Guest Post From Dr. Curtis About Chronic Injuries

I posted on IG a picture of some dood touching my knee a few weeks ago:

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I’ve been working with my mans Curtis to help with scar tissue removal from my knee capsule the last few weeks in addition to doing physical therapy. It’s painful, but I definitely get a ton of flexion back right after the session. The below post is a guest post written by Curtis. I don’t get any kickbacks or anything from this, just helping another brother out on the hustle. Read more:

The Secret Problem to Your Chronic, Nagging Injuries

If there was a really simple, easily solvable problem holding you back when it comes to your achey back and the tension in your neck, would you want to know what it is? What if this same problem was also the reason why you’ve plateaued on your fitness gains? And … the SAME issue was also the precursor to osteoarthritis, disc herniations, cartilage tears, and generalized stiffness associated with aging?

What would you do with that information?

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Before I go there, let me introduce myself.

curtis

My name is Dr. Curtis McClelland and I’m the new biomechanical guy doing structured personal fitness.

I’m the licensed chiropractor who doesn’t adjust joints.

I have nothing against traditional chiropractic, it’s just not what I do. And if you love your chiropractor, keep going to him or her! What I do isn’t physical therapy either. But if that’s working for you, great! And no, I’m not a massage therapist either.

I remove the most common pathology in the musculoskeletal system. It’s also the least talked about and most easily get rid-of-able issue out there. This makes it a secret problem, because you’ve probably never heard of it before.

What is it?

Muscle Adhesion

It’s the glue that your body lays down when you overuse tissue without enough time to recover. Some call it “excess fascia.”

Are you tight and you never understood why? It’s probably adhesion. Are you weak and you can’t figure out why all of the lifting you’ve been doing isn’t paying off? It’s probably adhesion.

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Adhesion literally glues down your muscles, preventing its ability to work.

The great thing about having adhesion is that it can be fixed. Most of our patients see objective changes in 4-5 visits, with significant resolution in 10-15 visits.

If you have pain and you don’t have adhesion, then you have structural problems that cannot be fixed. Even surgery can only minimize the magnitude of one of these problems and can’t completely get rid of it.

Curious yet?

I’d like to invite you to explore your body to see what path you’re setting yourself up on?

The one of living an able, functional, pain-free life into old age? Or the one with pain now that you just can’t figure out that’s only going to get worse in ten years, stopping you from doing the things you love?

  1. TAKE 20 MINUTES TO TEST YOURSELF: Go to the Testing section of the Barefoot Rehab website and test yourself.
  2. SAVE THOUSANDS OF DOLLARS + HOURS BY READING OUR FREE GIFT TO YOU: Take 15 minutes to read The 7 Biggest Mistakes People Make When Choosing a Pain Doctor.
  3. TALK WITH ME ABOUT YOUR PAIN: If you’ve only had your pain for a few days or weeks, the research says “80% of the time, it’ll get better no matter what you do”. Wait it out. If you’ve had your pain for more than a month and if you’ve seen multiple providers about your pain, I invite you to have a conversation with me about your pain. Call 929-251-3830 and I’ll discuss your issue with you, free of Charge.
  4. READY TO TAKE YOUR BODY SERIOUSLY? Because I’m starting off with structured personal fitnes, I’d like to offer to the first 10 people who contact me with a $45 exam (normally $145 – that’s $100 discount!) for you to learn just what’s been going on over the years with you. If you aren’t quite sure what we are talking about, we invite you to read the many testimonials we have from our New Jersey Practice

If you’re not sure about me, adhesion, or your injury, that’s OK. Please be gentle with yourself when it comes to doing your workouts though. The highest risk of permanent damage comes when you’ve been given the wrong diagnosis, the wrong advice, and you keep doing what you’re doing. Treat your body with the respect it deserves. This secret problem can wreak havoc, especially when you’ve never had it acknowledged before.

Feel free to come say hello to me on Tuesdays + Thursdays from 9-7 PM. Even if it’s just to say hi. Please email scheduling@barefootrehab.com or call 929-251-3830.

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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?

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:

ACL Recovery Day 74

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
  • Jog6.5 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)
  • Cross Leg Hop: 3X20
  • Hops Over Line: 3X30

ACL Recovery Day 46

Since my last post, exercises have gotten harder and I come away from my trainings a lot more fatigued than before. Now that I’m on month 2 of the recovery, a lot of what I do is more functional and sports-specific. I’m hoping to go shoot around tomorrow at an outdoor basketball court in the city!

The big improvement since last time is the ability to jog at about a 5.5 mph pace for close to 10 minutes without feeling too much pain on the patella. Additionally, the jogging is helping build up my endurance and gives me a chance to do some cardio as well.

Flexion

Month 1 was all about doing passive flexion exercises, but now I’m past 130 degrees and am actively pulling on my leg to bend it more. This is where things get a little tricky because I don’t want to pull too hard to the point of pain but still need to pull to the point of discomfort. Related to my flexion is the pain I start to feel after I extend my leg from a flexed state. Most of the pain is on the anterior side of the knee which is expected. Since I got a patella autograft, this anterior knee pain is probably going to be with me for the rest of my life.

I also have to knead the scar tissue where the patella tendon was taken out to ensure that I don’t limit the flexion. The amount I need to massage is also hard to gauge since I don’t know exactly how much scar tissue I am break up and how much it is impacting the flexion. Nonetheless, I continue to massage the scar as much as possible in my down time.

Exercises

  • Treadmill – I’m up to 10 minutes of fast-walking at 4.5 mpg at a 1.5 incline followed by 8 minutes of 5.5 jogging at 1.5 incline
  • Squats – 3X12 with roughly 80 pounds. The gym doesn’t have a squat rack and just has a bar with a few weights so I end up velcroing on ankle weights to the bar to increase the weight.
  • Single Leg Press – 3X12 with right leg at level 10 and right leg at level 14 with seat at level 9. This exercise probably gets the strongest strength stimulus for me and I can easily see how strong I am getting with my injured leg compared to the good leg.
  • Side Lunge – 3X10 with 20lb goblet hold. This is an exercise I was doing before the surgery just at any other training session at the gym. Very tiring but the biggest part is focusing on exploding off the leg after you’ve bent it. Still not an “explosion” yet on the injured leg.
  • Ball Hamstring Curl – 3X12, this exercise is actually kind of painful on the back of the knee when I’m extending the leg on the ball. Overall though, definitely a good exercise to re-build hamstrings.
  • Karaoke – A cardio and functional exercise that’s actually fun to do. I used to do this warming up for playing basketball and it feels good to be able to move laterally with some speed now.
  • Single Leg Jump – 3X20. Still a tough exercise since I’m putting my entire weight on the injured leg. The most difficult part is not being able to flex the knee as much as I should on the landing.
  • Single leg calf press – 4X8 just a typical calf strengthening exercise. Much easier to do since I’m sitting and lets me take a little break from the other more demanding exercises.
  • RDLs – 4X8 been adding a lot more weight to the bar to make this more difficult. I feel like I can do 100lbs+ without issues.