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The snowHeads ACL rehab club !

 Poster: A snowHead
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1969jma wrote:
If I have a ruptured ACL is it advisable to cycle on a static bike, am i likely to cause any further damage?

Just trying keep the weight off the waist!


Cycling fine if knee not currently swollen

Jonathan Bell
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22 dropout wrote:

Why are you keeping weight off the waist?


Isn't that something we'd all like to do?
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@miranda, ah, got it. For a while I thought 1969jma didn't want to exercise standing up rolling eyes
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Hi all,

Been a little while since I've wrote an update, hope everyone else is getting on OK too.

Almost 9 weeks since my operation I'd say in the last week maybe 2 things are noticeably getting easier with my leg being stronger. I invested in a Compex 3.0 as my quad muscle were as dead as the dodo, couple of sessions a day on that and my muscles have reactivated and seem to be getting stronger by the day couple with physio exercises.

Personal milestone achieved today as I walked my first fell since sustaining the original injury. I've (and perhaps the dog more so!) have really missed getting out for walks, there are so many good ones right on my doorstep living in the lakes. Between operations I got to doing some flat walks on well know flat routes but today I tackled what felt a bit like I imagine Everest must be like, all 400m of Lakeland fell! Shocked It's well pathed and with plenty of dry weather I felt confident enough to have a go.

I'm still on a stick when I'm out the house on longer walks, it's getting there but I don't think the leg is fully straight yet and certainly can't get close to hyper extension but there still is some swelling.

My quad getting stronger should see me get there but as I keep having to tell myself it's a marathon and not a sprint! It's difficult if you're used to being fit and active, with the reconstruction it's best not to over do it and risk the graft.
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@Grizwald, - good to hear from you! I was wondering how it was going. It sounds as though you really have moved up a few gears. Talking of which - are you on the static bike as well? How's the private physio going? I had to wait a couple of weeks as my physio was moving but saw him again on Friday - lots of new exercises and a sports massage (ouch! but effective). Really useful. It also occurred to me that icing the back of the knee might be a good idea,too - and I think it was.
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Grizwald wrote:
It's difficult if you're used to being fit and active, with the reconstruction it's best not to over do it and risk the graft.


I think this is hardest part, understanding what is reasonable with regard to damaging the graft. For me this wasn't helped with the NHS physio being withdrawn at about the point I was able to do more activities, about the 9 week mark.

With hindsight I think I was probably over cautious but maybe that's a good thing !
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@legalista,

I'm using a cross trainer, I don't have a bike. It's not as good as a bike but it's what I have-and a treadmill! Private Physio is great and I'm getting a weekly massage from the Rugby Club physio. I would have done my rehab with them too but they are only recently qualified so that put me off a little.

Good tip on the icing I will try it!

@AndAnotherThing.., Very true. I was told that the 12-14 week mark was the critical time to be cautious as you'll likely start to feel the best the knee has felt for a long time but this is when the graft effectively turns from tendon tissue to a ligament. A lot of grafts are undone by people returning to activity too early, a team mate made that mistake so I'm just going to take it easy and follow instructions!
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@Grizwald, It would be interesting to see the data on gaft fail during rehab.
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@AndAnotherThing.., My physio (NHS) has known it happen once and it wasn't his patient. Someone had an awkward fall suppose there's always that risk graft or not.

Interestingly he said around 60% of rugby players play again at amateur level after an ACL reconstruction it's more like 90+ for semi-pro players.
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Grizwald wrote:
have really missed getting out for walks, there are so many good ones right on my doorstep living in the lakes.


Oh I know that feeling! I did a whole summer season living up a mountain not being allowed to walk or cycle unless on the flat (i.e. not at all)! My surgeon ranked it with skiing and tennis etc. and said no for 6 months. I had full extension straight away and then the flex came steadily and fairly quickly, at which point - as I've mentioned before - he also forbade all physio for a couple of months. I know that is not the standard recommendation. As long as you trust your surgeon then you're right to just follow orders I think, as frustrating as it is. I might not have made the fastest return to full sport possible, but I wasn't a professional athlete who needed to do so with associated risks - much better to have secure and long-lasting results.

