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

marzNC

Angel Diva
#1
This is a thread for thoughts about the next stage of my life without an ACL. For Months 1-3 after injury, look here. Bottom line is that I popped off the ACL in my right knee in early June 2012 (not skiing), have completed several months of formal PT, was fully functional for day-to-day living by Month 3, and am doing fun stuff I like to do (zip lines, walking for hours at the zoo, indoor rock climbing), so do not plan to have ACL reconstruction surgery. I could always put full weight on the bad leg, had minimal swelling, and did not have any major pain. The strained MCL and meniscus tear did not need medical intervention to heal. My surgeon agreed at Month 3 that no surgery is needed.

Most information I've read about ACL injuries are related to reconstruction surgery and rehab. So my musings are for people who wonder what life as a "coper" is like. I've learned that people who are "ACL deficient" were thought to fall into roughly three equal groups: copers, adapters, non-copers. A coper can do everything they want, including sports that don't involve intense pivoting. Adapters give up activities to avoid surgery. Non-copers continue to have so much instability that they have problems even with daily living. In recent years, most medical research is focusing on how to deal with copers and non-copers. Much has changed in the last 10-15 years in terms of how knee injuries are treated medically as more is learned, especially about the ACL and the meniscus.

Every knee injury is unique. Early diagnosis by a specialist, preferably including an MRI can help avoid further injury after an ACL rupture. This is my story and may or may not apply to someone else with similar injuries. My hope is to provide food for thought.

First ski trip to the local hill is scheduled for the week before Christmas. Big trip to Big Sky and Alta starts in late March. :becky:
 

marzNC

Angel Diva
#2
The list of exercise equipment has probably stopped growing. I found a fitness center and personal trainer that I like. The bonus is that no monthly membership commitment is required. The climbing gym also has a few useful things in the little fitness area.

What I have at home includes:
* BOSU for neuromuscular (balance) exercises, 55 cm
* ankle weights, adjustable 1.25-5.00 lbs, using 2.5
* stability ball, 55cm (was in the house already), use 65 cm at gym
* recumbent stationary bike (was in the house already)
* mini-stepper (was in the house already, inherited from my mother)
* mat (was in the house already, folds in half, longer than the type that roll up)
* blue and green therabands, got them from PT
* 15-speed road bike
* Skiers Edge II (a steal from craigslist)

It's a three story house, so have steps to use for exercises. We live on a road with little traffic, so can take a quick walk any time. Dog would like it if I would take her for walks more often. There is a Rails-to-Trails bike trail a mile from the house.
 

marzNC

Angel Diva
#3
I recently found a few sources that support the idea that for a coper with no ACL and an intact meniscus, there is not higher risk for developing early arthritis. Assuming the coper gets appropriate formal PT early on. Prospective randomized trials in the last dozen years are coming to similar conclusions. One done in Sweden followed subjects for 15 years, others followed subjects for 3-10 years. In some cases, successful copers even returned to high level sports like soccer and basketball.

Some orthopedic groups now screen patients to see if they are good candidates for being successful copers. Research is being done to come up with accepted screening criteria. The ones listed here in 2011 include having no swelling, normal motion, good quadriceps strength, and no pain on a hop test.
 

marzNC

Angel Diva
#4
I started using KOOS--Knee Injury and Osteoarthristis Outcome Score--about two months after injury as a way to track progress. Checked about once a week for Months 2-3. I like KOOS better than other objective measures because it includes functional and sports/rec items in addition to stuff like pain or stiffness. Was fully validated in English by 2003. Range is 0-100. Patients who complete PT after ACLr surgery usually get to 92-97. Examples of functional: putting on socks, doing light housework, getting in/out of car. Also has Quality of Life topics like "How much are you troubled with lack of confidence in your knee?" A non-coper would have a hard time reaching 75.

My guess was that my score was 38 at Week 4, before any formal PT. I did the scoring a few weeks after the fact based on remembering what I couldn't do. My score was about 75 at Week 8, after 3 weeks of PT and pretty much daily exercises, mostly no impact. By Week 12, the score was up to 85. But it was incomplete since I was avoiding running, jumping, and pivoting to let the meniscus heal more so the scores for those items weren't too meaningful. After four months, my score is 89. Fully expect to get close to 95 before ski season starts now that I'm doing careful running and jumping exercises.
 

marzNC

Angel Diva
#5
Doing a bit of an experiment. I stopped taking any BaiYao a week ago. As I noted in the earlier thread, I was taking Yunnan BaiYao starting the day after injury since I was on vacation in China. I continued taking BaiYao 2-3 times a day through Week 15 or so. Then reduced to once a day. The idea was to continue giving the meniscus extra help during healing.

