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No ACL, no surgery, no problem - My new normal as a Coper
- Thread starter marzNC
- Start date
marzNC
Angel Diva
It’s been seven years since I popped off the ACL in my right knee (not skiing, age 56). I opted to take the conservative approach of exercise therapy only, meaning no ACL reconstruction surgery. In my case, the collateral damage was a minor MCL strain and a small hole in the part of the meniscus that could heal fully without medical intervention. I researched online and discussed the pros and cons of surgery with my surgeon after an MRI confirmed that the ACL was gone. At age 63, I am a coper with no knee pain, no knee swelling, no instability, and my KOOS score is about 98 (of 100). I ski at an advanced level (Level 8 of 9). Lately, I’ve been getting in 50 or more days a season, mostly at big mountains out west in recent years (requires flying). For my body and personality, deciding to work on fitness to become a successful coper was the correct choice.
I made two significant changes in order to continue skiing at an advanced level: 1) working on ski conditioning and general fitness on a regular basis year round, and 2) investing time and money in lessons and practice to improve ski technique. After three months of formal physical therapy for knee rehab, I joined a fitness center and started working with a personal trainer. I am in much better shape and a much better skier than before losing an ACL. I was never interested in the terrain park, hucking, or steep and narrow chutes. I’m enjoying trees, bumps, deep powder, and steeper terrain in ways I never expected given that I became an advanced skier after age 50.
For more insight into the rehab process during the first few months after injury (July-Oct 2012), here is my first coper thread:
Learning to be a coper without an ACL
The treatment approaches for how to treat ACL-deficient patients continue to evolve. The knee is complicated. Everyone's situation is different. Regardless of what can be learned online, there is no substitute for working with experienced medical professionals to come up with a personalized treatment plan.
I made two significant changes in order to continue skiing at an advanced level: 1) working on ski conditioning and general fitness on a regular basis year round, and 2) investing time and money in lessons and practice to improve ski technique. After three months of formal physical therapy for knee rehab, I joined a fitness center and started working with a personal trainer. I am in much better shape and a much better skier than before losing an ACL. I was never interested in the terrain park, hucking, or steep and narrow chutes. I’m enjoying trees, bumps, deep powder, and steeper terrain in ways I never expected given that I became an advanced skier after age 50.
For more insight into the rehab process during the first few months after injury (July-Oct 2012), here is my first coper thread:
Learning to be a coper without an ACL
The treatment approaches for how to treat ACL-deficient patients continue to evolve. The knee is complicated. Everyone's situation is different. Regardless of what can be learned online, there is no substitute for working with experienced medical professionals to come up with a personalized treatment plan.
marzNC
Angel Diva
I'm benefiting from the role models my parents provided. They lived into their mid-90s, and stayed active physically until the last few months. Stayed mentally alert until the very end. They weren't sporty as adults, but worked to keep up their balance and leg strength by walking on a regular basis. My mother also did a little Tai Chi now and then. She broke a leg at age 70 (rushing down stairs in their condo). Rehabbed very successfully by paying close attention during PT afterwards. She used what she learned to stay in good shape for daily living after that.
I’m very late to the party here but I just wanted to say a HUGE thank you for al of your information! I had a complete MCL tear and partial ACL tear in Dec 2019- skiing. Dr is hopeful of no surgery since I seem pretty stable I’ll see him again at 8 weeks out. MCL is healing but still sore and knee still swollen from either ACL or MCL. I read all 15 pages of posts. Thank you!!!!!
Susan L
Ski Diva Extraordinaire
@Freetoski Thanks for bringing this thread up and sorry about your injury, speedy recovery to you.
I just injured my knee last week - thought it was from overuse, but initial xrays shows a deep lateral sulcus that indicates ACL injury. I am seeing an orthopedic surgeon next week and hopefully can get an MRI soon. I cannot wait to find out what exactly is wrong so I can start looking forward to treatment/rehab.
@marzNC Thanks for sharing your experience!
I just injured my knee last week - thought it was from overuse, but initial xrays shows a deep lateral sulcus that indicates ACL injury. I am seeing an orthopedic surgeon next week and hopefully can get an MRI soon. I cannot wait to find out what exactly is wrong so I can start looking forward to treatment/rehab.
