Nymeria soaks in the bacta tank - (ACL reconstruction and rehab log)

[Nymeria]

I had huge plans for the first few challenges of 2014.  I was finally at a point where I was only using 4-5" of offset on my HSPUs, and I was using less and less assist on my full depth pistol squats.  I was also incredibly close to climbing my first V4.  I was going to go on a huge cut and lose 5-10 lbs.  I had huge plans and huge dreams. 

 

And then, one ill-fated climbing fall destroyed my knee.  Poof.  In an instant, all of my plans were destroyed, and I'm now facing a long and grueling rehab process so I can slowly begin to walk, drive, lightly jog, and do all of the other things I've taken for granted for so many years.

 

Since I can't really set normal goals, other than to cooperate fully with my physical therapists, I thought it would be interesting to do a daily log of my surgical reconstruction and rehabilitation process.  Plus, I'm sure the whole thing will be incredibly frustrating, so I could really use the support and encouragement of this community. 

[Nymeria]

The beginning of the story:

The Saturday before Christmas, I set out to do my normal 2 hours of climbing.  I was incredibly excited, because they had just re-set the walls, and there were new routes.  After finishing one route, I jumped down from the wall with my feet maybe 8' off of the ground (as is typical for bouldering).  Unfortunately, I didn't see that one of the ropes for top-rope climbing was tied off and hanging much lower than it should have been.  On the down jump, my foot snagged, and I ended up hanging upside down by my ankle, with the force from the fall twisting and hyper-extending my knee.  I managed to free my leg, and then spent the next few minutes rolling around in pain while cursing profusely. 

 

But, then the pain started subsiding, and I thought that maybe I wasn't too badly hurt.  Maybe it was just a minor sprain.  After trying to walk it off and icing my knee for a bit, I could tell that I really did need to see a doctor.  So, we headed to the ER.

 

Initial tests showed a minor break in my tibia near the knee and that my MCL was "loose".  Okay.  That didn't sound so bad.  They estimated that I would be non-weight bearing for 3-4 weeks, but then everything would be healed.  Even fully torn MCLs are self healing, so I would not need surgery, but would still need some rehab.  I felt very optimistic that I could spend that month working on pull-ups, and then be back on the climbing wall, as strong as ever.

 

Then, a follow-up with an orthopedics doctor and an MRI, however, revealed that not only was my MCL completely torn, but I also completely tore my ACL.  Ouch!  ACL tears definitely require surgery, and then you're doing painful rehab for a long time.  Maybe in 6 months, I'd be able to return to climbing.  And maybe it would be more like a year.  I was pretty devastated by the news.  I've worked so hard over the last year, and now I'm stuck starting again at level 0.  Plus, I have two small children to take care of, and it's overwhelming to imagine not being able to walk without crutches or be cleared to drive for a full 2 months after the injury. 

 

I'm not ashamed to say that I spent a fair amount of time crying and moping.  I also "coped" by some escapism in the form of re-reading the entire Harry Potter series while beached out on the couch.  Now that surgery is scheduled, and I have more of a timeframe on what to expect, I'm much closer to a point of accepting the whole thing. 

[Nymeria]

Now that I'm 12 days post-injury, I can give the timeframe for this type of thing.

 

Days 1-6 - stuck in a fully locked out knee immobilizer and on crutches.  Moving around was difficult.  I had some plans at the beginning for doing some pull-ups or DB work, but I just couldn't get in the mood.  Plus, getting around on crutches is much harder than it seems.  I actually wasn't in that much pain.  Honestly, I hear a lot of stories about people who tear their ACLs and are more or less unaware of that.  If I hadn't also torn the MCL, which caused my knee to buckle really badly when bearing any weight, I could easily see myself not having visited a doctor, wrapping and staying off of the knee for a bit, and then assuming it was a sprain that healed.

 

Days 6-10 - I was able to switch my immobilizer for a locked out hinged brace.  Getting around is still awkward, as is sleeping in the brace, but at least it is more comfortable than the immobilizer.  It's heavy, though.  Day 6 was when I learned that my ACL was torn.  I expected to schedule the surgery right then and there, but the doctor told me that it's customary to wait until around 3-4 weeks post-injury before doing the reconstruction, so the swelling in the knee is mostly gone and the range of motion has mostly been retained.

