind. Iliotibial Band Syndrome (ITBS) was the first: in 2004 it took me out for months after running my longest ultra to date, the infamously rocky 71-mile Ring in the Massanutten Mountains of Virginia. Eric put me back together, focusing on glute, hamstring, and quad strength on the balance board, and I incorporated all the PT exercises into my regular strength routine going forward. And for the next decade, I was able to run four 100s, averaged about 6-7 ultras a year, learned that 45-55 miles per week was my sweet spot, and became a champion for mobility, strength training, cross training, and recovery. In 2016, high hamstring tendinitis appeared after a slight pull while running a hard tempo run in frigid temperatures. Combined with post-menopausal hormone shifts, life stress – my 86-year-old mother died that May from complications from pneumonia – and too much sitting at work, this injury took me out of racing for the entire year with the exception of the Bighorn 50 in June (Eric gave me the green light to run, with the caveat that it would set my recovery back for months, which it did). Plantar fasciitis in late 2021 took months of eccentric calf raises, rolling frozen water bottles, and ankle compression sleeves to tame, and in late 2022 I discovered that my right knee was showing signs of mild osteoarthritis.

Until my fateful step while walking the dogs in October 2025, my left knee had shown no signs of wear and tear. And that is a good thing, because when I met with my surgeon, Dr. Matt Deasey, for the first time on December 19, I learned that despite a 30% failure rate, my root repair surgery would have a higher chance of success because the rest of my left knee was so healthy. The recovery – six weeks of non weight-bearing (NWB) on crutches – is extremely taxing to the non-surgical leg, but he felt that I could handle the load despite my age (apparently people over 60 are often encouraged to consider a full or partial knee replacement instead of root repair if they have advanced osteoarthritis). Matt is a former UVA basketball player, high school science teacher and coach, and a runner, and I liked him immediately. He trained at the Steadman Clinic in Vail, Colorado, so I knew he was capable, but I also appreciated that he listened to my worries about the recovery logistics regarding work and reassured me when we talked about probable outcomes with empathy and compassion. When I agreed that surgical intervention was my best option, he fit me into his busy schedule for December 29, which meant my husband could be at home to help me the first week post-op.

The next ten days were a whirlwind of Christmas prep and family gatherings, which helped keep my mind from venturing down negative rabbit holes. Twenty-plus years of consistent strength training routines emerged as a huge blessing, as I considered the need to keep core, quads, and hip flexors strong to be ready for NWB. I ramped up straight leg raises and single leg squats and lunges, enjoyed the last remaining mornings of sunrise hikes, and jogged a shorter portion of the 12 Days of Christmas workout with my friends. Accepting that this surgery and recovery was essentially my next “ultra” helped me prepare emotionally, as I’ve always loved the process of putting together a long-term training plan towards a challenging running goal, and the UVA recovery protocol gave me helpful – and hopeful – benchmarks to strive for:

UVA Orthopedics Meniscus Root Tear Protocol, page one. I discovered that 25% weight-bearing is actually fairly progressive compared to others, which are typically 100% NWB.

Despite the fact that my son and husband contracted the flu at Christmas, I was able to stay healthy (thank you, flu and Covid vaccine!) right up to the morning of surgery. I took my last walk with the dogs, wistful that it would be months before we would spend this time together on the trails again. But there were many positives ahead: getting to the “other side” of this injury, to the healing and strengthening part of the journey. The good fortune to live in a town with excellent health care mere minutes from our house, and to actually have affordable health care. To work at a school that values employee health, and provides flexible working arrangements. And a surgeon who knew his way around this particular repair, with a bedside manner that mellowed any anxiety I was feeling.

Before any race, I always remind myself of the little moments that have led to that big one. The early morning wake-ups, and the friends who met me at the trailhead. The speed workouts and lift sessions that left me breathless. The prioritizing of good sleep and good food. My family who support and cheer for me. No matter what happens during the race, if I can lean into these reminders, the day will reveal itself as it should. So as I laid on the gurney in pre-op, waiting to be wheeled into surgery, my mind went back to early October, when I had so many questions, worries, and fears about what this injury would mean for me. So far it has revealed kindness from strangers, the importance of adapting, the power of gratitude, the blessings of science, and that not all ultras are run on foot.

Month 3 Takeaways (in the spirit of good teaching, I’m adding a section of takeaways for those who prefer quick tips).

1. The only way out is through. Surgery and the recovery process scared me into thinking I had other choices, but eventually it was clear that surgery was the best option. Once the decision was made, all the mind clutter of “what-ifs?” disappeared.

2. Connect with others who have been there. I’ve had invaluable conversations with other women who have shared my fears, and their support has been crucial.

