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The snowHeads ACL rehab club !

 Poster: A snowHead
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miranda, Laughing


The hospital just called, Appointment Friday 9.30 with the knee consultant and MRI results. Things are moving quickly. A little sharper discomfort this morning while moving although I'm guessing it due to the swelling decreasing and things getting closer together in the knee.
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AndAnotherThing.., brilliant, so glad things are moving quickly for you.
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AndAnotherThing.., if you're going for a private MRI then the cheapest (& best) place in our area is at Worksop Hopsital. The MRI unit (which is more like a hotel) is only a couple of years old & there's parking right outside. They're affilated to Doncaster Royal Infirmary so you book via Doncaster for the scan at Worksop were they have two early morning appointments each day (7.45 & 8.20am I think) before the NHS treatments start. Cost for a full lower back/abdomen scan was just under £230 & they sent a full report inc CD images to my specialist, my GP & me. Every other quote I got was double that & my specialist commented on the thoroughness of their report & the high quality of the images. You'll need to get a GP or specialist referral to get an appointment.
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spyderjon, Cheers for the tip.

I lucked out with a cancellation so the MRI was done yesterday just after my NHS appointment. Presumably the Knee surgeon will do the analysis before the appointment on Friday. The chap I saw yesterday suggested they would sit down and review it together before hand. Fingers crossed.

Pedantica, Thanks - hope I can stay lucky with this.
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AndAnotherThing.., best of luck tomorrow - will be looking out for your update.

Forgot to add another tip that I discovered yesterday and that for some reason they do not put on medical ACL rehab sites and they should, given that commitment to your physio schedule is vital to recovery:

Do your slow, boring quad exercises whilst listening to 'Eye of the Tiger' and possibly even doing a few shadowing boxing arm movements whilst you're at it - increases the amusement factor hugely.
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miranda, Cheers, I'll let you know how I get on.

I was going to go for a longer walk tonight but thought better of it. Would be a bit silly to get it swollen for the consultation ! Beer instead Toofy Grin
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Consultant this morning. Confirmed ACL according to the MRI plus some knee cap issues due to old age ! The view is that it was already weak due to an old injury.

Op likely for early May (mainly due to Easter Hols etc.) so 'Pre Hab' beckons. The main issue is muscle loss which would appear to be unusually rapid. Odd as I've been using it and have regained a full range of movement.

The first NHS fail may prove to be the physio. When I booked in they suggested an appointment would be maybe 2 weeks. Luckily we have a PFA footy rehab centre up the road so I've booked in to get some drills I can do at home.
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AndAnotherThing.., see what they say at the football place I guess, but I wonder how much effect those electrode things have - my French physio has my quads plugged into them (whilst I am simultaneously doing some small lifts) for the first half of my physio sessions (so about 20 mins), 3 times a week. I am obviously using the leg and exercising at home too so no idea whether they make the difference or not... but it might turn out that paying for a few extra sessions of private physio is worth it.

Early May is still a good timeline from injury to op on the NHS.
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AndAnotherThing..,
Quote:

The first NHS fail may prove to be the physio.

you may well be right there. I broke my kneecap about five years ago here in France, stairs not skiing, and went home with it in a full length brace which I had to keep on for about 7 weeks. When it was taken off finally and the doc asked me to bend the knee it wouldn't bend at all - oh you need physio, urgently, - he said and that was put in train. The urgent physio sessions finally appeared about 8 weeks later - but in the meantime I had been to see our private physio a few times and got the whole thing moving. Until I had seen someone I was a bit reluctant to move it very much as I didn't know what harm I could cause. Well worth it.
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Muscle loss is absolutely classis side effect of the ACL injury, according to my sugreon.

Also my surgeon refused to operate on my knee until I got the swelling down and full range of movement back. He said that if you don't get it back before the op you won't be able to afterwards. He certainly did a very good job of my ACL reconstruction and I was back to hockey 9months after surgery (OK that was training only and strictly no tackling but was still a huge acheivement).

