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No ACL, no surgery, no problem - My new normal as a Coper

marzNC

Angel Diva
Bit of a delayed reply, I'm afraid, but thanks for responding. I've not had lessons in years but have skied a lot in France and Canada and a bit in the US. Thanks for the tip about the Sweetspot. I was interested in what you wrote about the Skiers Edge. I'd never heard of that but managed to track down a physio here who has one and had a go last week. Definitely good for confidence that the skiing movement is no problem.
I also have been doing the KOOS online since reading about it - again very reassuring to see the score come up over the months.
Good to hear that KOOS is helpful. I was feeling a lot more confident once my score reached 90 that reaching 95 was clearly possible given enough time.

Looking back at that first year after five seasons skiing, I have a different appreciation for milestones in those early months. It was the middle period that was the hardest in many ways.

Month 1: crutches (injury was during trip abroad, not skiing) and rest - June 2012

Month 2: formal PT, mostly no impact exercises while giving MCL strain time to heal completely, MRI confirmation that ACL completely ruptured

Month 3: completed weekly PT, started weekly personal training, fully functional for daily living, KOOS 86-88 (Mild or Moderate for Running, Jumping, Twisting/pivoting because avoiding those actions), second and final appointment with orthopedic surgeon

Month 4: continue personal training, back to indoor rock climbing, avoiding jumping and running (never liked running for exercise)

Month 5: final PT session included agility exercises, KOOS around 90

Month 6: ready for easy skiing, KOOS at 94 (Moderate for Twisting/Pivoting)

Month 7: skiing at speed on small hill (Massanutten) - Jan 2013

Month 8: started lessons with a very experienced instructor (three Silver Clinics at Massanutten with Walter, PSIA Level 3), decided not to bother getting a brace

Month 9: 3-hour private lesson out west at Bridger (Ric Blevins, PSIA Level 3, worked with Ric the season before), skiing at Bridger and Big Sky included a few bump runs steeper than during the trip to Big Sky the year before

Month 10: skiing harder ungroomed terrain at Alta than the previous year, KOOS about 96 - Apr 2013

The fact that my local skiing is at a small hill (Massanutten), as opposed to a large mountain, was helpful in a way because I had time to get comfortable before going somewhere with advanced terrain. My home hill doesn't even have any off-piste terrain and it takes no more than 4 minutes to finish a run going non-stop, even at moderate speed with lots of turns.

The main advantage of lessons during the first season is that I was able to improve a bit, not just get back to the pre-injury level. Since then, I've improved far more than I ever expected when I started skiing more regularly after age 50. Back then I thought I had about ten years to work on technique. Now at 61, I feel like I can keep improving for another 5-10 years, perhaps even a little longer. Being a coper won't make much difference in terms of technique improvement.
 

marzNC

Angel Diva
Started my sixth season skiing without an ACL a little earlier than expected. Had a chance for a day at Killington just before Thanksgiving. I was up north preparing to spend Thanksgiving week with my daughter who is in school there. We have relatives who not only cook a great meal, there were two turkeys this year because my nephew and the host husband/father wanted to try out making a smoked turkey. Yummy!

Since I've been working out pretty regularly since the spring, only the first run felt a little off. I'm about in the same shape I was in for the 2015-16 season. Feels good. Turned out that hyperthyroidism was a factor for me in assorted ways starting long before the diagnosis in October 2016. Took almost a year to get the thyroid hormones fully under control with low dose medication. Learned a lot from reading The Thyroid Solution.

I was at Killington on a Monday so even though there wasn't much terrain open, it was particularly crowded. I stayed on the long blue groomer top-to-bottom in the afternoon when the season pass holders had left.

https://www.theskidiva.com/forums/i...irst-impression-of-killington-nov-2017.22182/
 

marzNC

Angel Diva
The one set of exercises that I've done the most is the 7-Minute Workout that the NY Times made famous back in 2013. I wrote up details in my fitness blog recently. I started in 2014. It's good for when I'm traveling because I only need a little floor space, a towel, and a suitable chair to get in cardio and strength training. It's very good for the core because pushups, planks, and crunches are included. With a little warm up and cool down, plus stretches, one cycle takes about 15 minutes for me.