 

Day 10 - the brace was unlocked, giving me full range of motion.  At first, I could only bend my knee a little bit, but I've made a point of working on my ROM, and while I'm not quite up to 90 degrees of bend, I'm getting there.  I mostly worked on hamstring curls, where I'm using the weight of the brace as resistance.  I was also told that it was okay to do a little bit of weight bearing on my injured leg.  It feels very weird to try, but I have managed a few seconds here and there of balancing only on my injured leg.  The doctor said that as long as I'm wearing the brace, I can't really damage anything.  I just might make myself really uncomfortable.

 

Day 11 - I must have been overdoing the leg work a bit, because I had a small fall when I was heading down some stairs out of the house (stairs + crutches can be tough).  Fortunately, I could control the fall and land on my rear.  This scared me a little bit, and I'm now waiting until physical therapy to "work" my leg too much.

 

Day 12 (today) - I tried to do a dead hang pull-up, but I couldn't quite get there.  Either the inactivity or the extra weight from the brace was too much.  I did a couple sets of pull-ups starting with slightly bent arms and some flex hangs.  It feels great to be able to at least do something.  Tomorrow, I have my first "prehab" physical therapy session.  It's great that I can meet and work with the physical therapists for several sessions before the surgery.  They're going to be torturing me for a long time after surgery, so it's nice to be able to get a bit comfortable with them now.

 

Surgery is in 2 weeks.  I imagine they'll be a very long 2 weeks.

[Nymeria]

Friday, 1/3 - Met with the physical therapist, and started working on exercises to help with my knee ROM, as well as some strengthening exercises for my leg muscles, so they don't end up becoming significantly weaker from the inactivity.

 

I also learned that it will be *at least* 3 months after surgery before I'm going to be cleared to do one legged top-roping, and at least 6 months before normal top-roping.  Bleh.  I'll probably get to start working on yoga again in some capacity maybe 6 weeks after surgery. 

 

I feel like kind of a wuss, since I've read so many stories of people who went ahead with the one legged top roping right away, but I'm also concerned with the long term health of my knee.  It'll be hard to hold myself back, but I want to follow my PT precisely, so I can be sure my knee rehabs properly.  As soon as I feel a bit more up to it, I can at least work it on the pull-up bar and hangboard.  Maybe some concentrated effort there will result in being stronger than ever when I'm finally cleared to start climbing again. 

[Elastigirl]

I think reading Harry Potter is a great way of coping. So frustrating for you, sorry. I think you are wise to listen to the PT. Maybe some people do things anyway. But then they take longer to heal, or have problems later on. Patience now will help you heal. Pushing it will only potentially cause long term problems. 

[Nymeria]

Yeah. I'm not young enough anymore to ignore doctors and hope for the best. I really need my knee to heal. It's just going to be very frustrating.

I actually am hoping I can return to the next challenge, and focus on something unrelated to my injury, like pull ups or L sits. I've been trying to lurk on the assassin board to see what people are doing, but it's kind of depressing to see everyone else working on cool stuff while I'm feeling left behind.

[Nymeria]

Saturday, 1/4.

The PT routine right now is twice each day to do a set of gastroc stretches, knee ROM stretches, heel slides, knee extensions, hip flexes, and hip abductions.

It's nice to be permitted to do something, and it feels good to activate my leg muscles again after 10 days of immobilization. The knee ROM exercises aren't exactly painful, but I feel a lot of pressure and tightness that can be hard to work through. It kind of makes me paranoid that I'm somehow damaging something in my knee, even though the doctor and PT assure me that working through the pressure is exactly what I need to do. I've finally reached 90 degrees of bend.

I've also started doing 2 sets of flex hangs on my rings. I'd love to do more, but the pull up bar and rings are upstairs, and I'm not mobile enough to go up and down the stairs multiple times per day. I can't manage any dead hang pull ups right now, but that's not surprising given the extra weight of the leg brace.

[Nymeria]

Sunday, 1/5. Continued with my PT. I timed my prehab routine, and it takes 18 minutes. So, since I do that twice per day, it's just 36 minutes. The scary part is that the post-op physical therapy is supposedly much much longer.

I added hollow holds to the end of my routine, and I'm doing pull-ups and flex hangs in the morning and evening. I'm close to being able to do a pull up with the added weight of the leg brace.

