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Learning to be a coper without an ACL

vickie

Ski Diva Extraordinaire
Haven't purchased a brace yet. I'll have to research it first to figure out whose advice I want to follow. Doctors will prescribe something out of the subset of equipment their practice has chosen; company reps, from their product lines; etc. I'm sure the doctor will prescribe what's best for my knee, but that won't help if it's awkward or bulky and I end up not using it.

I'm hoping to be out west before I have to make this decision -- y'know, so I can go to an ortho who skis all the time who has the same knee situation. I know I'm not asking for much ...
 

marzNC

Angel Diva
Haven't purchased a brace yet. I'll have to research it first to figure out whose advice I want to follow. Doctors will prescribe something out of the subset of equipment their practice has chosen; company reps, from their product lines; etc. I'm sure the doctor will prescribe what's best for my knee, but that won't help if it's awkward or bulky and I end up not using it.

I'm hoping to be out west before I have to make this decision -- y'know, so I can go to an ortho who skis all the time who has the same knee situation. I know I'm not asking for much ...
Aah . . . another topic for research. Check out this webpage about knee braces. I have only skimmed it.

https://www.ski-injury.com/prevention/brace

The website is by a Scottish doctor who skis and has been interested in snow sports injury epidemiology since the 1990s. There was a comparison study done that was reported in 2006 that showed a brace reduced the number of new knee injuries for ski resort employees who had had ACL reconstruction surgery. But not sure that applies to how you and I are likely to ski in the future.
 

marzNC

Angel Diva
Downunder Diva: I think a Bosu Ball is on the shopping list. Have started to do lunges on one during PT sessions. I found that walking around on the mat floor at my indoor climbing club was great practice since it's definitely an uneven soft surface. My daughter was at day camp there last week.

Luckily the exercise bike my husband had bought is a recumbent one. So that's already available.

The best exercises in the last couple weeks in terms of daily living were stand-to-sit/sit-to-stand, step up/down straight, step up/down lateral. For stand-to-sit I started at 20 inch for a few days and now can handle a toilet seat without much special thinking. Progressed from 4 to 6 inch step on straight in a week and 2 to 6 inch lateral. Lateral definitely had a major element of proprioception. Makes a big difference if I watch my foot/knee/leg or not.
 

SkiNana

Ski Diva Extraordinaire
The goal is to get into good enough shape to have the confidence to check out more than the blue groomers at Big Sky and Alta in late March. Planning on being with friends, so have every intention of make the trip even if I don't ski that much.

:rotf: This is what happens when one tries to imagine marzNC lacking the confidence, whatever the situation, to "check out more than blue groomers". :rotf:

I fully expect you to be there, skiing circles around my timid old self, marz. I'll even bet a Fat Tire on it!
 

vickie

Ski Diva Extraordinaire
When you rip off/out the ACL, does it hurt? I've read that you hear it Pop.

I felt a Pop when I fractured my tibia. I didn't hear anything. And I couldn't hear anything for a while afterwards either ... for all the screaming that was going on. :embarrassed:
 

Moongidget

Angel Diva
No experience hearing a pop. I may have been screaming, but if my memory serves, it was so painful I could hardly breathe, let alone get a sound out. I was writhing around on the ground clutching my knee. Yes, it hurts. Of course, mine was due to an on mountain collision, so that may have been a factor.
 

Downunder Diva

Angel Diva
No pop with mine either... Just excruciating pain ( I recall thinking this is way worse than childbirth). I was unable to show my distress due to not wanting to alarm the people I was with. I was relieved when the pain vanished suddenly (ACL ruptured totally at this point) ... Although no further pain knee felt really wierd, I had this feeling of dread that although no pain something was really wrong...
 

marzNC

Angel Diva
I think there was a little "pop" but wasn't quite sure. In my case, there was a lot of twist involved with nothing after the initial injury. Most likely a complete rupture that happened so fast, I didn't feel any pain. Not then and not after if walking with the bad leg under me . . . nothing lateral. Any pain after the first week when the major swelling was gone seems like it was related to the MCL sprain more than anything else. Of course, I was being very careful for the first 5-6 weeks to avoid any lateral movement. Now at Week 8, I am doing lateral movement during PT sessions and it doesn't hurt at all.

Moongidget, Downunder Diva: What type of injuries did you have besides the ACL rupture? In particular the MCL and meniscus?
 

marzNC

Angel Diva
From my reading in various sport forums (ski, rock climbing, tennis, etc.) as well as KneeGuru, it sounds like there is a broad range of experiences during and immediately after the initial ACL injury. A lot of people hear a "pop" but some don't. Many people have a lot of pain but plenty of people report no pain.

Most medical resources talk about a "pop" and pain as being very common. For instance, here is what the well known Steadman Clinic in Colorado says about symptoms:

"What are the signs and symptoms of an ACL injury?