@marzNC Thanks for sharing your experience!
marzNC
Angel Diva
Sorry you needed to research a serious knee injury, but thanks for letting me know that you found this thread useful. Of course, knees are complicated and your ortho surgeon should be the best source of medical advice on what to do going forward.
For me, the MCL tear was small and could heal without surgical intervention. But it was what hurt for at least a couple months. I avoided a few PT exercises initially because they were painful.
Have you tried the KOOS self-rating yet? Doing that every 2-4 weeks was helpful to get a sense of progress during my PT period and extended rehab period working with a personal trainer.
Jenny
Angel Diva
Sorry to hear it's more than you first thought.
I did the KOOS test last night- I’m at 61. I agree it’s great to have a reference standpoint. I really appreciate all of your information and links!
another question for you- I was skiing on my old skis from 1999 when I was hurt, so the width was maybe upper 60s. time for a new set!
Do you find the new skis with the width to bother your knee? I was looking at a pair of Elan Ripstick 86 2019 version with kneebindings. The ski shop thought these would be a soft forgiving ski for me. I’m an intermediate skier not a real adventure seeker. I’m worried the 86 might be too wide. I live in Buffalo NY.
Thank you very much! Wish you a speedy recovery as well!
Mistletoes
Ski Diva Extraordinaire
Hi @Freetoski! I'm sorry to hear about your injury and hope it heals up quickly and completely. Glad you found the forum. These women and the forum are a wealth of knowledge!
I'm a Western NYer too, Bristol is my home mountain.
marzNC
Angel Diva
Later on, you can play around with your answers for KOOS to see what happens to the total score. my goal was to get to 90 and after that I didn't really pay as much attention. I noted my KOOS numbers in a blog post a few years ago.
Oct 2017, Over 50 Fitness For Skiing Adventures
Five years after rupturing an ACL, still a successful coper
I still have a pair of long, straight skis in my closet bought in the 1980s. Meaning over my head. Current ski sizing would be at nose or forehead height for an intermediate.
For skiing in the northeast, mid-80s is on the wide side. The skis I demo'd and bought several years ago for mid-Atlantic and northeast skiing are the Head Absolut Joys, 78 underfoot. The first good skis I bought after starting to ski more regularly (got my daughter started at age 4, she's in college now) in the southeast were 75 underfoot. I've only demo'd the Ripstick 93.
Check out this thread in Ski Gear about narrow skis, meaning under 80mm. What are your height/weight? I might be able to find a relevant gear discussion.
https://www.theskidiva.com/forums/index.php?threads/favorite-narrow-waisted-skis-below-80-mm.24335/
If you can wait, Holiday Valley seems to have a demo day in mid-December.
If your skis are that old, when did you buy your boots? Boot design has also changed since straight skis become retro gear.
As you've probably noticed, lessons and practice became a major interest for skiing after knee rehab, both locally and during trips out west. The skis I used the first season after rehab were used skis that were 72mm and a bit shorter than my all-mountain skis at the time (88mm, 159cm). I never had pain or swelling issues with skis of any width. That meant from 70 to 115 underfoot, depending on snow conditions and what region I was skiing in.
thank you! I’ll check that out. I was getting back into skiing after a 7 year break- my 6 year old twins were starting skiing. I purchased brand new boots this year and had them on with old bindings when I fell. It was a silly fall. A small bump like 200 feet from lodge at bottom of hill caught me off guard. I’ll have to measure my old skis I’m curious how wide they actually are! length was 170. Husband and I decided right then we needed upgraded gear. I’m 5’6” and was an out of shape 195 lbs at injury. Currently 185 working down towards goal of 165.
thanks!
marzNC
Angel Diva
Good that you've dealt with getting boots already.
My hiatus was longer since my husband is a non-skier for assorted reasons. It's lots of fun getting kids started. After my daughter was too busy for ski weekends, I started going to my local hill with a friend when her kids were 4 and 6. They've become good ski buddies for spring break trips to Alta.
Doesn't take much to mess up a knee. A couple years ago a woman in my Taos Women's Ski Week did a slow backwards fall at the top of an easy bump section, hardly moving forward at all. Another older woman and I were waiting to drop in and were surprised she couldn't get up. Diagnosis was a popped ACL.
If you haven't come across it already, good to read the info from Vermont Ski Safety about how to react when starting a fall in order to better protect knees.