PT was a little frustrating in that my knee ROM seems worse today than yesterday. I'm sure I will have to get used to that, too, as I bet it will be common to deal with that over the next few months. I'm pretty antsy, and really wish I could just have the surgery now.

[obax]

Good luck with all the prehab and rehab! I agree with Elastigirl that it's wise to listen to the PT. I've never dealt with an injury of quite the same magnitude, but I've had my share of bumps and bruises. It was always in my nature to push harder than advised, but with a more recent injury, I let patience rule and found a lot more success long term.

 

I've always found the hardest part to be, in the beginning, to trust that what the PT says will actually get you better, which I think you're experiencing a bit with the less ROM today versus yesterday. Sometimes it feels like you're taking a step back rather than forward and it's hard to trust that what you're being told will move you forward eventually, but it will!

[KB Girl]

Hey Nymeria!

 

First just wanted to say that I can only imagine how much this must suck for you. I'm really impressed you're already positive enough to be doing extra work like the pullups and actually sort of starting to plan how to go from here. 

You're not a wuss at all, you're actually so badass that you're still inspiring when you're about to have knee surgery, damn. 

 

How much does the brace weigh? Sounds like you're already getting stronger

[Aeryn]

Aha, found your rehab thread - I'm glad you're recording it all here. I'm sorry the knee wasn't the minor injury you'd hoped, but it sounds like you've got a good plan going forward. I hope the healing goes well!

[Paradigm]

Shit I totally missed the injury and the need for rehab I'm sorry it's not something super quick to get over. But I'm glad that you're doing the appropriate steps to get better. Please keep us updated, will be thinking of you and your rehab!

[Yuen]

Hey Nymeria, I'm really sorry to hear about your injury.

 

If we combine the two of us we could probably manage a full body routine together

 

I know its small consolation - but an ACL injury is something that it is possible to have a excellent recovery from. On the forums Chairohkey and Donar have both gone through the surgery and rehab. And the world is full of sportsmen and women who have successfully returned to their chosen fields post ACL recons. So while it is quite the setback, I guess you could also look at it as the fall could have been a lot worse!

 

It sounds like you have a good surgical and PT team. The ideal prehab for ACL surgery is

(1) To obtain a painless full ROM at the knee prior to the surgery

(2) Do the surgery before 6 weeks to avoid significant arthrofibrosis (scar tissue within the joint)

(3) Allow the MCL (if injured) to partially heal before the surgery - which is part of the hinged ROM brace's function.

 

You sound like you are heading towards all of those goals! Nice work

 

The knee ROM exercises aren't exactly painful, but I feel a lot of pressure and tightness that can be hard to work through. It kind of makes me paranoid that I'm somehow damaging something in my knee, even though the doctor and PT assure me that working through the pressure is exactly what I need to do. I've finally reached 90 degrees of bend

 

That is great that you are at 90°! Have you also been able to achieve full extension of the knee?

 

The pressure and tightness you feel in your knee is due to the blood and swelling in your joint. There is a lot more 'stuff' in the knee joint than there normally is. When you straighten and bend your knee, you alter the theoretical volume of your joint. When you fully flex you knee for example, it decreases the total potential volume of your joint. In your case because there is so much blood and fluid inside, it increases the pressure within the knee joint making it feel very tight.

 

You are definitely not hurting yourself by doing this however - and you should continue to work towards obtaining that full ROM. Your progress can have some daily ups and downs due to the change in swelling and blood inside your knee joint. Elevation and gentle cold packs can be your friend here.

 

 

 

I've also started doing 2 sets of flex hangs on my rings. I'd love to do more, but the pull up bar and rings are upstairs, and I'm not mobile enough to go up and down the stairs multiple times per day. I can't manage any dead hang pull ups right now, but that's not surprising given the extra weight of the leg brace.

 

You mentioned in my challenge thread that you admire that I've "rolled with the punches and modified the routine to focus on what you can do, rather than what you can't do".

 

I think I admire you in exactly the same way! You've hurt your legs and are diligently working at weighted pull ups and flex hangs. I've hurt my shoulder and am launching myself at weighted pistols! I don't think you're being "mopey" at all. Well not any more than any normal person with normal emotions would feel after being in your situation.

 

Heck you could even progress if you wanted even with ACL surgery and prehab and rehab. You could get your husband or partner to move the pull up bar and rings to a doorway downstairs (or even just buy a second one ). Watch the overtraining and elbow tendonitis though!

