ACL Recovery Archives - Page 5 of 5

2 Oct 2011

ACL Operation: The First 20%

Friday, 30 September, I went in for an ACL reconstruction on my left knee, which I ruptured in training in Dec of 08. Since that time I have worked a programme of rehab, bringing the leg to a solid level of stability and consulted with an orthopaedic who advised to avoid surgery. While I could and have trained around the injury, ultimately there was too much restriction on my activity levels; no running, no competing, modified training. So I got a second opinion from a surgeon recommended to me by a friend who has a PCL injury. He was very clear that reconstruction was the only way to get back to my desired level of activity and avoid any further damage to the knee; happily MRI scans showed that my injury did not include any tear to the meniscus and we wanted to keep it that way. This plan came to fruition on Friday, and as my surgeon noted at our final consultation, ‘The op is only the first 20% of this, the rest is rehab’. As so many of us in the grappling community have knee issues, I’m hoping to chronicle my recovery for you, starting with the day of the op and the aftermath.

The Operation

There are several approaches to an ACL reconstruction. A common approach in the UK NHS at this time, and the procedure used on my leg, is to use an arthoscope, aka a keyhole procedure, to create two small punctures at the front of the knee and a third incision on the front of the shin through which part of the hamstring ligament may be harvested. Through the two small entry holes, the diagnosis (made by MRI and manipulation of the structures) is confirmed, any cartilage tears are corrected and the ligament used as a graft to recreate the ACL. The procedure is around 1.5 hours long and is carried out under general anaesthetic.

Going Under

The introduction of anaesthetic was a world-changing development in medicine and allows procedures to be undertaken with far less risk and discomfort to the patient, while allowing for more complicated procedures than were possible before its usage. Local anaesthetic, like Novocain at the dentist, numbs a specific area but the patient is conscious, general anaesthetic renders the patient unconscious. In the NHS there is a tendency to use a cocktail of opiates for general anaesthetic, but it is also possible to use a nerve block to minimise the use of opiates. In my case, I had a nerve block as my previous experience with general anaesthetic was extreme vomiting in the aftermath; my tolerance for drugs is pretty wimptastic, so they used the block to reduce the amount of opiates to just that required to keep me asleep during the procedure.

My Day in Hospital

I had an early admission and reported into the surgical admission lounge for 7AM. I could drink water up to 6AM, which I did and could eat up until 2AM; my last meal was at 10PM the night before; there are restrictions on food and water because of risks associated with general anaesthetic. I had some waiting in the morning before going in. I was third on the list and saw my surgeon, my anaesthetic nurse and several other nurses to confirm all the details over the course of the morning. All the NHS staff were professional and ‘on the ball’. I was nervous when I got on the gurney and the anaesthetic staff were very kind in distracting me while they did their work getting me off to sleep.

When I came round I was extremely drowsy and on some crazy perpetual motion air mattress with a repeating cycle of waves and massage. Happily I did not feel sick at all which was the reason for the block, and I had excellent pain relief as the block was still in effect with a numbness in my thigh to calf, but I was sleepy in the extreme and couldn’t bring myself round. I was desperate to be released that day so was working hard to come out of it, but even on the mad moving bed, I couldn’t really wake up.

I was moved onto my ward after about an hour and my physio soon attended me. My physio, Chris, asked me how I injured myself and I started the spiel about being a grappler that I use with civilians and low and behold this guy is a blue belt in BJJ! Sweet! This started to perk me up and we went through my leg sensitivity and my basic exercises for developing range of motion. We then tried standing with the aim of moving to walking. This is when things took rather a sour turn. I stood on the the crutches and gingerly moved my weight from one leg to the other, while doing so I started to feel faint. I sat down and told the phsyio that I was about to pass out. I fainted and had what appeared to be a small seizure. This has happened to me on occasion and I even had an EEG in my 20s to check for lesions on my brain, but it is related to low blood pressure and low blood sugar, both of which I have a tendency towards. I came to and was very disoriented for a moment and drenched in a heavy, gross sweat and my little episode meant I was in for the night.

