ACL recovery - 1.75 month post op

This post will be rather long so I apologize in advance. I have a few things I wanted to talk about.

Rob says my progress is moving along nicely. The tenor of the PT routine has really picked up. Starting earlier this week, Rob added in some new wrinkles, like agility drills, that have made the routine longer and much harder. Most of the exercises involve the use of weights. In fact, I'm really cracking a sweat now! Also, Rob has modified several exercises to simulate the sorts of stressors a trail runner will encounter. For example, it's one thing to do lunges with dumbbells. However, it is an entirely different thing to do them when you have to plant your lead foot on a wobbly piece of styrofoam (I think trail runners sometimes are not aware of all the sorts of twisting and torque they are imposing on their body when they run ... until they are unfortunately injured).

I am still battling through small hamstring pulls. I didn't know this, but Rob explained to me that they didn't just excise a small portion of hamstring tendon. On the contrary, Rob showed that they took out what looked to be a 6-to-9 inch long bundle that wrapped back around underneath my knee. In fact, they have a tool that looks like a plumber's snake to do this. That is why the main incision on my knee is remarkably small.

After my morning workout yesterday, I headed up to the Cleveland Clinic for my checkup with Dr. Jack Andrish and his colleague Julia Brasfield.

These two folks are wonderful medical professionals and people, a point that my closest friends are probably tired of hearing me make. I do not know if anyone ever reads this blog but I would say that if I was ever asked what is the one thing that an active person with an ACL injury could do to increase their chances of a successful recovery, it would be to get the best medical treatment you possibly can. I will save the tale of how I "discovered" Jack for a future post. For now, suffice it to say the Internet can be a wonderful tool. After hours of research, there was no doubt in my mind who I wanted to do the operation and lead my recovery. Yes, it is a pain in the ass to get second opinions, and to get involved in a battle royale with your insurance company because your health care provider is out-of-state, or "out-of-network", to use the vernacular of an insurance representative. Resolve to pay the extra money and DO IT! Think of it this way: what price would you pay for several extra years of running or hiking, say, if you were told you could never do it again?

So what did I discover up at the clinic? All systems are go as of now! The popping I occasionally hear in my knee is probably nothing more than my knee cap adjusting to a different tracking. Jack is not a fan of treadmills for ACL recovery. I believe he said it has something to do with the biomechanics but don't quote me on that one. Alas, my return to running (and spinning) will be delayed for one month. However, the good news is that I can increase the mileage for my walks. In fact, I can increase my mileage incrementally until I hit 4 miles one month from now. As for swimming, I am now allowed to flutter kick (when I get to that point!) but whip kicking is definitely out of the question. What about biking? I can do stationary biking pretty much on an unlimited basis and I have also been given clearance for road biking as long as I don't use toe clips/clipless pedals. Other big news concerns my lower body weight routine; I am now allowed to make reasonable use of my twig of a "bad" leg. Thank God! Of course, it will take me awhile to build up equitable strength in both legs. Any sort of seated leg extension or other similar weight-bearing exercise that puts my knee into the so-called "open chain" form is strictly off limits because the shear force would be maximized on the ACL graft with potentially disastrous consequences. Finally, Jack recommended I incorporate a set each of abductor and gluteal exercises to stabilize the hip joint. Done! :-)

Swimming is coming along very nicely! As unpleasant as they looked, I am happy to say that today I did 8 laps freestyle with the pull buoy, something that would have been almost unimaginable a couple of months ago for a guy who was afraid to put his head under the water. Thank you Beth Byron. Wow! I think I am really going to like swimming and it is an excellent form of cross training. I have a buddy, Ken Boike, who is an exercise physiologist. He's always told me to "work the entire slab" and has espoused the virtues of cross training for runners. I think I've discovered through this injury that he's on to something.

Finally, if you ever have a chance, try working out with resistance bands. After several hours on the Internet doing some research, I bought a resistance band kit a couple of weeks ago: the Terrell Owens Super Strong Man Bodylastics Set. Before you curl up on the floor laughing, I can assure you that if you properly use them you will get every bit the workout you would in a gym. Last weekend I went to Alabama and this weekend I'm heading off to Vancouver. Rather than hoping the hotel has some crappy, beaten Bowflex machine, it's easy to slip some bands in your suitcase and work out in your hotel room. if you've never used resistance bands before, confuse your muscles a bit and give them a try!

That's the view from here for now. I hope everyone has a great weekend!

-- Phil

ACL recovery - 1.5 month post op

Time for an update of my "diary" ...

Next week I am due for another trip to the Cleveland Clinic to see Jack and Julia. Frankly, I am nervous because I am now in the "danger zone" I had talked about several posts ago regarding the structural integrity of the graft. It's time to remain focused.

Things are all business the past several visits with Rob and his colleagues over at Dynamic. They are wonderful people. I come in, the Tour de France is on the television for that extra bit of motivation, and I have done the routine so many times by now that it's as if I go into autopilot. Lunges? Check. Time on the bike? Check. Squats? Check. And on it goes ...

A sports medicine doctor at Dynamic told me yesterday that I was doing really well. There's been some talk lately that I might be getting closer to some spurts of light running on a treadmill and some new agility exercises. I try not to think about this too much because I don't want to become too excited and not have it happen for some reason. Rob said on my cardio days I can bump up my walking to 1.5 miles along with cranking out 20 minutes on the stationary bike; at least that's something, right!?

I have been asked what rehabilitation protocol I am following. It's called the MOON ACL Rehabilitation Program. The program is built up in five sequential phases where both time and patient progression are used to determine the pace of recovery. Right now, I am just getting ready to look at starting Phase 3.

