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Offline dirtyholt

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ACL Rehab Blog Of An Olympic Athlete
« on: January 27, 2012, 05:09:39 AM »
I am an Olympic athlete who has now had his 3rd ACL surgery.  I have gained some valuable advice by lurking on this board over the last few years and figured it was time to post my own blog.  I feel that I gained a ton of motivation and referred to other's blogs for reassurance so hopefully someone can find something useful in this recovery blog.
 A little about myself:  I am an Olympic wrestler for the USA at 60kg.  I finished 5th in the USA last year and before this recent injury I have wins over the #2 and #3 athletes.  I will not have enough recovery time to make the trials for 2012 London.  This is my 3rd ACL, the first were cadaver grafts on both legs, this time I opted for a PT autograft after hours of research and talking with other Olympic wrestlers about their ACL's.  For my first 2 recoveries I had unlimited access to the Olympic Training Center doctors, trainers, and equipment but this time I have moved back home for 5-6 months and will be doing the rehab completely on my own without a PT (the OTC gave me a ton of equipment to use). I will update the blog in weekly increments.  Hope this can help someone.


Saturday 12/03/11. 
Surgery went well on Weinstein’s part according to him.  Everything else was a clusterf***.  As they were putting the anesthesia in my arm, the nurse comes in and says “ok, we are doing an allograft on your right leg.”  I told them to stop the IV until we get it right.  They went and got Weinstein and we got it straightened out.  When I woke up, they were basically giving me all of the info when I was still high, and kicked me out within minutes.  After that, disaster struck.  For some reason the RN who put my knee braces on, put the braces on the wrong legs, and also left my reconstructed knee in the brace with full flexion and extension.  When I went to take a step up the stairs thinking my grafted leg would move, it did not and it caused me to take a nasty fall.  I was too high still to look and evaluate the situation but nothing seemed to be damaged badly.  I think I did bash my grafted legs patella and caused a bunch of swelling.  I had tears coming out of my eyes because I felt so vulnerable and helpless, and I may have just screwed the entire surgery.  Luckily one of my training partners Ben Sanchez went out of his way to help me so much.  I will never forget what he did for me because if it wasn’t for him, I would have had to do this all alone as my wife was at a birthday party in California for my surgery.  She asked for a divorce the 2 days before the injury anyway so I didn’t really think I could count on her or lady luck for the near future anyway.
All of the trainers were gone except Jenna, and she wouldn’t let me GameReady, even though it was Weinstein’s orders.  She wanted me to put the GameReady over about 3 inches of solid packed cotton and gauze, which would have done nothing.  It doesn’t even get cold over an ace wrap, and this had cotton padding, a cotton roll, a compression sock, and an ace wrap.  She also suggested I do it with the CryoCuff which is just dumb.  Sometimes I wish some of the trainers would have to go through a mock surgery and rehab just to see what it is really like to use different modalities and rehab protocols in real life.  I went back to Ben’s room and just iced.  I was able to walk my dog with limited use of crutches in about a half mile loop and felt great.  The pain with the autograft surgery option is much more, but also so is the mobility after surgery.  Pain meds made me puke bad so I won’t be taking them until they prescribe me something different.



Sunday 12/04/11. 
s**t is painful as hell.  Much more painful that my allograft surgeries.  My legs have stiffened up considerably from not being able to effectively ice.  I cannot walk with the ease I could yesterday.  Not taking pain meds because they made me puke again.  The last thing I want is to have to throw up in a hurry and not have the ability to move quickly.  Switched it up and just started drinking and that helped.  Even for me, this pain is very bad, and I have a very high tolerance.  Iced a bunch of times with the Cryocuff but it is pretty ineffective.  I will keep using it because that’s all I have.  Did some quad sets which were slow.  My nerves aren’t exactly in sync with my brain yet.  Got my wall slides to 90° which was the goal.



