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No ACL and doing fine?

 Poster: A snowHead
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Quick to the point update.
Snow gave way under me on 4th Jan, slipped in to a squat that was far more range of motion than I had in my knee, basically heel went on to but, lots of pain in the hamstring and back of knee, a twig-snapping sound somewhere 'round/in' my knee and an hours hobble off the mountain. No instability.
Visited local physio 2 weeks after and was told I had no ACL, yes I knew this, but they reckon it had healed back but was definitely no longer and gave me an ear bashing that I should go to the medical centre. I haven't done that- yet!

I have however been skiing everyday for the past 3 weeks, with the odd day of winter stuff in crampons and also snowshoes.
I am not in too much pain, 2-3/10 and the swelling above the joint line does go down slowly if I rest, but Im skiing as hard as my damaged quads will handle and can honestly say that in ski mode all is well, considering.
Im just getting on with it and trying to get fit.

Everyone knee is different, but we know that. I had a serious assortment of damage to my knee, but 12 months later Im back on planks and I would say at about 65ish% at what I used to do, I am however nowhere near as confident as I was skiing trees and steeper ground and I have found this extremely frustrating; quads and VMO in my bad leg are a long way off muscle mass and strength that they had pre accident, but functional strength is good.

I have also had a few ski falls, no pain, no injury to knee, so that part of the mid game is sorted.
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@Markhandford, that sounds worrying; but kind of good also. Digits crossed for you.

Jealous of how much skiing you're getting in. I've only managed my little week away and one day's UK combat (grass?) skiing - which was knee-challenging, and mentally challenging too, a little, but was also actually survived with no real knee annoyance (until afterwards, then the usual lateral joint line pains) and no falls; a couple of near-miss slips were recovered, fortunately. Desperately hoping that Scotland becomes useable asap, otherwise need to get myself abroad again.
I've done a few reasonable fell walks in deep heather and some snow, rocky paths and invisible deep holes - manageable, but again the pains and irritations afterwards (never mind very achy general legs, everywhere), and some recurrence of the older left leg/knee fizzy quads and irritated catchy kneecaps on long ones - so both knees are playing annoyances again, pain wise, and I seem to have hit an irritation barrier, whereby I can ski, board or walk as normal for, say 2 to 3 hours and then pains and muscle issues (or whatever) start to set in to varying degrees. I don't yet know if this will get to be a longer period as things continue to get better and stronger, or shorter, if more underlying irritation mechanisms kick in. So I have days of thinking that it's all not going too well, and getting worse, and others of thinking that it's as good as it was before and is going to get better still. The truth is in-between.
The head is fine, ish, until any ache or pain becomes apparent, and then it suddenly remembers how much it might hurt again if I get it wrong...
Sitting down all day at a desk is what mine really, really do not like, particularly after having been exercised, at home or outside.

I went to see a new private physio (who actually skis; a bit), who tugged and prodded and questioned and said that she couldn't find anything unusual about my knees bar the kneecaps not moving a lot - which I guess is good - and said that I have good muscle tone (for a not extremely fit middle aged woman - but she was kind enough not to say that aloud), but also couldn't explain why they hurt, except that it might be arthritis setting in as a result of the trauma of the injury and/or some constant underlying irritation process of some kind from the same cause. I managed to set one off quickly whilst there, demonstrating what set them off.... She can't tell that they look different to how they used to (but they do, very different) or explain why they feel very different (ditto); nor why I'm getting so much restless leg issues.

I need to go skiing again!!!!!!!!
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Well, the person's real but it's just a made up name, see?
Not long before going back on the slopes. My Don Joy Fullforce brace arrived and was fitted last week. Feels pretty good... I've been trying to wear it 1-2 hours a day while doing regular activities, working out or whatever so I can get used to wearing it. I don't feel like I need it per se... certainly not on a daily basis as I played football with friends yesterday without a brace but I know it will be good to have on the mountain. Wonder if I will eventually stop wearing it. TBD.
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Will have more to share later... day 3 of skiing... mostly sticking to half-days to not push it but have been extremely pleased and surprised. Maybe the brace is providing a level of confidence that would otherwise not be there. It feels "present" but not cumbersome in any way... like wearing a knee sleeve, in a way. That said, my instructor took me from a red to a black run on our second run (off of Plattjen at Saas-Fee) and everything felt fine. Surprisingly fine and normal. Still trying to fathom it but am very happy.
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Excellent. Taking it easy is probably wise, but it sounds positive so far Very Happy Just enjoy it, that's the main thing. Best wishes for the rest of the week.
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Well it seems a long time ago that I started this thread and it seems to have created a lot of interest, strange at a time when I thought I was the only unfortunate skier suffering.