Imagine, if you will, being doped to the eyeballs, on a perpetually moving bed so that each time you drift off you are awakened, oxygen is up your nose and you’re being poked and prodded by staff as they check your stats throughout the night. Not entirely pleasant. What was most troubling was the ‘bathroom issue’. I knew I needed to eat and drink to get my blood pressure up and to clear the drugs out of my system. Unhappily, I couldn’t walk to toilet so it had to be a bed pan. I just couldn’t. A new rotation of staff came on and we tried a wheeled commode but that too led to a fainting episode and the instruction that I was not to put my legs on the floor as my blood pressure couldn’t hack it. Meanwhile, I’m forcing down bits of Jamaican ginger cake and water at regular intervals, sucking down 2 litres of liquid. Nature will take its course and after being ‘threatened’ by the thought of a catheter, I finally managed a bed pan pee. Oh man, that is humbling, doing that and seeing it as an achievement. Much to my nurses’ chagrin, troopers that they are, I had 3 bed pans that night; no sleep and just drinking the water and eating the cake little by little, only way I was going to get better. By 5 I was getting an hour of sleep at a time and once the ward opened for biz at 7 I was much improved. The new sisters came on rotation and I was again humbled by the achievement of being able to use a mobile commode instead of the bed pan. Getting stronger! I finally got cleared for having my feet below me and I got wheeled to a proper loo. Thank the Graces! Having basic bodily functions be such a ruling and difficult thing to deal with is a truly humbling experience that has really a made me reflect on ageing, health, disability and the importance of living with gratitude. I’ve got it so dang good and easy!

Hospital Discharge and Day 1 of Recovery

When you’ve been so ill that you can’t imagine being on the other side and then start to see clearly and feel yourself again, that’s a great feeling that readers will recognise in their own experience. Once my blood pressure and blood sugar were strong enough to let me be upright I got rapidly better, ate more and got to work with my physio. We did my walk and stair work and I was cleared for discharge and just had to wait on my meds before being set free into the world at 15:00 on Saturday. What a welcome sight my home was!

Since seeing the physio and getting cleared for out patient status, I’ve been pursing my basic exercises on a ‘little but often’ basis. These exercises are for regaining range of motion and activating the hamstrings, quads and glutes. They include 3-4 reps of each of the following:

Point, flex and rotate foot to get blood pumping back up towards the body
Attempt to straighten leg by pushing back of knee down, hold for 3 seconds
Attempt to bend leg up, hold for 3 seconds
Squeeze glutes and hold for 3 seconds

I also need to keep walking in short but frequent bursts to keep mobilised and activate the muscles; post op ACL is fully weight bearing and it is important to keep the muscles and blood pumping as much as possible to rebuild the leg and to fight (inevitable) atrophy. I had better than average extension and bending of the knee from the moment I got out of theatre, which is surely down to all the physio I did before going in. At the moment I am at 90 degrees, which is at max considering the compression bandage and dressings and I am getting closer to straight already. I have also started to walk free of crutches; one week, eff dat, try 24 hours. This is very slow walking, on the flat and little infrequent trips. If it feels okay I am encouraged to fully weight bear and my leg is absolutely stable enough for the walking I’ve been doing. Psyched with my progress and I’m gonna do this time, easy. Well, I may be singing a different tune next week…

Thanks for all the well wishes on Facebook and G+, I really appreciate hearing from you and wish speedy recovery to those who are also on this journey.

Want to know more? Check out week 1 of ACL post-op recovery

ACL Recovery /

8 Apr 2009

Brace yourself!

I started training for the Essex Open last week, thinking that my knee was much further along recovering from an MCL injury sustained in December. In addition to the piece of soap my partner stashed in one of the grapes included in the salad I’d made for lunch, I had a nasty April Fool’s when I did the first sparring from stand-up I’d attempted since my injury. Missed a move and ended up landing bit funny on the injured leg and twisted it quite badly. Started an ibuprofen course to get the swelling down and I also invested in a new and heavier duty knee brace.

After some online research into the best knee braces for MCL injuries I settled on the Mueller hinged knee brace. Hinged knee braces are supposed to provide the extra support against lateral movement, which is where I’m weakest, but these babies aren’t cheap and the Mueller was one of the more modestly priced and had decent online reviews.

I ordered my brace from online UK retailer Vivomed, as they promised next day delivery and I was pretty keen to see how I fared in takedown practice with a properly strapped knee. Alas, it hadn’t arrived after 5 working days, so I gave them a ring. They were very helpful and suggested that it might be stuck in the postal system somewhere and I should contact my local sorting office and get back to them when I knew more. After an eternity on hold and responding the automaton Sarah with key presses, I spoke with a Royal Mail rep to discover that I needed to wait until the 22nd to claim for compensation (as the brace was sent first class and so had no tracking attached to it). I rang back Vivomed, but before I could even ask that I order a new one and return the missing one if it showed up, they offered to resend the item if I agreed to return the previously posted brace if it did show up. Wow! Fantastic customer service; true to their word I received the brace today and will be fully strapped at training tonight. Would recommend these folks to anyone needing physio equipment.

Rock on and roll on.

