sherwooa's ACLr (B-P-B allograft) plus meniscus trim - 28 Oct 2010

[sherwooa]

Into week 14 now and a brief update.  Running program been going pretty well, although still having a bit of swelling that I can feel.  Not really impeding exercise, but causes a bit of stiffness the next morning and I feel the fluid moving around a bit.

Been working up to 1/8 mile jogging intervals, and started 1/2 and 3/4 speed sprinting as well, which actually felt really good!  This was on a treadmill, of course.  Also started doing carioaca/grapevine drills, in addition to running figure 8's, circles, backwards walking, etc. to work on agility and coordination. 

Overall pretty pleased with the progress, though I wish the damn swelling would go away.  It's just annoying.  i guess I'm not really giving it a rest to allow it to subside, but I really want to build up more strength and coordination so I hate to slow down.  As I've moved past the 3 month mark, I've found my patience is starting to get tested.

[hibiscus_tea]

O yay! I wish I was ready for some running!! I'm just a week behind you, but I'm no where near running/jogging.  Hopefully soon, though!

I understand about the swelling... mine's still swollen a bit, too.  When will it go away? 

[sherwooa]

Hey tea!  Thanks for stopping by.  With the running, it seems that there's some variation in the protocols that OS/PT's follow, but my OS said I was good to go on that, and I've seen a couple of protoclols that call for running by week 6-8, assuming there's no other complicating factors (like an ACL revision).  Here's one, for example:
http://www.udel.edu/PT/PT%20Clinical%20Services/RehabGuidelines/ACL.pdf

I'm sure you'll get there soon enough.  Just keep hitting those single leg presses, leg squats, step ups and hammie work hard.

In terms of updates for me, I still often need to take a day between running sessions due to stiffness and slight soreness under the kneecap, but the running generally feels good overall, and the sprinting feels good, though sprinting on a treadmill is a pain in the butt.  My second winter cold has slowed me down a bit this week, but trying to fight through it.  Swelling is still there but I've upped my intake of fish oil to help reduce it.  Hopefully it will help.

My current routine is roughly as follows:

SUN: ACL Running program (jog intervals, sprints, agilities)

MON: Front Squat (to 90 degrees only), Shoulder Press, Chin/Pullups, Split Squats or Lunges, Single leg wall squats

TUES: Power Cleans (if I'm feeling up to it), ACL Running program

WED: Rest or ACL Running program, depending on how the knee feels

THURS: Front Squat, Bench Press, Dips, Balance & Plyometrics

FRI: Deadlift, Chin/Pullups, Glute-ham raises, ACL Running program

SAT: Rest or ACL Running program, depending on what I did Wednesday

Hope everyone's feeling well and that recovery is going well!

[sherwooa]

Quick update from me - went out on the lacrosse field yesterday for my club's first practice.  And though my participation was limited, I did stand in the cage (I'm a goalie) and take some shots during warmups and later on in full field drills, and then did my running rehab on the sidelines during other activities.  i have to say I felt quite good, including the new bruises from stopping a few shots with my body.  No problems maneuvering around or moving side to side within the goal crease with knee brace on (Ossur CTi off the shelf model), no pains or tweaks and had good stability and control.  In fact, I felt quite "normal", if that can be said.  However, I kept wondering in the back of my mind after most moves if I damaged anything.  I guess that's going to be in the back of my mind for a while.  But all in all, was really great to be back out on the field and I know it's going to be difficult to hold myself back until end of March when I'm hopefully officially "cleared" by my OS to return to sports.

[steved]

That's awesome!!! I can't wait to be back playing footy myself. Overall, how does it feel? Did your insurance cover your CTI brace? I highly doubt i will be able to play in one but i would definitely like to try it out if my insurance covered it. haha. I'm really happy to read that you are progressing well. Almost there!!!

[sherwooa]

Thanks steve!  Overall the knee feels good, though I still have some effusion in the joint and some slight soreness the day after strenuous workouts, reminding me to take it a bit easier.

My insurance denied a custom CTi knee brace (they basically said because I had the ACLr I don't need one, and the data on braces for sports are inconclusive) so I bought an OTS model instead for a few hundred $, and it fits me just fine.  I'm mainly wearing it for protective purposes, even though the data are sketchy in that regard.  Psychologically, it at least makes me feel better anyway.  The CTi is not bulky at all and moves quite well with me, so I don't forsee any issue with it.