Here's the reaction of someone who experimented with doing the 7-Minute Workout for a month in 2017. He did it in his apartment first thing in the morning 5-6 times a week. Most of the time he was doing two cycles.

 

jenh-m

Diva in Training
"Here's the reaction of someone who experimented with doing the 7-Minute Workout for a month in 2017. He did it in his apartment first thing in the morning 5-6 times a week. Most of the time he was doing two cycles."

Thanks for this post. I am really happy to learn about the 7-minute workout. I usually do 3 pretty high intensity workouts per week, but this fall due to some schedule and travel constraints usual workouts were scaled back, and *man* did I notice it. For the first time since one or two months into PT my acl deficient knee felt what I can only describe as a bit "loose." I've since stepped my workouts back up to my normal schedule, and it only took a few workouts to feel back to tight and stable, but it really scared me and made me reconsider the reality of living without reconstruction. If I'm not working my legs, my knee tells me. I feel like if I had been doing something like this 7-minute workout during the time I couldn't get to my normal workouts, I may have avoided my legs getting weak.
 

marzNC

Angel Diva
@jenh-m : I find that as long as I do basic hamstring exercises few times a week, that's enough. But my knee was always very stable. I have weeks when I follow a "less is more" principle. Meaning I don't worry about doing full workouts but keep up simple balance exercises daily and try to spend 10-15 minutes 2-3 times a week doing something at home, or wherever I happen to be. Essentially I keep in mind the key PT exercises that were recommended to do 2-3 times a day in the early weeks.

The easiest approach for me for hamstrings is the heel drag on a low rolling chair that my PT showed me. Or I use the TRX or Swiss ball since I have them at home. Hamstring curls on the floor are better than nothing. Doesn't really need to take more than five minutes.

https://over50skifitness.blogspot.com/2016/06/mat-hamstring-workout.html

https://over50skifitness.blogspot.com/2016/06/hamstring-curl-progression-on-stability.html
 

jenh-m

Diva in Training
@jenh-m : I find that as long as I do basic hamstring exercises few times a week, that's enough. But my knee was always very stable. I have weeks when I follow a "less is more" principle. Meaning I don't worry about doing full workouts but keep up simple balance exercises daily and try to spend 10-15 minutes 2-3 times a week doing something at home, or wherever I happen to be. Essentially I keep in mind the key PT exercises that were recommended to do 2-3 times a day in the early weeks.

The easiest approach for me for hamstrings is the heel drag on a low rolling chair that my PT showed me. Or I use the TRX or Swiss ball since I have them at home. Hamstring curls on the floor are better than nothing. Doesn't really need to take more than five minutes.

https://over50skifitness.blogspot.com/2016/06/mat-hamstring-workout.html

https://over50skifitness.blogspot.com/2016/06/hamstring-curl-progression-on-stability.html

This information and these links are very helpful thanks! My dip in knee strengthening workouts this fall was definitely a wake up call. I like the "less is more" approach and will apply it the next time I can't get in my usual workouts!
 

