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No ACL and doing fine?

 Poster: A snowHead
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I agree with @Weathercam, I do not see the Mojo as a brace. Perhaps it helps some knee problems by reducing some strain upon the knee or effort required in or through the leg muscles, but to my mind it's an entirely different device for different purposes.
Braces are, supposedly, specifically designed to give support or protection or prevention of certain movements (e.g. lateral twist, hyperextension) needed for different injuries or disabilities: ACL, LCL, MCL, PCL (and combinations thereof), OA, other knee pain or structural problems.
Donjoy are just one brace manufacturer/supplier, albeit a well-known one. They have a vast range for different needs and different grades of support or protection needed, some simple designs, some quite complex and adjustable in many ways. I would not describe the braces as "simpler" as you do: differing in design due to purpose.

It would be interesting if there was a full knee support/protection brace which also provided real support and relief for struggling and easily-tiring leg muscles (associated with knee problems perhaps, although there are other conditions where this is an issue), but we're effectively moving into the realms of personalised assistive equipment for disabled skiers. Of course, depending on how it affects you, I suppose without certain knee ligaments, someone can be classed as disabled to some degree or other; but not really a discussion or need really relevant to this thread, perhaps.
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Obviously A snowHead isn't a real person
Someone on one of the threads asked how my knees were getting on, so an update (1 year and 7 months now).
I think we have settled into a pattern: I take them for a long walk on rough or very hard terrain, I do lots of low knee bend exercise or I do reasonably aggressive or skiddy skiing (spent yesterday doing lots of short turns in a dome) and use drag lifts and something consistently hurts on the outside, joint line, of the knee. No one can tell me what it is. Skiing, and some dancing I found, sets off the right one most, the left might join in the next day a bit. Walking sets off both equally. There's some stiffness to fully flex the knee or kneel, some associated pain and annoying deep muscle type pains above and below the joint line area.
Start feeling some of this discomfort several hours into skiing, so am still respecting what the body's telling me, but I think I'm slowly building up time and strength: not able to get to a gym so my exercise is just everyday activities, a bit of countryside walking and some squats, lunges, static cycle and hammy exercises at home, when I find the time in a non-routine life at present.
The left knee has adopted some kind of delayed post exercise restless leg, deep outer foot, calf and thigh ache and constant tight feeling behind and above the knee.
Have developed an extra sensitivity to uneven surfaces, even just inside on old floors, although the balance seems good; still a bit cautious walking on slippery mud, ice etc - but getting less so I hope.
We live with it, hope it doesn't get worse, hope it'll get better. Still feel protective of them, but slowly gaining confidence that my knees can be used as normal and as before, except my muscles tire more easily and have this highly annoying itchy deep ache come pain. They will continue to be punished for it until one of us gives in and returns fully to whatever acceptable normal might be. Functionally, fingers crossed, they're OK: though I still have fully to convince myself of that sometimes and am always worried if they're not. But, hey ho, the damage was done and that's that. We are where we are. Bit more wear and tear maybe, and maybe developing a bit sooner than it should be.

P.S. conclusion (maybe bar the delayed muscle aches): if I was a better and smoother technical skier, and a bit stronger and fitter, I don't think that I'd hurt as much Confused It's proving to be a bit of a literal strain trying to get there.
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Well, the person's real but it's just a made up name, see?
@Grizzler, You can only do what you can do within the realms of daily life, if you can do single leg body weight exercises then that is really good.
IM 8.5 months post accident, and working hard in the gym and also hiking a fair bit, there is not a day where my knee doesn't feel like it is in a vice being gripped firmly all around, Im back on naproxen as I have started to swell up a lot above the knee (before swelling was minimal but was below the kneecap, its swapped round now?) It would fall on the scale of moderate effusion (comparing it to the amount of swelling expressed by the consultant months ago).
But getting stronger week by week and hope to be in the chlilfactore for some tentative turns next month perhaps, gulp!
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@Markhandford, sounds good progress - but maybe, just maybe, are you overdoing it a bit? Not sure that it should really be swelling and hurting quite as much as you describe. Inflammation don't do its insides (nor their future prognosis) any good at all Sad
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Well today after 9 months and 13 days I have banished some demons from my head.

