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View Full Version : Ryan--ACL progress?


Carrie Klumpar
03-31-2004, 10:20 PM
I hope nobody minds my using the board this way...

Just wanting to check in with Ryan and compare notes on the ol' ACL recovery thing. How are you doing these days? Where are you with flexibility and swelling and strength and workouts and suchlike?

I just hit my 5-week "anniversary." I'm now off the brace fulltime but still feel a bit delicate on my feet. Flexion is about 146 degrees and slowly improving. I still have some relatively mild swelling, which feels like it will *never* completely disappear. <sigh> My strength exercises are increasing each PT session ("group" sessions in rehab gym twice a week), though my leg is still all skinny and weak. But I'm doing mini-squats (less than 90 deg) now, and yesterday they put me in a Smith machine :lame: and let me do minisquats with the bar. I was tickled just to have the bar on my back and to assume the position. Someday, I'll be back. Eventually. But, man, is it frustrating to lose so much so fast!

Anyway, just thought I'd check in. It's always inspiring to hear how you're doing. Off to hit the ice...

Brad Hirakawa
04-01-2004, 08:46 AM
Congratulations on your recovery Carrie!! You'll be back in no time. :-)

Ryan Atkins
04-01-2004, 02:38 PM
Congratulations on your progress, Carrie. Although it is a Smith machine, I am pleased to hear that your therapist is introducing resistance exercises of the manner you describe. It helps reinforce some of the notions I've been developing lately regarding my own rehab.

There are a lot of positives going on in my recovery at the moment. I'm pain free 99% of the time and there is no swelling (that I notice anyway). Flexibility seems fine, but I do notice that my right knee is about an inch higher than my left when in a full squat position. Just this week, I've decided to reintroduce small amounts of resistance to some exercises (95# deadlifts, 30# dumbbell swings, etc.) in the WOD. I try to perform these movements slowly with as little momentum as possible and paying extra special attention to mechanics and feedback the more my knees flex. So far, so good. The facility where I go for therapy has Concept IIs available. After the therapist sets me up on the stair stepper and returns to her office, it hasn't taken me longer than about 5 minutes or so to find myself 'lost' in the vicinity of the rowing machines. Going full bore on the rower(1340m in 5:00 and 1000m in 3:28.1) has forunately not bothered the knee at all.

For me, the most disappointing part of this whole process has been the physical therapy. The past four times the exercises have almost always been on machines and have with little exception looked like this:

Leg press 2x20
Leg curls 2x20
Hip abductor 2x20
Reverse hip abductor? 2x20
Calve raise 2x20
Balance board work ~5 minutes
Stairstepper (5 min forward, 5 min backwards)

The therapist informed me that I have reached a plateau because it'll be several weeks before the next 'phase' of my rehab begins, so I'll only need to see her once/week until then. I certainly hope the workouts become more varied and/or functional during that time. I am toying with the idea of changing therapists.

The physical therapy routine I've been developing at home looks something like this:

1. Front squats (1st 10 w/45# bar, next 40 w/broomstick. Alternatively 2x10 w/45#bar)
2. Overhead squats (same rep scheme as above)
3. Lunges (20 ea. side, broomstick only)
4. One-legged partial squats (one step depth, forward and back 20 reps each)
5. One-legged 'balancing' calve raises (only support comes from standing leg which is on a raised 2x4)
6. Forward, sideways and backwards walking on an inclined treadmill or using therabands around the ankles for resistance.
7. Aerodyne bike

Extra care is taken when doing exercises 1 & 2 with the bar (really slow movement, no momentum), but I do go to full depth. I don't always have enough time to get through everything on this list, but if I make it at least through the 3 or 4 exercises (which I consider the most important), I feel I've accomplished something. I plan on gradually increasing the % of work I do with the 45# bar. Once I reach the point where I am performing all of the reps for squat, front squat and lunge with the bar, I'll reevaluate and decide where to go from there. Also, my therapist said it was important for me to work my obliques - perhaps I'll add some window washers.

If you don't mind, Carrie, keep us posted on your progress. I'm also interested in hearing about the approach and exercises used by the therapist involved in your recovery. If anyone else has input/suggestions concerning my modified rehab, I'd be interested in reading those comments as well.

