A Knee Pop While Skiing
Endangers Yoga Teacher Neda’s Livelihood
How Neda’s Determination
Got Her Back in the Studio
Written by Leigh Wilkins
Designed by Greta High
Photos provided by patient
Neda heard her knee pop as she tumbled over her skis. Adrenaline rushed through her body as she slid to a stop. She could not tell the extent of her injury.
Other skiers waited with her until the ski patrol arrived, then watched as she traveled down the mountain on a medical sled. A few hours later, a doctor at the local hospital examined Neda’s knee and told her she had torn her anterior cruciate ligament (ACL), but it was “no big deal.” Torn ACLs are common in skiing and other sports where jumping or pivoting occurs, including football, basketball, lacrosse and soccer.
For Neda, this injury was a very big deal—not just because it hurt and cut her trip short—but because Neda is a yoga teacher who relies on her body for her livelihood. In the next few days, she would learn the true severity of her injury. It would require surgery, intensive rehabilitation, a team of providers focused on her well-being and perhaps the most elusive resource of all: patience.
“Yoga is What I Love”
Neda has practiced yoga for more than 20 years. Her journey began in college when she was riding a stationary bike at the gym. “There was a woman on a bike next to me with great posture and a smile — she was just glowing,” says Neda. “I found out she was the gym’s yoga teacher, and I thought, ‘I want whatever she has!’”
Neda fell in love with yoga after her first class and continued to practice through college. After graduation, she worked as a bartender and was preparing to apply to medical schools. She expected to follow in her father’s footsteps and become a doctor. Then, one day in 2008, a friend convinced her to enroll in a yoga teacher training course.
That is when Neda found her life calling. “The more serious I got about my practice, the more I realized yoga is what I love. I wondered where it could take me,” she says.
It did not take long to find out. Neda lost her bartending job, and as she looked for another, a different friend challenged her with this question: “If you had all the money in the world, what would you do?” The answer was easy for Neda: open a studio and teach yoga full-time.
Today, Neda owns Tough Love Yoga, which offers online classes, and has a studio at her home in Reykjavik, Iceland. She integrates her love of science into her practice, focusing on biomechanics and alignment as she helps people meet themselves where they are physically, emotionally and spiritually. Her students include people of all ages, many of whom are recovering from an injury.
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Neda’s Knee Pop on the Slopes
Neda knew the risks when she decided to go skiing. “I was kind of scared to ski because, as a yoga teacher, my body is my livelihood,” she says. “If I hurt my body, I’m screwed. I’d skied before, but it had been at least 15 years.”
Neda’s love for adventure won out, and she felt excited as she headed to Steamboat, CO, with family members and friends. She took it easy the first two days, sticking to beginner and intermediate slopes. “On the third day, I was confident. It was my 40th birthday and I was ready to go,” she recalls.
As she skied down a challenging run, Neda realized she was going too fast. She tried to turn to slow herself down.
“I don’t know exactly how it happened, but I think the tip of my ski must have caught,” she says. “My whole body twisted except for my knee and shin. I heard and felt the pop in my knee.”
When the local emergency department staff sent her back to her hotel without pain medication or recommending crutches, Neda felt cautiously optimistic. But late that night, she was back in the emergency department in excruciating pain.
Imaging scans revealed a fracture in her tibial plateau, the larger lower leg bone connected to the knee joint. She left Colorado early and made an appointment with an orthopaedic specialist back home at a metro Atlanta hospital.
Finding Dr. X and Emory Healthcare
Finding a care team that listened to her continued to be a challenge. Neda visited a specialist—a friend of a friend—who she felt was dismissive and focused more on his accolades than her injury. “I walked out of there feeling very demoralized,” she says. She wanted to ensure she had a care team that would feel like a partner in getting her knee back in working order.
People urged her to make an appointment with John Xerogeanes, MD, known informally as “Dr. X.” Dr. Xerogeanes is the chief of Sports Medicine at the Emory Healthcare Orthopaedics & Spine Center and an ACL injury repair and recovery expert.