On the basis that my injured leg has now regained muscular mass and my knee does not need loosing up before exercise I decided to hit the indoor ski slope at Xscape Castleford. I have bought an Ossur CTi brace along with a leg sleeve which seems like a big comforter but for now a safety net. It is very slim fitting and hardly shows beneath my ski pants. So armed my new bit of kit I boarded the button lift to the top of the slope. Guess what? I skied like my old self with no hint of any problem which was something of a relief. At the end of the session I was linking short turns down a narrow strip at the side of the piste.

No noticeable discomfort or instability during or after session so feeling pretty chipper. Very Happy

My next question is at what point does one consider the use of a brace not necessary or will it be obvious? To be honest I did not notice wearing it which was also a surprise.

It seems a long journey coupled with lots of very interesting and informative threads to this topic. Thanks to everybody who has contributed, it does help to realise you are not the only one. Good luck to all who are on the treading the path to recovery, ACL or not.
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@ttrucwy, Brilliant to hear and well done you!
To allow me to compare legs! When you say regained muscular mass, does that mean your injured leg sizes are now the same as your good leg?
My injured leg is 1/4 less in the calf than my good leg, above the knee is 1/8 less and the thigh is a good inch difference.

I have just been discussing leg braces with my physio, mainly because my leg strength is still weak in the quads.
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Guys on here who are thinking about do I / don't I for braces this coming season, there's a simple way of finding out before you go skiing this season.

Get yourself up the top of a decent hill with a gnarly descent of a single track and then run down it, better if muddy & slippery and see how your confidence is as you descend.

If you're not totally committed and lack in confidence you might as well go with a brace.

As for leg size differential my thigh / quad on the leg (left) I had my hamstring taken and the reconstructed ACL from is still a good inch less and that after five or so years.

I am right footed and don't know if that makes a difference, but I do shed loads of cycling etc and just think at my age I can't build muscle back up rolling eyes
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After all it is free Go on u know u want to!
@Weathercam, Im hiking up and down mountains OK, but know for a fact that I can't run on the flat, let alone down hill, the impact makes my knee swell up massively, everyone Knee is different, the thread title is 'No' ACL and doing fine?

My muscle gains - ruptured quadriceps has been steady:
Left calf 15 1/2
Left Leg leg above knee 16 1/2
Left leg mid thigh 21

Right calf 15 3/4
Right leg above knee 16 1/2
Right leg mid thigh 22

Gains after 3 months
Left calf 1/4”
Left Leg leg above knee 1/4”
Left leg mid thigh 3/4”

Right calf 1/4”
Right leg above knee 1/4”
Right leg mid thigh 3/8”

So just one inch less on my ruptured muscle after 3 months of gym and bike. Strength is still a way off for my quads though, 5 steps forward and 2 back seems to be the norm at the moment.
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@ttrucwy, Excellent news Very Happy

@Weathercam, I don't think that my preparedness to run full pelt down a muddy steep track has anything to do with my need for a brace at all. Might say a lot about how prepared I am to fall over and hurt myself, knee or otherwise - but that isn't what an ACL brace is for, which is to stop your lower leg bone going forward because nothing's holding it on any more (i.e. to prevent 'instability'). Secondary functions are to provide other kinds of stability and maybe to relieve some strain, pressure and try to prevent some kinds of injury if you fall (maybe?). It shouldn't really compensate for lack of muscle strength, balance or proprioception, nor assist with pain relief or other soft tissue or joint issues. A simple neoprene support might give some confidence and minor overall support in your test, and certainly might assist with confidence.
For me, at least, not therefore really a viable test - though carrying or after a knee injury I will certainly agree that it is psychologically a challenge, physically sometimes, and I would not take on such an activity with anywhere near as much relish and gay abandon as I would have done 2 years ago Sad
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And trust a bunch of blokes to have a 'mine's bigger (or smaller) than yours' session Laughing

Somewhere back in my bored rehab phase, I have come across research indicating that you'll never get 100% strength or equal muscle size back. Sorry fellas. Tried Brazilian Quad Therapy Injections..? (Or more pizza?)
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@Grizzler, lots of wise words and very accurate comment. Bigger or smaller, well I have stared at my legs for so long it could be deemed not good for me or suffering from a bout narcissism but they now look the same. They didn’t and did not perform or feel the same. Nor would I run down a steep muddy track, ever, period.
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And love to help out and answer questions and of course, read each other's snow reports.
@Grizzler, good points, at the end of the day it's all about confidence in your leg, and doing "fine".