 

Also if you had the extra time to think about it, you could even go Donar and Waldo style macronutrient and calorie counting. You could do an awesome cut - losing fat while retaining lean muscle mass in your upper body. Your legs might get a little wasted... but isn't that the perfect climbers body? :)

[Nymeria]

Thanks, everyone! It really helps to know that I have so many people supporting me through this.

The brace is actually only 3 pounds. For whatever reason, it felt so much heavier. As soon as we weighed it, I knew I shouldn't have trouble with the pull ups, and that it was all psychological. So, I managed a couple sets of pull ups last night, and a couple more this morning.

Yuen, I do have full extension, and I've actually had that since day one. My knees naturally hyperextend a bit, so technically full extension is not quite full ROM for me. Mostly my PT exercises are ROM ones and quad activation ones, in the hopes that it will help minimize my quad shutdown from all of this. I'm actually not getting the mcl surgically repaired, since the rupture was right in the middle, and the doctor thinks it should heal and rehab fine when I'm doing the acl rehab.

Maybe I sound less mopey online, but I've had a very tough time coping with this. My "job" for the last 5 years has been taking care of my kids, and I'm not in any physical shape to do so right now. So I feel really aimless. If I had a desk job and could still work, I'd know what to do with myself, but right now I just feel like a huge burden on my family.

[artemiscuous]

Nymeria, thanks for continuing to post through rehab! I love your thread title, btw. :-) 

 

If you are like me, you have really high standards for yourself - and it sounds like it, from the "huge burden on my family" thing. I do understand! I obviously can't tell you about your family, only mine - and I know that my husband would probably not always be the most cheerful while picking up my slack in a situation like that. But at the same time, he would not want me to feel bad about it and would want me to make a full recovery! So, you know, feel your feelings, let your family feel their feelings, but keep that perspective that they love you and that your value is in your presence, not just what you physically do every day for them. Try to keep it light - which is a challenge in and of itself. As G.K. Chesterton said, "It is easy to be heavy; hard to be light." But that's something my best friend has to remind me, no joke, all the time - "Artie, stop taking yourself so seriously! It doesn't matter! It's all okay. Just be here now."

 

I think there is another dimension to it as well - that it's been your job and now you can't physically do it. I actually do worker's comp. That's an extremely common reaction to being put out of work and often leads to injured workers being prescribed antidepressants (especially if they are in pain from the injury). So what they have found is helpful for prevention is starting a project that engages the mind fully. So for example, writing a story that requires some research, or making something that can be sold (my friend once took up carpentry when she injured her foot playing rugby and made like a million coffee tables; another one did knitting, but I could never stay focused on that). I think re-reading Harry Potter probably does that for a period of time, but of course they are over far too quickly! So anyway, just a suggestion, since you can't do L-sits 10 hours a day. :-) I think it is great to keep on doing what you can, physically, though. I bet your shoulders will be ripped by the time you get back on the wall! 

 

Anyway, again, thanks for continuing to fight the good fight! It's so good that you're being proactive. I am excited to "watch" you make a full recovery!

[KB Girl]

Funny how the mind works, glad you were able to do some pullup sets then! 

 

How is your family doing? Do the kids understand what's going on?

Artemis has a really good suggestion actually, something to do. Maybe preferably something productive but if you need any book tips just let me know. 

[Nymeria]

Physical therapy exercises are still going fine. I somewhat feel as if my ROM work is stalling, but it also might be pretty normal to be stuck around 90 degrees, given that there's still swelling in the knee. Also, it might be that each session gives half a degree or so of flexion, which would mean the PT is helping, even if I don't readily perceive the changes.

I'm also doing 6x per day a single dead hang pull up followed by a very slow negative. I think most of my mental hang up with the pull ups is a fear of losing my grip or coming down to the ground fast and uncontrolled. So, this is a way to exercise while maintaining control. I'm also doing 40 sec hollow holds with my PT.

I'm still trying to figure out something productive to do with my time. I should try playing the piano again. I can't really do the damper pedal right now, but I guess it's a chance to brush up on my Bach and Mozart (which don't generally use pedal).

I'm not at all surprised that injured workers often need antidepressants. I had an annual with my normal doctor yesterday, and after she saw the injury, she asked whether I wanted antidepressants or anti-anxiety meds. It's nice to have a doctor who knows me pretty well. I'm highly considering getting that Zoloft prescription filled.

