T Nation

I'm 100% Back (ACL-R Recovery)


#1

Just wanted to let everyone know (and possibly pass along some encouragement to those going through the same thing) that I feel good enough to pronounce myself 100% back from my ACL reconstruction.

I have now come back from ACL reconstructions in both of my knees - my left one in 2005 and my right one which I had repaired last August. I just passed the 10-month mark last week. The week before that, I hit new PR's on my squat and deadlift. I had a hamstring graft (and meniscus repair) in my most recent surgery and I honestly feel like I recovered quicker this time around. A lot of that probably has to do with the fact that I had a better strength base before the injury, though.

I have been playing basketball since around the 8-month mark and have never had to use a brace. I have been sprinting since about 6 months out, and my 100m and mile times are faster than they were before I had the injury.

I will say I'm still very cautious when playing basketball, but I've felt a little more confident each time out. I suffered the second injury playing basketball, so I feel like that's natural (and probably beneficial). Athletically, I can pretty much do everything that I was able to beforehand, but there's still a little something (mental) holding me back from going from an all-out sprint to a dead stop or cut. Physically I can do it, but I'm still a bit hesitant.

The only issue that I've been battling is some mild (sometimes strong) patellar tendinitis and a small lump on the base of my patellar tendon. It comes and goes depending on the level of activity, but I notice it mainly after plyometrics. I have cut those out for now until the issue subsides.

Having gone through two of these (one patellar graft, one hamstring), I'd offer the following advice:

-Listen to your body. If you're in pain, it's ok to back off for a short while. Recovery is a marathon, not a sprint. I started plyos too early, did them every week despite some bad tendinitis, and now I have a lump that won't go away. Just because you were He-Man before your injury doesn't mean you're immune to complications from overdoing it.

-Start firing your quad ASAP after surgery and get your leg moving. They'll tell you to keep it immobile for at least 24-48 hours after the surgery. Do that, but as soon as they allow it, start the exercises they give you.

-Follow your physical therapist's protocol. All of those boring leg lifts and quad sets serve a purpose. Your PT knows a hell of a lot more about successful rehab than you do, despite what you think you may have learned from the web. It's about way more than quads, hamstring and glutes.

-GLUTES: WORK THEM HARD. Studies have consistently shown that glute activation is key to preventing ACL tears. Strong glutes keep your knee from bending inward (valgus movement) when running, jumping, etc. When your knee gets in that position, you're way more likely to tear your ACL.


#2

Thanks for the info, definitely useful.

Which of the two (patellar vs hamstring) would you recommend ? How long after the surgery could you start doing squats again ?


#3

great news! i'm happy for you. I am slowly getting there and i know how frustrating it can be!
( i tore my subscap yesterday but meh what's another month on 10). Enjoy your re-found (and improved) athleticism


#4

Congrats TripleC! Always good to hear positive stories like yours. Keep up the hard work and focus on your quad soft tissue quality and hip flexor mobility to help with the anterior knee pain with plyos.


#5

Every bird loves a good come-back!
Yeaaahhh buddy!!!

tweet tweet


#6

zahmad - From personal experience, I honestly can't recommend one over the other. Both were performed by different surgeons, but the results have been remarkably similar. There were parts of my hamstring graft rehab that were more frustrating than my patellar graft and vice versa, but at this point, both knees feel very similar.

They did a test to compare the strength/tightness of both knee joints at 6 months and both tests were EXACTLY the same. I read everything I could find about hamstring vs. patellar graft, but from my experience one isn't really better than the other as long as you do the rehab correctly.

As far as squatting goes, I had my meniscus repaired as well, so they had to hold me back from squatting to 90 degrees and lower for a very long time so it could heal. It was not until around the 3-month mark that I was cleared to squat under a bar. I took it VERY slow once I got to that point because that leg was significantly weaker, and that led to some awkward moments on the squat rack.

I would start my workouts with squats and then move on to unilateral exercises after that - with +2 or +3 sets on my recovering leg. It eventually balanced out, and I got my strength back pretty quickly. I went from the bar to 285 in ~7 months.

rehan - Sorry to hear that about your scap - how on earth did you do that? how is your knee otherwise?


#7

I was doing ab roll outs and went just too far, but it happens.
Decided to spend a weekend in montreal away from training and get recharged for workouts.

My knee is doing ok so far! not as good as I woul have hoped but at least it's back to improving after the second meniscus/AI tear.

