Tales From The ACL

Even though it's been one of the bigger things that have happened to me in 2017, I haven't written too much here about my ACL surgery and the subsequent rehab process. Part of that is probably just due to the general lack of desire to write a whole lot, and part of it is likely due to the fact that the whole process has just been one giant trial of patience and exercise in frustration. However, now that we've hit the 6-month mark post-surgery and it doesn't suck so much, I'm going to do a little kneecap recap.

I knew going into it that ACL rehab is no joke; between talking to my surgeon and doing reading on the Interwebz, I knew that I was going to be in for a 6-12 month recovery period. Whether it would be closer to 6 or closer to 12 would be contingent on how much other stuff was damaged; in addition to a complete tear of my ACL, there was also tear in my meniscus and some fraying of the MCL. Apparently, a meniscus tear that can be repaired (as opposed to having to have it completely removed) actually makes the recovery process a bit longer, but you have the added benefit of, well, keeping some much-needed cartilage in your knee.

The surgery itself was at the end of May; I spent the first week and a half in my apartment using a combination of crutches and my desk chair to get around, much to the dismay of my downstairs neighbor. Once I lost the crutches, I was still in the immobilizer brace for another 3-4 weeks, which was only slightly less not-fun. Crutches suck, but so does swinging your peg-leg around like a fucking hunk of dead meat. I remember one time trying to walk a quarter mile from my work to meet N for sushi and being completely exhausted by the time I got there. Fuckin' hell.

The rehab process in the beginning was largely about getting range of motion back. I remember after my first follow-up doctor visit that he said I needed to get to 90 degrees of flexion as soon as possible, and the only way to do that is with lots of heel slides. Fun. Straighten your leg as much as possible while not putting any weight on it. Bend it. Repeat. Do that a whole fuck-ton of times. Raise your leg, lower your leg. Repeat that a fuck-ton of times.

One thing I can say is that the post-surgery pain was actually not that bad. I'm not sure if this is due to the skill of my doctor (Dr. Jeffrey Halbrecht - this dude knows his shit, and I've already recommended him to one of my colleagues that was in a motorcycle accident and is having shoulder problems), the nature of my injury, advances in medical technology, or some combination of the above, because a lot of the reading that I'd done suggested that it was going to be more painful than it turned out to be. They didn't give me a nerve block during the surgery, and while I did take every single percocet they gave me (I mean, come on, who wouldn't?) there was never a point where I was pounding the pills to make the knee stop hurting. When there was pain, it was more along the lines of the annoying variety (dull aches here and there, or the occasional low-intensity stab when I'd step) rather than the excruciating or debilitating kind.

Rehab progressed over the summer, Ozora came and went, and somewhere around the 3-4 month period the frustration and impatience started to set in, kind of like I thought it might. Every time I'd go to the doctor's office for a follow-up visit, he'd check out my knee and say that it looked great and that he was happy and that I should be, too, but that didn't really make me feel much better. Even my PT said at one point that I was right on schedule or even a bit ahead of where I was "supposed to be" in the recovery process. However, you can know something logically and still not fully grok it. Just like I knew what I was getting into when I signed up for this surgery, I didn't really KNOW what I was getting into until I actually did it.

The one thing that I found interesting and which still holds true today is that improvement was not gradual, it was chunked. I don't know if that's common or if that's just how my body works, but I'd repeatedly find that I could go a few weeks with no measurable improvement in anything and then suddenly there'd be a step up to a new level, like I had been on one plateau and managed to jump up (fitting analogy, is it not?) to the next one.

Anyway... at around 4 months post-surgery they cleared me for biking and linear-motion leg exercises, such as leg press, so I started riding the stationary bike a bit and doing some one-legged leg press in my apartment complex's fitness center. They also said that I was free to do upper-body exercises as long as they didn't involve using my legs for lateral stabilization; anything where I was seated was OK. This is kinda funny, actually - my trainer had been trying to teach me how to use my legs when I bench press, and then I had to go back to consciously NOT using them. Fuckin' hell.

Also at 4 months I took a photo of my knees and posted it on Instagram; I kinda wish that I'd been doing that since the beginning to really get a better sense of how it had all progressed, but whatever. The size difference between my good leg and my zombie leg was quite noticeable, as was the strength imbalance. I was able to do the one-legged TRX squat on the left leg with no problems, but on the right leg that shit just wasn't happening unless I modified it. It legitimately felt like the strength in my right leg was only about 50% of my left. Again, not really much in the way of pain, but major amounts of frustration.

