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

[marzNC]

Just as well I didn't take the Volkl AC1 skis this weekend. Turned out that there was a free demo tent. So I did more hard skiing than expected. Including going at full speed . . . at least for the minute or two that's possible on the short Mnut trails.

TR Jan. 5-6
https://www.theskidiva.com/forums/index.php?threads/massanutten-january-2013.15531/#post-219448

There were a couple times that I felt a little tweak in the bad knee. More like a pull on the MCL or PCL than anything else. Very brief and didn't slow me down. What's more interesting is that the muscles around both knees feel equally sore after skiing hard on Sat while checking out demo skis.

The demo skis were all at least 152cm. Also did a run with Temptation 82 at 160. Knew they were long but the 152 was out. Didn't have a major problem with the longer skis, at least not because of the missing-ACL knee.

The guy at the demo tent said his mother hasn't had an ACL for a long time. Hasn't kept her from doing what she wants. Her doctor saw no reason for surgery.

 

[RockSki]

Similarly, I severely tore the ACL in one of my knees and have not opted for surgery. Thanks for taking the time to post all the helpful information. My injury took place almost 4 years ago, and I found this forum in searching for information and thinking about whether to pursue surgery. I also worked very hard at rehab and still do, although the gym is a bit stale for me right now so I am interested in the Bumps for Boomers routine. Yoga has been my mainstay, along with cycling and skiing. I ski with a brace (CTI brand) and tackle difficult terrain. Almost all of the time, I live pain-free. As an example, I slightly twisted my knee two days ago on a steep slope with chopped powder and again in moguls. This hasn't happened for more than a year. Today I skied without any pain whatsoever. I just took the KOOS test and agree that it's is an excellent instrument - and my score 95.8. If I had taken the test last week, my score would have been even higher, as I didn't tweak it at all in the previous week and often go months without a pinch.

 

[marzNC]

Similarly, I severely tore the ACL in one of my knees and have not opted for surgery. Thanks for taking the time to post all the helpful information. My injury took place almost 4 years ago, and I found this forum in searching for information and thinking about whether to pursue surgery. I also worked very hard at rehab and still do, although the gym is a bit stale for me right now so I am interested in the Bumps for Boomers routine. Yoga has been my mainstay, along with cycling and skiing. I ski with a brace (CTI brand) and tackle difficult terrain. Almost all of the time, I live pain-free. As an example, I slightly twisted my knee two days ago on a steep slope with chopped powder and again in moguls. This hasn't happened for more than a year. Today I skied without any pain whatsoever. I just took the KOOS test and agree that it's is an excellent instrument - and my score 95.8. If I had taken the test last week, my score would have been even higher, as I didn't tweak it at all in the previous week and often go months without a pinch.

I'm finding more and more stories of people who are doing fine without an ACL. Always fun to hear about advanced/expert skiers. Also found stories for people doing other sports when I looked around forums for rock climbing, golf, tennis, and a couple other sports in the summer.

Have you done much Pilates? Not so much for the knee, but I like it for the core.

 

[RockSki]

Pilates is not available at my gym, and I am not keen to switch gyms as the current gym is at my workplace so über-convenient in terms of location. The yoga class offered there is good for core plus overall strength and stability, including the damaged knee. For skiing, I do find core exercises to be very helpful as a tight core can help take pressure off the knee when turning.

I should have mentioned walking as a daily routine, as I walk about 30 min to/from work, including a significant hill that is often icy or snow-covered in winter. When we moved houses a couple of years ago, I was fortunately able to put walking distance on my priority list. We have less space overall and no home office for me, but absolutely worth it.

Standing up while cycling is bad news, and I do not do that anymore. I have begun to mountain-bike but do not harbour any ambitions for speed or technical trails. I do not particularly enjoy hiking with the knee brace, and would rather take up a new sport with brace and dismount with the bike for support if I feel uncomfortable. It is terrific to be out and about.


To my mind, in interpreting people's stories and the research studies, it is important to distinguish between outcomes. Laxity in the knee if poked and prodded does not always preclude a high quality of life and activity level (and the KOOS instrument reflects that often-hidden truth).

If I do end up being a candidate for surgery for this or something else, I want to be in good shape (physical and mental/emotional) to enable recovery.

 

[marzNC]

Nice to be able to walk to work! Do you ever walk backwards or sideways? I do that sometimes when I'm out walking the dog.

I was not a mountain biker. Gave a spinning class a try. Definitely not interested in learning how to stand on bike pedals for exercise indoors or out. But making good use of the recumbent bike my husband bought a while back . . . and doesn't use himself.