Anyway 14 months on and my 2018/19 season is all about done so an update.

Before Christmas I was just about back to my normal self, muscle mass back and more plus getting back to doing the things I loved pre injury. I still had some knee stiffness but nothing like what it was.

I have to remember that however I fool myself into thinking that my left knee is just as good as my right it is not. In curtain circumstances it will clunk, particularly in non weight bearing positions. It doesn’t hurt but it is disconcerting. Getting into and out of yoga positions has to be more controlled and slower otherwise I get the clunk.

After consulting with my physio I bought a Ossur OTS knee brace along with a tube grip to make sure there was no slippage. Advised by Ossur to go for a close fitting brace for max support. The brace hinges are very slim and as a result it does not really show. It is also very comfortable.

Skied 5 weeks in all conditions from steep and deep, powder, concrete, slush, bumps, moguls and well groomed pistes. Pushed myself hard to test I could still ski well. In the end I never missed or felt the need to miss a day due to knee problems associated with no ACL. The first few days on snow where very slow but I do believe my knee has got stronger.

I have been caught out by clunking of my knee, getting out of bubble lifts when it is still moving whilst you are trying to get both feet off the ground and stepping out of a bus with skis and stuff in hand. Learning points but now more savvy.

Ski technique is important, I could not afford to be lazy, at any time. Avoiding situations with flapping skis where the strain went directly to the knee was an early learning point.

After a long hard days skiing my kneecap will click and seem awkward, however overnight this soon goes.

So, the future? We are all different and no two cases are the exactly the same but for me I seem to have come to a point where I will go on skiing more or less the same as I did pre injury. Indeed, in December 2019 I am up for my 5 year refresher course that I need to complete to carry on leading for the SCOGB, already looking forward to it.

As for going forward wearing a brace? For me I cannot tell I am wearing it so until there comes a time when it is a pain the butt I will continue as I am.

I tend to feel that this is not just an injury where you are fully healed when you can resume skiing or other stuff, it is not and will take a long time. Still have some stiffness but gradually this is going.

Here’s hoping that all you non ACL skiers have successful outcomes and thanks for posting your stories.
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@ttrucwy, thank you. And thumbs up, it seems.
I'm curious: how do you find the brace? Does it feel like it's giving you compression and overall stability or...? What does it feel like if you don't wear it whist doing knee challenging things? Despite my initial Consultant not liking them, I'm toying with getting a pair, but looking at them the only point of contact at the knee are the lateral and medial pads, and to me it feels as if I'll miss that nice compressed and cosseted feel of full wraparounds. Can't"t find a physio or doc to advise me, so got to make some expensive self guided decisions. CTi are the only options that I can seem to get my paws on anywhere near locally.
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@Grizzler, firstly I am no expert re the mechanics of how the brace keeps the knee together. It does however feel as though it stops any lateral movement and also prevents the knee from slipping forward. It does not fully prevent the knee from twisting, I am not sure if any brace prevents this. The Ossur CTi brace has very clever hinges which are comparatively slim compared to other braces, the brace is also made of carbon fibre which makes it light with smooth edges. Ossur were also very good to deal with, my first brace was slightly too loose so exchanged it with no bother. They also provide the name of a physio close to you who advise and can fit the brace. Another plus point for me was that it did not make my knee sweat, a common problem with neoprene braces which wrap around with a high surface contact area. The bottom line for me was that it did keep my knee-leg alignment fairly rigid without affecting bending and I could not tell I was wearing it. You could risk not wearing one but for the money it was not worth the risk of further injury and months of getting back in shape, life is just too short for that.