A twist or strain has occurred which causes the following signs:
  • "Pop" - Many patients, but not all, will hear or feel a "pop" when the ACL tears.
  • Immediate onset of swelling - This is an indication that there is bleeding from the injured ligament.
  • Pain - Most patients experience quite a bit of pain with an ACL injury.
  • Instability - Patients often describe a buckling or unstable sensation in the knee."
https://thesteadmanclinic.com/acl/symptoms.asp

They only symptoms I had from this list were two buckling incidents, one later in the the day of the injury and one three days later. After that, I was careful to keep my bad leg/knee/foot directly under me when putting weight on it. Swelling started 4-5 hours after the injury and was much less by Week 2. I did treat the swelling beyond RICE and will talk about that later.

Perhaps the people who seek advice from an orthopedic specialist early on, say within a month, are more likely to have heard a pop. Needless to say, the posts by people who had no pain and little swelling are the ones who also talk about continuing to ski or whatever because they didn't learn the ACL was gone until months or years later. By then it's hard to remember the exact details of the initial injury, if they even know when it probably happened.

I wanted to have an MRI as soon as possible after getting home because I knew it's the best way to know exactly what's going on inside a knee. As I expected, the X-ray in Week 3 by my family physician looked normal. The MRI a few days later not only showed the ACL rupture, it also made the injuries to the MCL (strain) and meniscus (2-3cm tear) clear. Plus there was evidence of bone-to-bone contact that undoubtedly happened during the injury event.
 

marzNC

Angel Diva
:rotf: This is what happens when one tries to imagine marzNC lacking the confidence, whatever the situation, to "check out more than blue groomers". :rotf:

I fully expect you to be there, skiing circles around my timid old self, marz. I'll even bet a Fat Tire on it!

Well, I did say that the definition of a "coper" is someone who "can do everything they want, including sports that don't involve intense pivoting." I don't remember any need for intense pivoting going down Liberty Bowl. :eyebrows:
 

altagirl

Moderator
Staff member
No experience hearing a pop. I may have been screaming, but if my memory serves, it was so painful I could hardly breathe, let alone get a sound out. I was writhing around on the ground clutching my knee. Yes, it hurts. Of course, mine was due to an on mountain collision, so that may have been a factor.

Mine was totally the opposite. Loud pop (that other people heard too) and no pain whatsoever. I collapsed to the ground but it was just a thud, landing on my butt - didn't hurt. I did almost feel sick to my stomach, but it was more of that "knee shouldn't go that way, something is very wrong" feeling, not pain. Didn't hurt later either really. It swelled up a ton, and was hard to walk because it was so stiff, but I can't say it hurt. After I finally had surgery - then it hurt!

I knew what happened but kept skiing on it for the rest of the season because I wasn't allowed to see an ortho without a referral and couldn't get one. My general practitioner just kept telling me it was "just a sprain, take more motrin" for the swelling (for the knee that was the size of my head + lack of stability + classic ACL tear symptoms and mechanism of injury) and I'd be fine. Then I got to see the ortho but couldn't get an MRI for 6 months. Being young and not necessarily sensible, I figured if my ACL was already torn I might as well keep skiing until I could get it fixed.

Torn MCL? That hurt. Torn meniscus? That also hurt too when I've had pieces displaced (like flipped over in the knee - it was horribly painful to try to stand on it.) When I tore the other ACL years later that one didn't hurt either. Sadly I knew exactly what it was and it made me burst into tears immediately, but that wasn't from pain, it was from realizing I was going to miss ski season.
 

Moongidget

Angel Diva
I think there was a little "pop" but wasn't quite sure. In my case, there was a lot of twist involved with nothing after the initial injury. Most likely a complete rupture that happened so fast, I didn't feel any pain. Not then and not after if walking with the bad leg under me . . . nothing lateral. Any pain after the first week when the major swelling was gone seems like it was related to the MCL sprain more than anything else. Of course, I was being very careful for the first 5-6 weeks to avoid any lateral movement. Now at Week 8, I am doing lateral movement during PT sessions and it doesn't hurt at all.

Moongidget, Downunder Diva: What type of injuries did you have besides the ACL rupture? In particular the MCL and meniscus?

I had a whole slew of findings on my MRI, but the only operable thing was the ACL. No mensicus tears for sure, and if anything was wrong with the MCL it was just a strain or sprain.
 

marzNC

Angel Diva
The relatively unusual treatment that I'm doing for my knee is from Chinese medicine. I messed up my right knee towards the beginning of a trip to China when I was in Beijing. The day after I had a supply of Yunnan BaiYao in several forms (capsule, topical), plus another topical treatment that's designed for arthritis and problems with the meniscus (has a diagram of a knee on the package). I spent the day after at a cousin's apartment. Left with crutches, a stretchy ace bandage, and Chinese medicine. Headed off that evening on a night train to Xi'an with my daughter, my nephew (just graduated from college, was on the football team), and another family we traveled with. I and my husband are American-born Chinese, as are my nephew's parents so we have relatives in many Chinese cities. The second half of the trip was about visiting relatives more than sightseeing.

