Injuries and RehabTell us where it hurts! Do a quick search before asking about your shoulder injury to make sure your question hasn't already been answered (about 50 times), and read the sticky post first.
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.
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
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Life's a Journey ... Enjoy the Ride!
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.
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.
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.
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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?
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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.
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.
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?
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Life's a Journey ... Enjoy the Ride!
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.
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.
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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, pushjust 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.
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.
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I have been corresponding with Julie on my results but thought I would post for the benefit of anyone interested who might have the same issues.
Using the routine that Julie layed out here has, within a single week, already yielded some great results for me. My knee is not perfect yet but I am able to take stairs now. And I am walking without a limp. The stretching exercises almost immediatley made a difference. I have a ways to go but, just fyi, this routine has helped me greatly.
Couple of weeks into rehabbing and I keep improving.
I know I already asked about a yoga class. But I'm actually considering walking into a step arobic class for a session to see if I can "cut the mustard" there. Julie..would that be a mistake? Too much too soon? Bad idea or maybe good?
Right now ... yoga ... I have nothing against step aerobics, but if you are new to it, the choreography might be a challenge, so stepping up on a 6-8 inch step to new choreography at a fast pace might be a prescription for further injury at this point.
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Right now ... yoga ... I have nothing against step aerobics, but if you are new to it, the choreography might be a challenge, so stepping up on a 6-8 inch step to new choreography at a fast pace might be a prescription for further injury at this point.
10-4
I figured as much but needed someone to talk me out of it. It would have fit nicely with my efforts to shed fat. But hey..the stress relief of yoga will help avoid belly fat. So it's all good. Thanks!
I am in a similar situation as Jimbo. I was almost finished writing a rather long and detailed description of how I tore my ACL and the following doctors visits and information, but somehow went back from the reply page and lost my entire post. So now for a succinct version of my post.
May 20th: I completely tore my ACL dirt bike riding
got x-ray 4 weeks later: no break
got MRI august 29th
Sept 11: specialist told me results of MRI: "Completely tore ACL and there appears to be nothing else wrong with my knee"- specialist
Oct ? : tentative Knee surgery, using tendon not of my own to replace torn ACL. interesting/scary fact: 1 in 2 million chance of getting a venerial disease from tendon donor **crossing my fingers.
(If you're wondering why it took so long for everything regarding my injury, thank the great healthcare system this country has)
My question is whether I can follow the prescribed routine outlined for Jimbo by UCONN Julie even though I have slightly different answers than Jimbo, to her questions:
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? currently cant reach glutes with heel and cant fully extend knee
Does your knee go all the way straight (nonweightbearing)? No, falls just short of full extension.
How close to your butt can you get your heel? about 4" away on my best day. It depends on how swollen my knee is at the time. My knee swells up when I have an active day on my feet.
3. Can you bridge? Yes
4. Just walking around in your daily life do you feel like the knee is unstable? No, knee feels fine, but did tweak my knee playing tackle football on the beach, felt it give when I tried to make a plant followed by a lateral movement. I know dumb of me to be playing tackle football while I was injured but at the time my knee was feeling pretty good and Istill hadn't found out about my ACL tear.
Another question: What were the follow up exercises/stretches that UCONN Julie gave to Jimbo? They were not posted in this thread
What I've been doing up until Sept. 11:
I slowly started playing racquetball about 5 weeks after injuy (was low A level player before knee injury). Playing only as hard as my knee would allow me to play, slowly playing at higher levels. By the time I found out about ACL tear I was competing at a B level and winning a good percentage of the time.
What I've been doing since injury and current to date:
When I was able to walk around good enough(about 5 weeks post injury) I started to do an upper body only exercise routine also including ab and lower back work to keep at least my upper body from wilting away like my lower body has been doing (**sniff sniff all of my hard work down the drain as far as my lower body is concerned). I also have been icing my knee a couple of times a day since the injury.
This past week:
I started to do Aqua Aerobics (Tuesday and Thursday) and am going to combine it with swimming laps twice a week(did my first day today). Both aqua aerobics and swimming are done without pain, while still pushing myself. I just want to make sure these things will help me get ready for my surgery and not put me in a worse position.
Last question any other suggestions as far as preparing my knee for surgery and post surgery?