Monday 12/05/11. 
Woke up in major pain just from stiffness and the surgery.  Not taking the pain meds is really hurting.  Still only snorting them because of the extreme nausea they cause.  Trainers aren’t really letting me do anything still so I do my rehab at home.  Just basic heel slides, quad sets, some wall slides and stretching.  I can drive just fine, but getting in and out of the car is the tricky part. Finished with 200mcg DMSO



Tuesday 12/06/11
Woke up and the legs weren’t as sore and achy.  It seems sleeping with them flat instead of elevated is helping.  Went in and alternated weighted terminal extensions with heel slides to about 70° for 3 sets of 20.  Next was 3 sets of 20 quad sets which I had very good control.  After that I did 1 set of 20 each theraband ankle pumps and some ankle mobility.  Ankles are getting a bit stiff from always being in flexion.  Hung my legs off the side and let them decompress.  Finished out with the GameReady for about 25 minutes.
Came home and set my legs in the braces flexed at 90° for 15 minutes.  Figured out if I inflate the CryoCuff to max and wrap it super tight to a large edema area, it will push it down my leg for a short period of time.  Gets swelling out but also bruises the lower leg badly.  Looks like I got hit with a baseball bat.  Went to PT and it my leg made the biggest jump today.  I can walk fairly well without crutches.  Did single leg step ups at about 2ft, just up and down.  Did some gait training and then wrapped on Ice bags.  Used 100mcg DMSO in each knee



Wednesday 12/07/11
At about 2 A.M my leg was killing me and it woke me up.  It was pretty swollen and hot so I decided to drain it.  I pulled 10ML’s out of it.  That’s a lot considering I am using ½’’ 31 gauge insulin syringes.  If I had the right needle, no doubt I could have pulled out 40-50 ML’s.  That’s how bad it is.  However, when I woke up, my leg felt the best it has. Iced a bit and went to meet with the surgeon and PA.
Doc took one look at my leg and said “we need to drain that sucker, it looks like a softball.”  Weird.  Used a HUGE 50mL syringe with a 2’’ 18 gauge needle.  Put some anesthesia in there and said “this is gonna hurt tomorrow.”  He pulled out about 30 ML easily and asked if I wanted him to dig around for more, which would also hurt more.  I told him get as much out as he could no matter what.  He got another 15 or so mL’s out.  When he took the needle out it was bleeding badly so he asked if I wanted him to go back in again and try another angle and I said yes.  He got another 3-4 mL’s and said the rest was congealed from icing and my body taking it.  I didn’t even tell him I pulled 10mL’s out earlier.  They said everything was good and got me out the door.
Rehab was good.  I have just been doing it in the weight room in-between sets.  Today I did TKE’s 2x50 with theraband, 2x25 Straight leg raise.  Single leg step ups and back.  Gait training with no brace, and 2x200 each direction on the spinner.  I know people would freak-out if they knew I was on the spinner but my ACL protocol says I can and it honestly didn’t hurt.  Anesthesia in the knee wore off at about 8pm and hit like a f***** truck.  Hurt SO bad.  Ran home and vomited from the pain, then drank whatever was in the house to make it go away. 
« Last Edit: January 30, 2012, 09:35:14 AM by The KNEEguru »

Offline Lottiefox

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #1 on: January 27, 2012, 03:55:53 PM »
Forgive me as I'm in the UK...but are you injecting DMSO into your own knees? Is this part of your surgery protocol? DMSO isn't used much here, but I have explored it for use with RSD. Are you also self draining your knees?! Are you a medic as well as a wrestler - I wouldn't trust myself not to stab the wrong bit....

Good luck, your knee sounds likes its been through a lot.

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #2 on: January 28, 2012, 01:25:17 PM »
Forgive me as I'm in the UK...but are you injecting DMSO into your own knees? Is this part of your surgery protocol? DMSO isn't used much here, but I have explored it for use with RSD. Are you also self draining your knees?! Are you a medic as well as a wrestler - I wouldn't trust myself not to stab the wrong bit....

Good luck, your knee sounds likes its been through a lot.

Lottie

I am draining and injecting on my own.  I am not a medic, but I do have a Masters in Health.  I have some experience before this as I have drained my ears and my teammates ears from hematoma auris literally 500 times in my life.  The DMSO is harmless, as I am only using a 12mm 29g.  Injecting DMSO is far superior IMO to rubbing it on, as most of the smell eminating from your body is no longer a factor.  Stock up on gum!