Re: icing the back of the knee... yes, do it - the wraparound packs are really useful for getting the whole area iced.
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Hi folks looking for some advice ( tho I probably know the answer!!) History - Managed to fall over a windlip in bad vis last November in Scotland. Skis stuck in wet snow twisted my knees then came off. Managed to shuffle/snowplough back to the car & drive home. R knee was swollen - lay on the sofa for 3-4 days icing it. Had 3-4 physio visits & she reckoned it wasn`t too serious. I had the usual problems going down stairs getting in/out of car tho my knee never collapsed. Have skied all winter including a few falls & a 2 week ski touring trip to Lyngen, also a 3 week climbing holiday to Spain. Knee doesn`t hurt while skiing but is stiff in the morning & still wakes me at night sometimes especially lying on my back. Pain is on outside of the knee.Have also lost a bit of ROM trying to get knee to chest & am a few inches of touching my backside with my heel. Does this sound like I should go down the Scan/op/rehab route?? After 6 months would have thought I should be back to normal if nothing too serious? Should also say I am 58 tho fit for my age have heard that NHS not keen to do ligament type ops on folk my age.
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Hi @smac. It sounds as though you're doing really well. I've been rather waiting to see if anyone with more expertise answers, but it seems to me that you could have done all sorts of things to your knee, ranging from things that will sort themselves out over time, to more serious problems. For example, if you sprained/tore your medial collateral ligament, that will normally mend itself. If you did in your ACL, then it almost certainly won't sort itself out but some people achieve good stability without it and don't have the operation - although there's lots of discussion about this on various forums. Did you hear a pop? There are other signs of ACL damage that a skilled doctor can look for - e.g. Lachman test. The only way I suppose to know for sure what's happened is to have an examination by an orthopaedic surgeon with a particular interest in knees and a scan if he/she thinks there is evidence to support ACL damage. My experience is that starting this process does not mean that you inevitably end up having a reconstruction, even if the dreaded ACL tear is found. I had a reconstruction after an acl rupture and meniscal damage but only when it became clear that the knee was hopelessly unstable (and the meniscal tears needed surgery anyhow). Even if you have had an ACL tear, it sounds as though you have achieved a good level of function so it may be that the advice would be to leave well alone but it sounds as though you are sufficiently concerned that you would like at least to know what you've done to yourself- hardly unreasonable! Good luck.
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Thanks for the response legalista - sort of what I expected. No pop at time of fall. As u say its really about finding out what damage I have done & the long term prognosis. Will probably see a GP & try to get refered to a knee specialist & hopefully maybe a scan. Happy that my knee is in reasonable state just now but concerned about long term damage. cheers.
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smac wrote:
Hi folks looking for some advice ( tho I probably know the answer!!) History - Managed to fall over a windlip in bad vis last November in Scotland. Skis stuck in wet snow twisted my knees then came off. Managed to shuffle/snowplough back to the car & drive home. R knee was swollen - lay on the sofa for 3-4 days icing it. Had 3-4 physio visits & she reckoned it wasn`t too serious. I had the usual problems going down stairs getting in/out of car tho my knee never collapsed. Have skied all winter including a few falls & a 2 week ski touring trip to Lyngen, also a 3 week climbing holiday to Spain. Knee doesn`t hurt while skiing but is stiff in the morning & still wakes me at night sometimes especially lying on my back. Pain is on outside of the knee.Have also lost a bit of ROM trying to get knee to chest & am a few inches of touching my backside with my heel. Does this sound like I should go down the Scan/op/rehab route?? After 6 months would have thought I should be back to normal if nothing too serious? Should also say I am 58 tho fit for my age have heard that NHS not keen to do ligament type ops on folk my age.


Your problem, which i see very often on here, is a lack of a clear diagnosis.
There is a link to a blog on the topic in the blurb below or look up my blogs on my website www.wimbledonclinics.co.uk

Jonathan Bell
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@smac, good that you're getting it checked out. No reason to fear the worst as you clearly have good strength and range in the leg, but your comment about ROM shows there is fluid/swelling, and something is getting aggravated to cause that. November to May is long-enough for an insignificant thing to sort itself out. You had an amazing winter season. Isn't Lyngen special? Good luck with the diagnosis.
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Thanks for the replies guys going to try my GP first & see if I can get an appointment at the knee clinic & a scan, however I fear he will say I am too old/ perfectly healthy cause I can walk around!! If not will bite the bullet & get a private diagnosis. The guy who runs the NHS knee clinic here in Edinburgh is a skier but is also the guy who does the private stuff.
22 Dropout agree that if ski touring/ski mountaineering is your thing Lyngen is paradise been 3x2 weeks now & this time was based in South Lyngen - amazing hills & a lot less guided groups!!! Have skied in Cham quite a bit too & may be there next winter so u nevet know might see u there.
cheers
Smac.
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6 weeks and 3 days post op. I saw the physio last week - good strength and reasonable extension but flexion stuck at 90 degrees. I've been working hard on it though over the past week and (touch wood) it's improved quite a bit. I'll know for sure next week when I see the physio again. In the meantime, we've been back to the Alps for the long weekend and I was able to walk around the village - it felt so good and so normal!

