View Full Version : ACL again
02-15-2004, 10:19 PM
Questions for Ryan Atkins (or anyone else who's been through knee surgery recently), following up on the ACL thread from a while back:
Ryan, I gather from your posts of late that you've had the ACL reconstruction recently. Yes? Care to post a report on the choices you made, how it went, and, especially, how recovery has been and how you're working your way back into CF workouts? I go under the knife for mine in about 8 days :sad:, so I'm really curious (and apprehensive) about the whole thing--and especially interested in the rehab and recovery experiences of a dedicated CrossFitter, if you're inclined to share your story (if you are willing but don't want to post here, feel free to e-mail me directly).
02-16-2004, 10:19 AM
I had the surgery on the 4th of this month. Initially my doctor wanted to do a patellar tendon graft. However, after he asked how important knee flexion was to me and after I demonstrated the C&J and snatch to him, he changed his mind and felt that the allograft was the best choice.
Although no paradise, recovery has gone well. The fact that I try to stay physically fit, the nature of the allograft procedure and continuous rehab have both contributed, IMO, to an accelerated recovery. I was off the vicodin two days after surgery and am currently averaging about 400mg ibuprofen/day. Hopefully, I'll be able stop taking that in a couple of days as well.
After surgery, the physical therapist gave me a sheet of paper with about 9 different stretches/exercises. As quickly as possible I worked up to doing 3 sets of 10 done 3 times a day for most of the exercises (placed more emphasis on the partial squats - doing 30/set). For me, rehab is a release in a way. My knee HATES to be locked in place inside that damn brace (sleeping was a bear). The first few days post op consisted mostly of rehab, eat and sleep/rest repeated throughout the day.
Eight days after the operation (the 12th) I had my post operative visit. The doctor says that everything looks fine. His sports trainer was very impressed by my progress, but she did chide me for going to deep in my squats this early and reminded me not to go deeper than 30 degrees. One thing that does concern me is that the doctor removed my meniscus during surgery, as it was pretty much FUBARed. He says that I won’t miss it and, if I do, there is something he can do for me. I did some searching on this and a couple of sources (including one from my doctor http://www.cartilagedoc.org/knee_library.html Degenerative Arthritis - The Management of Active Patients) indicate that having the meniscus removed accelerates the onset of osteoarthritis. However, one could surmise from his article that practicing O-lifting and a Zone-like diet (low cytokine production) may minimize the effects/onset of the arthritis. I see him again in 6 weeks and plan on asking him about it. Formal physical therapy starts this Wednesday.
I am starting to get back into doing the WOD on a regular basis. As of now, I have thought of three options for replacing/modifying the exercises involving legs: (1)doing partial range air squats, (2)performing a one-legged version of the lift with my left leg and/or (3)doing a push-press with my left leg. If anyone has other ideas, I’m interested. Since my lower body is slightly impaired at the moment, I’ve focused any extra energy on development of upper body gymnastic skills. I’ve regularly been doing density training for pull-ups and will usually throw in a density training set of p-bar/ring push-ups, ring dips or toes-to-bar. HSPUs and more p-bar/ring work will be added shortly.
Carrie, I hope this wasn’t more information that what you were looking for. If you have any questions, please ask. Best of luck with your surgery and a quick, healthy recovery. Keep us posted on your progress!
02-16-2004, 11:50 AM
Thanks much for the post. It's definitely not too much info. It's really encouraging to hear how well your recovery is going so far, even with the meniscus removal. It's pretty amazing that you're able to do as much as you are already. A lot of the stories I hear are much more dire, with folks who don't get to your current ability level until many weeks--or months--following surgery. It's good to know that's not inevitable. Hopefully, going in with good strength and flexibility counts for a lot. How much have you used crutches, in addition to the brace?
Thanks again, and I imagine I will take you up on your offer and fire out more questions once I'm through surgery and into the rehab phase. I'll keep an eye on your WOD posts as well, for ideas about how to work back into things.
Good luck with your recovery.
02-16-2004, 01:56 PM
I've used the crutches three times since the surgery - twice for shopping and once for the post op visit. I felt that the knee brace provided more than enough support. After the post op visit, I've ceased using the knee brace as well. My knee feels strong and, as long as I am not being stupid biomechanically, can easily handle short distances for walking and reasonable times standing upright. ROM is increasing daily. I'm still a little tentative about kicking/pressing up to a handstand with a wall for support (without the wall, I can roll out keeping my right leg in a pike, my left leg tucked) for fear of landing on it wrong.
