T Nation

ACL Rehab Log


I’ve seen a lot of questions on here involving ACL rehabs, so I thought I would start my own thread on my rehab. I’m hoping this will act as a good resource for those going through ACL rehabs in the future.

My surgery date is this Thursday, January 17th. Its the second time I’ve had this surgery so I’m mentally ready.

I started my pre-hab around 8 weeks ago, starting with mobility work, going into Waterbury 10-10 for two phases (6 weeks) and then ending with a two-a-day Waterbury HFT (2.5 weeks) to really pile on the leg mass.

This pic is of my legs after the second phase of HFT. I’m also cross-blogging this on my site myaclrehab.blogspot.com/

You were doing squats/deadlifts without your acl?

Having had ACL reconstructive surgery once before in my life, I know it is very serious. Its a lot of pain and a lot of hard work. In my view prehab is as crucial if not more so than rehab. Don’t be scared of working out your ligament-less leg.

When I found out I was having reconstructive knee surgery I realized a few things:

  1. My 2-3 nights a week of sports was over.
  2. I was really lucky as I had very little swelling and pain and therefore could work out heavily.

I decided to start off with some fat loss before doing some muscle gain. I started reading T-Nation frequently and decided on Chad Waterbury’s 10-10 revolution. The 10-10 revolution is designed to help you lose 10lbs of fat and add 10lbs of muscle, hence the clever 10-10 name.

Phase I was a fat loss phase that lasted 3 weeks. I lost 7lbs in that 3 weeks, and in a hurry as well:
Day 1 - 8 x 3, circuit style, heavy, 30s rest
Chin-ups
Dips
Deadlift

Day 2 - High Intensity Interval Training (HIIT) - bike, 50 seconds slow, 10s all out, 18 min.

Day 3 - 5 x 8, circuit style, medium weight, 45s rest
shoulder press
row
DB Romanian Deadlift
Zercher Squats (look them up)

Day 4 - HIIT, bike, 50s slow, 10s all out, 18 min.

Day 5 - 4 x 15, circuit style, light weight, 60s rest
Good mornings
Inclined DB Bench Press
Woodchops
Reverse Lunge
Wide grip pulldown

Day6, 7 - Off

Repeat for 3 total weeks

Day 5 often left me ready to puke, it was the hardest day by far for me.

The diet was 3 meals and 3 snacks each day with a high protein, high fat macronutrient breakdown. Avg day was:
breakfast - eggs, grapefruit, celery, fish oil, greens+, coffee
snack one - cheese
lunch - chicken breast, broccoli,
snack two - handful of almonds and walnuts
dinner - salmon, broccoli
snack three - piece of chocolate or cottage cheese
Plus protein before and after workouts.

The end result, I lost 7lbs and at least a few inches off my waist.

Yes, I did deadlifts & squats without my ACL. I had very little swelling and pain as I had a clean rupture (lucky me). I also talked to my physical therapist before doing so. She was fully supportive, especially for single leg work like bulgarian squats, reverse lunges, etc.

The exercises to avoid when you don’t have an ACL are those that cause ACL shearing, such as:

  1. Quad extensions
  2. Normal lunges (note that reverse lunges and walking lunges do not shear and therefore can be done)
  3. Super deep squats (ass past 100 degrees), sissy squats & hack squats
  4. Pivoting exercises like drop lunges

I was going past 90 degrees in my squats once I had enough muscle and mobility, which was putting the knee joint at risk, but I had very little pain or discomfort and felt comfortable doing so.

Now that I had burned off some fat it was time to start adding some muscle. Adding muscle involved Chad Waterbury’s patented high frequency training (HFT). The strategy behind HFT is to frequently train muscles that you want to grow, frequently = 4-5x per week. I liked the Waterbury program as it had lots of functional lifts that worked many body parts.

