Learning to be a coper without an ACL

[marzNC]

What a great Week 12 report, Marz ... Congratulations! All of that hard work is paying off. I think yours is the official report. In a few days, you'll get confirmation that the PT sees it also.

Thanks! Very curious to see what the ROM measurement comes out. Not quite the same between the two knees, but getting close. Was at 135 a couple weeks ago. The good knee gets to about 145.

 

[marzNC]

Great news marzNC!

Sounds like you did brilliantly on your trip north!

Certainly spent more time wandering around outdoors than I expected. Helped that the weather was perfect. It's been a dry summer so the trails weren't at all muddy. Also had a chance to get on a horse to see how that felt. I don't really ride much. Maybe one or two basic trail rides a year. That won't be a problem at all, especially if there is a mounting block.

 

[ScottishGirlie]

That's great! Must have given you a bit of a confidence boost with your knee.

 

[marzNC]

ROM measured to 140 today without extra help. My good knee goes to about 147. That part of the rehab is pretty much a non-issue at this point. The meniscus is probably still healing so getting much farther could take a while. But from a functional standpoint, I have more than enough ROM to move around easily.

Learned several new exercises to play with at home. Moving on towards the next stage since pretty much done with what's needed for daily living. Adding balance and strength complexity. I bought a Bosu for home use so that makes it easy to do balance exercises regularly. Going to make use of the big exercise ball that my daughter got at a yard sale years ago.

Will continue with formal PT once a week for the next month. Mainly to learn new stuff. Also, I like being able to get solid advice about when to progress. The timeline is very much based on what I'm comfortable doing. I'm pushing to do more but at the same time being cautious.

 

[marzNC]

Had a nice easy appointment with my ortho doctor today. He agreed there is no reason to consider ACL reconstruction surgery given the progress that I've made already. Not even any reason to do anything for the meniscus since it's obviously healing steadily. Almost no crackles in the last week or two. What little pops there are only occur in the front. He did a little testing holding my leg and it's clear the MCL is healed, no pain when he applied pressure in the relevant direction. He showed me the little laxity in the top of the knee due to not having an ACL, but it wasn't much at all.

I'm putting off dealing with getting a brace until Jan. Has to do with how my medical insurance is set up. I want to apply the expense to next year's deductible. The only place I'll ski in Dec is Massanutten. Mnut is too small for me to be tempted by anything complicated. I can always use the basic velcro brace for a little more support.

My orthopedic group deals more with Don Joy, so I'll probably go with that. They can also get a CTi brace if that's what someone wants. There is someone on staff who does the brace fitting. So I don't need to pay to see the surgeon again.

Continuing format PT once a week for the next month. Plan to check in about once a month for a few months after that. Started shopping around for a fitness center to supplement what I can do at home. Between the recumbent stationery bike (was already in the house), a small hydraulic stepper (bought originally for my mother), a Bosu, a stability ball, ankle weights, a therapy band, plus stairs in the house, I've got more than enough to keep me on track.

Probably will do a few sessions with a personal trainer to come up with stuff to do for general ski prep in addition to continuing to work on the knee. Would like to learn more about exercise machines and useful exercises as quickly as possible. Only 3.5 months until my ski season starts!

 

[Skier31]

I am curious as to how your surgeon knows your meniscus is healing. Did you have an MRI?

 

[marzNC]

I am curious as to how your surgeon knows your meniscus is healing. Did you have an MRI?

It's an educated guess based the location and type of the tear, plus the lack of swelling even after exercise and other lack of symptoms when he tested the knee by manipulating it. Plus I told him that I have less stiffness in the morning compared to 2-3 weeks ago. I no longer need to "warm up" the bad knee before getting out of bed. If the meniscus had not healed in the last 6 weeks, I would think that I would not have been able to get the ROM to 140.

The MCL strain was pretty well healed around Week 8. That's when I starting doing hip adduction exercises because there wasn't any pain.

The MRI done for diagnosis was at Week 3. The meniscus tear was clearly visible as a 2-3cm longitudinal tear in the red-red zone. My surgeon told me that type of tear usually heals without intervention, but he was not willing to give a timeframe. He and my PT know I am continuing to take a low daily dose of Yunnan Baiyao.

