2 years post op!

2 years down, none more to go!

It's been 2 years since my ACL reconstruction surgery, and I'd say mission accomplished! I'm back to 100% (knock on wood) and feeling good about my leg. The past year I've been playing ultimate frisbee 3 nights a week and 1 night of personal training. I feel I still need PT to keep all the muscles in my legs/knee strong. The workouts target both legs (no preference for the acl leg)

Some various events in the past year:

• The tingling in my foot came back and this time didn't want to go away. Turns out it has nothing to do with my acl, but a condition in my foot called "XYZ". Not sure what it's called, but the doc gave me some special pads to put in my shoes and a month later it hasn't returned. The reason this cropped up is (as my doctor put it) "because you're doing so much running". So chances are all the ultimate and training put extra stress on my foot.
• Large tennis ball sized numbness on my surgical leg is still there, and is probably permanent.
• Inner quad on my surgical leg is 98% the size of my good leg. I've put a ton of work into getting there and I feel it's "good enough".
• I haven't noticed much knee soreness even with all the activities. Both knees get sore on various days, but it's not common. I assume being almost 32 is more likely the cause =)
• Playing ultimate at a competitive level now.

Goals going forward:

• Don't tear ACL.
• Watch my weight. This may seem odd considering I'm a lightweight, but due to part of my meniscus being removed and various bone bruises, I've been told I'll get arthritis at some point in my life. Every doctor says a different date (10 years, 15 years, 30 years). I can't stop it from happening but I can delay it. I can 1) Stop playing sports 2) keep muscles strong 3) keep my weight low. Since #1 is out and I'm doing #2, #3 is the only thing left.
• Don't tear ACL

I've decided not to tryout / play for a touring team, as I feel it'd be too much strain on my knee cartilage. But to be honest, I'm very happy with where I am now and hope to continue playing ultimate until my legs fall off!

1 Year Post Op!

Since tearing my acl in Sept '08 and having it reconstructed in April '09 I've come to the following conclusions: Tearing your acl sucks, rehab blows, but getting through it all makes you appreciate being healthy and being able to play Ultimate Frisbee! At one year post op, I'm still not done with rehab, but I'm feeling (and playing) pretty damn good.

A brief history since the injury:

Sept '08 - During one ultimate frisbee game, cutting one way then doing a 270 turn and a full sprint, gave a loud pop as I fully tore my ACL, partially tore my mcl,lcl, and pcl, and a large tear + displacement of my lateral meniscus.
April '09 - ACL reconstruction surgery using quadrupled Hamstring tendons, plus removing 60% of my lateral meniscus.

• For the next 10 days I had an immobilizer + crutches, and I was allowed to ditch one or the other (not both).
• After that, I was allowed to ditch both the crutches and immobilizer.
• Standard rehab for the next 2 months.
• Started light jogging at 3 months.
• At 4 months, started plyometric routines + more quicker agility stuff.
• Started personal training at 4.5 months post op, 2 days a week (about 5 times as intense as physio)
• Received the green light for sports at 6 months post op. Started playing Ultimate Frisbee again

Problems that arose and their fixes:

• 3-4 days after surgery, I had immense pain when standing up. This was apparently due to blood rushing. Massaging the affected area helped relieve this pain. Problem went away on its own in 5-6 days.
• At 7 Weeks I had a large amount of pain on the outer side of the knee when walking. I started using a foam roller to massage my IT band and the problem went away within a few days.
  
• At 7-8 weeks post op, my knee starting catching when going from straight leg to a bent one. This affected walking. My physio guessed this was the inflamed bursa sacks or possibly scar tissue. Stretching the quads helped stop this from occuring for a bit. (although it would eventually come back). It wasn't until about 7+ months post op that I stopped noticing the problem.
• Tingling in toes. This actually started before surgery. Sometimes my middle toe on the injured leg would start tingling. I never found out what caused it but I haven't felt it in the past 3-4 months. I even forgot about it until I re-read parts of my blog.
• ~ 8.5 months post op, I had a little bit of swelling a day after an ultimate game. I took a break for a week and tried to run again, but started feeling very strong pain around my kneecap when running (even a light jog). Doc said a weak inner quad muscle + tight IT band was probably the problem. I had my trainer focus a lot more on the inner quad. 3 Weeks later I was fine running again and the swelling hasn't returned.