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #3 on: January 28, 2012, 01:31:11 PM »
Thursday 12/08/11
Did the same workout basically twice.  Warmed up in the hot tub to actually get some blood flow going.  Most trainers freak when they hear heat over an injury with swelling, and one trainer here actually ran over last time and told me I was doing everything wrong and would ruin my surgery.  Recent studies have actually shown that heat dramatically helps healing and gets swelling out faster when used in conjunction with cold and used correctly.  The military has actually stopped using RICE only protocol for sprains.  After  the hydrotherapy the legs felt better and I went into Straight leg raise 1 set of 25 toe in, 1 set 25 toe out, TKE’s 2x50, calf raises 3x20, gait training, single leg step ups, 3x50 revolutions on the bike.  After each I hit the GameReady for 20 minutes, full compression.  You would think at the Olympic Training Center we would have machines that worked but these GameReady’s haven’t worked for at least 2 years.  The compression is horrible and 2/3 won’t run for more than 7 minutes.  Drained 10mL’s out of my knee.

Friday 12/09-Sunday 12/11
Stopped using crutches completely today.  Drove from Colorado Springs, CO to Bonney Lake, WA.  Didn’t do much more than some ankle pumps, quad flexion, and quick stretching.  Drove in a small Celica which also was filled to the brim.  Driving a clutch was fine.  My graft leg is the gas leg, and it continues to be more of a problem than my repaired leg.  I am just glad I had Weinstein do the surgery because it appears he can put things into my body better than my body can adapt to them being gone.


Monday 12/12/11
First day of rehab at the new gym and at home.  Only did one workout as I am adjusting to being here and figuring everything out.  Started with 10 mins hot tub, then 3x150 revolutions on the bike.  Straight leg raises 2x25.  Leg back hip dips 3x10.  Body weight squats to 90° 3x20.  Three set complex of calf raise x 10 and soleus x 10.  Finished with some passive ROM and 3 minutes on the treadmill.  Washington has different laws, so I got some 1.5’’ 3mL syringes and got out about 12 mL’s of fluid from my graft knee.  Iced and used stim to finish.


Tuesday 12/13/11
Right leg was very stiff because I haven’t used any of the pain meds in about 28 hours.  In the morning I used ultrasound on each knee.  Drained out about 12mL’s of fluid from my graft leg and it helped greatly.  Gait without crutches is improving to where I have a small limp you wouldn’t really notice.  Started with 10 mins hot tub.  Static glute raise 2x20.   Straight leg raises 2x30.  Three set complex of calf raise x 10 and soleus x 10.  Three set complex Romanian deads x 10/squats 90° x 10. Finished with some passive ROM and 150 revs on the bike.  Couldn’t get any ice.


Wednesday 12/14/11
Legs are gaining more and more flexion everyday as the edema and swelling goes down.  Drained about 9mL’s out before my workout.  Started with 10mins in the hot tub.  Went to 3x50 TKE’s.  Next was a complex of theraband shuffles 2x25 each direction – forward/backward/left/right.  After was a complex of cup steps 3x10 each direction – forward/backward/left/right.  Straight leg raises 3x10.  Finished with the bike.  Seat 17, 150 revs forward/backward/forward.


Thursday 12/15/11
Legs are massively sore today.  I know it is from the theraband shuffles I did because I remembered how sore I got when I have done these before for the first time.  Went fairly light today to give my legs a little bit of a break to recover and heal.  Went 10mins hot tub and started with box step ups/step downs 3x10, 2 blocks high.  Next was 3x20 body weight box squats.  Did cup steps 3x10 each direction – forward/backward/left/right.  These felt really good today and I was getting my legs really high and taking fairly long strides.  Finished with 2 way single leg storks - forward/backward 3x10.  Finished with ice and stim.