Found this overview of meniscus issues that includes diagrams of common tear types. Can see clearly why someone with a "bucket tear" should have surgery. Somewhere else I learned there are three zones going from the outside to the center: red-red, red-white, white-white. More blood flow on the outside thicker part. The Stone Clinic is in San Francisco. There are notes about the fact that the trend is to try to retain as much of a meniscus as possible based on new knowledge of how it functions in recent years.

https://www.stoneclinic.com/meniscus-tear

 

[marzNC]

Took another approach to researching online and found this article in ESPN-W from June 2011 that describes primary factors that can be used to assess the level of risk a female athlete has towards ACL injury.

https://w.espn.go.com/espnw/training/6660099/how-avoid-acl-injury

There is an organization called Girls Can Jump that promotes ACL prevention techniques, especially for girls playing sports like soccer and basketball. There are 8 factors including quad dominance and glut strength. All are described in a sidebar in the article. There is also a link to an app designed to help an athlete stick with an ACL injury prevention program like PEP or Sportsmetrics.

It's become clear to me that the approach to ACL injury, treatment, and rehab changed pretty dramatically in the mid-1980's. The recognition that women and girls were even more at risk came in the mid-1990's. The importance of improving proprioception is a key element to all ACL injury prevention programs. Also a core component of any formal rehab protocol after the mid-2000's.

 

[marzNC]

PT session #10 today. Fun to feel how much easier it is to do most of the exercises on the machines. Last week I was pretty sore for a day. Curious to see how I feel after this session. Being able to do something daily at home certainly makes a big difference. Still taking it relatively slow in terms of adding weight and/or reps. I'd rather do a wide variety of exercises consistently. Good form is clearly important in the long run.

 

[skibum4ever]

Go, marzNC! Good to hear.

 

[ScottishGirlie]

You're going to be a total pocket rocket when you get back on skis marzNC!!!

 

[marzNC]

Definitely going to be in better general shape than before. I haven't done this level of on-going deliberate exercise since I was on the soccer team in high school. It's good have skiing as the incentive to keep it up!

 

[marzNC]

I found a description of the internals for a knee that help make it easier to understand why it's quite possible to do a lot without an ACL. In particular why strengthening specific muscles can result in a pretty stable knee. However, I'm glad I had a quick full diagnosis based on an MRI so I could also learn good neuromuscular exercises to re-train my entire body to function automatically without an ACL. Staying in balance requires a lot more than a knee.

Static Stabilizers
: The static stabilizers are the four major ligaments of the knee: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL).
Dynamic Stabilizers: 
The dynamic stabilizers of the knee are the muscles and tendons that surround the joint. These muscles and tendons are controlled by what's known as neuromuscular input, the unconscious activation of these structures to control the position of the joint.
From: https://orthopedics.about.com/od/aclinjury/f/neuromuscular.htm

 

[marzNC]

Had my first ever session with a personal trainer. The first of a set of four 45-min sessions. Turns out she was an elem school teacher for 27 years before deciding to become a trainer as a second career. Good thing is that she skied growing up so has some appreciation for the sport. Not that easy to find here in the southeast.

Didn't do too much today. Mostly the assessment. She showed me how the TRX Suspension system works. Definitely looking forward to learning more next week.

Starting to understand which exercise machines are most relevant for rehabbing and maintaining muscles relevant to the knee. Have been doing on-site research to see if I can find a fitness center to join. Want to find one I like in terms of the staff and the people who use it, as well as the equipment.

 

[marzNC]

If you are wondering where the posts went from Sept. 7-29, they were lost in the server crash that happened around Sept. 28. I'll put the most useful links in another thread at some point once I figure out what I mentioned.

 

[marzNC]

Had what was probably my last PT session today, #12 at Week 16. The last session was three weeks ago. In between I was working with a personal trainer, doing stuff daily at home, went hiking last week on short rocky trails, and started indoor rock climbing a few days ago. ROM is pretty close to the same as my good knee. Perhaps a degree or two off both for full extension and full flex.