ACLess

Diva in Training
MarzNC - your blog has been one of the most informative sources of information on ACL injuries I've found - and I've done a lot of searching - THANK YOU. I left my ACL at Arapahoe Basin on Dec 30th, and spent the rest of the week with beautiful views genning up on ligament and knee injuries?!. On returning to the UK the worst was confirmed - ruptured ACL, badly damaged MCL. As half centurians go, I'm pretty active, run with the dog most days, spend a lot of time in the hills, walking, bit of cycling, pilates, and at least two weeks of skiing a year - there isn't much snow in the UK normally. Surgeon suggested reconstruction, Physio suggested 'coping', either way I started physio three weeks post injury. After reading your posts it was my intention to try and become a coper, but after my knee collapsed a couple of times when I wasn't wearing a brace I had a rethink - I'm not the most patient soul..... 5 weeks post injury, my torn ACL was stitched back together and threaded with an 'internal brace', it's a procedure mainly promoted by two surgeons in the UK, Gordon McKay and Prof Adrian Wilson, although I understand surgeons across the globe use it. It wasn't an easy decision, there are about two years of clinical trials on the procedure, lots of positive stories of super quick recoveries, but it's costly, and inevitably there are other surgeons who challenge the evidence. I walked out of the hospital the day after surgery without a brace, lost the single crutch a couple of days later, and started serious physio on both straightening and strengthening my leg. 5 weeks post surgery my KOOS is over 80%- I haven't started running yet, my ROM is within 10% of my good leg, and things are looking good. For those who find your posts as helpful as I did, I just wanted to let people know there is a 'third way'. I hope to get a pre season ski trip in with a few girls to get my confidence back in December this year, your exercise tips will definately be part of my preparations. Thanks again.
 

Grizzla

Certified Ski Diva
I just thought I'd share something advised to me recently by a UK sports physio who works with a lot of athletes - he advised me not just to do various static exercises to activate the VMO muscle (inside quad immediately above knee, as is often advised as the 1st exercises to do post injury or surgery) but to make sure that I can 'clench' and feel the VMO actively throughout the full ROM, starting with seated exercises with the foot sliding on a bed or couch, then seated but with the leg hanging in the air, then when doing squats and other movements weight bearing.
Very surprised at how hard this was at first, how much the VMO gave up once I tried to maintain it throughout the movements. But now it's starting to remember how to activate all the time, and my knees fell a lot more solid and don't collapse inwardly as much. Apparently that's what he was after happening.
 

marzNC

Angel Diva
MarzNC - your blog has been one of the most informative sources of information on ACL injuries I've found - and I've done a lot of searching - THANK YOU. . . . 5 weeks post injury, my torn ACL was stitched back together and threaded with an 'internal brace', it's a procedure mainly promoted by two surgeons in the UK, Gordon McKay and Prof Adrian Wilson, although I understand surgeons across the globe use it. It wasn't an easy decision, there are about two years of clinical trials on the procedure, lots of positive stories of super quick recoveries, but it's costly, and inevitably there are other surgeons who challenge the evidence. I walked out of the hospital the day after surgery without a brace, lost the single crutch a couple of days later, and started serious physio on both straightening and strengthening my leg. 5 weeks post surgery my KOOS is over 80%- I haven't started running yet, my ROM is within 10% of my good leg, and things are looking good. For those who find your posts as helpful as I did, I just wanted to let people know there is a 'third way'. I hope to get a pre season ski trip in with a few girls to get my confidence back in December this year, your exercise tips will definately be part of my preparations. Thanks again.
Glad my info was helpful. The Internal Brace surgery approach looks very promising! Some form of repair is clearly better than the current reconstruction approach with a substitute ligament. Having a better alternative is especially important for young adults or teenagers.

The Internal Brace approach is being done in Washington DC. Looks like the medical journal papers date from 2015 forward.

https://www.medstarwashington.org/our-services/orthopaedics/treatments/acl-repair-surgery/

 

marzNC

Angel Diva
The surgeon who pioneered the Internal Brace concept is Dr. Gordon MacKay in Scotland. The early work was done 2011 thru 2014. Can be used not only for ACL repair but also for ankle and shoulder injuries. The case studies on his webpage are for people who play netball, rugby, and Olympic skier Alain Baxter. For Baxter, he was fully functional with a healed ACL in about five months after injury. Per usual, the treatment will not apply to all types of ACL injuries and situations. Still researching the topic.

https://www.mackayclinic.co.uk/the-internal-brace-at-a-glance/

In general, it's clear that in the last 5-10 years there are several approaches being researched that are based on repairing a damaged ACL instead of using ACL reconstruction surgery with a replacement ligament.
 

marzNC

Angel Diva
A bit late with the annual update about my ski season because I ended up doing a trip out west in May. Wanted to finish up the trip report for the last trip first because in early May I went to four mountains for the first time and was in full tourist mode. Knowing where to go after most big resorts close up in April will come in handy in the future.