Friday 12/16/11
Knee flexion is getting better every day.  The surgery was 2 weeks ago tomorrow so I moved on to weeks 2-4 of the rehab protocol from Weinstein’s office.  Pulled out 13mL’s of fluid in the graft knee.  The fluid is turning from dark red blood to a lighter color and I am pretty sure it’s just left over waste I am pulling out now so I will be only removing fluid from here on out if it is really swollen or sore.  Started rehab with 15 mins in the hot tub.  Did 1 mile on the bike in 5:30 on level 1, seat at 17.  This was very easy and there was no pain at all.  Did 4way storks on the balance pad 2x10.  After that I did Romanian deads/squat complex 3x10 with 40lbs.  This was also very easy but I don’t want to push it or use any weight until about week 5 minimum.  Next was glute raises 2x20.  Finished up with lateral box steps 3x10 on 2 blocks.  All of the box steps I have been doing are very easy for me as far as height and difficulty, but I am mainly doing them for the balance and proprioception of the step down portion, which is why I am keeping the reps and height fairly low for another few weeks.


Saturday 12/17/11
Hit the hot tub for 10 mins.  Started with 4 way stork stands on the balance pad 2x10.  Next was Straight leg raise 2x35.  After that was a complex of theraband shuffles 2x25 each direction – forward/backward/left/right.  Next was some flexion stretching followed by a calf raise/soleus raise complex 3x20.  After that was tke’s 2x50.  My reconstructed knee isn’t as good as my graft leg.  There is some slight popping and can’t get full extension.  I will start to incorporate these more and hold for longer at extension.  Finished with 2x50 up/down the stairs.  Iced and stim after workout.


Offline The KNEEguru

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #4 on: January 29, 2012, 10:09:07 AM »
Are you injecting the DMSO around the tendon or actually into the knee joint?

Needling the joint space for any reason as a 'home procedure' like this is, in my opinion, putting you at major risk of infection within the joint space with its usually dire consequences. You would be wise to have a chat about this to your surgeon.

KNEEguru
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Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #5 on: January 29, 2012, 03:32:43 PM »
Are you injecting the DMSO around the tendon or actually into the knee joint?

Needling the joint space for any reason as a 'home procedure' like this is, in my opinion, putting you at major risk of infection within the joint space with its usually dire consequences. You would be wise to have a chat about this to your surgeon.

KNEEguru

I am just going into skin tissue.  Its an insulin syringe, it doesnt even get through the subcutaneous tissue.  The risk of infection is extremely low.  My father in law is an ortho BTW.  I use DMSO by injection for 2 reasons:  It eliminates smell from the skin and it eliminates the burning/itching of the epidermis.

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #6 on: January 29, 2012, 08:23:31 PM »
2 WEEKS POST OP


Sunday 12/18/11
Hips and gluteals are f***** smashed today.  I think I am going to cut my theraband shuffles in half so that I don’t have to rest a day or two in between.  Doing the quad sets and passive flexion throughout the day before/after my rehab sessions are starting to pay off in my opinion.  Went in the hot tub for about 10 minutes and went right into hip dips 3x12.  These are getting very easy, but I am still only going down about 85°.  Next was tke’s 2x50.  These felt a little better on my reconstructed leg than yesterday.  After that was bodyweight box squats 3x22 at 90°.  Next was standing leg curls with the theraband to 90°.  Finished with complex of cup steps 3x10 each direction – forward/backward/left/right.  After I did ultrasound 7 mins each knee. 



Monday 12/19/11
Talked with one of the trainers from the OTC today about my rehab.  He had some ideas that I thought were really good.  The first was to start logging my ROM which I will do.  The second was to incorporate more balance work into my rehab.  My ACL protocol only says “balance board,” but I can do balance things fairly easily so I will also do that as well.  Also, he said he only allows resistance in the exercises after full ROM is achieved.  Since I am only using resistance on a few exercises, I don’t think this will matter much.  Doing TKE’s or Romanian deads with no weight seems like a waste of time since they are so easy already.  I think he mainly told me that to make sure I don’t rush ahead and start adding resistance to everything, as it seems like I could already. 
Started with simple stork balancing on one leg – 3 sets – 30sec eyes open/30sec eyes closed.  Next were glute raises 3x22.  After that were heel slides 3x20.  These are really only helping my reconstructed leg but the faster I can get all the way back to about 150° or so where I can sit on my calfs, the better.  Went into with 4 way stork stands on the balance pad 2x12.  Finished out with 3 sets of tke’s – 50/50/10 with 2 second holds at extension. 