On top of that, I gained about 10lbs due to inactivity, which added to both the frustration and the difficulty of the rehab. What I should have been trying to do this whole time was drop weight. That was another potential gotcha that I knew about going into this but didn't stay focused on sufficiently well to prevent it from happening. Apparently I just like to make life difficult for myself and add challenges wherever possible; I'm certainly good at it.

Remember what I said about chunked improvement? Somewhere between month 4 and 5, the TRX squats became a non-issue. One day I just went into the PT office and did them correctly without any problems, even though I couldn't do them unmodified the previous few weeks. I made a comment to one of the PT aides that this whole rehab process was starting to feel like more of a mental game than a physical one; there was probably more strength in my leg than I thought, but my brain was still in "FUCK NO, DON'T DO THAT!!!" mode and extremely resistant to certain activities.

As we came to the end of month 5, PT went down to once a week, and much of the focus was on balance-related activities. My balance is probably better now than it was pre-injury; I've never spent so much time on one leg as I have this year. When I'm riding up and down the elevator by myself at work I use that as practice time; I close my eyes and see if I can make it from the 4th floor down to the 1st on one leg. It's easy with my eyes open, but I've not yet made it more than 2 floors with them closed. I'm sure it will happen one of these days - although it has to happen by the end of January, since we're moving to a different building.

This past month has had some good and bad. At PT they've started having me do this thing on a slide board, which is lots of fun but also really tiring. It's showing me just how out-of-shape I've gotten as a result of this injury. They've also had me jumping, which I was a bit gun-shy of doing at first, because I didn't feel like my right quad was strong enough to absorb the impact in a controlled fashion. I'm still not a fan of the jumping; it kinda fucked me up a little bit right before Thanksgiving, and my knee started clicking every time I'd bend or straighten it around the 20-degree mark. That went on for about two weeks, but it has since gone away; it was a patellar tracking issue caused by a little knot in the quad or the tendon where my femur and kneecap meet.

This morning I posted another photo of my quads on IG; there's still a visible difference in size, but I went back and looked at the photo from two months ago, and there's also a visible improvement in size differential. In terms of strength, it's hard to say where I'm at now vs. where I was two months ago, because at that point I hadn't been measuring it. However, what I can say is that as of today, my one-leg leg press 1RM is 16.7 percent weaker on the right side. Last week, it was 20 percent. Oddly enough, the raw difference is the same; I went from 200/160 last week to 240/200 today. I've also noticed just in the last two days that going up and down stairs is smoother than it had been (chunked improvement!) - it's still not 100% even on both sides, but it's getting there.

Realistically, today has probably been the first day in the last six months where I felt legitimately optimistic that I will be back to doing all of the things that I like to do without any restrictions in the acceptably-near future. I don't know how much longer I'll be in PT; I think the way it works is that you don't get to stop going until they are satisfied that you can pass all the tests that they put you through, at least one of which involves jumping up and down. Ideally, I would be done by the end of the year so I don't have to start shelling out co-pays for each visit, but I doubt that's actually going to happen. I would not be surprised if I'm in PT, even if only once a week, for a few more months, but again, we will see.

I go back to the doctor tomorrow for what I suspect is going to be either my last or my second-to-last follow-up visit; last time I spoke to him he said that at six months is when they start letting people ski, so we will find out if I'm cleared for the slopes, and/or if I can start squatting and deadlifting in the gym again.

I'll update this again in a few months, hopefully with a photo or two from the top of a ski mountain where I'm NOT being tended to by ski patrol. =)

PS: If anyone happens to be reading this that is facing ACL surgery, the only thing I can tell you is that in the end, it is not going to matter how many accounts of others' experiences you read. For some people, it goes well. For some people, there are complications. Your story will not match anyone else's in exactly the same way. I think the whole process sucks, no matter how prepared you think you are, but that's because a) I'm impatient, b) I hate being sedentary, and c) I hate being told that I can't do something. Do your exercises, listen to your doc and your therapist (and your body - I can't stress this one enough - if shit hurts, speak up), and eventually you'll get through it.