The current situation:

• Knee feels fine when running / jumping.
  
• No more swelling
• Large tennis-ball size area around incision is still partially numb.
• Inner Quad is looking damn good.
• Surgical leg is still smaller than good leg.
• Still seeing a trainer twice a week
• I'm still very nervous when I first step out onto the field of an ultimate frisbee game.
• I'm still somewhat cautious cutting while an opponent is close by.
• I was able to walk 4 hours without any problems.
  

The future:

• Starting in May I'll be playing Ultimate 3 times a week. It'll be great to play again in nice sunny weather!
• I'll be seeing a trainer once a week to keep my legs strong.

Although I'm not at the same level I was before the injury, I'm happy to be playing Ultimate Frisbee again. Sure, there are still issues: knee clicking, cracking, stuff moving around, knee getting stiff when standing for long periods. But overall, I can't complain.

Time to enjoy the summer!

11 Months Post Op!

The recent (2 months ago) pain / swelling in knee is now gone. Although my left leg is still smaller than my good right leg, it is noticeably bigger than before. All the strengthening I've been doing for the past 2 months has paid off! I'm back to playing ultimate 2-3 times a week with no pain.

Unfortunately, I've also found I've gotten into the old bad habit of playing careful with my surgical leg and am overloading the good leg more. This is a no no, and hopefully I'll get more confidence back into my leg and treat them equal!

Even though I'm 11 months post op and my new ACL should be rock solid, I'm still nervous while playing and won't make the aggressive D's if the cut is too hard. Hopefully this will go away with time.

Goals for the next month:

• Make surgical leg bigger / badder / stronger
• Treat both legs equally
  

10 months Post Op!

Over the past month I've been slightly out of commission for ultimate as I re-work my inner quad and IT band. On Tuesday I was able to play a game without any pain and no extra swelling.

I've been doing 3 exercises every morning (wall squat hold for 30 seconds x 5, reverse lunge hold x 10, IT stretch with foam roller). I can feel quite a big difference in my inner quad now than before. Although it is still smaller than my good leg.

My physical trainer sessions have revolved around my surgical leg. Basically 30 minutes of pure burning for my weaker leg.

Goal for the next month:

• Try to get both legs equal in size.

follow-up

I visited my sports doctor today to go over the pain in my surgical knee when running.

Apparently the pain in my knee from running is from the kneecap not tracking properly and it's from both a tight IT Band and a weaker Inner quad muscle. The good news is that it's nothing to worry about. He recommended 3 things:

- hitting the foam roller every day to smooth out the IT band
- more strength training for my inner quad.
- wear a knee sleeve during sports to help the kneecap track better.

He also mentioned my surgical acl is slightly looser than my normal knee but that it's still perfectly normal and nothing to worry about. The surgeon tries his best to make it match the other leg, but sometimes it doesn't work out that way.

9 months post op!

One step forward, one step back.

The swelling / extra fluid that showed up 2 weeks ago is completely gone. Even the fluid that was there normally after surgery is gone, which was a nice surprise.

However, I now have pain in my knee while running. The pain is located above the kneecap. Funnily enough, going from a stop to a run doesn't hurt, only when I'm running at a steady pace. My guess is some form of quad tendinitis / overuse injury, or possibly cartilage damage. Unfortunately, the 2 weeks I took off didn't help as during my ultimate frisbee game last night I still felt pain while running and was relegated to guarding the "slow guy".

This is my 9 months post op post, and unfortunately this past month hasn't been too great. However, the acl is still in great shape and my knee is completely stable. At this point I may have to take some time off depending on the what the doc says.

Swelling

... and just when I thought everything was peachy clean.

Last night my surgical knee had extra fluid in it. I'm not even sure when it got there as I didn't notice until I was about to hit some zzz's.

The past week:

Tuesday: Personal training - Worked entirely on jumping / plyometrics
Wednesday: Surgical Knee was sore going up / down stairs
Thursday: Personal training - various strengthening routines for quad / hamstrings
Friday: same soreness as Wednesday.
Sunday: Played high level ultimate frisbee game. Although knee was sore, no pain / instability / swelling after game
Monday: pain in knee when going up / down stairs. Most it's been since surgery. Although not unbearable, still unusual.
Monday-night: Noticed my knee has more fluid in it than normal (since surgery)

Currently, there's very little pain when going up/down stairs, no loss in range of motion, no instability. Just a little bit of extra fluid / puffyness.