Honestly, I would avoid racketball ... everytime you plant that foot and pivot you risk re-aggravating the knee ... and if your other ligaments are intact now, you want to keep them that way until surgery.
Keep swimming/water aerobics. Great stuff for knee rehab. If you have access to a belt (that allows you to float vertically) then you can even run in the water.
ROM exercises: 2+ times daily until the knee is straight, then once daily until surgery
1. Prone Hang: Lie prone at the edge of the bed (across the bed) with your knee at the edge and your lower leg hanging off. This will allow gravity to help straighten your knee. You really want that knee straight before surgery.
2. Sitting Hang: Sit in one chair and prop your heel up on another. Again, let gravity pull your knee into full extension.
I wouldn't worry a whole lot about gaining flexion right now. If you lay off the racketball, the swelling will likely come down enough that it will return on it's own.
But you do want to keep the quads and other muscles surrounding the knee strong before surgery. This may sound like a wimpy exercise, but if done properly it will help before surgery.
Strengthening Exercise:
1. Straight Leg Raise in 4 Directions: Lie on your back and bend the non-injured knee. Press through the heel of the injured leg, squeeze that knee as straight as you can, and lift the leg until it is parallel with your other thigh. Slowly lower. 10-20 reps. Then roll onto one side and repeat. Roll onto your belly and repeat. Then roll onto the other side and repeat. Once a day is sufficient with this.
And don't worry about the allograft. I know many people who have had them and had no problems.
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i had an allograft acl repair in 2001. can't say enough good things about it. after surgery and re-hab b sure to keep the quads and hamstrings strong. i have no pain and no real limitations on activity- other than things i dont do by choice (running, tennis). i haven't worn a brace since 6 weeks post-op either.
squats will be your friend!!
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I wanted to say that I've had BOTH of my ACL's (and MCL's, medial meniscus's, etc) repaired using my own patella tendons - one in 1989, one in 1992 - both from college soccer. Surgury came a long way just between those two dates, so I am sure it is far better today. I have some major scars, but, was never going to be a model anyway...
Just wanted to pipe in to say that I never think about my knees at all, am able to do anything I choose to do, but...I do select my activities according to my priority - I choose not to play soccer, but I have skiied, waterskiied, wakeboarded, snowboarded, and done just about every type of cardio and lifting, with no issues. I pick my battles thoughtfully at 38 - as just being able to go to the gym and go to work are my most important daily activities!
I tried to rehab my first injury for 6 mos before deciding on surgury, and it was alot of pain, and the knee seemed to "slip out" more and more frequently. I would be more aggressive about getting the surgury faster if I had it to do over again (but I guess that depends on the MRI diagnosis - partial or complete tear-wise). Hmmm, I guess I DID have to do it over again!
Good luck to both of you - it's a very recoverable surgury, but it's major and you definitely want to make sure you are in good hands with your doctor/surgeon (look at whether your surgeon works on the local professional sports teams or college teams), and that you are working with an aggressive physical therapy program (for athletes vs just the average person who tore it slipping on the ice).
Karla
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Awesome tips guys thank you all for taking the time.
Julie:
I will definitely follow the advised ROM and Strengthening exercises. I haven't played racquetball in over 11 days and I am missing it soooo much. It will be hard not playing one of my favorite sports daily like I use to.
Is it fine if I also do the excercise/stretches you prescribed to Jimbo?
Chickdiver:
It's good to hear you aren't really limited after your surgery, gives me hope since I'm an EXTREMELY active person. Squats and deadlifts are some of my favorite excercises, can't wait to get back to them.
Karla:
Good tips on the surgeon and physical therapist program. I'm going to request a program for an athlete.
Thanks again to all who posted their advice and support,
Since the surgery I've DLed a PR of 500 and have no limitations in activities. I only notice that I've had knee surgery when doing deep squats, but I'm sure eventually that will go away. Let me know if you have any questions. Good luck!
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"We are what we repeatedly do. Excellence, therefore, is not an act, but a habit."-- Aristotle
Julie:
Wow I am amazed at the progress i've made in literally 2 days. I was able to fully extend my knee last night for the first time since my injury and today i was able to touch my heel to my butt.
eastcoaster: Great to hear you have bounced back so well from your ACL tear. Really gives me a reason to aim high in my post surgery recovery!
Torn ACL
Also Tore my ACL
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