Something struck a chord this me recently regarding ACL reconstruction surgery and that is the mental aspect… the physical part is one thing, but what happens between the ears really does have its ups and downs! A good friend of mine suggested I should share the experience for others. I thought, but why… but here we are, if this helps in some way then this will have been a good thing. I’m not one for the written word, so please excuse the horrendous grammar and spellings lol!
I have written a little bit before about this, which you can read HERE, but if you just read on, as I go into more detail in this post.
Back in July 2018, whilst running the MMA session at Trojan Worcester I stepped in just whilst one of the lads went for a quick piss, not warmed up properly, I said to Shay, let’s just keep you warm and take it easy, so a little flow grappling, I went for a casual Harai Goshi (hip throw) something I’ve been doing since I was 7 years old and that was it…pop, click, crack and snap. The pain was intense, Shay quickly grabbed the ice pack and I hobbled off the mats… ugh, I knew it was serious.
Fast forward 6 months after recovery seemed to be going nowhere I booked in for an MRI scan which showed full tear of my ACL, a tear in my meniscus and cartilage damage, plus potential LCL tear which would be examined during surgery.
My surgeon Mr Molholkar wanted to go to consultantion with other knee specialist as he wanted to consider a procedure called a High Tibial Osteopathy; A high tibial osteotomy is a surgical procedure that realigns the knee joint. For some patients who have knee arthritis or a history of knee problem such as meniscus repair in 2013 and constant patella tendinitis, this surgery can delay or prevent the need for a partial or total knee replacement by preserving damaged joint tissue. When the joint damage is beyond repair, knee replacement surgery can correct this condition. But in certain patients, a high tibial osteotomy can can realign the knee to take pressure off the damaged side by wedging open the upper portion of the tibia to reconfigure the knee joint. Weightbearing is then shifted away from the damaged or worn tissue and onto the healthier tissue.
The idea of “wedging open the upper portion of the tibia” just didn’t sound like fun whatsoever and also had a long rehab, which at the end of it could still require the ACL reconstruction, so I was very pleased to hear them conclude that opting for the ACL was the best option… phew!!
On the 14th December at 12noon I was put to sleep… 5 hours later I woke up to the most intense pain imaginable, it was ridiculous, I was literally climbing the walls with pain. I was given liquid morphine that took the edge off but dear god it was rough!! Lying in the hospital bed 4 doses of morphine later, they gave me Tramadol, now at the time it was amazing, sent me off to sleep for a few hours and the pain went to a dull ache. Thank the lord. I was then discharged from hospital with the sexy green stockings on and pair of crutches. Let the rehab begin!
The swelling and the pain.
It was clear this was gunna be a long road, just keeping on top of the swelling was a mission, icing every 2 hours and keeping the leg elevated.
The more quickly you can reduce swelling, the sooner you will:
- regain muscle fiber recruitment/activation
- reduce degree of quadriceps atrophy
- recover strength
- increase ROM
- lower vascular resistance
- maximize metabolic function
For the first couple of days the Tramadol dealt with the pain but the stuff is horrid; constipation, the feeling of fallen unconscious was enough for me to stop taking them. Enter CBD oil! I had been taking CBD since back in september and found great results in general well being and the knee pain I was getting pre surgery but came of it as didn’t want to mixed the anisthetic and other drugs I was about to be taking. I began taking approx 20mg of CBD oil and in particular Feel Supreme 500mg infused in MCT oil and it did wonders managing the pain and the inflammation.
The rehab drills I had were quite simple but very challenging:
- Leg extension
- Knee bends
- Up on to my top toes
- 30° mini squats
- Prone leg curls
The impossible patient
Managing the swelling was still quite the challenge, any progress being made in the gym was being stifled by swelling straight after, this is where the mental struggle started to come through. By nature I just wanted to get on, no fuss, but to be done with this and to get back to my usual way of life, driving the kids to their clubs, being independent and doing things for myself. Having to rely on others, my wife especially, was hard and to quote her “you’re an impossible patient”
Having to accept help for simple things like getting a snack from the cupboard or the ice pack from the freezer was infuriating! The feeling of helplessness wasn’t something that was going to sit comfortably for me, so it was time to double down and get on with the rehab.
Ps. took out my own staples… check out my Instagram lol!!
There is light at the end of the tunnel!!
I’d managed to get rid of the crutches and the swelling and pain was now managed. I was also getting to the gym 3-4 times a week and was back on the road not only for the kids, but for work (I’m a Sales Director, so traveling is part an parcel of the job)
Being able to get my independence back was a big turning point, I was feeling positive and rehab, with the exercise I’d been given was going really well. I was weight bearing and walking well, albeit with a limp.
