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25th February 2012 – From the advice of my surgeon, I increased the exercise I was doing in order to continue strengthening my quad and hamstring. I cycled at a quicker pace, with more resistance and for longer. I also started doing more exercises involving my leg. I used the quad and hamstring weight machines in the gym for the first time and used a kettle bell when doing squats to create a bit more resistance than just that of my body weight. I made sure that I was working my leg more rather than sticking to doing exercises incorporating my left leg, but making sure as to not put it under much strain. I was now off of crutches but still didn’t feel much at ease for anything other than a slow walk on flat, even ground.
Deadlines loomed and illness struck keeping me from going to the gym for a couple of weeks which was very frustrating. I managed to keep up with a few of the exercises at home, but when you’re ill you just don’t feel like straining yourself too much. Plus my mind was concentrated solely on the work that I had to do. It was a minor setback, but played on my mind a quite a bit.
I returned home for the Easter break that I had from University and visited the physio. He gave me a few more exercises to do in which to strengthen my leg muscles whilst work on my balance a bit more. These included single leg squats, which really worked my quad as well as helping me focus on regaining balance in my left leg. This was also to help the nerves in my ACL to start interacting with my brain again as when I tore it, the blood supply through the ligament had stopped and this meant that the nerves had stopped working.
25th March 2012 – I reached a massive personal goal and went out for a cycle ride with my Dad for the first time since my injury. It was only a gentle cycle that probably lasted less than half an hour, but to be doing exercise whilst outside in the open air felt much better than being in a gym facing a wall next to some sweaty man I did not know. At least this way I knew that that man was my Dad. It was also nice knowing that I now had another way of getting around other than walking at a slow pace or being driven/driving somewhere as it was slightly too far to walk.
I had also gone out and bought myself a cheap gym (Swiss) ball from the advice of another physio that I had a session with during my time at home. This allowed me to do more towards recovering at home and is also a flattering addition to my already clustered room.
Walking had become much easier at this stage and getting around is much quicker now that I can use stairs without too much of a problem. I no longer have to search out lifts and ramps all the time. I am still finding walking downstairs to be a bit of a problem though; I am not able to walk down at a constant speed as my left leg struggles to cope with the weight when my leg is bent whilst moving my right leg down to the step below.
10th April 2012 – 136 days after tearing my ACL, I ran for the first time. It was not at a very fast pace, it was not for a great period of time, and it was only back and forth in the car park of the physio, but I knew that it was a massive step in my recovery. My knee felt a bit sore afterwards, but I guess that was to be expected with not having used my leg in a high impact manner for 4 ½ months.
The next day I ran a few lengths of my garden as a warm up before I started doing my exercises for the day and felt OK but I was still very wary about every step I took with my left leg. The day after, I was back at the physio and did some interval running on the treadmill, and this time it felt amazing. There was no longer a dull pain in my left knee and I felt more confident about each step so I was able to keep my head up and just run. I probably only managed about 4 minutes of running but it felt natural and invigorating. I didn’t really want to stop.
13th April 2012 – NEW SHOES!
On advice from friends and my dad, I decided that I should get a decent pair of running shoes now that I was at that stage in my rehabilitation. My dad suggested a specialist running shop in Portsmouth where they spend about half an hour thoroughly examining you by conducting a biomechanical assessment. They look at the way you stand, the curve in your knees, bow in your legs, the way you walk (gait) and jog etc, then they give you advice and suggest the correct footwear for you. I now have a pair of the most comfortable shoes I have ever worn and they help reduce the strain that my legs take whilst running.
I recommend to anyone who is thinking of getting some running shoes to pay that extra bit more and get a decent pair after being examined by a biomechanical specialist. Especially if you have any sort of current leg injury or are injury prone. It is definitely worth it.
I was extremely excited about the next few months of my recovery; the thought of running really buoyed me, along with the notion of regaining all of the fitness I had lost over the past few months.
