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.

 

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ACL Recovery Day 12

The last two days have been the toughest so far in terms of the exercises and rehab. In addition to the exercises I was told to do from PT, I’m also doing a whole new plethora of exercises from the b-reddy manual. Today’s workout legit took 2.5 hours to do, and I plan on doing this faster in like 1.5 hours tomorrow morning by not resting as much in between sets.

Needless to say, I’m freaking tired. I was hoping to do two sets a day but given the volume of exercises and reps and the time it takes, it’s not feasible even though I’m pretty much sitting on my ass these days.

The biggest thing I’m working on right now is flexion, and I remember having a similar experience with my wrist injury. I can definitely force myself to get to 90 degrees flexion, but there’s a fine line between discomfort and pain. Being able to differentiate between those two feelings is what makes your recovery good vs. great.

Knee Flexion on Day 11 - Around 70 degrees flexion.
Knee Flexion on Day 11 – Around 70 degrees flexion.

Exercises

  • Quad Pumps – 3X50 – Pain on top right of knee on the contraction, but not too much (3/10).
  • Wall Hang – 5 minutes – Pain definitely starts setting in the longer I “hang” on the wall, got to around 80 degrees to day so expecting to get to 90 degrees tomorrow.
  • Standing Active Flexion – Still difficult to do, part of it is the lack of strength in hamstring
  • Bike – 15 half-revolutions – Set seat at 12 in gym, still can’t get the full revolution. Easier on the knee on the forward pedal vs. back pedal.
  • Plantar flexion/dorsiflexion  – Still some pain on the dorsiflexion
  • Sitting Hamstring Stretch – Makes such a big difference when you do this exercise on a bench versus the ground since you can grab the bottom of the bench to pull yourself forward.
  • Standing Hip Flexion – 4X12 – Able to get thigh parallel but still not 90 degrees flexion (expected):
  • Side Lying Leg Lift – 4X12 – Did both legs and definitely fatigues the hips/abductors
  • Glute Bridges – 4X12 – Not that easy to do since it requires flexion in the knees, but did as much as a I could with the flexion I have.
  • Straight Leg Lift – 4X12 – Pretty easy now, should be able to blow through this exercise tomorrow.
  • Heel Raise – 4X12 – Supposed to do this exercise with legs slightly bent, but it’s difficult to do this with the right leg slightly bent and still get good “push” off the ball of my right foot.
  • Seated Leg Kick – 4X12 – Definitely the hardest exercise on the patella since I can feel the pain on the medial side of my patella on the kick up. Still a great exercise for building strength.
  • Quarter Wall Squats – 4X12 – Also a tough exercise since I only go to 45 degrees of flexion, and tough to keep weight even on both legs since I’m favoring the good leg to push up. Also difficult to push off of the right heel due to anterior knee pain.
  • Conditioning – Did 5 minutes of the elliptical going backwards, definitely pretty tough but easier than the bike since there’s not as much flexion. Will shoot for 10 minutes tomorrow.
  • Proprioception – Just been practicing “walking” focusing on heel-to-toe mechanics and mimicking the good leg as much as possible. Definitely still a limp but pretty much full weight bearing at this point.

ACL Recovery Day 6

Summary

Been consistently doing the exercises from b-reddy’s manual and did one set in the morning and one set at night. I was even able to throw in upper body work since I haven’t touched those muscles in over a week. Just because you have a messed up ACL doesn’t mean you can’t work out other body parts.

The two biggest issues right now are:

  1. Swelling – I’m usually not a “sweller” and I’ve been icing like crazy, but my knee is still so puffed up you can’t make out the shape of the patella or any of the surrounding muscles (or lack thereof). This is the one time where I actually don’t want to get swole, or achieve hypertrophy for the lifters out there.
  2. Flexion – It’s so freaking weird to not bend your knee…at all. I was able to achieve 45 degrees of passive flexion through a supine exercise, but the swelling and tightness make it anatomically impossible to bend the knee further. My ortho said I need to think past this and just bend the fucking thing. I’m not sure I feel the same way, but regardless I’m pushing myself.

Nutrition

Over the last two days, I finally got my normal appetite back. I think due to the harder drugs, I really had no interest in eating, but forced myself to eat anyway since I knew I would just get emaciated if I didn’t. Getting my appetite back made me feel like an animal again, needing fuel to go on the hunt. In this case, the “hunt” is just doing my PT and mustering the energy to walk around on crutches.

