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ACL Injury - Rehab Time

post #1 of 28
Thread Starter 
Back in 97 I had a tibial avulsion of my ACL in my right knee after a hard tackle playing football. It healed fine and supposedly the ACL did not sustain damage.

I started skiing in 2000 and loved it.

Last year in Feb I took a nasty spill at Cannon in NH and blew out my ACL on my right knee. I stopped skiing for the rest of the season and I didn't realize it was blown out until I got an MRI in April.

I had surgery the end of May using my patella and so far it feels good.

My physical therapist said I should be on schedule to ski in November but I was wondering if I will be at any risk other than just irritating the knee.

I know I didn't give alot of details but please ask if you need specifics.

After the PT says I can do any exercise I am going to start using my BOSU ball and Skier's Edge which I think will help alot.

I can't wait to ski again.

Thanks in advamce for any advice.

[ August 16, 2003, 11:09 PM: Message edited by: Scalce ]
post #2 of 28
I blew out my left ACL and MCL about 15 years ago. The first two seasons after the injury my knee was quite tender but generally stable enough for any skiing I wanted to do. After that everything was fine until about 5-7 years ago when I developed arthritis in that knee. My orthopedist tells me it is from the (arthroscopic) surgery and having the internal bits of the knee exposed to air. Anyway, today the amount of knee pain I experience while skiing is inversely related to leg strength. The stronger my legs are the less my knees hurt.

I highly recommend cycling as an exercise to rehabilitate your knee. Ask your PT and Orthopedist about it.

Aar
post #3 of 28
Thread Starter 
My PT said I can use a stationary bike with low resistance right now.

I don't have one so I was wondering if any of you had any preferences?
post #4 of 28
post #5 of 28
Thread Starter 
Thanks for all the links.
post #6 of 28
Unfortunately, I have a lot of experience in knee rehab . . .

First, listen to Lisamarie. She's an expert that combines technical authority with inspirational enthusiasm.

Eccentric emphasis--just a real slow (8-10 count) release phase of your squat or press--will be the most beneficial weight training, when you're ready for it. Your ready for it when it doesn't hurt. Also, loose the machines and do as much of your training as possible with free weights, which train all these little stablilizing muscles you need for balance and recovery. Be sure and include lots of core strength conditioning and hip stuff (abductors, adductors, Reebok slide board, stability ball, plank), all of which will aid your recovery strength. Although you want to rehab the knee and its surrounding support system, skiing is a core-strength sport first. Just look at the Austrian team--they're big waisted like weight lifters, not fat, but core-strong.

How old are you? Unfortunately, a reality you should consider is the regeneration speed of youth vs. maturity. That new ACL of yours only started to vascularize after 6-9 weeks, and won't be a thick, strong, juicy, "ligament" for two years--it's got to double or triple in size. The young ACL victims I know (the freestylers--you're doomed if you continue to ski like your animation) have the advantage of rapid regeneration. However, it only gives them the chance to blow their knee out again, sooner--it's like a tattoo: "Born to Fly--on my 3rd ACL". Einstein defined insanity as doing the same thing over again and expecting different results. They just keep doing the same stuff that blew their knee in the first place. My ACL has got to last, as I don't have time to spend rehabbing the rest of my life, and I only want to do this once.

Finally, learn to rest. What my orthopod says is that you can only get the "training effect" if you do two things: train, and then recover. If I've learned anything in the last two years of rehab it's to rest, and that "no pain, no gain," does not mean pain=gain. You can only grow when you're resting. For me, an older athelete, variety, technique, and periodization timing are far more important than pure, blow 'em out max weight/max reps the youngsters pursue. I can accomplish all my goals at 60 to 85% of max weight most workouts. Recovery is a wonderful word, and it's exactly what you need to do when you're working out seriously.

Re: stationary bike--1) big flywheel; 2) electromagnetic resistance is better than mechanical/friction (wears longer, is more constant); 3)pedal straps so you can spin on the up-stroke. I've got a Bally/Lifecycle and have put a gazillion trouble free miles on it. Spin that sucker for hours, and keep that knee loose and juicy. Do one-legged sprints on the repaired side, 30 secs. on, 30 secs. off.

Good luck.

"Motivation won't take you very far if you haven't got the legs." Lance Armstrong
post #7 of 28
What an excellent post, Dave! Please feel free to ask questions about anything that was not covered in the 4 threads above. One thing that is becoming more definitive. Anyone with an ACL injury needs to avoid the leg extension machine. If you are not injured, there is still much controversy on this subject. But keep in mind, open chain exercises are not the best choice for ski fitness.
post #8 of 28
Thread Starter 
Thanks for the tips.