I had a very good season, started early and ended late, with a couple of longer trips out west in the middle. First season skiing in four different regions: mid-Atlantic, northeast, Rockies, west coast. Had some low snow conditions in Jan and Feb, but caught snowstorms in Mar and Apr. Ironically very good conditions at my home mountain in Virginia, Massanutten, in Dec and Jan. Got in some powder turns at Alta during my annual spring trip. Ended up with 54 days of skiing, with 31 at big mountains in the west. I skied at Massanutten in Jan quite a bit because I decided to do the multi-week Gold Clinic on Sunday mornings again. Since my daughter is in school near Boston, I had an excuse to explore a few new mountains in New England. For the new places, had the most fun at Jiminy Peak in MA, Tenney in NH, and Bachelor in OR. Hope to ski at those mountains again sooner rather than later.

New mountains for 2017-18

Early season
* Killington, VT
* Montage, PA - with local Divas
* Berkshire East, MA

Mid-season
* Jiminy Peak, MA - with local Divas
* Tenney, NH
* Telluride, CO - with traveling Divas

Late season
* Bachelor, OR
* Mt. Hood Meadows, OR
* Squaw, CA - first time on upper mountain
* Mammoth, CA

Trip Reports for 2017-18
https://www.theskidiva.com/forums/i...irst-impression-of-killington-nov-2017.22182/
https://www.theskidiva.com/forums/index.php?threads/tr-belleayre-in-ny-catskills-12-17-17.22281/

https://www.theskidiva.com/forums/index.php?threads/tr-taos-feb-10-16-2018.22516/
https://www.theskidiva.com/forums/index.php?threads/telluride-feb-17-21-2018.22575/

https://www.theskidiva.com/forums/index.php?threads/tr-tenney-nh-3-9-2018.22656/

https://www.theskidiva.com/forums/i...ca-bachelor-hood-meadows-squaw-mammoth.22840/
https://www.theskidiva.com/forums/index.php?threads/tr-mt-bachelor-may-2018-first-impressions.22801/
https://www.theskidiva.com/forums/i...ay2018-first-look-timberline-lodge-too.22819/
 

marzNC

Angel Diva
From a fitness standpoint, I was in pretty good shape by the time I took the first ski trip in mid-December. After a few ski days in the northeast in December and skiing at Massanutten in January, I felt prepared for the Taos Ski Week in February. As it turned out, there wasn’t enough snow for any black terrain to be opened so didn’t really get tested in terms of ski conditioning until I was at Telluride.

After a week of fantastic lessons at Taos, I felt ready when it snowed 9+ inches overnight at Telluride. However, during the run I took first thing in the morning that had deep and slightly heavy powder on top of big bumps, my right calf cramped up. That had never happened before when skiing, before or after the knee injury. I thought perhaps the difference was the Stöckli Stormrider 85 skis, which are less forgiving than my old Black Pearls. Seemed related to left turns, which is the side that needs more practice on steep terrain.

Telluride 2/20/18 off Lift 9 aka Plunge
Telluride Diva share Feb2018 - 7.jpg

I had some tightness once or twice in the right calf the two weeks at Alta, but don’t remember the exact circumstances. I found that wearing leg warmers was helpful after done skiing. As it has been before when I’m not in the best shape.

