ACL prehab & rehab

Dr Nic

Torn acl, torn lateral meniscus, osteochondral damage to to both tib/femur.

Surgery due this month hopefully. Meeting surgeon July 12.
Time to start prehab...

Prehab routine
I've been looking around for some evidence based medicine on ACL prehab, but havent seen any decent studies yet...
So for the time being im going with standard weights & stretching. If it hurts or swells i stop... No running or plyo's allowed

Some nice reading - not sure how sound the author is though...
http://www.livestrong.com/article/427803-prehab-exercises-for-your-acl/

Dr Nic

A good blog...
http://myaclrehab.blogspot.com/

Waterbury 10x10 as prehab?
I dont have enough time to complete it, so maybe 8 days of each phase?

Dr Nic

When asked about how he dl'ed & squatted without an ACL...

Yes, I did deadlifts & squats without my ACL. I had very little swelling and pain as I had a clean rupture (lucky me). I also talked to my physical therapist before doing so. She was fully supportive, especially for single leg work like bulgarian squats, reverse lunges, etc.

The exercises to avoid when you don't have an ACL are those that cause ACL shearing, such as:
1. Quad extensions
2. Normal lunges (note that reverse lunges and walking lunges do not shear and therefore can be done)
3. Super deep squats (ass past 100 degrees), sissy squats & hack squats
4. Pivoting exercises like drop lunges

I was going past 90 degrees in my squats once I had enough muscle and mobility, which was putting the knee joint at risk, but I had very little pain or discomfort and felt comfortable doing so.

Dr Nic

Now we're talking...
http://www.carletonsportsmed.com/aclrehab.htm

eilo1

Hey Dr. Nick

I just did a presentation on this yesterday!! lol

The 2 links above look pretty good so have a good read through them and get started on your basic quad drill (static and inner range quads, straight leg raise) as well as abduction and adduction all in lying just to be safe.

Its best to find out where your graft is coming from most places do a graft from your hamstring or patella tendon. (I think the Beacon surgeons all do Hamstring)
So you can start doing some work to prepare yourself for the rehab after the graft is removed.

Dont forget to strengthen your good leg as well as you will be relying on it heavily post surgery when your on crutches.

Its great that you are getting started on your exercises now it will really stand to you!

Dr Nic

Thanks - Whats your backround Eilo?
What arena was the presentation given?

I've no idea where my surgeon will take the graft from but im seriously considering the synthetic graft...
Cant find any studies on its strength - any idea's?

Dr Nic

Great thread here
http://tnation.t-nation.com/free_online_forum/blog_sports_body_training_performance_bodybuilding_log/acl_rehab_log?id=1892667&pageNo=2

Dr Nic

Great thread here
http://tnation.t-nation.com/free_online_forum/blog_sports_body_training_performance_bodybuilding_log/acl_rehab_log?id=1892667&pageNo=2

Dr Nic

http://intl.gameready.com/products/knee.htm
Cryocuff - http://www.amazon.co.uk/Aircast-Knee-Cryocuff-SELF-CONTAINED/dp/B000W05AC6

Dr Nic

Today - started Waterburys 10-10
Ate well.

Wide grip chins - 8x3 30s rest
Decline bench 60kg - 8x3 30s rest
squat - 60kg 5x3 30s rest

Going very light today, and all was well until the fifth set of squats when both hammers came at me - probably from lack of use!
Nothing serious - just shows the serious need of prehab.
If i went into surgery like that, what would i be like after surgery.

Some light stretching and core work then home...
Haye Klitscho - looks like the giant will take it...

Dr Nic

Ate well again - 85.5kg this morning. Im cutting til i see 83 something on the scale or this Friday comes - whichever first!

Today - Tabatha on the bike. 18mins - 50s easy, 10s hard
Followed by P90x Abripper.
I forgot how flabby and weak my abs have gotten. Prob > 15% BF now

Scales says 13% but i know its 3% out from comparison with DEXA scan results

Dr Nic

Measurements - baseline to guage atrophy

Thigh at thickest point 12 " above most rostral part of patella
Left - 25"
Right - 24.75"

Bicep
Left 14.25"
Right 14.5"

Waist at belly button
36.5" - not good

Calf - fingers length below patella
15.5" both sides

Boom

Dr Nic

Reading about Noesitherapy.
Its an old form of 'hypnosis' for pain during surgery. Although the doc who pioneered it says its totally different to hypnosis and works 90% of the time.
Finding how to do it is hard. His own book doesnt say how.
No studies verify it, so it is quackery, but some high profile journals carried articles on it so maybe there'e something there??

Dr Nic

Todays weight: 85.1kg
Maybe by thursday we should see 83.x on the scales. This aint just water loss either

Todays exercise:
Waterbury 10 10 DAY 3
Circuits: 5
Reps: 8
Load: medium (a weight you could lift 10-14 times before failure)

1. Push press or standing shoulder press - Rest 45s - 50kg
2. Row - Rest 45s - 30kg DB's each arm
3. Dumbbell Romanian Deadlift - Rest 45s - Didnt later - forgot lol - good mornings at 50kg
4. Front squat or Zercher squat - Rest 45s - 50kg - didnt go past parallel more thru fear than anything else - Knee was fine but a lil bit tight
5. Repeat 4 more times

Dr Nic

Day 4 of the cut :
These next 2-3 days are always the hardest. The body fights to hold on to its fat stores, so no hugely noticeable change in body composition. But come Day 8 it just seems to drops off almost simultaneously!