The meniscus is definitely the trickiest complication to deal with.

One of the things I do with unilateral exercises is work the weak leg first and that will dictate how much I work the healthy leg (as well as arms etc) that way i can maintain healthy side strength while the weak side catches up.

Btw, your hamstring, how is it doing now? mine has made it's way down to my medial gastroc and attached there instead of my pes anserine. It's a super weird feeling!


#8

Boy am I glad this got bumped! I'm heading in for ACL reconstruction (cadaver allograft) and a repair of my lateral meniscus in a few weeks (same knee). As i'm sure many of you were, I've been pretty bummed out by the whole situation, so i'm really glad to hear some positive feedback on recovery time, as well as some useful advice on rehab, etc. And congrats to you Triple C!

I figured I'd have to take a few weeks (month maybe, no?) off from weight bearing exercise post-surgery to focus on rehab, so I'm trying to get as strong as i can pre-surgery. My doc basically said don't run or anything like that, but to weight lift if I want as long as it doesn't hurt.

Normally I oly lift and play soccer, but seeing as these are out of the question i've been doing a body building split - upper body, then hams, glutes and quads, but recently I got a bit paranoid that I might be injuring myself more by pushing it a bit too much?...

Does anyone know of any exercise that I should definitely NOT do while I await surgery?

Many thanks!


#9

well, with the complication of the lateral meniscus tear it becomes a lot harder since you won't know what affects it until it is too late. As the doc said whatever doesn't hurt, and by hurt it means even the slightest pain. Unfortunately it's just one of those injuries where you are hamstrung(no pun intended).
The hardest part is accepting that you are not 100% anymore and then just start from there to get back to where you were before. Bouncing back requires some mental fortitude. On the plus side you are getting a cadaver allograft which will eliminate the hamstring complications. If you can make it through the first 8 weeks you will be golden.

For exercise selection stick to closed chain controlled movements. No ballistics and definitely no oly lifting. (I know it can be tough but just think about getting back)


#10

TripleC, well done! It's simply amazing do get on the other side of that surgery/rehab and feel athletic again.

To follow on your thread theme of providing encouragement to others who take this path, I can confirm that picking a smart surgeon and PT and working hard through a realistic and disciplined rehab can get you back.

i am one year post-surgery: ACL reconstruction with allograft (picked by my surgeon due to osglood-schlattters) and meniscus repair. I am now comfortably rolling on the mats in brazilian jiu-jitsu regularly and have met and exceeded my squat and deadlift numbers pre-surgery on the 5/3/1 program.

Keep up the good work and congratulations again on your hard work and progress.


#11

Hey folks, sorry to bump this but I need some guidance -

Here's the situation - I'm 7 weeks post op from an ACL reconstuction (no meniscal repair, just removed). I've definitely made some progress with rehab (can touch my heal to my ass without tears, lol!) and I personally feel well enough to start resistance training more seriously.

I've designed myself a BBing split to ease me in. Its the usual high reps/lighter weight, back and bis/chest and tris/shoulders/legs and one ab day/pilates.

So here's the thing, I asked my surgeon about this and he said all upper body weightlifting is good to go, so that's that. BUT when I asked him about lower body all he said was "ask your PT and don't do anything stupid" (i.e. no ballistics, etc - which is fine by me, since the thought of that makes me a bit ill).

When I asked my PT lady, she said "what did your surgeon say" and then looks at his protocol and then doesn't say more than that. AND to add to this, I had a substitute PT guy last week who told me I could definitely start lower body resistance training if I felt like it. I'm cofused!

Anyways, my leg day looks like this: (all weight is about 30% my max, but here's what I did on Mon)

BB squats to parallel (empty bar)
Rack pulls (85lbs)
Leg press
Ham curl
Calf raises

I don't know - I think this is ok and I felt fine when I did it on Monday, but I really want someone comfirm that I'm not going to spring my ligament loose or something.

Sorry for all of this!! I'm feeling a bit lost and misunderstood, haha! Just looking for thoughts/opinions/recommendations...


#12

^^^I have morning clients. When I return, I'll give my thoughts on your question. Until then, please do not do the leg workout you described.


#13

LOL! Ok :slightly_smiling:

I will be awaiting your response!! Thanks!


#14

Maschy,

Doing squats to parallel could be viewed as potentially dangerous, because the knee is most unstable when knee flexion (the angle of the knee when it's bent) is 90 degrees. Contrary to popular belief, full squats (assuming you have the flexibility to do it properly) is safer, creates more strength, and has more athletic transfer than a parallel squat.