Tips For Knee-Friendly Skiing
https://vermontskisafety.com/research/tips/
marzNC
Angel Diva
It’s been eight years since I popped off an ACL (not skiing) and then decided to be a coper instead of having ACL reconstruction surgery. For my particular knee injury and the way I approach life, that was a good decision. (See Posts 1, 4, 9, and 282 for more background.) With the abrupt end to the 2019-20 season due to the SARS-CoV-2 pandemic, I was doing a lot of cooking at home in April 2020 instead of enjoying my usual stay at Alta Lodge. So I never got around the end-of-season update for this thread.
In Jan-Feb 2020 I did a few trips to Massanutten in VA with friends. Also used the Indy Pass (initial season) to check out Bryce in VA and Cataloochee in NC for the first time. Mid-season out west started with another Taos Ski Week in early February followed by a few days around SLC, finishing up with powder skiing at Steamboat over Pres. Day weekend.
It was the fourth season in a row I spent a week skiing at Taos Ski Valley in February. This time I set up a Private Ski Week with a few ski buddies, which worked out very well. Bonus was getting to hike the Ridge after a powder storm. Snow conditions were quite good so the lessons focused more on tactics than technique. What I learned was put to good use at Alta and Steamboat.
TR Taos Feb. 1-7, 2020
https://www.theskidiva.com/forums/index.php?threads/tr-taos-feb-1-7-2020.24581/
While staying in a VRBO house in SLC, we skied Deer Valley, Alta, and spent a day at Solitude. I took the Sol-Bright trail over to Brighton for the first time. Usually it either hasn’t been open or there hasn’t been time. Even with the lift upgrades at Solitude, I like Brighton a bit better. Fair to say that the lessons and mileage are adding up so that the type of terrain I’m skiing at Alta is far more complex than 4-5 years ago. I ski far more in the Wildcat trees and chutes than before.
An unexpected purchase was a pair of DPS Zelda skis, 106 underfoot, 158cm. Wasn’t really looking to buy powder skis since renting demo skis has worked out fine for the few powder days I'm lucky enough to catch. Especially since I have skied my Stormrider 85s in 10-15 inches of fluffy powder in recent years and had a very good time. The Zeldas are staying out west with my primary ski buddy so that I won't have to lug two pairs of skis around airports.
Going to Steamboat was mainly to check it out for future reference. Since it was a holiday weekend, I set up a longer semi-private lesson for me, Bill, and Jason partially to have a guide and to cut lift lines. We completely lucked out. That Sunday was a deep powder day, with at least a foot of fresh snow in the morning and it was still snowing. It was a great way to play with my new powder skis. Definitely would not have found some of the stashes in the trees otherwise. After lunch we got some good tips about skiing deep powder in trees. Based on the experience, Steamboat is on my list for future trips.
On the way to Denver we spent a couple of hours enjoying powder turns at Howelsen Hill, which is right in the town of Steamboat Springs. Check out my trip report for some views of Steamboat on a blue sky day. Howelsen has a lot of history.
TR Howelsen Hill, Steamboat Springs, CO - Feb. 18, 2020
https://www.theskidiva.com/forums/i...-hill-steamboat-springs-co-feb-18-2020.24709/
Overall, 2019-20 was a good season. Especially when it came to catching powder storms. The on-going investment in high level lessons continues to be worthwhile.
In Jan-Feb 2020 I did a few trips to Massanutten in VA with friends. Also used the Indy Pass (initial season) to check out Bryce in VA and Cataloochee in NC for the first time. Mid-season out west started with another Taos Ski Week in early February followed by a few days around SLC, finishing up with powder skiing at Steamboat over Pres. Day weekend.
It was the fourth season in a row I spent a week skiing at Taos Ski Valley in February. This time I set up a Private Ski Week with a few ski buddies, which worked out very well. Bonus was getting to hike the Ridge after a powder storm. Snow conditions were quite good so the lessons focused more on tactics than technique. What I learned was put to good use at Alta and Steamboat.
TR Taos Feb. 1-7, 2020
https://www.theskidiva.com/forums/index.php?threads/tr-taos-feb-1-7-2020.24581/
While staying in a VRBO house in SLC, we skied Deer Valley, Alta, and spent a day at Solitude. I took the Sol-Bright trail over to Brighton for the first time. Usually it either hasn’t been open or there hasn’t been time. Even with the lift upgrades at Solitude, I like Brighton a bit better. Fair to say that the lessons and mileage are adding up so that the type of terrain I’m skiing at Alta is far more complex than 4-5 years ago. I ski far more in the Wildcat trees and chutes than before.
