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:

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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