T Nation

Need Advice on Torn ACL

Powerlifting
#1

I tore my ACL in February but didn’t realise it as the physio told me I had medial and lateral ligament damage and a possible meniscus tear. Eventually I hassled my GP to get an appoinment with another physio and that led to an MRI scan and the news that my ACL is ruptured. I was told this last week.

He suggested I do exercises for 3 months and if there is no improvement, to get surgery done. However I don’t know what exercises to do as he referred me to a few websites to get ideas from, as I can’t attend any ACL rehab class after I leave the country in a few days.

So I look around a few websites and the exercises are all too easy imo. I can run in a straight line, cycle and even do a one leg squat on my bad knee. However my knee is by no means stable and most days feels like it’s about to give way or do something it is not meant to.

Nearly all the exercises I see on ACL rehab pages involve tedious exercise like knee extensions with no weight.

So what exercises should I be doing? I’ll be dointgthem for about 3 months and if there is little or no improvement in knee stability, go for surgery.

#2

pull a weighted sled. attack at all angles. front/back, side to side, cross overs with lift weight of course to start.

#3

What the fuck?

Someone told you to reapir a torn ligament with exercise? Hooooly Shit! Do they think it will just grow back together?

There is another guy who has posted recently in the same boat but with a fresher tear.

I hope the previous poster was joking about sled work and all angles etc. It seems appropriate with the other recommendations for your ‘physio’ and ‘GP’.

I will post a link to the other thread shortly.

Dude, get surgery scheduled yesterday?

Who is “physio”? and I gues GP is general practioner?

Where do you live and are these guys liscenced?

FYI - your ACL keeps your knee from inverting and it crucial for any sport or performance work.

Here is the thread. Sorry if I sound harsh. Good luck.

http://www.T-Nation.com/free_online_forum/sports_body_training_performance_bodybuilding_strength/tore_acl_need_help

#4

Nah you don’t sound harsh and if you did I wouldn’t take offense as I don’t consider this to be of my own making. I’ve been trying to follow the advice of accepted authority figures but it hasn’t gone well.

The first physio I saw for the month after my injury and with the back of my knee swollen up along with medial and lateral ligaments he said that I had medial and lateral ligament strains and a possible meniscus tear. His advice was to continue cycling and to attend a knee rehab class for a few months and/or do the exercises at home. So I turn up twice and it’s all too easy, balancing on a trampoline and bouncing a football against the wall etc etc. I stop going but continue to cycle everywhere.

After 3 months I know that there is something very wrong with my knee as it feels unstable and I had a dream of me viewing the inside of my knee with it all messed up (superficial detail that). So I go to the General Practitioner to ask to get an MRI scan.

In England you have to speak to a GP first to get referred to a specialist. GP’s are like jacks of all trades who weed out timewasters. She asks if I’ve been doing the exercises and I say no, but I’ve been cycling a lot and doing a bit of running and my knee still feels odd. She tells me to do the exercises and come back in a month.

I wait 3 weeks before going back with a more aggressive approach, and get myself referred to another physio 6 weeks later. He tells me I probably have an ACL tear and books me for an MRI scan. 3 weeks later I have the scan, and 2 weeks after that I go back to the physio.

It’s an ACL rupture, my knee is f*cked. I wonder why it’s taken 7 damn months to find this out. He said that by strengthening the muscles around the knee I can compensate for a missing ACL and possibly be ok in about 3 months.

Or I can get keyhole surgery and spend another 9 months out of action. (7 months, plus 9, plus 2 waiting for surgery = 18 months. Hurrah!)

So here I am asking about internet chat rooms for advice the NHS should have or could have provided me with. I go to the Czech Republic in 4 days and will need to arrange surgery there. I can’t get surgery in England, it’s not possible when I’m not here.

I take it sled work is a bad idea? I’m a little clueless here and hope a Czech doctor can help me out.

Had checked that other thread but it appears to deal with post surgery rehabilitation if I’m not mistaken. I’ll go read it again in case I’m missed something important.

Thankyou.

