Sunday, August 2, 2015

ACL Warrior: Getting back to "normal"

Oddly enough, it has been almost exactly a year since my last blog post.  I've been busy with ACL reconstruction surgery, my first Michigan winter, a second knee surgery (scar tissue removal), losing my job, finding a new job, and a whole lot of knee rehab and physical therapy.  

Since I'm a fitness nut (although I have no formal education or certifications on the topic), and still recovering from an ACL reconstruction, I'd like to focus this entry on KNEE REHAB.  I searched the internet high and low for information about getting strength back after ACL reconstruction.  I've read a ton of articles and followed people on Instagram.  This doesn't make me an expert--and everyone should check with their physical therapists and surgeons before trying any of this.  But I wanted to share with you what worked and what didn't.

I found lots of articles and blogs about success stories--young people who torn their ACLs, had the surgery, and were back to running in 3 months or less, back to sports in 6 months.  I WAS NOT ONE OF THOSE CASES.  This isn't meant to scare anyone, its meant to be a realistic story about someone who struggled.  Because when I struggled, I felt alone.  I felt like I was the only one on the planet who's surgery didn't go exactly as planned.  So if your surgery was similar, know that you are not alone.  Everyone responds differently.

I also don't want to focus on the surgery itself or the couple of weeks after it.  For the most part many doctors and PTs have different protocols.  And so you should follow that.  And a lot of that is pretty straight forward--heel slides, prone hangs, quad sets, and other simple exercises will become your life for at least a few weeks.  Where I ran into trouble was when I couldn't get my extension and flexion back, so I had a second surgery or "clean up" to remove scar tissue.  By the time all of this had happened (4 months post-reconstruction) I had lost so much strength in my injured leg, I had no idea how I would ever get it back.  This is where I found a lack of information on the internet and had to pull things together on my own.  Keep in mind that I'm a female, 32 years old, and have been Crossfitting for over 2 years.  My main goal was to work on leg muscle imbalances and get back to Crossfit.  

Here is the run down on my surgeries:
July 16, 2014 -- tore ACL in right knee while playing soccer
Octoer 2014 -- started "prehab"
November 11, 2014 - ACL reconstruction, hamstring graft, hybrid with my tissue and cadaver (I have never met anyone with this method!)
March 17, 2015 -- second surgery to remove scar tissue (gained better extention, but not equal to my uninjured knee).

Now I'll talk briefly about the exercises that worked for me and what I gleaned from here and there.  I had some help from my physical therapists but I really had to figure things out on my own in terms of getting back to Crossfit and evening out my imbalances.  My general advice is to 1) take things slow and don't overdo it, 2) focus on  hitting every part of the leg during a workout (calves, quads, glutes, hamstrings), and 3) remember that it will take a while to get the injured leg's strength back if you were like me and were unable to use it for months.  

Biking.  After the second "clean up" surgery, I had a mini pedal bike that I could use right after surgery in the comfort of my own home.  I also used a passive motion machine, but sometimes insurance doesn't cover that, so the mini bike is a good one to keep in mind.  I tried to use it a few times a day--there's probably no limit to that, and you can adjust how much your knee bends by moving it closer to you.  After the mini bike got too easy, I moved to an Airdyne, but any bike would do.  It's low impact, and great for working on range of motion.  About 3 months after my "clean up" surgery I went to a spin class--45 minutes, was able to pedal with my butt off the seat with fairly strong resistance.  I also started using an outdoor bike.  I replaced all running at the gym with biking or rowing.  I've also done a lot of single leg biking--which is kind of awkward if you don't have a place to put your unused leg.  (Don't try this outdoors, haha!)

Rowing.  Low impact as well, and early on I used it just to work on range of motion.  I also found that one leg rowing worked well--put your unused leg on a small skateboard or other wheels so it can move along with you.  Most Crossfitter's know correct rowing form, but if you have never used an ergometer, make sure to watch a video first.

Squats.  Correct form deep (below parallel) squats were my goal, but I started with squats to parallel. Then I squatted to a box just below parallel, and then to a medicine ball a little lower than that.  Try squats while standing close to a wall to work on form (there are YouTube videos for this).  Then you can start adding variety--dumbbells, kettlebells, using a PVC pipe or band overhead.   After about 2 months post-clean up  surgery I was back to barbell squats at low weights (back, front, overhead). Still working on these since my ROM is a little off.

Sled drags.  When I couldn't quite hit my quads that well with squats because of poor range of motion, I used a weighted sled and dragged it while walking backwards.  Great for the VMO (vastus medialis oblique).  This muscle has likely atrophied, and it is located above the knee on the front inner part of your quad.

Backwards farmer's carry.  Yes, backwards.  This helped me focus on getting my leg extension back.  I usually held a 20 pound dumbbell in each hand and walked down and back for as long as I could hold them.  Also helps with grip strength and just plain learning walking mechanics again (I had a limp for a few months when my extension was still bad).  Forward walking is probably helpful as well.

Single leg deadlifts.  I used a kettlebell to do a Romanian deadlift or stiff leg deadlift, and the injured side got more rounds and reps than the uninjured side.  This works the hamstrings and glutes, as well as helps with balance.  Make sure you watch some videos to make sure you are doing it correctly.

Bulgarian split squats.  Another one to google and watch on video first.  Great way to isolate one leg if the injured one is a lot weaker than the other like mine was.  You can put one foot on a box behind you and hold onto something for support if needed.  Just make sure that your knee stays over your ankle as you squat down.  Works the quad and glute.

Step ups.  Grab a box and some dumbbells and step up with one leg.  Simple, straightforward, and you can increase the height of the box, the weight you use, and you can also do lateral step ups.  Works the quads when squatting isn't quite working yet.  Really focus on firing that VMO muscle and make sure that your knee doesn't cave inward (push it out!).  Don't use your other leg or other muscles to get yourself up there--focus on that quad doing the work.

Hamstring curls. My hamstrings were extremely weak.  Some people may use a gym that has machines that would work for this, but I was at a Crossfit gym.  I used a 10 pound ankle weight and did curls either lying face down, or standing up.  

Reverse hyper.  Our gym has a machine for this, but before we got it I used the GHD machine. There's some discussion about whether or not these are safe (as there is with almost every exercise out there), but they were good for helping me work on the posterior chain without bending my knee.  My advice would be keep the weight low, don't do them every day, and make sure you do them correctly.

Calf raises.  Pretty simple.  I can visibly see a size difference between my two calves.  And when I couldn't do much jumping I did calf raises from the floor or on a step.

It's been hard for me to get back to jumping and running--in fact, I haven't actually tried running yet. For jumping I used jumping rope, low boxes, and agility ladders.  I'd have to say the agility ladder is a great tool to have.  At almost 4 months post clean up, I can finally hop on one leg again.

It's ok to get frustrated and feel discouraged!  I frequently did.  But just know that it will get better--it just takes time and it feels like forever.  It helped me to make small goals and write down when I achieved them.  And I made myself focus on the new things I could do, rather than what I used to be able to do.  My first squat, my first 20 inch box jump, my first double under, my first single leg hop through the agility ladder--all new PRs!

I hope this helps someone out there.  Feel free to ask me questions if you have them.  Good luck!

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