ACL reconstruction

[coachjvinson]

Looking for thoughts and guidance
Will schedule acl reconstruction in the next 3 wks - acl complete tear LCL partial tear - cartilage appears intact
Am an avid and active coach age 38
I know rehab protocol is essential and want to hear from others about what has worked well as well as what pitfalls to avoid - thoughts on nutrition and supplements - exercises and activities - therapy and treatment
V

[Bubba PV]

I've been on the business side of the PT business for 24 years (I am not a PT) and I can tell you to expect a full year to be back to full speed; maybe 9 months if you are really smart and careful. The reality is the biggest problem with ACLs is that you seem to progress rather fast at times and that almost always causes you to get a bit more aggressive than you should. This causes setbacks and those setbacks are frustrating and take you much longer than it should to get well.

I had two Achilles surgeries and treated them with the same caution as I would an ACL and that really helped. Good luck to you! Bubba

[charlie]

Bubba, I've had Achilles tendinitis for about a year, ( at least that's what i think it is) but no pain in the Achilles itself. The only pain is on the right side of heel on left foot . Any suggestions . I still try to jump one day a week and play golf every day!!! Thanks Charlie

[Bubba PV]

Charlie I had that in 1995 through Worlds in Buffalo. I had the tendon sheath (not the tendon) injected with cortisone and it was like it never happened. You have to ask around if the MD is willing to inject the tendon sheath. If not then go to the next one on the list. I quit jumping in spikes except for the very end of meets and had no further problems. My big Achilles problem came from something unrelated. Good luck to you! Bubba

PS - hope you had a great birthday last week!

[VaultMarq26]

Most surgeons have a protocol that the physical therapist will follow. Bubba is about right on the recovery time. I am a PT and see recoveries from 6 months to a year. Do your exercises and quit smoking if you do to speed the process

[Bubba PV]

Great advice. My partner has been a PT for 40 years and we intentionally set longer recovery time goals for me in order to build overall better conditioning but also to set ourselves up mentally not to rush the process EVER!!

[Classof91pv]

I'm about the same age as you, and I had an ACl replacement 3 years ago. I'm not sure if you still jump, or if you just coach, but from a jumping perspective, it took me awhile before I got my legs back. It was my right knee, so I didn't have to worry about the stress of planting, but of course speed is the biggest concern. Luckily, speed does not come from the knees, but mentally you need to get to the point where you can trust that your knee will hold. If the surgery is a success, there is no reason why you can't be almost 100%.

It took me a year and half before I went down the runway again, but I was over-cautious. Instead of going straight to vaulting, I instead ran long distances to a) teach myself to run again (sounds crazy, but you may forget how to) b) keep my weight down c) slowly build up my confidence that everything was holding and that scar tissue was not a problem. Ended up running a half marathon, so I knew I was physically ready at that point.

I don't feel any pain when I vault, and my speed is almost back to where I need it to be. I wear a sleeve over the knee, and it does make me feel more confident. The sleeve does not impede my running, so I'm sticking with it. I actually feel soreness in my other knee, and the doctor warned me that that would happen, as the knee that I had surgery on will probably be STRONGER than my non surgical knee.

Rehab is always the key, and regaining your flexibility will be the most important part to getting you back to normal. You need to work through the pain to get that range of motion back fast, or scar tissue will build up. If you still vault, not vaulting will HAUNT you while you are recovering, and you will want to get back as soon as possible. Just preparing you for the mental pain of not being able to get out there while time continues to go by and you are hating the fact that you are not getting any younger. It will be ok, though, just look at the rest of the folks on here jumping well into their 50's and 60's. There will be plenty of time to do more when you are ready to. You don't want to get out here too quickly and injure something else!