I have had an acupuncturist at home for several years that I usually see monthly. In July, I got a few weekly treatments after getting home. She was treating the other sore muscles (good leg, calf, glutes) plus the knee. I think that helped a lot. So by the time I started PT, I didn't have any major areas that felt sore or strained.

I'm continuing to take Yunnan BaiYao daily in capsule form. Using a topical patch for days where I'm using the knee more for whatever reason. Perhaps once a week.

At Week 3, there was a small sore spot on the exterior of my knee that was due to the sprained MCL. By Week 7, the sort spot was gone. So then it was possible to start exercises that involved lateral movement. Still can feel a little something uncomfortable for resistance exercises but fading daily.

I first heard of Yunnan BaiYao when my mother broke her leg at age 70. It was a spiral fracture just above the ankle (caught a heel on carpet rushing down stairs to go give a lecture) very similar to a ski injury. My mother was not sporty but was in good general health and pretty fit. Often mistaken for being 10-15 younger than she was due to her sharp mind and energy. The doctor cautioned that she would probably be in a cast for 4-6 months given her age. She started with a full leg cast. She took the Chinese approach. Pretty much avoided walking the first six weeks (bed on the same floor as bathroom and kitchen, used a wheelchair in the townhouse, stayed home except for medical appointments), took BaiYao, and ate stuff consider useful for healing bone breaks by Chinese medicine. At the six week check-up, the X-ray showed that her leg was healing like a 40 year old. Her doctor was pretty astonished. Her recovery continued to go very well after that.
 

marzNC

Angel Diva
Had a long PT session today. Used ankle weights (2 lb) for leg lifts (20 reps) for the first time. But still avoiding the one direction that puts stress on the MCL. It's healed a lot, but not 100% yet. Can feel it on lateral moves. No bad, but enough that I'd rather stop than push through any pain. I'm not yet into "no pain, no gain" status, more like "if pain, then wait." Have plenty of balance and hamstring exercises to keep me busy. Added the mini-tramp for 1-leg balance.

Doing formal PT sessions twice a week the first half of August. Have been adding or progressing exercises every time. Each session lasts about an hour. No swelling so I don't ice or do anything special after PT. Then headed out for a last summer trip. I see the surgeon August 31. So that's when I'll figure out the next stage.

I'm doing a full list of PT exercises at home at least once a day. Including 10-15 min on a recumbent stationary bike for 2.0-2.5 miles. During the day, there are usually opportunities to do flex holds while sitting or hamstring curls while standing or other little exercises. Have learned enough to invent little useful things to do pretty easily, especially for improving proprioception.
 

altagirl

Moderator
Staff member
Yeah, MCL recovery is slow, and you can for sure feel it when you do too much too soon. And with MCL's there's not much you can do to speed it up - it'll heal when it heals and all you can do is try to keep the muscles around it strong in the meantime.
 

marzNC

Angel Diva
Yeah, MCL recovery is slow, and you can for sure feel it when you do too much too soon. And with MCL's there's not much you can do to speed it up - it'll heal when it heals and all you can do is try to keep the muscles around it strong in the meantime.
Since I can do lateral step ups at 6 inches, along with lateral lunges onto a Bosu Ball, I'm happy to wait until the MCL doesn't twinge at all before doing much more. For the lateral lunges, I start relatively close to the Bosu.

Already much better in the sense that I'm not worrying about keeping my foot directly under me. So making a turn or changing direction when walking doesn't require extra thought any more. The only time I feel any pain is when I'm doing a PT exercise.
 

marzNC

Angel Diva
8 weeks after losing the ACL and 4 weeks after starting PT (7 sessions), daily life is pretty straightforward. Things I can do without worry, although perhaps with a minor adjustment:

* stand or walk around for 30 min or more, as in going shopping for back-to-school clothes with my daughter or attending her school's Open House or doing stuff in the kitchen
* pick up something small from the floor without holding onto anything by bending knees
* open a self-closing door and walk through it
* walk up stairs normally
* walk up or down 1-3 steps without a handrail (curb, 3 steps outside front door)
* put on or take off socks and pants
* put on or take off shoes, without sitting down
* sit down, stand up from chair or toilet without holding onto anything
* take a shower standing (have a safety bar and bath seat)
* carry something up/down stairs, perhaps up to 10 pounds
* carrying something on level ground, like box with stuff in it that's not too heavy or a laundry basket
* walk the dog in the dark (have a fenced yard but I like to take her for a walk before bed)
* walk on grass or gravel or a somewhat uneven surface
* driving (have been since Week 5)
 

marzNC

Angel Diva
Sounds like it's going well. Keep at it!
Thanks! Finding that anything I do can be framed in terms of helping my body figure out how to compensate for no ACL. Even wandering around the supermarket trying to remember that last item becomes a chance to walk more. Always get a cart because then I can walk faster without concern. My mother used to do that after she slowed down after age 90 or so.

Still have to concentrate a bit to make sure that my gait is correct. Even though I have more than enough Range of Motion to walk normally, my body prefers to play it safe and limp. End up talking to my leg sometimes, as in "stop limping and do it right!"
 

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