It’s fair to to say that the soft and potentially sticky snow during the May trip made me somewhat nervous. Sure enough, the calf acted up a little the first day at Bachelor after mid-morning when we started exploring off-piste. But then something happened that made it clearer what the issue was and how I could avoid the problem. When we were checking out Mt. Hood Meadows, I was straightlining at one point to keep up speed for runout and my calf tightened up. No turning involved. I realized that I was simply tense all over because I was worrying about the possibility of sticky snow ahead. Since one pair of skis had DPS Phantom and the other didn’t, I also noticed that I was more tense on the skis that depended on wax. The waxed skis were my BPs (88mm), which are much better in soft spring snow from the standpoint of width underfoot and tip rocker. But I trusted that the Absolut Joys (78mm) treated with Phantom would keep gliding and not stop abruptly. The solution was to stay relaxed and loose no matter what. Of course, easier said than done.

After a couple days with more skiing on sticky snow at Bachelor, I was able to stay relaxed enough on steeper terrain to keep my calf from tensing up to the point of cramping. I stopped more often to regroup if needed. The practice helped when exploring Squaw and Mammoth. Even managed to consciously relax when picking up needed speed while making turns on a black trail just before I needed to tuck to get over to the groomer on the far side of Lift 5 on the last day at Mammoth. One of the few times that day I was moving quite fast. Helped that we had just done the same run 15 min before so I knew the snow conditions.

Looking back toward top of Lift 5 at Mammoth, need speed to reach Solitude trail without working hard to get past the uphill section
Mammoth slopes May2018 - 4.jpg

I used to sometimes get tense on traverses at Alta. Meaning on the Ballroom or Saddle traverses, which are relatively easy. During a semi-private lesson with a friend with a similar problem on traverses, the instructor said that one way to relax was to deliberately tense up more, and then relax. Once I identified the problem, I applied that idea and it worked. Gaining confidence on sticky snow takes practice. But normally I don’t stay on the slopes for long when it’s warm enough for snow to get sticky.

I haven’t been doing that much to strengthen hamstrings lately. Need to get back in the habit of doing the basic exercises I learned during knee PT at least a few times a week, even if not doing any other ski conditioning. Have slacked off on foam rolling too. Guess it’s time to schedule a few personal training sessions to get back on track.
 

marzNC

Angel Diva
Lessons with very experienced PSIA L3 instructors continue to be of interest as I turn 62. I did 4 of the possible 8 Sunday morning sessions of the Massanutten Gold Clinic. Per usual, learned as much from observing Walter teaching the other skiers as I did from comments he made to me specifically. It was well worth the extra travel and $245. Since the Silver Clinic at Massanutten for Over 50 Skiers was discontinued, I did a semi-private with my friend CB. I met him at a Silver Clinic several years ago. We did a 2-hour semi-private lesson with Peter Stransky, who is a PSIA Examiner. What Peter did was a very useful way to cover a progression of fundamentals to pinpoint weaknesses. He hadn’t seen CB ski before.

At Taos in February, I ended up doing a Ladies Ski Week because we happened to be there for the right week. The perk of interest was free demo skis for the week. I was in the Level 9/10 (of 10) group with Teri Koss. Bottom line is that I learned so much that I plan to do another Taos Ski Week next season.

The last lesson wasn’t planned in advance. In late March I did a semi-private with my Alta instructor, Arthur Haskell, with CB and his DC Ski Club roommate. CB was at Snowbird for a week as part of a DC Ski Club trip, along with a few Divas who are Massanutten passholders and a couple men who have worked with Walter in the Gold Clinic. I played mountain host and gave about a dozen DC Ski Club folks a tour of Alta for a couple hours one morning. CB’s roommate had been skiing challenging terrain with friends for decades without ever having a lesson. However, he was quite willing to consider booking a private lesson. During lunch at Alta Lodge with the DC Ski Club group, I got the idea that having a lesson with him and CB would be pretty interesting. I was right. I learned a LOT from observing Arthur teaching the two men. They wanted to learn how to ski bumps better. Arthur didn’t spend a lot of time on fundamentals but he made it clear they had some bad habits to overcome. The roommate had never heard of the concept of “shin to the boot.” We worked on a few drills on Mambo before heading to the big soft bumps on lower West Rustler. We did some interesting stuff on those bumps that I worked on for the rest of the trip. At noon, we extended the 2-hour lesson to three. That gave us a chance to learn a few fun routes good for somewhat hidden powder from Arthur. In particular how to get to Devil’s Playground (not marked on the trail map), which is near where the old Cecret lift used to unload.