Training today...
Tabatha bike for 18mins. 50s medium, 10sec hard. Repeat 18x.
Got a nice android app to time it - its a poker timer lol - 45sec off, 15 on - repeat 18s
Love android! That Htc was the best thing I've ever bought nearly!

Plus i'll do 2 P90x circuits - Ab ripper again and stretching maybe? Or maybe Beachbody Abs and stretch?
We'll see

BW = 85.5kg this am

Dr Nic

Last night did 30mins Abs with beachbody - Tim Hortons program before P90x. Good stuff really.
Kicked the crap out of my hip flexors - must do again - a lot!

This am - BW - 84.6kg Love it!

Had my 1st cheat today. Small slice of apple pie+ spoon of cream + 1/2 cup of milk. First milk in a week.

Todays training will be:
DAY 5
Circuits: 4 - Reps: 15
Load: light (a weight you could lift 18-22 times before failure)

1. Good morning - Rest 60s
2. Incline dumbbell bench press - Rest 60s
3. Woodchop - Rest 60s
4. Reverse lunge (alternate legs with each rep) - Rest 60s
5. Wide grip pulldown - Rest 60s
6. Repeat 3 more times

Dr Nic

Today - Day 6 so no training. Tomorrow day 7 no training either but im definitely doing something.

Been reading bullet proof knee's by Robertson. Seems ok. Quite a bit of anatomy in it. Low enough level stuff. I got a bit worried when i saw the massive page borders used to fill the book out to 220 pages. Shame really...



Prob finish it before i go to bed tonight
145degrees of flexion are back in the knee now - pain free for a month...

Dr Nic

yesterday - 8 sets of 3 - wide grip chins, push press @ 60kg, bulgarians with 20kg.
Today - 23 min HIIT cycle + AB ripperX

Diet went a bit skew ways last few days... Back on track today...

Dr Nic

2 big days...
Exam results today - 2 more sets of exams and im a real doctor lol.

Tomorrow - meeting the surgeon about my knee...

Today - unilateral day.
bulgarians - 45kg, db row 25kg, db press 25kg- 3 sets of 5 each side
some core work too

burpess pushups mountain climbers

Dr Nic

I dont know lol!

Lachmans positive - anterior drawer sign inconclusive - no posterior sag.
Clinical picture positive of ant cruciate damage.
MRI suggests cruciate damage.

BUT - the consultant asked me how i've been doing. I succintly relayed the contents of this diary. So - ive been doing everything bar playing a match.

And then he shocked me...

He said go back to full training.
And scheduled me with a physio for a rehab program & some isokinetic testing...

What? You just told me my ant cruciate was torn, but you advise me to go back training?

He finished by saying theres a 50-50% of needing surgery. The acid test is going back and trying it out.

I dont get it... What do i do? If he said i definitely need surgery then ok - lets go... But now i dont know where im at... I dont want to lose next year aswell... ****...

Dr Nic

Went training - just jogged around.
My knee felt ok sometimes and other times it felt like 2 lumps of meat held together. Proprioception was poor. Couldnt fully flex my hip.

Maybe just maybe thats down to not running for 6 weeks...
But i doubt it - so i booked in for surgery this am...
Could be 3 months waiting :what the fook:

Disaster...

Dr Nic

23 mins on bike - tough going!
light plyo's - maybe the knee can be built up...
I have 3 good tendons/ligaments - maybe it can be done...
Tomorrow i'll be starting Bullet proof knees program...

Dr Nic

Breakdown - im ****ed...
Its too sore to carry on.
Im only swinging a lump of meat on the end of my leg that used to be my shin and foot. Its alien to me now

Time to find a surgeon who will operate asap - in ireland or overseas...

Dr Nic

In Blackrock clinic on Friday to meet a surgeon who should be able to operate on me inside a week hopefully...
Been cycling & weights quiet a bit since.
Diet is going steady. Im giving up rugby to concentrate on speed alone, so the plan is to be around 77kg for next summer. Im 85kg at the moment at 15% BF, so if i hit 8% BF then thats the 7 or 8 kg i need to lose - loss of fat only fingers crossed...

Dr Nic

ACL surgery tomorrow hopefully, although it seems there may be a cock-up in the Beacon about scheduling. Here's hoping

Leg is 100% these days. No problems on daily 2miles runs on rough terrain

eilo1

Good luck with the surgery tomorrow!

Let us know how you get on and by the way which surgeon did you get??!?!

Dr Nic

Mr. Nelligan in the Beacon...
Just had last meal...

eilo1

Dont worry he is a lovely man and excellent!
I watched him carry out an ACL reconstruction a few months ago and it was fabulous!

You will probably have physio with one of the girls tomorrow, fit you into a Donjoy brace and head off home after that.

Best of luck!

