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The snowHeads ACL rehab club !

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It would probably cost more than the foam roller! Very Happy Very Happy Very Happy
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Hi all, I snapped my ACL and MCL in April 2017, and had remedial surgery in August of that year. I didn't ski last season - I was lax in my early physio, and I think it would have been too soon.

My physio has been patchy at best. I have many excuses - job being nuts, a house renovation and a new baby - but frankly I have not done as much as I should have done However, I have been active, from cycling a bit to doing plenty of stuff around the house etc, including plenty of work on the house and work in the garden. I don't really think about the knee any more except for when it feels a bit sore, usually after sitting at my desk for too long rather than after physical activity.

In physio, I am happily pressing 90kgs one-legged for 5-6 reps, and lighter weights for more reps, but the good leg can do more reps. I can use a wobble board, mini trampoline etc. I can run - but my problem is more cardio fitness than the knee. I can use a cross trainer, rowing machine or cycle fine for a decent length of time. I can do box jumps, but one-legged ones only to a low level, and I feel a bit unsteady still when doing those.

The big issue that remains is that my hamstring, from where the graft was taken, remains much weaker than the good leg, and fatigues easily, even cramps sometimes. I am working on this with hamstring curls. My good quad is a bit bigger than my bad one, but they are at the same max strength, almost.

Today, I went to the Wimbledon Clinic to get a leg brace fitted. A wallet-lightening experience, but also a confidence builder as I was told that whilst there is a leg imbalance, many people go back to skiing far less strong than I am. So I will wear the brace, take it easy, and build myself back up on the slopes.

I am lucky - I am taking a career break and heading out with the family for the whole season, so I should be able to do little and often for while, and hopefully build my strength and confidence back up (the latter is a big one). I used to be an expert skiier, and have to accept that I just won't be back to that standard for a while!

Anyway, I just wanted to wish you all the best of luck, as I know how hard and painful this all is. I shall report from the slopes to let you know how this is going, what works, what doesn't, and how I feel. I hope it helps.
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@Harry Flashman, thank you! It does help to hear you’re doing so well, and have been cleared to ski. I’ve hit a bit of a low patch mentally - I’m at 6 months and the knee has rebelled on me properly for the first time since I started rehab. The good news is that it’s muscular according to my physio, so it will pass. But it’s so dispiriting when it’s suddenly as sore to walk as it was at 2 months. The words “I barely think about my knee” are music to my ears!
In turn I can offer some consolation (I hope) that both my physio and surgeon say it’s perfectly normal to struggle with the hamstrings for a while. My surgeon said the graft site can take up to two years until it heals completely. The physio said there always tends to be a bit of a deficiency there vs the other leg, but functionally it shouldn’t make a difference with good conditioning. Keep up those curls and you’ll get there.
You’ll be amused to hear my current issues are also caused by the hamstring. The calf and adductor have had enough of doing all the work for it and have had a wobbly - and don’t i know it! The sooner it passes the happier I’ll be. I’ve got Nordic hamstring curls to do for that... And yes, even before this episode my hamstring did cramp if it was unhappy/fed up/or just because, you know, it’s a Tuesday. Onwards and upwards though, we’ll get there!
Very best of luck with the extended skiing break - do keep us updated. Nothing like hearing from someone who’s been there, done that, got the T shirt.
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@Harry Flashman, Good to hear your story so far... Let us know how you get on!
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Thanks guys. I too had a knee rebelling period - I got ill last November and the joint got infected: we only just caught it with drugs: nearly got to the open it up and clean it out surgically stage *shudder. I was back on crutches and it was all horrible. But it does get better again so chin up!

I hope the knee holds ok on the slopes. My instinct is that there will be some pain and frustration, and that patience will be needed! I'll definitely update the thread so hopefully you can learn from my inevitable mistakes and hopeful triumphs!
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@Harry Flashman, yikes! That’s tough. What caused your infection??
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** Very ** early days but -

https://3dprintingindustry.com/news/university-of-utah-develops-3d-bioprinting-for-ligaments-and-tendons-141804/
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BorntoRun wrote:
@Harry Flashman, yikes! That’s tough. What caused your infection??


