By the end of her Round One heat last week at the Cascais Women's Pro, every surf fan from Portugal to Singapore learned that Tyler Wright had torn her MCL 70 percent -- a painful, if not season-altering, injury, due to a freesurfing accident. After losing the heat, she acknowledged the elephant on the beach: the bulky plastic brace on her right knee (her back leg, unfortunately) that was locking things in but not, as it turned out, necessarily blunting the pain.
Wright went on to surf Round Two, but lost again, to event wildcard Teresa Bonvalot. That opened a big door for other Title contenders to gain ground, and even more so when World No. 4 Stephanie Gilmore and World No. 2 Courtney Conlogue went on to lose as well. Still, in contrast to some reports, Wright has not withdrawn from the next women's CT event, the Roxy Pro France. As World No. 3, in fact, she's still in the race for the World Title, although arguably compromised in her ability to win heats.
The World Surf League's medical director, Chris Prosser, has been treating Wright and shared some insights on her injury and prognosis.
World Surf League: What exactly happened to Tyler?
Chris Prosser: She was freesurfing as a warmup for the competition Monday morning. She was going backside, and in coming down off the lip caught the front of the wave and she lost the front foot, was suddenly under a load on the inside of her leg, which created a lot of stress, which stressed the inside ligaments within the knee.
She had an ultrasound -- Frederico Morais' dad is a physical therapist, so she saw him that day, which was Monday, so he ultrasounded and diagnosed it as a ligament injury. We examined her on Tuesday morning and decided to follow up the ultrasound with an MRI. Nuno Oliveira is an orthopedic surgeon; he's local and he's also our medical director for this event. He organized an MRI on Tuesday, and it confirmed that it was an MCL injury, a grade two-plus - they go up to four, which is a total separation from the bone.
So Tyler has a grade two-plus tear, of the medial collateral ligament, the MCL. It attaches to the tibia. So there's 60 percent that's not connected there anymore. It's tender to touch, and tender and painful to swim - but if she avoids most movements that stretch that, that position that unfortunately is always happening for a naturalfooter [where the back leg is loaded up with weight].
The other thing that was great was there was no internal [derangement]. No medial or lateral cartilage displaced, the big ligaments are fine. There are signs some old damage, but that's just some wear and tear from what she does. So the injury is very much specific to that ligament.
Why did Tyler decide to surf in the event? What did the decision-making process entail, from the medical side?
There's no surgery needed for what she has. But if you then go out and surf and reinjure it, or exacerbate what you had, there's a possibility that you could progress it to a grade four. So for her, it's a non-surgical procedure. She's actually stable, she can 90-degree squat without pain. She's got good stability in the tissue around it, except for the injury itself. We went through that process, explained it to her, suggested that it's usually a six-to-eight week healing process. That it's unlikely that she'll be surfing through the European leg, but that we don't need to make decisions now - that was Tuesday.
So Wednesday came along [Round One], and we worked with her Tuesday morning and night. We did some work on her breathing and her functional movement around her hip to get her glutes and stability patterns turned back on. We worked on getting her system to relax [some places] and making sure the joint was hinging well, so you start to speed up the healing. And we did active release techniques to help that ligament so it's not only healing, but healing in a nice, functional position, where the joints are positioned so that the muscles around it are doing what they need to.
We worked on taping that to support that ligament, and we gave her a hinge brace, which allowed her to bend, but not move laterally. That was the morning, and then in the afternoon we followed that up, and layering [the treatment].
What was the thinking behind her surfing Round Two?
That first round, she felt fine. She didn't get through, but she wasn't far away. But Thursday, she wanted to follow up and surf round Two. We re-examined her, and she was starting to heal. She's very determined and very professional, who understands her body well and is able to make choices that are based on some good understanding and integrity around what the risks and benefits are.
So she surfed that second round heat. The issue there was the waves were a little bit bigger. It was always going to be harder for her to lead, and she knew that, and wanted to take the opportunity to see how it went. We thought that because it was tricky conditions, maybe she could get away with it. But it's always an evolution. If she wasn't competing and going for a World Title and we were at home, would she be competing? Of course not. But at the moment, she's resting comfortably, not in more pain, and we're progressing with her rehab.
These MCL injuries rarely affect the injured for a long time, but they can be complicated. Surfers, particularly women, take 30 percent longer to heal MCL tears, because of the nature of the sport. Tyler has a long career ahead of her, and we didn't want to do anything to jeopardize that, so they took a calculated risk to surf. The great thing is, these injuries will heal. We'll facilitate that along the way, and we don't want it to be complication long-term for her. And it shouldn't be, if all goes well.