The snowHeads ACL rehab club !

A snowHead

@22 dropout, I still sit as much as possible with my legs elevated and find I'm subconsciously doing the ankle pumps, especially after a hard day at work or skiing! Here at home I have a footstool that is exactly the right height for it to be comfortable. My friends when they see it, ask if I'm keeping time with the music!!! At the rehab centre, my therapy sessions began with LDM which meant I was able to move more freely when I moved on to the physiotherapy part. Luckily I am in Germany and have a month in a rehab centre where I work on regaining the range of movement all day for a minimum of 4 weeks. That can be a residential stay or as I opted for my last reconstruction, as an out-patient. After the month is up, if you are still in work, i.e. neither a child nor a pensioner, there is a period of extra therapy to last up to 6 months, that enables you to work and also have therapy which sorts out the kind of problems you describe. The therapy centres are open at 07:00 in the morning and close at 7:00pm, so you can usually manage to make a couple of sessions a week which supplements what you can do for yourself.

A snowHead

Well I have got aquianted with my crutches once again, and met some very nice cold peas. Now 48 hours since op-
NHS - once I was in the treatment stage things certainly ramped up - Seemed very efficient to me- very good communication and everything was triple checked - was put at ease all the way through - I would say they were excellent - I was in just before 8.00am - Operated on about 9.00 ish - came round 2 hours later - fed and watered - and got out about 6.00 ish -Anticipation was probably worse than the real thing-Had to spend bit of time with physio demonstrating I could drive a pair of crutches satisfactorily No snow ploughing down the stairs!- 3 exercises only - knee slides - lifting leg and straight leg putting pressure on back of knee.
First several hours were fine as the affects of local anaesthetic must have still been there - next 12 hours seemed worse than the day I wiped out - pain from where they took the graft - and round my shin? Very stiff and strange leg - Swollen knee -but no severe pain in the knee - just used paracetomol - codeine & anti inflamatory. Started reducing codeine already -
No sleep first night- but read through all these posts again and took advice on propping up bottom of the bed - and last night slept no probs.
Cling film has been useful to keep dressing dry in shower - and when using bags of peas it stops the condensation wetting the dressing.
Now lots of little goals as suggested on here to hopefully keep making progress.

Well, the person's real but it's just a made up name, see?

@barney2, Glad it's gone ok. Shine discomfort possibly nerve damage, I had the same but it should improve. Once you are a few days post op the pain is much better.

You need to Login to know who's really who.

@barney2, glad it went well. Do you have you first Physio appointment through? Did you ask when you should expect to see the Physio? If you don't get an NHS Physio appointment in the appropriate time period I do recommend booking them privately if you can afford to.

Anyway, snowHeads is much more fun if you do.

@NickyJ, Thanks - The physio in the hospital said they would make a referal through to our local small NHS hospital where i have already been working with physio there - so guessing 2-3 weeks time when dressing has come off and the wounds have healed up?
I think that perhaps the best use of our money is spent on getting to swimming pools as much as poss later on -
@AndAnotherThing.., - Thanks - yep - your probably right-

You'll need to Register first of course.

@barney2, only reason for suggesting is that I know how important it was in my recovery and I have just had shoulder surgery. I made the point of check if when I should be being seen after the operation as I like you was being referred for surgery at the local NHS Physio different hospital o where the op was done due to that hospital not doing operations. I was told it is best to be seen 1-2 weeks after surgery. Sadly I still have not even receive a Physio appointment via the NHS and my operation was 4 weeks ago this Wednesday.

Then you can post your own questions or snow reports...

@NickyJ, I had shoulder surgery last August (repair to the rotator cuff) and had physio (passive) from the first day after the operation. For the 6 weeks of immobilisation I had passive mobility physio and started my active physio at 6 weeks+ 1 day. You need to be really pro-active if you are not going to have problems getting the range of movement back. If you can find a good private one who will help and has experience of working with the type of operation you had.