Also long pauses in the lowered position of the squat also open the knee up for injury. Not that there should be a massive bounce at the bottom position, but just don't stay in the down position too long.


#15

Thanks Max! And I realize that at this stage the graft is at its weakest, so I don't want to put myself in any compromising positions (so to speak).

I'll keep this in mind!


#16

That's fairly common how the ortho referred you to the PT and the PT referred you to the ortho. The ortho's job is to fix what's broken (or torn, etc.). The PT's job is to get the patient reasonably close to where the patient was before the trauma.

It's the all important bridge from rehab to strength/conditioning that neither specialize at. And that's not necessarily a bad thing. Each person has his unique skill set.

MaximusB makes an excellent point about 90 degrees. At this angle, the knee is quite vulnerable. In fact, orthos and PTs will often place the patient's knee at that angle to test it.

I'm sure you're aware of the seemingly trivial yet highly important things such as hydration, proper foot wear, warming up.

Do keep your knees warm prior to and during the workout. Those neoprene sleeves help some people but it can also compress the patellae. A better option might be those knee warmers that cyclists use on chilly days. It provides just enough compression and retains body heat. The bottom line is, you need to warm up the synovial fluids and keep them warm through out the session.

SMR/static stretch/mobility drills are important. As long as the static stretch PRE and PERI workout do not exceed 10 seconds and are not performed in an aggressive manner, you will not risk down regulating the muscles (ie reducing strength).

Try starting your leg session with a closed chain posterior chain movement. I don't know if you're aware of the Lombard paradox. Essentially, when coming out of the hole in a squat pattern, the hamstring complex assists the glutes and quadriceps even though they should be acting in an antagonistic manner.

Okay, you're saying. That's a nice bit of trivia but how does it effect me...? Well, most people have trouble engaging the posterior chain, so starting off with exercises that target that area will make you more neurally efficient; so when you do move onto a squat pattern, the posterior chain will be "awake and ready to work." Furthermore, the hamstring complex help to isometrically stabilize the knee which is very important.

So, I recommend starting out your workout with RDLs. Do NOT perform these to the point of exhaustion. We want neurally activate and warm up. If you create too much fatigue, they won't be able to help in the squat.

Now, after the squatting is done, you can try being a little more aggressive on the RDLs. You can also include sitting leg curls. This is one where many will disagree with me. They'll argue that open chain movements have no place, that the pelvis is locked in and you're short circuiting the kinetic chain, etc. All valid arguments.

The way I see it, however, is that you may not be able sufficiently strengthen the biceps femoris short head. This is the ONLY muscle in the hamstring complex that flexes at the knee yet nothing else (the other three muscles - biceps femoris long head, semimembranosus/tendinosus - flex at the knee and extend the hip). If the pivot point in the leg curl machine lines up with your knees, and you perform slow eccentrics (two legs concentric, one leg eccentric slowly and under control) you MAY be able add just enough of proper volume.

Of course, someone will argue that when you squat you should also be able to stimulate the biceps femoris short head via the Lombard Paradox. This certainly is possible. However, I think only those with the highest degree of mind-muscle connection can accomplish this.

Now the squatting part...

Drop the leg press out of your routine. Because the pelvis is locked in, the shearing stress will go to the knees. Sure, you can place the feet high on the platform but I still believe there are better options for someone in your place.

Obviously, for a lifter with reasonably healthy knees who is interested in hypertrophy, the leg press is a viable option. So all you BBs out there, please spare the hate comments.

And I also realize that I may sound self-contradicting in that I think the sitting leg curl is okay but the leg press isn't. Keep in mind the former involves flexion at the knees and the latter involves extension.

I would have someone in your place start off with ball squats. Place a stability ball between the small of your back and a wall. Walk your feet out so that when you're in the hole, the tibia is perpendicular to the floor OR less. The stability ball will allow you to flex at the hips first, sit back, and get an overall feel for how your knees are doing before you attempt more aggressive movements. The initial sets should bottom out ABOVE 90. As you warm up, you can go slightly below 90. Do NOT bounce or otherwise rush the point bewteen the eccentric and concentric. A slow tempo is ideal here as you want to strengthen the connective tissue (which the slow eccentric can do) and you want to gauge whether or not you want to take it further in that particular session (nothing wrong with calling it good if you don't feel right).

