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

[marzNC]

Quick update after the start of the 2022-23 season . . .

Between more acupuncture treatments over the summer and ski conditioning in the fall, my lower leg is back in skiing shape. I skied at Winter Park and Wolf Creek over 11 days straight during an early season trip in December 2022 with no issues. I'll probably be more diligent about stretching and foam rolling during the ski season.

 

[marzNC]

Managed to ski for 10 days on southeastern groomers without incident. Included a very fast run down a slick black at Timberline in WV where I was essentially doing controlled side slips. The Drop normally has bumps when there is enough snow but had been groomed flat after a warm spell.

It was great fun to ski the new blue trails on the upper mountain at Massanutten. The flat sections along the ridge are great places to practice new drills I learned in December. The increased snowmaking power is impressive.

Last section of Upper Paradice leading to Ridgecrest (no snow on Lower Paradice yet), January 11, 2023


First big turn on Mueller's Mile, January 14, 2023

 

[shadoj]

@marzNC I know it's not a whole lotta snow, but that scenery is gorgeous! Glad places like this exist to get folks started skiing, even if on the "edge" of the climate/terrain!

 

[marzNC]

@marzNC I know it's not a whole lotta snow, but that scenery is gorgeous! Glad places like this exist to get folks started skiing, even if on the "edge" of the climate/terrain!

Actually for Massanutten, there was far more snow than I expected a few days before the trip started. They have been making snow there for over 50 years, but the major improvements to the snowmaking infrastructure in the last five years makes a huge difference when daytime snowmaking is possible for 2-3 days in a row.

I finally managed to start a trip report for Massanutten. Hope to do one for Timberline eventually.

TR Massanutten Jan. 11-17, 2023

Not sure I've ever done a trip report for Massanutten. It became my home mountain before I joined TheSkiDiva in 2009. Usually just post comments in the annual Mid-Atlantic/Southeast thread. Thought it was worth a separate report because of the new trails and other changes for the 2022-23...

www.theskidiva.com

I didn't do a private lesson at Massanutten this time. I did shadow the lesson my friends did together since I knew the instructor well.

On Thursday after I did some turns in front of the instructor/trainer I've worked with the most, he made a point of giving me one sentence of advice the next time he passed by. I'd chatted with him very briefly just before he headed out to do a clinic for a few of the younger instructors that morning. What he said is something he'd been saying 10 years ago when I first started doing lessons with him after knee rehab. Having worked on all sorts of stuff at Massanutten, Alta, Taos, and elsewhere since then, it helped to focus on that aspect. Found that I can do what he said much easier than before. Even on skis that are 10mm wider underfoot compared to the skis I was using back then.

 

[floatingyardsale]

Okay so I've read the whole thread and I have one question:

You mentioned that you can't stand on your bike pedals, but that you don't care bc it's not your sport. It is mine, however -- why couldn't you stand? Discomfort? Instability?

 

[marzNC]

Okay so I've read the whole thread and I have one question:

You mentioned that you can't stand on your bike pedals, but that you don't care bc it's not your sport. It is mine, however -- why couldn't you stand? Discomfort? Instability?

I can stand on bike pedals. The time I had trouble with standing on pedals was when I tried out a spin class. Can't say that anything hurt, but it didn't feel like a good idea. Probably more mental than anything physical. I think that was within a year of finishing knee rehab.

I did a "learn to mountain bike" day at my home mountain organized by SheJumps in September a while back. We had lessons in the morning on the beginner track. Standing on the pedals was not an issue. The reason I decided mountain biking wasn't for me didn't have anything to do with no having an ACL. In general, I'm not that keen about bike riding. I can reach a Rails-to-Trails trail a mile from my house. Probably only bike it once or twice a year. More likely to go play on the disc golf course that's along part of the trail.

 

[marzNC]

For anyone interested in what type of terrain I'm skiing these days, here are my trip reports so far. The conditions in Colorado in December included plenty of deep powder turns. Also early season lessons that were the first powder lessons I've had in a long time. For the Taos Ski Week, there was no new snow and plenty of sunshine so it was a perfect time to work on bump technique. I was able to add another approach to skiing bumps of all sizes that will take a few seasons to become fully ingrained.