It was probably about 3 hours after surgery that a physio came in to my room and went through all of the exercises that I could start doing. They were mainly aimed at helping to get my quads to fire; this is as they had not been used for the last 6 weeks whilst I was non weight bearing on crutches. About an hour after, another physio returned who helped me to start bearing weight on my leg whilst still on crutches. With it being 6 weeks since I had last walked, she had to explain to me the basics of how the leg is meant to move when walking. Still, I managed to walk whilst putting some weight onto my leg and even managed to walk up a few steps that were placed out in the hallway.
Less than a week after the surgery I went to the recommended local(ish) physio where he went over the exercises that I had already been given and showed me how to maximise the effect that each one had. He also went over how important stretching out my calf and hamstring would be in the recovery process. They, along with my quadriceps, had lost a lot of muscle mass whilst also becoming tight due to not being used for 6 weeks, stopping my leg from straightening fully.
I started heading to the gym in my second week back in Brighton. There’s a matted area designed for doing exercises and stretches which is perfect as it is much softer to sit and lie on than the wooden floor in my bedroom and there is much more space. It also allowed me to do some working out on the equipment whilst I was there. There is a selection of seated, upper body, weight machines which were perfect for me to use as no strain goes through my legs, and more importantly my knee, but they allow me to start re-strengthening muscles in my upper body.
I was told that using the cycling machines in the gym would be a good exercise to help and get some muscle mass and strength back into my quad, but to start by keeping the saddle a bit closer to the pedals than usual. This meant that my quad was doing most of the work and my knee was getting used to bending whilst being used for power but in a low impact way. Jumping or running would of course be high impact on my knee. I decided to start by cycling on the recumbent fitness bikes that were at the gym as I felt less weight would go through my knee sitting down and cycling as opposed to a position more similar to standing up.
I have listed the distance and times I cycled for during each gym session below and have calculated the approximate speed I was cycling at. This is more to show how the strength and endurance of my leg increased during the first few weeks of cycling.
25th Jan – 2.8km in 18mins (5.8mph)
29th Jan – 5.3km in 18mins (11.0mph)
1st Feb – 6.2km in 18mins (12.8mph)
5th Feb – 5.45km in 12mins (16.9mph)
8th Feb – 4.6km in 9mins (19.1mph)
15th Feb – 5.2km in 10mins (19.4mph)
I got some good news when I went to see my surgeon for a check up on 24th February, he said that my knee was stable and the meniscus tears have healed well over time. He was very happy with my progress since the surgery and was pleased that I hadn’t over done it and caused myself more damage by trying to do too much on it. He was also able to inform me as to why I was feeling pain underneath my knee whilst walking and also why my knee clicked quite a bit when bending/straightening my leg. However, he made it clear that the rest of my recovery was down to the effort that I was to put in from now on. My left quadricep was still lacking muscle mass and strength; this was what was causing my knee cap to not being kept in place properly, hence my patella tendon (the tendon just below the knee cap) being sore and the clicking that happened when straightening my leg. The best news he gave me was that I was allowed to start on quad strengthening exercises as my knee had become stable enough to cope with more strain.
Let’s face it. Injuries suck. Spending time on the sideline when you want nothing else than to be on the pitch playing your friends really is a terrible feeling. I am still to decide whether watching ultimate is keeping me eager about playing or is slowly destroying me inside knowing that it will be over a year until I get to participate in a competitive game. It is a waiting game, but you can’t take time off because of it: you have to work harder than ever so as to recover properly and not draw out the length of time you’re stuck on the sideline for.
The recovery process is also a lonely one, and I am sure there are many hours ahead of me training away from the team, with the aim of trying to get myself back to competition fitness before I can contemplate getting back into the game. In a sense, writing this blog is a chance to connect with both my teammates and other people in a similar position. I have read a few blogs from people who had suffered from an ACL injury and reading about how they recovered really helps me see the long term rehabilitation. A few of them comment on how they started writing their blog so that they could compare their recovery to that of others, and I guess this is probably the main reason why I’m writing this.
