Torn ACL - JP Fitness Forums

Jimbo · 08-01-2007, 07:00 AM

Anyone here ever had a torn ACL? What has you experience dealing with it? Any success stories out there? I need to hear some..

Edited to say - I'm under a great knee surgeon's care and will be discussing surgery options in a couple of weeks. I just wanted to hear from anyone who has been through this. Looking for a glimmer of hope that life will be "normal" again some day.

UConnJulie · 08-01-2007, 11:48 AM

Jim,
I tore my right ACL (complete tear), right MCL (partial tear) and right medial meniscus (also known as the Unhappy Triad of O'Donohue) skiing moguls in 1993. I knew it was torn immediately (heard the "pop" and had immediate massive swelling). I was working for a surgeon at the time and saw him the next day and had my MRI etc. Scheduled surgery three weeks out from injury to allow some of the swelling to come down. I was on crutches because I couldn't weight bear due to the MCL tear. I was also in a long-leg brace (hinged, but locked into zero degrees of flexion).

Surgery was uneventful (I had a modified Clancy procedure done where they take the middle 1/3 of the patellar tendon with a plug of bone at each end and drill through the tibial plateau and femur and insert etc) except that he did not trim away the meniscal flap (which occasionally gives me trouble nowadays).

I had a great therapist and within 6 months I would never have known that I had torn my ACL. Currently I can do ATG squats without much difficulty (if the meniscus is behaving) and the only limitations I have are more self-imposed. I no longer downhill ski (I took up cross country instead and like it better), I have trouble playing full-on contact sports where your feet leave the ground, like basketball -- I still do it, but I have to be careful. And I can't do the "bump" when dancing at weddings. I don't wear a brace because I find them uncomfortable and my knee is stable enough for me that I feel I don't need it.

Surgical techniques have come a long way in the past 14 years ... incisions are smaller and there are other procedures which cause less trauma to the surrounding areas (use of an allograft, hamstring graft, etc). I have also treated a lot of people with this surgery and they do fantastic.

A fellow fitness buff Renee tore her ACL this year doing martial arts. She has a great blog and talks about her injury, surgery, and recovery in detail. http://skwigg.tripod.com/blog/

If this wasn't enough detail, feel free to ask more specific questions and I'll see if I can answer.

Best of luck,
Julie

Jimbo · 08-01-2007, 02:24 PM

Uconn that's awesome. Thanks for you history on that. It really helps.

I'm pretty sure there will be som self imposed limitations here too. I'll check out the link!

Axis · 08-01-2007, 02:55 PM

I tore my right ACL in March of 2005. Had it reconstructed with an allograft in October 2005. Rehab went extremely well. By 10 days I was walking without crutches. By two months, I was running and I was feeling great by 4 months. By all accounts this was very fast. Doctor encouraged me to work back into all activity as I felt comfortable, without restrictions. Other people I have talked to seem surprised that he cleared me so early.

At around five months, playing a "relaxed" pickup basketball game, I got into a freak collision and the knee gave out a bit. Went back to the doctor, manual tests indicated it was still stable, but there was no telling for sure without an MRI, which I never got (partly because I'm cheap, partly because I wasn't sure I wanted to know the answer).

Ever since then, it's been generally stable, but feels a bit "loose" when I play some sports and ends up painful for up to a week after playing basketball. If I wear a brace, though, no pain (other than general muscle soreness from being out of shape).

My unqualified opinion is that the collision "stretched" the graft, without actually tearing it, leaving me less stable than optimal, but still way better off than a re-tear.

After ~2 years, I can do all activity I did previously (except maybe downhill skiing . . . haven't tried yet) if I wear the brace, and only have minor limitations without it.

Moral of the story . . . just because 7 of the 8 people on the court are just messing around having fun, there may be one moron who thinks he's playing for the NBA title. Stay far away from that guy.

Advice: work on quad sets prior to the surgery. It will be one the first exercises you will be asked to do in rehab and it helps to know what they are supposed to feel like.

Jimbo · 08-09-2007, 07:44 AM

Quote:

Originally Posted by Axis

Advice: work on quad sets prior to the surgery. It will be one the first exercises you will be asked to do in rehab and it helps to know what they are supposed to feel like.

Axis! Thanks so much for your info. I just saw this. I'll be avoiding sports - ball of all kinds I can live without. I'm really more into lifting and running anyway so I should be able to avoid re-injury in the future.

I was just wondering - when you said "quad sets" what were you referring to? What are quad sets? I may PM you on this..now that I have typed this.

karky · 08-09-2007, 08:07 AM

i belive its just flexing your quads.. belive me, when you have an injury, its not as easy as it sounds :p

UConnJulie · 08-09-2007, 10:19 AM

Quad set = with your leg out straight (ie resting on a bed or the floor) tense the muscles on top of your thigh as if you are trying to press the back of your knee down into the bed. Hold for 10 seconds or so and then relax. Rinse. Repeat. A lot.

