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Skiing after ACL tear poll


I have (medically) confirmed ACL tear and
WITHOUT ACL reconstruction I ski as aggressive as before (moguls, off piste, backcountry, freeride)
29%
 29%  [ 14 ]
WITHOUT ACL reconstruction I ski but only on piste and easy (blue - green) lines only
4%
 4%  [ 2 ]
I did NOT have ACL reconstruction and I've stopped skiing
4%
 4%  [ 2 ]
After ACL RECONSTRUCTION I ski as aggressive as before (moguls, off piste, backcountry, free skiing)
58%
 58%  [ 28 ]
After ACL RECONSTRUCTION I ski but only on piste and easy (blue - green) lines
4%
 4%  [ 2 ]
After my ACL RECONSTRUCTION I had to stop skiing
0%
 0%  [ 0 ]
Voted : 48
Total Votes : 48

 Poster: A snowHead
Poster: A snowHead
ianbradders wrote:
Summer 2012 ruptured my left ACL, skied twice winter 2013. Knee did give me a lot of grief (swelling and pain) but didnt stop me going where and as hard as i wanted.
Just got back from a week in Austria, and my knee didnt even twinge. I only wore a elastic support but feel that is only a placebo.
Feel like i should go for a recon but i am a big baby.

Background, 43 YO male 19 years skiing.


If the knee still gives way that's a clear indication you should stabilise the knee or avoid activities that provoke giving way( a bit diff. If it gives on day to day activities or something as important as skiing
)
Even if not you are not aware of giving way, without an ACL you have a high risk of tearing the meniscii. Once these are torn your risk of developing arthritis goes way higher. So if joint surfaces and meniscii are healthy do consider a reco..

Elastic supports help on a number of levels, they keep( worn ) knees warm, help with proprioception and give some psychological comfort . It is the latter point that means many wear a brace or support after reco. There is nothing wrong with that but you probably don't need an expensive brace as a simple support will do.

Jonathan Bell
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
Wow, thank you for the personal consultation JB.
My knee doesnt "give way", but i certainly do limit what i do i.e. i wouldnt dream of running. But as i said skiing this last week was not the slightest problem.

Great info on the elastic support, thanks again, although i now need to google proprioception!

Got me considering a visit to the experts. I suppose now is the perfect timing as i would probably be recovered for next winter.

snowHead
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
ianbradders, it looks like I partially damaged my ACL recon last march. I thought it was fine, felt stable (I now know I only have half an ACL left) I was doing some sprint training at hockey and it just gave way. The damage that that cause to my meniscus was extensive and left me non-weight bearing on a locked knee until I could get the surgery by paying for the MRI and consultation privately I was able to get that two months later. I now only have 1/3rd of my cartelage remaining. I would stress again it FELT stable. Best of luck
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ianbradders

Proprioception.

The ligaments and other soft tissues contain nerve endings that record the stresses and pressures during movement.
The brain uses this information to allow it to monitor what the knee( In fact all parts of the body) is doing.

It then uses this to control muscle timing , strength of contraction etc.

It's basically feedback.

When a ligament is damaged proprioception is damaged. A knee sleeve can be perceived as moving and rubbing and causing pressure on the skin. The brain picks up on this as a sort of substitute for the proprioception that is missing from the damaged ligaments. This same effect is also useful in arthritis.

Jonathan Bell
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 Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
Cheers for that explanation.
Call to the docs in the morning. Need to be a brave soldier.

Thanks JB.
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Proprioception
How bizarre, from never hearing the expression before i have just watched a program and it was mentioned several times.

It was the di-section of the foot on BBC3. Got the presenter to try balancing in different scenarios.
Very interesting.

Appointment with the doc next week.
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 Then you can post your own questions or snow reports...
Then you can post your own questions or snow reports...
hi guys, just thought i'd open this chat again rather than a new one. i've had ACL reconstruction 2 weeks ago after a complete tear. i'm back in the gym, albeit on the bike, but progressing nicely. i'm looking to get something booked for new year. any advice from people who have had the injury, and been back skiing 8 months later? thanks in advance.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
barthez1980, good luck with the rehab. Do a search - there's loads of info/threads about it. You'll find the answer is do the rehab and 8 months should be fine, barring complications
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barthez1980, how was the op? if you are back in the gym are you fully mobile now?
I am thinking about how long off work?
I have seen my GP got an MRI next week. My GP seems to think as my knee is mostly stable and pretty much relatively pain free the consultant will not do a reconstruction.

