ACL Recovery

Week 5 of ACL recovery progressed much as Week 4, with daily incremental improvements in pain reduction, stiffness, strength and mobility. Those goals outlined at the start of the week were completed including 3 gym sessions, daily ‘little and often’ physio, observing Friday class and the chin up challenge of 3 consecutive chin ups. The interval between sessions with my Physio has lengthened and we’ll meet again in Week 7, so there’s been no alteration to the exercise plan to report.

While there remains notable swelling in the knee and stiffness, it almost has a complete blend at this point; when laying on my back with my knees tucked to my chest the heel of the operated leg almost touches my bum as the non-operated leg does. However, when standing and bending the operated leg up, there is still significant weakness in the back of the leg which inhibits range of motion; though the restrictions on mobility from swelling are dissipating slowly but steadily. The reduction in swelling and increased mobility is also apparent in descending stairs, which I can do now with some speed and high levels of confidence. At the end of each day there may still be fatigue and swelling in the operated knee, and a couple paracetamol before bed are needed most evenings.

To keep things spicy, I added chin up challenges to my weekly conditioning. Downtime from normal training is, after all, best viewed as an opportunity, as Julia Johansen is discovering for herself with some pretty troubling back issues related to a herniated disc that she’s working through; send her your best wishes! My chin up abilities are pretty limited (and haven’t yet raised ambitions to pull ups!), so time to remedy that weakness! Over the last week the goal was to raise my baseline of consecutive chin ups by one, to 3 consecutive chin ups, and am delighted to have realised that goal! Hope to add a 4th rep in Week 6 and, indeed, my Coach has challenged me to be able to perform 10 consecutive chin ups by our ‘training date’ for my return to the mats on 17 March, which we agreed in Week 3. I’m up for it! Hope to also be able to perform some pull ups by then.

Been a big fan of conditioning all my life and was around my dad’s free weights since I was 5 and ‘bench pressing’ dumbbells in our basement while he did his workout. As noted in a chat with a friend of MegJitsu on Facebook, really dig body-weight conditioning as the recovery time isn’t so intense – in my experience – and the risk of strain or injury much lower. Conditioning work is such a mental game with oneself. If you go into an exercise with a numebr of reps in your head, it is so difficult to go beyond that number even when you simultaneously feel there’s something left in there! That’s been my historical experience, anyhow, and, just like with BJJ or running or other forms of physical activity, the nexus between the mind and body always leaves me fascinated.

For Week 6 the plan is:

• continue to work the rehab in the gym with 3 sessions over the week while repping different rehab options at home
• increase to 4 consecutive chin ups
• 3 reps of 10 on 10kgs dumbbells for curls

Haven’t yet decided about whether I will observe Friday class this week. Frankly it gets me down a bit, especially watching the sparring, and it pressurises my Friday gym rehab work (somewhat impractical to complete the day’s work obligations and have time to hit the gym then make the commute to class, which is double from my gym than from my home). Usually like to structure my goals as the week starts, but going to float this one…

Week 5

Physio:

• Wall sits – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Bridge – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Prone hamstring curl with flexed foot – 3-5 reps, 3 times per day
• Hamstring push backs – 10 quick reps, 3 times per day
• Hamstring push back with weights (gym rehab sessions)
• Squats – two-legged, shoulder-width stance, 10 reps 3 times per day
• Reverse lunge – sets of two at a time, holding for 5 secs for each rep, repeat 5 times each leg, 3 times per day
• Balance – stand one-leg ‘little and often’, e.g. brushing teeth, waiting for a Tube, standing in queue
• Stationary bike – 15 minutes, 80-90 RPMs, 7:10 perceived exertion level
• Elliptical/cross trainer – 15 minutes, 80-90 RPMs, 7:10 perceived exertion level

No change in exercise options since Week 4. The aim is to ‘mix and match’ different exercises throughout the week.

