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Reinjury Fears

post #1 of 24
Thread Starter 
In the last five years I have had both knee ALC's damaged.Since then I have a fear of reinjury resulting in my technique getting sloppy when the going gets tough. I feel my technique is solid but I cannot commit in steeper terrain if conditions are less than perfect.In blue terrain,I can let em' run but I'm lessened to skidding and back seat driving otherwise.
Now to my question. I plan to attack this problem this week with instruction,either 1hr,3hr or all day. I know this is a barrier inside but I am hoping with help and reworking technique things will get straight. Have any of you helped with this problem before and if so how should I approach this with my instructor?
Skiing bio.: 18 yrs.+- , Ski mostly eastern hardpack and ice, solid level 8 in my opinion. 55 years young @ 215lbs .
EPIC is by far the best site going with the most dedicated skiers on the planet.Thanks to EPIC for being here for us all.

Marc
post #2 of 24
While my injury was only a minor one, this is a subject near and dear to my heart. Some suggestions:

1. Choose your instructor wisely, preferably someone know for having empathy in this sort of situation. This is not the scenario where you want to have someone tell you that "it's all in your head." :

2. If you can go with an all-day lesson, it will be great. Sometimes it will take awhile to see a consistant movement dynamic.

3. Tell your instructor about the injury. Sounds like a no-brainer, but it's amazing how many people leave out that detail.

4. Do not be upset if your instructor makes you try some easier movement patterns on easier terrain.

5. Be patient with yourself. Don't expect to ski double blacks your first week back.

6. When life gives you lemons, make lemonade. A good instructor will make you aware of the movement dynamics that caused the injury in the first place. In my own case, now I can feel them happening, and prevent the injury before it occurs. As a result of working with someone post-injury, I ended up skiing harder terrain than I ever thought possible.

Good luck and keep us posted!
post #3 of 24

Reinjury common sense

Marc,

Good God man, are you nuts???? (Just kidding - I couldn't resist) But seriously, part of overcoming fear is the recoginition that ACL injuries are very common in skiing. You are taking a risk. Getting a coach is a very smart thing to do. Consider consulting with your coach on a regular basis as opposed to blowing your budget in one swoop. Compare the cost with investing 15K+ in another knee operation and another year of rehab.

Everyone has their own little pact with fear. ACL injuries come in many flavors too. So your mileage is definitely going to vary. You don't mention whether your ACLs are gone, repaired but weak or good as new. That will have some impact on what kind of skiing you're able to do.

Read Mermer's book (In the Yikes Zone - a conversation with fear). It lays out a path you can use for your recovery.

Check out Vermont Safety Research. They have some great advice for things to do to avoid ACL injuries. Just going through this will either scare the hell out of you or give a lot of confidence that ACL injuries are avoidable.

Do you need/have a brace? Not all braces are skiing friendly. The good ones cost mucho dinero. I remember hearing friends talk about going through 3-4 different braces before they found one they liked for skiing. A quick search of Epic shows a lot of threads mentioning braces, but none devoted to a general discussion of brands. You might want to start a new topic in the gear or health sections.
post #4 of 24
Marc, I've also had both ACLs rebuilt, the left more recently (1999) than the right (1985). Originally I tore the right ACL playing lax in 1982, then re-tore it alpine skiing at Wintergreen VA on the practice run before the DC area ski shops annual employees race in early 1983. I got a Lenox-Hill brace for it in 1983 until the surgery in 1985 which followed some cartilage damage due to the no-ACL instability. Post-surgery I wore a custom molded Townsend brace on the right knee from 1986 until 2001. In 2000 I returned to skiing post left ACL and got a BREG custom brace for the left knee. I skied all season withi the two braces, but worked very hard at PT on both legs toward the goal of no-brace skiing.

In 2001 I skied for the first time in 18 years without any encumbrances on either knee. Man did it feel great. I was also just then learning how to ski really cruddy old snow, which scared me because it was so inconsistent. I kept fearing that either or both knees would get reinjured in the heavier crud. right about that time I was starting to get some help from a friend at my ski area, and he helped me with several technique issues which then enabled me to feel much more comfortable in my previous "rough spot" areas of the mountain (steeps, moguls, trees, cruddy snow).

