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The snowHeads ACL rehab club !

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@Homey, my understanding is that it's very hard to completely isolate the VMO to exercise it by itself. The exercises I've been given are to get it to fire together with the medial hamstring and calf, to support my knee cap on the medial side.

With the usual caveat about checking it with your physio first, as it might not be safe for you, etc etc. Mine are all to be done slowly, focusing on pushing the knee cap out through an inner rotation in the shin and an outer rotation at the hip: McConnell squat holds
http://youtube.com/v/_j99ednCD2o ; one legged hamstring bridges on the operated leg, with your body on the floor and your foot up on a chair; lateral step downs with the operated leg on a step, and focusing on pushing the knee cap out http://www.cornell.edu/video/lateral-step-downs ; single leg calf raises, on the outer side of your foot as much as possible; and split squats with the operated leg forward, again focusing on the knee cap pointing outwards. The latter progressed into Bulgarian split squats - with the caution that they can be very evil on the knees if done badly, so to really watch out for any anterior knee pain.
One big element though has been the physio checking my form on all of these, and if I'm doing them correctly to activate the right muscles and not to injure myself. At the beginning he literally kept his hand on my knee to check that the muscle was firing. So do run them past your physio and check them against any restrictions, etc. before you do them.

Grizzler's post above has some very good tips on activating the VMO through the full range of motion as well.

Foam roller: I use it on my ITB, which is tight as anything. Essentially I sit on my side on it, propping myself on my arms and good leg, and roll my body up and down, but not rolling the actual knee structure, just the muscle. Concentrate on the sore points- it's painful, I won't lie, but in a way that brings instant relief. I was told no more than 2 minutes, but some people do it for longer. The physio must have spotted I'd go crazy on it if given the chance! And I'm strictly not allowed to roll the medial hamstring/ hamstring graft site, as that's still too sensitive.

Here's a handy guide from Runners World https://www.runnersworld.com/health-injuries/a20812623/how-to-use-a-foam-roller-0/

How long are you post op by the way? I'm at 4 months now.
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@BorntoRun, Swiss balls are great, um, 'fun' for 1-legged bridges ( even 2-legged) and hamstring rolls. Also good to squeeze to strengthen inner thighs and to sit on when knackered Very Happy
Often, I am told - although you are surgical and I am not - not enough emphasis is put on the hammies and too much on the quads. The first thing which my physio niece ( a boarder) advised me: get the hams strong and they'll hold your knee together for you.

What holds, reps and sets are you doing with your exercises? The vids you listed show pretty constant movement as opposed to, say, split squat and hold for 10 secs, repeat x 10 and repeat x 3. Has anyone commented on this aspect to you?
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@Grizzler, youíre spot on about the split squat! Youíre a true expert. I do exactly as you said, 10 reps, 10 second hold, repeat 4 times, and now holding two dumbbells. Ouch! My legs are blancmange afterwards. The McConnell wall squat is also a hold, 10 secs x 8. Another semi static one is a wall sit with heel raises, 4 sets of 50 reps. I also do cobras for the hamstrings, which are also holds, 10 secs x 6 and repeat 4 times. It seems such a basic exercise but itís made such a difference to the hamstrings since I started it.
Also spot on about the hamstrings, or so the physio tells me too. I wonder sometimes if Iíd have torn my ACL had I paid more attention to the hamstrings. My weights used to consist of body pump classes, which have a lot for the quads but not much for the hamstrings (and zero for glutes). Apparently women often over rely on their quads vs hammies. One more reason why more women tear their ACLs?
For the hamstrings, other than the cobras and bridges, I also do one legged Romanian deadlifts with weights and hamstring curls with a resistance band. The RDLs are to lengthen as well as strengthen them, as mine are short apparently. On the bike I also push up with the ball of my foot, toes pointing down, rather than using the heel, to activate the hamstrings too.
Good tip re the Swiss ball, I should really invest in one. Itís more of a question of space though, our flat is small and already looks like a branch of Fitness First! The chair for the hamstring bridges is in fact the physioís substitute for a Swiss ball. He said to pick one I could push forward- but try not to. As you say, great fun! The first time he got me to try, at 4-5 weeks post op, I literally couldnít lift my bottom off the floor. Then for a few weeks all you could hear was the chair scraping against the floor, and me cursing it. I did get some satisfaction though, as he recently got me to also do the hamstring exercises on the healthy leg. A lot more involuntary chair pushing on that side now Very Happy
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@BorntoRun, I am by no means an expert! Just been there, done the research and trying out. Perhaps some thinking and analysing: but according to some SHds that isn't a good thing Laughing (Unless a dispensation is granted for rehab?)