After doing some research I think it might be overuse and/or scar tissue irritation. But either way, I'll be taking a break over the next 2 weeks and give it time to relax. It's also possible my patella isn't tracking 100%. If it doesn't get better, I'll see a doctor / physiotherapist in the new year.

8 months post op!

99.9999999% back to feeling normal! My ultimate game last Sunday made me realize how much I've forgotten that I injured my leg. Which is a good thing as we're playing a higher level of ultimate now.

Personal training continues twice a week (30 min sessions) until my two legs are equal. My surgical leg is currently 1/4 inch smaller than my good leg.

I've been doing warm-ups before each game and haven't pulled my hamstrings since.

Stuff that has improved over the past few months:

• still a large spot below the knee cap that is partially numb, but I'm slowly feeling it again.
• the catching problem doesn't happen anymore, although I can sometimes feel like it wants to catch. It's a lot less noticeable now.
  
• the tingling in the toes only happens when I wake up, no longer during the day and it's quite minor now.
• size difference between my two legs is only 1/4 inch now. (down from 1/2 inch)
  

Goals for the next month are:

• Don't be tearing no ACL!
• Keep my legs strong!
  

7 months Post Op

Over the past month since being given the go-ahead for sports, I've been playing 2 days of Ultimate a week + 2 days of personal training (30 mins of pure torture for my legs). Overall, the knee has constantly been improving, I have more confidence in my leg, and with the intense PT sessions my muscle strength is coming close to matching my good leg.

I managed to do a full field sprint without feeling like I'm using my right leg more than surgical left, although I'm nowhere near top speed. However, I ended up straining my good leg hamstring and partially straining my surgical leg hamstring. Note to self: warm up before the game. This one seems obvious but I totally forget to do it and it's extremely important.

The knee catching still happens every now and then but it's slowly slowly getting to the point where I don't remember it.

I've also noticed some muscle anomalies with my surgical leg. When sitting on the floor with my legs straight out in front of me, and raising both legs (while straight). I've noticed the middle quad muscle in my surgical leg is very pronounced, whereas the right leg has all muscles balanced. Hopefully this is nothing to worry about.

I still have skin numbness below the kneecap on the outer size and about the size of tennis ball. If it's getting better, I can barely notice. I've read that the nerves take a long long time to regenerate.

Over the next month, I'll be sticking with personal training 2 times a week to get the surgical leg equal to my good leg.

My goal for the next month is:

- Do a proper warm-up before each game!

Ditching the knee sleeve and playing too much

Over the past 7 days I've played Ultimate: 1 hour on Monday, 1 hour on Thursday, 3 hours on Saturday, 1.5 hours on Sunday and I'll be playing 1 hour tonight. I told myself not to do this, but when someone asks "Can you sub for Ultimate", I just can't say no. However, while playing, I'm fairly conservative. I'm barely breaking a sweat by the end of the game (although my legs do feel a bit tired). I'm still cautious when changing direction and going for a long sprint. It seems when whoever I'm guarding goes deep, I don't keep up. This wasn't the case before the injury, so over the next 2 months this is my goal: Do a full field length sprint and keep up with who I'm guarding.

I've also ditched the knee sleeve as it wouldn't protect me from tearing anything and it makes me aware of my weaker leg. Right now, treating my surgical leg different than my good leg is a bad idea as according to this study, I'm about 3 times as likely to tear my good leg than bad. (2.8% vs 1%). That study also showed there's no difference in re-injury if you return to sports at 5 months vs 9 months (assuming patellar tendon graft was used). Also this study showed (and every other study I've read) there was no statistical difference in the outcome of acl reconstruction if you wear a brace or a sleeve.

I played against a guy yesterday who was recovering from his second acl surgery (he's torn both legs). Since I do not want to go through this process against, I'll be sticking with Personal Trainer 2 times a week until I'm treating both legs equal.