On the private front, the local private hospital (BUPA one), did an ACL package which included the surgery, all physio and follow up consultations (from memory) for £2500. Which actually given the amount of physio I had afterwards (twice a week for the first 4-6 week, once a week for several months, then once a fortnights), was actually a very good package. Also the quality of phsyio was very very good and put the NHS physio I had prior to the surgery to absolute shame. She was basically looking up the injury exercises of the computer before hand and couldn't answer any of my questions. However the exercises did get my ROM back and the swelling down.

Although I did the surgery privately (shaved at least 6months of the waiting list), I stuck with the same consultant as I trusted him, he did seem to know what he was doing. IF you were in the Reading area, I would be highly recommending him, but it looks like you are Wales?
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A friend of mine did hers playing hockey, had the op 2 months later and was back playing hockey 9 months after the op - all done through the NHS. I had thought the fact that she had the op within a couple of months was because she is in fact an NHS surgeon herself (not knees) but AndAnotherThing.. seems to have been offered a similar timescale. I'm sure the NHS physio is absolutely fine, it just depends how often you can get it.
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NickyJ, £2.5k inc. physio seems a good deal. I worked out the possible cost of private physio and it came out at perhaps 1/2 that.

miranda, I have a suspicion that they do make a judgement based on lifestyle & work. I stressed I'm a Ski Instructor & Coach and that all my interests (hill walking \ climbing etc.) need a strong lower body. Also I have regained almost full range of movement already and swelling is almost gone so I suspect that made the decision a bit easier.

It aches today though !
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AndAnotherThing.., yes, my friend was back at work 4 weeks after the op so I did wonder if they had pushed her through more quickly for that reason! She spent the first 4 weeks post injury denying there was a problem despite the limp and not being able to go up stairs more than one at a time because she, er, didn't want to have an operation Confused (I imagine it is not uncommon for surgeons to feel this way about having someone else operate on them when they are used to being in charge). She has absolutely encouraged me to have to op though when I started wavering and looking at all the really active people I know who haven't had it. If I had been in the UK I would definitely have gone the NHS route (though I possibly would have topped up with private physio depending on how much I was offered). Everyone I know who's had the NHS op has been highly positive about the outcome. You sound like you have made extremely fast progress on the range of movement and swelling. Very Happy
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You know it makes sense.
With regard to the swelling \ range of movement I suspect that's it's partly due to the likelihood of an old injury rupturing rather than a completely fresh injury. However Samerberg Sue has been really helpful, encouraging me to do some light exercises and get some range of movement asap, which I started the day after the injury.

The thing I haven't done is any specific work with ice etc to reduce swelling but again, compared to a fresh injury I suspect that perhaps I didn't have so much to start with. The consultants explanation is that when the body repairs ligaments the new growth tends to be fibrous ad without much blood supply, so when they go there is less bleeding to cause swelling.

The consultant gave me a range of options including physio & see how it goes, which I confess was very tempting over an op. It's the prospect of the knee 'failing' and me causing more damage put me off and made me think the op was the way to go given my choice of sports.
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 Otherwise you'll just go on seeing the one name:
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AndAnotherThing.. wrote:

The consultant gave me a range of options including physio & see how it goes, which I confess was very tempting over an op. It's the prospect of the knee 'failing' and me causing more damage put me off and made me think the op was the way to go given my choice of sports.


Me too... choice of sports the same as yours and a very active job too. Still, the physio option is tempting particularly as I'm feeling quite good 8 weeks on and walking normally, not wearing a brace, and managing to work (albeit a lot more slowly at the moment than usual). But there is the possibility of delaying arthritis to consider really, as well as having to control the urge to run and jump and do all sorts of damage before my knee is ready, which is what is making me lean towards the op... I will make a definite decision this week as last guests leave at the end of the month. I'm 99% going for the op and I'm glad I've had time to think about the rehab and prepare and schedule for the whole thing rather than going straight into it.