[coachjvinson]

Yes - experience has taught me that patience is the key - many times surrounding areas are simply strong enough to reinjure the area in question - in my case it was a scapular bursa - in my 20s that would FEEL good until it would come undone again - through impatience and inexperience I turned a 4-6 mo recovery into 18 mo simply from re-injuries - I have heard from another vaulter that the proprioception and joint awareness is still lacking a bit after a year even when the knee is strong and stable in the run and plant - he has a12 year advantage on me.
Smoking is not an issue - coffee is
The Dr mentioned I had micro fractures on the tibia and fibula - did not mention cartilage tears - I am hopeful that holds true -
Thank you for the responses and inpuT
V

[superpipe]

From an ACL point of view, I had a full tear and reconstruction at age 31. I was and still am a competitive freestyle snowboarder and vaulter. I was back on snow doing everything off big jumps and in the pipe in 9 months. 6 months of recovery with rehab and 3 months of progressive workouts "normally" to get back in shape. Surgery was at the end of March 2004 and I was back on snow riding 100% mid-end of December 2004. So here's my experience from it. There are two major factors with the recovery:

1. Muscle atrophy in the leg
2. Scar tissue build up from the surgery

I personally f'ed up on #1. The issue with the body is when muscles are not used, they atrophy exponentially fast vs. the extremely slow rate of growth when you workout. What did I F up? Well, right after surgery the one type of strength exercise you are allowed and MUST do MULTIPLE times a day is isometrically flex the whole leg. I'm talking 3 sets of 20sec holds 3 times per day every day until you are allowed to actually walk normal again. I slacked on this big time and the muscle atrophy took me a solid 12 months to get back to "normal" matching my other leg.

The other bigger issue in the long run is the scar tissue build up. This is what causes pain and restricts full range of motion. Another one you have to stay on top of for years following. Doesn't stop you from doing any sports 100%, but when you try to squat down and do certain stretches, it becomes very annoying. It can limit your flexibility alot. They will have you on a bike initially, but you must eventually work that "full" quad stretch movement of pulling your heel all the way to your butt. Scar tissue takes eons to break down completely so expect to have to work that quad stretch exercise for years. My favorite drill that has basically rid me of scar tissue is the "sumo squat to stand" exercise I do as part of my dynamic warmup. Here's a vid of it on my website. I got it from coreperformance.com:
http://www.mansfieldathletics.com/pole_vaulting/dynamic_warmup/dynamic_warmup.html

Follow the rehab protocol to a T! Don't miss one day of doing it over your 6 months. Isometric contraction of the leg while it's out of use after surgery is KEY!

Don't worry, you'll be back to 100% for sure. ACL's are common place now. Hopefully they said your LCL was a "small" partial tear that will heal back to 100% vs. leaving you with a "loose" one. The partial tear stuff can be worse than full ones that are "black and white" in terms of fixing them.

[coachjvinson]

That last LCL statement was great info - will speak w doc about - will Estim help deter the atrophy? And is it permitted in the early weeks? Am doing some now to deter the atrophy and prehab - quad sets are SO boring - I know they are important - Squat type dynamic movements will be great - at the right time ( +/-6mo?)
How is the 3mo window - when the ACL graft is "at it's weakest" but the physio system and the mind are "ready for more"
All of the info is Great,
Thank You All
V

[VaultMarq26]

Estim doesn't help with strength, NMES (which is a different way of using the machine) can be used for helping muscle contraction. Few home Estim machines double as a NMES machines though. But if you are able to do a quality quad set, there is really no reason to be using the NMES for muscle contraction. It is generally only used when someone can't do a quad set on their own.

[tsorenson]

I had my ACL reconstructed in 1993, using a patellar tendon graft from the same (left) knee. The cadaver grafts were pretty new back then, but I wish I'd have been able to have that surgery instead, because most of the pain that persists is in the patella tendon area where they cut out the new "ligament." Almost 20 years later, I still don't do deep squats with heavy weight, and kneeling is painful. It's only at the maximum flexion that the knee hurts.

Dynamic squat type movements took a while to get back into, but I was back vaulting full speed at less than one year. The lateral movements in football and basketball were (and still are) harder on the knee than vaulting. Running straight down the runway and taking off isn't too bad on a reconstructed knee.

The 3-6 month time was a great time to ride a bike and swim. I never was a fan of exercise bikes, so I bought a mountain bike. It was low impact, fun enough to keep me engaged, and helped regain the range-of-motion and break up scar tissue. I also did a lot of upper body lifting, and work on the highbar and rope to stay fresh on the vaulting.

May these videos give you inspiration in your recovery:

Joel Pocklington 1-legged pole vault:
http://youtu.be/JfIUz7q4qZY

Dan West goofy-foot vault 12 feet (scroll down):
http://raisingthebarpv.com/Site/Vault_videos_.html

Good luck,
Tom