#5

If you compete in sports football, weightlifting, etc your knee will never be stable enough without reconstructive surgery. I tore my ACL and went without a repair for two years. Even though I was active and lifting weights my leg atrophied and became much smaller than my healthy leg. It wasn’t until my knee was repaired and I was able to properly rehab that I gained full use of my leg.

That being said. If you don’t plan for an active future you can live without an ACL. My mother tore hers in high school and never had a repair.

If you get the repair, rehab aggressively and it can be good as new in 6 months.

#6

I would strongly advise getting it surgically repaired. Your previous Dr. owes you time and money for the improper analysis and neglect to address the real issue.

You will be out for about 9 months following surgery but you will be back to 100% after that.

I would check out the link I previously posted for more opinions concerning ACL injuries.

Best of luck.

#7

[quote]Mahatma wrote:
…

It’s an ACL rupture, my knee is f*cked. I wonder why it’s taken 7 damn months to find this out. He said that by strengthening the muscles around the knee I can compensate for a missing ACL and possibly be ok in about 3 months.

Or I can get keyhole surgery and spend another 9 months out of action. (7 months, plus 9, plus 2 waiting for surgery = 18 months. Hurrah!)
[/quote]

If you had gone to the rehab and participated in it for any length of time, they probably would have identified the extent of the injury.

Your ACL will not grow back together on it’s own, and if you are involved in sports, then rehabbing it through exercise without the surgery, that may not be good enough. If you plan on being sedentary for the rest of your life, or plan on wearing a brace, then you could try the rehab approach.

ACL ruptures should be repaired, and you should go through the full course of rehab. Yes, some of it will seem tedious, but there is usually a reason for everything. Usually by the time you are feeling like it is completely healed, the repair is at it’s weakest, and will take several more months to fully strengthen.

My advice is to get it repaired, and start the rehab process asap. It will not get better on it’s own, and if you are active on an unstable knee, you are setting yourself up for meniscal damage due to the femur sliding on the tibia. The medial and lateral ligaments have probably healed on their own, so the surgery would most likely be to graft a new ACL and clean up any cartilage damage in the area(meniscus).

Good luck.

#8

Hello again. I am about 2 months away from surgery and I would like to know what I should do about my training program leading up to surgery. My concern is that post-surgery I will not be able to do any weighted leg exercises for at least 3 months, but I’m skinny and weak at the moment and have just got back into lifting weights again.

So what should I do with myself? Growing big legs until surgery seems totally futile as they will wither away, so should I specialise upper body for the next 1/2 a year and do minimal leg work?

#9

just fyi, you probably will not be able to lift anything above like a resistance band for 6 months after your surgery. Just focus on your rehab, as stated before because your gonna have to retrain your quads how to fire when they cut open the knee capsule.

#10

Therizza, if you had to wait 6 months to lift after ACL surgery, you had a very conservative Physical therapist. I had a hamstring tendon graft to replace my ACL, in rehab the morning after surgery, squatting ATG 3 months post surgery and back to work(firefighter)at 6 months. Safe but aggressive therapy as prescribed by my surgeon. I haven’t had a problem since.

Mahatma, if possible talk to your surgeon and see what he has to say about the workouts.

#11

[quote]ltffmed wrote:
Therizza, if you had to wait 6 months to lift after ACL surgery, you had a very conservative Physical therapist.quote]

OP, What’s up man! You haven’t had surgery yet and you are till 2 months out? That doens’t sound right to me.

I would try to get in there for surgery today if possible…

I was also in rehab the morning after. Your therapist and dr. should have a program designed for you before your go into surgery.

Your question is hard to answer becasue you really can’t perform many lifts properly with a torn ACL. I remember spendin hours on the bike.

#12

prior to surgery you need to make sure you can straighten your knee all the way. It can be done by lots of hamstring stretching, but may need the assistance of a physio if you need mobilization of the knee cap and knee joint proper.

Then try to add as much mass as possible. I used to tell my patients before surgery "an inch in muscle girth you gain before surgery is one less you lose/need to get back after surgery.

