The ACL Recovery Process As You Age

I recently read b-reddy’s latest post about ACL recovery and it made me think about the optimal age to recover from a torn ACL.

Is there a such thing as an optimal age? Isn’t tearing your ACL bad all around for you? Obviously yes.

However, the physical and mental capacity to deal with the recovery process is underrated and this Brian talks about this a bit in the post. Let’s consider the different age ranges and its implications on your recovery process:

  • Teens – You’re 16 years old and playing JV basketball and tear your ACL in a game. As Brian refers to in the post, you may think your high school basketball career is over. In addition to the lack of ability to play, you miss the camaraderie of bonding with your teammates as they go through the season.
  • 20s – If you didn’t play college or junior college sports, you are most likely a weekend warrior like most new professionals are. This is the optimal age range to tear your ACL in my opinion since you have the maturity and resources to go through with a full recovery protocol. You’ve probably experienced various amounts of pain both emotionally and physically, so are better equipped to withstand the pain to come with recovery. Your knee will also recover quicker the younger you are, but not as quick as when you were in your teens.
  • 30s – Unfortunately, things just get tougher as you age. Your body does not recover as quickly from a traumatic experience (in this case, an invasive surgery) and your athletic activity may be decreasing due to work and family commitments. While you definitely more mature in this age range to deal with the recovery, many may just opt to not go with the surgery since they know their physical activity will not require a lot of sports or side-to-side cutting.
  • 40s – I’m not there yet, but I would assume that unless you are physically active all the time, the surgery may be avoided all together since you want to be able to still play with your kids but not in an athletic sense. Your body definitely will not recover as quickly as when you’re in your 20s but that’s expected.

While it’s never good to tear your ACL, I’m glad it happened in my 20s vs. another age range given that I was already at a certain level of fitness and the recovery process felt like it was like working out to build up a muscle that I’ve been wanting to work out anyway.



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 33

It’s been one month since my operation, and I’m definitely starting to feel the mental grind of going to the gym every day and doing the same exercises over and over again. One aspect of the workouts I’ve tried to change to make the exercises more fun is by gamifying sets. This means trying to get in a few more reps than normal, going to a higher weight, etc.

Since I have “graduated” from b-reddy’s one-month manual, I’ve stopped doing some of the exercises from his manual and moving to more technical and physically demanding exercises for strength and flexibility prescribed from my physio. Being able to squat with a 50-lbs weight has definitely helped with building my confidence that I will be able to build my posterior chain without too much pain or stiffness.

I’ve also changed the frequency in which I see the physio, so now I’m only seeing her 1/week on Monday mornings. She says many of the exercises I can do myself, and my dedication and commitment will determine how far I progress without see her as often as I should (to make sure I have enough sessions with my insurance to see her for at least 4 months post-op).


As I said before, many of the “old” exercises from the 1-month manual have been phased out of my protocol. Straight leg lifts, side-lying leg lifts, active hip flexion, quad sets, etc. have been phased out and I’ll only do them as a warm up for the more physically demanding exercises. Many of these exercises are difficult to do even on my healthy leg:

  • Bike – I start at level 4 at my gym, and physio wants me to get to level 16 at her office tomorrow
  • Wall Squat or Squat – I’ll do the wall squat with two 20-lb weights which actually makes the exercises tougher on my core. The regular squat I’ll do with 50 lbs on my back and it’s difficult just because I’m trying to get equal force on both legs.
  • RDL – 4X8 with 50 lbs. Form on the RDL is much better now since I focus on shooting the hips back and shooting them forward.
  • Single Leg Press – 3X12. I do this on the leg press machine and am able to get to level 7 or 8. Comparatively speaking, my good leg is at a level 12, so I’m at 66% of full strength which is better than I thought. I still don’t get flexion to 90 degrees in between contractions.
  • Lunges – 3X10. This is a new exercise added from last week, and I step forward with each leg and lower into the lunge. It’s difficult when I’m stepping out with my left leg since my right leg doesn’t want to bend as much, forcing me to put more weight forward on my left leg than I should. Trying to fix this by making larger steps so that my right leg doesn’t have to flex as much.
  • Glute Bridges – May be phasing this exercise out since the strength stimulus is not very high compared to RDLs or squats.
  • Single Leg Squat With Weight – 3X10 with 10 lbs. This is one of the more difficult exercises since I’m training my knee to bend again and putting my entire body weight on the lift. It’s not a regular single leg RDL, since I’m bending the leg, but there’s still a lot of hip hinging involved.
  • Single Leg Calf Press – 4X8 at level 8. This is done on the machine, and much easier than doing a standing calf press/heel raise. Will mix this up this week between the leg press machine and standing.
  • Single Leg Squat With Opposite Leg On Bench – This is really a ROM exercise since I’ll put my right leg bent on a bench and lower with my left leg until I feel a stretch. Definitely gets painful since I’m doing active flexion.