For today's "work out" I think I'm going to channel Joe Simpson's fighting spirit and listen to some Boney M as I feel the burn with with those high octane heel slides wink
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miranda, Laughing just thinking of you while stuck in very big bouchon in Annecy. Hoping you weren't a patient at Clinique 'Argonay' wink
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Lou, Laughing no, off to the Clinique Generale this week to meet a surgeon that everyone round here is saying I should go to. Unfortunately I think this will be the point that my EHIC stops being of any use whatsoever... so there goes our delayed honeymoon savings. rolling eyes Oh well, they promise patients "confort hôtelier", so at least I'll get to enjoy the pampering and butler service of a posh hotel stay using the funds even if the OH doesn't Toofy Grin

Shame about the bouchon but what a beautiful day! Have a fab holiday x
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The op appointment came through, and it looks like it's going to be about 6 weeks from accident to op. I've also a pre-op appointment 10 days before that for tests etc.

NHS physio got in touch last week and I'm due to see them this week. I'm quite keen to build a relationship with them so that I can get the physio in place asap after the op.

So far the physio that my 'private lady' (!) has given me seems to be going OK. Swelling is almost gone, although still visible and range of movement is improving by the day. The exercise to get maximum straightness from the leg is quite painful but it appears to be making progress. That's the key area she's especially keen to sort out. The hardest thing is to balance the amount against causing more swelling.

Oddly (??) I'm not feeling any lateral instability but sometimes 'forward' stability feels iffy, say if I miss step.
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AndAnotherThing.., what particular exercise have you been given to straighten your leg? That's my biggest problem too at the moment - it's almost excruciatingly painful, although that might be the fractured bone. I have to work on it though.
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RachelQ, The specific exercise for this is to sit on the floor, legs flat in front, tense your quads (?) and straighten the leg. If you do this with your good leg first you'll see your heal will lift a few mm of the floor*. This is what you are after. When I tried for the first time I struggled, not through any restriction on range of movement, rather I'd sort of forgotten how to do it. To make it easier the physio rolled up a towel and popped it under the heal. Now I do 5 with the towel and 5 without.

The exercise sheets says
Quote:
"Lying back with your legs straight. Bend your ankles and push your knees down firmly against the bed. Hold 5 secs and relax." The pic shows the foot at 90^ to the leg.


When the physio was checking this she had her fingers under the knee and reckons she should be able to feel the back of the knee pressing down. I think that getting the right 'muscle mix' on this is quite hard. Early in the week I felt something 'go' in my knee when it was tensed and I was actively pressing the back of the knee down. Now I'm focusing on getting the heal lift which feels a bit safer.


* I say this but when Mrs AAT tried she didn't get much lift.
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Ah, thank you, that's similar to the one my physio gave me, except I put a little towel under my knee rather than the ankle, and press down on that, which is probably a bit more gentle. I didn't know about lifting the heel though. I'll have to have a go and see if I can do that - even with my good leg! I'd hoped there might be an exercise that was more effective and less hurty. Smile
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This is similar to one of the quad-strengthening Pilates exercises I often do when watching telly (which I always do sitting on the floor.) The heel will come off if you flex your foot. I have tried pressing on the pillow or towel under the knee thing, for my (much less damaged) strained knee: FWIW, I found it more painful and less effective than the above. Best of luck with your recuperation, both of you!
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RachelQ, The other thing I did immediately after the injury was to put my leg up on a chair or table supported only by heal. Gravity is your friend depending on how much it hurts.

Pedantica, Cheers, you too Happy
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AndAnotherThing.., the other thing you did was drink...heavily wink
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Perhaps a three legged ski partnership is on the cards... there is still time for the EOSB you know. It would be a first for the race wink
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AndAnotherThing.., wow - I think that's really quick, only 2 weeks longer than going private and a fair few thousand of pounds cheaper. I met the surgeon this week and have decided to definitely do the op, though his diary is totally full for the the next month so you'll be all mended before me. He was very confident and explained the graft and everything to me which made me feel a bit squeamish but at least he didn't suggest the cadaver option Shocked (although I did subsequently think, wouldn't it be great if you got to choose whose leg ligaments you got? I'd go for Michael Jackson I think - I've always wanted to be able do to the moonwalk).