I am 27 years old so I'm not sure if that puts me on the young list.

I do have a habit of recovering fast but I have been babying my knee.

I had surgery May 28 and my knee now feels fine.

I walk up stairs all the time when taking the T in Boston and I have a 20 lb backpack on.

At first my knee would feel slight pressure when doing this but now it feels fine.

I have full range of motion but I cannot put my heal to my but to stretch my quad but this is probably due to tight muscles and still some internal inflamation.

My PT is not aggressive enough even though I told her my goal is to be skiing by Nov/Dec and she agreed I would be able to.

Last night I got annoyed at doing the basic movements she gave me and I hopped on my Skier's Edge for about 10 minutes. It felt fine while doing it and it doesn't hurt today. I feel where my leg is weak but no pain.

I also balanced on one leg on a BOSU for about 5 minutes and that felt fine also.

I have been doing hamstring curls for the past 4 workouts so that is getting stronger.

Is it wrong for me to push like this when I do not have pain?

I know my own body and when it is not ready but I don't want to risk not skiing for the rest of my life.
post #9 of 28
You are headed down the right path. I have torn both of my ACL's (both skiing, both after jumping, but due to very different reasons, so fortuantely, I don't fall into Downhill Daves doomed and insane category). All of the information already mentioned is good. Don't worry about the time frame, November is still two full months away. My first ACL surgery was in May as well, and I was cleared for full activity in October. After the second surgery the ortho and PT told me to slow my rehab down, because at three months I had full range of motion, 94% of my strength back, and the jumping tests were normal. The surgery was Jan 2, and I skied on March 30 (despite the docs recomendation). Stick with the rehab and you will be fine.
post #10 of 28
Good comments by everybody. I encourage you to keep working aggressively on it but with some caution. There is a point about 3 months after the surgery where the pain is reduce greatly but the ACL is not still that solidly attached to the bone. You have to be careful to not be overconfident and pull it out of the bone. The ACL is very well attached after 6 month. Aggressive rehab works but within reasons.

A word on periodization, if you want to increase strength and endurance at the same time, work on increasing the volume and or intensity of strength training for 2 weeks as you keep your cardio constant. Then in the next 2 weeks cut slightly the volume but not the intensity of strength training and increase volume or intensity of your cardio. Then you repeat again. This way you can maintain a quality for 2 weeks while you improve the other. You will make faster progress this way because the body doesn't like to adapt to too many differents stimulation at once. It was used successfully by high level athlete that required both cardio vascular endurance and strength.

[ August 20, 2003, 01:06 AM: Message edited by: Frenchie ]
post #11 of 28
Here is a link to a topic on periodization:
http://www.epicski.com/cgi-bin/ultim...=000192#000000

BTW, once you establish a consistent conditioning program, your training cycles will become more or less intuitive. A well conditioned body knows exactly what it needs.
post #12 of 28
Thread Starter 
Thanks for all of your help

My next question is should I wear a knee brace when skiing this season and of so what kind?

I know that a brace is not going to save me from injury so is it even worth it?
post #13 of 28
Thread Starter 
I just came back from my chiropractor and he worked my quad and hamstrings alittle.

So far it feels great but I will go back for more visits.

I am also scheduling some massage therapy for my knee and scar tissue which will help bring my full range back. I already have normal full range but not what my personal range usually is.

I am also going to take some Glucosamine which helps promote cartilage regenration and healthy joint.

Hopefully this all works.
post #14 of 28
The knee brace issue is controversial. Here is a topic:
http://www.epicski.com/cgi-bin/ultim...=000059#000000
post #15 of 28
Brace: If you get one, get it fit by a pro. I used a Breg X2K last yr. (when I was skiing w/o my ACL). It's set up with ratchets to limit your extension range, critical for protecting the ligament, and certainly offers some collision barrier. If your insurance won't pay for it, check out Canadian prices.

Glucosamine: there seems to be some research that endorses it, certainly for a worn out old guy like me, and while you're at it, may as well combine w/chondroitin, and MSM, a sulfate, another important joint nutrient. I'll remind you again, however, that all the supplements in the world won't "supplement" rest. Sure, work it, but rest it plenty, too. Everything around that knee will heal and grow faster than the ligament and cartilage.

Chiropractor vs. P.T.: you sounded disappointed in your P.T. Find a sports practice, somebody that knows knees, who's rehabbed a lot of them, and who you have rapport with. I saw a gal for a few sessions in Whistler that had forgotten more about knees than most P.T.'s will ever know. My P.T. here at home (a sports medicine specialist) is just great, and has taught me so much about conditioning and training I'm a better athelete, and will certainly last longer, because of it.