Basically the flu knocked out my immune system and I got a bacterial infection in the graft. It was bloody painful but a day on drip antibiotics and then a course of pills sorted it. Put me back a few months though - would have knocked out my ski season, but I had already been told I wouldn't make it. Occupied myself with a full house renovation instead!
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Harry Flashman wrote:
Occupied myself with a full house renovation instead!

There's always a positive side Toofy Grin
Actually, having done a large house move and somewhat strenuous house/garden 'improvements' myself over the last year, it's not a bad way to get a lot of knee-related things exercised, stretched, over-tired, irritated, trained, stiffened, strengthened and generally gotten used to working and moving in their normal ways again. Not the most stress-free way; but cheaper than the gym.
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@Harry Flashman, @Grizzler, good news for my rehab then, as we're finally hoping to put our flat on the market pretty soon...
@AndAnotherThing.., I fervently hope not to need it again, but wouldn't it be amazing?
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@jjams82, looks like it's not just my rehab I keep exciting. You know how falling in the bath is Room 101 for most ACLr patients? We've got a bath board across our bath to make our over-the-bath shower ACL safe. Which it did, until, loosened up over the last six months, it slid right from under me this morning! I landed bang on my bottom (ouch!) and the legs, which didn't have much weight on them anyway, slid painlessly and seamlessly forward with the bath mat... Rationally I was pretty sure I couldn't have done anything to the graft that way - there wasn't any twisting, any hyper-extension, it barely had any weight on it, and I didn't feel anything at all in the knee, not even a twinge, either during or after. But I still made my way pronto to the physio's office, all a gibbering wreck! All well, thankfully. I feel like I've dodged a massive bullet, and that bath board is going right in the bin. I don't think I want a replacement either. May be a stupid idea, but I'm more inclined to trust my own two legs at this point!
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@BorntoRun, Yes. Lots of interesting research at the moment but the bit I'm struggling to understand is how to implant the new tissue growth into place, say in the case of soft tissue grown to ease Osteoarthritis.
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@AndAnotherThing.., good question! For the ACL, I wonder if they’d try to “stitch it” along with the old one- a bit like the “internal brace” but with your own tissue? But if I understand correctly, the “internal brace” relies on the old ACL regenerating. And I’m not sure if it’s widely accepted in the medical community that it does, or at least not for everyone. I may be talking gibberish here mind you!
Ideally you’d think they’d want to avoid drilling into the bone, which causes so much trauma in the joint...
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 You know it makes sense.
You know it makes sense.
@AndAnotherThing.., thinking of it, if it was just a question of stitching the new ligament with the old one, they could surely do that now with the hamstring/patella/donor graft?

And, resulting trauma aside, anchoring it into the bone as they do now doesn't address the fact that the implant is then just an approximation of what a "real" ACL is like, in terms of placement, etc.

So I'm stumped! Very Happy
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Same - I'd imagine that perhaps some sort of injected stem cell therapy must be in research. As you say the mechanics of implanting regrown soft tissues between bones seems a tough one.
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@BorntoRun, Christ, you muppet... Sounds scary!

I'm surprised you needed the bath platform to begin with, come on now, rule 5Very Happy
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Obviously A snowHead isn't a real person
Very Happy Very Happy Would that be “put your big girl pants on, BtR”? If so, good point well made! Toofy Grin
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Well, the person's real but it's just a made up name, see?
Words to that effect:D
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@BorntoRun, Do not, repeat not, use decent hair conditioner anywhere near the bath or shower without a thorough scrub down afterwards. I didn't need a bathboard Laughing
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@Grizzler, wise words! Or bath oil... Lucky I don't like baths anyway.
To be fair, the bath board was more for the early days when maneuvering me over and into the bath was like trying to steer the Titanic away from the iceberg. Ouch, ouch ouch yelled the hamstring graft. It also helped with keeping dressings away from the shower and dry. And then I got lazy, because who doesn't like to sit blissfully and for far too long under the hot water, given a chance? Well, not me anymore! Very Happy