Workout:
Day 1 - 6x3, heavy, 60s rest, alternating
Chin-ups & Front squats
DB Romanian Deadlift & Dips

Day 2 - 3x16, light, 90s rest, alternating
Push-ups (hands on bosu ball) & good mornings
Row with palms-up & Step-ups

Day 3 - 5 x 8, medium, 60s rest, alternating
wide grip pulldown & reverse lunge
shoulder press & single leg deadlift

Day 4 - off

Day 5 - 6x3, heavy, 60s, alternating
Chin-ups & zercher squats
DB Romanian Deadflit & Dips

Day 6 - 3 x 16, light, 90s, alternating
push-ups & good mornings
rows & step-ups

Day 7 -off

Repeat for a total of 3 weeks

Diet
-same as phase I but add fruit at every meal
-add raisins into post workout meal to help upload creatine

Supplements
-Protein before and after workout
-Add Branched Chain Amino Acids, 10g before and after workout
-Creatine 5g after workout
-Fish oil (5g)
-Greens+ (one scoop)

The results, I went from 187 to 195 but Christmas helped to add some fat. But still I probably added 5lbs of muscle.

My knee won’t bend past 90 degrees right now, but I only tore it 8 days ago. How long did it take you to prehab up to the point where you could do ATG squats?

I had a scope to clean up the torn cartiliage and remove the screw from my first ACL surgery about 12 weeks ago. 3 weeks after I was ATG.

At the end of phase II of the Chad Waterbury 10-10 revolution I had a choice, go to phase III and lose more fat, or try to pile on more muscle before the surgery. Losing fat would have advantages, I’d be healthier, lighter and more mobile going into the surgery. Gaining muscle would help as well given I would lose a lot of muscle in my left leg.

I went with the latter. This time I decided to sculpt my own workout based on Chad Waterbury’s High Frequency Training program. This workout is hard but paid off with huge results. I put on another 6-8lbs of muscle… possibly more as it looks like I’ve burned fat. I went ~from 195 to 202lbs.

Workout

Day 1 Morning - 4x4, 60s rest, alternating
BB military press & Front Squart
Chins & DB tri ext
Standing calf raise & hanging leg raise

Day 1 Evening - 2x12, 75s rest, alternating
DB Incline Bench & BB Back Squat
Chins & Tricep Pressdown
Donkey Calf/Single leg squat/reverse crunch

Day 2 - Off

Day 3 Morning - 4x3, 60s rest, alternating
Deadlifts & Dips
Rows & Reverse lunges
Seated calf raise & lying ext rotation
Hammer Curl & front planks w/ rear leg raises (glute flex)

Day 3 Evening - 2x14, 75s rest, alternating
DB Romanian Deadlift & Decline DB Press
Rows & Single leg, leg press
Calf raise & standing cable ext rotation
BB Curl & side plank w/side leg raise (hip extender flex)

Day 3 - Off

Day 4 Morning - 4x3, 60s rest, alternating
x band walk warm-up
chins & good mornings
Incline db press & bb back squat
donkey calf & reverse crunch

Day 4 Evening - 2x14, 75s rest, alternating
band skating strides
chins wide & big ball ham curls (single leg)
bb miltary press & front squat
Standing calf raise & hanging leg raise

Day 5 - off

Day 6 - Morning - 4x4, 60s, alternating
Bench & Dumbell Romanian Deadlift
Row & Overhad squat
Seated calf & cable external rotation
Reverse curl & cable hip extender leg raises

Day 6 - Evening - 2x12, 75s rest, alternating
DB BP & Sumo deadlifts
Rows & walking lunge
seated calf raise & external rotation
BB Bicep Curl & clam shells

Day 7 - off

Diet
Eat a lot! I was consuming over 4000 calories a day. The diet was same structure as the past two phases, but I added a lot more carbs into the diet.

Supplements
-30g of protein & 5g of BCAAs before and after each workout, also with raisins afterwards
-5g of creatine after the morning workout
-coffee before the morning workout (often at 6:30am)
-5g of fish oil
-greens+

Ok, the really bad news. My surgery is Thursday and I woke up this morning with a stuffed up head and a cough. Man, this sucks really bad. I’d love to hear how others have dealt with colds prior to surgery?