Other things the physio asked me to include is massage the scar tissue and stair master. The scar tissue on the lateral side of my knee almost feels like a golf ball at times, so I’m constantly massaging to break up the scar tissue before it gets too stiff. I haven’t done the stair master yet, since I feel like walking up and down the subway and stairs at work have helped with the strength stimulus from walking and the cardio involved as well.

In other news, having more time at home has afforded me the ability to focus on fixing a broken Samsung LCD TV. Replaced a 2200 micro-farat capacitor (which I think was the issue) and also chipped away a lot of the gunk and glue that has melted on some of the power supply board. TV works for now, but will check tomorrow to see if it turns on again!


I Tore My ACL

I’ve been injured so many times from basketball, I already know what the recovery is like, how fast things heal, and when I can go back on the court. The only injury I’ve had where I’ve needed surgery was a fracture scaphoid (wrist). Up until that point, it’s just been ankle sprains, bone bruises, and a few strained muscles. When I got the wrist surgery, I thought that that I wouldn’t be the same anymore after surgery since a permanent screw had been placed in my wrist. I thought I’d be like a machine.

You Are Fragile and Can Be Broken

I’ve always had this belief that you should never do anything to your body that’s “fake.” What I mean by that is something as innocuous as taking whey protein and supplements to increase your performance, to putting in screws to your write to make your hand and arm function normally. Even though these prosthetic accessories should and can help you recover from an injury or increase your athletic performance, I believe that what you organically are born into the world with is what you should leave with as well.

This is obviously a flawed way of seeing the world.

You will be broken. You will suffer injuries and pain. With age, being able to recover from a 5-hour session of pickup will take longer than it used to. As hard as it is to accept, the faster you can come to the reality of your age and physical abilities, the happier you will become. I see guys who are in their 40s at the gym pushing themselves to get ripped and build mass, and a part of me respects them for wanting to get back into shape and beating the odds. The other part of me thinks they should slow down and avoid the risk of injury which could decrease their quality of life for the next 5-10 years.

The Prognosis

This is the mental backdrop to the recent injury I sustained while paying pickup. I felt me knee bend in a weird way but remember having a similar injury back in 2009 where I partially tore my MCL. A minor tear to the MCL will heal on its own through rest and ice. In my mind, I thought this was what had happened to my knee, and thought that it’s not the end of the world, I’ve done this before.

The physiatrist looked at me and made a long sigh, and I could sense he was uncomfortably trying to avoid eye contact. I knew that it was something serious, and that it would be far worse than the minor MCL tear I sustained more than 5 years ago

You tore your anterior cruciate ligament (ACL), which is bad, and also some tears to the meniscus.

When he said ACL, I just thought, “this can’t be me.” I’ve never had knee problems and always worked on strengthening my quads, glutes, hamstrings, etc. and never thought the ACL injury could happen to me. The physiatrist said he was surprised I wasn’t more shocked by the news. I was shocked, terrified actually. But I didn’t know how to show it while sitting on the piece of butcher paper in the physiatrist’s office.

I’ve done all the research, consulted with friends, and decided surgery is the best route. 9-12 months of recovery, or 9-12 months of not playing basketball or any impact sport. For the first two weeks I was in denial and kept on thinking I could somehow avoid the surgery since I’m just such a superhuman freak of nature and don’t need my ACL.

In rare cases, there are actually people who don’t need their ACL since the strength of their other ligaments make up for instability when no ACL is present. I’m not one of those guys, unfortunately.

Preparing For Surgery

I am a voracious consumer of health information and appreciate when trainers and physical therapists cite numbers and actual studies to substantiate their claims. One guy I’ve come across is Brian Reddy, who explains the mental barrier many athletes face. He says that most people know that surgery will indeed fix their ACL and should help them return to a high impact sport. However, most athletes are not prepared mentally for the recovery process and all the dedication required for physical therapy.

This part of the surgery is what I’m most concerned about; being mentally prepared. My goal is not necessarily be able to play competitive basketball again, but rather have a healthy knee that allows me to live a regular life post surgery. I plan on keeping track of my recovery process via this blog, and would appreciate any comments or suggestions you have about going through ACL reconstruction.