@jjams82, I'll repeat that to myself as I try running again this Saturday. How's the knee treating you?
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Six months and three weeks in, and I had a check up with my surgeon today- turns out it's the last one, if all goes well (fingers crossed). The graft is there and feels solid, which is always a relief, and I was able to prove my physio compliance creds with some seriously ouchy DOMS when he was testing my leg. So I've been sent on my way, on the condition that I continue to work hard at the rehab and do as the physio tells me. Though he did add that I shouldn't really ever stop doing the weights, even post "official rehab" Toofy Grin

So back to the gym I go then. My programme has changed a bit again, and it's now two mega sessions a week (body pump class followed by half an hour more torture by Nordic hamstring curls, split squats, TRX hamstring bridges, leg press and one-legged Romanian dead lifts). Then two days of very very light rehab- bridges, calf raises, supermen that kind of thing. Also two days of the walk-running- or bike if the knee is not cooperating. I'm still a complete weedy weakling though, DOMS notwithstanding. My goal from the physio was to get to 55kgs, my body weight, on leg presses overloading the op leg by next week. I nearly strained my other knee pushing up with 37.5kgs today, so it's safe to say I WON'T be at 55 by Wednesday, unless I turn into the Incredible Hulk overnight. Right now, that sounds like a worthwhile trade off Very Happy At least I'm not too far off my pre injury weight on squats at pump (now 2x 7.5s on the bar, previously 2x 8.5). Much work still to do though.

Symptoms wise, there's the occasional discomfort on the front/medial side pushing up from a squat, but it comes and goes. I had it squatting on Tuesday, but not today. Other than that and the occasional funny nerve sensations in the numb patch, nothing too bad. I can still feel the hamstring walking (apparently it can take up to two years for some people before that goes away), and there's a painless click going from bent to straight - though that's beginning to go away a bit. And it still gives me a general tired/irritable feeling at times after a heavy rehab session- like today.

So there we are - back to the grindstone, and onwards and upwards. Hope everyone is doing well fighting the good knee fight!
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@BorntoRun, Well done! Super positive update.
For what its worth, I got to bodyweight one leg, leg press and then my knee really swelled up and my VMO did what is does when swelling occurs - it switched off. I also still get annoying, not not painful, knee clicking (9 months after injury). I found that 3 sessions a week was good up to a point, then as I got close to full bodyweight single leg stuff, I needed to get 4 days rest instead of 1!

Sounds like you are well and truly on the road back to skiing Smile
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@Markhandford, thank you for the encouraging words, truly appreciated! And a very helpful warning for me to heed about not over training . I also fear the dreaded swelling/VMO shutdown, so I've well and truly taken that on board. Granted, though I'm overloading the op leg on the leg press, I still have the other leg on the press contributing a bit. So I think my 37.5kgs has to be taken with a big pinch of salt! Better to go slow and steady though than over reach, so that's what I'll aim to do.

How's your knee coming along? Hopefully still feeling good? I do look at the thread about rehabbing without an ACL as well, so I've watched your progress with interest. Your last few posts sounded like very positive news Madeye-Smiley
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@BorntoRun, Wheeey, you're doing pretty good there! Glad to hear it:D

I'd forgot about this thread for a while... Probably a good sign eh! I realised recently (around 4 months from the op) that I'm now doing everything I used to do as far as work and daily life stuff goes, just some of the more iffy stuff a little carefully still!