3. “I get to do this” is an important reminder while doing any hard thing. Be grateful, always.

4. I re-read Katie Arnold’s wise story of her knee injury, recovery, and redemption, Brief Flashings in the Phenomenal World. Her aloof and impassive surgeon made me incredibly grateful for mine.

5. Sunrise from my couch isn’t too bad. It’s just different, for now.

Next post: the first six weeks of NWB and a new appreciation for my quads

Two days after Masochist, I went in for my MRI. I had been getting along with one crutch, feeling the stress reaction improve daily. In fact, I distinctly remember feeling almost no pain as I was crutched out of the MRI suite, and I was able to ditch the crutch a few days after that. Thus began the cycle of wondering if all of this was for naught, that my disappearing pain was a signal that I was healed, and that the MRI would just reveal the remnants of the bone edema, and I could now go on my merry way. Ha. Remember denial?

Two days later, a message about the MRI results popped up on My Chart. Gulp. My Chart is a convenient and expeditious way of getting medical test results, but also creates unnecessary anxiety if the medical jargon is complicated or dramatic. Here’s what mine said:

IMPRESSION:

1. Complex tear of the posterior root of the medial meniscus with extrusion.

2. Insufficiency fracture of the medial tibial plateau (Eric later told me this image was “lit up like a Christmas tree” on the MRI, showing significant stress/bone edema, despite feeling almost 100% on that day)

3. Mild surface cartilage loss without high grade articular cartilage defect (in other words, the rest of my knee has almost zero osteoarthritis, unlike my right knee).

Not complicated, but it was dramatic. The more I read about meniscus root tears, the more I realized this was not a typical meniscus injury. The cartilage connecting the meniscus to the tibia, the meniscus root, had degenerated and torn all the way through (thus, the “pull” or “pop” that I felt), leaving my medial meniscus floating untethered and extruding at the joint line. It’s basically the same thing as not having a working meniscus. Twenty years ago, doctors would simply remove the meniscus (aka meniscectomy), but patients would inevitably return, in more pain, with increased osteoarthritis and in need of a partial or total knee replacement. Nowadays (yay, science!) standard protocol is to repair the torn root if the patient is a good candidate, meaning no or low osteoarthritis, enough remaining root to work with, and good knee angles and spacing, among other things.

David Hrivniak messaged me the next day and didn’t mince words: “Sophie, this is a significant injury. Let’s get you in as soon as the insufficiency fracture heals, most likely three more weeks from now, and discuss next steps. We could talk with surgeons about surgery/root repair, but I do wonder if most of your pain is coming from the bone. I would be hopeful if we can get the bones to heal, we can get you back feeling good and running.” This meant early December. Ironically, as Thanksgiving approached, I felt better and better each day. I was hiking, biking, swimming, and lifting with little or no pain. I knew of four other women runners who had experienced this kind of injury, and quickly connected with them via text. All enthusiastically shared their successful outcomes from the root repair surgery, with the exception of Alyssa Godesky. Her initial repair in 2023 failed at the four month mark post op, and doctors determined that her knee alignment created overdue medial stress on the repair, so she went back for a more dramatic, but ultimately successful, root repair with a tibial osteotomy in 2024. The great news is that Alyssa recently finished 4th female in the brutal winter Spine Race in the UK, her first big push post-surgery!

Despite all this positivity, I couldn’t look away from the reality that the recovery from this repair is no joke. In fact, it quickly became the reason I started leaning towards no surgery. Six weeks of non weight-bearing with crutches was more than I could wrap my head around, and since I was feeling so good in all my activities, I quickly started telling myself the story that this was my new normal. This included snippets of, “I don’t need running when I can bike and hike” and “THIS is that time that I’ve been dreading, and expecting: the day when I can no longer run.” I jumped over the next stages of grief (anger, bargaining, depression), headlong into the fifth, acceptance. I told myself, “it’s your turn to be injured after all these years, so get on with it and start your new journey.”

Sunrise on my favorite climb. I miss this.

Hellgate 100K, my favorite ultra, had been on my race calendar before the injury. My first finish was in 2005, and I was hoping to run and complete my fourteenth, but now it beckoned me in a different way. Held each year on the second Saturday in December at 12:01am, Hellgate draws a quirky and devoted following of adventurers who return year after year, and I was determined to serve in any capacity – to give back, but also to keep my mind and spirit buoyed. Late autumn and early winter is my favorite time of year to be in the mountains, and it was really hard to not be able to experience the season in the way I had for the past twenty years. I offered my services as a volunteer and Instagram account manager to David Horton, the creator and race director of Hellgate, and then plowed ahead with creating content at @hellgate100K. It was fun and rewarding to research and share historical data, highlight newbie runners and resilient veterans, share race updates out into the world, and to create a permanent place for followers to interact.