Re wearing the brace for other activities? I don’t play golf and have given up football a long time ago. I find running OK and swimming BS or FC is also fine. Having said all that skiing is very different and merits some protection.
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@ttrucwy, thanks. I did look at one when I first had my injuries, and at the time couldn't work out how it would give me the support which I felt that I wanted (I understand how it's meant to, which is very different to physical, maybe psychological feel). I also have some concerns about where it contacted with and pressed onto the lateral and medial joint lines: at the time that was exactly where it was very sore and tender, and now is exactly where I am getting pain after enough exercise. It's this as much as anything which I'm trying to stop or ease off with a brace (my physio isn't sure what's causing it).
Obviously I need to try them on again; you and many others seem to find them useful, though so far I've just used spring sided neoprene wrappers and they've seemingly been OK (bar the pain bits on lateral compression - but I can do that without skiing or boarding, too) and not sweaty or unpleasant.
It's difficult to know what to do for the best: am I doing or risking damage by not wearing full braces or... Puzzled
I have found that there is a "sports injury specialist" (not quite sure what qualifications, not a physio) quite close to me who is an authorised Ossur fitter, and I did have quite a lengthy phone chat with her, which was more impressive than most to everyone else whom I've tried to contact about braces - so I might well move forward on it, though at well over £1,000 (for 2) it is something which I'm not sure I can afford without bring able to trial them; which won't likely happen (bar a snow dome or late Scotland miracle) for a while. Trouble is, they won't get even one in of my size and then tinker with it for fit until I commit to spending the money.
It's worth paying for an assessment, maybe: though that's still £££s just to get some advice and look at them again Sad
Where did you get yours fitted?
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@Grizzler, mine was a over the phone consultation with a Ossur person re how snug the fit around my knee should be, I already had the brace.
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After six days, I'm leaving the mountain injury free. Brace was really nice to ski with and never felt in the way or that my mobility was impacted, at all. If anything, it gave me confidence to ski and, again, I felt like nothing had changed since last year's season-ending injury... that is, my knee felt like it did in the minutes before my ACL was destroyed. So, overall very happy... only pulled half days on the mountain but that was enough to keep me happy since my family is not as obsessed as I am. I knew I would be good on a morning when I logged in about 4300 meters in 2 hours without any knee issues.

It can be done... everyone is different but all of you who are in the beginning stages of this should take heart.
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And love to help out and answer questions and of course, read each other's snow reports.
Not my best video and it was a rather slow blue coming down from Felskinn at Saas-Fee to a little off piste... have better footage but this was day 4... knee felt great:


http://youtube.com/v/EZWxU3B58ck
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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
Better footage of how the knee feels fine... also, this gives a better image of some of the runs at Saas-Fee for those interested. Weather was mostly garbage while we were there. The last day, I took the run from Langfluh to the base in whiteout conditions and called it a day. No more knee injuries for me, plese.


http://youtube.com/v/7pfxYnm-xxo
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 You know it makes sense.
You know it makes sense.
@ItaloSkier, massive well done you for grabbing the bull by the horns and getting back on skis. I'm now 12 weeks post injury and rehabbing like crazy. The plan to try conservative treatment seems to be going well and I'm allowing myself to think about next season Very Happy. I still have reservations about not having the surgery but not because of anything physical more the mental aspect. Time will tell if it's the right decision but reading this thread has given me hope that's it's certainly doable.
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 Otherwise you'll just go on seeing the one name:
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You can absolutely get past the mental aspect... assuming you're working towards next season, you have lots of time to build up strength. You'll find that as you can handle more and more activities (ex: running, playing a bit of easy football, etc.), your confidence will build it. I started psyching myself out as I got closer to the trip but then I realized that if I could do everything I was doing off the slopes, I would be fine on the slopes. It took one good run with my ski instructor for the mental aspect to fall away. Having a brace also helped with confidence so I strongly recommend finding one you like. The Donjoy Fullforce was great and was recommended by my orthopedic surgeon as he wears one, as well.

Keep at it!
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 Poster: A snowHead
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And this is me, pretty much 2 years to the day from having ACLs and MCLs taken out. Hoping that I might get a tad more in Scotland yet, but realistically this might also be my end of season report.
Just managed 5 days ski and board in Austria (should have been 6 but that's another non knee story). Not massive long runs, not super high standard skiing/boarding, about 3-4 hours a day without stopping; up chair, down piste, repeat. Could have done more, but stopped by high temps, sun and heavy spring snow: so started the day on hardpack and icy courderoy, and ended it bouncing down through heavy slippery slush snowHead
Knee jointlines were twinging on and off, and definitely irritated to aches once back to the apartment and neoprene spring sided supports taken off: but a lot better and less painful than in Finland earlier this year. Muscles seem about what they were pre injury, not super strong but OK for a middle aged aggressive recreational skier who didn't do any extra special pre trip training. Feeling strong enough and feeling stable with wrap around knee supports. Definitely got a new aching to painful outer lower leg issue though.
Snowboarding is definitely more painful than skiing, both punting along and generally on both knees.
Confidence (after a good instructor in Finland) is better, but still I'm very conscious of the consequences of falls (on the knees and otherwise), and whilst steep slushy reds are now very much back on the fun list, very long very steep hardpack reds to blacks are not.
Not looking forward to the deep aches and restless legs settling back in once I get home and back to normal life though Sad Obviously I should just ski every day...
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"Obviously I should just ski every day..."