An unexpected purchase was a pair of DPS Zelda skis, 106 underfoot, 158cm. Wasn’t really looking to buy powder skis since renting demo skis has worked out fine for the few powder days I'm lucky enough to catch. Especially since I have skied my Stormrider 85s in 10-15 inches of fluffy powder in recent years and had a very good time. The Zeldas are staying out west with my primary ski buddy so that I won't have to lug two pairs of skis around airports.
Going to Steamboat was mainly to check it out for future reference. Since it was a holiday weekend, I set up a longer semi-private lesson for me, Bill, and Jason partially to have a guide and to cut lift lines. We completely lucked out. That Sunday was a deep powder day, with at least a foot of fresh snow in the morning and it was still snowing. It was a great way to play with my new powder skis. Definitely would not have found some of the stashes in the trees otherwise. After lunch we got some good tips about skiing deep powder in trees. Based on the experience, Steamboat is on my list for future trips.
On the way to Denver we spent a couple of hours enjoying powder turns at Howelsen Hill, which is right in the town of Steamboat Springs. Check out my trip report for some views of Steamboat on a blue sky day. Howelsen has a lot of history.
TR Howelsen Hill, Steamboat Springs, CO - Feb. 18, 2020
https://www.theskidiva.com/forums/i...-hill-steamboat-springs-co-feb-18-2020.24709/
Overall, 2019-20 was a good season. Especially when it came to catching powder storms. The on-going investment in high level lessons continues to be worthwhile.
marzNC
Angel Diva
Although I didn't update this thread for the 2020-21 season, I skied a fair amount that season. I skied over 60 days, half in the southeast and half after flying out west. Travel planning with my ski/travel buddies shifted a bit to adapt to the pandemic situation. I skied with local friends a few times in January driving to my home hill, Massanutten. A southeast highlight was checking out Timberline in WV after the new owners took over and made major upgrades. Wolf Creek was the highlight when exploring new ski areas in Colorado. My annual stay at Alta Lodge included skiing with Divas, including a few I met for the first time.
Dec 2020: Jackson Hole, Grand Targhee, Alta
Jan 2021: Massanutten (multiple driving trips), Timberline (day trips from Massanutten)
Feb 2021: Colorado sampler: Copper, Monarch, Wolf Creek (with lesson), Arapahoe Basin, Loveland
Mar 2021: Taos (Private Ski Week)
Apr 2021: Alta (2 weeks), Solitude/Brighton (day trip)
Dec 2020: Jackson Hole, Grand Targhee, Alta
Jan 2021: Massanutten (multiple driving trips), Timberline (day trips from Massanutten)
Feb 2021: Colorado sampler: Copper, Monarch, Wolf Creek (with lesson), Arapahoe Basin, Loveland
Mar 2021: Taos (Private Ski Week)
Apr 2021: Alta (2 weeks), Solitude/Brighton (day trip)
marzNC
Angel Diva
It’s been almost 10 years since I popped off the ACL in my right knee (not skiing, age 56). I opted to take the conservative approach of physical therapy only, meaning no ACL reconstruction surgery. In my case, the collateral damage was a minor MCL strain and a small hole in the meniscus that could easily heal fully without medical intervention. An MRI 3 weeks after injury had confirmed that the ACL was gone. I researched online before discussing the pros and cons of surgery with my surgeon.
At age 65, I am a successful coper with no knee pain, no knee swelling, no instability, and my KOOS score has been 95 plus/minus 2 (out of 100) since six months after the knee injury. After knee rehab I became a solid advanced skier (Level 8 of 9) with the help of lessons at my home hill and at destination resorts.
I’ve averaged 50 days a season in the last 5-6 years, more than half flying to ski at at big mountains out west. For my body and personality, deciding to focus on ski conditioning and lessons to become a successful coper was the correct choice. I don’t use a knee brace.