I started very much doing holds, now finding I want to put in more slow repetitions throughout the ROM. Both have their place of course. Again, caveat that I never had the graft to worry about.

I didn't get given 1 set of exercises per se, nor ongoing monitored physio advice as such, just a few bits gathered together from a few people here and there and a lot of internet research. Talking to my physio niece yesterday and got ad hoc advice on a neural stretch that may help the aches and restless legs bit.

I know what you mean about the fitness clobber clutter! I'm luckily enough to have a small spare room for it, but end up with therabands, squeezy balls etc in other rooms too.

I discovered that the sofa is excellent for the bridges cum ham curls - chairs would just go sliding for me, but feet up on the sofa is great: in the conservatory I can look up at the clouds; in the lounge I get a warm back on the log burner (we don't have huge rooms either). The recliner's leg bit also gets used as a ham curl machine (push down, raise back under control).
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@Grizzler, believe me, Iím well aware how lucky I am on the physio front. The private health insurance I have through work is very good, so Iím lucky enough to have an excellent physio and enough time with him to have a properly tailored exercise programme. So I thank my lucky stars and do exactly as he says, to the letter. And of course thereís the extra incentive of protecting the graft. I feel heís taking that seriously, but pushing me at the same time. So I donít feel any temptation to rush or do things Iím not allowed too soon. Once the official rehab covered by the insurance runs out, I think Iíll pay to see him once in a while anyway- just to check the muscle balance, that everything is working as it should etc. Iím beginning to realise ACL rehab is pretty much for life.
Sounds like youíve done extremely well in putting a programme together for yourself and persevering with it. Takes a lot of grit to keep the rehab up by yourself. No such thing as too much thinking and analysing in my book. But then I would say that, Iíve been accused of much the same myself Blush
I like your thinking on recliner leg = hamstring curl machine. The resistance bands I ordered on the internet came with a door anchor. I didnít see any point in it at the time, but I use it for all itís worth now.
By far our clunkiest piece of rehab kit is an exercise bike we hired. Itís huge, and seriously evil on the resistance. A 2 on that is about a third of full resistance on a sprightlier gym bike. And itís a lot easier to use if itís had a ďwarm upĒ - i.e. if my husband has been on it first. Which suggests all is not quite well with its inner workings Very Happy Itís currently competing for space with a clothes drying rack by the window in our bedroom...
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@Grizzler, I dont know if you know this but the point of doing the bridges on the chair is to do them without the chair moving. Doing them on a static sofa is too easy
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@BorntoRun, yep, I have an evil old exercise bike too; definitely old ( think it was my Mum's about 20 years ago). Can set it so stiff that it takes all your leg push just to get 1 rev! Belt drive needs a bit of adjustment occasionally, and I dread the day when the belt or other bits go as I've tried new super duper bikes in the shops and they're wimpy pants! It's also sturdy enough that you can hook your toes under it for sit-ups! (Don't forget those core muscles...)

Never found a door strong enough that I trusted it. Once tried looping resistance bands round an old solid bed leg and a very heavy old sofa. 2 scratched wood floors later I was banned from trying that again. But I'm only a weak and weedy (mature) gurly...

Now all I need is something to trap my feet into or under so that I can do those lovely hamstring reverse sit ups ( lean forward, pull self back upright). Any ideas?

Must admit, I did a fair bit on the daily exercise programme, interspersed with gentle to steeper and longer hill walks, for 5 1/2 months, then a house move took over and I've only recently done anything formal again at all. Never went near a gym. However, lots of kneeling, unpacking, carrying and 6 months of constant heavy manual labour, serious weightlifting and digging in our new gardens have seemingly kept up something positive, combined with some good UK skiing over winter to spring.

For what it's worth, I think that steep hill walking is one of the best all round rehab and strengthening exercises - quads up, hams down - and maybe most enjoyable, time permitting. Can you get out to the N Downs or other suitable up and down places? The longer the better, I reckon. Climbing might also be good if permitted; indoor climbing wall?
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I know what you mean about the resistance band and the sofa leg. I tried the same, and much to my surprise it moved. I say to my surprise, because it was at the "can't lift bottom off the floor" stage, so my curl attempts were seriously weedy. But it seems to work with the door, especially if you are on the side where the curl movement would shut rather than open the door, if you see what I mean.