Recover well,

Ryan

Carrie Klumpar
04-01-2004, 11:30 PM
Brad, thanks for the congrats and encouragement. Somehow, it helps. :happy:


Wow, Ryan, it sounds like you’re doing a lot of great stuff on your own, even if PT hasn’t been what you hoped for. Maybe it would be worth it to shop around a bit and interview some other PTs to see if you could find one who might be a better fit with you. In any case, between the official PT and what you’re doing on your own, it sounds like you’re covering your bases. IMO.

Even if they’ve got you at a mandatory plateau, it seems like there must be some way to work in more variety. My surgeon warned me that I would likely be most frustrated at some point in the future (say, 2-3 months post-op), when I feel able to do lots of things that they just won’t *let* me do because the graft isn’t strong enough. I think this is when people really want to get back to their sports and the doc and PT have to be the bad cops, getting people to stick with the safe (but maybe boring) exercises and not run onto the soccer field or basketball court or ski slopes or whatever.

Since you seem interested in the specifics, here’s what I’m currently doing in PT “class,” which is me & two other ACL guys (all hamstring grafts), 1.5 hours twice a week. I’m 5 weeks post-op now.

- Stationary bike with some resistance (but not a lot), 15 min.
- Standing knee extensions on low pulley w/ ~ 50 lbs (facing the pulley)
- Standing hip extensions, to the back and each side (I think these were just for the beginning before they added more stuff; probably won’t do them much anymore, which is fine w/ me because they’re b-o-r-i-n-g)
- Side step-ups (stand on ~8-inch step w bad leg, bend knee and straighten)
- Wall squats (back to wall, bend knees and slide down wall, keep above 90 deg, straighten)
- Lunges across room
- Chair pulls (sit on low stool on casters and pull yourself around the room using bad leg; this doable but hard for me
- Calf raises (though the PT isn’t very interested in this any more)
- Smith machine back squats, 45-lb bar, but not even to 90 degrees (maybe I’ll see if I can get them to let me put some weight on the bar next week)
- One-legged balance stuff (balance on squishy pad while pumping a “Body Blade” thingamajig; wall ball with Swiss ball, put stretchy band around ankles and pull to good side at various angles)
- Walk on treadmill backward, ~10 min
- StairMaster (Did this for the first time today. 5 min.)
- Bending stretches to keep improving flexion

That pretty much covers it. My hamstrings (uh, the remaining parts, that is) are still unhappy and weak so they don't want me to do much hamstring stuff at all yet. No pain is basically the guiding principle for the strengthening stuff.

I’m glad to hear the rower has been ok for you. I haven’t given it a try yet but now I’m encouraged to not put it off for too long. I’m amazed that you can do full-depth squats. I can’t really even *think* about that yet. And I suspect the PTs would have a lot to say about "too much shear force on the knee joint" at this point anyway.

Good luck, and keep me posted.

Ryan Atkins
04-03-2004, 01:35 PM
Thanks for the info, Carrie. I can't help but get the feeling that you've got the better deal when it comes to therapists. About a decade ago I was introduced to the concept that exercises that move the body through space are more effective/functional than those that don't (i.e. dips and pull-ups are better than benches and lat pull-downs, even at similar resistances). Another concept I hold is that standing exercises are likely to be more worthy than exercises where you are seated or prone (i.e. standing press vs. seated military press). IMO, your therapist is following those 2 principles more than mine. Your standing leg/hip work, walking lunges, and chair pulls compare favorably to the seated leg extensions/hip work and prone leg curls/squats my therapist has me doing. Although I'm still considering moving my therapy to a different facility, my therapist did mix things up yesterday, introducing the wall squats and reviewing some of the 'squishy' balance work you referred to (maybe she read our posts :happy:).

BTW, is the body blade that thing that supposed ab device looks like a wing?

Ryan

Carrie Klumpar
04-03-2004, 06:27 PM
The body blade thing sort of looks like a ski, but flimsier and with a handle in the middle and two long blades extending out. The idea is that you hold the handle and move it quickly back and forth so you get the blades oscillating. It's just enough to jiggle the body, essentially, and activate the little stabilizer muscles in the bad leg when you're balancing on it. But it's still not particularly challenging or by any means the only way to accomplish that. (Heh--looks like they have a Web site, so you can even see photos: www.bodyblade.com (http://www.bodyblade.com).)

Too bad we can't do some rehab workouts together, eh?