A few days before race day each year, a group of local runners who are entered in Hellgate gather on a favorite trail loop and bring “offerings” to the mountain spirits. These offerings might represent something a runner had to overcome during the past year, a symbol, or a mantra to be used when the race gets difficult. My offering this year was a printout of my MRI results, and it was cathartic to watch it go up in flames (very fitting for a race called Hellgate).

Offerings. In a previous year, my offering was a small mirror, a reminder to hold onto feeling young and strong despite what the mirror might reflect back. This year it was my MRI report.

As I walked into my appointment with David Hrivniak on December 4, I was prepared to discuss the MRI and options for a return to run plan (in fact, I had cheated and started running 1 minute on/1 minute off for the past week, and felt great). As we looked at my images, and talked about the current standard of care for root tears, it soon became clear that my options were either: stay the course, with no surgery, but run, hike, and bike as I feel, and come back in a few years with accelerated osteoarthritis and in need of a knee replacement; or schedule a surgery consult as soon as possible, because the window for a successful repair was 2-4 months after initial injury, and my injury had occurred exactly eight weeks prior.

Suddenly, the story I had been creating and telling and re-telling was falling apart, fast.

Month 2 Takeaways (in the spirit of good teaching, I’m adding a section of takeaways for those who prefer quick tips).

1. Look for the helpers. In fact, be a helper. As I re-learned as a volunteer at Masochist, it’s hard to feel sorry for yourself when you are genuinely thrilled to cheer on and help others.

2. The stages of grief are not linear. You will jump all over the place, and that’s OK.

3. You can always re-write the story that you are telling yourself. In fact, this is a big truth in overcoming anything hard.

4. Be grateful for high quality healthcare, especially doctors who are also runners.

5. Embrace like-minded friends and family who get you, who invite you to their post-run coffee meetups, and who aren’t shy about reaching out to say, “I know this must suck for you. I’m sorry.”

Next post: Surgery consult and reality check

OK, I’m limping, now what? I knew it wasn’t just a “tweak.” Panic and (Dr. Google) trouble shooting ensued. I emailed Eric’s scheduler, Emily, and by divine providence, he happened to have a late afternoon cancellation. (Readers from my hometown know how difficult it is to get a timely appointment with Eric, so I thanked my (very) lucky stars..and Emily). The standard meniscus and ACL tests he performed were negative; the only pain I was experiencing was weight-bearing on the single left leg. He asked me if I felt a “pop” when I took the step – of course I did, but couldn’t find the courage to say so. Saying so would make it so. Instead I hedged, but (of course) he knew better.

Two days later I was in the office of Dr. David Hrivniak, local fast runner and orthopedist. He had diagnosed my right knee with mild osteoarthritis in 2022, and since I was now not feeling any pain in the left knee, he was baffled. Could this be bursitis? IT band junk? Eric was leaning towards the possibility that I had some sort of “loose body” swimming around in there. Neither mentioned “root tear” and X-rays and ultrasound were inconclusive, so David sent me off with the recommendation of “take it easy, and stop running if it hurts.” So I dutifully jumped on the bike, went to the pool, and didn’t run for a few days.

A week later, I was blissfully enjoying my third run in a row because everything felt fine (and this is the tricky thing with root tears – once they settle down, things can feel almost normal). In a moment of hubris, I picked up the pace from easy 12 minute miles to around 9-10 minute pace — but apparently this was too much. A new pain suddenly emerged, this time on the medial side of my knee, much more painful than my initial injury. I slowed to a walk, then a limp. I was crushed.

In all my years as a runner, I’ve been lucky to have never experienced a stress fracture. Consistent strength training, off-seasons from running, and intentional rest and recovery after big pushes have been the ingredients to keeping me injury-free, outside of the aforementioned soft tissue tweaks. So as I limped around at work later that morning, barely being able to tolerate the pain in my knee, the last thing I suspected was a stress reaction. I messaged David Hrivniak and explained what I was feeling, and a few days later I was on the schedule for an MRI for November 3 — a date that was two (very far) weeks away. In the interim I was to stop running and get the weight off the left knee.

A funny thing happens when you’re on crutches. People are kinder, more considerate, incredibly compassionate. They offered to hold doors, get my lunch, even take the empty shopping cart back inside the store. I work as a high school mental health counselor and lacrosse coach, and a lot of my work is in helping my students through their own injury journeys. As I crutched down the hallway that first week, almost every student I passed stopped to ask if I was okay, or what they could do to help me. I attended the weekly support group for our schools’ Morgan’s Message club, a national non-profit that raises awareness for mental health in athletes, and shed a few tears alongside other students who were recovering from their own surgeries. Being with my students, and feeling their sincere empathy during those first tough weeks, was a true gift for my soul.