Neda set up an appointment with Dr. Xerogeanes, where they discussed the extent of her injury. In addition to the fractured tibial plateau, she had a complete ACL tear—the ligament was no longer attached to the bone. Neda also partially tore two other ligaments in her knee, the MCL (medial cruciate ligament) and PCL (posterior cruciate ligament). In a structurally sound knee, these strong but flexible bands of tissue connect bones around the joints to stabilize them.
Dr. Xerogeanes explained Neda would need reconstructive surgery for her ACL; the MCL and PCL would heal naturally. However, without surgery, her knee would be unstable for the rest of her life.
A Surgery Tailored to Neda’s Goals
Before explaining the surgical options, Dr. Xerogeanes took time to get to know Neda—especially her goals for recovery. He does this with every patient to tailor surgery and rehabilitation to their unique needs. Dr. Xerogeanes remembers being impressed by Neda’s passion for yoga, knowing it would motivate her to get better and help her heal physically.
“I dabble in yoga as part of my own exercise regimen, and I recommend it to all of my surgical patients,” he says. “Yoga is challenging and offers many benefits for anyone who practices it, from improved flexibility and balance to increased endurance and better sleep.”
Armed with an understanding of Neda’s lifestyle and priorities, Dr. Xerogeanes described several types of ACL reconstruction surgeries to her.
Ultimately, Dr. Xerogeanes and Neda chose an ACL reconstruction using a cadaver ACL—tissue from a deceased person. This approach is a good option for athletes like Neda in their 30s and 40s. Providers associate it with a faster recovery than other ACL repair types.
"We needed to choose a surgical technique to allow Neda, as a yoga teacher, to do everything she wanted. The goal was to stabilize her knee but be careful not to make it too stiff, or she couldn’t do her job."
Not Just Rehabilitation, but Prehabilitation
Neda was anxious to have surgery and resume her active lifestyle as quickly as possible. Her yoga students needed her; she had training sessions on her schedule and a sold-out workshop to lead in the Netherlands.
As an athlete himself, Dr. Xerogeanes understood the impatience. But he advised her to prepare for a longer recovery—it could be three months or more before she could return to yoga.
Dr. Xerogeanes told Neda before surgery he wanted her to do five weeks of ACL “prehabilitation” to position her for the best surgical outcome possible. Prehab can include physical therapy (PT), weightlifting, cardiovascular exercise and other activities. Dr. Xerogeanes prescribed PT, and urged Neda to ride a bike to build additional muscle in her legs. Her strength and mobility before surgery would determine how well she did afterward.
Neda balked at the idea of biking. “I was like, are you kidding me?” Neda says. “I tore three ligaments in my knee, and I can’t even put weight on it. My whole leg is so swollen and bruised it looks like a sausage. How am I supposed to get on a bike? But he said I should, so I ordered a bike online and did my best. At first, I couldn’t even push the pedal all the way around.”
With Dr. Xerogeanes’ consent, Neda added several other therapies to her prehab routine, including acupuncture and massage to address the swelling, and electric muscle stimulation to loosen up her muscles.
Neda added electric muscle stimulation to her prehab routine to loosen up her muscles.
Neda added electric muscle stimulation to her prehab routine to loosen up her muscles.
“Right after my skiing accident, people would say, ‘Be sure to do PT, or you won’t recover as well,” Neda says. “I was like, you don’t have to worry about me. I’ll do the PT. And then I’ll do it more. And really, I hit it harder before and after surgery than I ever would have otherwise because Dr. X stressed it so much. He has cared for so many professional athletes; that motivated me. I knew if I listened to what he said and did what he asked me to, I would return to my life faster. And that’s what happened.”
Swelling in Neda's knee after her injury.
Swelling in Neda's knee after her injury.
As part of her "prehab" prescribed by Dr. X, Neda rode a bike. She says at first, she couldn’t even push the pedal all the way around.
As part of her "prehab" prescribed by Dr. X, Neda rode a bike. She says at first, she couldn’t even push the pedal all the way around.
"I knew if I listened to what he said and did what he asked me to, I would return to my life faster. And that’s what happened."