And to gain that confidence is all about how much prehab / rehab pre / post op / pre accident is done which in turn can often be determined, for want of a better word as to how "sporty" you are / were.

I know of more than a few people who were good Cafe piste skiers, but that was pretty well the nearest they came to sport they did in any one year, and on having done an ACL they never made it back on to the piste, for a number of reasons, but confidence in their leg not doing it again is probably the major fear, and totally understandable especially if they have not done enough work before and after the op.

My daughter sort of falls in the above camp, though she does still ski but always with a brace, four years on, and still on hikes when it comes to walking down a steep mountain path she has no confidence in her leg at all!

Post Op she really only played at exercises, as pre doing her ACL she never really exercised, so there's probably no real differential in legs as she never had built up any muscle Puzzled

And @ttrucwy, you say you would not run down a steep muddy track, well it's not far off having to walk around an icy ski resort in the depths of a cold winter to get to and from a bar in most places, as @Markhandford, will find out* Toofy Grin

* steep road at 17% for 250m
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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
Weathercam wrote:
... a steep muddy track [is] not far off having to walk around an icy ski resort in the depths of a cold winter ...

Or up or around anywhere, UK or not, in snow, ice, mud or just on slippery or 'polished' rock - never mind in stiff ski or mountaineering boots.
I think that one's perception of risk and outcome simply changes. I can't say if my actual ability to walk (or run) on said surfaces changed - although thinking about it now, there was at first a physical restriction component, caused by muscle stiffness and knee swelling - but my attitude towards them very much did. I put that down purely to not wanting to go through the pain and reduced mobility again, nor wanting to incur further injury. i.e. I simply did not want to fall.
Like all types of traumatic injury it takes time both to recover physically and to feel comfortable back on the horse, and some people will become more cautious than others, and some will stay more cautious. Big strong muscles help, but they're not the only factor by far. Research shows that a good proportion elite sports people with ACL injuries never return to their old levels. General thinking is that it's not necessarily or solely anything to do with their strength, rehab, prior activity levels, bracing protocols or surgical success.
Me, I'm a big wuss now. Not only on snow, but on my motorbike, walking on slippery descents (out come the walking poles these days): anything where it could hurt a lot if it all went wrong. Getting a bit less wussy as time goes on and I do more things successfully - but I ain't getting any younger, and everything aches and hurts more now, so I'll gracefully (bllx!) accept my compromises if I can still get my enjoyment without any more injuries or pain. No guarantees, of course, always some risk of something. But taking a bit more care isn't always a bad thing.
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 You know it makes sense.
You know it makes sense.
There seem to be quite a few people who, post ACL op (or no op), mention the swelling that occurs after your first ski trip back to the slopes. Out of curiosity, did those people experience swelling biking, running, lifting weights prior to skiing? I never have swelling issues... trying to understand if swelling is a given or if something like altitude impacts it (may be making that up)
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I have no ACL in left knee, last season skied with a brace and I got a bit of swelling below the knee, I think this was possibly down to the tightness of the brace as I don't get swelling when I am MTB or riding my dirtbike.

Have been doing a lot of MTB since the season ended, hiking bikes up steep hills and descending steep technical trails and fast riding and get no swelling, don't wear a brace when on the bike.