Our Charlottesville Area Trail Runners at the Mountain Masochist finish line party. I’m on the left, front row, genuinely happy for the first time in weeks.

Another unexpected gift was to be able to give back to my running community. Once I was clearly not going to recover from the initial injury in time to race on November 1, I pulled out of Mountain Masochist 50k, and signed up to volunteer at the first aid station instead. Even on crutches, there was no way I was going to miss Masochist weekend, as it brings together our vibrant Virginia trail running community to celebrate one of the OG ultras and provide an on-ramp for newcomers to the sport. I could still bike without pain, so on race morning I brought my mountain bike to the aid station, and then rode the three rocky double track miles to the next aid station once my shift was over. It was a brilliant, cold, bluebird fall day in the Blue Ridge mountains, and it bouyed my spirits to be able to cheer on and serve my friends.

Month 1 Takeaways (in the spirit of good teaching, I’m adding a section of takeaways for those who prefer quick tips).

• “If you can name it, you can claim it.” This helpful cognitive behavior therapy mantra goes for injury debriefing too. When you’re injured, tell your doc or PT exactly what happened. You’re in denial, but that won’t make it go away. Be brave.

• “Clear is Kind” — another favorite saying from Brene Brown, LCSW. I wish my doc had told me to call for my MRI appointment instead of me waiting….and waiting… to be called. And I could have asked, too. Duh. I wasted three days when I could have gotten on the schedule sooner. My bad.

• People are kind when you’re on crutches. Especially teenagers. Say yes to offers of help.

• Serving and celebrating others as they reach their goals helps with the pain and disappointment…and puts things in perspective. It’s my turn to give back to the sport and community that has given me so much.

Next post: MRI results, Offerings, and an unexpected conversation with my doc

I’ve been a runner for 45 years, and a trail ultrarunner for 23. Over the years I’ve had my share of typical running injuries — patellar tendinitis, IT band syndrome, a high hamstring pull. I have been fortunate to live in a college town with a huge road and trail running community, as well as top-notch orthopedic experts (many of whom are runners). In February 2002, debilitating IT band syndrome appeared during my first 50k, so I made an appointment with Eric Magrum, the PT recommended to me by fellow endurance athletes. Eric is an adventurer, mountain biker, and dedicated trail steward who didn’t look at me cross eyed when I told him at our first session that my recovery goal was to run a 50 miler in November. He just put me to work.

As runners age, there becomes casual talk of “when I’m no longer running” or “when I can only hike.” At least that’s what I found myself saying as I entered my sixties and started to feel a twinge of mild osteoarthritis in my right knee during the Hellgate 100k in late 2022. As a former triathlete, I was already comfortable swimming and cycling as cross training, but the reality was sinking in that the days of running 5-6 days a week were dwindling. I started lifting heavier weights, ran every other day, and increased mobility, cycling, and swimming. All of this kept my right knee happy, despite a creaky hum when I ran that became a constant reminder that things were wearing down.

My left knee? I found myself talking to it and saying, “thank you, left knee, for feeling so good! I will take good care of you!” And it took good care of me. In December 2023 I finished Hellgate without any problems and set the 60+ women’s age group record. In 2024, I finished 7th female at the Mountain Masochist 50, and in 2025 I was able to pace my friend Sarah Lavender Smith to her first Hardrock 100 finish — after a week of exploring the mountains and trails around Silverton, Colorado. I was feeling strong and healthy at age 62, and training for the Mountain Masochist 50K in early November and my fourteenth finish at Hellgate, (my favorite race).

With my friends Kerry, English, and Marc on the Wild Oak Trail, October 5, 2025

In early October 2025, a group of friends and I ran a loop of the Wild Oak Trail, affectionately known as TWOT. The loop is 28 miles with 8k of vertical in the mountains west of Harrisonburg, Virginia, and is a favorite training run for mountain runners. I have run a loop every year since my first in 2004, and this year I was particularly pleased with the gorgeous weather, dry trail, and great company as I brought up the rear. Despite slowing down, I try hard to run with gratitude: gratitude for my body, for the trail, for the friends who say yes when I throw out adventure ideas. On this day, I also found myself wondering, “is this going to be the last time I will be able to run TWOT?”

Two days later, on a recovery walk with my Australian Shepherd pups, I took a step and felt a pulling sensation inside my left knee, the “good” knee! Immediately, I knew it was bad. I could barely put weight on it, and gingerly hobbled home, in tears, a mile away. My injury journey had begun.