Are you running yet?

[steved]

Ok, I see. Yeah, I'm pretty sure it'll be the same deal with my insurance but I'm also not too sure if I woudl be able to play in one. I recently met someone who had ACLr a couple years back. She showed up to play footy with some of my friends & was also wearing a brace. Funny thing is after about maybe 10-15 mins of playing in it she yanked it off and tossed it on the sideline. She had worn it several times before but she did say it definitely impedes her from moving well while playing. I might just try out a more traditional knee brace or "sleeve" once I'm good though those have always been annoying to wear as well.

Running? Ehhhhh. I'm starting some light running on the treadmill this week. My PT has me limited to basic stuff right now but it does feel great to do. I'm still doing ladder running exercises during PT & at the gym. Running forward by taking quick steps in between ladder, then quick diagonal runs, quick side steps. Other than that I also just run in place for a few mins at a time.  It all feels pretty awesome now. I kinda wish she (my Pt) was a little tougher on me but I gotta listen & be patient.

Like you, I'm DYING to get back on the field and give it a go. I recently took up coaching an adult soccer team just to get out some of that anxiety that's been brewin' in me. Haha. Had a chance to kick the ball aorund this past weekend but still can't bring myself to trap an incoming pass with my "new" leg. It just doesn't feel right yet. It's like my body's telling me "dude, not yet". Soon though, very soon i hope!

[sherwooa]

Yeah, I could see how for soccer/footy having a brace on would be an issue.  The data don't really show any conclusive evidence for knee braces versus knee sleeves in terms of functional benefit, so the knee sleeve sounds like a good idea.  And for prophylactic use, only the ski studies show benefit, but I'll still wear it for a little while as it doesn't seems to impede me.  For me, as a goalie, it doesn't seem to present too many mobility issues yet, though I won't really be active outside of the crease until my OS clears me for full play anyway.  So hard to resist right now as I watch my teammates practice, but I won't do anything stupid until at least end of March. 

Anyway, glad to hear that you're doing the ladders and the light running.  In the long run, I don't think it will make much difference starting a couple of weeks later.  My jogging/sprinting is picking up and I did a couple of full field sprints on Saturday while my club was practicing.  Those felt pretty good because it's much easier on the joints to run on fieldturf than on the treadmill.  My ACL running plan from OS also had me starting some light cutting activity this past week - basically jogging backwards 5 yards and then running 45-90 degrees in the other direction for 10 yards.  Felt pretty good though I can still feel a bit of the fluid under the kneecap.  That's been getting a little better this week as I've upped my fish oil intake but it's still not gone by any stretch.  I can't wait for the day when I don't feel that bit of fluid shifting around in there.

Can't believe I'm in my 17th week already...

[sherwooa]

Today's update: 

Been hitting the weights increasingly hard, but have had to dial back the running, sprinting and agility somewhat (to 1-2 days/week at most) because it seems to aggravate the knee a bit and encourage a little swelling.  My PT said not to try to push through it, but rather to scale back a bit and let things calm down. 

Strength work doesn't seem to bother the knee much, and in fact makes it feel quite good.  I've been doing lots of front squats and deadlifts, as well as lunges, step-ups and split squats (as well as my usual regimen of pullups, shoulder press, bench pres, etc.).  Front squat weight is now up to 165 lbs (3 rep max) though I feel I can do more, and I've been going a bit past 90 degrees since it hasn't caused me any pain or discomfort to the meniscus.  Pre-injury, I was front-squatting 225 lbs for 1 rep, so I really want to get back to that.  Deadlift has come up to 225 lbs for 3 reps max (used to do 325 pre-injury) but a long way to go there.  Lunges and step-ups are done with 25 or 30 lb dumbbells.

Plyos have been limited to 1 day a week due to the knee swelling/irritation.  When I do them, I do split jumps, 2-legged and 1-legged box jumps (forward/backward and lateral), leg to leg lateral hops, as well as some jump rope.