Milestones:

• 3 consecutive chin ups
• Near full knee bend in a prone position

Disclaimer

Every ACL op and recovery will be particular to the person. The thoughts and experiences recalled in this series of posts is in no way intended as medical advice or as a replacement for seeking medical attention for any injury. This information is presented merely as a record of one person’s experience with ACL operation and recovery.

The operated leg recovers little by little and incremental improvement, though small, is apparent each day. Compromises were made on reaching all of Week 3’s recovery goals, but the bigger picture of recovery is moving in the right direction and the range of sanctioned activities has expanded. In addition to levelling up my exercise options, low-level knee pain is very reduced, confidence in walking and descending stairs has increased and I was able to visit my home club for our quarterly Marc Walder seminar, which gave the mind a positive boost. The positivity has also been supported by taking advantage of the training down-time by spending more time with friends.

BJJers often work hard to maintain a balance between family, friends, work and training. Unhappily, in my case, it is often friends that get neglected. At the end of month 1 of 9, I’m grateful for the opportunity recovery has given for reconnecting with pals. So, over the last week, went to the movies with one pal and made a movie with another. The good company of friends is missed when my weekly schedule has to accommodate training so it is nice to have breathing room to give important people in my life more of my time.

Consultation with the Physio yielded more exercises and I can now swap in the elliptical (aka cross-trainer) during my weekly gym-based rehab sessions; I’ve been alternating bike and elliptical over the last week. While I aimed for 3 sessions this week, I was unable to meet those goals due to fatigue in the knee. While it is important to meet goals and to push the knee, it is equally important to ease off sometimes and I’m confident that I have the balance right between not ‘wimping out’ and ‘being sensible’. So, I had daily ‘little and often’ physio work at home, such as doing my bridges or squats while boiling the kettle, but only two gym sessions. Will aim for 3 again next week; in my experience and my Physio’s opinion, after a couple weeks of a rehab cycle one often needs a lighter week to rest the knee while actively healing it through physio.

I am delighted to report, that after a month off the mats, but working hard on conditioning as the leg allows, I’ve maintained my weight and, as far as my Tanita is concerned, I’ve shed 1.5% body fat. Pretty pumped that the beef-to-fat ratio is getting slicker during this period, and it is definitely motivating as far as the gym work is concerned. In addition to my curls, press-ups and V-sits, I’ll be adding new chin up goals in Week 5. At the moment, I max out at 2 consecutive chin ups. I will be working towards 5 quality, consecutive chin ups and once I hit that target will worry about performing from the pull up position. Challenging myself in this way and taking a goal-oriented approach has really helped to keep me feeling reasonably fit and mentally tough.

This recovery lark is largely in the mind, perhaps 80% mental and 20% consistent rehab work. Striving for goals within the parameters of rehab allow one to enjoy progress and to focus on what one can do, rather than on what one can’t. It is important to seek to maintain, as much as possible, one’s pre-recovery lifestyle. So, for instance, when I visited the club for a seminar this week – what a delight to see the guys! – I took my gi along and did some rehab on the mats and then observed the seminar. Feels a little silly to be prancing about in a gi and not training, but it feels 110% better than being benched in street clothes! Got to take every opportunity to keep the mind focused on what it can do. The commute to Kent from my home in East London was a little taxing on the knee and compounded the fatigue in the knee, but I will seek to visit our main Academy once a month, as I really miss my team mates; will exchange a Friday night Ilford class observation for a Saturday lunchtime Dartford class observation going forward.

So, yeah, bring it on; 5 more months til drills begin – can do this time easy!

Week 4

Physio:

• Wall sits – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Bridge – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Prone hamstring curl with flexed foot – 3-5 reps, 3 times per day
• Hamstring push backs – 10 quick reps, 3 times per day
• Hamstring push back with weights (gym rehab sessions)
• Squats – two-legged, shoulder-width stance, 10 reps 3 times per day
• Reverse lunge – sets of two at a time, holding for 5 secs for each rep, repeat 5 times each leg, 3 times per day
• Balance – stand one-leg ‘little and often’, e.g. brushing teeth, waiting for a Tube, standing in queue
• Stationary bike – 15 minutes, 80-90 RPMs, 7:10 perceived exertion level
• Elliptical/cross trainer – 15 minutes, 80-90 RPMs, 7:10 perceived exertion level

As the number of exercises has increased over the past month, the aim is to ‘mix and match’ different exercises throughout the week.