Tuesday 12/20/11
Went in to 2 different PT’s today without much luck.  The first guy told me “Sports are my thing, I am taking a 1 year class to work with athletes.”  This didn’t sound too promising but I don’t really need him to be great at putting me through workouts, just to do soft tissue.  The deal breaker was that he already wanted to start f****** with my protocol and made it sound like the majority of my time there would be doing exercises.  I already exercise my leg about 2 hours a day minimum, I don’t need to pay to go in there and have him watch me do leg raises;  I need him to let me use modalities for recovery that I cant do myself or afford the equipment.  The second place looked great but didn’t take my insurance.  I am probably the worst kind of patient for these people because I can perform at a much higher level than they are used to, I have a lot of experience with ACL injuries and know what works for me, and I am used to having full time trainers who are the best in the world IMHO.  This is why I am checking all of my options because the last thing I want is a PT who cant handle my demands, no matter how bossy or eccentric they are.
Started with 10 mins hot tub and right into Straight leg raise 2x35.  Stairs 3x82.  Flexion is improving so stairs are becoming easier.  Next was stork balancing on one leg – 3 sets – 30sec eyes open/30sec eyes closed. After that I did standing leg curls for 3x20.  Snapped the theraband.  Finished with bodyweight box squats 3x25.



Wednesday 12/21/11 – 12/25/011
With the holidays I am lumping all of my workouts into one post since I was only able to do a real dedicated rehab workout at the gym for 2/5 days.  Made a makeshift goniometer.  ROM – Graft Knee:  Full.  Reconstructed Knee: 140
12/22 - Stork stand – 30 sec eyes open on balance pad, 30 sec eyes closed on mat, Straight leg raise 2x40, 4 way stork stands on the balance pad 2x12, Glute raise 3x24.
12/21 - Bike 1 mile, 4:25, level 1, seat 17, 1 way hip dip 3x14, Calf complex 3x22, TKE’s 50/50/10 – 2 sec holds last set, Theraband shuffle 2x10, Heel slides 3x20, Passive flexion.



Monday 12/26/11
Somehow my leg flexion increased a ton with the last couple of days of rest.  ROM – Graft Knee:  Full.  Reconstructed Knee:   150.  Rehab is going good.  I will keep everything the same as last week with the exception of adding one more balancing exercise.  After this Saturday, I will progress to the week 4/phase 3 ACL protocol exercises.  Today was a light workout comparatively.  Started with 3x14 hip dips.  Next was calf complex 2x22.  Did 4 way cup steps F/B/L/R and they felt great.  Did a superset of glute raise and heel slides  - 2x24, 3x20. 
« Last Edit: January 30, 2012, 09:39:29 AM by The KNEEguru »