As far as the (limited amount of ) running goes, I've also been trying to work on changing to a more "natural" forefoot running style (some refer to it as "POSE" or "Chi" style running) to reduce possibility of injury and be more efficient at running.  I think over the long-run it will be easier on my now partially carved meniscus.  But it's difficult to change gait after all these years so that will likely be a long-term project.  Agility work is ladders, circles, figure-8's, squares, cariocas and backward jog then cut 45-90 degrees.  No hard cutting yet.

Hoping for the all-clear on March 21st so that I can rejoin my lacrosse club on March 27th, but I'm also still a bit leary of coming back too soon.

hope all are doing well in their recoveries!

[steved]

Hey Sherwooa, hope you're feeling stronger today! About the plyos, this is abotu the only thing that currently irritates my knee. I've been jogging a bit, running backwards, kicked the ball around a few times and of all the things that irritates my knee, it's those step downs!!! I can easily go up stairs, i've been skipping a step everytime i ascend a staircase and it's perfectly find, I've actually noticed a huge difference on my control lifting myself up on to higher ground/objects. The issue is stepping down. I do hav emore control, but when i perform about 20 stepdowns, my knee (patella) gets a bit aggrevated. I have to make sure to save those for the end of my routine or else it'll totally kill my workout if done prior to anything else. Did you experience this at all?

My VMO is looking pretty good, my quads another story. Feels like its been SO hard to build it up fast. I mean I'm a small dude and my other leg isnt THAT big to begin with but it is well proportioned. I've never really lifted, I do perform squats. Should i incorporate some dumbbells in there? Hope you're doing awesome!

[sherwooa]

Hey Sherwooa, hope you're feeling stronger today! About the plyos, this is abotu the only thing that currently irritates my knee. I've been jogging a bit, running backwards, kicked the ball around a few times and of all the things that irritates my knee, it's those step downs!!! I can easily go up stairs, i've been skipping a step everytime i ascend a staircase and it's perfectly find, I've actually noticed a huge difference on my control lifting myself up on to higher ground/objects. The issue is stepping down. I do hav emore control, but when i perform about 20 stepdowns, my knee (patella) gets a bit aggrevated. I have to make sure to save those for the end of my routine or else it'll totally kill my workout if done prior to anything else. Did you experience this at all?

I totally know what you mean on the step-downs and plyos.  I have to take a couple of days rest after them to let the knee calm down a bit.  And walking downhill and doing lots of step downs also irritate my patella/inside the kneecap a bit.  I definitely experience that too, so you're not alone!

My VMO is looking pretty good, my quads another story. Feels like its been SO hard to build it up fast. I mean I'm a small dude and my other leg isnt THAT big to begin with but it is well proportioned. I've never really lifted, I do perform squats. Should i incorporate some dumbbells in there? Hope you're doing awesome!

Squats are the main thing, so you're in good shape if you're doing those, but you can supplement them with a couple of 3x10 rounds of some dumbbell work as well, with things like:
- Walking lunges w/dumbbells
- Step-ups (onto a bench, chair, etc.) with dumbbells
- Split squats w/dumbbells
- Single leg squat holding a dummbell or kettlebell

Let me know if you need more...I've been tracking a list of lots of exercises to do.  Be well!

[sherwooa]

Well, I saw my OS this morning, and he said things are looking good, and that I can begin returning to sports as of April 1st!  This will be just past the 5 month mark for me and I am so excited!  He said that the knee looks good, and that I am in the top of his patients in terms of recovery  He said that if I have been following the running/agility program that I am good to go to ramp up my sports activities.  He suggested I don't go all out at once, but come back gradually (which I'll do), and to avoid very high friction situations for a while - i.e. he suggested I not wear cleats/spikes on the turf fields (which I don't anyway) or play in very muddy conditions.  I think I'll plan to play a quarter or a half of my last few games in April, and then play a bit of pick-up lacrosse with the older guys until summer league starts in June.  Obviously will continue my strength and running training as I always do.

As for the knee getting a bit puffy and angry after harder running and plyo workouts, he said it's to be expected and that he didn't actually see much fluid in my knee.  He thought that because my knee capsule is relatively small, that I am going to be more sensitive to any amount of fluid in there.  He said it will come and go for a while with certain activities, but that it shouldn't limit my activity.  He also said that the knee still won't feel "normal" for about a year, which has been discussed on this board many times, so I expected that.  Hopefully by fall I won't think about it anymore.