Has anyone experienced a feeling of things not being lined up right in the knee, just below the kneecap and slightly to the left, as you move from extension into flexion? I often seem to get this and sometimes there's a click as well, and then things move fine. Scar tissue perhaps?
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I've been through this a few times and was told each time I'd never ski again (except by the guy who sorted out the pig's ear of a mess made by someone working way out of his specialist area, but too arrogant to hand me over to a top knee specialist in the same hospital. @legalista

The clicking (if there is no pain is usually the last of the internal op scar tissue breaking up. I still click occasionally 8 years later Toofy Grin

For getting the last few degrees of extension I've always used passive hanging. This means the knee itself is not supported. I use a footstool still to do this. I also made a big mistake with my first (open knee ACL reconstruction of resting with something under my knee and it resulted in me having problems getting full extension 😚😳

Walking backwards and using the stationary bike to pedal backwards helped a lot in the end. I had adjustable pedal cranks on the excercise bike that let me cycle a lot once I could bend rgrough 90*. For a non-adjustable bike I think you need to have around 110* of flex

If you can do it yourself get your physio to show you how to mobilise the patella and your graft site.
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@legalista, clicking and correction is normal. It can be quite frequent and loud (and quite satisfying). Your muscles are starting to fire again, the clicking comes from your muscles not firing in the optimal order, but that will come. In particular, your hamstring is weak and slow, and your VMO (vastus medial oblique) is impaired by even the smallest amount of swelling, and that one especially aligns the knee cap as the leg straightens. That is what the cycling, nordic, hops, running is for - systematically working with more load and different muscles over time to get them firing again without stressing the graft too soon.

Nothing you've described sounds strange but do mention it to your physio for peace of mind. Keep a watch on the flexion. I got stuck at about 70 degrees due to scar tissue and at 7 weeks I had to have another op to get flexion. You should be close to or cycling at 7 weeks ideally or seeing regular improvement in flexion. The key indicator for me was when I stubbed my toe. The pain was excruciating because it was going straight into the scar tissue rather than my knee bending to absorb it. I knew it wasn't right. If you feel you're stuck at 90, doing all the icing and the knee blows up every time you try to push into a bend go to see your consultant. They will know immediately if you have got scarring that is impeding progress.
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@Samerberg Sue, @22 dropout, - thank you so much ! Very reasssuring to know that the weird feeling is probably entirely normal. The explanation about the VMO makes a lot of sense as it does feel that things in the knee are having to go into alignment as I do the movement. I think I'm getting there on the flexion, albeit slowly ..... but 22 dropout's experience re the toe stubbing made me wince! Ouch. Did the operation sort it out quickly or was it like going back to the beginning?
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That depends on the audience Very Happy It sounds brutal - they just force the knee until the scar tissue rips and tears open. Ouch.

In reality, I was under general anaesthetic, felt nothing and it worked. The scar tissue was simply re-absorbed and it was amazing to get in the pool the next day and bend my knee. I had nearly full bend from that point onwards. The hospital even had a machine that did the bending for me - I just lay there, strapped in and it bent my leg and straightened it for hours at a time! Mentally and physically it was an enormous relief. I will never forget those first seven weeks, but then, who does?

Hang in there.
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@legalista, each and everyone of us rehab differently and according to our surgeon'current protocols. I've bee through this 5 times no and although there are commonalities no 2 recoveries have ever been exactly the same because each operation is unique to that situation. Surgeons learn new and better techniques all the time.

My first 3 reconstructions were all open knee surgery in the late 1980s early 190s. They were using artificial kevlar(?) and carbon fibre grafts back then and mine kept snapping.
Eventually I persuaded my consultant in Br.istol to use the B-T-B ( bone tendon bone plug graft that Gazza had had. Since then no problems and it is still / or was at the last check working well.