"The Tour is won in bed." Anonymous member of the peloton
post #16 of 28
Thread Starter 
Thanks for the all the help.

I just hope that I can ski this year or I will be greatly dissapointed.
post #17 of 28
no...

...please...

...not...

...the chiroQUACKtor!

sounds like you have been punished by the medical gods. ignore that quack spine adjuster. spines don't need "adjustment." chiropractic is DANGEROUS and is a ripoff.

get thee to a physical therapist who specializes in SERIOUS athletes who need maximal strength and optimal recovery.
post #18 of 28
Thread Starter 
I actually go to my chiropractor for Active Release Therapy.

The spine adjustment is not the main reason and is actually only the last 2 minutes of my sessions.

I had a pain in my lower back and upper quad that I went to my primary care physician, orthopod, and PT at Mass General for.

They gave me the basic crap of stretching and normal PT type exercises.

I went to a chiropractor and my issue was fixed in 2-3 vists.

The nerve that runs through the lower back into the quad was getting squeezed in my leg and causing burning in my upper quad.

The only way to release it is by ART or massage.

My insurance actually picks up my chiro appointments.

People who dismiss chiropractors and massage therapy as good additions to PT and doctors are either misinformed or think that they only live to align spines.
post #19 of 28
Quote:
People who dismiss chiropractors and massage therapy as good additions to PT and doctors are either misinformed or think that they only live to align spines.
1) what is the SCIENCE behind chiroquacktic?

2) palliative is not the same as curative.

3) "manipulation" in its various forms still is MANIPULATION.

4) who has the "normal lordotic curve"?

5) if the chiroQuacktic says your spine has an abnormal lordotic curve, yet never saw you before the "injury" that caused you to go see the chiroQuacktic, how does he/she know the curve is abnormal? what is the baseline?

6) what about DC school teaches differently than PT school or MT school? (hint, it's in the pseudoscience)

7) it's your money, waste it as you wish.
post #20 of 28
Quote:
Originally posted by Scalce:
Back in 97 I had a tibial avulsion of my ACL in my right knee after a hard tackle playing football. It healed fine and supposedly the ACL did not sustain damage.

I started skiing in 2000 and loved it.

Last year in Feb I took a nasty spill at Cannon in NH and blew out my ACL on my right knee. I stopped skiing for the rest of the season and I didn't realize it was blown out until I got an MRI in April.

I had surgery the end of May using my patella and so far it feels good.

My physical therapist said I should be on schedule to ski in November but I was wondering if I will be at any risk other than just irritating the knee.

I know I didn't give alot of details but please ask if you need specifics.

After the PT says I can do any exercise I am going to start using my BOSU ball and Skier's Edge which I think will help alot.

I can't wait to ski again.

Thanks in advamce for any advice.
I few things I learned with my ACL rehab

I did weights against the PTs advice. Absolutely no sheer force weights (leg extensions) and light weights to start and limited balance requirements. I believe strongly that this got me back faster than a thousand reps of no weight was going to.

Another vote for the bike being very good and I was on my road bike when the first 5 minutes saw me lifting the hip to get the pedal around. Then I could ride smooth spinning low gears on flats for some pretty long rides before long.

Big thing that helped a lot BEFORE downhill skiing was Xcountry skiing. Although the knee was strong it wasn't until I used it in a coordinated balance and movement situation that I felt it was ready to go skiing. Roller blades or ice skates would give similar muscle use and development.

Something I learned recently is that Cartledge does not like blood. Even if they was no cartledge or meniscus damage there was likely bruising. This bruising causes the tissue to become fibrous and lose it's resilience over time. Start gobbling the glucosamine now to keep the tissue lubed and cushy as possible. Learning about this while the orthopod digs a crator out of your cartledge seems a tad late to be functional.

A strength training coach (Charles Poloquin who LM can vouch for)said to me once, 'go to physio to get your range of motion back and then get the hell out of there. They don't know anything about getting strength back.' His words not mine although I whole heartedly agree. Athletic therapists are different and specialize in getting people back to their activity or sport healthy and with functional strength.

[ August 22, 2003, 09:04 PM: Message edited by: L7 ]
post #21 of 28
Thread Starter 
Thanks for the post L7

I had a massage therapist work on my knee for an hour today and it feels 100% better.

He used to be a AT so he gave me some good advice like to ice it all the time no matter what I am doing and even at work.