Today was the first time since the op I'd been in a confined space with multiple cattle, pregnancy testing a group of them. A bit scary pushing them into pens trying not to get knee-kicked or squashed against a wall, and I didn't jump in between a gang of them and ram them about like I used to, but it felt good to safely complete a morning of probably the most knee-sketchy work situation without incident.
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@BorntoRun, to make sure I don’t do weights unequally on my legs, ever since my recon I have done leg press and other leg exercises in each leg individually. Making sure I am on the same weight for each leg.
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@jjams82, delighted to see you're still the superman of ACL recovery! That's a fire test - or cow test? Too bad they can't all be issued with their own Clearblue and instructions for use
Seriously, it sounds like your recovery is going very well indeed. I think not thinking about it is the big goal, and it sounds like you're pretty much there. Sounds like you'll get to keep that ticket to the Italy bash Cool Cool Cool
As for me, the physio did tell me the knee had a few more tricks up its sleeve and he was proved right (yet again) sooner than I thought. On and off medial pain squatting, a sore hammie, lateral aches, and a lovely, crampy ache across the knee after running, this week I had it all. On and off, a mixture of the above, and sometimes all at once. Also an IT band tight as concrete. A long and winding road this one, when you're a bit naturally muscle challenged like me. As soon as you're onto a ladder, there's a snake lurking round the corner. It's physio day today and my bet is he'll say the quad and hammie aren't there yet (they're not) and need more strengthening work (they do). Onwards and upwards onto the leg press!
@NickyJ, thank you, I think you make a very good point. Most of my rehab exercises (not the body pump class of course) are one legged - the single leg dead lifts, the single leg hammie bridges, the lunges, the singe leg calf raises etc. The two legged leg press overloading the op leg I think was meant just as a transition into single leg press. I'll ask the physio today if I'm moving onto that. I fear that in my attempt to overload the op leg I'm doing the presses badly, and possibly straining the other knee. And of course you can never be sure how much you're compensating with the "good leg" in double leg exercises, as you say. I do catch myself doing that with squats sometimes, and have to make a conscious effort to distribute my weight evenly...
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My major remaining problem appears to be the donor hamstring. Time to up my game on the exercise!
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My hamstrings (or something similar) in 1 leg still seem to be a problem, stiff and irritable - and I didn't even donate any!
Still, if they're holding the knee together, I can't complain (too much).
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You know it makes sense.
@Harry Flashman, in what way does it bother you? And what exercises do you do for it if you don’t mind me asking?
The donor hamstrings (two in my case unfortunately) have also been the bane of my recovery to date. My surgeon says they can take up to two years to stop being a bother, so it sounds like what you’re experiencing is not unusual - if that offers any reassurance. My physio says on testing vs the other leg, the donor hamstring will always be a bit weaker. But on the bright side, he says if you keep in good shape it shouldn’t affect function after recovery.
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@Grizzler, I feel your pain! Think our hamstrings are pretty similar, and I remember you have valgus knee as well.

Do your hamstrings ever cause you back pain? Even pre injury I used to get episodes every 6-12 months where they’d tighten up and pull the back in the wrong direction, especially on the right side. Which is incidentally where I always pronated more, and had more pronounced valgus knee. Coincidence that I then tore the right ACL?? I know it’s different for you on that, as your ACLs didn’t stand much of a chance once someone ploughed into you...
Well, inevitably the back joined the party this week and has been stuck in a spasm... The knee didn’t even get a look in at the last physio session, it was all dry needling, taping, massaging, stretching and coaxing the back into relaxing. So frustrating to have to take it easy on the weights rehab as well, just as it was progressing nicely. And not even because of the knee!
Hey ho, mustn’t grumble (yeah right Toofy Grin Toofy Grin !)
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@BorntoRun, Every muscle which I own is an expert in chronic pain and spasm, unfortunately.
I certainly can suffer with back issues, but never associated it with knees or hammies - though everything's connected, certainly via the posterior.
My last massage session also was more Lats Dorsi and less legs: she said I was standing as if 1 leg longer than the other because of this.
My 'valgus' knee (both prone to it because of foot pronation) is more the right one (something slightly odd in the bone, ankle or foot bone alignment, some say, though I can correct it with orthotics and training the inner thigh muscles); the irritated leg remains the left one.
Was interesting when I went to a Warren Smith biomechanics evening recently to find that I have good hip rotation in the right and very little in the left. Whether that's the back muscles or what, I don't know: but I thought that both were good. Been trying to coax more rotation, but that pulls on the outer knee. Really ought to go and find a suitable physio and ask them about it...
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@Grizzler, I'm told the hamstring-lower back connection is a classic, so maybe worth looking into if your lower back is an issue. I was first diagnosed with tight and short hamstrings years ago by an NHS physio, when I went in for my painful lower back. Then my husband did his in this year, and it turned out to be the same issue. It's also a bit of a curse of desk-bound jobs, but guessing that's not your case. That said I'm not sure there's too much you can do beyond strengthening and stretching the hamstrings, which I bet you are doing anyway. I've found one legged Romanian deadlifts, Nordic curls and cobras really helpful with that but you're probably doing way more sophisticated stuff.
And definitely yes to strengthening inner thigh muscles for valgus knee. I've seen a marked, if pretty gradual, improvement there.
Interesting about the hip rotation. I thought mine was pretty good too, but the physio reckons my current spasm is also courtesy of grumbly hip flexors- as we've done a bit more work to build them up of late. It's improved the single leg deadlifts no end, but I could have done without the side effects Very Happy
And can I offer all my commiserations and sympathy for your muscle spasms. My back pain so far had been joints inflamed and irritated by being pulled in the wrong direction. This spasm business is a completely different kettle of fish. I don't think I've felt pain like the pain of having it massaged and needles going into it this week. Some pretty fruity language was heard all the way outside the consulting room! Physio also said regular NSAIDs won't help much, only muscle relaxants really do the trick. Typing with a hot water bottle behind my back right now...