I found that the only way I got past the reinjury fear was to focus on improving my general skiing, which translated to being more comfortable overall on nasty terrain. Because I'm more comfortable skiing such stuff now, I never even give my knees a 2d thought. I've been skiing for 3 seasons that way now, worry-free. I'm sure you can reach the same freedom.
post #5 of 24
Thread Starter 
LM: Thanks .I was leaning towards an all day session as you mentioned.I don't want to short time the instructer and It will give him/her time to work in an acceptable time frame.Good idea about requesting someone with this type of experience.

Rusty: Thanks for the info. and the links.Good idea on the new thread.Will post in general disc.
I have a brace but very uncomfortable.Never had the surgery.Too costly and no insurance. They weren't completely torn but did seem to heal,just took a while.Yea,I know "SKI WITHOUT INSURANCE, IDIOT". But thats another thread in another forum.
Thanks for the info.
Marc
post #6 of 24
Thread Starter 
gonzo, you give me hope.Which PT did you employ?I am doing some walking/slow run on a soft track mixed with low weight workout. Sounds like expensive but effective bracing. I also feel that refining my technique will give me more confidence.Thanks.This is what makes EPIC great.
post #7 of 24
NC Marc,

You are such a wuss. The crap some people will do for attention on these forums. I tore my ACL, I have a subdural hematoma, I have flesh eating disease. Scorcese didn't win a Golden Globe. Everybody knows the ACL is a superfluous structure and real skiers don't need 'em. :

Seriously: I had my ACL autograft years ago around 1998-99. T

This depends sooo much on your personality and inner drive. I gradually pushed myself back to where I was in about 1 season or less AFTER my ACL had healed and been incorporated and my rehab was done. For me the key issue is once I got my adrenalin going and was having FUN with big smiles, I forgot all about my ACL. I now am better than I ever was and attack bumps with no fear; take jumps; hit the chutes (sometimes with fear but not for my ACL).

FWIW, I had an autograft, not an allograft. A huge affect upon my atheletic performance was getting a KNEED-IT brace for my patella tendon donor site. I am not affiliated with it in anyway. It seem like a simple thing and full of bull but it helped take the strain off the donor tendon. Good luck.
post #8 of 24
Hey NC Marc,

I'm gonna follow along here too if you don't mind. I too need some solid advice about ACL.

I wanna know if there are skiers out there who NEVER got 'em fixed, but still ski well and without problems? Marc, you said yours weren't complete, right?

My right ACL is gone - nothing/zip. I did it nearly 3 years ago (as a non-skier) while learning to play soccer with my 23 year old, mostly male classmates (I was 39 at the time). As a side note - my mother told me post-injury that I should "act my age":

It was unstable and buckled medially, but there was little damage to the meniscus or MCL, so that was a plus. The orthopod I saw was pretty conservative and wanted to give it at least 4 months to see how it rehabbed first before deciding whether to fix it or not. I really wanted to push for surgery, but only had crappy student insurance, and it wasn't like I was a career athlete or anything. I also have three kids and it was my right (gas pedal) knee, so how the hell was I going to get around town post-surg?? Crappy insurance paid for little of the rehab, so I end up doing most of it on my own, since the student rec center had much of the same equipment.

SO.....no surgery, less than 3 years out and I am re-learning how to ski after a 20 year hiatus. I have been fine so far - but only been out maybe 5 days, and I'm maybe a level 5.5 skier anyway. I am a bit worried that as I progress that I'm putting my knee in more jeopardy the more I demand of it. Is this really the case? Or if I haven't minded it yet, is it not going to happen? All I have is a drugstore brace, and I hate it, so I don't use it.

I'd love to hear from anyone who is ACL-less no-fix, who still skis well --- do we exist????
post #9 of 24
Quote:
Originally Posted by NC Marc
I feel my technique is solid but I cannot commit in steeper terrain if conditions are less than perfect.In blue terrain,I can let em' run but I'm lessened to skidding and back seat driving otherwise.

Skiing bio.: 18 yrs.+- , Ski mostly eastern hardpack and ice, solid level 8 in my opinion. 55 years young @ 215lbs .
Based on your ability, age, and previous knee injuries, I would stay off of terrain that puts you in the backseat or makes you ski defensively.

You are just asking to blow out another knee by skiing like that.

Where do you normally ski? What terrain did you used to ski?

A solid level 8 skier would be getting into steeper bumps and uneven terrain. If you are in the backseat in this type of terrain I would say you are more like a level 7 skier.