Dr Nic

eilo1 wrote: »

Dont worry he is a lovely man and excellent!
I watched him carry out an ACL reconstruction a few months ago and it was fabulous!

You will probably have physio with one of the girls tomorrow, fit you into a Donjoy brace and head off home after that.

Best of luck!

Thanks!

Job done, awaiting brekkie physio and DC.
The beacon is fantastic!

connollys

Best of luck with the rehab, this is where the work really kicks in, had it done myself last year and luckily havent had any issues since. Never got any brace for it though like mentioned in earlier post, feel kinda left out now

Dr Nic

connollys wrote: »

Best of luck with the rehab, this is where the work really kicks in, had it done myself last year and luckily havent had any issues since. Never got any brace for it though like mentioned in earlier post, feel kinda left out now

Thanks!
I have to say the beacon is the best hospital I've ever been in.
fantastic care, excellent surgeon, included cryo cuff. Really top stuff...

Hard work begins now. No pain, 110 degrees flexion.

Dr Nic

Dr Nic wrote: »

connollys wrote: »

Best of luck with the rehab, this is where the work really kicks in, had it done myself last year and luckily havent had any issues since. Never got any brace for it though like mentioned in earlier post, feel kinda left out now

Thanks!
I have to say the beacon is the best hospital I've ever been in.
fantastic care, excellent surgeon, included cryo cuff. Really top stuff...

Hard work begins now. No pain, 110 degrees flexion.

What's the story with pain guys? I'm asking cause I've got very little until I start to push the hardest physio exercises. And I'm only taking my difene.

I did a **** tonne of physical & mental prep for this but also in general over the years and it seems to have worked. 2 mile jog everyday for last 6/8 weeks. Foam rolling. 30 set pistols ass to grass. Ghr. Etc. Etc

Mentally has been far far more important it seems. Really delighted with my pain control.
I was pretty much ready to ditch my crutches yesterday :-)

connollys

I was in the same boat, didnt even bother using all my difene or painkillers, saved for inevitable other injuries from playing football.

Once you can walk without a limp dump the crutches, if can walk without them but not as normal keep using them til its right. I know I was down to one very quickly as we in the house on me own, so carrying a cup of tea or a plate or anything was just too much hassle when using two.

Dr Nic

Im definitely taking all my difenes to get the swelling down asap.

My surgeon said he doesnt care when i ditch the crutches so they're gone since day 2. No limp really.

Been doing my physio exercises 4x per day which is about 2 hours work. Then icing about 10x per day for another 15 mins each. All is coming along nicely

Right knee is now 16.75". It was 18" Left knee is 16.5" So a little bit of swelling and the bandage makes up the quarter inch difference

Right quad 6" proximal to epicondyle of femur is about half an inch less than left.

Right knee can be flexed to 90degree and fully extended under gravity. Havent weight borne yet. Anything more than 90degrees really feels tight in my knee. Also i get very slight pangs from my shin when i flex more than 90. Possibly stitches?

My goal for day 14 is 90degrees unassisted flexion, walk with no limp.

Im day 6 now and already hitting those goals. im about 70degrees unassisted ham curl flexion against gravity - so a bit of work to do there yet...

Very good progress though and touch wood the cruciate op doesnt seem to be the horror rehab others have spoken about. Touch wood

Dr Nic

Day 10.
Well the pain never came. Havent taken any pain killers. Finished my difenes 2 days ago.
Right knee is now just than 16.25". Left knee (unoperated one) in 16". Little bit of swelling to go but not much.

Icing my knee about 10 a day. 12 exercises, 4 sets of each exercise 4x per day.
Knee flexion is 90degrees now unassisted against gravity. Hamstrings & quads starting to contract again nicely. Maybe half an inch lost off my right quad but not a huge amount.

The next big day is Thursday when i meet Mr Nelligan again, get the stitches out and get a progress update.

That will be day 15. We'll see what happens.

Very happy with the knee and my progress. I'll probably go back to work on Tuesday/Wednesday

Dr Nic

3.5 weeks out now...

Limp almost completely gone.
Full extension on seated leg extension almost. like 170 degress or something.
Cycling 1 hour per day on my road bike. Normal saddle and no problems wiht mobility.
1 leg pistol squats to a chair at 90 degree knee flexion. 3x7, 3x per day

Knee flexion max is probanly 120 degrees maybe. Getting more every day, but the damn screws are very sore to touch especially if i kneel down.

Knee still feels 'full' sometimes with fluid. Also hamstrings feel tight sometimes.
But other days then everything feels great...

Hoping to do some jogging in the next 10 days or so...
We'll see
Moderately with recovery so far

Dr Nic

jogged 1 km under 6mins this am. < 5weeks out
We're on the road again lol.

Limp completely gone. lunges & step ups no problem.
Joggin every day this week is on the menu.

Next big move on the recovery will be plyos next week - week 6.

2 months ahead of recovery

connollys

all sounds great, be careful enough with the plyo work but ya know yourself how ya feel and how far you can push it really.

Dr Nic

4k in 17:30 this week. came 28th out of 180 runners.
sprinting full session this am

8wks out, rehab is pretty much over :-)