Milestones:

• Weight maintenance with fat percentage loss
• At the club and in my gi
• Great reduction in pain in terms of low level ache and sharp stiffness on walking after period of inactivity
• Much greater confidence in walking and stair-descending

Disclaimer

Every ACL op and recovery will be particular to the person. The thoughts and experiences recalled in this series of posts is in no way intended as medical advice or as a replacement for seeking medical attention for any injury. This information is presented merely as a record of one person’s experience with ACL operation and recovery.

Credits

Images courtesy of Salvatore Vuono | FreeDigitalPhotos.net and photostock | FreeDigitalPhotos.net

Knee rehabilitation has been steady and managed to meet last week’s goals and then some. Physically and mentally am making progress and doing my best, within safe parameters, to stay fit(-ish), get stronger and rehabilitate the operated leg. Consulted with the Physio and levelled up my exercises, observed Friday class and had a few visits from BJJ friends all of which helped keep recovery moving in the right direction.

This week’s recovery got an extra boost from the people around me, not least my BJJ people, and I’m feeling very loved which definitely helps to keep the mind strong. Had lunch with Coach whose positive reinforcement and nurturing vibe is always a buoy; he brought flowers and a card signed by the Team. Was very touched by the obscene sketches of male genetalia as I’ve come to understand this is how some men emote and is a flattering assurance of my place in their ranks – HA! Indeed, all the well wishes and the simple ‘It sucks not to have you here’ meant a lot! I miss the Team terribly and look forward to seeing my people at next week’s Marc Walder Seminar, which I’ll be observing. Also met up with my training partner, Keelin, out of Roger Gracie Academy. She’s a pal, a training partner and has had her own serious knee issues to work through and while she’s had a lot on her plate this year she’s been a rock and a generous sounding board for me as far as jits and knees are concerned. The friendship and support heaped on me this week reinforced the fellowship aspect of BJJ and its central part in my love of the art.

I got back to class for the first time since the op on 30 Sept and observed our Ilford class where I had a very warm welcome. Took my grappling diary along and noted the techniques, offered a few pointers on the drills for some of the guys and watched the sparring. Was useful in a number of ways, not least just being around the jits and some of the Team. For me, the most important benefit was the help to my visualisation which several readers here and on Facebook have recommended. Woke up Saturday morning dreaming of the previous night’s techniques in my normal fashion and took a little time before I started the day to run them in my mind’s eye and ‘feel’ the movement.* Won’t suggest that seeing the jits in front of me wasn’t mouth-watering torture, but I’ll withstand the itch while I rehab as the benefit of being around it outweighs any feelings of frustration.

The Physio was pleased with my progress and prescribed additions to my list of ‘at home’ exercises, including some balance work and two-legged squats without weight. She also did some ‘release work’ massage, which really helps the hamstrings and inner thighs which get very tight. She rubbed out the keyhole scars too which felt majorly funky, but massages here is important for getting the nerves to regenerate properly and for reducing scar tissue. My extension is about 95% and flexion about 110%. The Physio reckons there is more bend there but swelling makes it awkward, so we’re not pushing more bend until the swelling recedes. I am to continue my gym work and I hit my 3 sessions goal this week and am rolling over that goal for Week 4. My upper body work is paying dividends and I’m up to 3 sets of 15 quality one-legged press-ups and escalated to 10 kilo dumbbells for my bicep curls (reps of 10, 6 and 5 – will take sometime to feel comfortable 3 sets of 10 at which point will boost it again). While the bike is still pretty uncomfortable due to the swelling in the leg, it is getting a little easier every time and the leg continues to gain mobility and have less pain, little by little.