All the instructors I worked with this season had a specific suggestion related to improving my left turn. Peter had me focus on something related to hip movement on a green enough times that I finally did a turn correctly. Once I could feel the difference, it was possible to practice more effectively. Arthur showed me a drill at the end of the lesson that was very helpful and easy to remember. He’d obviously been thinking about the best suggestion to work on my bad habit.

Being willing to invest money and time for private lessons is definitely part of the silver lining for having to rehab after a major knee injury. Having more incentive to do ski conditioning is the other major benefit of being a coper minus an ACL in the long run. The key being that my ACL-deficient knee is completely stable and I never have any knee pain or swelling. Six seasons after completing knee rehab I’m having loads of fun skiing terrain that I never expected to consider as remotely skiable. Also makes exploring new big mountains far easier when snow conditions are less than ideal. Looking forward to qualifying for some senior rates in a few years.
 

Ski Sine Fine

Angel Diva
I’ve only started reading this thread. MarzNC, you are an inspiration. It’s going to take me a while to go through all the resources you compiled, and it is such a motivation to not just get back to skiing, but to ski even better.
 

marzNC

Angel Diva
I’ve only started reading this thread. MarzNC, you are an inspiration. It’s going to take me a while to go through all the resources you compiled, and it is such a motivation to not just get back to skiing, but to ski even better.
Thanks.

It's fair to say that a common theme from other Divas who have posted is this thread over the years is that lessons and improving technique pays dividends. Certainly helps with decreasing any fear issues that are likely to exist. The bonus for me has been the incentive to be in better physical shape in general, especially in terms of working on balance all year long. Being able to ski on one ski is a skill that more than one instructor has taught or encouraged as a fundamental skill.

Keep in mind that every knee situation is unique. Having good support from medical professionals is always important.
 

Elinor

Certified Ski Diva
Gosh! You really have had a 'journey' with that ACL challenge, Marz. You sound ultra fit, and utterly determined to adapt and heal yourself, which has clearly paid dividends. Good for you! :clap:
 

Elinor

Certified Ski Diva
My knee problems have been so minor. The first was thought likely to be an ACL rupture ( when skiing), but thankfully turned out not to be, and it's healed pretty well. The other knee was damaged ( not skiing) and needed an arthroscopy. Like you I've been diligently doing my exercises to strengthen and stabilise, and daily take Curcumin and Chondroitin - hoping the supplements do some good, but who knows?!
From my own experience I can echo your advice of frequent exercising and not 'overdoing' it.
Your observations about balance interest me especially, as I'm finding this an increasing challenge.
Thanks for your sharing and informative suggestions, Marz.
☀️
 

Elinor

Certified Ski Diva
Speaking of balance, my physical therapy facility has this: https://www.shuttlesystems.com/products/shuttle-balance

Quite fun to use, but there are much cheaper devices for the home!
Hi VickiK - that device looks intriguing! Thanks for the link. Too bad I live far away from PTswith such gear... And - for a range of reasons - am inclined generally to seek non-equipment based methods. So exercises I can do daily at home seem to serve me best. (My trusty old iPad is the one bit of equipment I do need though! )
I saw some good balance exercises on a YouTube video just yesterday that are relevant and will provide plenty of challenge to this wobbly body!!
It's helpful getting leads and ideas from others...many thanks.
 

Christy

Angel Diva
Sorry I haven't read this whole thread and maybe it's been mentioned, but watching racing this weekend they mentioned that Carlo Janka is skiing on the World Cup with no ACL.
 

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