I am in better shape and a much better skier than before losing an ACL. I was never interested in the terrain park, hucking cliffs, or steep and narrow chutes. I’m enjoying assorted ungroomed terrain including bumps, trees, and deep powder when I get lucky enough to catch a big storm. The unexpected bonus it that after a few seasons of lessons, I started enjoying challenging, steep terrain that I never expected to ski. For those who know Alta or Taos, examples are Supreme Bowl, or Lorelei, or terrain off the Kachina lift.
For insight into the rehab process during the first few months after injury (July-Oct 2012), here is my first coper thread:
Learning to be a coper without an ACL
The treatment approaches for how to treat ACL-deficient patients continue to evolve. The knee is complicated. Everyone's situation is different. Regardless of what can be learned online, there is no substitute for working with experienced medical professionals to come up with a personalized treatment plan.
At age 65, I am a successful coper with no knee pain, no knee swelling, no instability, and my KOOS score has been 95 plus/minus 2 (out of 100) since six months after the knee injury. After knee rehab I became a solid advanced skier (Level 8 of 9) with the help of lessons at my home hill and at destination resorts.
I’ve averaged 50 days a season in the last 5-6 years, more than half flying to ski at at big mountains out west. For my body and personality, deciding to focus on ski conditioning and lessons to become a successful coper was the correct choice. I don’t use a knee brace.
I am in better shape and a much better skier than before losing an ACL. I was never interested in the terrain park, hucking cliffs, or steep and narrow chutes. I’m enjoying assorted ungroomed terrain including bumps, trees, and deep powder when I get lucky enough to catch a big storm. The unexpected bonus it that after a few seasons of lessons, I started enjoying challenging, steep terrain that I never expected to ski. For those who know Alta or Taos, examples are Supreme Bowl, or Lorelei, or terrain off the Kachina lift.
For insight into the rehab process during the first few months after injury (July-Oct 2012), here is my first coper thread:
Learning to be a coper without an ACL
The treatment approaches for how to treat ACL-deficient patients continue to evolve. The knee is complicated. Everyone's situation is different. Regardless of what can be learned online, there is no substitute for working with experienced medical professionals to come up with a personalized treatment plan.
marzNC
Angel Diva
For me, the 2021-22 season was a good one but didn’t quite end up as planned because of an early season injury unrelated to the ACL-deficient knee. That meant I skied less at Massanutten in January after a great week skiing powder in the trees at Wolf Creek in December. After a few weeks rest before the Taos trip, I was able to enjoy the rest of the season as planned but dialed it back a bit in terms of how much time I spent skiing challenging terrain on a given day.
I strained calf muscles when I caught an inside edge on a groomer in early January at Timberline in WV. As a result, I spent less time than usual on challenging terrain at Taos and during a late season trip to Alta. After straining the calf, I did weekly acupuncture and rested when I was at home. I was able get to the point that I could participate fully in an advanced Private Ski Week (6 consecutive morning lessons with 3 friends). My instructor provided more than enough drills to practice on groomers in the afternoons while having fun skiing with friends who are intermediates. After a good week at Taos, I wasn’t concerned about the other ski trips I had planned.
Dec 2021: Wolf Creek (drove from NC to CO)
Jan 2022: Massanutten, Timberline (driving)
Early Feb 2022: Taos (Private Ski Week)
Late Feb 2022: Indy Pass ski safari driving to the northeast, plus a Plattekill powder morning
Late Mar 2022: SLC ski safari
April 2022: Alta Lodge (2 weeks), powder storm April 11-13
The Indy Pass ski safari included day trips to Catamount, Berkshire East, West Mountain, then I headed west to Plattekill (not Indy). Since I had Ikon, I checked out Windham on the way from MA to Plattekill. I stayed as close as possible to Plattekill knowing that it would snow that night. I finished the trip skiing at Montage the next morning before driving home.
The late season trip to SLC was a mix of spring skiing and a powder storm. A few friends who were intermediates were also staying at Alta Lodge, so it was more of a social skiing vacation. Although that’s usually the case for Alta in April. A fall in deep powder that led to a small bruise below the knee was another reason to take it easy for a few days.
Overnight snow on RAV4 Prime at the Colonial Motel near Plattekill, Feb. 25, 2022
Lots of snow, not very many people
I strained calf muscles when I caught an inside edge on a groomer in early January at Timberline in WV. As a result, I spent less time than usual on challenging terrain at Taos and during a late season trip to Alta. After straining the calf, I did weekly acupuncture and rested when I was at home. I was able get to the point that I could participate fully in an advanced Private Ski Week (6 consecutive morning lessons with 3 friends). My instructor provided more than enough drills to practice on groomers in the afternoons while having fun skiing with friends who are intermediates. After a good week at Taos, I wasn’t concerned about the other ski trips I had planned.