Just did three days of MTB in a row and my knee is feeling great, the more I keep it moving the better.
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@ItaloSkier, swelling is, to me, a sign of overdoing it and internal irritation, and I get mild general swelling or a bit around specific areas, usually lateral joint line, if there's pain following overdoing it. That would be hiking, mountaineering, skiing, boarding, heavy manual work/gardening....
But fingers crossed it's diminished or gone away as I've done more, skiing and otherwise, and the knee and other bits have continued rehabbing.
It probably depends on what other traumatic injuries and lasting damage is in the knee too to cause the underlying irritation and resulting or related swelling (the exact causes of and different types of I really can't recall at this time of night, but there are differences). So it might not be ACL or graft but, say, meniscus, OA, cartilage, etc etc.
Altitude could be a factor too.
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@ItaloSkier My knee has been constantly swollen for the past, 2 months, with 3 weeks being very restrictive movement due to swelling, it settled a little after RICE and no gym work for 10 days, but as soon as I want back to the gym it swelled up again, Physio says it can only go one of 2 ways; stop all rehab until all swelling completely gone, or work through the pain and swelling; I tried the later and it hasn't worked, 3 weeks back on naproxen and omeprazole, aircast cryocuff and the odd dose of paracetamol and the swelling hasn't gone down at all.

Saw my GP, as I have been signed off by consultant for some months now, GP mentioned arthroscopy, the slight meniscus tear I have, and that I guess I don't want it at the moment with the upcoming winter season.

I remember a time in the lovely summer where I had no swelling, lots of mobility and could nearly pull my heel on to my buttock while standing and things seemed to be going great.
I tried to do a bit of limping jogging- that made things worse, then a NHS physio review where I did lots of running on the spot with dabbing out to the sides -even though I said this hurt me, which was ignored- then even more swelling after that, so running no good for me.
Range of movement last week was at 135 degrees, so I have lost 4 degrees and my VMO is struggling to stay switched on as any exercise seems to make my knee swell up, most of this is above the knee cap, but it has now started to track around the lateral side and to the bottom of the knee cap laterally.

On the positive side, my functional strength for skiing may be OK, just, but another review with physio week after next to see how the change in rehab exercises has worked or not.
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@Markhandford, sorry it's not going so great Sad
I was told by one physio I saw that it only takes about a teaspoon of internal joint fluid (?) to switch off the VMO; not an amount which even gives visible swelling. There's also different types, causes and sources of swelling. When I first got back to skiing it really upset my outer knee on one leg, though I wasn't supposed to have had any injury there (but had pain and problems, especially lateral hopping, twisting etc since starting rehab). That, after skiing, seemed related to swelling and stiffness in that knee, although it could have been coincidental as I can now get said pains post exercise in both outer knees with no noticeable swelling. Might be muscular or neural, certainly irritates them, not noticeably VMO though. An NHS physio muttered "wear and tear" and maybe meniscus, but not ever diagnosed as having injured the latter on either leg: but certainly didn't have these pains pre accident either.
Hey ho rolling eyes

P.S. I blame it on the weather at the moment. My left knee has gone into super cranky, catchy creaky kneecap mode and developed lateral and medial joint line pains. Maybe it's lack of exercise (weather's been shi*e up here) or too many low squats or... Nah, it's the weather...
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@Grizzler,

I woke up last Friday morning with a knee that 70% of the swelling had disappeared overnight and the joint was gliding super smooth and no clicking!
I guess this must mean something has settled back in to the right place overnight. So back to hiking and gym work to find a bit of strength loss but nothing that can't be worked.
After a few days the clicking knee is intermittent, it might do it when going up stairs or it might not. No more leg extensions though as that may have been a factor, and no running either.
Im going back to see a local physio tonight, they did a lot of work with me post accident and got the rehab really going, I booked with them as the swelling was so bad last week, but even though it has mysteriously rapidly gone away Im still seeing them.
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@Markhandford, I noticed your reference to leg extensions. My physio strictly forbade any weight loading work with this type of exercise, ever. He said that with no ACL there is nothing to stop the knee joint moving apart and potentially more causing damage. There are lots of other alternative types of exercises to get the same effect.
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@Markhandford, Toofy Grin Toofy Grin
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Leg extensions is an exercises I have avoided, quite literally, for decades. Bad bad bad for the knees. If you want to work on the quads, look at barbell hack squats (more effective than machine hack squats), goblet squats, lunges... maybe step ups.