Knee Injury /

5 Dec 2008

‘Poor meniscii’, or the fraught relationship between BJJ and knees

I FUBARed knee #2 on Tuesday night. In the short time since, I’ve been through denial, despair and am into acceptance. I’ve been down this road before and I know the drill in terms of following the RICE protocol in the initial stages followed by a build-up of physio exercises. It is a major bummer, but a word with BJJ brothers and sisters confirms that knees are an endangered species in the sport, or as one friend put it, ‘Once the meniscus is messed up, it is gone. Best to just cut it out. Very much apart [sic] of the BJJ game. Poor meniscii.’

Two years ago I mangled my right knee. Classic why-novices-don’t-use-heel-hooks-in-sparring situation. As readers may know, the trouble with heel hooks is that they target the knee and unlike, say, an arm bar, there is little indication of the joint being in danger before it is too late. I had no experience with this technique at the time – my opponent had not learned it in our instructor’s class – so, in ignorance, I rolled straight through the knee; the memory of the loud ‘pop’ turns my stomach to this day. After the initial shock and the adrenaline dump, I felt all right and thought I was able to stand, but I buckled under my own weight and dropped like a stone. I was out of grappling for 9 months.

Recovery was a slow, painful, arduous and demoralising process. I could barely walk for the first month. I started seeing a private physiotherapist about 8 weeks after the injury. While I had been to my GP and A&E the day following the injury and was referred to an NHS physiotherapist, the wait ended up being too long and of course a private physio could work around my schedule rather than the other way around. Essentially, I’d messed up my MCL and meniscus. Months of dedication to physio, starting with getting in and out of my chair on one leg and building up to a weights routine in the gym, paid off and I’ve successfully managed the injury through exercise. Since the injury I’ve become a regular runner, even doing pretty well in the BUPA London 10K last May (48 minutes and change). I do still get occasional weakness and clicking in the knee, which dictates what sort of conditioning I do alongside training from week to week, but overall I’ve been happy to maintain the leg without surgery. What was hardest to heal was my confidence. It took years to feel really safe on the mats again, and only in the last couple months have I been able to confidently pursue take downs.

Having finally ‘gotten over’ my fears and hesitations about moving from standing to the floor, I hadn’t expected to blow out the other knee while doing some light take down practice in no-gi class. This time was pure accident. I had my partner’s leg over wrapped with my right leg and was seeking to take him down by pivoting towards the right while hooking his leg further up. As his weight started to shift he pushed back towards me and the pressure and angle was just not quite right on my supporting leg (the left) and the knee collapsed. My training partner was close to my weight and I believe in this instance it was a case of several factors re. the positioning of my leg as I twisted and as he moved his weight that conspired against me. I managed the walk and bus back home all right, but had to ring my partner to come collect me from my stop as I needed a little support getting back to the house. At this stage, the adrenaline was wearing off and I was becoming increasingly worried that the knee would buckle badly and worsen my injury. I got home and started the RICE protocol and the first dose of a 10-day ibuprofen course, and sort of felt as if I’d only be out of action a few weeks.

Wednesday I was really blue and had a ‘crisis of faith’. The swelling was coming on, the knee was super stiff and I had pain on the inside of the knee and a lot of instability if I tried to get about without a strap. The thought of handling another MCL injury along with the worry of how the hell I was supposed to keep the ‘bad’ knee strong with the ‘good’ knee out of action made me hysterical. I was weepy all day and felt that perhaps I’d be better off getting out of this crazy game that has left me with two bum knees.

By Thursday I had my emotions locked down and had accepted that injury is as much a part of sport as, for instance, drills, warm ups and cool downs and competition. Indeed, as I’d ‘tweeted’ my injury, I heard from half a dozen players also suffering knee troubles at the minute, so I’m in good company. Ultimately, there is a process of recovery that can’t be rushed, and while it is frustrating to be forced into inactivity, it could be a lot worse for me. As an ‘Internet entrepreneur’ I’m in the privileged position of being able to work on my lappie from bed with my leg up and iced; I don’t need to be physically fit for my living, which is a blessing. My legs are pretty strong as I’ve been working conditioning and physio for two years to maintain the right knee, and this should help recovery. I’ve also got a wonderful coach and team that will help me ease back onto the mats, once I’m rested and well along the road to recovery, perhaps in six to eight weeks.

Today, the knee is still swollen but much less stiff. The RICE and ibuprofen treatments are paying dividends and walking up and down the stairs is much less terrifying and I can support my weight on one leg. I’m hoping to start some light physio next week, but am concentrating for the moment on getting the swelling down so that the muscles can fire properly. It gets me down that I’m going to be out of action for some time, but if I take care of myself I can recover well and get back to being a sweaty mess. In the meantime I can work Pilates as the knee allows and try to enjoy my newly freed up time. As coach says, injuries allow us to take stock of where we are and force us to work in new ways while increasing our tenacity and mental toughness.

Knee Injury /