Here's a pilates video I found a few months ago. Made a lot more sense after having a class since I'd never done pilates before. Had seen Divas mention it so was curious. I like it better than yoga because there's more movement. I agree that changing gyms is not worth it. I spent several months figuring out what type of fitness center made sense for me since I'd never belong to one before. For me, I'll do a class now and then but not regularly. Prefer working on my own with personal training sessions to keep me going in regularly.

Since I was hiking around in August in the Adirondacks without a brace even before completing PT, I would probably not wear one for that. I'm only likely to do day hikes in any case. Definitely useful to working the muscles involved in balance and adjustment.

The amount of laxity my ortho found about 3 months after injury was minimal. A family practice physician might not even find it that easily. I was glad to have done an MRI early on. Read all sorts of stories of people in Canada and the UK who had to wait months for an MRI.

 

[marzNC]

Had a training session today. It's been about a month due to the holidays. Definitely enjoy working with my trainer. I'm using the entire 45 min using the TRX based on a list she works out beforehand. She uses a variety of exercises so it's not the same stuff every time while making sure that all areas are worked. I warm up on my own before she arrives. Then spend another 45-60 min doing other stuff with the machines after finishing with you.

Quite sure that the money spent for the community center membership and training sessions is a good investment not only for having more fun skiing, but for my long term health in general. A silver lining for becoming a coper without an ACL.

Being away from the machines is useful in a way. I could tell that I don't need to do strength exercises all the time to maintain muscles. I could even increase the weight on one machine, probably from doing other exercises for that muscle group. While I did some exercising in the last month, it was much less consistent than in the fall.

 

[marzNC]

Found a neat book about stretching: The Anatomy of Stretching by Brad Walker, 2nd edition. Covers pretty much all muscle groups. There is a drawing of a person showing the relevant muscles for each stretch. Plus a list of all sports for which the stretch is useful.

Now the stretches by Bumps for Boomers and other stuff I've found make even more sense.

 

[marzNC]

Doing way more than just coping this weekend. Did a lot of skiing at Massanutten today. Most significantly had a 2-hour lesson with a Level 3 instructor. Gave is a shot because it was a bargain at $30 for a Senior Clinic for $30. No one else showed up today so I got a private lesson.

It's very clear that with increased core strength and legs in general, I can continue to improve my skiing as much as I want.

 

[snow addict]

Marz, you are a source of inspiration.

 

[marzNC]

Marz, you are a source of inspiration.

Thanks.

My impression is that there are plenty of folks skiing at a high level without an ACL. But few talk about it publicly or do much more than post a few times on some online ski forum or other sports-related forum. So someone who has an ACL problem can think that reconstruction surgery is necessary to ski at an advanced level. The decision on how to handle knee injuries is complicated.

 

[marzNC]

After a full 2.5 days of skiing, the muscles around my knees are tight. During the weekend, walking up and down stairs took extra effort. It was easier to ski. I was moving pretty slow when walking around in ski boots. The good thing is that BOTH legs feel about the same.

 

[mustski]

After a full 2.5 days of skiing, the muscles around my knees are tight. During the weekend, walking up and down stairs took extra effort. It was easier to ski. I was moving pretty slow when walking around in ski boots. The good thing is that BOTH legs feel about the same.

See, now that is good news! Normality rocks.

 

[marzNC]

So after the long weekend at Massanutten with my daughter and friends, I drove home and then went back solo on Wed afternoon (timeshare condo good until Friday morning). Skied Thursday morning, then had another 2-hour Senior Clinic in the afternoon. Not nearly as sore as on the weekend. What was really fun was Friday morning. Frigid temps followed the rain on Wed. So snowmaking all day and night Thursday. The two black runs were in great shape Friday and pretty much empty. Not only because it was a weekday, also because it was in the low 20's with a strong wind. It was a good thing I'd taken all my cold weather gear just in case.

Bottom line: skied non-stop laps Friday 9:00-10:30 and again 11:00-1:00. Was doing pretty much the same as last season in terms of speed (fast) and types of turns. Felt good! Had to drive home (4 hours) or would've skied more.

 

[ScottishGirlie]

Sounds like you have done a great job getting that knees of yours fit for skiing! So glad that that you're having fun and getting some nice turns in!

Not long to Big Sky!! Is it really a year ago since we were there?

 

[marzNC]

Sounds like you have done a great job getting that knees of yours fit for skiing! So glad that that you're having fun and getting some nice turns in!