Even on my hardest workout days, while I may feel some pain later on, I have yet to deal with swelling. All this gives hope but have no idea what it will mean once I have skis on.
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ttrucwy wrote:
@Markhandford, I noticed your reference to leg extensions. My physio strictly forbade any weight loading work with this type of exercise, ever. He said that with no ACL there is nothing to stop the knee joint moving apart and potentially more causing damage. There are lots of other alternative types of exercises to get the same effect.

Maybe it is a bad exercise, but it replicates what you do in skiing.
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Leg extensions as in sitting down and having a weight across your outstretched, in mid air, feet are 'open chain'. ACL-less people and those with ACL damage or surgery are advised to avoid these as there is a risk of the lower leg bones moving more than normal relative to the knee structure ( there being no ACL to hold it in place). My physio said be careful with, certainly until sure my muscles are very strong, and even then...???
Closed chain exercises are where your feet are in contact with and pushing against something like the floor, walls, pedals etc. Closed chain exercises are what's recommended for us 'anACLers'. So squats, lunges, step ups and downs, 1-legged versions, leg press machines (probably, watch angles), cycling, etc.
How far you flex the knee is another argument: my physio had no problems with going right down, my knees sometimes do and sometimes don't have a problem, but some people with OA or meniscus or cartilage damage probably would (surgical rehab I know nothing of).
Leg extensions just via clenching the VMO are OK, apparently, and good practice.
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Hit a personal bechmark today... ACL-less leg, able to now go through pistol squat sets and today managed three nice and quite low pistols with almost no pain. Very happy.
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@ItaloSkier, yay! Very Happy
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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.
@ItaloSkier, brilliant and well done, time to get those skis serviced.
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Some of you may be following one thread or another, So thought I would just update those on this thread;

No ACL and doing fine?

Yes doing fine snowHead


It's nearly 11 months since acl,mcl,lcl, double ruptured quads and fractured tibial plateau and condile.
Strength and size wise there is still a long way to go for the quads on my injured side (hamstrings are super strong).

But yesterday was the first time back on artificial snow, and having brilliant ski coaching from @andanotherthing.dot.dot I finished a 3.5hr session with my mental demons conquered, back on the horse so to speak and with some coaching words firmly embedded in my brain.

Please don't give any critique on ski style or technical inconsistencies, as the purpose for sharing the vid, is to give folks a giggle at some poor skiing and to show that "You will recover from your ACL injury/surgery and you will ski again".

https://photos.app.goo.gl/QnrLRVWwFVq4Fp2u5
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@Markhandford, Very Happy snowHead Very Happy
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@Markhandford, fantastico! Very Happy
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@Markhandford,

Have you tried Kaatsu/BFR training?
My NHS physio has been trialing it.

I use an Occlusion Cuff & a Neuotrac Sports+ tens machine

Pump up the cuff. Set my Tens Machine program on & just sit there watching TV while technology does all the work.
I also do light work with it, but nothing weight based or lifting or hard/heavy pressure on the joint.
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@Mr.Egg, Hi, no I haven’t used either of those, it’s great if it’s working for you Smile I will have a read though.
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Wow Mark... all that (ACL, MCL, LCL, etc. etc.) and you look great! Phenomenal!!! Congratulations.
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Markhandford wrote:
@Mr.Egg, Hi, no I haven’t used either of those, it’s great if it’s working for you Smile I will have a read though.


Its worth a look at for non impact training.
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@Markhandford, I second the vascular occlusion training. I did it early post ACLr when I couldn’t use any weights. The idea is that the blood flow restriction builds up the fast twitch muscle fibres without stressing the joint. They normally only kick in at high weight loads, but with the lack of oxygen they do so straight away. Mine was a very simple version. I used a blood pressure cuff on the op leg thigh at the setting recommended by the physio, and did body weight squats and split squats. For the first few you think it’s a doddle, but a few more in and you quickly change your mind Toofy Grin
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