Thoughts or opinions?
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barthez1980 wrote:
hi guys, just thought i'd open this chat again rather than a new one. i've had ACL reconstruction 2 weeks ago after a complete tear. i'm back in the gym, albeit on the bike, but progressing nicely. i'm looking to get something booked for new year. any advice from people who have had the injury, and been back skiing 8 months later? thanks in advance.


I reckon that if I can do the reconstruction before early May then I should be able to get you back on snow Bh end of year. I run a confidence building day in November/ early December. We'll check your recovery around August , give you a ski specific program and then have day at Hemel on snow with instructor .
Check it out here https://www.facebook.com/wimbledonclinics. If it may be if interest pm me your email and I'll let you know details nearer the time

Your priority at this stage is

You must be getting full extension, if not that is your primary focus
Control of swelling, if knee still swelling go easy on amount you do and ice 5 plus times a day

Then try to increase flexion but go easy if above not achieved

Once you have at least 90 of bend then try to get a good heel strike, even if that means using one crutch still.

Cycling is only useful at this stage if above achieved.

Jonathan Bell
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snowHeads are a friendly bunch.
I had an ACL replacement, repair of a torn meniscus and cartilage cleaned up, 09 Apr 2013. I skied New Year for a week and January for another week. Some swelling, very little pain, no worries.
You will get your exercise programs from your physio, here are my small bits of advice for what they are worth.
1) RICE rest, ice, compression, elevate. is really recommended. Ice, ice and more ice. I got bags of that chemical gel, 8 in the freezer, put 4 on my knee at a time, while 4 were refreezing. 20 minutes on 20 off with tissue paper between the ice and my knee and a stretch towel wrapped around to give it compression, and wished I could do more. As much as you can stand it.
2) Keep doing the ice after every physio or exercise session for months. If I had done this more I am sure my recovery would have been much better.
3)Straighten that leg. Get it straight right from the beginning. As you start to strengthen the leg it will not want to straighten, it is a balancing act, strength vs flexibility. As Jonathon Bell has stated above, this will really help get your heel strike, and this is the pressure you need to kick into your bindings, or that is how it feels to me.
4) Follow the program. Do as you are told. As was explained to me there is a 'bandwidth' of recovery time, it is very difficult to get above the recovery curve, but it is really easy to fall below it. Even professional athletes take 6-9 months to recover from ACL replacement.
5) Initially don't over do it, it is really tempting to do more, until you wake up the next day with your lower leg full of a liter of liquid and you are back to point 1, unable to exercise for a few days.
6) Once it is safe, do as many of the exercises as you can with your eyes closed, this will help with a word you will probably read a lot about proprioception.
7) Every so often exercise in front of a mirror. For me I had to do squats with a piece of string dangling from the back of my pants, so that I could stay symmetric, the cat loved this.
Cool Exercise both legs to stay balanced.
9) I discovered after about 6 months it is mental, do the lateral hopping exercises when you get that far you will have no worries skiing, another word you will read pliometrics
10) The first day skiing was very nervy but once I got back into it I was fine.
11) Carving is really tough I could feel the lateral pressure on the knee joint, so I had to lift off. This has made me more determined, more exercises this year, cross trainer forward and reverse, stair climber etc.. should have being doing more of this before Christmas.
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
Along with the RICE method you can use a blood flow stimulator to speed up your body's natural healing process. There's a great site that sells these stimulators and they also have a ton of info on how to recover from injuries faster. I put the link in below:

http://www.kingbrand.com/Knee-Injury-Meniscus.php?REF=52PV50
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So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much
Quote:

Along with the RICE method you can use a blood flow stimulator to speed up your body's natural healing process. There's a great site that sells these stimulators and they also have a ton of info on how to recover from injuries faster. I put the link in below:

Site looks like pseudo-scientific drivel to me - stick to the KISS principle unless your doctors advise otherwise Very Happy
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 You know it makes sense.
You know it makes sense.
Quote:

Site looks like pseudo-scientific drivel to me - stick to the KISS principle unless your doctors advise otherwise Very Happy