I found Aqua jogging good as is walking backwards to help get some extension back extension is more important as you can use a normal gait to move around . And you feel amazing the firs time you don't I limp!
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@Samerberg Sue, @22 dropout, - really helpful information. In a way, it's useful to know that there is an operative solution if I just can't get the movement back. However, I'm pushing it hard on the heel slide and cycling lots on the static bike - fingers crossed but I think I am making progress. Apart from the ROM, everything else is good so I'm concentrating on improving in this area. And at least the weather has suddenly got better! Thanks for all your advice.
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@legalista, are you getting into the pool? As @Samerberg Sue, says, the water is very, very good for rehab. The water pressure helps reduce swelling effectively. Without knowing exactly what's going on in your knee you will still be dealing with swelling. I didn't bother actually swimming as I felt that would affect my ability to concentrate solely on my leg. I held onto the side of the pool and did various kicks and bends for five minutes each at a time. I got a good workout in 20 mins, and I could flex my leg more afterwards than before (after the manipulation of course). You can jog, walk, and all the time the water pressure is helping pump fluid out of your leg. It might be that in pushing more into flexion you are getting resistance from swelling (swelling is a soft resistance, scar tissue is a sudden resistance). It also provides respite from all that cycling!
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@22 dropout, @Samerberg Sue, I will take my swimming cossie to work tomorrow and pop into the pool on the way back! I'm also seeing the physio tomorrow before work. The knee is still a bit swollen so maybe that's the reason I'm struggling a bit.
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Well, the trip to the pool was great - thank you for suggesting it. Visit to physio was also much more positive as flexion now up to 117 degrees, which is a huge improvement. I'm going to try to get to the pool 3 or 4 times a week and continue the cycling etc - feeling much more positive now! 8 weeks on Friday since the operation.
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@legalista, great, what did your physio think? The 8 week point is quite hard. I think it is because it is already a quarter of the way in to the magic nine months and normality seems a long way off. Find a routine that suits you and the work you do now on controlling swelling and putting a little resistance on the bike will be the foundation for future months.
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Hi! I delayed replying as saw physio last night. Flexion now up to 120 degrees (only a slight improvement but it was end of the day and knee a bit swollen and achy). He was a bit half hearted about trips to the pool - the anchor stitch in the scar is right on the surface and is a tiny bit irritated - he's a bit worried about an infection route - although I haven't had a problem so far. He reckons I should get back the last bit of movement when the swelling finally goes. At the moment, it's a case of steady as I go until the 12 week point when I can get going more on the strength but I am now walking without a limp (yay!), doing a good 45 mins per day on the static bike and, when it's not raining, going for a good walk around the block (1.5 miles) in the evenings so I am doing ok, I think.
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@legalista, sounds like it to me. I think my longest static bike was 20 mins… Is the scar soreness coming from swelling, i.e. the knee is swollen so the skin gets pulled tight over the swelling when bending the knee?
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Yes, there's an element of that, but the knee is still a bit swollen (not gargantuan, but just a bit bigger all round) and I think I can feel the extra synovial fluid in the joint restricting the movement rather than the scar itself being a problem - sort of like a feeling of painful blancmange as I stretch into it. Not sure that's a great allusion. Anyhow, the biking is not done in any heroic way which is probably why I can do it for so long. In fact, I just pedal away watching telly which is quite good as it makes me feel I'm not just slobbing out and am doing something worthy!
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Would any have any good recommendations for getting rid of a limp. Left leg is the issue.

ive been told i) to tense left buttock as left heel is placed.
ii) to have full leg extension iii) use of treadmill
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@1969jma, concentrate on every step, make sure you step with a heel strike and push through to the toe - worked for me
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@1969jma, have they also suggested walking backwards on the tread mill?
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agree with @holidayloverxx, - the heel strike is key, I think. Then think it through as you walk - heel strike, full extension, let the weight move through the foot and push off the ball of the foot at the end. It's better to get it right than to hurry.
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In addition to the above do you have full extension in the first place? If you do is this just a habit or are your muscles unequal in strength? If they are unequal (do some tests) then you might want to do some extra things to balance them out. There is loads of stuff on the Internet about leading normal activities with a different leg, doing two steps at a time, step exercises etc. for strength and also breaking the habit (walking backwards, heel strike etc.) which will not change without conscious thought. Of course, you could go the other way, get some loose fitting pants and a hoodie and just cultivate a funky limp...
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It's nearly 16 weeks since I've had my operation and I'm finally starting to see the light at the end of the tunnel!

I'm walking without my stick on even ground although I lack a bit of control and strength still going down steep inclines/hills. I can kneel on the floor just bout although it's no marker it's still tender. I've had a little jog on the treadmill. A side effect of not be active for the best part of 9 months is I've put on over 2 stone which won't help! So need to get that off and back on the road to fitness. It will be October and maybe more realistically December before I should consider returning to 'cutting' sports. I'm 'probably' done with rugby I think but hope to have decades of skiing in me!

It's been difficult, and some way to go to getting back to the way the knee was but like I say at least I can now walk, drive and do normal day to day stuff! Hope everyone else is doing OK.
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Good to hear from you @Grizwald, . It's a long old haul, isn't it? How far do you walk at a time?
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Does anyone have a view on road cycling post ACL surgery? At what stage have you done this?
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i got back on the bike on the road around 5 months post op, i dont think that was in any way early, in my case it wasn't part of my rehab, it was just what i felt like doing. I'd be on the stationary bike for quite a while at that stage as well. Interestingly, my repair has gone now (snapped)(to be fair, its been 20 years) and my consultant has advised against another one. Buggeration.
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