I'm still not at 100% strengthwise, nor completely pain-free and I'm coming up to my first anniversary, but I do have a full ROM!! Toofy Grin

After all it is free

Still a bit of pain (not much) and certainly no full range of movement after 6 months of rotator cuff damage. But my attitude is: too bad, I'll live with it. wink

@Samerberg Sue, yep that's why I booked private Physio had 3 sessions now and range of movement it really good considering. Just trying to warn Barny to not rely on waiting for NHS to get around to giving you an appointment when it is so very important. Talking Of which time to get the theraband out again. Smile

*Ski* the Net with snowHeads

@Hurtle, that was my thoughts until the moment I reached out of the car to pull the toll ticket out of the machine near to Verona llast summer and the last threads of my Supraspinatis snapped! I was paralysed with pain for a few minutes and was unable to lift the arm after that. Saw a surgeon after my return home and he proposed surgery - arthroscopic hopefully but full open if he found that he needed to go in and do more work. Luckily he had pretty fine fingers, but the first 6 weeks sleeping sitting up with the shoulder and arm immobilised were horrendous! But he had me ready to ski again in December, which was all I was worried about. rolling eyes

snowHeads are a friendly bunch.

@barney2, find a private physio. Doesn't have to be expensive, mine was 35 quid every 3 or 4 weeks. The NHS one wasnt familiar with the protocol required for the op.

snow reports

@Samerberg Sue, eek! Shocked

@barney2, I had my first post-op physio appointment 5days following surgery. Glad your op went well & good luck with the rehab.

You know it makes sense.

Quick question if I have reconstruction surgery in September shouls I even think about skiing next season? ACL.

Otherwise you'll just go on seeing the one name:

I wouldn't have been able to, about 9months post op I would have been able to manage it.

A snowHead

@Filthyphil30k, depends entirely on you to be honest - I was skiing again at 5.5 months after an ACL operation in the middle of August (so end of January). I used a brace because they also reconstructed my lateral collateral ligament at the same time as re-fracturing and resetting the fib head where it joins the knee capsule. Some people heal quickly, some don't; there is no fixed plan/protocol that applies to everyone as we are all unique - the way your body heals, how you cope with pain, how much time you can invest in physio and rehab to get enough fitness, as well as the impact on your protocol of any other work done in the same area. If you have a meniscus repair for example, this can slow the rehab process down initially.

A snowHead

@genepi, Thanks - just concentrating on keeping swellling down - avoiding doing anything daft! and hopefully no infection - I have the 3 exercises to do for now anyway. Been looking at Kneebindings and their take on avoiding ACL ski injuries- interesting how they are said to work -looks like a good idea?

Well, the person's real but it's just a made up name, see?

@margaret, - Best of luck for Friday -

You need to Login to know who's really who.

@barney2, thanks Barney you have given me a little confidence. My first physio appointment is on the 15th July. Best of luck with the rehab, I would just like my op to be over right now! See you on the other side Very Happy

Anyway, snowHeads is much more fun if you do.

@barney2, here I am, now on the other side! Operation done, and now I am on the road to recovery. How are you barney2? I am sore at times, the bandages are off, and the rehab has started. It is sore to work my leg, but it will improve. I will have ups and downs but I am being positive. After all it will be nice to walk again. Without a wobble in my knee Very Happy

You'll need to Register first of course.

@margaret, Glad it went ok Smile

Then you can post your own questions or snow reports...

@margaret, Good to hear that bit is behind you now. Next stage then?
I am now 9 days in - stopped all pain killers/anti inflamtories at 8 days. Walking round house with one crutch - stairs and outside I use 2. I can straighten leg OK - but still numb and no feeling below knee / top shin bone - expect this will go - Leg does feel strange though.
Wounds are very nearly healed and see physio this Thursday.
Just slooooooww!!
Been looking at different ski bindings - also looking at cross country/skating skis - thinking best way back late season- But also thinking - I really wouldn't want another 12 months of this - Too much time on my hands me thinks?

After all it is free

I too am Trying to think of ways of just squeezing in a late trip of sorts, and like you have been thinking of ways to get back on snow. I guess it is good to have goals, but not to be too disappointed if it doesn't happen. I did ski without an ACL unknowingly, but knowing what happened since has consolidated my mind. I do not want to be here again either. I don' t have much pain until I start my physio, and then it is uncomfortable. Am weighting my leg more today and sleeping well. I am so frustrated though, it is not normal for me to ask for help. Feel that I am wishing my life away. Had some good news though, grandchild number seven on its way! At least I shall be able to chase him or her around Very Happy

please keep me posted on your progress.