It's worked for me with ganglions in my wrists and a sprained ankle. My friend couldn't swing a golf club until he got the elbow one. I don't know what's complicated about the treatment, it's stimulating blood, what the body uses to bring oxygen and nutrients to damaged tissues to repair them, seems to be following the KISS principle to me.
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 Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
Hi

Fell over yesterday sideways and not particularly backwards (on skis) knee hurt like whatsits so went to centre medical here in avoriaz and they said that they suspected that I had just stretched my ACl but that it could be a small tear, they could not tell without MRI ad have given me referral for MRI when I get back to UK, and told me not to ski for the rest of the week

Question to the experts in this thread, they have given me a super brace (should be at £144) my knee feels fine I was walking on it fine to get to centre, and its feeling better all the time. Can i get away with say resting for a couple of days and then go and do some light ski-ing on my last 2 days using the brace? Or is it not worth it, the docter here said that it was upto me, but that I ran the risk of a full rupture if I fell again.

I am torn, mostly I am thinking screw it lets just get on, as I have had falls before that felt like this rested and carried on skiing without a brace. but my concern is that if I do carry on and get a full rupture that my insurance probably won't cover it in those circumstance (probably quite rightly if I am being honest with myself)

Thoughts
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 Poster: A snowHead
Poster: A snowHead
When I broke mine I iced and rested for two days and then skied again. Didn't feel like I could fully depend on it but was happy on piste. Didn't have a brace as I didn't know I'd ruptured it, only got diagnosed back in UK. Have you got an effusion (fluid in the joint)? usually a useful pointer to how severe the damage is. If you decide to get back on your skis might be worth reducing the DIN settings on your bindings slightly so there's hopefully less strain on your joint if you do go over. Mind you, I am not an orthopaedic specialist so you must make your own decision. Good luck!
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 Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
@gordonrussell76, did they say you shouldn't ski on it? If they did then you will be skiing against medical advice which certainly invalidates my policy. However if they didn't say you couldn't then I can't see why there should be a problem.

However be warned IF you have torn your ACL (even partially) your knee could be unstable and you have the risk of causing further injury, but the brace should hopefully protect against that.
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Thanks for your input

No no effusion of fluid, its really weird the knee looks completely normal, no swelling no bruising, what also make me think its a pull and not a tear, is that it hurts more down to the left of my shin, Ie about 8 inchs below the knee, I am no anatomist but I am guessing maybe this is wear the ligament attaches?

To be honest I have strained my knee before and normally a night rest and its just stiff the next morning. The only thing different this time is that it was painful all night (i did not take any painkillers due to back problems and the tendancy for them to be made worse by sleeping whilst on painkillers) and waas still very painful in the morning so I thought hmm best go double check thinking they would just give me some ibuprofen and maybe a neoprene suport. next thing I know they are strapping me into an x-ray machine.

I do wander if they were just being belt and braces,because now another 4 hours later, there is no pain, I have not had any painkillers and the knee feels almost back to normal, although posts above suggest that might not mean anything.

I think I will rest it another day and see how it feels then.

G
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@gordonrussell76, no swelling is a really good sign. When I ruptured my ACL it swelled up very quickly and didn't go down until about two months later with the help Of Physio exercises.


Last edited by You need to Login to know who's really who. on Tue 30-12-14 19:37; edited 1 time in total
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Good news then, I am pleased

Just been doing some exploratory bending.

Feels totally stable with up and down movements.

It only hurts when I twist my foot side to side, which makes sense. Should probably have mentioned, and to doctor but did not really notice at time but my ankle also hurts, I think it was a twisting motion that injured it not a falling backwards

I fell sideways and the ski twisted slightly twisting my knee. But not as I was going backwards. I deliberately fell tot he side becuase the whole thing happened as i was skiing with a friends son between my ski's. His ski went under mine stopping me from turning and we were heading for a building so I chose to fall and not impact. But I wanted to make sure I did not fall on him So lifted him up and threw myself sideways. ski dug in at front and motion meant i twisted round knee joint as we landed



G
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@gordonrussell76, IMV (and I am not a doctor) it's mainly down to how confident you are that you won't have another twisting fall. it's a very different question for a skier who can confidently say they can ski all day without falling and one who can't
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Fair point i can say that if I am not skiing with a child between my legs its been a very long time since i have fallen on a blue and thats probably what i would stick to to be safe, but valid point.
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 After all it is free Go on u know u want to!
After all it is free Go on u know u want to!
gordonrussell76 wrote:
Hi