TR Wolf Creek, CO - Dec. 11-17, 2022

My early season trip to Wolf Creek Ski Area was even more fun than last year. The crew was a bigger and ranged from 4 to 8 people. We opted to stay in a big house on the east side of Wolf Creek Pass. It was fun to introduce WCSA to a few new people, including an older intermediate starting to...

www.theskidiva.com

TR Taos Ski Valley (TSV) Jan. 28 thru Feb. 5, 2023

I got to see the Taos uphill policy in action last Sunday morning. I walked over very early from Alpine to put my skis on a rack. I was just in time to see the group of four start out. The woman in the third picture came over as I was walking away and asked me a question about going uphill or...

www.theskidiva.com

 

[mdeyan]

@marzNC it has been so inspirational to read through your story. Thank you so much. I tore my ACL skiing this December. I'm 46 and I am an intermediate advanced skier. I did a month of PT and today I got back on skis. It went well which I am so happy about. It only confirmed my decision to be a coper. I had a lot of anxiety and fear lately but after doing a quick search online yesterday I found your thread and your experiences have helped a lot!

 

[marzNC]

@marzNC it has been so inspirational to read through your story. Thank you so much. I tore my ACL skiing this December. I'm 46 and I am an intermediate advanced skier. I did a month of PT and today I got back on skis. It went well which I am so happy about. It only confirmed my decision to be a coper. I had a lot of anxiety and fear lately but after doing a quick search online yesterday I found your thread and your experiences have helped a lot!

Nice to "meet" you. Although sorry it's after you lost an ACL. Every knee injury and recovery is different. Anxiety and fear after any skiing injury is pretty natural. What region do you ski in the most?

As you've read, for me being a coper has worked out. Glad sharing my experience has been helpful. The silver lining is that skiing provided the incentive to get into better shape in general. Which means my fitness level and strength is better in my mid-60s than it was a decade ago when I popped off the ACL (not a skiing injury).

Have you noticed links to my fitness blog? It's geared to folks over 50 but is really appropriate for any adult interested in learning what exercises are good for ski conditioning. Check out the posts about hamstrings.

Over 50 Fitness For Skiing Adventures

over50skifitness.blogspot.com

 

[mdeyan]

I am a wanna be skier. It is a passion of mine but I get to ski just a couple of times a winter. My family and I do long weekends at Snowshoe, WV. The conditions are sad at the moment but we are making the most of it. My son is 7 years old and I've been trying to have him get a ski bug. After skiing for a couple of years, he turned to snowboarding, as he would say all cool kids are doing it. Oh well
Your dedication to fitness is as fascinating if not more as the fact that you have been able to ski anything you wanted in the past decade. It is very impressive and as I said inspiring. Love the story. For sure I will be tuning in on all the posts and links you did here to continue working on my knee strength and overall fitness. It is a must, should I want to continue to be able to ski. Which is my happy place.
I am also grateful for my orthopedic surgeon not pushing me into a reconstruction. I've seen two specialists and I looked into B.E.A.R. procedure, the future of ACL repair.

It is raining a bit now, however, we will be going out shortly.

 

[JaneB]

I had ACL and meniscus surgery 18 years ago. I ended up much worse off than if I had never had it done.
It's major surgery with the very real possibility of significant complications.

 

[marzNC]

I've seen two specialists and I looked into B.E.A.R. procedure, the future of ACL repair.

Hadn't thought about B.E.A.R. in years. Glad to know that it was approved by the FDA. I was following the early results from the clinical trials from the start. My professional life was as a biostatistician in the pharmaceutical industry, so I understand why it takes so long to complete the clinical trial phase of research for a new treatment. As I remember, the focus was for younger patients. Partially because the natural ability to heal is better at younger ages. Also, the impact of not having a natural ACL or having to deal with a 2-year recovery process after ACL-r surgery for someone who is under 30 is usually more significant than for someone over 50.

Looks like B.E.A.R. is being offered near me at Duke. There is a recent case study article.

January 2023

Bridge-Enhanced ACL Repair (BEAR) Allows Torn ACL to Heal Itself

Surgeons at Duke perform a new procedure, bridge-enhanced ACL repair (BEAR). It allows a torn ACL to heal itself and eliminate the need to take graft tissue from another part of her body.

www.dukehealth.org

 

[marzNC]

I had ACL and meniscus surgery 18 years ago. I ended up much worse off than if I had never had it done.
It's major surgery with the very real possibility of significant complications.

I'd like to think that treatment for ACL and meniscus injuries has improved in the last couple decades. However, I understand your point. When I researched the options in the summer of 2012, I read enough stories and medical journal articles to appreciate that the potential for less than optimal recovery was a factor to consider.