I missed the boat on the early part of this thread. If you have an ACL tear and are not having instability problems, you can do just fine without surgery. I haven’t seen many of these cases. The surgeons I used to work with have done a lot of research on the ACL and there are still lots of questions.

#13

[quote]JGerman wrote:
ltffmed wrote:
Therizza, if you had to wait 6 months to lift after ACL surgery, you had a very conservative Physical therapist.quote]

OP, What’s up man! You haven’t had surgery yet and you are till 2 months out? That doens’t sound right to me.

I would try to get in there for surgery today if possible…

I was also in rehab the morning after. Your therapist and dr. should have a program designed for you before your go into surgery.

Your question is hard to answer becasue you really can’t perform many lifts properly with a torn ACL. I remember spendin hours on the bike.

[/quote]

He’s not from the US where surgeons are a bit more aggresive

Good surgeons typically have full appointment books.

A rehab program prior to surgery will quickly change after depending upon how the patient presents.

Although I am an advocate for ACL r/c, I have seen many high functioning people with ACL deficient knees. I myself squatted over 500lbs prior to r/c.

#14

okay I had a similar injury a couple years back fully torn acl mcl pcl and meniscus. Are your ligaments fully torn? If this is the case your leg will move in directions its not supposed to. If so you need to get a “proper” brace for it (nothing you can get from big five).

I would highly recomend getting acl surgery if you do the next couple months will be spent healing your mcl before you get surgery. During this time you should find a physical therapist to help you prep your knee. Good luck and take care of it now so you dont have to the rest of your life.

p.s. go smack your old doctor and find an actual surgeon that specializes in knee reconstruction

#15

As far as post-op rehab it is definitley possible to start light weight training not long after surgery. In fact I’ve had some post-op patients do pin loaded leg press with up to 40kg one day post-op (Im a physio/physical therapist). A lot of post op protocol depends on the surgeon and how good they really are.

I work with patients of a surgeon who is one of the best around and ive seen some of his ACL repairs return to elite level sports in 6 months or less without any problems.
Pre-op you can do plenty of lunges, light squating, leg press, SLDL etc (closed kinetic chain). Dont push through restriction or pain though.

#16

JGerman… just as an interesting side note we have found anecdotally that about 1 in 100 torn ACL’s do spontaneously form re-union and repair.
edit( more like 1 in 200-250 now that i look over my notes)

#17

[quote]James487 wrote:
JGerman… just as an interesting side note we have found anecdotally that about 1 in 100 torn ACL’s do spontaneously form re-union and repair.[/quote]

Sooo you’re telling me there’s a chance??? I like those odds if playing the lottery.

Onto serious questions:
Were these athletes?

Was it (1 in 100) a complete tear? How long did it take?

Do you medical guys think an athlete can perform above 75% of a normal range with a torn ACL?

#18

Yes the re-union cases I have seen are mostly in athletes and they are complete tears. It still takes a long time to heal but saved them going under the knife. But I agree with you- surgery ASAP is usually the best option- the comment was just for interests sakes.

#19

Can’t say I’ve seen an ACL heal on it’s own. I guess I just haven’t had any of those 1 in 100.

I’m not sure what you mean by 75% of range, range of motion or are they participating at 75% of their prior activity level.

It’s actually quite easy for an athlete with an ACL deficient knee to regain ROM and strength well over 75% of their non affected leg. I have seen lots of athletes participate near their pre-injury level of function.

The big problem with acl deficient knees is the instability with changing direction. You almost always see the athlete have an episode of giving way or they have some type of avoidance maneuver, which looks awkward and is very slow.

#20

Thanks for all the responses.

As for my knee, it’s in good condition with full ROM and I can do a few one leg squats on it. However, I can’t go ass to calf and get myself back up again, but I can go to parrallel and back up. I assume I should be doing lots unilateral exercise instead of bilateral exercises.

Can I go ahead with deadlifts and squats as usual? There is no discomfort when I do but I’m curious. My physio’s secretary is out for lunch whenever I ring so I haven’t had a chance to ask him yet.