It's been several weeks since I had any stiffness getting out of bed in the morning. The knee itself looks and feels pretty normal. So perhaps the meniscus is getting close to completely healed. From my research, it can take 6-12 months depending on the exact type of tear.

My calf is a little sore because of all the extra exercise . . . and so is the other one. Glad I found a set of good videos for self-massage. Plus I'm doing "maintenance" acupuncture about every three weeks, instead of four.
 

marzNC

Angel Diva
#6
Decided I like the mat Pilates class at the fitness center where I meet my personal trainer. Pretty low key for only a few people. Went for the second time today. Definitely not for knee rehab, but very good for ski conditioning.

Now that I have a variety of exercises and places to exercise, that's keeping me engaged. It does help to have a class or personal training scheduled once a week. I log what I do so that I can remember what types of stuff I've done recently. Only put down the more significant exercises, with more details for those that are directly related to the knee.
 

marzNC

Angel Diva
#7
Went indoor rock climbing again today. My daughter had a teacher work day so could come and be my belayer. She got her Belay Tag this month since she turned 12. So now she can be my climbing buddy as well as my ski buddy. :dance:

My confidence when climbing is better than a few weeks ago. Not thinking about how I'm placing the ACL-deficient leg at all. Just doing whatever makes sense for doing the climb. Since I only do 5.6, 5.7 if following a route, it's not that complicated. That's all I was doing before any way. I just like to climb for exercise. Gets the heart rate up pretty quickly.
 

marzNC

Angel Diva
#8
For ski conditioning at home, one of the ways I'm doing that is to do Phase 1 of the video series by Bumps for Boomers. They are in Aspen and specialize in teaching boomers (born 1945-1964) how to have more fun beyond blue groomers for more years.

http://www.bumpsforboomers.com/ski-fitness-ski-conditioning-programs-get-you-shape

Also includes warm up and stretching ideas. I like the fact that all the exercises can be done at home and don't depend on exercise machines. There aren't any of these exercises that I can't do now that my knee is fine for jumping or running. My ROM in the ACL-less knee is within a degree or two of the other knee. Has been since somewhere in Month 3. Kneeling hasn't been an issue for quite a while.
 

marzNC

Angel Diva
#9
One of the terms I learned when I started to research ACL injuries was "ACL deficiency." Now that I'm done with formal PT, the overview from this webpage make sense. The title is "Physical Therapy Exercies for Chronic ACL Deficiency" and draws info from a 2010 issue of the North American Journal of Sports Physical Therapy. The exercise categories include:
  • Range of Motion (ROM)
  • Strength
  • Stability
  • Functional
The first three lead into the fourth naturally during Months 1-3. I'm not done with progression for Functional yet since I haven't gotten into cutting or pivoting exercises. Not planning on doing sports that require that type of movement, but would still like to go farther. Never know when a surprise event results in a reaction that involves cutting/pivoting. Improving or maintaining Strength and Stability is ongoing. But probably not really any different than if I was simply staying in good shape with a strong awareness of ACL injury prevention exercises.
 

marzNC

Angel Diva
#10
Gave a spinning class a try a couple days ago. I stayed for 25 min of the 40 min class. That's not for me. Especially since part of the time the idea is to stand up on the pedals. That's really tough to think about when one knee has no ACL. Also seems easy to overdo. Pretty sore for a day or two. I can do it, but don't see the point since I can do lots of other things for cardio exercise. If I'm going to sit on a bicycle seat, I rather do that outdoors. Wasn't that much into cycling before in any case.

On the other hand, I enjoyed doing more with the TRX with my personal trainer yesterday. Spent 30 min with the TRX, including repeating about half the exercises in a second round. She's adding more variety, including things like lunges that are obviously good for knee rehab and ski conditioning. We are learning together what makes the most sense for my interests and abilities.

Definitely want to continue with weekly personal training sessions. It gets me going again if there have been too many distractions in a given week so that I've slacked off exercising at home. Have had 9 sessions with her. The value added is more obvious now. I spend 45 min with her, then continue on my own at the fitness center for another 45 min or so.
 

altagirl

Moderator
Staff member
#12
Gave a spinning class a try a couple days ago. I stayed for 25 min of the 40 min class. That's not for me. Especially since part of the time the idea is to stand up on the pedals. That's really tough to think about when one knee has no ACL. Also seems easy to overdo. Pretty sore for a day or two. I can do it, but don't see the point since I can do lots of other things for cardio exercise. If I'm going to sit on a bicycle seat, I rather do that outdoors. Wasn't that much into cycling before in any case.
For me, it took a while after various knee injuries to get back to standing up and pedaling, but it comes and feels good again. I think it's a matter of getting back to it slowly and retraining your muscles - like everything else. Regardless of if you're doing it indoors or outdoors. I've got 2 deficient ACLs these days - they are there but both grafts are loose.
 

marzNC

Angel Diva
#13
I was never interested in mountain biking. Not really that much into road biking either, but have had fun on Rails-to-Trails. So standing up on pedals to make it up a hill is not something I would need to do when biking outdoors. So while I know I could do a spinning class eventually, I'm not likely to keep it on the list of things to do.