Neda’s Hard Work Pays Off
Before her surgery, Neda was nervous and excited. “My pre-op nurse was so nice—she asked about my hair, tattoos and dogs,” says Neda. “She talked to me like I was a human being, not just another patient. She put me at ease.”
The surgery went well, and Neda returned home the same day. Dr. Xerogeanes used minimally invasive techniques to repair her ACL, leaving minimal scarring.
Neda jumped back into PT within a few days of her surgery, following a detailed PT plan from Dr. Xerogeanes. “Each week, I was supposed to hit certain goals for strength, range of motion and other measures of recovery,” Neda says. “The end results felt very far away, but seeing where I’d be each week was comforting.”
All of Neda’s patience and hard work paid off. Six weeks after surgery, Dr. Xerogeanes gave her the green light to practice and teach yoga again. Six weeks later, she returned to Emory Orthopaedics & Spine Center for advanced biomechanical tests to evaluate her strength and mobility in both legs. “Dr. X told me my results were something he’d expect to see at six months, not three months,” Neda says.
Dr. Xerogeanes used minimally invasive techniques to repair Neda's ACL, leaving minimal scarring.
Minimally invasive techniques left minimal scarring.
Neda was able to return home the same day as her surgery.
Neda was able to return home the same day as her surgery.
Neda jumped back into PT within a few days of her surgery, following a detailed PT plan from Dr. Xerogeanes.
Neda followed a detailed PT plan from Dr. Xerogeanes.
Six weeks after surgery, Dr. Xerogeanes gave Neda the green light to practice and teach yoga again.
Six weeks after surgery, Neda could restart her yoga practice.
Back to Work, Life and Being Active
Back teaching yoga classes, Neda initially modified how she taught since certain yoga poses could injure her knee, which was still healing. Instead of demonstrating poses for her students, she talked them through each one while seated on a bench in the front of the room. As her knee grew stronger, she could do more poses in class and at home.
“Practicing yoga and teaching means the world to me,” Neda says. “This injury took an enormous toll on me, physically, mentally and financially. And so to get back to my physical practice and teaching so quickly and to have such a full recovery is honestly mind-blowing.”
In addition to resuming her yoga practice, Neda enjoys other aspects of her active life, such as walking her two Dobermans and hiking with her family.
Dr. Xerogeanes says he is impressed by Neda’s recovery but not surprised. “Neda understood her recovery hinged on following an aggressive physical therapy regimen,” he says. “Without it, she would have developed stiffness in the joint that would have made certain yoga poses impossible.”
Gratitude for Emory’s Top-Notch Care
Three years later, Neda sees her expert Emory Healthcare care team less often than she used to. But, she has not forgotten her experiences as a patient.
“Everyone at Emory Orthopaedics & Spine Center and Emory Sports Medicine took such good care of me,” she says. “The facilities are so beautiful, and everything runs like clockwork. The standard of care is so strong—it’s just top-notch.
At age 43, I am actually stronger and more flexible than I was before my injury and surgery, which I am amazed by. I totally credit Dr. X and his skill and encouragement. He planted a seed and I took it and ran with it."
She also has the unique opportunity of being a better teacher thanks to her experience.
“I’ve taught many students with knee injuries,” she says. “Intellectually, I understood what they were going through. But now I’m so much better at helping them through it because I know what it feels like to be injured and what it takes to get back to your normal life.”
Leading Orthopaedic and Sports Medicine Treatments
Emory Orthopaedics & Spine offers comprehensive orthopedic and spine care at multiple locations across the Atlanta metro area, and our orthopaedic and spine programs are ranked among the top in the nation. Our highly trained orthopaedic and spine specialists work together to diagnose and treat a wide variety of orthopaedic, spine and sports medicine conditions.
Our physicians use innovative approaches to care—many of them pioneered right here at Emory—to ease your pain and get you back to an active lifestyle.
Emory University Orthopaedics & Spine also has among the highest patient satisfaction and best outcome rates in the nation for your surgery. By using advanced research techniques developed by our top surgeons, we can make sure your surgery is done right the first time.
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