Fell over yesterday sideways and not particularly backwards (on skis) knee hurt like whatsits so went to centre medical here in avoriaz and they said that they suspected that I had just stretched my ACl but that it could be a small tear, they could not tell without MRI ad have given me referral for MRI when I get back to UK, and told me not to ski for the rest of the week

Question to the experts in this thread, they have given me a super brace (should be at £144) my knee feels fine I was walking on it fine to get to centre, and its feeling better all the time. Can i get away with say resting for a couple of days and then go and do some light ski-ing on my last 2 days using the brace? Or is it not worth it, the docter here said that it was upto me, but that I ran the risk of a full rupture if I fell again.

I am torn, mostly I am thinking screw it lets just get on, as I have had falls before that felt like this rested and carried on skiing without a brace. but my concern is that if I do carry on and get a full rupture that my insurance probably won't cover it in those circumstance (probably quite rightly if I am being honest with myself)

Thoughts


I see and treat lots of ACL ruptures. ACL rupture is a clinical diagnosis. By that i mean it is a diagnosis that is made from the history and, most importantly , the examination of the knee. Most knees swell up after even partial injuries to the ACL. I do not rely on a scan to diagnose an ACL rupture. There are a number of reasons for this.

MR often under reports the severity ( completeness) of the injury)

Ive also seen ACLs with a bit of oedema on scan ( bruising ) where the ligament has felt totally normal

A small number of ACL injuries can do very well without surgery and get back to normal or virtually normal ( though this is a rare outcome)

So your problem centres around one key point.

Have you injured your ACL?

I find that it can often be helpful to relook at a knee a couple of weeks after the injury to reassess the ACL. it is particularly helpful in those cases that appear to be incomplete ruptures.

I would suggest that you ask them to have another look at your knee or see a knee specialist.

If you have had a partial injury to your ACL and you just wait a few weeks for the knee to settle then return to skiing your risk of reinjury is extremely high.

Jonathan Bell
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Hi All

Sorry got back and real life TM and 4 year old daughter etc took over, but thought it would be interesting to update you.

I did ski a bit after the accident, but to be honest with you I was not really upto much however I will give full marks to the knee brace they gave me as I fell once and it locked up and I popped out of binding and no further damage.

Interestingly got home and got a proper diagnosis, nothing to do with Cruciate ligament thank god. I had a partial sprain of the anterior ligament, what my physio in laymans terms my second line of defence and partial tear of two of the small parts of my hamstring where they attach to the fibia.

Have had physio and am signed off to ski in March (yeay)

I am thinking of getting braces for my knees as my physio says that I have no muscle issue but I lack hip mobility and that is putting excess strain on these ligaments. Until my physio and stretching alleviates that I want something, probably more for my peace of mind.

I have had a look at a few things and basically I am wandering should I get the Sprung loaded jobbies which will give a bit of additional support to my knee but not lock out, or should I go full metal jacket and get a hinged one (but smaller than the full length leg one the centre medical gave me which is not practical to ski in and kept slipping.

I was looking at Mueller HG80' and they do one with springs in it and another with hinge, which is best. My gut tells me I don't need the full hinge.

Cheers
Everyone and Jonathon thanks for chiming in at the time it was very helpful.

Gordon
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Why not ask your physios advice on which grace would be best? I have the hinged mueller one but that was the one adviced to me by my Physio (and I now only have half my reconstructed ACL left intact)
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I did ask today and he said that they are all the same and to go for one that has straps, he did not mention hinges or stabilizers, in fact he was quite vague. I get the impression he does not really approve of them. At the beginning of my treatment I asked about this and he said 'you won't need one we will get knee strong enough' I asked again today and I think he stills thinks that my knee will be strong enough, but the way I injured it, I don't care how strong it is if that happens again its going to go again.

Having said that it may well be that regardless of what brace I have on its going to go again if I do what I did last time.

The other thing is though my knees always hurt after skiing so I want something that gives them some help as I think that by the time I had had my fall I was already carrying a slight sprain of that ligament, so it was not in best condition to cope with fall. I want to bascially make sure that my ligaments are not being asked to work so hard.

This is why I thought a stabilized as opposed to hinged might be best. Would not limit my range of movement as much, but would provide additional support for minor pulls and keep my ligaments in good shape if something bad does happen. Rather than ski around with robocop legs as a just in case thing. I did not do cruciate so I don't think I need a locking hinge.