Week 3

Physio:

• Wall sits – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Bridge – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Prone hamstring curl with flexed foot- 3-5 reps, 3 times per day
• Squats – two-legged, shoulder-width stance, 10 reps 3 times per day
• Balance – stand one-leg ‘little and often’, e.g. brushing teeth, waiting for a Tube, standing in queue
• Stationary bike – 15 minutes, 80-90 RPMs, 7:10 perceived exertion level

Milestones:

• Down stairs walking taking weight on operated leg on shallow steps without need for support
• 1st BJJ class observation
• Double digit dumbbells for bicep curls
• Sets of 15 press-ups (up from 10)
• Agreed date in 6 months for beginning drills with Coach (assuming cleared by Physio)

Disclaimer

Every ACL op and recovery will be particular to the person. The thoughts and experiences recalled in this series of posts is in no way intended as medical advice or as a replacement for seeking medical attention for any injury. This information is presented merely as a record of one person’s experience with ACL operation and recovery.

*Don’t laugh at my definition of ‘normal’, you know you’re just as demented and obsessed – HAHA!

At the end of the second week of recovery, I feel that I have built on the knee rehabilitation of week 1, and while the medium term commitment of this process is becoming – starkly – more clear, it is equally clear that every day brings overall improvement. Some high points of the last week include first session with the sports physio and first gym session. On the other side of that is easy knee-fatigue, continued ache and a greater appreciation for the rehab-hill to climb. These less positive elements are balanced, however, by an awareness that this is only a temporary situation, that the rehab is working and that, really, I am so fortunate to have access to keyhole ACL reconstruction, so any ‘first world problems’ should be kept firmly in perspective!

Wednesday was my first physiotherapy consultation with the same Physio I have worked with for MCL rehab and pre-op ACL rehab. My Physio was very happy with my progress and in her opinion I’m about 3 weeks ahead of the curve in terms of recovery; this is down to the heavy commitment to physio work before the operation. We worked through the next set of exercises to add to my daily regime and I was cleared for restricted gym duty. I started work on the stationary bicycle on Friday; Physio prescribes 10-15 minutes, 80-90 RPMs, focus on the push and pull to work hamstrings and quads and a 7 out of 10 level of exertion. I achieved this but it was extremely challenging as there is still swelling and stiffness and it is difficult to fire the hamstrings on the operated leg. While I thought I wasn’t going to be able to make it happen, after about 5-6 minutes of warm-up was able to work at the desired level and got a wee bit of a sweat around the hair line and some heart rate, but not a drippy crazy sweat or high level of exhaustion. Physio also advised to integrate upper body work on these sessions to help with motivation and so continued the one-legged press-ups from last week and brought in bicep curls (as of this week on 3 sets of 10 reps with 9 kilo dumbbells and hope to improve – I’m sure sounds majorly puny to some readers!). Felt so good to get into the gym and went out that evening so a fair bit of walking that day, which did lead to soreness through the night and the following day, but a lot less of an ache and more mobility after 48 hours, which seems to indicate that I’m not over doing it, but I am pushing it enough to get benefit. I am aiming for 3 days a week at the gym plus daily physio on a ‘little and often’ basis.

I’ve chosen to fund my own private physio. I was offered physio from the NHS and there are physios with BJJ experience available at my hospital. However, in my experience of various knee injuries over the last 4 years, I’ve come to understand that the NHS-perspective seems to be heavily biased towards ensuring a person can safely and happily carry out day-to-day tasks, rather than be prepared for activity and sport. I believe this is why my original orthopaedic advised me to avoid surgery as recommendations may be filtered through this bias which doesn’t really account for the more marginal lifestyle of the amateur athlete. My experience suggests that there is a sense in the NHS that one is either a professional athlete or not – ‘true’ as far as it goes – and there is less appreciation for the lifestyle of the amateur athlete, where physical activity is integral but not the entirety of life and work. This perspective perhaps reflects wider trends towards obesity and associated inactivity and over-eating. I am not criticising the NHS-perspective, but rather noting my observations based on my limited experience with a very small portion of the system, but it is clear from my own history that the lifestyle and physical expectations of the amateur athlete aren’t catered for within NHS protocols; unhappily, very active non-professional athletic people, are rather rare. Statistically, folks are either couch potatoes or professionals and it is entirely rational for the NHS to use this notion as a basis for its protocols (if that is in fact that case), but as my goals are to go beyond the ability to enjoy the day-to-day in comfort, incurring the expense of a private sports physio is a worthy priority.

