Decision to get surgery now or later... - JP Fitness Forums

pyropinup · 01-02-2008, 12:30 AM

I work in the US as a wildland firefighter. This involves a rigorous physical training regimen along with work carrying up to 40 lbs (20 kg) or more, walking on uneven, rocky, unstable and sometimes steep terrain, and working for up to 16 hours per day. I recently ruptured my ACL while skiing in late December, and after a recent MRI the doctor said that after 2 weeks of physical therapy we would look at the options of surgery. However, I hear that recovery periods post-surgery can be up to 6 months of more before returning to normal use. My job will begin in early April. The doctor said it is an option to strengthen the rest of the leg and wear a brace, but that this could cause further injury if I am not careful. Based on your knowledge bases and experiences, would it be possible AND probable to be in great shape for April if I take a determined and aggressive approach to rehab and wear a knee brace, and then get the surgery in October (when the season ends), or is it not physically possible?

Also, I would like to add that yesterday at the post-MRI appointment, my range of motion was 10 to 100 (not able to straighten it out all the way, but almost, and can bend it more than 90 degrees), and I am using a cane to move around now. I injured it 2 weeks ago and am icing and taking ibruprofen. The joint doesn't feel too unstable. Going up and down stairs is a little uncomfortable.

Hope this illustrates my situation more clearly. I am also a determined, athletic person who would undertake any regimen if it meant that I could perform my job starting in April.

Jean-Paul · 01-02-2008, 06:49 AM

If it is going to have to be repaired I would just do it. You seem disciplined enough to rehab it properly and aggressively. I don't think you should put it off till you start the job considering what its going to entail. You should be far enough along by then to be able to handle the work

pyropinup · 01-02-2008, 11:20 AM

Jean-Paul: you make a logical argument that my pride, drive and schedule don't want to hear, but really it is the difficult right over the easy wrong. You keep a glimmer of hope alive, which I appreciate.

I go back and forth between bouts of determination and depression/defeat. I hate it!!!!!!!

I realize there are many people on this forum and elsewhere who desire to return to sports ASAP. Has anyone actually returned to full physical activity within 2-3 months post-surgery? How do biking and swimming factor into rehab? good? great? Any other activities/strategies that helped people?

My main concern is doing the fitness tests within the first couple of weeks of starting (early April). We do a pack test which consists of carrying 45 lbs (22kg) on a flat, 3 mile course within 45 minutes. Then we have certain amounts of pushups, pullups and situps to do, along with a mile and a half run in less than 11:40. We do daily training both physically and in the classroom when starting out. I need to talk with my boss and see if there can be an arrangement made, since we don't start becoming available for firefighting until late May or into June.

I see a PT today for an evaluation. I can use all the positive vibes I can get, and more replies are always welcome!!!

Cheers,

Jeanne

LisaS · 01-02-2008, 11:45 AM

you might want to check eastcoastsurfer's experience documented here
I think he was about as motivated and dedicated to his rehab as it sounds that you will be -
[of course no two injuries are identical, no two surgeries, no two recoveries, YMMV, etc. ]

pyropinup · 01-02-2008, 11:53 AM

LisaS,
ha! Funny you should mention eastcoastsurfer's situation, because actually I have been PMing with him about his recovery. His ordeal does provide a glimmer of hope for me. He was doing more workouts post-injury/pre-op than I am, but I am meeting with the PT today for an evaluation.

Thanks,
Jeanne

Quote:

Originally Posted by LisaS

you might want to check eastcoastsurfer's experience documented here
I think he was about as motivated and dedicated to his rehab as it sounds that you will be -
[of course no two injuries are identical, no two surgeries, no two recoveries, YMMV, etc. ]

ericajones80 · 01-02-2008, 12:07 PM

I've had several knee surgeries...reconstruction on both my left and my right. It's tough to gauge recovery time because it differs so much. I've played soccer and ran my whole life so it was easy for me to recover because all the muscles built around the knee were strong and gave it more stability. I'd personally say you can gut it out through your work season w/o surgery....just make sure you have ice and pain meds on hand! Good luck!

UConnJulie · 01-03-2008, 08:57 AM

Jeanne, as a physical therapist and ACL-reconstruction patient (in 1993) I can say that it IS possible, you just have to have a serious discussion with your surgeon about your true desire and the exact nature of the stresses it will be putting on your knee (as the graft gets weaker before it gets stronger). Really weigh the pros and cons of surgery now versus October with him. Look at the braces (they are often restrictive and uncomfortable, and don't really restrict the rotation movement which is often the direction of instability in an ACL deficient knee.

Let us know how things went with the PT ...

pyropinup · 01-03-2008, 04:55 PM

Well, I met with the PT yesterday, and she said it was possible to strengthen it up and possibly with a brace, hammer out the season. She gave some ROM exercises and quad strengthening exercises since my muscle atrophied a little. :-/ She said that I could get surgery but that the recovery would be around 16-20 weeks, possibly longer.. So she said basically all that you've been saying.

Armed with this information, I talked to my boss. Surprisingly, he didn't even mention the possibility of not doing it at all, but said that if I got the surgery and wasn't ready to go, that I could work on his crew next year in 2009, potentially. I told him my number 1 option was to strengthen and do the season, and he understood that option. He said that even if I rehabbed and sometime in March I decided that for whatever reason I wouldn't be able to do the work, that he would put me on the list for 2009. If this sounds confusing to you, it is because I normally work in NE Oregon on a district fire crew. The crew I want to work on for the summer is a hotshot crew, which trains more and functions as an autonomous 20-person crew. I worked with them for 2 weeks last year as a trial so I know the rigorous demands. I asked him if anyone else had performed as a hotshot without an ACL and he said that he hadn't. soooo, a first time for everything!

I ruminated quite a bit on my decision (I am an overanalyzer at times) and after discussing further with my best friend, who is also a PT, I will push forward and train train train and strengthen strengthen strengthen. Actually, while I am typing this, I am performing heel slides on the floor!

What do the knee braces actually do if they don't limit the rotation movement?

I am now scheduled for PT 2 days a week and I will be joining a gym soon to work on the rest of the body!!

Thanks for the replies, everyone.
Jeanne

UConnJulie · 01-03-2008, 06:17 PM

Jeanne, glad that you have a decision you feel good about. The surgery really is not a huge deal though, and rehab goes pretty quickly. But have it when your season is over and you'll be glad you did.
The braces are generally designed to limit rotation and anterior translation. They do a fair job at limiting anterior translation, and and ok job at limiting rotation. My recommendation is to get a custom brace, and maybe look at a few different types before having the cast done. Also, if you have atrophy, then work to restore your muscle bulk before getting the casting done. I had my casting at about 4 months out from surgery and 8 months out from surgery I could barely wear the thing!!

For your rehab, first focus on decreasing inflammation and getting full extension. Also focus on quad reactivation and strength, but most of all work on posterior chain strength -- FUNCTIONALLY, not sitting on a machine. When able, you should be doing all sorts of single leg balance exercises (single leg RDL, single leg squat, SHELC -double and single leg) etc. Especially because of the demands of your job ... carrying heavy weight on unlevel ground with low visibility ... you need to have your balance at top level.

Best of luck, and keep us posted!