It also kind of ruins my big plan, i was going to work out the night before my surgery to try and have my muscles in a state of hypertrophy during surgery to counteract the quadricep shutdown, but the doc wants me resting to get rid of this cold.

Take some ZMA and megaboost your vitamin C. 3000-6000mg of vitamin C should help you kick it faster. You will know if you are taking too much if you get the runs. Dial it back then.

I will second the vitamin C boost. It’s a water soluble vitamin with a pretty short halflife, so if you pop 1000mg periodically throughout the day (I try to do it at least when I wake up) you should get the benefit. Remember, humans (along with guinea pigs) have a broken copy of the vitamin C gene, so external supplementation is hard to overdo. CT also mentions in one of the currently ongoing physique clinics that vitamin C blunts the effect of cortisols. In addition, it is an antioxidant.

Good luck with your recovery and surgery.

Thanks for the advice, funny enough my doctor gave the same advice. I guess I expect doctor’s to give antiquated advice like bloodletting or something.

Ok so some thoughts on how I chose my pre-hab strategy. First I used a few resources, of course T-Nation and I also paid for an assessment & 3 sessions with a personal trainer. This was worth its weight in gold. A quick assessment revealed a few things:

-I had a torn ACL in my left knee (duh!)
-I had a tight ITB and some patella-femoral cracking in my ‘good’ knee
-I had very weak glutes
-I had weak hamstrings
-I had tight ankles and limited ankle mobility

Apparently all the years of basketball & soccer goaltending led me to some serious quad imbalances.

As I had already used my patella in the first surgery, my ACL reconstruction iss going to be a hamstring-graft. So I had to get my hamstrings strong, as well as my quads firing.

The Chad Waterbury 10-10 program was solid in that it:

-Had lots of hip-dominant movements to grow hamstrings & glutes
-Had a lot of back exercises (chins & rows) vs chest to help rebalance my shoulders

I assume weak glutes/hammies is a common problem and Chad seems to have designed the workout accordingly. Zercher squats, good mornings and others are not common gym exercises so be prepared for a lot of stares from the upper-body only workout crowd.

In my phase III HFT program I added in a lot of leg movements as well such as clam shells, planks with glute & hip lifts, walking lunges, and overhead squats. This helped develop my quads and further develop my hips.

Here’s my overall comments on my program:

Phase I - the diet was very hard. I was often spacey and couldn’t sleep. I had to switch my last meal until right before bed to help me sleep. The circuit workouts were brutal - I often felt like I was going to barf on the last workout.

Phase II - This phase was relatively easy for me. The workouts weren’t as tough as the first phase, all though challenging.

Phase III - I almost died a few times. This workout is tough on the nervous system. I’m also helping start a company right now and I often don’t sleep enough, work hard and travel which probably didn’t help. A few memorable highlights:

I dropped a 135lb overhead squat when I lost balance (nervous system dying on me)
My last workout in New York, lying on the ground for about 5 minutes after I finished my last set of 3x14 squats
Working out at 6am before going to apply for a US TN visa and sitting there in a bath of sweat waiting for an immigration officer with a body that would not recover
But so far its all been worth it. My stats are great:

Lost 7lbs of fat
Added 12 lbs of muscle
Bench press went from 185 to 225lbs for 4 reps
Back squat - 225 for 4, ass to the ground
Deadlifting - 305 for 4
Overhead squat - 135 for 4
Military press - 135 for 4

I’m 6’ and currently weigh in at 205lbs.

I had my last pre-hab session with my physical therapist yesterday. I asked her about my ‘crazy’ idea of doing a harcore leg workout tonight (surgery tomorrow), sot hat my muscles would be hypertrophying and possibly counterbalancing the fact that my quads were about to shutoff.

She told me it was in fact crazy and wouldn’t work, and then gave me the biological explanation upon my questioning. Typically the brain shuts the quad off due to the trauma to the area. This would also mean that the muscle wouldn’t heal properly over that time period, and I’d therefore have significant muscle soreness while trying to recover.