Good luck with it all and looking forward to hearing your update about a smooth and successful op.
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AndAnotherThing.. wrote:
The other thing I did immediately after the injury was to put my leg up on a chair or table supported only by heal. Gravity is your friend depending on how much it hurts.
That wasn't so easy for me with a full leg plaster cast followed by a full leg brace for a week.

Pedantica, Thank you. Happy
Sharkymark wrote:
AndAnotherThing.., the other thing you did was drink wink
Me too! Blush
Scarpa Laughing
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I think you need to borrow a Labrador to sit on your leg, then it will straighten. I've heard {b]Genepi[/b] has one that will oblige.
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RachelQ, I was also given the straightening exercises that AndAnotherThing.., describes - but the labrador roll as described by Hells Bells, was much more effective Laughing You only have to ask if you'd like to borrow him wink I also found that icing it while trying to straighten it helped (prior to Toby)
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Thanks for the offer of the labrador. Toofy Grin But I might just try the icing instead - I hadn't thought of that. Sorry to hijack your thread AndAnotherThing... Blush
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Laughing Laughing Laughing Laughing Laughing
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Hells Bells wrote:
I think you need to borrow a Labrador to sit on your leg, then it will straighten. I've heard {b]Genepi[/b] has one that will oblige.


That's only for the special Dutch videos Shocked
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miranda, Good luck with yours. I confess that now the appointment is through it's a little more 'real' !! We'll be able to compare rehab notes Little Angel
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AndAnotherThing.., Laughing yes, though I suspect you have a fair bit more muscle mass than me to begin with so I must remind myself not to try and keep up with you if you start racing ahead in your progress! I have a friend's wedding just over 2 months after the op - I have issued instructions that I must not be allowed to drink too much champagne and get tempted by the dancefloor.

Any ladies reading this thread who've been through it already... heels are a definite no no, right? Which is fine, but I so rarely get to wear glamorous shoes these days now I'm a mountain person (plus I will look a bit silly in the wedding photos standing next to OH who is a foot taller than me rolling eyes). Oh well, I'm sure I can find some nice sparkly ballet pumps or something.

Sorry for the totally trivial thread hijack! Embarassed Embarassed
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miranda, it's surprising how important shoes are when one's feeling ill, incapacitated, or low in any way at all. So it's not really off-topic. wink
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Pedantica, thank you - it's true that they help, as does a trip to the hairdresser. Already resigned to the fact I'll be wearing trousers (which again are my usual mountain attire) as I'll probably have a skinny thigh - hopefully not too bad as the surgeon said no post-op brace required - and healing incisions on the knee, so would be good to at least have some nice shoes to wear.

But post-op knee + champagne + heels + being overexcited + dance floor = disaster waiting to happen! Laughing
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miranda, You should start the ACL post op shoe thread wink Laughing
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miranda, shoes are mighty important! You could maybe wear some platforms or wedges so your heel isn't actually raised but you've got some extra height - there are some lovely ones around at the moment. I just can't wait to be able to wear something other than the old cardy uggs I've been wearing for the last 4 weeks cos they're all I can get on. Good luck both of you with the op. Very Happy
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AndAnotherThing.., yes, I know, my contributions to your ACL thread have involved discussions about the merits of achieving skinny thighs without arduous dieting/exercise, advice on skimpy underwear v Bridget Jones pants, and now questions about shoes Embarassed Embarassed Embarassed To be fair it was genepi who started talking about short skirts! wink But I have also discovered that leaning forward with your legs straight and flexing your foot whilst painting your toenails is a really good way of stretching out your hamstrings and working on the extension of your dodgy leg...

I will leave your thread alone now, I promise! Laughing
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RachelQ, ah wedge heels... hadn't thought of them, thank you!

ps - yes, I know that feeing of only being able to wear the same boots day in, day out!
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