Jimbo · 08-09-2007, 10:43 AM

I see. Thanks!

PS - I have a brace on my leg now..and I can do these without pain. Probably feel a little different after surgery though.

UConnJulie · 08-09-2007, 12:42 PM

Are you seeing a PT now? I noticed your thread in the Training Forum and it sounded like you are not. Many people do better after surgery having done a pre-op exercise routine to keep the muscles contracting and the inflammation down. What does your surgeon think of this?

Jimbo · 08-10-2007, 09:48 AM

Quote:

Originally Posted by UConnJulie

Are you seeing a PT now? I noticed your thread in the Training Forum and it sounded like you are not. Many people do better after surgery having done a pre-op exercise routine to keep the muscles contracting and the inflammation down. What does your surgeon think of this?

Actually, I only had the diagnostic MRI recently and will visit with my doc about the results this upcoming Monday. So I'm not sure what he would think. I'll sure take his lead on this though. He's a great doctor..THE knee doctor around these parts and a long time runner. I trust him.

I'll ask about a routine. Keeping my knee imobilized in this brace has certainly made it stiff.

Jimbo · 08-14-2007, 06:35 AM

The MRI was "inconclusive" as far as how badly torn the ACL is.

Doctor wants to try rehab for a while but wants ME to rehab the knee on my own since I go to the gym all the time. This saves me $ but he didn't give me much guidance though I specifically asked about a routine..all he said was to:

Avoid squats
Avoid lunges
Avoid leg press

To do:
leg extensions
leg curls
Swim

Extensions? This flys in the face of everything I ever thought about knee health. WTF?

I asked him about eliptical training..he said only if I felt my knee was ready for it...

Anybody here with experience rehabbing ACL injury have an opinion on this rehab advice?

He wants me to strengthen my quads and hammies and come see him in 6 weeks. I'm a bit nervous about rehabbing this on my own. I obviously have no idea what I should do since I would have never in a million years chosen leg extensions or curls.

UConnJulie · 08-14-2007, 06:41 AM

Quote:

Originally Posted by Jimbo

Doctor wants to try rehab for a while but wants ME to rehab the knee on my own since I go to the gym all the time.

He didn't give me much guidance though I specifically asked about a routine..all he said was to:

Avoid squats
Avoid lunges
Avoid leg press

To do:
leg extensions
leg curls
Swim

Now..this flys in the face of everything I ever thought about knee health. WTF?

I asked him about eliptical training..he said only if I felt my knee was ready for it...

Anybody here with experience rehabbing ACL injury have an opinion on this rehab advice?

He wants me to strengthen my quads and hammies and come see him in 6 weeks. I'm a bit nervous about rehabbing this on my own. I obviously have no idea what I should do since I would have never in a million years chosen leg extensions or curls.

Another example of a sadly misinformed surgeon. Sigh.

Obviously you don't want to start with heavy squats or lunges or whatever, but they are not inherently "dangerous" for ACL-deficient persons. The focus of your "rehab" needs to be fourfold:
1. Get the quads firing properly again.
2. Get the hamstrings strong to make up for the lack of ACL.
3. Get the gluteals working properly.
4. Full range of motion in the knee.

Before I give you some exercise examples, I have some questions ...
1. Are your quads atrophied on that side? Can you contract them and feel them contracting (with your fingers on the muscle)?
2. What is your range of motion like? Does your knee go all the way straight (nonweightbearing)? How close to your butt can you get your heel?
3. Can you bridge?
4. Just walking around in your daily life do you feel like the knee is unstable?

Jimbo · 08-14-2007, 07:23 AM

Quote:

Another example of a sadly misinformed surgeon. Sigh.

Obviously you don't want to start with heavy squats or lunges or whatever, but they are not inherently "dangerous" for ACL-deficient persons. The focus of your "rehab" needs to be fourfold:
1. Get the quads firing properly again.
2. Get the hamstrings strong to make up for the lack of ACL.
3. Get the gluteals working properly.
4. Full range of motion in the knee.

Before I give you some exercise examples, I have some questions ...

First, thank you so much for responding! I'm feeling a little lost.

1. Are your quads atrophied on that side? No.

Can you contract them and feel them contracting (with your fingers on the muscle)? Yes.

2. What is your range of motion like? Not as good as left one

Does your knee go all the way straight (nonweightbearing)? Yes

How close to your butt can you get your heel? about 5" away
I was surprised by this. I haven't tried that since the injury. Hmm. Some limitation there. Hurts to go any closer.

3. Can you bridge? Yes

4. Just walking around in your daily life do you feel like the knee is unstable? Maybe just a little. I took the stairs down off the parking deck today. I had to be really careful when I put my lef tfoot forward and had weight on the bad knee. It hurt just a little to do this.

EDIT to add: When I try pulling my heel of my right leg to my butt, my hammy starts to cramp up big time. wow. hurts.