YES! Exactly what I told my wife. After a week back, I've found that my knees felt better on the mountain and while around the mountain than they do back home. Is it a temperature issue? Its warm here so that doesn't make sense. Altitude? 20 meters avove sea level versus 1800+ ? No idea.

I will say that the trip left me happy enough to order a pair of skis and bindings.
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Well, the person's real but it's just a made up name, see?
@Grizzler, good to hear your back on the skis and board with success Very Happy. I found when I sloped back to Austria 8 weeks post injury armed with my donjoy brace it actually helped massively skiing for 3 hours a day. My knee felt stronger by the time I came home and even though the little voice in my head was yelling you crazy mare
at me everytime I boarded the cable car up in the morning I am so glad I went back and actually skied. Yes I breathed a sigh of relief when I got home but I really believe it massively helped me physically and mentally. After all aren't we all just working towards clipping in and hurtling off down the mountain acl or not Laughing
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absolutely ruined my knee last week.
Even my toes have now gone numb. Started with 1 & now the 3 middle toes!

Maybe I should go to the quacks
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@Mr.Egg, oh no.....what have you done? Was you skiing? I would go get it checked for sure.
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Blighty1066 wrote:
@Mr.Egg, oh no.....what have you done? Was you skiing? I would go get it checked for sure.


my knee is completely screwed anyway. Lots of things wrong with it. Who knows what damage I have done this time.
Last time I had a big injury I couldn't walk for 6 months. kind of weird having the last 3rd of your toes numb though. Guessing Ive trapped a nerve somewhere.
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@Mr.Egg, Im no doctor but it does sound like a nerve problem. Fingers crossed it's not a major injury and your up and running again soon. Prior to my injury on Xmas eve I never ever thought about my knees really. I've been very lucky up to that point and never had any issues but now they rule my life.. Every twinge or cracking sound sends me into a meltdown, every pain or ache convinces me I've done more damage. Oh to be a normal kneed person again Confused
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After all it is free Go on u know u want to!
@ItaloSkier, great video clips, so glad the hard work has paid off and you are back on skis, brilliant
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@Blighty1066,

Running Laughing
My knee gave it long ago to stop me running.
Ive not run for 8 years.
Doc’s orders is self management to avoid a knee replacement before im 50
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Here's a weird one... Went out on a Pennine hill walk recently; nothing stupidly strenuous, nor overly long. By no way my first, nor most tiring or rough in the last 12 months (and I'm not walking in total flatlands by any means on a weekly basis). Involved, however, one very, very, very steep descent on rough grass - easily came down it, felt very well balanced and stable (in fact, knee-wise, felt as confident as I ever used to - yippee!), side stepping and making speedy progress in stiff sided alpine boots (also my everyday walking ones). Wasn't an overly long descent, and nothing which I didn't used to do back when I lived in a more hilly area on my back doorstep.
Long story short, though nothing overly problematic (well, not unusually so) with legs or knees going up or along, by the end of said very steep descent, my thighs were utterly at the end of their ability to keep going, felt well the wrong side of melted quivering jelly, could hardly support me upright and I really, really struggled to pick my way down the rest of the flatter but rocky bouldery descent. Never ever felt that 'challenged' in the leg department before. Fortunately, Mr G was there to offer a steadying hand as I lost a lot of balance and ability to place my feet where I needed - without him, I don't know how I'd have done it.
Managed to recover enough and get enough dextrose down me to finish the walk tired but not otherwise too bad, and with no additional knee pains or issues.
BUT - the next day and the day after (that's today): yeeeeeoooowch!!!!!! Seriously, my quads are literally ripped to pieces. Can't bend, never mind kneel, can't bear anyone touching them they're so tender, can't even get into or out of the car easily, never mind sit back onto the loo or go down stairs. Crazy! Never had pain like it in the muscles, even after hard skiing or when starting out on snow. (Deep Heat or Ibuprofen gel does nothing to help.)
And yet the knees were and are utterly fine, as are all if the rest of the leg muscles, and there's none at all of the usual deep dull restless leg outer ache.
WTF?????? Puzzled
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@grizzler really glad to hear the knees are doing well. I'm definitely no expert but I would say your quads were doing their job very well and working extra hard to save your knees whilst going down hill. Give them a rub and show them abit of gratitude Very Happy
Not sure I'd trust mine like that just yet but getting there slowly as every days a physio day now Very Happy
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And love to help out and answer questions and of course, read each other's snow reports.
@Grizzler, excellent quad workout. When I have a heavy squat session i have to lower myself onto the loo! It doesn't happen when skiing because of good technique
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holidayloverxx wrote:
It doesn't happen when skiing because of good technique

Well, um, yeah, obviously... Laughing (or in my case, not so much.)