Last Saturday I had the unfortunate experience of seeing a girl go down while playing ultimate and hear the words "I was running and then I heard a pop". Hopefully not a full ACL tear but it still makes me cringe and feel sorry for her. On the bright side, at least I know from experience it's not the end of her sports career!

So my goals over the next month or two will be:

- Get both legs equal in strength and usage!
- Full field length sprint
- Don't play so much Ultimate (this will be a tough one!)

Turning 30 and playing Ultimate Frisbee

Today was my first Ultimate Frisbee game in 13 months. It also coincides with my 30th birthday which was a nice birthday present!

Overall the knee felt fine. No soreness or swelling. And although I played a pretty relaxed offensive game, on defense I played fairly hard. It felt great to play again! I wore a knee sleeve just to remind me not to do anything stupid. I feel like I'm still using my right leg more than my left, so hopefully more personal training will help solve this imbalance, or perhaps it's just a confidence thing and I just have to become more comfortable with it. Either way, it's Ultimate season for me!

Houston we have liftoff!

- Can I play sports?
- "Yes"

Oh, what a sweet sweet word.

I didn't know what to expect going in. I figured it was a coin toss 50/50 chance of being allowed to play. I put my cards and effort on the table and had to hope for the best. After a 2 hour wait to see a random doctor in the clinic, he gave me the good news and congratulated me for graduating the 6 month mark. Tested out the ACL and said I'm clear to play. No brace and no restrictions. Just go easy on it at first. Also, try and even out the 2 legs in terms of muscle size. Out of the blue, the massive headache I had all morning suddenly disappeared.

I'll be sticking with personal training 1-2 days a week until both my legs are equal and who knows, maybe I'll stick with a personal trainer forever. I figure the stronger my leg / core muscles are the less risk of re-injury or injuring the right leg. Lesson learned: don't tear your ACL.

Now, to find an ultimate team to sub for...

6 months Post Op

Yesterday was my 6 month mark since surgery. It's very hard to believe it's been so long since the surgery, but even longer since the injury. In 2 days I'll visit the surgeon for the go ahead for sports!

Over the past 2 weeks I've been in Ireland and about 7 out of the 10 days I did 30 minute rehab exercises in the morning. I also did lots of walking and hiking up cliffs:


Overall, the knee felt good. I had to do my regular quad stretches to get rid of the knee catching. One interesting event which gave me a lot of confidence in my knee was when me and my girl Alice were running around a cliff, going up and down the rocky terrain. At the end she mentioned how I didn't have reservations about running and jumping on the rocks. It was a defining moment that I didn't think about my knee and worry I'd re-injure it.

I feel like I'm ready to play sports again, now I just need the doc's permission!

2 Days Left!

24th Week Post Op!

As I approach the final 2 weeks to Judgment Day I've started to exam my leg, comparing it to my good one. It's currently 1/2 inch smaller than my right, which isn't too shabby. Agility drills are approaching a normalcy that I'm quite proud of now. I've started to do a regular jump off the left leg and it's feeling quite normal. Walking, however, has some minor issues but overall nothing too serious. The fat pad still catches every now and then, but a quick quad stretch fixes it.

I'm heading to Ireland for 10 days and since I don't want to lose all the muscle I've gained I'll be doing 30 minute workouts every morning with a combination of the following exercises:

drop squats, one leg raise onto chair, one leg squat with other leg in front, one leg squat with other leg behind, various core exercises, jumping jacks, cross country skier, 5 plate lunge, hammie drop, squat jump onto bed, and calf raises.

Due to the fact that this is Ireland I'm going to and beer is cheap, I highly doubt I'll be doing this every morning, but this is the goal!

12 Days to go!

22nd Week Post Op

22 down, 4 more to go!

I saw my physio for probably the last time this week. I only have to come back in if I have questions. Right now all my workouts are done with my personal trainer twice a week, but I'll probably bump it up to 3 times a week to makeup for the lost physio session. My PT is a bit more charismatic than my physio... ie "Don't jump like an old lady, jump like you're athletic!". The sessions are very very intense and I find myself barely able to walk afterwords, but this is exactly what I'm looking for.

The past few weeks of PT have brought a lot more confidence in my leg. They've also brought a bit more tingling in my toes. I'm not sure if this is something to worry about or not. It doesn't affect my ability to move my toes or any part of my leg / foot. From internet research, the best guess is that the nerve is getting irritated by either the remaining swelling or inflamation.