Keep in mind, I'm not advocating these post-op practices to you (or anyone, for that matter), but am trying to convey how positively my rehab has gone so far. Like you, Carrie, I've heard a lot of horror stories regarding knee surgery and recovery. I sincerely hope that anyone who undergoes a procedure like this will be as fortunate as I have been so far. Also, the allograft is known for having a quicker recovery time when compared to autografts. However, incorporation takes longer, so it might be some time (9 months or so) before I start doing intensive lifting on it again. I've read that trying to get back to full athletic activity to soon may result in stretching of the graft. This is something else I have to clarify with the physical therapist and/or doctor. Are you getting the allograft as well?
Hope this helps,
02-16-2004, 03:00 PM
Nope, autograft for me--hamstring tendon. So that could slow things down a little.
From what I've read and heard, it sounds like you're right to dive right into rehab and physical therapy but hold off for quite a while on the intensive lifting and heavy loads, since the graft typically weakens as it gets incorporated and vascularized.
Thanks for being upfront about your own "post-op practices" even if they are a bit unorthodox. I realize that your results so far are atypical, but it sure is nice to hear a story from that end of the spectrum rather than the horror stories that are so common. I hope my experience will be near your end of the recovery continuum, but, don't worry, I won't hold it against you if I'm not doing handstands, squats, and the WOD in less than two weeks post-op! :wink: (On the other hand, I do hope that my doc is being unnecessarily conservative when he says that I won't even be able to drive for 4-5 weeks!)
Jason "J-Dog" Highbarger
02-16-2004, 11:32 PM
Hello Ryan and Carrie,
Ryan, I don't know if this will help or not, but a semi-pro wakeboarder client of mine durring a conversation a few years ago stated that he never had any knee troubles yet his sport is known for being very brutal/destructive to the knee joints and lower backs of it's participants. He is also one of the taller athletes in the sport at 6', making him more prone to injury within that sport due to it's nature. Anyway, he attributes the innitial "strength" and integrity of his knee joints to years of Water Polo. He says he had the strength/integrity from water polo, but that CrossFit added greatly to it.
He told me of how his water-polo team would have to take the metal fold-up chairs used in auditoriums and hold them above their heads as they treaded water down to one end of the pool and back.
Anyway, I had sinced mentioned treading-water to maybe a dozen or so clients over the years as a possible way for adding a little more integrity to the knee-joints and possibly assisting/accelerating the rehab process. I suggested they consider spending a little time treading water in the pool since my wake-boarder/water-polo player swears by it. ...6 out of the 7 that I can think of who did apply it with some regularity a couple times a week felt it was helping. The 4 I can think of who didn't apply it, well, they didn't.
The knee maladies ranged from post-op acl/mcl blow-outs to just chronic "knee-pain".
I don't know that this info is worth much as it's somewhat annecdotal and I don't have any solid research cited on the subject, but I thought I would offer it up as something to run by your doc/phys-therapist to ask about.
For example, 10 minutes a session 1-to-3 times a week of, say 30 seconds on, 30 seconds off for starters might provide some benefit.
On of our CrossFit trainers/athletes and good friend of mine, Kevin Johnson, recommended having people just wade into the surf/current of an ocean or river/stream and just walk around a bit against the pull of the current. Yet another friend of mine, a basketball player/coach suggested this as well but for ankle injuries, working the ankle in the sand. For either joint the approach provides a bit of mild work for the whole joint while simultaneously providing somewhat of an "iceing" effect if in cold water.
Beyond that I would say the Zone diet with some fish-oil and Glucosamine/Chondroiten/MSM/Vitamin-C. Maybe some Alpha-Lipoic-Acid too. That and just keep up the good work. Remember, the mental/emotional strength of ones "Will" will ultimately expedite ones success durring the healing process. (Just keep in mind the stories of, say, Kerri Strug [US Gymnast] from the 1996 Olympics and Laura Wilkinson [US Diver/10m Platform] from the 2000 Olympics. Both are inspirational.) You are obviously on the right track thus far though. :-)
02-18-2004, 08:55 AM
Thanks for the good info! As a former swimmer/lifeguard I like the idea of getting back into the water on a regular basis. I do have some reservations, however. Before the operation, one of the easiest ways I could pop my knee out of joint was to do a breastsroke kick (which, if I remember right, is very similar to the motion used in the rotary kick(?) for treading water). Maybe I could include treading water as part of maintenance program after the knee's fully healed. I'll definitely ask my therapist about it today and let you know what's said. The place I'm going to for therapy (Centre Club - Liberyville, IL) does has a pool so it could be an option.