Eeek, reverse hamstring curls look hard. I dread the day when I get moved to those. Could you stick your feet under a sofa, or would you end up lifting it? Or can you bribe a family member or friend to sit on your feet?

I do miss long walks, including over the Downs. There's a book of walks near London, within a two hour train ride roughly, and we used to do lots of those. I also walked a lot round the city just in every day life. I have to build it up slowly though, I'm currently doing 2-3 30 minute strolls a day, but my gait isn't yet perfect and the hamstring graft site still gets uncomfortable by the end of that time. Slowly, slowly I'll get there. And I'm still amusingly insecure about hills! It's probably psychological, not trusting my quads enough and fearing I'll miss-step and twist the graft. It's a bit silly, because I don't feel the same way about going downstairs, and I can do it no problem. I do hold on to the banister though, just in case of a klutz moment!
How are you finding the psychological aspect of the ACL injury(es)? Do you worry about falling/twisting, or is that something specific to having a graft? I'm still very neurotic about it. I did the smallest of hops forward to adjust my position in a split squat today, and I've been worrying about it ever since. I didn't twist, I didn't hyperextend, didn't lose balance, or slip, and there was no discomfort. There was probably no more impact than a heavy step forward. But I know I'll obsess about it until I see the physio on Wednesday and he tests out the graft. He'll probably also give me a gentle ribbing for being such a Scaredy Cat!
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@BorntoRun, I think there must be much more fear and psychological issues when you have a graft, and the need to take it easy, be patient, not do what you're not meant to, etc. You're probably very sensible to take it in little steps at present. TBH, one reason why I really hope I'll not need a graft is because I just can't see me being able to avoid or stop doing the things which you have to for 3, 6 or 9 months to protect the graft; and, yes, I'd feel very very worried about harming it. Rehab is OK, but taking it easy, not pushing it and physically stopping yourself from doing certain (maybe essential) movements? No: not for me if I can avoid it. I hope that you are better at coping with that side of things.
I just have to be fearful about trashing my knees more in general without there knowingly being anything to hold them together rolling eyes (Or maybe the ACLs might have reattached to some other structure and can be pulled off again?) So, still a fair bit of worry about any time when I have to, or accidentally do something which stresses them. Great caution especially around anything slippery - wet floors, ice, mud etc. On the positive side, I have lost balance, stumbled, gone over on my foot side etc many times when walking, both more recently and nearer injury time, and had no problems, also had a few ski falls now too: but somehow that feels different to slipping and having the leg go off from under you at an unpredictable angle. That did happen to me whilst punting along on my snowboard this year, free leg slipped, and it did hurt and I was worried that I'd done more damage.
But I hope that the stronger things get, the more you do and try, the more confidence you get. I can only talk about recovering function and dealing with pain and stiffness as I don't have that graft, so maybe surgical people are different and others will be better placed to advise you. I hear many say that once their 9 months are up, maybe a ski season too, and they're as good as new. Research also suggests that many people, including top sports people, never return to where they were before, and that could be that few % points of holding back 'just in case', maybe. We're all different... The psychological stuff can take a long time for some people, I guess; and it won't be a problem for others. I was terrified when first skiing, still am less adventurous than I was and am always conscious that my knees could so easily rip themselves apart again (and they or the soft tissues are often not ache or pain free, either). Also conscious to stop as soon as the muscles feel tired as I don't want to make mistakes which they're too tired or slow to correct.
The other personal thing is that I still carry memories of 2 very very painful, tender and swollen knees, and I am terribly keen not to do anything which might hurt like that again. Lots and lots of knee padding, but it still affects my motorcycle riding and climbing/scrambling - I know how much it could hurt if I get it wrong and impact them again. That's a bigger fear than twisting for me.
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If you ski, board, ride a motorcycle, climb and scramble, you're doing exceptionally well in my book. Clearly whilst the thought of the knees is there at the back of your mind, you're not letting it get in the way of actually doing these things. And as you say, the stronger you get, and the more time passes since the injury, the less you will hopefully think about it.
I think learning to stop when muscles get tired is probably a positive rather than a negative (one of the few!!) from this injury. That, and keeping muscles strong enough to withstand the activities you're doing are two things I think we all should do, ACLers or not. That said, it sounds like neither of us can blame our injuries on tiredness. You can definitely blame it on somebody else, and on very bad luck. In my case it was also pure, sheer, random bad luck. The only thing I think I could have done, besides not be there at that particular time, is tested my bindings' release, and/or asked to have them set more loosely. And maybe have stronger hamstrings, but in reality once the bindings didn't release I think the writing was on the wall anyway.
I also hope you don't need the op(s), obviously. Holding back from some every day movements actually I think happens almost automatically - you don't have to do it actively. Subconsciously you move very, very gingerly post op because your sense of balance is totally shot, your muscles are mush, your knee is so sore and unwieldy, and you feel so vulnerable and exposed. You then gradually reintroduce movements as you feel better, sometimes only on being cajoled to do so. I had to be actively told to start walking down stairs normally, or to stop going round corners in a weird staggered movement, or to lift my operated leg without supporting it with the other leg. I've never found myself thinking "oh I really want to kneel on the operated leg, but I'm not allowed to", for example. You become so protective of the leg, that you'd have to actively override your fear and reluctance to do it. I said to my physio that I'd probably refuse to run the first time he tells me I can! But he says not to worry, by then I'll know I'm very strong, because of the things I'll be able to do with my leg in the exercises.
But yes, you would have to give up a lot of activities for 9 months or so, and that is hard. I don't miss running- my main form of every day exercise - yet, because right now the thought of the impact through the knee makes me shudder. But as it gets better I will. And I missed the basic fact of walking where I wanted, when I wanted, for as long as I wanted, and I hated the loss of independence (and yes, I know I am very lucky that it was only temporary). So there's no avoiding that, and I can see why you wouldn't want to go through it. Or I should say "you wouldn't want to go through it again" because I imagine you already went through a lot of this at the time of the injury and worked hard to rebuild from that and to be able to do the things you love again...
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Mini milestone, week 5.6... This morning I drove my nice car (heavier clutch and not as easy to get in and out of) for the first time since the op, to the MOT spot, and walked home. Only 2 miles but it's the longest completely crutchless walk yet, about 40 min including the odd short break. Not fast, but not too slow either, and nowhere near as troublesome as I'd expected, I took a crutch just in case but carried it the whole way. More tiring than it should've been (fitness has taken a whack) and not pretty yet, but getting there.

