T Nation

ACL rehab

Has anyone out there had ACL reconstruction? I race motocross and tore
my ACL this Easter. I had an arthroscopy which basically revealed the
extent of the ACL damage, which is roughly 50% ruptured. For about a
month now I have been trying to strengthen my hams (and quads doing as
deep squats as I can manage) in preparation for ACL reconstruction which
I’m afraid is inevitable. I’m doing all the stretching my physio
prescribed in order to increase my range of movement which is at about
90% right now - it still hurts like hell if I go too deep in a squat
though.

What I wanted to ask was if anyone has had such an op, and how long
after the op will it be before I can do full squats, run, and then race
motocross again? And is there anything I should be doing (or not
doing!) now, or after the op to help recovery and limit atrophy?

I think I’m doing all I can for my knee but sometimes it feels like I’ll
never get back on a bike again. I know this is a real defeatist
attitude but it really gets me down sometimes. It would be great to
hear from anyone who has had ACL reconstruction to get a guide on how
long it will be before I can really kick some ass in the gym and on the
track again!

Simon – Sorry to hear about your knee. I had my ACL reconstructed in January 1996. When I tore my knee up I hadn’t been in the gym for several months – coincidence? About two weeks after I tore the ACL I was able to get back into the gym and work on building some strength back before surgery. I was able to do squats, extensions, hamstring curls, etc. with little pain. I think the pain that I did have was from soft tissue damage. While fishing around inside my knee they also took out a good sized chunk of my medial meniscus.

Here are my lessons-learned from ACL reconstruction:

  • Most importantly, find a physical therapist who is accustomed to working with athletes and will PUSH you. My PT was very conservative. Don’t be afraid to switch to a more aggressive PT. Also, make sure your PT understands that you want to incorporate strength training into your rehabilitation.
  • Similarly, find a orthopedic surgeon who is committed to helping you get rehabbed quickly. My doc was the team surgeon for a Division I football team, but recommended against jogging until 4 months post-op, huh???
  • Do what ever it takes to get the swelling down (mainly lots of icing) ASAP after surgery.
  • Push through the pain and get your full range of motion back ASAP.
  • Once you get past the first 8 -12 weeks turn up the intensity. By that time your new ligament will be as strong as it’s going to get.
  • Don’t let the setbacks, and yes everyone has them, get you down – push through them. Keeping a positive mental outlook is key.
  • If you start to get patellar tendonitis take it seriously!
  • Find the combination of loading and reps that works best for you. It might not be the same as pre-op. Also work each leg separately to prevent cheating with your “good” leg.
  • Don’t even bother with a brace – I lost mine and it was the best thing that ever happened to me. The braces that are available don’t prevent twisting injuries,which pose the greatest risk of ACL re-injury. I found that when I had the brace on it was a constant reminder that I had a bum knee.

I was riding my motorcycle in 2 months, but only on the street. I was back playing sports competitively in about 6 months. By 9 months I’d say my knee was back to 90+%. In a year I was back to 100%.

Good Luck!

Thanks Kirk. It’s so good to hear from someone who’s actually gone through the whole process. Competitive sports in 6 months? That sounds almost bearable, and I’m glad that you emphasised the need to push yourself through rehab. I’m gonna see a sports injury physio who I’m sure will make me sweat through it.

When you say that after a year you are back to 100% does that mean that you don't even feel it's been injured, or simply that, for example, you can press the same amount of weight with the post-operative leg as you can with the 'good' one? Why I ask this is because I'm concerned about the risk of re-injury and that my 'bad' knee will be at greater risk of future ACL injury than my 'good' knee. Motocross is renowned for being very hard on the knees.

Also, I've always worn hinged neoprene knee braces to prevent hyper-extention of the knees, which of course doesn't stop the twisting effect that damages the ACL. But I was thinking of investing in an (expensive, about £900)CTi knee brace. I don't know if you've heard of them but they're tailor made and are supposed to be the best you can buy. In the light of what you said I'm gonna call the makers of this fancy brace and find out if it will prevent the rotation associated with ACL injury.

Thanks again for your advice, and I'll definitely stay positive and focus on my goal to race again!

By 100% in a year I mean, stronger than pre-op and playing sports without a second thought. I think my vertical jump is down an inch or two, but hey, I’m getting older as well… My reconstructed knee always feels tender and sore for a day or two after hard activity, but nothing to stop me from going 100%. I also think a lot of that is due to the cartilage damage I had. I completely understand your concerns about re-injury. I still get shivers at the thought of re-injuring my knee, but I was told a reconstructed knee is structurally stronger than the other knee in 12 weeks. The first twelve weeks are high risk because the circulation is just getting established to the new ligament, etc.

My insurance covered a similar knee brace to the one you describe – custom fit, light, etc. If you think it will help you get back on your bike with confidence then buy it. As I said, losing mine was a blessing in disguise. I know that motcross is brutal and maybe having the brace would help in getting you back on the bike at full speed. Mentally the brace bogged me down. From what I’ve heard the braces don’t do much, if anything, for rotational injury prevention, but can prevent hyperextension. Personally, I’d spend the money elsewhere.

I know exactly what you mean when you say you get shivers at the thought of re-injuring your knee. I didn’t know that a reconstructed knee is structurally stronger than the other knee in 12 weeks, so that’s something to keep me positive.

Thanks again for taking the time to fill me in. Just like the rest of this T-mag site with the right knowledge I reckon you're pretty much half way to success!

It is essential to get back full range of motion in the joint as quickly as possible. You need a pysio theripist who understands athletes. I can’t emphasize getting range of motion back enough, it hurts more than anything else but you HAVE TO DO IT. My theripist gave me weekly guildlines that I had to meet for flexibility tests. One sure way to meet the standerds was to get my brother to force my knee bend to a certain angle each week. Ly on the floor face down, brother (or anyone else who doesn’t like you) place one hand on hamstring (so you can’t cheat by lifting your legs off the floor) and use other hand to force your knee joint to a set angle. I know how this may sound but it was an effective way for me to reach my flexibility goals and today (2 years post op. i am playing football in university outside linebacker)Good luck, and may the Lord be with you!

Cheers Greg. When it comes to it I’ve got a few people I owe money to who would gladly “assist” my rehab!

I didn’t have ACL reconstruction, but I had my elbow reconstructed in March 97. Something that helped a lot with post-surgery inflammation was mega-dosing anti-oxidants, etc. before surgery. There was an article in an old MM2K about this, the writer had gotten ab etching or something like that and mega dosing anti-oxidants seemed to help him. My surgeon and physical therapist were both surprised at how little swelling I had in my elbow after surgery. I don’t remember the dosages I took, but some of the things were vitamin C, vitamin E, grape seed extract, beta-carotene, and some other things I can’t remember now. It doesn’t really cost much, so it’s worth a try. However, the most important thing is doing your rehab hard and consistently with someone who knows what they are doing.