At this point I was keen to see how my progress was going in comparison to others, so I took to Instagram and started following the hashtags #aclrecovery and #aclreconstruction and it was inspiring and deflating in equal measure! On one hand seeing others at the same pace as me was reassuring and on the other hand seeing the athletes seemingly smashing it made you realise how far there was still to go. I recall watching a video of a guy doing lateral jumps, and I remember thinking, no way!! At this point going down stairs was a challenge.
In terms of CBD I increased my dosage to 50mg per day, 25mg in the morning and again at night and I’d also started using the 300mg CBD balm from Four Five CBD to help massage the scar tissue which was building up.
Following a good visit with the physio who was very pleased with the my progress I was feeling great!
Rehab drills were the same as week 1 but more sets and reps and the inclusion of the following:
- Assisted TRX squats
- Abductor and adductor machine
- Step up and step down (approx. 1 foot height)
- Leg lifts, getting a good contraction in the quad
- Leg straighten with band resistance
Don’t push ya luck!!
Having had a really good week previously I decided that the watt bike and rower would be next!
At the time it felt good, so we cracked on… 2000m on the rower and 10mins on the watt bike, also did some dead lifts. I even got on the punch bag all excited!!
By the end of that week I’d realised that was a bad idea, swelling came back and the pain increased, by the end of the week I was feeling pretty low. It hit me hard. I was snapping at the kids and was generally a grumpy shit!! I’d taking 1 step forward but 2 massive steps back… I was gutted. This really was going to take time, all the while my weight was getting hard to manage (because I eat like a child) especially as my “go to” when feeling shit is a spoonful of Nutella! Watching all the fitness freaks on Instagram crushing it and maintaining there perfectly ripped bodies just makes you feel like a fat lazy shit, well fuck you im eating Nutella and not one fuck was given (apart from all of them were)
Rest and recoup
I was forced to take a week just getting the swelling under control and finding a good balance in my exercises, one that was challenging but at the same time not going over the top.
This week I had my follow up consultation with the surgeon and physio… the physio promptly gave me a dressing down and was far from impressed with my previous weeks antics and reminded me that the ACL grafts were not going heal by doing more. Just to explain; the ACL reconstruction that Mr Molholkar performed was a hamstring graft.
In a nut shell; the remnants of the original ligament are removed and the anatomic insertions of the ACL on the tibia and femur are marked.
Once this is done, holes are drilled in the tibia and the femur to place the graft. These holes are placed so that the graft will run between the tibia and femur in the same direction as the original ACL.
The graft is then pulled into position through the drill holes. Screws or special suspensory devices are used to hold the graft inside the drill holes.
No amount of additional exercise we’re going to speed this process of healing up, it simply needs time and every patient is different.
After surgery, the body attempts to develop a network of blood vessels in the new graft. This process, called revascularization, takes about 9-12 weeks. The graft is weakest during this time, which means it has a greater chance of stretching or rupturing. A stretched or torn graft can occur if you push yourself too hard during this period of recovery. When revascularization is complete, strength in the graft gradually builds. A second surgery may be needed to replace the graft if it is stretched or torn.
So it was fair to say I was put in my place!
I did however have a really good discussion with Mr Molholkar about my use of CBD for managing the pain. He was very interested to hear about my experience especially for people who seemingly don’t respond to traditional methods of pain relief. He went on to explain that some people just do not respond to pain medicine when experiencing chronic pain, so to hear that I’d had such a good response to CBD in managing the pain and inflammation was good to hear.
Rubbing salt in to the wounds, as a family we’d also decided that the skiing trip planned for the end of February was off!
I’d gone to a place of denial in terms of this holiday, “it’ll be fine” I kept saying knowing full well that there was no way I’d be able to ski but also just walking around on the ice would just be silly as one slip could mean complete disaster. We were all gutted, but the thought of going to the sweet shop and not having a sweet would just be miserable not only for me but for everyone.
Getting back to it.
After a week of rest and recuperation I was back at it with a more sensible approach, adhering to my routine but ensuring that I listened to my knee and how it was responding to the exercises I was performing.
Friday 1st February 2019 marked 7 weeks since surgery and I am determined to get things going again, not only in my knee rehab but also on my overall health and fitness and getting my weight below the dreaded 100kgs (good god man, 100kgs!! Jeez)
Since getting to the gym in the 3rd week since surgery I’d been filling my time working my upper body and the gunz were for sure showing signs of a comeback. For this week I’m going to add swimming to the visit to the gym to get the cardio in as I’ll more than likely be struggling against doing depths than lengths which should get the old ticker going whilst not putting unnecessary strain through my knee.
Feel free to follow me on Instagram @dan_rich81
the plan is to update the site with a new blog every few weeks… so if your interest stay tuned – Thanks and much love.