Dec 2021: Wolf Creek (drove from NC to CO)
Jan 2022: Massanutten, Timberline (driving)
Early Feb 2022: Taos (Private Ski Week)
Late Feb 2022: Indy Pass ski safari driving to the northeast, plus a Plattekill powder morning
Late Mar 2022: SLC ski safari
April 2022: Alta Lodge (2 weeks), powder storm April 11-13
The Indy Pass ski safari included day trips to Catamount, Berkshire East, West Mountain, then I headed west to Plattekill (not Indy). Since I had Ikon, I checked out Windham on the way from MA to Plattekill. I stayed as close as possible to Plattekill knowing that it would snow that night. I finished the trip skiing at Montage the next morning before driving home.
The late season trip to SLC was a mix of spring skiing and a powder storm. A few friends who were intermediates were also staying at Alta Lodge, so it was more of a social skiing vacation. Although that’s usually the case for Alta in April. A fall in deep powder that led to a small bruise below the knee was another reason to take it easy for a few days.
Overnight snow on RAV4 Prime at the Colonial Motel near Plattekill, Feb. 25, 2022
Lots of snow, not very many people
marzNC
Angel Diva
After the calf injury in January, I confirmed a day later at my local Urgent Care that there was no involvement of any knee ligaments. An X-ray showed no bone damage. I’d seen the Ortho PA before (nothing to do with leg muscles). The Orthopedic Urgent Care office is associated with the Orthopedic group who helped deal with my ACL injury in 2012. He had me push in all directions, which I could do with a lot of strength and no pain. Based on the examination, an MRI was not warranted. He gave me a list of PT exercises to do. I recognized most of them from PT in 2012. They were related to Range of Motion or adductor/abductor strength.
I took Yunnan Baiyao for several weeks after the calf injury. I did acupuncture treatments weekly in between ski trips in January, February, and March for a total of 8 treatments over about 10 weeks. Given that was an acute injury, the treatments included electric stimulation for 3-4 points. After each treatment, I could easily tell it made a difference.
I've been wearing knee socks and a leg warmer to keep the injured calf and knee warm during the day. I also used the leg warmer when sleeping. Keeping that knee warm was helpful during recovery in 2012. When it’s cold, I often wear leg warmers over both knees for a while after taking off my ski boots. Especially if I’m doing a day trip and need to drive for a bit.
In general, skiing wasn’t an issue. Walking down stairs is another story and I’m doing that slower than usual. In general, my calf muscles are tight on both legs. I took hot baths during trips as a substitute for a hot tub. Using the hot pools and sauna during the longer stay at Alta Lodge after skiing was very helpful. There were a few days I didn’t get to do that until after dinner. It was clearly better if I warmed up and stretched the calf muscles sooner rather than later.
Before next season I’ll probably work harder on adductor/abductor muscles, along with hamstrings as usual. Those muscles were emphasized during knee PT.
I took Yunnan Baiyao for several weeks after the calf injury. I did acupuncture treatments weekly in between ski trips in January, February, and March for a total of 8 treatments over about 10 weeks. Given that was an acute injury, the treatments included electric stimulation for 3-4 points. After each treatment, I could easily tell it made a difference.
I've been wearing knee socks and a leg warmer to keep the injured calf and knee warm during the day. I also used the leg warmer when sleeping. Keeping that knee warm was helpful during recovery in 2012. When it’s cold, I often wear leg warmers over both knees for a while after taking off my ski boots. Especially if I’m doing a day trip and need to drive for a bit.
In general, skiing wasn’t an issue. Walking down stairs is another story and I’m doing that slower than usual. In general, my calf muscles are tight on both legs. I took hot baths during trips as a substitute for a hot tub. Using the hot pools and sauna during the longer stay at Alta Lodge after skiing was very helpful. There were a few days I didn’t get to do that until after dinner. It was clearly better if I warmed up and stretched the calf muscles sooner rather than later.
Before next season I’ll probably work harder on adductor/abductor muscles, along with hamstrings as usual. Those muscles were emphasized during knee PT.