My PT said that at this point starting running or jumping in a controlled way is fine. Getting his opinion on that question was the main reason I scheduled this appointment. I wasn't quite ready the last time. He showed me a few agility drills that I can work on, starting slow then speeding up as I get more comfortable with them. So the only movements I will continue to avoid is cutting or pivoting on the bad leg, which is not an issue since I don't have any interest in sports that require that type of movement.

 

[marzNC]

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)

Update two months later, a total of 4 months since rupturing the ACL. MCL strain healed two months ago, meniscus probably still has a little more healing to do but no longer have any symptoms that I would attribute to a torn meniscus.

* walking around a zoo non-stop for 3 hours was no problem at Week 10
* walk up or down stairs pretty fast, no handrail needed even if carrying something 10+ pounds
* take a shower standing (not using safety bar or bath seat)
* walk the dog in the dark, including walking backwards some of the time
* hiking up a trail with lots of loose stones and acorns at normal speed without unusual concentration (Week 15)
* hiking down a trail, a little slower than normal but not much if there is a reason to move faster (Week 15)
* can leg press 75 pounds with 2 legs, 65 single leg (started at 50 a month ago)
* using 2.5 lb ankle weights for relevant exercises
* changed to blue band for relevant resistance leg exercises

In short, no knee stability issues and noticeably stronger legs. Can do everything normally for daily living. Plus fun stuff like zip line or indoor rock climbing. Didn't worry when the dog tried to take off and chase a deer in the woods the other night. I'm more a bit more than twice her weight. More important than any added strength is that sudden shifts do not require conscious thought any more for me to adjust in a manner that keeps the bad knee safe. Very glad I invested in a BOSU early on.

 

[marzNC]

For the continuing story, I started a new thread:
New normal as a Coper

 

[RX2SKI]

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

My journey just started on Sunday, 2/3/13

I guess I'm in the felt a "pop", no pain, minimal swelling group.
I was skiing a few small moguls--on the 4th I absorbed and felt the pop. I didn't fall until afterwards. Then, I didn't feel like I had the strength or stability to get back up. When I realized that there was no way down to the base mountain from where I was, I called for ski patrol.

I still have no pain--just a lot of stiffness from wearing a brace the first couple of days. I can straighten my leg all the way, but not bend all the way yet. I just keep doing ROM exercises and lots of ice (Aircast Cryo Cuff). I didn't use crutches at all yesterday since I was in the house and didn't walk any long distances. Today, I hope to keep to 1 crutch and make sure I'm walking heel-to-toe without a limp. I cannot find any point tenderness with the LCL or MCL. It is rare that just the ACL is injured, but I'm hopeful at this point. MRI will be today (Friday) or Tuesday. Doc on next Friday.

I'm hoping to be a coper. That way, I figure if I do need surgery down the road, I'll have had plenty of pre-op physical therapy to become as strong as possible. Also, I want to lose as much weight as possible, before surgery.

 

[snow addict]

My journey just started on Sunday, 2/3/13

I guess I'm in the felt a "pop", no pain, minimal swelling group.
I was skiing a few small moguls--on the 4th I absorbed and felt the pop. I didn't fall until afterwards. Then, I didn't feel like I had the strength or stability to get back up. When I realized that there was no way down to the base mountain from where I was, I called for ski patrol.

I still have no pain--just a lot of stiffness from wearing a brace the first couple of days. I can straighten my leg all the way, but not bend all the way yet. I just keep doing ROM exercises and lots of ice (Aircast Cryo Cuff). I didn't use crutches at all yesterday since I was in the house and didn't walk any long distances. Today, I hope to keep to 1 crutch and make sure I'm walking heel-to-toe without a limp. I cannot find any point tenderness with the LCL or MCL. It is rare that just the ACL is injured, but I'm hopeful at this point. MRI will be today (Friday) or Tuesday. Doc on next Friday.

I'm hoping to be a coper. That way, I figure if I do need surgery down the road, I'll have had plenty of pre-op physical therapy to become as strong as possible. Also, I want to lose as much weight as possible, before surgery.

Walking on crutches will make you lose weight. I lost about 10 lbs in 3 weeks but I was almost as fast after the first 5 days as I am without them and I moved about quite a bit.