Ryan Atkins
04-06-2004, 07:23 AM
No kidding. When I read that you had the oppurtunity to go through therapy with others who had the surgery, the thought occurred to me (again), "why can't my physical therapist run sessions like that." Having a chance to go through rehab with other athletes (or better yet Crossfitters) would be great for motivation, comparing notes and sharing humor, IMO.

Carrie Klumpar
05-25-2004, 09:39 PM
Hey Ryan,

Are you running yet? I just discovered yesterday (my 3-mo. surgery anniversary already!) that I can do a little pathetic shuffling jog, but I don't feel ready to try for much more than that yet. At this point, it's hard to tell what I really shouldn't be doing and what I'm just scared to do. Where you at these days? What things do you still need to modify and what can you do normally? Are you indeed back to heavy squats and o-lifts already?

-Carrie

Ryan Atkins
05-26-2004, 10:15 AM
Hi Carrie,

I've been running since the 3rd week of April, but my speed isn't quite back to normal. For example, the recent 5k we had I ran in over 27 minutes. Before surgery, I think I was averaging around 24 minutes, or so. Also, my sprint speeds are noticably slower than what they were before surgery. Hopefully, by October I'll be up to speed (literally).

Around the same time I started running again I reintroduced the squat snatch and variations of the squat clean (using just the 45# bar). I was a little timid at first, but the knee didn't complain at all. My warm-ups as of late have included light weight (55#-95#) front squats or squat cleans coupled with overhead squats or squat snatches. Some upper body gymnastic work (handstand practice, pull-ups, ring dips, etc.) is also thrown into the mix.

Exercise modifications are luckily becoming more of a memory than anything else. I think, for the most part, my knee can handle the WODs where a weight is given (225# deadlifts for 21-15-9 reps might still be a stretch, however). I'm still gradually reintroducing the big weights. On the heavy deadlift and squat WODs (where the rep scheme is 3-2-2-2-1-1-1-1-1 or 3-3-3-3-3, for example) I've been using a 'baseline' and increasing the weight by 10 pounds every set. The next time a heavy lifting day rolls around I'll increase the baseline by 5 or 10 pounds and do the same thing (recent baselines have been 155 and 160 pounds). Hopefully by using this scheme, near the end of the year I'll have gradually worked up to where I was before surgery.

Overall the knee has held up surprisingly well and I consider myself very fortunate. The only times I experience soreness are when I am being grotesquely stupid (i.e. running 5 miles or so shortly after being given the OK to run 'a little' or attempting a no-handed roundoff from a springboard at a recent family event).

it's hard to tell what I really shouldn't be doing and what I'm just scared to do
Are there certain exercises that you're hesitant about trying? If so, what ones?

Hope you're healing well.

Ryan

Carrie Klumpar
06-04-2004, 10:09 AM
Argh, I composed a whole long response the other day but lost it before the post went through. Try again.

Thanks for the response and info, Ryan.

I haven't been doing any running yet, though it's probably time to start working into it with some jogging and see how that feels. I'm still doing substitutions for some things that involve the knee directly: instead of running, I row (or bike); instead of box jump I just do step-ups (though last week for the first time I did mini-jumps instead—on an 8 or 10-inch step); instead of rope climb, I do single rope pulls. However, I got back into my kayak after about 6 weeks, which was really important, and by now I'm ok with most kettlebell stuff, clean and jerks (not very heavy though), and pretty much full squats, even with some weight (I did 5 sets of 5 at ~100 lbs earlier this week, which is fairly heavy for me for those reps). It's hard to say whether the pain and mild swelling and the weird "catch" I'm experiencing these days are just a phase that I'd go through regardless or whether they would subside if I backed off a bit with the squats and other training. Most of the time, I'm still and inch or two from being able to touch heel to butt on that leg. So, it's still slowing me down a bit, but there's no shortage of things to do.

I tweaked the knee yesterday, just by not paying close enough attention walking down the street and slightly hyperextending it when I didn't notice the downward slope of a driveway through the sidewalk. So it's complaining about that now. Nothing serious, but it's pretty annoying, and it freaked me out a little at the time.

That's great that you don't have regular soreness any more. I still ask all former ACL patients I meet if they're 100% recovered because I'm so intent on getting full ability (and confidence) back. I understand that it might take some time, and I don't expect 100% right away, but I do want to know that it will get better and that at some point I won't still think about it every time I want to use the knee. Just gotta have faith (and keep working on it), I guess.

Later,
Carrie