I might ring up a couple of places that sell these things and ask there advice. I am seeing physio again next week, but if I wait and order one after that I won't have time to return it and get another if I get the size wrong before going away on hols.

G
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 And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
gordonrussell76 This is quite a common question on snowHeads so i have done this entry on braces and what to look for..

http://www.wimbledonclinics.co.uk/blog/to-brace-or-not-to-brace-january/

Glad to hear knee holding up

Jonathan Bell
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@Jonathan Bell, great write up, really helpful.
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 You know it makes sense.
You know it makes sense.
Jonathon

Thanks interesting reading.

I have gone with a McDavid 425 brace as I agree with your article, I don't believe a brace is going to prevent the injury again.

I am mainly after something that is going to hold knee in right place and give me some support to prevent weakening during normal activity. In addition the prioperception (great word) or what i call a nice reminder to think about knees and how my technique is affecting them is also very helpful.

I am hoping i won't fall again, it was a very strange situation not one I have encountered before and hopefully not one I will encounter again.

Its strange my worse skiing injury came going about 2 miles an hour. 2 of my friends also got there worst skiing injuries on nursery slopes at low speed, bizarre. Obviously the key to safety is to just go full tilt and only ski blacks Smile

Joking

G
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 Otherwise you'll just go on seeing the one name:
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gordonrussell76 wrote:
Jonathon

Thanks interesting reading.
Its strange my worse skiing injury came going about 2 miles an hour. 2 of my friends also got there worst skiing injuries on nursery slopes at low speed, bizarre. Obviously the key to safety is to just go full tilt and only ski blacks Smile
Joking

G


Most ski induced ACL ruptures occur at slow speed.This i think for a number of reasons:

If you fall backwards slowly the tail of the ski bites and flexes causing a severe twist to the knee that is already under strain because of the fall backwards.

This typically occurs at a relatively slow speed on the slopes, getting off a chair lift or when defensive skiing when intimidated by the terrain ie backseat.

When skiing slowly or falling slowly the bindings do not release as easily.

There are a number of solutions.

If you fall backwards then "let it go"

Choose your company on the chair lift wisely as the fall that ruptures the ACL is often caused by the person next to you falling across your skis.

Ski everywhere at high speed so at least the tale of your ruptured ACL sounds more impressive.

Jonathan Bell
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 Poster: A snowHead
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Quote:

Ski everywhere at high speed so at least the tale of your ruptured ACL sounds more impressive.

Laughing
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Obviously A snowHead isn't a real person
Sorry meant to come back to this thread before.

Ski-ing trip post physio was a huge success. Made it through the week with no further injury, the braces were fantasic no slippage unlike my previous one and the metal was great as it gave me more security pushing out of turns.

What was really interesting was that the knee that had not received as much physio attention did start hurting towards the end of the week.

Conclusions

1) I need to keep working on my stretching exercizes from my physio and to now do it equally on both legs as they both have the same issue. Namely that my hamstrings are too tight at the hip and during skiing this manifests at the knee.
2) Continue working on my ski-ing technique because I am fairly sure that I am doing something wrong that is putting undue pressure on my legs as a whole.

Thanks everyone again for all your help this season and to my physio as it meant I actually got a season which at one point I thought was looking very doubtful.

G
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 Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
Sorry to post in another thread... given the recent occurrence of my injury, I'm reading everything I can to get some perspective.

Ruptured my ACL exactly three weeks ago coming down Mont Joly when another skier and I collided... not the collision but the backwards momentum into powder on the side of the piste. Tail of ski gets buried, I keep going. You know the story. Complete rupture of the ACL, strained MCL and a couple of other smaller injuries.

Walking without a limp, have good strength in both legs and no real ROM of motion issue. Still have some stiffness and I'm not going to pistol squat anytime soon but my PT is already having me doing exercises like kettlebell goblet squats since I can squat down to 90 degrees without knee pain. I haven't felt instability, yet. Will that change? I don't know. I'm very optimistic about all of this just based on MY knee and how everything is right now but it will be a while before we do any tests like an agility ladder or plyometrics.

So, can't tick a box yet. I'd like to do get back to "reasonable" off piste meaning some steeps but not crazy Glenn Plake steep.
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