Last edited by Obviously A snowHead isn't a real person on Thu 29-11-18 15:32; edited 1 time in total
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@Grizzler, I'd wholeheartedly recommend my physio, who's also a proper skier. But he's all the way in London...
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@BorntoRun, Sophisticated stuff ? Laughing Laughing Laughing As sophisticated as a bit of gardening, decorating and the odd walk at the moment. Trying for Nordics, but difficult to find anything at home to hook my feet under (the recliner armchairs kind of do it; kind of). Swiss ball curls as a mainstay (though they wreck my outer lower calves) and sofa bridges.

Your physio sounds great. Now if they only had a seriously-Northern branch... Loads of claimed runners' specialists up here, but struggling to find a physio who really inspires me with any confidence in what has now moved from rehab to chronic-cum-maintenance-cum fitness.

And re muscles, etc, I actually used to spend all day chained to chair, desk and then computer: hence why now have permanent pain and spasm problems, despite many many years of physios and every other kind of therapist I could get my paws on. My knees were the only still-decent bit of me left Crying or Very sad
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@Grizzler, my husband is on Nordics duty, so he can also keep my feet pointing inwards to make sure I use my inner (donor) hamstrings. The body tries to cheat out of that whenever it can, to protect them. Not one you have to worry about thankfully. I have to do the Nordics straight after my weights class together with the leg press, single dead lifts, split squats, etc. So the poor soul has to get up at 5am twice a week to go to the gym with me! I do worry that witnessing my rehab at close hand will put him off skiing forever. Much like the ski racer the other day who retired after watching his team mate break his leg!!

Quote:

they wreck my outer lower calves
Yes! I hate the calf raises in my rehab. No matter how many times I do them they don't get any easier, on either leg. I seem to spend half my life foam rolling my calves.

Quote:

hence why now have permanent pain and spasm problems
And who says skiing is bad for you?? It's the desks you've got to watch! Toofy Grin Toofy Grin


Last edited by Anyway, snowHeads is much more fun if you do. on Fri 30-11-18 10:43; edited 1 time in total
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@Grizzler, if you can improvise the equivalent of TRX straps at home, doing hamstring bridges with your feet in those is a good one. I think it's because the balancing part works the smaller muscles (that's my uneducated guess). I guess the single leg Romanian deadlifts also have a balancing element. You can do those with a heavy book instead of a weight if necessary.
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@BorntoRun, That's one dedicated super-hubby you have there!
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@Grizzler, I’m very lucky, and the poor man has put up with a lot since March. To say that I haven’t taken this injury particularly well - mentally- is a bit of an understatement! Embarassed Embarassed
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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, Glad I could help. snowHead snowHead
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