Neither of these things were anywhere near as troublesome as expected. It's easy to get into a "that's going to hurt, you're not ready for it yet" way of thinking eh.


Last edited by snowHeads are a friendly bunch. on Thu 16-08-18 13:02; edited 1 time in total
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Great work @jjams82! You really do put me to shame. I only reached the 40 minute walk mark now, so that puts you a full 12.5 weeks ahead Very Happy And 2 miles in 40 minutes is really not bad going at all. Isn't it lovely when you start doing things like that and begin to feel more like a person again, and not just a knee with a body attached? Light begins to glimmer at the end of that (bone) tunnel.

I did the carrying a crutch thing for a while too. Also very useful for warding off kids on scooters!

When's your next physio session? You were thinking squats were on the horizon at that one?

17.6 week update: physio session yesterday, and he upped the weights to a (still puny!) 10kg for some of the exercises - including my current nemesis, the Bulgarian split squat. It's a thing of pure evil, but I can feel the VMO working its little backside off. Makes a change to limp from something other than the knee afterwards! Also started the world's most pathetic one legged squats. They were written in my programme as "half squats", but, after I demonstrated, the physio said "umm, let's maybe go for quarter squats" Toofy Grin
Lots of exercises for the medial hamstring too, as the physio confirmed I still land my right foot pointing outwards a bit more than the other when I walk. As I suspected! My husband was swearing blind that both feet look the same, but then the poor guy was caught between a rock and a hard place there!
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@BorntoRun, I'm simultaneously dreading and looking forwards to proper exercises like that... Learning so so many new names for torturous sounding squats and other horrific exercises from this thread - I don't think I ever want to know what a bulgarian split squat is. Unfortunately, I suspect my knee has different plans for me.

Next physio session is next tuesday, along with a return to visit the surgeon for a chat about the op and my progress etc... Not long now.

And yep, it feels great to be walking half decent distances again:D

Now all I need is to be able to do it without the gait of a lopsided C-3PO.
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@jjams82 I get that feeling every morning as I start the exercises. "eeeek!!" but also "look, look, there's a little bit of muscle there - if you get a magnifying glass out"!