I was also given a jobst pump, I’ll post pictures later. Its a giant inflatable leg brace that compresses and pumps up and down my leg to help reduce the swelling.

I’m actually going in for ACL surgery on the 6th of February… I can’t fully extend my knee because of a meniscus tear too… I want to start working it but, I’m not sure what I can or even should do…

You should do quad extensions until the cows come home (joke)

Maybe upper body and other leg single leg work and hope for some cross development?

Otherwise I’d be scared to give you advice for your injured knee in the event that you hurt it. Some easier hip mobility drills maybe a good place to start though??? Check out a cressy article maybe?

You’re in my prayers this morning since you’re probably under the knife right now… Anyone think taking so Alpha Male might help with my recovery time? And since I want to get some more muscle mass I thought that might be the way to go…

Man, I am in a world of pain. Right now my left leg is a 60lb dead weight. My quad is completely inactive and I have no control over the leg. I can hamstring curl to about 80 degrees.

I came out of surgery feeling well. I had pretty good range of motion and could do straight leg lifts and flex quad. Or maybe that was just the morphine talking.

My wife and my folks visited me in the hospital and I was pretty chatty… then they left and everything went wrong.

The nurse came in and left me a jug to pee in. I told her I’d be fine and able to make it to the washroom. They tied me into the continous motion machine and shot me up with some demmerol and I was off to sleep congratulating myself for my diligent pre-hab and how well it paid off.

I woke up shortly thereafter with an unconscious amount of pain, and I had to go to the bathroom. I was pretty happy to have the jug, I could barely sit up to use the jug let alone walk to the bathroom.

I paged the nurse to get some more painkillers but she wouldn’t have it, I was 2 hours away from my next dosage. I laid there sweating, in and out of sleep for that period. Eventually they came in and gave me another dosage but it was pretty useless.

I was in so much pain all night, until they took me out of the continous motion machine. As soon as they took me out I was out of pain. So I have all kinds of thoughts on the continuous motion machine, which I will ask the physiotherapist about on Monday. I had good range of motion already, I wonder if the CMM moved me past that range of motion into an area that caused swelling. Or I wonder if I was always going to have swelling and a world of pain that night.

So my workout now is the following:

  1. Standing ham curls, holding on to a chair, 3 times per day
  2. Lying flat quad contractions - lie on bed and squeeze your quad, as often as I remember
  3. Seated ham curls - foot on floor slide towards yourself
  4. Calf stretch
  5. Gentle hammy stretch
  6. Breathing exercises (helps clear out the anaesthetic)

I use the following rehab tools:

  1. Bregs Polar Care Cyrotherapy Unit - continously ices my knee to help fight swelling
  2. Jobst pump - compresses up and down my leg to break up swelling and ensures blood flow to the calves

I’m on percocet for pain, and I’m fumbling around on crutches with a severe case of armpit rash.

Diet - I’m following Berardi’s Nutrition & Injuries

  1. High calories @4500
  2. Tons of veggies & protein
  3. High fiber carbs

I have the following shake twice a day:

  1. Protein
  2. Water
  3. Banana
  4. L-Glut
  5. L-Arg
  6. Greens+ Daily Detox

I also have a fiber supplement to help me wtih regularity, the percocet blocks me up.

Good to hear the surgery went well… All that pain sounds discouaring for me… How long did they keep you after the surgery? I was told I’d be out of there within 2 hours or so…

I have started to make real progress today:
-I can lift my leg off the ground, i.e. my hips are activated.
-I can then quad extend about 15 degrees, so my quads are slightly activated.
-I can ham curl about 30 degrees.
-And I can walk without crutches in a straight line!!!

Forget 225lb bench presses, I can move my leg!

I’ve been tracking my vitals as well (pre surgery/post surgery):

heart rate: 59/71
body temp: 98.1/99.1
body weight: 203/197
left knee size: 15"/17.5" (2.5" of swelling!)

I am constantly sweating, I can feel that my metabolism is in overdrive trying to heal this puppy.

Here’s a pic of me in the jobst pump, a great tool that i recommend.