Tried my best to get through a detailed post from b-reddy about a new form of non-invasive surgery championed by Dr. Martha Murray:
Detail of the actual operation from b-reddy’s YouTube channel:
I posted a comment on b-reddy’s post about this new surgery, and I tend to agree with his point that this surgery is still way too new, but maybe that’s how all revolutionary movements start? The gold standard has always been a patella autograft, and those who are going to undergo ACL reconstruction or have had ACL reconstruction may harbor confirmation bias towards this operation over inferior operations (i.e. allograft). In other words, the sample set is not big enough for this new form of surgery and thus I would not elect to get this operation if I tore my ACL today and needed to select my preferred ACL reconstruction operation.
Passed the 6-month mark, and honestly the rehab and training now just feels like I’m, well working out. The exercises are more intense and high impact such as agility work, jumping, and deadlifts/squatting. Been seeing a new physio every week for about 8 weeks now, and I can honestly say the rehab process feels like I’m training for a sport. Which is exactly what I’m looking for (going back to basketball), but sometimes I miss the more laid back rehab from the early months when I couldn’t do a lot of dynamic exercises yet.
Throughout the week, as I’m going to the gym and doing my exercises, I sometimes lose focus of what I’m doing all this for. At this stage, I can go about what physical therapists called ADL (average daily living) activities. This means that the only real reason I’m still training hard at the gym is to go back to basketball and sports. Lately, I’ve been contemplating if I even want to go back to playing basketball and high impact sports. Ever since my surgery, I’ve had more time to watch documentaries, read, and pursue other hobbies. I didn’t realize how much time league games and pickup took from my life.
I may just be in a funk since I haven’t played in so long, and when I get back to playing my addiction to the game will come back and this whole train of thought is moot. Nonetheless, this is what I’ve been thinking about when I’m working the agility ladder on Friday night.
Hoop Dreams
Literally, dreams about hooping. On two different occasions, I had these vivid dreams where I felt the longing to play basketball more so than when I’m conscious. Here’s a description of one of these dreams where I was half awake but felt the impact from the dream after I woke up.
It’s hella early in the morning, maybe 5-6AM. I was waking up to go to the gym and walked by an outdoor basketball court with flood lights keeping the court and backboards lit. I swear this was a dream, despite it sounding like real life.
The basketball court is on my way to the gym, and as I get closer I see that there’s a 5-on-5 game going on and the guys are going at it. I stop and watch and see players driving, pivoting, and getting fast break layups. My natural reaction in this situation is to walk up and see who’s standing on the sidelines and ask who’s got next. But before I can do this, I’m reminded about my injury and the rehab I need to do at the gym. I see the guys play and reminded about the times I was trying to really play ball and make a career out of it, and I see that dedication in each of these guys who are up and playing at 6 in the morning.
In addition to this dream, I’ve had another one where I am doing a fastbreak layup. That feeling of gliding through the air, getting past the defense, and laying the ball up is one of the more positive feelings I get when playing ball now that I think about it, which is why I probably dreamed about it in the first place. When I woke up from this dream, the reality about my injury came forward and I contemplated whether I would be able to do this action again. I quickly dismissed the fact that I wouldn’t be able to do this again, and just trusting in my physio and rehab will get me back on the court to hopefully 90% of what I used to be before.
Exercises
I’ve still been posting most of my exercises on insta, but the exercises are, as I mentioned earlier, becoming more dynamic and sports-specific versus building function back in my knee and leg.
Took a break from my rehab for about a week for the holidays, and haven’t been keeping up with my exercises for the last few days because of New Year’s, but am getting back on track with a good workout today. At my last PT appointment, my physio said that I’ve progressed really well and on track in terms of what activity level is 4 months out. The problem is that she can only do so much for me, so now I’m on the hunt for a new physio focused on basketball-specific training.
My friend is a PT in NYC and I had my first screening with him a few days ago. His assessment of my condition:
On track for 4 months from surgery (knew this already)
Quad strength is good (but can always be stronger)
Glute and hamstrings could be stronger
Hip muscles pretty weak on both sides (wtf?)
Flexibility needs work
The last two points were surprising to me since I’ve never had any hip strength problems, but now that I think about it, it might be that I never had good hip strength since I’ve don’t consistently do exercises focused on these muscles. The flexibility aspect was also interesting, and he worked on my flexion and extension (pushed me to a little hyper extension) and was able to get my leg to 150 degrees flexion by me laying on my back and bending my leg backwards.
Next Steps
My focus will be on the jumping and agility for the next few weeks, and hopefully getting into a regular routine with my friend who does basketball-specific training. Aside from all the workouts and exercises, dealing with all the logistics of scheduling the training is also a headache (but nonetheless necessary). My original physio accepted my insurance, but my friend’s clinic doesn’t take my insurance so I’ll be paying out of pocket, although we’re going to try to work something out.