All in all, very exciting news.  It's been so painful to stand on the sidelines watching my teammates play and not be able to go out there.  Now I just have to be careful not to go too fast...

[steved]

Ha, that's AWESOME!!! Well done on your recovery! It seems like time went by so fast now. Haha, at first it felt like an eternity! I'm happy to hear you're back at it again. I know what you mean about being on the sidelines watching your team, I've been torturing myself the same way. My Doc cleared me for soccer training, passing, shooting, dribbling etc. I won't be cleared to return to full contact until April 19th. I'm DYING! Ha. I'm really glad to hear your good news. Today's marks my 5 month mark. Gonna hit it hard this next month. Feels good to finally be running without any problems. I forgot what it felt like to be honest. There was a point during the rehab where you're trying to remember what that sensation is like and you almost doubt you'll get there anytime soon and outta nowhere, it just happens!

I had a CRAZY scare last night. While at the gym, i walked into the mens room and slipped on what seemed to be soap on the floor. My first instinct was to try and keep balance but once I realized i couldn't i just tried to not use my involved leg & fall back on my ass. I definitely tweaked it out a bit as I fell but as i got up, i couldnt tell if it was sore from the fall or from the workout. I was SO paranoid after that. I worked out for another 25 mins but couldn't shake it outta my head. Went home, iced, massaged and took some advil. I can't pinpoint any pain but it just feels sore. I'm hoping/assuming its just from the all the running. It was definitely a nasty feeling though.

I'll be looking forward to reading your future updates. Good luck in your return to lacrosse. take it easy!

[sherwooa]

Thanks steve.  Yeah, it does seem like forever ago that this journey started, but then at other times it feels like the 5 months has gone by pretty fast.  That's awesome that your doc is green lighting you too...looks like we're both doing really well with this.  Our athletic addictions are hard to cure!

Sorry to hear about the fall - that is definitely a freak-out kinda moment but I'm sure if there was real damage you would know after you went back to working out.  I still get somewhat sore after a good workout anyway, so probably that's all it was.

[sherwooa]

5 months post-op

Passed the 5 month post-op mark last week, and per my "release" from my OS, played in my first lacrosse game on Saturday night, which felt awesome!!!  I had a full week of working out beforehand, including my lifting, running program and plyos, with a Crossfit-style workout the day before my game, which was several rounds of running 400m followed by sets of pullups.  The knee was a tad sore on Friday afternoon, and I'm still a bit sore in the hamstring insertion these days, but with a bit of stretching and a couple of Advil, was good to go by game time.  I warmed up as usual, put on my brace, and stepped into the net for the entire second half of the game.  And though I was a bit rusty on a few of the shots I faced, It felt great to be back out there after the buildup and anticipation, and I acquitted myself fairly well, with several hard sprints to the endline to chase errant shots or passes.  I even came out of net a few times, though after initiating some contact fighting for a ground ball, I thought better of it and let my defensemen take over 

Overall, though I can't say the knee feels completely "normal" yet, it's pretty close, and I'm very happy with how things have progressed.  I don't feel like I've lost much in terms of ability or speed, though it's hard to judge objectively at the moment, and I may be fooling myself a bit  .  Either way, I'm pretty happy considering the severity of the initial injury, even if I will always have to deal with a few twinges and such here and there.  I guess, when I think about it, like many others, I forced myself to look at the rehab process just like part of my regular fitness training, and the challenge of trying to come back to where I was provided me with an objective.  I still have a ways to go obviously, but I'm working on it.  As we all know on this board, it's frustrating to have to go slow at times and to wait until you get all the required clearance, etc. but having now been through the first six months, the timing makes sense to me given the need to allow things to heal and to reestablish the strength and coordination in the involved leg before pushing for the harder stuff.  Now I just have to keep working hard and watching myself to make sure I don't do it again. 

By the way, a very useful resource I came across is www.sportsmetrics.net, and specifically this exercise protocol: http://www.sportsmetrics.net/wp-content/uploads/2009/11/WIPP-Exercise-Breakdown.pdf
It has some great stretches, drills and exercises that anyone can use to help train your body to avoid ACL injuries in the future.  It teaches you how to jump and land properly to avoid non-contact ACL injuries.  Great stuff.

Hope everyone is doing well!