I am going to pick up a wobble board this weekend to start using that.
post #22 of 28
I'm curious if you think this mocking inflexible bias you show in the name calling below could be the sort of thing that helped the gathering thread go so horribly wrong. My impression is that your mind is totally made up and you will or can absorb no new information on this subject. But I can't resist.

Quote:
Originally posted by gonzostrike:
</font><blockquote>quote:</font><hr />People who dismiss chiropractors and massage therapy as good additions to PT and doctors are either misinformed or think that they only live to align spines.
1) what is the SCIENCE behind chiroquacktic?

L7 If the joint moves again it has hope to continue to move and the muscles around it can be retrained for strength and range of motion and break the cycle of spasm that causes the joint to stay locked.

2) palliative is not the same as curative.

L7 What's your point?

3) "manipulation" in its various forms still is MANIPULATION.

L7 Again what's your point? It is still manipulation and it CAN be effective which is why physios will also use it.

4) who has the "normal lordotic curve"?

L7 I tend to think that most people with a functional spine throughout all the joints could be said to have a normal curve.

5) if the chiroQuacktic says your spine has an abnormal lordotic curve, yet never saw you before the "injury" that caused you to go see the chiroQuacktic, how does he/she know the curve is abnormal? what is the baseline?

L7 If the spine is dysfunctional at one or several joints and that would likely create an abnormal curvature.

6) what about DC school teaches differently than PT school or MT school? (hint, it's in the pseudoscience)

L7 the traditional medical community is often narrow enough in it's view that anything they don't understand or didn't learn in school is 'psuedoscience.' Sadly they also have a rich history of prescribing treatments and drugs based on their self proclaimed hard science that later proves deadly wrong. Thalidomide and Estrogen therapy come to mind.

7) it's your money, waste it as you wish.

L7 I spent 10 years chasing and treating symptoms with a highly regarded physio therapist. Improve your posture was a common refrain despite my apparent inability to do that. When I walked out of the Chiro on my first visit I was finally able to feel the benefit of that improved posture. My chiro through re-establishing blood flow got my hip to feel better than it had in a decade despite my physio's warning that I couldn't avoid hip replacement. That hip also proved to be much of the root cause of my trouble instead of the many symptoms that were treated. My chiro took me through numerous tests to narrow down a knee problem after my doctor had sent me out the door with the exact statement I had entered the room and stated to her. The knee eventually required surgery which he happily sent me for but only after I insisted we explore all other options first. I too am in a position where my health care coverage covers the chiro better than the physio so the money is not just better spent but less of it is being spent by me.
</font>[/quote]There are many bad doctors, there are many bad physios and there are many bad chiropractors. There are also many examples of good ones in each field. Each field has practioners who will make claims that they can't back up. All three can also provide beneficial and valid treatment much more so when the treatment is provided with an open mind towards various therapies and approaches.

I didn't bother to denigrate the names to any the fields listed here. That just seems juvenile and would only point out my bias. Sort of like people who make jokes at the expense of lawyers.

[ August 22, 2003, 08:59 PM: Message edited by: L7 ]
post #23 of 28
Scalce-Buddy:
Would you rather ski "moderately" this season, or rehab a 2nd surgery? Maybe when they replace the ACL with a cadaver's ligament you can be 100% quickly, but you now have a sliver of your patellar tendon where it's never been before, and it's got to nearly triple in size to replace what was there before. I saw the before and after photos--didn't they show you? Itty Bitty now. Biggy wiggy then. Tendon grows slow (2 yrs.). Muscles grow fast. Strong leg. Thick Head. Thin Lig. You do the math. Moreover, the patella tendon has to regenerate, at, you guessed it, nearly the same slow rate as the ACL. The chief side effect of this type of surgery is patellar tendonitis. That takes years to go away, and lots of prednisone. To summarize, the cost of pushing it too hard or too far could be a wasted surgery and rehab, or years of pain. The benefit would be one more season out of many. Just seems like venturing a lot to gain a little. You go ahead and do what you want. As my p.t. says, they'll be happy to help you rehab all you want. Good Luck.