Kevin Johnson's recommendation is also doable (I live 10 minutes from Lake Michigan - doesn't compare much surfwise to the Pacific, but it can get pretty cold).
I've recently read The Omega Rx Zone and Mastering the Zone (Kirkland capsules arrived yesterday). That paper that my doctor coauthored does mention glucosamine and chondroiten sulfate as two supplements that have shown results in managing/preventing arthritis. Do I have to be as picky about choosing brands of those supplements as I had to be with the fish oil?
Jason "J-Dog" Highbarger
02-18-2004, 07:12 PM
Uhhh, as for brands with the fish-oil, I too got a little drawn in with the whole "purity" issue regarding the fish-oil capsules. (The Omega-Rx Zone is particular regarding this issue.) But a Consumer Reports study tested many different brands and determined that they were pretty much all the same as far as "purity", and that the only real difference was cost. You mentioned Kirkland, that's the Costco brand, correct? They got the best rateing in the consumer reports study primarily due to cost. That's what I take by the way (and I store them in the fridge). As for the "heavy metals" that many people worry about, I believe (correct me if I'm wrong, Robb), that Robb Wolf, stated that the heavy metals have a 10,000 time higher affinity to bonding with the proteins than they due the fats. Thus it shouldn't be much of an issue.
As for brands of the other, (glucosamine/chondroiten), I haven't done a lot of in-depth research lately on different brands. I used to take the Pharmanex (pharmanex.com) brand because they put all of their nutritional suppliments through the same rigors of testing as the FDA does a medicine. That level of testing/quality-control was impressive for me and we knew a rep so that's what I went with. The Costco (Kirkland) brand may be every bit the product Pharmanex is, I don't know. I know there has been a lot of talk lately about the, (if I remember correctly), GLC-2000--Glucosamine/chondroiten mix, but I personally haven't tried it.
I think others on the board such as Mark Twight or Scott Parker, and others, might have more to offer as far as info on preffered brands.
As for the swimming popping the knee out, I don't have a solid background in swimming so it would be hard for me to comment on such. I believe the Russians used a sort of "frog-kick" for treading of water and the Americans used more of an "egg-beater" motion, for whatever that's worth. :-) (Thus I believe Mike Schweene, the wake-boarder/water-polo-player, was useing the "egg-beater" method primarily.)
I'd be curious to hear what your phys-therapist has to say though.
If I think of anything else I'll post or e-mail you. In the meantime, I wish you a speedy recovery.
02-19-2004, 09:19 AM
Talked to the therapist yesterday and asked her about swimming in regards to therapy. She said that it is used as an option, but only as a backup measure for those who can't handle the weight bearing exercises well (i.e. non-athletes and/or elderly).
Good point about storing the fish oil in the fridge - I'll make sure and do that. Thanks for the info on the glucosamine/chondroiten. I found another thread (http://www.crossfit.com/discus/messages/23/2648.html) where Scott contributed to that had some more info on the subject.
BTW, awesome post in the Tabata scoring thread. The relationship to NHB competition was, I thought, especially insightfull.
02-29-2004, 10:20 AM
I think it's been almost a week since your surgery was scheduled to happen. How did everything go? No pressure to share, just curious.
03-01-2004, 05:35 PM
Thanks for asking. Yep, the big day was Tuesday, 2/24, so I’m on Day 6 now. Surgery went well (I watched all the arthroscopic stuff onscreen during it, which was interesting), and there’s no additional damage to the menisci or anything else, so that’s a relief. The surgeon said that once I was numb and my muscles completely relaxed, he could feel a lot of excess laxity in the knee, so that’s a clear sign that having it fixed was the right choice. I had a post-op appt with the surgeon on Friday, and he was pretty pleased with my condition—“minimal” swelling (it seems like a lot to me, but he said it wasn’t, comparatively), full extension, nearly 90-degree flexion (but ouch!), off the narcotics (oxycodone, in my case) after 2 days and onto acetaminophen. However, if this is as good as it gets, I have to say I have sympathy for folks who really have a hard time with it. As you say, it’s no picnic--though, for me, the immediate, day-to-day stuff is easier to cope with than the prospect of the long downtime and recovery period. I felt like I was really making progress with my strength and technique right up until last week, and it’s frustrating to get set back. However, I think the CrossFit work I was doing beforehand has helped me immensely in getting through this so far, both psychologically and physically.