When it comes to my healthy, I’ve never been shy about spending the money or resources to get the best treatment, but at times the reality of the cost of healthcare leads me to fall back on what providers accept my insurance. This is always a slippery slope, but in this instance of getting back on the court, I can’t see no other option but to pay for this myself since it’s important to re-gaining a healthy knee for the rest of my life. Once I’ve set up a schedule with my new physio, I’ll still see my old physio for checkups on my progress, but they will most likely be limited to once per month.
Additionally, the surgeon’s rehab protocol kind of “stops” from 4-6 months. The primary goal during this phase (according to the protocol):
Gradual return to athletic activity; Discharge onto home program
The exercises prescribed include “Jumping,” ” Unilateral hopping,” and “Agility drills; running, cutting.” Not super helpful in terms of detail so I’ll have to start doing my own research on what kind of drills and exercises I should be doing to build up the endurance and speed I need to get back on the court. Most likely, it will be a combination of agility and jumping, mixing in the usual strengthening and conditioning exercises I’ve already been doing. On top of this, I need to allocate more time for stretching to re-gain flexibility in my quads (to prevent tightness around my patella). It feels like the exercises just get added on top of each other, I almost miss Day 1 when the main exercise was the leg raise.
Exercises
Not a whole lot of new ones, but I recently purchased an agility ladder to help with all the agility exercises I want to do built speed and quickness. Having a ladder has allowed me to use my creativity and doing exercises that I wouldn’t do otherwise. Who would have thought a simply object as a ladder could be so beneficial for sports recovery?
It’s been roughly 30 days since my last update and about 3.5 months since my surgery. The recovery has been going well, although each incremental percentage of progress gets that much harder.
Diminishing Incremental Progress
What I mean is that the first month I actually saw the most visible progress. Going from 0% to 50% in 30 days was awesome since every day it felt like I was accomplishing something. Whether it was doing a basic leg raise, to starting to squat again, or being able to jog.
Then from days 30-60, the progress went from 50%-70%. Only 20% of progress but that 20% was so necessary in order for me to start doing agility exercises and lifting heaver weights.
Now on day 106, I’m probably at 80% of my pre-injury athletic level, so in the last 45 days or so I’ve only made 10% of progress. While the recovery is not as visible as before, you must continue pushing forward despite not seeing the results. There were times over the last few weeks where I thought “damn I’m pretty much there, why do I need to still work so hard to squat and do agility exercises?” The answer is that I’m not in game-shape like I was before, so getting to the point where I can cut and move laterally with ease is the goal.
Exercises
My exercises haven’t changed much, except now I try to alternate between strength and agility days. Strength-wise, I’m still doing the normal bilateral squats, deadlifts, single leg squats, and lunges. I started introducing anterolateral and anteromedial lunges which basically means lunging diagonally so that your knee is not straight when you plant the foot. This helps train the knee to perform under stress and weird angles.
In terms of agility, I’ve really started experimenting with all types of new shit and of course things the physio has taught me:
Line Hops/Ankle Bounces 3X30 – A pretty basic exercises where you lay a jump rope on the ground and bounce with both feet side to side as fast as you can.
Mini-Suicides 3X10 – To train your knee to stop laterally and change direction. Overall this is a tiring exercise since you’re running back and forth.
Side Lunge Jumps 3X10 – A pretty fatiguing exercise since you are pretty much jumping off one foot side to side as fast you can. I also go slower and go for distance to help build my explosion.
I purchased a $9 agility ladder on Amazon to do more agility exercises that involve precision. My physio told me that it’s not just about speed but accuracy as well. So being able to step in and out of a ladder knowing exactly where you want your foot to land will help you get back into game-shape.
Running
I’ve probably made the largest progress in this department. Prior to my injury, I wasn’t really running on the treadmill that much since I got most of my cardio from playing basketball. After the surgery, I really have no option but to get back onto the treadmill to get back the endurance and wind to play a full game. When I used to run on the treadmill, these were my typical numbers:
1.5 incline
8.0 mph
10 minutes
It’s not the greatest, but I would mix in some jogging at 6.5 mph and do a little sprinting here and there at 10.5 mph for 30 seconds-1 minute. I never really ran long distances and treated treadmill work as just a warm up for strength training. However, I know after 10 minutes of 8.0 mph I would get winded so I set that as my benchmark.
Yesterday, I was able to do those same numbers except at 7.5 mph. I know I can probably get back to 8.0 mph easily, so my “cardio” is back to normal and I even did some sprinting at 9.5 mph without any issues. Being able to run/sprint and feeling my legs and hips extend to accommodate a sprinting gait was definitely a great feeling since I haven’t done that in close to 5 months. Long story short, I think I will get back to full-on sprinting in a few weeks.
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)
Hopping
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.
Conditioning
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.
Strengthening
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)
getontheline 