What I'm doing is experimenting to see what types of exercise that involve an instructor/trainer interest me enough to do it somewhat regularly. Mat pilates works for me. Having a weekly personal training session for 45 min, plus 45 min at the fitness center afterwards, works for me. If I go to the fitness center twice a week, that may well be enough given the other stuff I do at home or at the rock climbing club.
 

marzNC

Angel Diva
#14
Regardless of what I do on a given day, I'm trying to do some 1-leg balance work on the BOSU as often as possible. I know when I was using the BOSU daily during early rehab that it made a big difference in terms of how quickly I got to the point of not worrying about day-to-day function of the ACL-less knee.

While having skiing as the main incentive for exercising regularly is useful, what's more important is that 5 months after injury I can do everything I was doing before in terms of daily life. For our big yards, that includes doing things like digging a big hole for a bush with a shovel, climbing up into the pickup to toss mulch using a pitchfork, or weeding for a while.

When I found that I could do all the Bumps for Boomers Phase I exercises, as well as use a Skiers Edge, that really gave me confidence that skiing will all fun and no worries. Of course, it also helps that my ACL injury had nothing to do with skiing and the knee has never been unstable since Week 1.
 

gr8outdoors

Ski Diva Extraordinaire
#16
marzNC - December 19th? - Are you limited until then? Just wondering why that particular date.

Loved reading about your biking. Spinning totally kicks my butt. I try to work out frequently, but that really gets my heart racing. I don't mountain bike either, but have never really tried it. My favorite trails around here are the old rail trail, which is now a bike/walking path
and just our "bike path" that runs along side the expressway, but leads to the village where there is an ice cream shop and a Dunkin Donuts. :-) Sometimes we need to officially go somewhere for our son to want to join us for a ride.
 

marzNC

Angel Diva
#17
Our first ski trip up to Massanutten is the week before Christmas. My daughter has school until Dec. 18. We'll leave right after the science fair and class party that afternoon. That's why my first ski day will be Dec. 19.

In the southeast, while there is usually skiing at all the ski areas by mid-Dec, it's usually not worth driving 3-4 hours to get there. I used to do a mid-Dec weekend to catch a local Demo Day, but that was before we started going out west regularly.
 

marzNC

Angel Diva
#18
The most useful info I learned about soon after starting PT during Month 2 was proprioception. Even now in Month 5 when I've been doing everything for day-to-day function without issue for a few months, my non-conscious actions sometimes revert to when the ACL-less knee made my system nervous in Month 2. The most common thing I find myself doing is leaning forward against the sink or kitchen island when I'm there doing something for more than a few minutes. I remember needing to brace that way in the few weeks after I started doing things around the house and before the PT exercises to build hamstring strength and balance had made a difference. Now there is no reason for bracing. But it happens sometimes. Just like limping in early stages, it takes very deliberate thinking to re-train the entire system because of the change in the signals coming from proprioceptors in and around the knee.

The thread about skiing slow to improve technique for advanced trails has me thinking that going back and doing basic PT exercises from Months 2-3 every so often is probably a good idea.
 

marzNC

Angel Diva
#19
I like doing a personal training session weekly. Definitely helps that my trainer has been on skis. A long time ago, but she has some appreciation for my interest in doing exercises that are somewhat related to ski conditioning. In contrast the instructor of the Pilates class has no clue. Not that it makes that much difference for a general 45-min class.
 

marzNC

Angel Diva
#20
After working with my trainer for a couple months, I have a better appreciation for what she does. She comes prepared with ideas for an interesting work out that builds on what I've done before. She's also quite willing to get ideas from me. I've sent her a few links for ski conditioning and knee rehab exercises. She's incorporated a few exercises into the workout.

For me, it also helps to have an appointment. I work with her for 45 min and then do other exercises for another 45 min. Otherwise it can be easy to blow off a visit to the fitness center. Can do the same with a class, but I look forward to working with the trainer more.
 

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