This particular horror is basically a static lunge where the back (healthy) leg is elevated behind you on something - the sofa if you're home gym DYI-ing. Means there's a nasty, looong way for the op knee to go as the back knee goes down to the floor (or not, by the end of the set!).

Fingers crossed for the next session, and surgeon appointment - let us know how it goes!

Oh, THE GAIT! Can't tell you how much time I've spent thinking/analysing/getting very very annoyed/ trying to change the gait! The physio provided tweaks here and there, you know, the basics- extend fully, flex, don't let the knee cap slump in, etc. But his basic take is, it'll only recover fully when the muscles are rebuilt- the cut medial hammies in my case. So I should stop worrying and "let it flow"- "your brain still knows what to do, you just don't have the hardware yet". Easier said that done, when you're boiling over with frustration because "something just doesn't feel right in my walk"! But I think he's right.. It really is improving by itself as bits and pieces of the leg kick back into action. It's just taking its sweet time about it, like most of ACL rehab Very Happy

PS That said, there was one tip I found very useful. If you aren't already, make sure you land with your heel first, then the full ball of the foot, then little toe working towards the big toe. Then, as you push off, do it through all your toes in turn, starting with the little toe. The big toe leaves the ground last- a sort of inward ankle rolling movement. Before doing that, I was thumping that poor foot down like a pancake.
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@jjams82, will the knee be up to sitting in a kit car by the bank holiday weekend? I'll probably be doing a run out somewhere on the Sat and it might as well be in your direction as anywhere else.
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@BorntoRun, Ta, I'll have a think about the heel/ball/toes progression foot motion thing when I'm next walking.

It's funny having to think about how one walks eh. I go through phases of feeling that best progress is not thinking about it (as you say, the brain still knows what to do) and analysing it (the brain still has a tendency to favour a ministry-of-silly-walks gait since the accident)... It seems on balance the best is not thinking too much about it, but it's sometimes hard when one has to force the leg into certain motions!

I find pretending I'm trying to fool someone into not knowing I've had a major knee op is a good one. I thought I was pretty good at it until I showed a friend that particular walk - apparently not Very Happy
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@adithorp, I was thinking about that on my walk earlier and yep, I reckon it would be! Drop me a PM closer the time if you'll be anywhere near.. I don't mind driving somewhere that'd be more on the way for you btw, save you too much detour.

Funnily enough, I was googling Fury stuff last night and found a thread on pistonheads, some guy called Ade had posted a pic of an orange bike engined fury... Yours?

If you take me out for a spin I could do with trying to sit in the drivers seat to see if I fit in there... My hips were a little wide for the Striker I went to see, it has me worried I might be the wrong shape for a Fury.
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Quote:

I go through phases of feeling that best progress is not thinking about it (as you say, the brain still knows what to do) and analysing it (the brain still has a tendency to favour a ministry-of-silly-walks gait since the accident)...


That's me! The first time I walked at a semi human speed since the accident/op I was chatting away to a couple of friends. Hey presto, I wasn't trailing everyone by a mile. Try to impress the surgeon with my improved walk though, and I look like I've had an accident, or swallowed a broomstick. Interestingly though when I first did the pushing off with the toes in turn thing, I practiced it slowly a couple of times in our sitting room.. and then the body just got into it. I sometimes have to remind myself, but pretty rarely.

That's not to say I'm there yet by any means. I found it so unhelpful when rehab protocols talked about "walking with normal gait by 6 weeks" or whatever. It made me feel like I should be sent to remedial class! Then I read people's blogs saying things like "my gait isn't 100% right at 20 weeks" and I felt a whole lot better.

We'll both get there! You before me, at the rate you're progressing! Very Happy
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BorntoRun wrote:
That's me! The first time I walked at a semi human speed since the accident/op I was chatting away to a couple of friends. Hey presto, I wasn't trailing everyone by a mile. Try to impress the surgeon with my improved walk though, and I look like I've had an accident, or swallowed a broomstick.


Yep, that sounds vaguely familiar Laughing

BorntoRun wrote:
...rehab protocols talked about "walking with normal gait by 6 weeks" or whatever...


They also said it'd be weight bearing immediately after the op... Bloody liars:D
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Anyway, snowHeads is much more fun if you do.
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weight bearing immediately after the op


Ha! If I'd tried that straight after the op, the floor would have borne my weight right away!
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@BorntoRun, Same:D
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