I have had two ACL surgeries on the same knee. Once in 97 playing football and once in 2003 skiing.

Just rehab like crazy and work your way back up to more challenging terrain. I had to take it easy last year to get my technique down again and get the balls to ski harder stuff again. Remember that your brain, muscles, and knees will want to react differently after surgery in order to protect themself from injury. Most people don't realize that a simple task such as walking down stairs is affected by ACL damage and surgery. For instance you might slightly twist your leg when putting all of you weight on a step because your body is over compensating for the weaker leg. You need to relearn how to do basic things and rehab and exercise is the key.

This year my knee is an after thought and I am back to skiing everything.
post #10 of 24
Not repairing a completely torn ACL places you at risk (if not guarrantee) for premature degenerative arthritis of the knee. That is not fun.
post #11 of 24
Quote:
Originally Posted by Jim S
Not repairing a completely torn ACL places you at risk (if not guarrantee) for premature degenerative arthritis of the knee. That is not fun.
I agree

Cartilege does not grow back and you are just asking to blowout your MCL if you ski nasty stuff without surgery or a proper brace.
post #12 of 24
Quote:
Originally Posted by Scalce
I agree
Cartilege does not grow back and you are just asking to blowout your MCL if you ski nasty stuff without surgery or a proper brace.
I was afraid you were gonna say that
After I rehabbed, I actually spoke with one of our Rheumatologists who was a beloved icon here at the med school (Rest in peace Dr Di). He told me that I should definitely get it fixed after residency - or run the risk of needing a Total Knee Replacement by the time I was 60 or so.:

The problem is that I wasn't skiing at the time I spoke with him. Now I AM skiing, but it will be three years 'til I get through residency, so the question is, how much am I gambling in the meantime?

I'm not skiing anything terribly nasty - just greens and easy blues - and my proprioception on that side is pretty durn good, but I do worry about it.

Hmmm.... can we say "DENIAL"?:
post #13 of 24
Dr. Frau,

Order the video from the Vermont Ski Safety site. You'll feel better about your risks.
post #14 of 24
Quote:
Originally Posted by DrFRAU
I
I'm not skiing anything terribly nasty - just greens and easy blues - and my proprioception on that side is pretty durn good, but I do worry about it.
If you have good muscle control and strength then skiing on greens and easy blues is not a huge risk. There is still some risk.

When you lose your ACL your proprioception will never be the same no matter how good it feels. I spoke to a few doctors that said your ACL has some nerves in it that have neurological connections to your muscles in your knee and leg area. Once you tear it, you lose those connections and learn to compensate. World Cup skiers are such great athletes that it is not a huge issue for them.

I worked on mine by biking, running, tennis, BOSU, bongo boards, wobble boards, exercise, rehab exercises, stretching, and some yoga. It feels pretty damn good to me but I know it is not like it used to be.
post #15 of 24
Scalce - I have no proprioception & ski just fine.... I compensate using my senses of touch(light touch & pressure)... & sight.... (& Yes I mean none - in my whole body it seems I have none)

proprioceptive loss can be very disruptive to a normal person (don't know what you've got till it's gone) but CAN be compensated for quite well with work
post #16 of 24
Quote:
Originally Posted by disski
Scalce - I have no proprioception & ski just fine.... I compensate using my senses of touch(light touch & pressure)... & sight.... (& Yes I mean none - in my whole body it seems I have none)

proprioceptive loss can be very disruptive to a normal person (don't know what you've got till it's gone) but CAN be compensated for quite well with work
I think it depends on how good an athlete someone is.

I played sports growing up so I would guess that I have pretty good muscle control. This probably helped with the pre and post surgery rehab.

My bad leg is pretty damn close to my good leg's speed and strength.
post #17 of 24
I'm a NON-athlete..... no stretch reflex.... no idea how much tension is in a muscle.... no idea where hands are to catch a ball... etc etc....

Simply put your brain will build pathways to compensate and use what feedback you have.... I will never have the reflex compensation blanace skills of a high level athlete - but I still ski very well with no proprioception....it simply requires WORK at learning to do the movements well.... muscle strength can help to stabilise the knee.... proprioception is not muscle strength....
post #18 of 24
Quote:
Originally Posted by disski
proprioception is not muscle strength....
When I say speed I mean how fast my muscle fires. I was just saying that my muscle strength is almost 100% again. I know proprioception is not muscle strength.