Knee surgery is one of the subjects of the Radio 4 health series,to be broadcast Tuesday at 9pm next week.

*Ski* the Net with snowHeads

@barney2, that all sounds pretty good. How is the bending going? Amazing to think you're 2 weeks out of 40 through rehab already.

snowHeads are a friendly bunch.

@22 dropout, Bending is pretty crap - knee slides are only half what they were - There is a restriction - either from the stitches or from the Op? I am at the physio today first time since op so maybe few more exercises ?. Had to ice up yesterday - first time in a week - think I just walked too far and on my feet too long?
So how far have you got now with rehab? Can you bike OK yet?
I saw the video of my crash for the first time - Interestingly it was not how I remembered - Visibility was worse than I thought with light snow and flat light - Fresh snow on piste - I did crash at an easy spot on a red and not going fast - but the guy behind me crashed straight after me in exactly same spot - His skis stayed on and he was up in seconds - He is an excellent skier - So I can't blame my lack of technique or lack of concentration anymore - there must have been a bit of a bank of snow or something where piste basher had missed or something - I had got up and put weight on my leg and walked to side of piste - which I hadn't realised - Funny how you forget these things. So upshot is - there was a definite reason for my wipe out.

snow reports

@barney2, I could not get the flexion and eventually, at 7 weeks, I went back into hospital for "manipulation under anaesthetic" to break down scar tissue and get bend into the knee. This scar tissue was preventing me bending and getting on a bike. Since then, making steady progress as the residual swelling allows. Main focus is the hamstring now which is very weak after the graft. There is no knowing, but I felt if I had stayed off my feet more and continued pain killers for longer I would have pushed the bend harder and the scar tissue might not have formed. Certainly, when I compare what I can do now before my leg swells and what I was trying to do in the early days I realise I was doing too much that required effort too soon. Getting the swelling down, keeping pumping the leg with ankles and quad clenches and testing the bend a couple of times a day off the side of the bed is the highest priority. You're doing the right thing seeing a physio as soon as you can as they will push you to do things that you would worry about doing otherwise.

I went on a watt bike today for the first time. These are the red, white and black ones and physics talk about them a lot. They measure the power in each leg throughout the rotation of the pedals and give you a real time graph. It shows how much your good leg is compensating the bad one and helps you even up the effort. Really good if you can find one occasionally.

What I realised is that getting mobile is a false objective compared to the other ones. Necessary, but not to be rushed. Everyone is different though, and the only real comparison is at 9 months.

I have booked a couple of big trips next winter as an incentive and have found that really useful as a fixed date goal to motivate me.

I have no cause to my accident other than me. The icy mogul was exactly the same as all the others and I shouldn't have been there in hindsight with touring gear!

@22 dropout, Yes - remember you saying bike was difficult. 2 weeks in and swelling of knee is worse than after my op - but really only after walking or exercises - think I have been pretty lucky so far with that aspect. Going back into hospital does not sound good !- I will bear this in mind in terms of flexing the knee - and keeping swelling under control.
You are right about physio - she had me off the crutches and walking straight away -instilling confidence.
I got on the exercise bike yesterday - and today can pedal OK on lowest setting which really isn't anything atall but is giving that fluid movement. You are right about goals - but mine are tiny ones at the moment - Like not falling over! Also - as my wife suggests -to stop walking round the house looking like I have pood me pants!!! We do find some of this experience very funny - my wifes impressions of me have to be seen to be believed and do help to keep things in perspective - afterall it is just a knee.
So - been out for a short walk today without crutches so another milestone passed.

You know it makes sense.

Nearly 3 weeks since op - swelling still whenever exercising and walking - but this seems in line with other peoples experiences.
Walking is interesting as I still don't have a rock solid knee when walking. I was thinking that everything would have tightened up - and certainly this is the experience with the few exercises I have got - I can feel the difference since op. However when out walking - I still get moments! seems to be as the leg nearly straightens/ should lock - on the walk through - seems I get a bit of a slip - which is a pretty scary and saps the confidence - Physio was implying that I should have more confidence now after op - not the case yet - but maybe it will improve? Just wondered how other people got on with getting back into walking?