The knee is very complicated. Blowing an ACL always means there is collateral damage. In my case, it was not an skiing injury and the small hole in the meniscus and the MCL strain could heal within a few months without medical intervention. The difference in laxity between my two knees was quite small even a couple months after injury and only a few weeks of PT. For what I liked to do and intended to continue for a few decades didn't require an ACL so I opted to work at being a successful coper.

My personal trainer popped an ACL after age 60. It was work related and the ACL reconstruction surgery was 100% covered by Workmen's Comp. She knew from my experience that she could be a coper. But opted for the surgery after considering her options and doing PT for a few months. There was a time limit for the Workmen's Comp coverage. In her case, everything went very well. Her passion is swimming, in particular the butterfly stroke. That was another reason during the surgery made sense.

 

[marzNC]

My family and I do long weekends at Snowshoe, WV. The conditions are sad at the moment but we are making the most of it. My son is 7 years old and I've been trying to have him get a ski bug. After skiing for a couple of years, he turned to snowboarding, as he would say all cool kids are doing it. Oh well

It is raining a bit now, however, we will be going out shortly.

Hope you'll post about your ski day in the MidA/SE thread. My home mountain is Massanutten. They were able to make snow last night. Need it to get to their Snow Moon Fest March 3-5. Was getting pretty thin last week although Massanutten was able to keep the core trails open.

Mid-Atlantic/Southeast skiing (PA, NJ, DC, MD, VA, WV, NC, TN) for 2022-23

With fall colors starting early in central NC, it feel like time to start news and discussion for the 2022-23 ski season related to skiing/boarding in Pennsylvania, New Jersey, southern New York, Maryland, Virginia, West Virginia, or North Carolina. Decided to add Ober Gatlinburg in TN too...

www.theskidiva.com

I am also grateful for my orthopedic surgeon not pushing me into a reconstruction.

Having a supportive ortho surgeon is very important, regardless of whether someone decides to be a coper or have ACLr surgery. My surgeon supported my decision. He had skied a bit so that helped as well. Not as easy to find a surgeon who is a skier in North Carolina.

 

[marzNC]

Hmm, where did the time go? Realized I never finished off the story of my 2022-23 season, which marked 10 years skiing without an ACL. It was a fully adventurous season after being more cautious while letting a calf strain in January 2022 heal completely.

2022-23 Skiing Overview (days)
Dec: Winter Park (3), Wolf Creek (8)
Jan: Massanutten (8), Timberline (2)
Feb: Taos (9)
Mar: Sundance (1), Snowbasin (1), Grand Targhee (2), Big Sky (6), Bridger (3)
Apr: Brighton (PM only), Snowbasin (1), Park City (1), Alta (13)

The days at Snowbasin and Park City in April were unexpected. My daughter was taking her first trip back to SLC and Alta since middle school after graduating from college in 2022. With the wet slide issues in LCC due to super deep snow and unusually warm weather, we didn't get to Alta quite as soon as planned.

TR for mostly Alta, April 6-23

My annual April trip to Alta will be April 6-23. Mostly staying at Alta Lodge but starting with a few nights in SLC. Just as well given that Hwy 210 has been closed for several days and it's unclear when it will re-open. What's different this time is that my daughter is taking her first ski...

www.theskidiva.com

Fair to say I skied more deep powder than usual. Had powder lessons at Wolf Creek that came in handy at Sundance, Grand Targhee, and Alta. I actually learned a drill to practice on groomers that helps in powder.

 

[brooksnow]

I actually learned a drill to practice on groomers that helps in powder.

What is the drill?

My H has torn both ACLs. no surgery. It hasn't stopped him from skiing or doing anything else.

 

[marzNC]

What is the drill?

Can't really describe it well enough. We covered it in a semi-private lesson taught by a very experienced Level 3 instructor who taught for 30+ years at Crested Butte and Vail before moving to Wolf Creek. The shorthand that reminds me of what to do is "tip and twist." The actual movement is very subtle. He did covered several other ideas in the full-day lesson a couple days before, as well as at the beginning of the half-way lesson when there was plenty of fresh snow. We worked mostly on groomers during the lessons.

While I learned the concept of the drill at Wolf Creek, it wasn't until I did some related skills in the Taos Private Ski Week with Derek a couple months later that the drill really made sense.

Hoping I can get back the feeling this season. I'll do more lessons at Wolf Creek in December. Not going to Taos this season. However, I'll probably have another lesson at Bridger with Ric. He's another older Level 3 instructor that I've done lessons with more than once.

