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Maryanne Scales 12-06-2007 06:34 PM

What to avoid with torn ACL (surgery not an option - now)
Hello All!

I started working out consistently last January to prepare for an ACL reconstruction. The history is that I tore my left ACL (no meniscus damage - light MCL collateral damage) about 10 years while skiing overseas. For some reason, the dr.'s I saw didn't think a 24-year old would really need an ACL, so I was not approved for surgery. (Can you believe it???!!! This is why I am not a fan of socialized medicine.)

Anyways, my insurance company resurrected a rider, and I was not able to go through with the surgery earlier this year. However, I really enjoy working out - and working out hard. I discovered CrossFit and started following RX'ed WODs in September.

Because I danced for numerous years, I have pretty strong quads and calves. My hamstrings are getting stronger. Therefore, I am able to do a lot of exercises that people think I shouldn't be able to do. However, I have noticed that a few exercises seem to exert some torque on my knee - it doesn't feel too good (and can't be good for my knee).

What exercises in the CrossFit repertoire should I avoid?

Based on what I have felt - I am doing static lunges instead of jerks. (I know that it doesn't get the same power from momentum, but anyone who has had an ACL injury will know the nauseating feeling that you get when your knee quivers. I felt that - I know the feeling is a warning for me.) I also felt some torque jumping down from a box jump.

Any advice?


Mike Kelley 12-06-2007 06:46 PM

Re: What to avoid with torn ACL (surgery not an option - now)
As it was described to me by my doctor, you can do anything that doesn't cause too much pain, but until you get surgery you'll have a "trick knee"...some days nothing could go wrong, but others it could act up and give out on you. I've also heard, "there's nothing left to mess up", but with the MCL, PCL, etc. I don't know how true that statement really is.

Before I had my surgery (less than 2 weeks ago) I was doing everything for CrossFit workouts with little to no problems (with reduced loads)...and then the week before surgery during Filthy 50 I was doing Burpees and my knee gave out.

I would get a second opinion or find a way to get the surgery done sooner rather than later, especially at 24. Possibly try and find a doctor that works with sports teams who understands your need to return to activity (that's what I did).

Steven Low 12-06-2007 07:05 PM

Re: What to avoid with torn ACL (surgery not an option - now)
You should really get a second opinion on that because if you ever want to do anything like skiing again you'll definitely need it as you can tell. Heck, try to get it repaired really at any cost (preferably the least).

Basically you just need to do exercises where you're strengthening your knee whether it be the hamstrings, quads, abductors or adductors. Since you have pretty strong hams and quads already that's good. A lot of balance work to start engaging the smaller muscles around the knee would also be good.

Maryanne Scales 12-07-2007 06:52 AM

Re: What to avoid with torn ACL (surgery not an option - now)
First of all, thank you for the feedback.

I should have been clearer. I tore the ACL 10 years ago - I had to put off trying to get the surgery until this past year because of work issues. (I also have a rider on the knee because I was honest when I took out the policy. I took out the policy because of this experience. I don't ever want to be in a situation again where I don't get a medical treatment that I need.)

EVERY doctor I have seen in the States has been shocked that they didn't do surgery at the time of the injury. Unfortunately, now I am going to have to duke it out with the insurance company to get the surgery.

In the meantime, I am doing CrossFit!

Corey Duvall 12-07-2007 07:52 AM

Re: What to avoid with torn ACL (surgery not an option - now)
You've been without it ten years, have you noticed problems other than these exercises?

The ACL prevents sliding of the tibia when the leg is passive, but when active it acts as a position sensor. It tells your brain the position and stresses that are on the knee, along with all the other ligaments of the knee. Repairing the ACL will limit the sliding of the passive leg, but you never get that position sensor back. What your body learns to do is utilize the other position sensors to a greater degree. When your leg is active the muscles prevent the sliding, not the ligaments. This is why open-chain exercises (leg extensions) are no where near as beneficial (and possibly detrimental) as closed chain exercises (squats, deadlifts). Closed chain exercises engage ALL the muscles surrounding a joint, not just the muscles moving in one direction. I've got a professor here at school who plays basketball with us on a regular basis without an ACL and says he never notices problems at all (knock on wood). IMO, the knee giving out is a result of a misfiring of the musculature, and not of the lack of an ACL itself. Train only closed chain exercises and use caution when approaching fatigue (will result in a higher likelihood of misfirings). I believe that you can push the limits of your fatigue, but understand that it will take greater and greater focus to maintain that proper positioning.

If there is no swelling/inflammation in the knee, a lack of an ACL should not cause pain when doing these exercises. If it does, you need to check your technique, knees diving inward or weight coming forward on the toes will create excessive torque on the knee, but a proper squat or deadlift (or any of the other exercises in the repertoire) will not cause pain.

Let us know how things progress.

That said, I had my left ACL replaced when I was in high school ('98) and have had no problems since.