Swimming lessons are going well. Yesterday, Sarah Quesen (a great swimmer, by the way) told me that I have been using the term "pool buoy" wrong. It's "pull buoy", because you use the buoy to "pull" your lower body through the water. Here's what one looks like:

Yesterday was an interesting day in the pool. Beth (the swim coach) had me squeeze the pull buoy between my legs and dog paddle the entire lap of the pool. This includes the vaunted deep end which I had never been in. With her encouragement pacing the side of the pool, I was able to do it but I was stressed out enough that I think I had the pull buoy squeezed down to a wafer by the time I completed the lap! Later, we even tried some freestyle swimming with the pull buoy. I think I was good for 6 yards - ha! Try it, all you swimmers, if you never have. It's tiring! I wonder what this "swimming" will be like when I can actually use my legs?

I've been surprised at the amount of time all this is taking on any given day. Somedays I am rehabbing/exercising for easily over three hours. However, as I just told a student this morning, my health and recovery come first and that's just the way it will have to be this summer and fall.

ACL recovery - 1.25 month post op ... and then some

Well, the recovery regimen keeps bumping up in length and intensity. For example, we've added more strength exercises and bumped up the ankle weight to 5 lbs. Yesterday, I pitched the compression wrap and only took a couple Ibuprofen. Every day I feel stronger. This morning I walked a mile down by the river and felt fine. I then went to the gym and after my PT routine I did 20 minutes on the stationary bike! This is a big step in the right direction because I can now finally get in at least a semblance of a true cardio workout.

In a few hours, I will head to the pool in my quest to learn how to swim. Unfortunately, I still can't use my legs but I can use a pool buoy. The swim coach Beth Byron is outstanding and has the patience of Job :-)

This morning I felt a bit distressed not having been able to attempt my first 100M this summer, i.e., the Mohican. It has now been two months since I last ran (The Capon Valley 50K). The past several days I have been reflecting back on that race.

It was wonderful to be out there at the start with the grey storm clouds, the wind blowing, and the rain trickling down my face. At that point in time, there would have been no other place I would have rather been. Dannielle Ripper and I started off together the first couple of miles before we parted company. The first aid station passed. Then another. Then another. I ended up bumping into Eric Ripper and we ran together for a considerable distance. The scenery was really nice and Eric and I were having such an enjoyable conversation that the miles just zipped on by. Finally, the sun broke free just about the time I knew I could finish ... it was quite emotional ... I felt overcome with gratitude for I knew that this would be the last race for many months.

I set no PR that day but I discovered that I am really blessed to have some good friends that have been and are a solid support system. I also realized that there is something about the heart of a long-distance runner. It does not matter how much pain, mentally or physically, you are in. It does not matter if the external forces of life have seemed to have conspired against you. When I am running I feel safe living only in the moment where time is measured only by my footfall. My mind becomes a blank palette and I focus occasionally only on the rhythm of my breathing. And all is right with the world after a good run ...

I patiently wait for that first mile back.

ACL recovery - 1 month post op

I was reminded by my surgeon Jack this week to take it slow and not push. It's good to get these reminders from time to time because it's easy to become seduced into picking up the pace of recovery.

All this being said, Rob picked up the pace. We are adding more and more weights into my 2-a-day routine.

This morning, after my routine, I finally entered the pool again. Jack told me that this is ok as long as I do not use my legs! Yikes. Therefore, I did some "resistance" walking in the pool, and doggy paddled several laps using only my arms. I actually felt challenged and it certainly beats the hand cycle! I think it's time to bring the swim coach into the mix.

I'm happy to report the swelling and tightness in the knee has greatly subsided. Let's hope it stays that way. I'm looking forward to a nice, leisurely one mile walk along the river tonight ...

ACL recovery - 3 weeks post op

I just got back from visiting Jack and his colleague Julia Brasfield at the Cleveland Clinic. The stitches were removed and some new x-rays were taken. Following are some random thoughts I have about the visit and the recovery in general:

#1. I tried to get off the Demerol and Ibuprofen as soon as possible after the surgery. I might have been on the former for about three days and the later for a week? The reasons are a.) I humbly submit I have a fairly high pain tolerance; b.) I believe it can mask other problems, and; c.) I don't like pills, in general.

This being said, there is still some swelling in the knee that Jack said could impede progress in my recovery. So, to get rid of the "boggy" knee and to get it looking like the other one, I will take moderate daily amounts of Ibuprofen for the next two weeks, hit the knee with ice at night, and wear a compression wrap.

#2. I am convinced my diet has and will greatly facilitate my recovery. While I am not nearly as militant as I once was, I still do eat a ton of fruits, vegetables, whole grains, and try to avoid junk as much as I can. My friend Sarah Quesen keeps me on the honest path about this.

#3. My PT Rob explained the following to me (I am paraphrasing here). The ACL has been replaced by a tendon. Your body "knows" the purpose of this "thing" is to do the things a ligament would do. Therefore, starting at about 6 weeks, the tendon cells die off, the graft is vascularized, and new ligament-like cells start to grow there. At this point, the graft is at its structurally weakest point. This is despite the fact that I may feel fine, the swelling is down, etc. Evidently, this whole metamorphosis takes several weeks. One false move, one yearning for "just a quick run", could sever the graft and I would be back to ground zero. Again ... Patience ... Patience ... Patience.

#4. My sister turned me onto this next tidbit. It was also independently confirmed by Rob. Taking Vitamin E capsules and rubbing them into the surgical wounds will reduce scarring.

#5. I keep getting little micro-hamstring pulls. The reason this is occurring is because of the loss of hamstring tendons used to form the graft. In effect, the muscles of my left leg have less machinery to do their work efficiently. Jack said the lost tendons will, more or less, grow back with time.

At PT this morning, we bumped up some weights and added resistance to certain exercises. That's all that's on my mind today.