In 1941 Wendy Morse set the speed record for a rope tow ride: 91 mph on the Suicide Six in Woodstock, Vt.
post #24 of 28
Not meaning to imply going out there and giving 'er. Moderate would be key and paying attention to fatigue and pain or swelling. My injury and surgery were in early July. I was on skis in early Nov. A little earlier than my doc reccommended and earlier than was ideal but I had commitments. First half of the season was very moderate but I never used a brace. My doctor relied on me being able to not fall down for a few months and skiing back to a full range of motion and ski muscle. I was able to keep all work commitments but skied no bumps until some small ones in Feb. Bump skiing quite a bit by March but still 'protecting' the leg. Wasn't until the next season that I was truly full bore after a full cycling season. Also realized that next season how much I had altered my technique to protect the knee. My doc used the semi tendonosis and was very clean with only two one inch incisions (plus the 3 little scope holes I can't find anymore). Friends who had surgery using the patella but more aggresive in terms of early mobility got back as fast or faster. I had no problems at all until 12 years later when I needed a little articular cartledge clean up related to the bruising I mentioned above. Thick head would be a bad approach, thick leg not so much so. Just make sure that thick involves lots of hamstring strength.
post #25 of 28
Thread Starter 
I am not going to ski aggressively this season but probably work on technique.

I am going to rehab aggressively so my muscles can compensate for my weak ACL.

My doctors all said that I didn't even need surgey unless I wanted it becasue my leg more than compensated for the knee stability.

I had the femur and tibia slip once or twice and decided I would rather rehab after surgery than damage my meniscus.

I value all your input.

Well all except gonzostrike.

[img]tongue.gif[/img]
post #26 of 28
Thread Starter 
I went to New England Fitness Company in Vermont today and picked up a wobble board and a set of ProBells.

If you have never seen them check them out.

ProBells

My apartment is pretty small and I already have a BowFlex, Skier's Edge, Bosu, and all the other exercise stuff I own.

I really like the Bowflex but for curls it just doesn't do the trick.
post #27 of 28
Scalce,

sorry I am WAYYYYYY late in joining this discussion, but I am in pretty much the same boat as you - blew out my right ACL Feb. 2003 in Whistler. Had surgery March 27, so I'm about 7 months post-op. And dealing with the T while in the post-op brace (before pre- and post-op) was a nightmare.

I just turned 30. I'm kind of at that crossroads where I'm not old enough to slow down, but need to start thinking twice before leaping off cornices. My rehab has been pretty quick, although the muscle hasn't come back as fast as I would've liked.

I think the comments about getting range of motion back first are right on. That was the first thing I was told to concentrate on. I did my first 6 weeks of PT on my own, all range of motion activities. When I went to PT, they concentrated on more range of motion, strengthening and balance.

once formal PT was done, I got a membership to the local Y. There it was all strengthening for my thigh and hamstring. He suggested I keep the weight on leg raises as close to my knee as possible. It reduces strain on the kneecap. But he didn't want me doing, squats, presses, anything closed-chained. I thought that was odd, but I still do some of them anyway (very lightly though). Definitely goes contrary to what Lisa says and what I learned at PT. I also started taking spin class once a week (GREAT rehab) and just ran 2 miles on the treadmill the other day for the first time since the operation.

I just got my brace - a Breg that everyone else in here is talking about. I got it from a guy near Andrews on the Red Line - drop me a note if you want his info. I have heard there is no proof that it prevents injury, but I want one for peace of mind. I'll probably ditch it after a season or two.

I would've thought 6 months post-op would be an aggressive schedule to be back out skiing. I'll be at about 9 months, and I was nervous about that. But then I hiked Mt. Washington at 4 months. I didn't hike down (thank God for the hiker shuttle), but still. I thought my orthopod was going to kill me when I told him that. I think as long as you keep up with your PT fairly religiously and take it easy for a bit on the slopes, you'll be good.

Good luck and see ya on the slopes!
post #28 of 28
Thread Starter 
Thanks for the post.

Overall my knee feels great.

I do about:
15 minutes on a stationary bike,
15-20 on a Skier's Edge,
wobble board for about 5 minutes,
squats and hold them on a Bongo Board,
4 sets of 20 squats with a yoga ball
3 sets of plyo straight jumps and touch my butt to a bench and repeat,
weighted walking lunges,
hamstring curls on a bench,
hamstring curls on a yoga ball doing abridge,
and starightleg deadlifts

every other day or 2 days inbetween.

I also do my upper body and abs right after these legs exercises.

The true test was the other week while I was in New Orleans and I was drunk every night until 6 or 7 a.m. dancing and stumbling and running around in shoes on uneven sidewalks.

During the day we would just walk everywhere all day.

My knee took it like a champ and didn't hurt one bit. It would get stiff on me but that's what the jacuzzi was for. [img]smile.gif[/img]

It's only month 5 for me but I feel good, I'm eating good and taking supplements, working out on a regular basis, and getting excited about skiing.

Skiing drives me to rehab properly and as soon as there is enough snow here, I will be on the hill.
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