It's also not a bad idea to place a mini band above the knees when doing the ball squats. This will (hopefully) teach you not to go into valgus (knees caving inward). Direct work such as clam shells are also recommended.

The next move - IF you honestly feel you are ready is either a box squat or reverse band squat. Both will allow you to sit back back back and have a vertical tibia when in the hole.

The reason I keep harping on the vertical tibia is this reinforces a hip dominant squat. As the OP found out first hand, proper glute activation is critical. Also, the hip dominant squat (tibia vertical) tends to create less shearing stress at the knees which is the LAST thing you need right now.

As you progress, you should be able to integrate the quad-dominant squats (tibia past vertical) as well. However, just as most people should perform pull to push in a 2:1 or 3:1 ratio, I believe most people should perform hip-dominant squats in a similar ratio.

A very well-known trainer who writes for magazines recently came out with an article about how your trainer sucks if he tells you to never let your knees go past vertical in a squat movement. Perhaps the editor chopped out the full article. Regardless, the trainer/writer failed to make the distinction between hip and quad dominant squats and why there should be a certain ratio favored towards the hip.

I mentioned the reverse band squats. If you have access to high quality bands and you are willing to go through the learning curve, I sincerely feel this is a fantastic way to be able sit back (hip dominant pattern), have less load on the knees when in the hole, and learn to accelerate (due the accommodating resistance provided by the bands).

As stated before, now you have the option to be a little more aggressive in posterior chain work. Obviously, do NOT grind out reps. And for YOU - I strongly advise that you do not train to failure. Stop each set with at least one perfect rep left in the bank and stop each exercise with one perfect set left in the bank. Ease into it slowly and let the volume take care of the rest.

That's all I can think of now. If you need any clarification or have any comments, post here and I'll check back after my evening clients.


#17

WOW!! Thank you SO much, 56x11! This information is invaluable!

I've read through everything you wrote and I think you make sound arguments - of course I'll read through everything again so I can reconfigure my leg day, but I think you make loads of sense. So again, thanks!

I already do wall squats with a stability ball and squats on a balance board at my PT sessions (2-3x a week), both of which I do with ease and no pain - thus the reason why I think I'm ready for a little something more.

At any rate, thanks again!! This is exactly what I needed, a "bridge from rehab to strength/conditioning" - brilliant!

If I have any questions, I'll get back to you. But quickly, I did do RDLs in the leg routine, just forgot to mention. I'll keep those, obviously. Do you think I should drop the rack pulls?


#18

In my experience, as well as watching other lifters, it is all too easy to fall under the sweet temptation of going heavy on rack pulls. Because of this, I would not advise it at this point. Yes, the knees are in a mechanically stronger position; however, we need to remember that you are still crossing the metaphorical bridge.

Feel free to keep us posted. Hitting PRs post injury can be pretty damn satisfying.


#19

Addendum regarding the seated leg curl and its role in strengthening the biceps femoris short head.

1) the biceps femoris short head also externally rotates the tibia. An over active biceps femoris short head can therefore contribute to valgus. However, proper strengthening of the other three muscles of the hamstring complex as well as glute medius should eliminate such risks. Furthermore, this muscle inserts at the fibular head, tibia, and the lateral collateral ligament. Since your ACL is under rehab, it stands to reason that you should carefully strengthen the LCL via slow eccentrics so that it is not overwhelmed.

2) all four muscles of the hamstring complex (semimembranosus, semitendinosus, biceps femoris long and short head) isometrically stabilize the knee. By skipping the seated leg curl, you just might be missing the fourth muscle that can assist in knee stability. Again, I believe that only those with the highest degree of mind-muscle connection, technique, discipline, etc. will be able to target the biceps femoris short head via the Lombard Paradox.

3) different leg curl machines have different strength curves. hopefully, your gym will have several to choose from. and you can always set up a cable station with ankle loops. some may suggest using bands; I think the strength curve of a band may make the situation worse if used for this particular movement

4) I'll repeat that it's important to line up the pivot point on the machine with your knees. If you're wondering why I prefer the seated version, it's because people (women in particular, who have bit more lordosis at the lumbar spine) tend to hyper extend at the lumbar spine when doing the laying version. We certainly don't need more lordosis in addition to the acl issues.

At the end of the day, this is an open chain movement and has inherent risks. Therefore, apply the highest degree of caution and base your final judgement on how your body reacts.