1 year since injury

Today marks the one year anniversary since my injury and the last time I played a sport. Cutting hard one way, then slowing down, then doing a 270 while speeding up caused my knee to explode. I'm a very fast / agile guy and my specialty is stopping on a dime and changing directions quickly. I've been playing sports for years and every game I'm running / cutting hard so why did it happen that game as opposed to any other? I've come to conclude it was a multitude of factors:

1. Playing 4 nights a week - doesn't give your muscles time to heal up. The weaker your muscles are, the more strain is put on your ligaments.
2. Quad / Hamstring ratio strength - I never did any exercises (lunges) to build up my hammies. Hamstring's protect your ACL. I never built up the muscles around the knee either. I'm sure my quads were way too strong for my hamstrings.
   
3. Tight Hammies - I never did any stretching and when attemping to touch my toes I was about a 1 foot away from them.
4. Turf field + Gaia cleats - locks you into the ground. The gaia ultimate cleats I use are kind of like football cleats and they provide very good grip. However, the turf field I was on sort of locks you in, ie. there's no give. Someone I played with tore their ACL on that field too.
5. Age - I was 28 at the time. Apparently when you're 18 the ACL can handle 3000N of force, whereas when you're 30 it drops to anywhere in the low - mid 2000N's.

I've been trying to find a silver lining to this whole experience and all I can think of is that I can possibly prevent others from going through this. Yesterday at ultimate practice I showed my team the exercises I do and tried to explain how important lunges are. It's something really simple to do every morning to build up muscles to protect the knee!

5 months Post Op!

5 down, 1 to go!

It's hard to believe it's the final month! Due to me moving places this month I've started to slack on routines. Thankfully personal training started up last week with some intense workouts which has really helped me build confidence in my leg. Also my cardio seems to be fairly decent (according to my physio).

I've also started to actually run for the disc now instead of the usual rumping. Although it's not a full out sprint, I do try and push myself to catch the disc regardless of how far away it is. It feels great!

Size wise, my left leg is still slightly smaller and still has some inflammation. But overall, the muscles are looking much better! The fat pad catching problem is still around but a simple 20 second quad stretch gets rid of it.

My goals for the next month are the same as the last month: Get that left leg to be equal to the right and have equal confidence in both legs!

One month left!

20th week post op!

20 down, 6 more to go!

I have to admit I'm getting a little nervous that in 6 weeks my left leg won't be up to par. Unfortunately this weeks' new pair of shoes has given me extremely painful blisters on my feet that has left me limping around on both feet and unable to do my physio. Personal training started this week, however, all he ended up doing was manual therapy on me... which is somewhat disappointing. Apparently we'll be starting on muscle strengthening next week.

My physio has tossed around the word "proprioception" but I've never fully appreciated what it meant until I started juggling while standing one legged on the bosu ball. Normally, both my legs are fairly equal while standing on the bosu, but add juggling to the mix and it's completely different. I can balance a lot better on my right leg while juggling then my left. This is good news in one way: I can measure improvements in the propriocepters in my knee while doing this routine!

I've also crossed the 50 day mark, woohoo!

19th week post op!

19 down, 7 more to go!

The last week has been good to the knee. More agility exercises were given (figure 8's, S's) Everything feels normal and I have to say I'm quite happy that I'm still fairly agile. I'll be starting personal training next week to help speed up the recovery.

I've also noticed the large patch of numbness below the knee is slowing fading away. I can actually feel things on it now and although it's no where near normal, I'm happy that it's returning.

My physio was examining my knee today and the difference in muscle strength. Everything looks really good as I'm approaching the size of the other leg.

18th Week Post Op!

18 down, 8 more to go!

I've started back up into physio 2 days a week now as I'm now cleared to do the harder physio routines. Most of the exercises are about legs & core and jumping onto the bosu ball. I found all the exercises fairly easy so I'm hoping for tougher ones for the next session.

I may pickup a personal trainer for 1 day a week at a gym mainly for 2 reasons: a) I'm finding it's becoming more difficult to push myself on my own and b) the physio place I go to (Athletes' Care) doesn't have a big area to practice running / agility drills.