The kids somewhat understand what's happening. They know that mommy is injured and can't take care of them, but they have years and years of being conditioned to expect me to take care of them. It's tough.

9 days until surgery. It really can't come quickly enough.

[Nymeria]

I have thought about doing a cut, but since I'm really sedentary, I have no idea what my metabolic rate is. I'm also hesitant to restrict nutrients too much when I'm trying to get my body to heal. Plus, I'm pretty dependent on my husband for meals right now, and I don't want to add to his burden by adding demands.

I'm hoping to just be mindful of portion sizes and snacking for the time being, and not gain too much weight. When I'm back to being able to care for myself and prep my own meals, I'll try to do a cut.

[Nymeria]

At the risk of throwing a pity party, I've been looking back over the last year, and 2013 really didn't treat me very well. I had a week of insomnia followed by a major panic attack (requiring a trip to the ER), two episodes with poison ivy, the second one requiring another ER trip, a steroid shot in the a$$, and a month of prednisone. Then we had a wasp infestation, where I had to kill upwards of 30 wasps each day inside my house for the better part of a month. And then I tore my ACL (and had another ER visit). Normally, I get through a year with nothing more major than catching a few colds and maybe picking up some sort of minor fever bug.

But, on the flip side, I managed to give up soda after being a 2 soda per day drinker over the last 15 years. I'm eating much healthier. I've made huge physical gains. I passed the first two actuary exams. So, life hasn't been so bad, after all. I'm so glad I've had the support of so many people on NF over the last year. It has really helped me stay sane and focused.

[KB Girl]

Oh I remember the poison ivy and the wasp infestation. And you've had lots of sinus issues too!

Glad there is a flip side pretty much just as big. Makes me want to give you hugs. 

 

Somehow I missed you were doing actuary exams, what is that exactly if I may ask?

[cgm]

I'm actually excited to find your prehab, surgery, rehab thread! You had a nasty fall, and I'm glad to see sharing your way through it. 

 

My wife broke her collar bone in September. She couldn't sleep in bed so I spent around four weeks sleeping on the floor beside the couch. And doing everything for our 18-month old. And doing all the household work. I know she was frustrated that she couldn't help, but I made sure she knew that I wanted to do it all for her. She needed time and space to heal and that's what I could give her. While her collar bone only took about six weeks to fully heal, I would do the same thing if it took her six months.

 

I hope the next 9 days go quickly for you.

[artemiscuous]

I'm actually excited to find your prehab, surgery, rehab thread! You had a nasty fall, and I'm glad to see sharing your way through it. 

 

My wife broke her collar bone in September. She couldn't sleep in bed so I spent around four weeks sleeping on the floor beside the couch. And doing everything for our 18-month old. And doing all the household work. I know she was frustrated that she couldn't help, but I made sure she knew that I wanted to do it all for her. She needed time and space to heal and that's what I could give her. While her collar bone only took about six weeks to fully heal, I would do the same thing if it took her six months.

 

I hope the next 9 days go quickly for you.

 

I love this, and second the 9 days going quickly for you. I hope you are able to do some piano practice or just have some fun!

[Nymeria]

Blah. Today, I'm having a poor ROM day. I'm in pain at knee angles I could hold painlessly yesterday. I'm getting frustrated with the apparent lack of progress. At least I will see my physical therapist again tomorrow, so I'll get more feedback on whether this is typical.

For today, I'm just going to do my 2 sessions of PT, and otherwise try to take it easy and ice my knee a lot.

I wish NF had a dedicated rehab board, so it would be easier to find people who are going through similar injuries.

[cobaltsword]

*hooded assassin appears*

 

Seeing what has happened it would be wise to rest right now. Not to tire yourself out but to let your injury heal. We assassins are strong, we bounce back.

But I still look forward to reading your thread as often as I can. I'll be watching ^^

[Elastigirl]

Blah. Today, I'm having a poor ROM day. I'm in pain at knee angles I could hold painlessly yesterday. I'm getting frustrated with the apparent lack of progress. At least I will see my physical therapist again tomorrow, so I'll get more feedback on whether this is typical.

For today, I'm just going to do my 2 sessions of PT, and otherwise try to take it easy and ice my knee a lot.

I wish NF had a dedicated rehab board, so it would be easier to find people who are going through similar injuries.

Good idea. Maybe ask about it