I go to physical therapy tomorrow for the first time. So far, I’ve just been doing the basics on my own—extension, bending, quad flex, straight leg lifts, ankle flex, etc. I have trouble putting much weight on it, mostly because my calf and shin are so sore and painful. I assume a lot of that soreness is from the graft-harvest site. The incision for that is just below the knee, slightly to the inside of my leg. The day that I’ll be back to even modified CF workouts feels pretty distant. At this point, I can’t imagine doing anything more strenuous than my little rehab exercises and a few pull-ups and some ab stuff. I know it’s not really true, but it feels like I’ll never be able to do squats.
So, you’re almost at a month out from surgery now, aren’t you? How’s it going for you at this point?
03-01-2004, 06:12 PM
For what it is worth:
My coach, Mike Burgener, talked about getting good results with swimming (among other things) for an athlete who had torn patella tendons. Apparently this athlete had failed to respond to physical therapy. The athlete had been referred by his doctor to Mike.
03-02-2004, 11:05 PM
Hang in there. Kudos for getting off the narcotics early. I can sympathize with you on the pain felt in the shin/calf area. Now that you mention it, it was my most uncomfortable area when I was wearing the brace.
Recovery continues to go well - thanks for asking. I no longer use my brace and my gait is normal. I still notice soreness if I'm on my feet for hours on end and do not get a chance to do the rehab exercises every couple of hours or so.
I'm beginning to reevaluate my stance on the O-lifting however. Initially, I thought the 9-10 months of recovery would be a perfect time to focus intensely on the upper body gymnastics skills I've mentioned previously. What I failed to consider until recently was that it also presents an oppurtunity for me to emphasize the "perfect world" (i.e. broomstick, maybe bar) training aspect of the O-lifts. I think Coach alludes to the value of O-lifting movements with regards to therapy in this month's CFJ. Also, didn't Robb Wolf previously posted something about successful results of using O-lifting movements in rehab with knee replacement patients? If anyone has some info on how to approach post knee surgery physical therapy w/incorporation of the O-lifts, I'm interested.
Do you know what swimming exercises Coach Burgener used? Was it something besides the treading water/wading methods that Jason mentioned?
Thank you both,
03-03-2004, 10:05 AM
Sorry Ryan, I don't have any details.
03-03-2004, 03:32 PM
Yeah, I'd be interested in "info on how to approach post knee surgery physical therapy w/incorporation of the O-lifts" too!
Before surgery, I showed the doc a picture of an overhead squat and asked how long til I'd be able to that. His first reaction was "What the hell is that?!" His second was at least 9 months. When I said without any weight, he reconsidered and said about 3 months. I'd guess that once you've got the necessary mobility, flexibility, and stability to do squats--and the strength and confidence to pull off that kind of flexion and speed--working on O-lift form without weight should be ok. Personally, I think I'd be pretty conservative about adding too much load though. Of course, I imagine that the bar is relatively heavier for me than it is for you... And I'm a still newbie to the lifts anyway, so big grain o salt and all that.
Glad to hear you're doing so well, Ryan.
03-05-2004, 07:02 AM
Thanks for the word of caution, Carrie. Until somebody gives us something more concrete to work off of, I was planning on basing the incorporation of O-lifts off of the exercises they give me in therapy. For example, on Wednesday of this week, my therapist said it was OK for me to air squat to 90 degrees. I'm assuming that holding a broomstick and OH squatting it or racking it and doing a front squat won't put me in any danger. In addition, she instructed me to start doing one-legged partial squats on my operated leg. Here I'm assuming that, if it's OK for me to support my 215# and do a partial squat with just the leg that was operated on, that it's probably OK for me to use a 45# bar and do power cleans or push presses while both of my feet remain on the ground. I'll ask about both of these issues in therapy today.
Also, I think I have a good substitute for the thruster for people in our situation. I use a stretchband (the kind with the handles on the ends of surgical tubing). Basically I just stand on top of the middle portion of the band, spread my feet to about shoulder width and perform the thruster from that position. IMO, it works well because in the squat, where the band is not stretched so much, there is hardly any resistance outside of one's own bodyweight. At the point I'm at right now I'm still looking to increase ROM (I can get parallel, but not much beyond). As I extend to the press portion of the move the band stretches and gives a decent workout to the pushing muscles of my unimpaired upper body. Using this method allows me to rehab my knee, place a noticeable stress on my upper body and avoid dividing up the whole body movement of an exercise that really gets the heart going, especially when done tabata style for 15 work sessions.
I'm guessing the same thing would probably work with a light bar/sturdy broomstick and some chains.
Just some thoughts. Hope you're doing well, Carrie.
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