Otherwise you'll just go on seeing the one name:

@barney2, Once you're on the bike your flexion will come. Lower the seat a little once you are comfortable to keep pushing into the bend. The locking is normal but, as you say, very disconcerting. Your muscles are not firing right to hold the leg as it extends. This comes from getting the swelling down and keeping up the quad/vmo clenches and getting the hamstring firing. This all takes time. There won't be many leaps forward, more small daily improvement that all add up. I have to stand quite a bit during the day and I get locking even after a few months. With my physio I have found that my abdominal engagement is just as important as the leg muscles and, now that I am thinking about supporting my weight from the core the locking is less frequent - it's actually logical i.e. preventing your weight from sinking to your weak side.

It sounds like you are making really good progress. In hindsight I would have carried a crutch to 4 or 5 weeks to minimise swelling after walking and to ensure stability. That is just based on what I know now which is the more you can minimise swelling, the better the progress you will make, and that it's easy to overdo things in the early days.

Are you back at work yet and if so, how are you finding the journey and the work environment?

How are you doing Margaret?

A snowHead

@22 dropout, Yep - what you are saying all makes sense. Saw the physiotherpist today - I need to increase the bending/flexing of the knee - take pain killers if necessary - can't say I really want tablets - so we will see how far I can get - bloody painful when she was bending it - but after your previous post I thought it has to be done.
Work - no problems! Not doing any - We decided to travel around Europe for 3 years in our motorhome - We did get 6 months in Scandinavia and Finland and also a months skiing - best laid plans and all that - so we are just using our savings - hence being very careful where we spend money on my getting back fit again - If money was no problem then I would get extra physio for sure -
Ditto to how are you doing Margaret?

A snowHead

As a repeat offender with ACL injuries, I've learnt you need a minimum of approx. 90° bend to get on the stationary bike set up and rock the pedals and 110° for a normal full circle. A trick a physio showed me on my own home trainer was to RAISE the saddle while approaching and between those 2 values. If I could not manage a full circle then rocking back and forth until I could also helped. In the rehab centre we have adjustable pedals according to your flex allowing patients with as little as 30° bend to get on the bikes. Once I am able to achieve an easy full circle, I start to lower the saddle to the correct position. This was controlled by the physios at the centre as they moved the pedals along the shaft until I had a normal setting. I spent hours in each rehab cycle on my bike, either at home or in the rehab centre, passing the time by reading a book. Now with a kindle app on my phone it is a piece of cake to lose a couple of hours this way while also increasing my cardio as well as reducing the swelling. After an hour, I then rest the knee in an extended position, but unsupported (i.e. nothing under the knee itself) and iced while keeping the leg elevated and ankle pumping as if my life depended on it. Both the cycling and the elevation and ankle pumps helped to reduce the swelling and freed up more flex.

I repeated this 3 or 4 times a day when I was signed off and twice a day after I returned to work.

Well, the person's real but it's just a made up name, see?

@Samerberg Sue, I seem to remember bikes with variable pedals a few years ago in gyms but not any more. How useful must that have been for your rehab. I had never thought about how much bend cycling required, in fact I thought it was very little, until after the op. Then I went into the gym, tried three different types of bike and couldn't turn any of them.

I made enquiries into Lymphatic massage. If it is the same as in Austria this is very light directional and targeted is it not. Did you have this through the Austrian health system? Your treatment seems to have been very progressive ad well thought through. Good thing too if you keep repeating the injury Smile

Were your repairs hamstring grafts?

You need to Login to know who's really who.