So. I guess I should start with how I was injured.
We had come out of our pool at Uni Indoor Nationals, which we believed to very much be the ‘pool of death’, with 3 wins from 3, 2 of which came in sudden death points. We had moved into the power pools with our 1st seed and faced another difficult game against an old foe that we have played a lot over the last few years, often in close games that we were victorious in. I felt the game had begun in a bad way: early on one of their players had failed to get a block on high disc to me, but had managed to scrape his studs down my ankle next to my Achilles – this is something that is actually still painful now, 8 weeks after happening. There were calls, as there had always been between us, and we had fallen behind after taking an early lead. We had just gathered the momentum and I made a lateral cut (I cannot remember whether it was to the open or break side). There was a poach coming out the end zone and my defender was trailing me by a couple of yards. A sort of pop pass scuba was put into the space ahead of me and I got up early and took it down well away from where any of the defenders could ever hope to reach it. As I was landing one of the defenders managed to land on top of me, putting a lot more weight on to my leg than I was expecting. The extra force caused my leg to buckle. I remember feeling a sort of pop in my knee. The next thing I remember was being in agony on the floor with a lot of people around me – it’s not that I passed out, but I think my brain has decided to black out any memory I may have had of the immediate aftermath. I knew I was in trouble, but I didn’t know how much trouble. I could feel that my knee was causing me a lot of pain and after being asked by the TD, I thought it would be best to get an ambulance to the hospital so I could get my knee checked out.
It was the first time I had ever ridden in an ambulance and I will be very happy if it is also the last time I ever have to ride in one as well. After a lot of waiting around at the hospital (and a lot of having to explain to the paramedics what Ultimate Frisbee is) I was eventually seen and left the hospital on crutches with my knee in a brace and a copy of my x-rays to hand – not that anyone had really worked out what they meant. I might have a meniscal tear, I might have fractured my shin, I might have dislocated my knee. The staff at the hospital weren’t entirely sure. I eventually managed to get a referral to go see a knee specialist in Havant and after an MRI scan he was able to diagnose exactly what I had done. I think his first words to me were along the line of: “Yes, you certainly have damaged your knee”. Always reassuring to hear.
Every injury is different. Even if the recovery is the same, the initial treatment may be different. It is exactly the same for ACL injuries. The most common is when the ACL ligament simply snaps in half. This is known simply as an ACL tear. Occasionally the ligament is strong enough that the tension causes the ACL to rip from the bone which it is attached to, usually the femur (thigh bone for those not knowing). This is known as an ACL avulsion. My ACL ripped from the tibia (shin bone) which I was told occurred in less than 20% of patients who suffer from an ACL avulsion. It had also taken a chunk of the bone with it, hence why there were fractures visible in my x-ray.
As I said, every injury is different, and again this rings true about mine. As well as suffering from an ACL avulsion, I had also suffered a lot of damage to the rest of my knee resulting in meniscus tears (which is the cartilage in the knee) and slight strains in my lateral collateral ligament.
Treatment is again all so similar yet is different from one person to the next. Before I could have surgery I had to reduce the swelling around my knee. I was instructed to go to a physio where I was attached to some electrode stimulators which helped fire my quads so that blood could pump more freely from my knee. I also had some ultrasound on my knee to help reduce any scar tissue that was forming.
Surgically, the most common procedure for younger adults is to ‘reconstruct’ the knee by replacing the ACL with a similar tendon or ligament and pinning it into place by threading the replacement ligament through drilled holes in the femur and tibia. This can be done with a part of your hamstring, a patella graft or even a tendon from your foot.
I had kept my knee elevated and supported in a brace in the 6 weeks from my injury up to the surgery, and when it came to the operation, the surgeon decided that he was not going to reconstruct my knee. This is because the bones had started to fuse back together as I had kept my leg straight in the support.
That was the surgery done with, but the physio was to start almost immediately.