UConnJulie · 08-14-2007, 10:04 AM

I'm still sort of astounded that your surgeon thinks you can rehab this on your own ... but whatever ...

I'm going to give you some basic starter exercises. When they become a piece of cake in a week or so, let me know (PM or email) and I'll advance them.

OK ... first lets do some range of motion exercises to get the joint moving well again. This will help with any residual swelling etc.

1. Wall slides: Lie on your back with your butt up against a wall and your legs up the wall (or in a doorway with just the involved leg up the wall and the other stretched out through the doorway). Bend the involved knee and let your foot slide down the wall as close to your butt as you can get it. Hold for 20 seconds or so and then straighten it by sliding your foot along the wall again. Repeat 10 or so times.

2. Supine towel slides: Sitting with your leg out straight in front of you, wrap a towel over your foot and grasp both ends. Pull on the towel and slide your heel toward your butt. Again, hold for 20 seconds or so and repeat 10 times.

3. Prone knee stretch: Take a towel (or you might need a sheet for this one) and wrap it around your foot. Roll over onto your belly and pull the sheet over your shoulders. Keep pulling until your knee won't bend any more and you feel a stretch in your quad. Hold 20 seconds or so and repeat 10 times.

I'll find or make pictures if these descriptions don't make any sense. Just let me know ...

OK, so now for getting your quads going ... this will be easy to start.

1. Straight leg raises: Lie on your back, and keeping your knee locked straight, lift it in the air about 24 inches. Pause, and slowly lower. Work up to 3 sets of 20 reps.

2. Short arc quads: On your back again, place a full paper towel roll under your knee (or a foam roller if you have one). Lift your foot up, squeezing your quad, until your knee is straight. Pause for several seconds, then slowly lower. Work up to 3 sets of 20 reps.

And now for the glutes and hamstrings ...

1. Bridging: Start with two-leg and progress to one-leg (when you get here, do them on each leg). Lift high ... and hold at the top for a good 10 seconds. 10 reps. 3 sets.

2. Clamshell: Lie on your side with both knees bent (doesn't matter which side because you are going to do both). Keeping your feet together, lift the top knee toward the ceiling. Keep your pelvis vertical and prevent it from rolling backward (so the movement is isolated at your glutes and hip). Work up to 3 sets of 20 each.

3. Single leg balancing. Balance on the involved foot on a firm uncarpeted surface. Hold for one minute. Do whatever compensation you need to stay upright, but don't fall over. If you can't do one minute, work up to it. We'll be doing a lot of single leg exercises in the future and we want your glutes and other stabilizers really working properly.

You can do all of these daily. Especially the stretching. In a week, we'll advance. Keep me posted.

Jimbo · 08-14-2007, 11:14 AM

Quote:

I'm still sort of astounded that your surgeon thinks you can rehab this on your own ... but whatever ...

You're not alone there. I had a lot of confidence in this guy prior to yesterday. Now I'm really wondering about him.

Thank you so much Julie!

Quote:

I'll find or make pictures if these descriptions don't make any sense. Just let me know ...

All makes perfect sense. No pictures needed. However, I'm wondering just how hard I need to push myself? Stop before ANY discomfort, push just a little, Push a LOT? I can tell already that developing the flexibility is going to be one of the toughest things to do.

Quote:

1. Straight leg raises: Lie on your back, and keeping your knee locked straight, lift it in the air about 24 inches. Pause, and slowly lower. Work up to 3 sets of 20 reps.

I do these already. Groovy.

Quote:

And now for the glutes and hamstrings ...

1. Bridging: Start with two-leg and progress to one-leg (when you get here, do them on each leg). Lift high ... and hold at the top for a good 10 seconds. 10 reps. 3 sets.

I did 2 legged front bridge (and side bridges) for 1 minute the other day (since my injury occured) but I had on my leg brace. Hmm..i bet it will be different without it.

I'll be doing all you recommended every day and let you know how it goes. You have no idea how helpful this is.

UConnJulie · 08-14-2007, 12:03 PM

You are most welcome ...

Regarding pushing yourself ... remember that you are rehabbing, not training ... so push a little, but if something HURTS, back off. Discomfort is okay ... stretching, pulling, tight, shaking ... but not true PAIN.

I think we are using the same terminology for different exercises. What you describe, I think of as a plank. (elbows on the ground, toes on the ground, hips in the air) This is what I mean when I say "bridge" ... some might call it supine hip extension or something else (just ignore the bands around the knees). Basically start in supine with your feet flat on the floor. Lift your hips in the air, pressing your pelvis toward the ceiling. Feel your butt with your hands to be sure that your glutes are working (some can do this without using the glutes ... see articles by JB on Dave Tate's Gluteal Amnesia). You might get a hamstring cramp ... if you do, just lower your butt and straighten that leg up toward the ceiling to stretch it out. Try again, really focusing on squeezing the glutes. It should get better after a few sessions.