Interestingly, I'd thought that downhill would get the hammies more - but this one really and literally ripped the quads (only just getting happier and stopping limping 5 days later). Never have these problems doing squats etc, nor usual hillwalking. Clearly not trying hard enough!
Also interestingly, I didn't get any of the usual 'restless leg' deep aches, delayed or otherwise, nor knee outer joint line issues (think that maybe the former's just creeping a tad back in? General mild general aches certainly are today after a desk-bound session.)
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You know it makes sense.
@Grizzler, what weight do you squat?
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@holidayloverxx, just whatever my body weight is (on a variety of different squat types, and other exercises). Don't have access to (or funds for) a gym, nor facilities/space to do bar weights at home.
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@Grizzler, ah...body weight squats are ok but it needs weight to do any real good.. could you not fit a squat rack in an outbuilding? The footprint isn't very big
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The easy answer is that it is down to the individual and their symptoms. No two people will have the same symptoms despite the same injury. I could ski (on/off piste), play squash, run, HIIT train and mountain bike with no problems at all yet on a bad day my knee gave way 5 times in a 1.1mile walk and I could not hit a backhand shot in tennis without wearing an Ossur ACL brace. I did not need the brace for any other of the sports I do.
I have managed for 3 years but 14 days I had it reconstructed and time will tell whether or not this was the right decision.
Long term, the outcome depends on whether there was a cartilage tear as well as the ACL rupture - if there was (and this is far more common than an isolated ACL rupture) then you will get early onset OA whether you have reconstruction or not.
Rehab wise it's about 6 months for full return to sports and if you don't do the rehab then you might as well not bother with the surgery.

Sorry if my answer sounds a bit woolly but it really is down to the individual and what you're experiencing.
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holidayloverxx wrote:
@Grizzler, ah...body weight squats are ok but it needs weight to do any real good.. could you not fit a squat rack in an outbuilding? The footprint isn't very big

Outbuilding? Entire rack? Er, no. Don't live in a mansion.
Clearly my physios need to be sued for wrongful advice!!!
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@Grizzler, lol...I was thinking shed or garage! I don't know what your physios advice is but i would find it odd if they were happy just with body weight squats - that's just the equivalent of getting up from a chair.. I am squatting with 60% bodyweight and am aiming for 75% next week. 100% next year..... maybe.
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@Grizzler, when I joined the gym at Ringwood leisure centre, and mentioned reason for going was to keep muscles strong due to injuries in my knee she said that you can get a couple of months memberships via GP referral. Now not appropriate for me as I am long since discharged from physio etc after my last surgery but I need to keep doing the exercises for live due to what’s (not) left in my knee. However could this route be helpful for you?

Also to at least start to increase the weight you could use stuff from around the house / kitchen? Thinking bags of sugar / flour.... not a lot I know but little steps.
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What about even doing things like stair climbing or wearing a weighted vest while stair climbing?
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Re GP referrals, I don't know if you can still do it; last time that I looked it was the standard NHS 6 sessions only. My main gym problem is pure distance though, (OK and cost), and the ones which I might be able to make aren't open at reliable or convenient times (pretty rural area). Still looking into it...

All my physios, NHS and private, never recommended anything at all except free, non-weighted, exercises; squats, lunges, 1 legged bends, Swiss ball hammy stuff & bridges. Bit disappointing, tbh, but none ever suggested the need for anything else (though did say don't do open chain stuff).

I do have some free weights in a small second bedroom, but not anywhere to rest them, and struggle to lift them or put them on a bar over my neck (upper body issues too Sad ) and aren't terribly keen on dropping 40+ kg onto the rather weak floor, me, furniture etc. But I'll be giving it some thought. Using the static cycle set at 'very hard push' setting seems to do something, maybe.
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2 years ago, and after a couple of years of a worn out left meniscus, which compromised skiing but i could still run, i went for a slow ski and it collapsed and i heard the pop. i went to see dr christian fink, who has operated on many sportsmen, based near innsbruck, nice bloke. had an mri, and he showed me the full rupture to the acl and pcl. he could tell on examination that the meniscus was worn. he promptly said you should have this done and it will be better. but first he said i should do some intensive prehab to make the muscle tone better than ever before, as this would help post op rehab. i liked this firm advice. so we did all of this. and then post op, which involved the thigh tendon graft and removal of some of the meniscus, i am still doing loads of rehab, stairs and cycling, it is all pretty good. it is the rotational forces that are a bit of a problem, whether you have the op or not, but i am pleased i did it.
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