Why do you think you have no proprioception?

I would think that is impossible.
post #19 of 24
the doctors & physios tell me so.... I fail all the proprioceptive tests dismally..... the guess is my nerve feed into cerebellum got damaged at birth....

It is NOT impossible - read the book "the man who mistook his wife for a hat" the chater called the disembodied lady is pretty close to me - but I was born & adapted rather than having to relearn.... too much Vit b6 will do it also...
post #20 of 24
Thread Starter 
DrFRAU: I did not have surgery as well. Wish I could have but $$$$$. After the injury,I laid out from shiing for about a month and pampered the knee the rest of that season.I seemed to not have a problem seasons after but it was always in my thoughts and would affect how I would deal with certain terrain.I have insurance now and will probably see someone about it now especially after reading Scalces posts.I never realized the consequences.I have a bad habit of thinking I am still 20.Thanks for the info.Scalce.
Rusty,I ordered "The Yikes Zone".looking forward to it.
Scalce: You may be right on the #7. I Ski soft bumps at speed and love ungroomed terrain with a passion and prior to injury wasn't back seat driving.
Thanks to all for the feedback.Some scared/enlightened me to the point of seeing someone about the knees.You may have lengthened my skiing years,thanks!
Marc
post #21 of 24
Quote:
Originally Posted by Scalce
If you have good muscle control and strength then skiing on greens and easy blues is not a huge risk. There is still some risk.

When you lose your ACL your proprioception will never be the same no matter how good it feels. I spoke to a few doctors that said your ACL has some nerves in it that have neurological connections to your muscles in your knee and leg area. Once you tear it, you lose those connections and learn to compensate. World Cup skiers are such great athletes that it is not a huge issue for them.

I worked on mine by biking, running, tennis, BOSU, bongo boards, wobble boards, exercise, rehab exercises, stretching, and some yoga. It feels pretty damn good to me but I know it is not like it used to be.
Yep, you are right that there are proprioceptive nerve fibers in the ACL that never come back. I know it's not the "same" -- I was just hoping for "good enough", and was happy that I achieved that. Or at least it was "good enough" for what I WAS doing.

Is it "good enough" for skiing is the question for me now. I do get very occasional medial pain if I've exerted alot of valgus stress - sometimes even Varus stress - like sitting "Indian style" for extended periods, so it's this residual that makes me wonder. I don't do much active PT anymore, since it has "normalized" -- beyond my normal exercise routine that is.

(SIGH), I suppose I need to think harder about surgery. I've got about 6 weeks free between Graduation and the start of Residency - that's the only place it could possibly fit.
post #22 of 24
Quote:
Originally Posted by DrFRAU

Is it "good enough" for skiing is the question for me now. I do get very occasional medial pain if I've exerted alot of valgus stress - sometimes even Varus stress - like sitting "Indian style" for extended periods, so it's this residual that makes me wonder. I don't do much active PT anymore, since it has "normalized" -- beyond my normal exercise routine that is.
I'm sure it's "good enough" for skiing as long as you know your limitations.

That pain is normal even for some people who have had surgery. You probably have scar tissue and dead blood all blocked up in your knee which limits your mobility and causes pain. Go see a sports massage therapist and even a chiropractor as they can do wonders for breaking up the damage in your knee.

I don't do any PT stuff anymore either.
post #23 of 24
Dr Frau ... I learnt to compensate for lack of proprioception by working very hard on it.... just is a bit slower to learn & you need external feedback (like watching in a mirror) TO COMPENSATE for the loss of internal feedback... eventually your brain will build the pathways to use the senses you have left (work on removing visual clues such as mirrors & vertical lines as they are not so useful in skiing...
post #24 of 24
i totally tore my acl getting out of control on bumps at snowbird-at least it happened after lunch on the last day we were there
i did not have surgery, i was going to but the pain went away and i did PT and rode my bike during the summer. i spent one depressing winter at home because the doc said no side to side movements.
the next year i decided to try skiing again and if i hurt myself again, then i would have it done.
that was about 10 years ago, now
i am cautious skiing, but that is just my nature, i would probably ski almost the same way without the injury.
i had 68 days last year(8 in utah), up to 29 this year(in killington)so far. we go up every weekend.
i go down all the trails and have fun!
i am most cautious in icy conditions
i use ankle weights to build muscle strength in the knee area
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