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #7 on: January 30, 2012, 12:32:40 PM »
Monday 1/9/12
From here on out I am just going to give weekly updates and list my rehab logs unless there is anything of significance that happens.  I now have full flexion and extension in both knees.  I can sit on my heels with a little bit of discomfort, although I do not do it for extended periods of time.  I will begin to sit on them for longer in the next week.  This week will be going into the 6th week of recovery.  I will get back with the trainers at the OTC and get suggestions in addition to the protocol that my surgeon gave me.  I will not be going to a PT because none will take my insurance and they are wanting to charge $100 dollars for an hour. 
1/8/12
•   Hip dips 3x20 
•   Toe touches on foam roller 3X10
•   Glute raise 3x27
•   Knealing flexion stretching – sat on heels
•   Romanian dead lifts 2x10 45/65
•   4 way depth drops 3x10 – 2 blocks.  Forward/Backward/Left/Right
1/7/12
•   Stork stand – 30 sec eyes open on balance pad, 30 sec eyes closed balance pad
•   Theraband shuffle 2x14
•   calf complex 2x24
•   Prone hamstring curl 2x12
•   Flexion stretching
1/6/12
•   Stork stand – 30 sec eyes open on balance pad, 30 sec eyes closed balance pad
•   Standing leg curls with the theraband to 90° 3x20
•   Cup Steps with hips open 2x20
•   TKE with theraband medium resistance 3x25
1/3/12
•   Prone hamstring curls
•   Hip dips 3 way 3x16
•   Toe touches on the foam roll 3x10
•   Glute raise 3x27
•   Flexion stretching
1/2/12
•   Stork stand – 30 sec eyes open on balance pad, 10/10 sec eyes closed balance pad
•   Calf complex 3x24
•   Theraband shuffle 2x12
•   Straight leg raise 2x40 
•   Flexion stretching
12/28/11
•   4 way stork stands on the balance pad 2x12.
•   TKE with theraband 50/50/10 with 2 sec holds
•   stork stands on the balance pad 30 sec eyes open/30 sec eyes closed x 3
•   Standing hamstring curls with theraband 3x20
•   Flexion stretching
12/29/11
•   Romanian deads/squat complex 3x20 with 40lbs
•   Hip dip 3x16
•   Plate RDL 2x20 with 45’s
•   Heel slides to max 3x10
•   Theraband shuffle 2x11

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #8 on: February 03, 2012, 08:50:13 AM »
Monday 1/16/12
This was an awesome week of rehab.  A couple of weeks ago one of my ATC’s at the Olympic Training Center gave me the suggestion to add more balance work and sent me some literature and I really took it to heart and it is paying off big time.  Most of my strength work has gotten so easy that I will have to incorporate balance elements to those since I cannot add significant weight to them for at least another 2-3 weeks.  My reconstructed leg actually feels better during the rehab than the graft leg, but I believe this is due to feeling the scar tissue.  In these upcoming 2 weeks I will start to really focus on proprioception and moving into exercises that will get me ready for jogging i.e reverse lunges, depth drops, and single leg step ups.

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #9 on: February 03, 2012, 08:51:17 AM »
1/10/12
•   calf complex 2x26
•   BOSU Tennis Toss – Flat up 3x20
•   Open Hip Cup Steps – 2x20
•   Theraband Shuffle 2x16
•   Bodyweight Box Squats – 3x26
•   Stairs up/down – 2x90
•   Prone Flexion Stretching

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #10 on: February 03, 2012, 08:51:49 AM »
1/11/12
•   Jump rope 3x100
•   RDL/Squat complex 2x10 65
•   BOSU Squats – flat up 3x10
•   Flexion stretching
•   Prone hamstring curls 3x20

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #11 on: February 03, 2012, 08:52:16 AM »
1/12/12
•   Theraband Leg Curls – 3x24
•   TKE’s Medium Resistance – 3x26
•   calf complex 2x28
•   Foam Roll Tennis Toss – 3x10
•   Hip Dip 3x20

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #12 on: February 03, 2012, 08:52:45 AM »
1/13/12
•   Romanian Deadlift/Squat Complex – 2x10 65/65
•   Foam Roll Toe Touch – 3x12
•   Foam Roll Tennis Toss – 3x12
•   Bodyweight Box Squats 70° - 3x10
•   Passive Flexion – single leg aggressive

Offline sanjiv

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #13 on: February 06, 2012, 07:29:32 PM »
Hi DH,
These all sound like great exercises.  Do you have a reference/website with descriptions of them?
Thanks!
1/29/11 PCL, ACL, MCL complete tears + meniscus partial tear
2/15/11 Repair MCL, PCL allograft, meniscus repair
5/17/11 Scoping & MUA
8/30/11 ACL allograft

Offline dirtyholt

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Re: ACL Rehab Blog Of An Olympic Athlete
« Reply #14 on: February 07, 2012, 04:34:40 AM »
No website really explaining what they are.  My trainers also use different terminology for some of the exercises but I try to keep the terminology close to 100% literal.  What exercises dont make sense?















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