In terms of meds, I stopped taking the Oxycodone, but will take one more Meloxicam tonight just to be safe. I took off all the ace bandaging and the gauze, so all I see now are the white butterfly strips covering up 3 different wounds with dried blood that has set into place over the last few days. Figured the Meloxicam might help with any last bit of inflammation that’s taking place.

Everything Is Slower

And I mean everything. From taking showers, to getting ready to leave the apartment, I think about wrapping my knee up, putting on the brace, getting the crutches, putting on shoes, etc. All these actions I normally take for granted now have 10 or 20 steps involved.

I remember Day 1, just getting to pee was the biggest ordeal. First I had to get the crutches to get to the bathroom which was only 5 feet away. My dad had to help with making sure I wouldn’t piss on my shorts, and I had to position my body in such a way that I could actually pee while holding onto the crutches while pointing things a certain way. Everything is slow because all I think about are angles. Angles of how my hands and feet need to occupy the space to support my 200lb body. I think about how my body needs to contort to sit on a type of chair or any surface.

It’s more tiring from a mental perspective, since you can’t just sit on the fucking toilet anymore to drop a deuce. I have to think about how I’m going to prop up my leg on some object so that I don’t prop up my right butt cheek too high from dropping bombs.

This is getting a little outside of the recovery process, but I think mentally recovering from this injury is just as important as all the physical stuff. There have been times when I was down, where everything sucked, and I’m sweating just to raise my foot one centimeter off the ground. I’m glad I read about all the psychological aspects of this injury, because for better or worse, it prepared me for the first few days of absolute misery.

ACL Recovery Day 5

Summary

Got in the best day of rehab so far, doing 4X12 leg lifts with relatively little pain (3/10). Only took fish oil and glucosamine/Chondroitin for supplements. Tried passive flexion and was able to get to around 45 degrees which is a lot more than I expected. Since there’s still a bit of swelling, getting the flexion is pretty tough so have been icing in hopes that the swelling will go down to get ROM.

Also did a little bit of walking (with brace locked):

Longer update tomorrow!

ACL Recovery Days 3 and 4

Summary

Day 3 the pain definitely has subsided, and the swelling has gone down as well. I still feel a lot of tightness near the patella, especially when I try to tighten my quad. Still was not able to do a straight leg lift. What I was able to do is bend my left leg, and sort of lift my right leg using my body which is not the same as a leg lift. Biggest hurdle was getting over the pain over the patella when I try to tighten and lift the entire leg.

Day 4 I told myself I had to get the leg lift done and spent most of the morning working on tightening the quad despite the patella pain (which has also gone down). It was a struggle, as I was only able to get my foot off the ground for a few centimeters. Over 30 minutes, I moved on up to one foot, to the point where I could actually do a normal leg lift without having to rest my leg on the floor due to fatigue and atrophy. Getting to do these leg lifts was a big step in the rehab for me since I know that my quad is now slightly working.

Rehab

Total Time Day 3: 1.5 hours, started at 11:55AM

Did all the normal exercises and didn’t feel that different from Day 2 in terms of strength, but pain was not as strong. Still no flexion yet but will be working on that on Day 4 (today).

Total Time Day 4: 45 minutes, started at 10:15AM

Biggest accomplishment today was the straight leg lift as mentioned above. Now I have the confidence of lifting my leg when getting onto a chair, lifting the leg onto another chair, and just using my quad muscle more often than using my arms to lift the leg up and down from surfaces.

Videos of other exercises:

Meds

I haven’t taken any Oxycodone since Day 2, and stopped taking Melixocam Day 3. As per b-reddy’s manual, I’ve avoided taking the hard drugs as much as possible to prevent addiction in the worst case scenario, and just having a healthy stomach. I started taking supplements Day 3 and will continue with the rest of the rehab. This is what my Day 3 looked like:

9:30AM – Fish oil

10:00AM  – 2 Glucosamine/Chondritin/MSM

11:00AM – 1 Melixocam (no more starting Day 4)

11:50PM – 1 Ibuprofen (no more starting Day 4)

pain meds for ACL injury
Medley of pills and supplements. Hard shit on the right Oxycodone/Melixocam).