@22 dropout, LDM activates the lymphatic system and the swelling is reduced by gently massaging the excess fluid to towards the nearest lymph nodes (for knees that is in the groin). A good masseur starts the massage system by massaging the lymph nodes to stimulate them, then they begin the process of moving the fluids. My physio sessions always started and ended with LDM, the exercises I had to carry out always caused more swelling. When I was full time in the rehab unit, I had had LDM at least twice a day as well as CPM and icing between activities. One thing I learnt pretty quickly about LDM was to make sure my bladder was empty before it started as it sure as hell wasn't by the end! I had LDM in the hospital in St Johann in Tirol when I wrecked my right knee back in 1989 as soon as it was possible but on my repatriation to the UK things did not work out as well. My most recent abuse of the other knee resulted in treatment in Germany under our Industrial Injuries insurance (I live and work in Bavaria but ski primarily in Austria). I was on my school's Year 7 ski trip when the injury occurred, so the work accident insurance covered everything.

My last reconstruction however was a revision, using part of my hamstring tendons in the same leg - Semitendinosis-Gracilias bundle as the graft. I have also had 2x patella tendon grafts and 2x carbon/kevlar(?) artificial ligaments. The latter were way back in the days before autografts became the standard treatment and both failed within a year of being put in. At the time I was upset, but having read horror stories about them disintegrating in situ, causing all sorts of problems for the patient, so with hindsight it was good that I mistreated them! wink

Anyway, snowHeads is much more fun if you do.

6 months post op for me, and follow up MRI unfortunately was bad news. A subchondral fracture laterally not seen on previous MRI, and meniscus tear still looking the same with a bigger vertical component. I also now have a Bakers cist and more effusion in the knee than before op.
The new ACL looks ok, but with tests it feels a bit lax!
Dr now wants to do a microfracture procedure , but I am getting another opinion first. Feeling pretty depressed and hopeless - I did all my rehab and exercises so dilligently!

You'll need to Register first of course.

@lizski, What a dissapointment for you You were also expecting to go on a trip in August??
Can I ask - did everything feel OKish when you were doing exercises - walking ? and only find out through MRI? or did you have MRI because you thought something wasn't right? I think your idea for a second opinion is a good one. I can imagine how sick you will be of it all at present.

Then you can post your own questions or snow reports...

Yes, I have had to cancel that unfortunately. I need to get over the disapointment and sort this out properly now.
The dr said initially after the op that he will do a MRI at 6 months to see if I can run again, because of cavitations he had seen during operation, and to see if bone bruise had healed. Rehab was going well and I got back for an hour of Mountainbiking, then after 4 days knee blew up and from there it was downhill with now pain even with walking. I asked him to repeat MRI but did not expect extent of residual problems.
I always felt as if I was walking on a bit of a balancing board, but as you would know , with the nerve damage around the incision etc. you just know its not feeling normal. The one thing that always worried me was that the pain at end of extention never went away, although I could fully extend it, it stayed painful at the end of the range.
I have had a fall down stairs after 6 weeks, and we had to do a lot of traveling and walking so far this year - so maybe that can be contributing as well.
It takes such a long time , and I hope you are patient and treat your knee well. In retrospect I maybe could have taken things a bit slower and given myself more time to heal.

After all it is free

Now 4 weeks post op, and 6 months since injury. Had follow up check and as far as we know all seems OK and tickety boo?- no more checks now till about 5/6 months time.
Knee is now starting to feel more together - still bit of numbness on shin - slight increase in exercises - and will start easy biking on the flat next week and into swimmming pool for first time since op. All scabs have gone.
Rehab seems bit more positive for me as now we are doing it for real - rather than mostly to get ready for op. Will heed advice to progress slowly.

@barney2, Glad it's going ok, good luck with the rehab.

*Ski* the Net with snowHeads

Three weeks and counting. I think all is going well. I have ditched the Nora Batty leggings as I am on my feet a lot more now. Knee slightly swollen under my knee, and it feels as though I have been to the dentist. It is numb. Had a week with the family (including 5 grandchildren) in Cornwall last week. Felt challenged at times, and did not go body boarding or surfing.😳 Did manage to build a huge sandcastle sat on my bottom. I managed to get the pedals on my turbo trainer round today, so I am off! Did not feel up to the bike race today though, Maybe next time. Physio session tomorrow. Do not see my surgeon until beginning of September.

Help!!

The snowHeads ACL rehab club !

snowHeads Forum Index >>> Ski Fitness, Exercise, Injury and Rehab