Not long to Big Sky!! Is it really a year ago since we were there?

Definitely looking forward to Big Sky again. I've booked a 3-hour private with the instructor I worked with last year. That will be on the first ski day in MT. While I'm obviously having fun skiing locally, the main idea is to be in the best shape possible for the trip out west in March. The 2-hour Senior Clinics at Massanutten are perfect prep.

 

[marzNC]

One of the things I learned from my physiotherapist was how to decide when to increase the weight for an exercise machine. He said that if I was comfortable with 2 x 15 reps, then could go up to the next level and start again with 2 x 10 reps. The good thing about being able to use the same equipment is that it's easier to tell how things feel compared to a few weeks ago. I'm not particularly trying to push for heavier weight, but it's interesting to note whether or not a given weight still works if I haven't been to the fitness center for a while. Maintaining a good level of strength for the long term is of more interest than trying to increase just for the sake of being stronger . . . if that makes any sense.

 

[marzNC]

Since I got back on the slopes, I haven't been spending as much time at home doing exercises. In particular not as much with the BOSU. My trainer asked about what I've been doing besides working with her weekly. Made me think about the question. I knew that I wasn't likely to keep up the level of intensity that I had last summer and fall. When I ski hard for a day or two, I'm going to rest for a day or two afterwards. Plus spending weekends skiing means fewer hours left in a week for other stuff.

The goal is to get back into an exercise mode for the next month in order to be in the best condition possible for my two weeks of skiing at Big Sky and Alta. Not really with a focus on the bad knee. More for general conditioning. I figure if I'm in better general shape, then I'll be less likely to make a mistake due to fatigue.

 

[mustski]

I am so impressed by your dedication and progress. Before this thread, I didn't even know that "coping" was an option. Good for you!

 

[marzNC]

I think that there are far more "copers" in Europe because the medical system there is less likely to result in ACLr surgery, especially for people over 50. Quite a few of the controlled clinical trials I found were conducted in Europe.

For me, I wanted to end up a "coper" and not an "adapter." An adapter lives with no ACL, but gives up activities. A coper continues to do all activities of interest, after appropriate rehab and then on-going exercises. The fact that I stopped playing sports like basketball, volleyball, tennis, and competitive table tennis 15 years ago or more made it much easier to decide to work on being a coper as the first choice. Never was much of a runner. It was clear early on that there is no downside to postponing ACLr surgery from a medical standpoint, as long as care is taken to avoid situations that might result in further damage. Luckily, I haven't had any buckling incidents after Week 1.

 

[Thymeline]

Thank you for sharing so much information, I think it is wonderful what you have tried and achieved so far!

I am in a similar situationbut different.... I am a 45yo woman in the Netherlands and I tore my ACL 4 weeks ago skiing in Austria. I fell, twisted the leg inward, felt much pain, a 'pop' and then the pain was gone.

When the accident happened, after it was clear what the problem was, there was no doubt in my mind that I wanted a repair. But after reading a lot on the subject I have begun to change my mind. If my leg could be stable enough to skate again without increased danger of injury to the meniscus, coping without the surgery is definitely the best way to go.

After the accident the Austrian doctors immediately diagnosed a complete rupture of the acl. they found much laxity in the knee. A MRI that same day showed the ACL is in fact not completely ruptured but the remaining fibers do not carry much strength. The Dutch doctors the next week confirmed that they found very much laxity inh the knee. Still, after the first week, in spite of this laxity I have not experienced any significant buckling of the leg in any situation (but I am not up to running and jumping yet). After 3 weeks of intense physio I definitely feel more confident and the only movement I need to avoid which causes some instability and much pain is a twisting/stretching action while putting weight on the leg, as in standing on pedals while biking - which I have tried- and pushing forward while skating/rollerblading - my pt made me do an excercise on the bosu ball, jumping onto it from a diagonal direction, which stretches and/or compresses all sorts of structures on the inner side of the knee in a very unpleasant way. The first week this movement when it accidentally happened, was excruciatingly painful. That pain is almost gone now. Nothing definite showed on the MRI, but it may have been the meniscus.

I would not be able to bear having to give up skating because of this. It appears I could be an excellent 'coper' except I am afraid that if there will remain this laxity in the knee, even if it doesn't buckle, the extra movement and wear on the meniscus will damage it if I do not give up skating. For next season I need to decide on this in two weeks from now when I get to see the ortho again.

Thank you for sharing and bringing together so much information helping others to decide on our options, I am really very grateful.