J Lin’s Ruptured Patella Tendon

Watching Jeremy Lin’s recent ruptured patella tendon injury brought back memories of when I tore my right ACL.

Up until my injury, I always thought torn ACLs happen through someone running into you at full speed or getting hit in the legs directly. Little did I know a majority of ACL ruptures are non-contact which makes it even more frustrating. You can be strong, flexible, and self-aware but if you just happen to land at the wrong angle, everything can go haywire.

The Slow Realization

The most devastating part of this video is the confusion J Lin has as he’s feeling his knee. A few seconds when you don’t realize what’s wrong, but just know something is definitely not right.

Granted I didn’t fall to the floor bawling my eyes out but I remember feeling that this is something I’ve never experienced before. It was beyond just sucking it up and playing through the rest of the game. It may require surgery.

Now more than 2 years out from surgery, I’m back to playing full speed and not limited to a certain amount of minutes, but I am still mentally aware of not driving into the lane or trying to battle down low since I know that’s where your body can start to contort and twist in ways you have no control over.

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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 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).

Exercises

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!

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ACL Recovery Day 21

Physical Therapy Session 3

The physio did a lot more “massaging” during this session, although she corrected me and said the proper term is ischemic compression. Once the blood rushes back into the knee, it feels so much more flexible and less swollen, and there’s less discomfort with walking. Really hoping I can figure out how to do this myself.

Got to 105 degrees of flexion, and learned a new exercise I can do while sitting at a desk. You take your healthy leg, and pull the injured leg back at the ankle to help with the flexion. It’s definitely not passive flexion though, so it hurts if you use too much force.

Exercises

  • Elliptical – Alternating days between pure strength and conditioning. Able to do 20 minutes on the elliptical at a level 16/17 resistance.
  • Step Up – Found out at PT my form was not correct (hips were sometimes sagging on one side), so I reduced the height to step up to focus on the form. Will try both boxes tomorrow to raise the height to approximately 10 inches.
  • Bike – Since flexion is much better now, I’m able to do full revolutions at a level 7 seat height on the bike.
  • Wall Squat – Getting to about 50-60 degrees flexion on the bend down.
  • RDLs – Able to do this with 30 lbs (probably more) bar. Feels just like a deadlift, so not too hard right now.
  • Leg Press – First open chain exercises, did 3X12 on a weight of 5 for injured leg.