Without the knee injury, I probably would never have discovered how much could be learned from very experienced instructors on groomers that make skiing challenging terrain off-piste much easier in the long run. Knowing how to practice fundamentals regardless of snow conditions has been very helpful in the last decade. At the same time, it probably helps that I'm not a worrier or a perfectionist.

 

[marzNC]

When I was researching options in 2012 after I popped off an ACL (not skiing), I found a noticeable difference in the info I was finding depending on the country.

Just came across a recent article from Australia that suggests that delaying ACLr surgery may be the better option in many cases. The author has been a "snow-sports physiotherapist operating clinics in the Japanese ski fields" for 18 years and wrote that "I’ve personally treated hundreds, if not thousands, of people with ACL injuries in the first few days post-injury." Some of the conclusions are based on a study done in Australia called "Cross Bracing" reported in early 2023. As is common, the study participants were adults ages 16-36.

July 2023

https://www.snowsbest.com/acl-injury-skier/

" . . .

What we now understand about ACL​

The ACL is often partially torn.

The ACL can heal, even full ruptures.

People with healed ACLs have better outcomes than those with ACL reconstructive surgery and people with non-healed ACL who do not have surgery have the same or possibly better outcomes than people who have surgery.

Osteoarthritis rates are higher in the surgical group than in those who had healed ACLs, although OA rates are higher post-ACL tear with or without surgery.

Many people do return to pivoting sports without an ACL.

The graft type doesn’t seem to matter much, and none of the options are as good as the original.
. . ."

 

[marzNC]

My 2023-24 season is off to a good start. I did a fair amount of ski conditioning in the last 6 months and am back to full strength. The calf strain in January 2022 had an impact on the 2022-23 season.

I skied at Wolf Creek Dec. 9-15. Took it easier the first couple days and felt pretty good by the time we had a semi-private full-day lesson on Day 4. Three of my crew were working with a 20+ years Level 3 instructor who we started working with last season. The second half of the lesson we were working on bumps. Bonus was that the second full-day lesson a couple days later was a powder lesson. There was a snowstorm that blew in around 11am on Wed, dropped plenty of snow overnight, and was done by the next morning. By the end of the week, I felt pretty much back to where I was at the end of last season.

After Wolf Creek I spent a few days checking out Vail and Beaver Creek. I was skiing solo and in tourist mode. The long groomers meant plenty of opportunities to practice fundamentals based on the lessons at Wolf Creek. I did a few bump runs as well where there was enough snow coverage.

This season will be a bit unusual. I won't be skiing big mountains again until March. Instead I'm going to have fun with friends at my home mountain, Massanutten, and will explore midwest skiing in Michigan.

 

[floatingyardsale]

When I was researching options in 2012 after I popped off an ACL (not skiing), I found a noticeable difference in the info I was finding depending on the country.

Just came across a recent article from Australia that suggests that delaying ACLr surgery may be the better option in many cases. The author has been a "snow-sports physiotherapist operating clinics in the Japanese ski fields" for 18 years and wrote that "I’ve personally treated hundreds, if not thousands, of people with ACL injuries in the first few days post-injury." Some of the conclusions are based on a study done in Australia called "Cross Bracing" reported in early 2023. As is common, the study participants were adults ages 16-36.

July 2023

https://www.snowsbest.com/acl-injury-skier/

" . . .

What we now understand about ACL​

The ACL is often partially torn.

The ACL can heal, even full ruptures.

People with healed ACLs have better outcomes than those with ACL reconstructive surgery and people with non-healed ACL who do not have surgery have the same or possibly better outcomes than people who have surgery.

Osteoarthritis rates are higher in the surgical group than in those who had healed ACLs, although OA rates are higher post-ACL tear with or without surgery.

Many people do return to pivoting sports without an ACL.

The graft type doesn’t seem to matter much, and none of the options are as good as the original.
. . ."

I joined their Facebook group early on after I blew up my knee, and it's really interesting. Australia has a high rate of ACL tears and often a longer wait for surgery, so they've shifted to a PT/prehab first model and there's more and more evidence that a lot of people don't need the surgery as much as they need quality rehab.

For me, the practical takeaway was: you can wait and see how it goes. The typical US model really rushes people toward surgery but even a good surgeon will say that about a third of people are copers. It's just hard to predict who will be a coper, and most people don't want to wait.