Maryanne Scales 12-07-2007 01:36 PM

Re: What to avoid with torn ACL (surgery not an option - now)

Thankfully, I rarely have issues. Every blue moon, the knee will just slide on me for no apparent reason. (Even more rarely it will do so when I have a bonehead moment and try to do something like jump over a fence or see how low I can go under a pole with a back bend at a party. I won't try that again.) It bothered me a little when I started running on a treadmill, but buying the right shoe seemed to fix that. I can actually do some dancing, as in salsa not ballet, as long as I'm careful and don't do any really quick turns. I'm really amazed that your professor can play basketball without an ACL, though. That would be a certifiable bonehead moment for me. I would definitely have a problem with that one.

It's interesting what you say about doing the "closed-chain" exercises. When I decided to start with CrossFit in September, I stopped doing the muscle-specific exercises (leg xtns, decline squat, ham curls, etc.). I have been wondering about whether or not I need to incorporate some of those in as supplemental exercises. I will keep at what I'm doing and see how that goes.

BTW, I think it was the split jerk (jerk into a lunge-stance landing?) that caused my knee to slide. (I watched 12/7's demo on the Main page, and I realize that the jerk by itself shouldn't be an issue.) My knee does its trick when it is the "passive" leg in the lunge. If split jerks come up, I will probably just modify them to lunges without the jerk.

Thanks again!

Corey Duvall 12-07-2007 02:15 PM

Re: What to avoid with torn ACL (surgery not an option - now)
That move really does make sense. If you try to make your leg passive there will be some play, and if it becomes passive while moving, you've got problems. I might suggest adding some agility work to your warm-up, training your body to keep that leg firing even if it is temporarily not weight bearing. Funny thing is, those are the exact things your PT would have you do after an ACL reconstruction. Teach your body to move quicker and quicker, start stop, change directions, spin, etc. Do this daily as warm-up and eventually it'll become second nature.

Let us know how it goes.

BTW, I would never again bother with the isolation exercises. If you're a body builder and need exact bilateral symmetry, it might be helpful. Beyond that, I struggle to see who they would be good for (certainly not all the elderly who come into my gym to use them incorrectly).

Dan Ruch 12-07-2007 05:39 PM

Re: What to avoid with torn ACL (surgery not an option - now)
Hey Maryanne,

Just chiming in as a Certified Athletic Trainer. Corey is definitely on the right track, particularly with the function of the ACL. If surgery is not an option, then continue with those closed-chain exercises.

The main thing you would want to strengthen is your posterior chain (glutes, hams, gastroc), particularly the hamstrings. If you notice the origin and insertion points of the hamstring muscles, both the semimembranosus and semitendinosus originate off the ischeal tuberosity (butt bone) and insert on the anterior part of your tibia. Because muscles pull insertion toward origin, these will almost act like an makeshift ACL to help keep your knee in a stable position.

Again, this is if it is that active leg. If not, this posterior chain training can certainly help, but you still won't be providing that feedback to your brain, so it won't be quite as effective.

So basically, Crossfit can provide this, and more, if done under the right conditions and supervision.

Hope that helped!

....Oh yeah, first post

Victor Putz 12-08-2007 04:08 AM

Re: What to avoid with torn ACL (surgery not an option - now)
Following this thread with interest as my wife popped her ACL skiing a few years ago and the USAF docs said "eh, you can get by without surgery". And she has (walked a marathon without it, which isn't really a dangerous activity ACL-wise but I'm still proud of her), but it scares me. I'd love to get her doing some strength work, but I'm just not sure what actions are safe and what aren't.

Jake Thompson 12-08-2007 07:02 AM

Re: What to avoid with torn ACL (surgery not an option - now)
Maryanne, based on what you have said the recommendations Dan and Corey have made are right on track. I would also focus on single leg exercises, multi angle lunges, and don't forget the gastrocnemius (calf) work.

The only issue with not having surgery, and you should explain this to your physician as well as your insurance provider, the wear and tear on you knee is significantly increased and it is likely you will have issues in the future.

This is only a suggestion to your DR. and insurance company. Talking from personal and professional experience osteoarthritis is more of a use it or loose issue. What i mean by that is if you remain active, perform full ROM squats, WOD activities, stay mobile your "arthritic" knee should be relatively asymptomatic. I have what would be considered a clinically unstable knee from an injury when I was in high school, torn meniscus and MCL with partially torn ACL. I had some issues with knee pain due to an increase in running activities, had an ortho look at my knee and tell me if I kept it up I would be seeing him in a year for surgery to "clean up" my knee. Well 8 years later and avoiding the typical knee saving suggestions I learned in PT school and the Ortho gave me my knees feel better than ever.

Use pain and inflammation as your guide, you can be a high level athlete without an ACL if you are functionally stable. John Elway and Thurman Thomas to name a few professional athletes had very good careers in the NFL without ACLs.

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