While I am very happy with my progress and feel very positive about rehab and being on the other side of this process, it is frustrating to be out of BJJ and I am missing my team mates and the training a great deal. This has been compounded by the announcement of a Braulio Estima seminar at my club in December! I am pumped that Braulio is coming to Dartford BJJ and will be able to observe, but is just a bit of a bummer as am losing fitness, timing and missing out on this month’s Marc Walder seminar, so had a minor pity party this week and baked oatmeal raisin cookies and sorted out my autumn wardrobe. Hoping increased gym work will distract me from these less healthful coping mechanisms going forward.

Week 2

Physio:

• Wall sits – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Bridge – 3-5 reps, hold for 10-15 seconds, 3 times per day
• Prone hamstring curl – 3-5 reps, 3 times per day
• Continue ‘little and often’ walking, icing and elevating leg

Milestones:

• 1st physio consultation
• 1st gym session – stationary bike
• Stiffness and ache still very prevalent, but moments when there is no ache

Read ACL recovery Week 3

Disclaimer

Every ACL op and recovery will be particular to the person. The thoughts and experiences recalled in this series of posts is in no way intended as medical advice or as a replacement for seeking medical attention for any injury. This information is presented merely as a record of one person’s experience with ACL operation and recovery.

Credits

Images courtesy of Photostock | FreeDigitalPhotos.net

The timeline for full recovery from an ACL operation is 9 months.(1) That is 9 months until no restrictions on activity. However, this does not mean that one is under complete rest for those 9 months, quite the opposite! Indeed, post op ACL is fully weight bearing. There is no brace or cast. There are crutches but this is for stabilisation over the first 1-2 weeks and patients are encouraged to support their own weight as much as possible, as soon as possible. Likewise, rehab through physio begins from the moment one leaves the theatre and recovers from the general anaesthetic. Over the course of the next 9 months, or 36 weeks, I hope to record each week’s recovery goals and progress; lots of us have knee issues and perhaps this diary of recovery can be a useful perspective.

Week 1

Physio:

• Static exercises for quads, hamstrings and glutes
• Prone stretches – allowing the back of the knee to hang unsupported for 20 minutes to encourage straightening
• ‘Mini workout’ – 30-50 reps each of V-sits, one-leg press-ups, one-leg tricep dips off the bench and Pilates clams every day to keep core and upper body mobile while taking it easy in the first week

Milestones:

• Free of crutches (indoors) after 24hrs; still used as ‘stabilisers’ outdoors to avoid being knocked over
• Compression bandage off after 48hrs and dressing changed
• Walked upstairs normally after 3 days; didn’t manage normal down stairs walking this week – bending and supporting weight too much
• Full extension after 3 days, though ability to press back of knee to floor much reduced (difficult to fire quads with swelling)
• Slept through night without waking due dull ache in knee and need for painkillers after 6 days
• Stitches out after 7 days
• Free of crutches (outdoors) after 7 days
• First meeting with Physio on Monday

Read ACL Recovery Week 2

Disclaimer

Every ACL op and recovery will be particular to the person. The thoughts and experiences recalled in this series of posts is in no way intended as medical advice or as a replacement for seeking medical attention for any injury. This information is presented merely as a record of one person’s experience with ACL operation and recovery.

(1) My experience is based on the care and approaches currently in use in the NHS; it has become apparent that other ACL-recoverers may have different timelines based on their geographical locations. There’s many ways to crack a nut and this telling is founded on the NHS-experience.