New Non-Invasive ACL Surgery?

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.

ACL Recovery Day 199

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.

 

ACL Recovery Day 129

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?

Discipline Equals Freedom

Not my words, but a phrase I’ve been thinking about the past few days after listening to Tim Ferriss’ podcast discussion with Jocko Willink.

Jocko Willink & Tim Ferriss

Talk about a power-hitting duo. For the last few months, I started listening to podcasts at the recommendation of my friend TJ, and I constantly find myself going back to Tim Ferriss’ podcast since I have always been a fan of Tim since reading the 4-Hour Workweek. So this podcast brought out the precision of Tim’s interview style with a guy that has looked at death right in the face as a bad ass Navy SEAL in Iraq.

Thoughts About Discipline

Tim asks one of his classic questions “What would you put on a billboard?” and Jocko answers:

Discipline equals freedom.

His belief is that being disciplined in all aspects of your life, be it work, gym, eating healthy, etc. rewards you with more free time (and freedom) to do other things you want to do. The counter-argument is that being disciplined in these areas of your life also can mean you are locked in to a way of doing things and following a protocol that is the opposite of being free and creative.

In my life, discipline means being able to control my destiny to a certain degree. Being able to follow a process and protocol that I know will lead to an outcome I want, whether it’s work, working out, basketball, etc. I know I can control the outcome with X% confidence, and the rest is left to luck and the higher powers.

A few examples:

  • ACL Injury – My last few stories have been about my recovery from ACL reconstructive surgery, and no other injury in my life has been as physically challenging as this one (typical ankle injuries and bone bruises from playing basketball). The protocol from the PT office and from other resources I’ve found online break down the exercises you need to do on a daily basis. There is no room for error, if your goal is to recover and build strength back in your leg. Straying from the protocol, for me, means failure. So on the days I was tired, sick, or had other things to do, I found time to get in my exercises because I did not want to fail. It boggles my mind that one could forego a life of a healthy knee because they were too tired or lazy to get their ass off the couch and onto a yoga mat to do some stretching and exercises.
  • Eating Healthy – Some people say I am the most boring person to eat with, and I don’t blame them. I am disciplined about what I eat because I feel that I am able to really enjoy other foods and meals when I have a baseline of meals I always consume. This means the same omelettes, chicken, salads, spaghetti, and newly added steak make up 90% of my diet. Part of it is that I know how to make all these meals very efficiently and there is not a lot of room for experimentation or fucking things up. Every meal does not need to be laced with truffle oil or ice cream, because if they were, wouldn’t the enjoyment you derive from these “unhealthy” foods be less?
  • Morning Routine – Much like I follow a protocol for my ACL recovery, having a morning routine prepares me for any shit I have to deal with that day. This is where I see Jocko’s point a little more clearly, because I feel that if I don’t go through my morning routine, I don’t have the energy and stamina to get through my day. More specifically, I do not feel equipped with those attributes. I eat the same shit for breakfast, do my pushups and pull-ups, and everything is done in a specific order. I remember Tim talked about this in one of his podcasts but accomplishing these small tasks in the morning such as making your bed have profound effects on your mental capacity throughout the day.
  • Work – This is a little harder to find the connection, since I’m working on a startup and every day new problems and challenges come our way. However, we could easily let emotions and anxiety rule our minds and respond to these challenges in unproductive ways. Instead, my team approaches every challenge the same, by prioritizing which problem needs our attention the most and then doing a triage from there. If you become too emotional about someone who has brushed you off or losing a deal, you will fail. Your business will fail. In this context, discipline around how you conduct operations and business processes helps you control the final outcome.

Being A Man From a SEAL

Tim also asks Jocko what 3 events led Jocko to feel like a “man.” A big question that could yield all sorts of answers, but Jocko gives his top 3:

  1. Jiu-jitsu
  2. Combat (in Iraq)
  3. Getting married and having kids

These seem like pretty generic answers to me, but the theme between all three answers is that these events gave Jocko confidence in himself. I wrote about being a man in a previous story, and confidence is probably the main quality trait Jocko has that many men lack. He was unwavering in his answers back to Tim and it showed that these events truly turned on a light switch in his mind about what it means to be a man.

 

ACL Recovery Day 106

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.

A few videos from the last few weeks: