ACL Class of 2013

[runningfortheslopes]

Anyone know of some good strengthing exercises to do? My quad is still not the size it should be and I just ran out of PT visits. I'm at 19 weeks out, almost full ROM (could still go 3 more degrees each way). Really want to get my quad back for ski season. Thanks!

[rottennor]

I am 8.5 months out. I bike, run, lunges, and jumping exercises and my quad is not the same size either. Keep working at it and add weights. Thats why they say it takes at least a year to heal. Good luck.

[MRG_girlwonder]

Anyone know of some good strengthing exercises to do? My quad is still not the size it should be and I just ran out of PT visits. I'm at 19 weeks out, almost full ROM (could still go 3 more degrees each way). Really want to get my quad back for ski season. Thanks!

Interestingly, my PT said to me that quads often do not return to the same "size," they frequently are smaller than pre-surgery. However, they regain all of pre-surgery strength with good training, if not even more.

Regardless if this is true or not, I'm feeling really great at 10 months. Ready to go w/full confidence. But there was a serious level of monotony, boredom and frustration months 4-7, feeling like nothing was ever going to get better. But it was working. Here are things that I've been doing in the weight room 2-4x week:

- I did 8-10 weeks of Cosgrove's "No equipment, no problem" workout - It's basic strength, often single leg work using a 25-35# dumbbell. Also gets in a lot of core stuff great for snow sports. PDF of the workout is free here: https://www.precisionnutrition.com/m...ead.php?t=5196

- (obvious one here) squats, as full depth as the surgery knee will allow, using rack, not smith machine.

- squats using a single dumbbell in left hand for 15-20 reps, no rest, then right hand. Fight to keep perfect form w/each rep no matter what. (this will highlight the R/L imbalance and challenge you to correct it over time). If it gets too easy, hold the dumbbell up (in a half "Y" ) and keep it up there and still keep perfect form, chest up and R/L symmetry.

- deadlifts and cleans w/low weight, or just even barbell, to get range of motion back (NB: I was experienced in these lifts for a few yrs prior to injury.)

- medicine ball tosses against wall, squatting down all the way on catch then dynamic explosion up to throw it again.

- anything single leg I could think w/dumbbells (bulgarian split squats, romanian deadlifts single leg, lunges, single leg squats on mini bosu thingy, standing on bench x1 leg and squatting down so opposite heel just graces the floor, then back up again)

You'll be rocking it by February.

[yendell]

Hi Folks, Am one week after my 2nd ACL graft on right knee and cam accross this forum so thought Id share some thoughts.

Technically im in class of 2011, broke ACL in right knee after making the epic mistake of carrying too little speed into a cliff drop in val d'isere, france and landing hard on the flat before the aim of the powder field below. Thankfully this was at the end of one of the best seasons at home in Scotland for many years. Had first surgery (hamstring) in September 2011 which failed after 7 months while walking down a mountain in Scotland. Personally I blame poor surgery in combination with poor physio care leading me to do too much too soon.

Having tried to ski 'sans ACL' last season and failed I have now just had 2nd surgery with a different surgeon reccomending the patella graft from my good knee and so far its looking good with very little swelling and bruising and am off crutches already but still taking it very easy and barely left the house for a week!

Having looked back at others stories in this thread I have a few throughts from my experiences.

1: Dont ski or do twisting stuff too soon, I was told hillwalking was fine after 4 months by previous physio. I now think this is utter boll**ks as the graft simply isnt strong enough by then.
2: Single leg squats are great for the knee and also muscle balance. I did them a lot before trying to ski without the acl and they helped my stability no end, unfotuntely not enough to ski any pow but a good do most easy pistes.
3: Brace, I used an off the shelf Donjoy metal hinged brace when trying to ski last winter with no ACL. It made a difference but i think more psycological. I could do the same simple skiing with a simple neoprene brace on and when it came to thre crunch I still managed to jar my knee when trying more techy stuff with the donjoy on.
4: Muscle size, After my first ACL i lost a lot of muscle. The definition came back quickly but the size took about the entire time between my first and second op (over 2 years) to come back. I acheived this by cycling to work pretty much every day for the last year and a half.

Am intereterd to read others experiences, are there any 2nd timers out there with any tips?

[pesto]

It sounds like there are a couple of people who have picked up Breg Fusion braces. Has anyone had a chance to try it with their ski boots? Any interference issues?

[Wildman]

Pesto - I been skiing 5 times in it. I have had zero issues with ski boot interference (Alpine, AT and Tele). The only issue I have had with the Knee brace is that it interferes with my BD telekensis knee pads (when tele skiing).

Also i have been wearing the Breg over my baselayer with litte to no slippage.

[Lindahl]

Thought this would be a good time to come back and comment on how things are going for me. 31 years old, athletic. I had a pretty simple ACL tear - was backseated on a flat landing, caught an edge, and it slowly tweaked until it popped. No real other damage (very minor meniscus tear). The injury was in February. I was able ski without the ACL until May, when I decided to get surgery - hamstring version.

Anyway, after 4.5 months, I was back skiing on groomers and touring, slowing stepping up speed, and tackling bumped up terrain. After 5.5 months I was back to sending 10-15' cliffs, slowly stepping it up to 20-25' at month 6. I was pretty focused on landing totally forward to completely avoid backseating anything. Probably won't step back up to 30-40' until Feb (month 9). It'd get a little tired at the end of the day, but I could ski powder all day long, jumping off everything in sight, for a full day, with only a small ping of soreness. Pretty stoked with the recovery I've had - very little difference in strength between both legs by 5.5 months (hamstring was most noticable). Haven't touched a brace since month 1.

Here's my exercise and recovery schedule (aside from normal PT ROM/strengthening).

1.5 months - road bike about 150 miles a weekend over Vail Pass and back (~50mi), plus 1 hour every weekday morning.
3 months - mountain bike about 50-80 miles a weekend (a couple 20-30mi, with a 10-20mi ride in between), plus 1 hour every weekday morning.
4.5 months - changed to a PT that works with professional skiers, much more aggressive exercises than you'd get with a regular PT

Here's the more advanced exercise regimen he had me doing (the more advanced ones started at 5 months):
A few advanced pilates exercises targetting the core
Jumping deep lunges (start in a deep lunge position, jump and land in the opposite deep lunge)
Jumping deep squats (start with your butt ALMOST resting on your heels, jump as high as you can and land back down into a deep squat)
One-legged wall sits
One-legged pistol squats to about 90 degrees
One-legged squats on a bosu, tap toe to side, tap toe to rear
One-legged jump onto a bosu, landing in a shallow squat position, stabalize, then jump off, landing in a shallow squat again (both laterally outside-and-back and forward-forward)
Sideways skater between two bosus
Lunges onto a bosu with a medicine ball in extended hands, and twist to the outside
Squats on an upside-down bosu with a medicine ball held above your head
Hip hinges with a couple light dumbbells (works hamstrings also)
One heel on workout ball, pull heel to ~butt, pressure heel and lift butt/back off ground, back down, and push heel back out (hamstring)

When I wasn't skiing, I spent 90 minutes exercising each day - 30 minutes riding my mountain bike, followed by 60 minutes of the above exercises (I split them into 2 routines). The routines focused on strength first, then finished up with jumping/agility. This was about 4 days per week. The other 3 days a week I was skiing (2 days touring, 1 day at the resort, skiing as much vert as I could and trying to flow through bumps as fast as possible).

Unfortunately, I got pretty unlucky and got injured again (non-ACL). Wolf Creek had a 50-60" base, but I still managed to hit a stump, directly under the ball of my other foot at full speed (probably 30mph) and cracked the bottom inside part of my tibia (medial malleolus). Definitely not an ACL or strength related injury, just a fucking well-placed stump. Pretty random, considering coverage was pretty much like typical Colorado mid-winter coverage. Anyway, I'm in a hard cast for another 3 weeks, and will be back to skiing in another 2-4 weeks. Probably can't charge and jump off stuff until February, but we'll see. Lots of one-legged hopping will probably make my ACL-reconstructed leg even stronger.. hah

Hope my exercise routine/schedule helps!

[bilkovet]

Pesto - 3 days so far using my Breg Fusion with no interference issues. I can't do a deep squat with it on, and multiple layer of clothing, and I also found it slips unless I wear it directly on skin which is a challenge for base layers.

Lindahl - It's always interesting to see other rehab routines. I've certainly not managed the hours you have but have tried to stay consistent since my surgery last December. Bummer about your fracture but at least they typically heal a little faster than soft tissue.

This week is my first back on snow and I have to say, after trying to power through on day 1 - it was after all a powder day - I've realized my knee isn't up to that yet. I've spent the last couple of days cruising the groomers which hasn't caused any issues at all. I know my strength isn't there yet so I'm suspecting that is what caused the patellar pain. Has anyone else had similar problems? I've had no issues biking, but struggled to get back to running because of the same reason.

[Lindahl]

Yeah, its a patella tendon issue. My PT said the best exercise for that was the pistol squats to 90 degrees (if you can - not easy, but hold a railing if you have to). You need a stronger butt/hips. You're doing them right if you don't feel much in your quads. Do em with both legs, it's a GREAT skier exercise, probably my favorite. Deep squat jumps will help too, but that could just aggravate it. If you need something easy, try step ups - it sort of hits the same places (but quads too).

The main soreness I still get is from the patella tendon, but its all but gone now.

[MRG_girlwonder]

I know my strength isn't there yet so I'm suspecting that is what caused the patellar pain. Has anyone else had similar problems? I've had no issues biking, but struggled to get back to running because of the same reason.

I had patella tenderness running and deep squatting until about month 9, and patella-tracking issues are still clearing themselves at a plucky pace. My sister also said it took forever for hers to go away after ACL repair.

[meggers]

hit the 6 month mark a a week ago and got the OK to ski after I pick up my brace. So stoked!
Been running 3 times a week on flat trails since the 4 month mark and it made all the difference as well as cycling and some yoga mixed in. Still have mild pain and stiffness but it is so much better than before surgery

Can't help but be thrilled about the clearance and hope all you continue to heal up, the hard work pays off!

[bilkovet]

It's interesting to see how quickly some of you are getting back to skiing.

My surgeon recommended I wait a year post-surgery before skiing, but I'm wondering whether this is actually more because of the Canadian health system. I had about a year after injuring it before I could get surgery (not by choice) but because of the instability there was a lot of things I couldn't do during the year - ski, mountain bike, run etc. I think because of the delay it's really slowed how quickly I've recovered.

I'm super happy to be back on skis after almost 2 years. Will be stepping up the PT to see if this helps as well.

[MRG_girlwonder]

It's interesting to see how quickly some of you are getting back to skiing.

My surgeon recommended I wait a year post-surgery before skiing, but I'm wondering whether this is actually more because of the Canadian health system.

Actually my doctor and all the surgeons at UCSF here in CA are starting to turn the tide back and waiting more than 6 months to return patients to sports (10-12months for skiing, soccer, basketball, tennis, etc). It's a teaching medical school, so when they saw a statistical rise in re-injuries/healthy leg injuries when the PT protocols were letting sports happen early and are hoping to see a reduction injuries within the first 1-1.5 yrs after surgery. But also, they don't require patients get a brace to ski unless patient wants it, unlike most other recommendations in the group here. Doctors are still humans w/their biases...like everything else in life, the sweet spot probably lies somewhere in between 6-12mos. Regardless, for us here in the Sierras, it didn't start snowing until last week and there's still not quite enough to rush out to...

[bilkovet]

It's -13 here today - so it's not my knee that's making me relucatant to go out!

MRG_girlwonder - Thanks for the info. Probably got a little too excited at the thought of skiing again, and need to remember not to rush. I'm hoping this knee lasts me a long time without further injury. I did get a brace (as recommended), but only to ski. So far, I've been glad to have it but primarily for my MCL. I had this replaced at the same time as the ACL and it still twinges quite a bit.

[Wildman]

Really interesting article on Grantland about ACL tears. Only a brief paragraph about skiing, but a good read nonetheless.

[perry_78]

Hey guys, a 2013 inductee as well. Took an inside edge in march coming out of some moguls at 10mph, gently tumbled to the side and hit the trifecta.

had surgery at the end of may BPTB ACLr, partial menisectomy and notchplasty (MCL took its time to heal and then my doc got ill, so faced a long layoff), nearly 7 months post-op. rehab has been incredibly boring and I hit every complication possible it seemed. post-op infection, long-term swelling, you name it i got it. the knee was progressing badly through rehab and putting any force through it was an issue even at 5months post-op.

i was out on sick leave from my work for 6months, and decided to move back home to copenhagen in denmark which is the land of the bicycle and decided to spend serious time in the pool with flippers to work on the leg. wheher it was just natural healing or the change of rehab from 'boring pointless gym' to 'i bike everywhere and swim an hour a day' finally now at 7 months out i feel that it's going somewhere. due to near total muscle hypertrophy as a result of 6 weeks pre-op bracing and post-op infections, the muscle is still very weak and i'm going to skip this season rather than increase the risk of going through it again.

that said i don't think i'll ever comfortably ski the at the time 9 days old equipment which blew my knee. i've had tons of high speed crashes (once hit a guy during GS training and miraculously both of us walked away) but the little tumble took me out.

[NSOutWest]

Hey guys,

Technically class of 2011. Three day skiing bender on almost no sleep; spun a 360 off of a small jump and caught an inside edge. Tits up in the rhubarb. I was absolutely exhausted and stupid to have been skiing.

I damaged my ACL/lateral and medial meniscus. Surgeon did a hamstring graft and excised of a piece of one meniscus, forget which. Cycled 50-75km five days per week during the summer, been doing mostly strength training since September. Loads of pistol squats and some slacklining, the occasional bike jaunt. Running a lot, and swimming occasionally. I did not know how to form a good workout routine, and am still learning.

My hamstring is definitely not where it should be. I really didn't have much idea where to start with physio, my therapist was pretty lax. Should definitely have read this thread sooner. Going to completely revamp my routine.

Just got onto skis today due to the slow Canadian medical system. I definitely tweaked something. Popping off of jumps became painful after a few hours, and fully extending my leg after getting off of the chairlift caused a sharp pain that subsided when I stretched, which only came back after I sat down for a period. Carving hard turns and doing anything but vertical, joint-separating movement was fine. Now walking around the house is giving me sharp pains.

Going to call the doctor Monday. Any thoughts in the meantime? I really don't want to have to stay off of my skis for any longer, but if I must...

I feel like I may have simply overstretched it, but that pain was reminiscent of post-op pain from moving the graft.

Also, any recommendations on where to start learning about forming my own exercise routines? I've read a few books, but with the wealth of knowledge out there it's hard to know where to start. I have yet to read the previous threads, but I will.

Thanks for all the incredibly helpful posts. Major thanks.

Cole

P.S. this post may or may not come across as completely brain-dead. Exam period will do that.

[Lindahl]

So you went from no skiing to going off jumps? That might be half the problem. Ease into it man. I spent about a month on skis before getting back to cliffs.

[bilkovet]

It's been just over a year since my surgery so I thought I'd post an update.

Started skiing about months post-op. First day back skiing was definitely hard on the mind, and knee but things have only got better since then. The patellar pain has mostly gone, only coming back when I really push my knee. On Saturday I managed a good powder day in resort and was keeping up with my buddies for the first time without feeling I was overdoing it. Building confidence every time I go out.

Pleased with the Breg brace. It took a couple of fittings to get it right for me but so far it's already probably prevented a couple of knee tweaks when I've hit ice, or bumps I didn't expect.

My knee since skiing has generally felt a whole bunch better. I'm not sure whether it's the extra intensity, or just a mental thing but it's nice to wake up each morning and not find it's the first thing I'm thinking about.

My first backcountry hut trip since the injury is in 2 weeks. Needless to say I'm stoked for the rest of the season

[MRG_girlwonder]

It has been a slow winter in sierras, so as long as I'm recovering from surgery, I am sitting out until we get enough natural snow. I did however ski 2 hrs over the holiday week on the man-made just to test out the knee (it was about 10 month mark).

When I carved a turn and really had to use my edges and my surgery leg was the downhill leg, I still felt mild tenderness in the tibia around where all the drilling and my bone bruise was. Anyone else still feel it a little bit? Sometimes also when I run. Never any pain that alarms me...but just curious who else out there is having similar.

My bone bruise from the accident was significant and they said it would take over a year to clear, so it could be mostly that. Drilling through the whole thing can't help, though!

[bilkovet]

I still get tightness around the same spot, which used to also be tenderness. When I asked at my year check up apparently it's just scar tissue around the drilling point/insertion of the graft and can take up to a couple of years to resolve. Interestingly the more stress I've put on that area, the faster it seems to resolve. I'm guessing the scar tissue is being stretched when I'm doing more. I had the same issue around my MCL repair which finally seems to be settling down. I also had a similar feeling around my thigh where presumably the upper graft went through although that seemed to resolve faster.

[ate'em]

Just want to update with a big FUCK YEAH! for getting back on snow yesterday.

10 months post-op from ALC/MCL/meniscus reconstruction, I snowboarded bell to bell in three feet of fresh. My knee felt a little wierd, mainly in the scar tissue of the Patella Tendon area from the graft. Overall, snowboarding seemed really good for my knee. It felt better at the end of the day than the beginning, and it feels better today than it has since surgery.

I kept it mellow, no airs. Still nervous about skiing with all the torque, but that will come in time.

PT is the key. Hard work pays off. I couldnt even imagine yesterday coming, but it did. And I am stoked.

[runningfortheslopes]

So awesome to read about everyone coming back to skiing! Just thought I'd do a little update of myself. ACL and meniscus repair surgery was June 25th so the 6 month mark was on Christmas day. My first day out was the 27th (bf's birthday). While I was SUPER nervous, it went better than I thought it would. I was able to ski to about 80% of my ability, probably more now. I got a custom Don Joy brace and that has helped a lot mentally. I am hoping to only use it for this season. The only thing I notice is that my legs get tired pretty quickly, but that could be that I am actually skiing in the correct position rather than making up for not having an ACL. I need to be more diciplined about strenghtening exercises, but I have tried to encorporate running more into my life. Yoga has also helped a ton. I do have stiffness when I sit for longer periods so I try and walk around as much as I can and prop it up under my desk.

Good luck to everyone out there. I know it is super rough at times, but it is worth it end the end.

[MRG_girlwonder]

Great to hear! I'm really impressed w/all you hitting the slopes at 6 months. I wouldn't have dreamed it the way my non-surgery leg was still over compensating!

I will reach my 1 year mark this week. I don't ski with a brace, and am glad I took my time this season slowly letting my surgery leg remember how to do equal work so I build confidence that it could handle skiing again. My first few ski days were 1-3hours on groomers. I'm now back on top of the moguls and able hop jumping in the heavy sierra powder. I stopped feeling the stretching of the last scar tissue buildup recently, so really feeling like I'm finally 100%!

[famid]

Hi everyone,

First timer here. I joined the club on January 5, up in Aspen. Tore my ACL with a partial tear to the MCL, LCL and meniscus. Last run, last day. Skied alone because my flight was canceled and everyone else in my group got out. Pretty cliche, pretty horrible. Wasn't focused and attacked a cat trail head on from a steep. Made a last second turn and my ski got caught, but my body kept moving. Had to ski the rest of the way down and heard another pop and crumbled to the ground. Skied the remainder on one leg.

It was a pretty rough ride, and had to wait it out six weeks for surgery. Saw a bunch of docs and ultimately had the surgery just over two weeks ago. BTB patellar autograft. Luckily, the MCL and LCL didn't require any work, and the meniscus was a bit torn, but stable, so no work there either. Just the ACL replacement.

The first 72 hours post op was hell. So much pain, even with the painkillers. Was on a CPM machine for eight hours a day until my first post op visit 12 days later. Also had to spend another two hours doing the towel under the ankle leg straightening exercise. Wasn't pleasant, but I just got the stitches out five days ago and started PT. Getting better day by day. Was able to turn the wheel on the stationary bike two weeks post op and I'm told I might be getting rid of the crutches and brace in a few days. Hoping for a speedy recovery.

My goal is to ski Japan over the holidays next year. Any thoughts on whether this is possible?