Hit the 10 week mark and things have progressed pretty fast over the last two weeks. The main development is that I’m starting to do agility exercises to help me regain speed and coordination back. In addition to the strengthening exercises, I end up more fatigued than usual since I’m building up conditioning now. I’m up to jogging at 6.5 mpg for 20 minutes and going over 2 miles at a time.
Physio’s Protocol vs. Surgeon’s Protocol
I had a follow up appointment at about 8 weeks with my surgeon and I walked her through the rehab protocol I’ve been doing with my physio. My surgeon’s first response was pure frustration and disappointment. I was surprised by her reaction since I thought I was progressing well and even going ahead of schedule. The surgeon’s main feedback was “don’t rush it.”
Her point was that while the knee feels strong since you are strengthening the muscles around your new ligament, the ligament itself needs to get vascularized and get integrated into the rest of the knee naturally. You simply cannot rush biology. The main things that she said I shouldn’t have been doing that could have resulted in a re-rupture of the new ligament included:
- Running (beyond a light jog)
- Single Leg Squat
The rationale behind avoiding these exercises is that the movement is too dynamic and the high impact can result in the bone plugs coming out of your knee and potentially fracturing your kneecap. Just thinking about this happening sounds scary, so I definitely took her advice and avoided doing those exercises.
Needless to say, the next PT appointment was a bit awkward since I told my physio that the exercises I had been doing were not approved by the surgeon, and that my surgeon wants me to follow the exact protocol that she prescribed, not the latest protocol used by my PT office for ACL rehab. The two protocols are pretty similar, with the absence of the hopping in my surgeon’s protocol. If you’re interested in reading the protocol used by my PT, you can read the whole thing here.
Ultimately, the protocols rely on clinical research and the time in which you (the patient) should start doing certain exercises. I think surgeons and physios both have protocols they follow based on prior experience and the latest research from the AAOS, and the responsibility lies on you listening to your body and seeing if something hurts too much when you push yourself.
To me, the fact that my surgeon cared so much about me following her protocol shows that she cares a lot about me and her patients. I mean think about it, the follow up session could have very well went like this:
Me: So my physio has me following her protocol which include some hopping, running, and single leg squatting.
Surgeon: Ok, well it looks like your leg is strong so keep up the good work!
I would have been scared shitless if she said that! You drilled holes into my knee and cut a piece of my fucking kneecap off and threaded it through my knee to re-create an entirely new ligament in my body, and all you have to say is “keep up the good work?” Long story short, if your surgeon (or physio) doesn’t care about your recovery and more importantly, trusts you will follow her protocol, you’re going to have problems and need to consult someone else.
I didn’t tell her this at the session but I have a lot more respect now for my surgeon since I feel like if I were her and I saw 50 patients a week or something, I’d be checked out after I finished the surgery and let my patient out on his own to get his leg back to functioning normally. That’s just me thinking how I would approach the situation psychologically but I’m sure very few physicians think that way.
As I mentioned, the list of exercises now gets longer and longer. I alternate between strengthening and conditioning days now. Here’s what a conditioning day looks like:
- Fast Walk: 4.5 mph/1.5 incline for 5 minutes
- Jog: 6.5 mph/1.5 incline for 20 minutes
This results in 2.19 miles of jogging and 0.36 miles of fast walking. My goal is to get to 3.0 miles of jogging without getting fatigued or sore.
My exercises are now a mix of traditional strengthening plus the new agility exercises. Here’s what a typical strengthening session looks like:
- Squats: 3X10 @ 107 lbs
- RDLs: 3X10 @ 127 lbs
- Single Leg Press: 3X12 Right level 12/Left level 14
- Single Leg Squat: 3X10
- Lunges: 3X10 w/ 25 lbs each side
- Side Lunge: 3X10 w/ 20 lbs
- Anterolateral/Anteromedial Lunge: 2X10 w/ 15 lbs
- Hamstring Curl on Ball: 3X12
- Single Calf Press: Using body weight or level 9 on leg press machine
Here are my new agility exercises:
- Quick Feet: In and out of 4 quadrants 3X10 (clockwise and counter-clockwise counts as one rep)
- Cross Leg Hop: 3X20
- Hops Over Line: 3X30