To Cut or Not to Cut: Part 2

Small Group Fitness in New York - Catalyst S.P.O.R.T.

Welcome back to the story of my ACL surgery and recovery.  If you missed Part 1 and want to learn about how I decided to have ACL reconstruction just Click Here. For everyone else, continue reading to learn more about my post-op experiences and the recovery process. 

My surgery was complete and getting home was an adventure.  After several hours of cracking jokes to the occupied beds around me, jokes such as describing how my car is basically the little red car emoji in your iPhone, and how subsequently I probably won’t fit anywhere in the car with my knee locked in extension, I was finally on my way home. Still being a little high on anesthesia, and whatever pain meds they had me on, I began making food orders.  Well, by making food orders I was actually telling my wife from the back seat of the emoji car the types of food I wanted to eat.  There were a lot. Thankfully my wife, Alex, got us and all the food home safely. 

When scheduling my surgery, I tried to think ahead. So, I decided to schedule it for a Friday.  My Idea was to interrupt work as little as possible, and to have as much help at home over a weekend as I could muster from my wonderful wife.  This worked out well.  Being the wonderful woman, she is, she got me everything I needed/wanted so that I didn’t have to keep getting up.  This was tremendous. 

Dealing with the first 48 hours
For the first 48 hours you are not supposed to take off your brace, or remove your bandages, and you are told to sit at home and rest.  Prior to surgery I spoke with one of my physical therapists.  He led my initial recovery, the mighty Lee Scantalides (@mvmt_Ryu_Physio), he stated that getting my quad to fire and my knee to extend was one of the first things I needed to accomplish.  Digging a little deeper, Lee told me about something called extension lag. This is when you can’t fully extend your knee using the power of your quadricep (thigh muscle).  During the recovery process extensor lag can cause pain behind the knee when you are trying to lift your leg while lying down or moving around in general.  During the initial portion of recovery extensor leg can put undue stress on the joint while it’s trying to heal.  If it is not addressed, it can cause negative effects on gait and proper leg function during sports.   

To me, my first objective was clear.  I needed to get my quad activated and my knee extending on our own ASAP. Once I came out of my anesthetic sleep, I began trying to get my quad to contract.  Yes, I was lying in my hospital bed, still in my gown, and hooked up to tubes trying to squeeze the crap out of my thigh.  After I could feel it ‘turn on’ or contract, I started lifting my leg off the bed a little bit at a time.  The weight of the brace and all the fluid in my leg made this quite challenging. Since my leg was going to be kept in this brace for 48 hours and I was only supposed to lay around, I did leg lifts with my quad contracted as often as possible.  

Several times I have stated that I wasn’t allowed to take off the brace, but there was one exception for removing the brace. When using the Game Ready Cold and Compression System you need to remove the brace.  The Game Ready unit for the knee (there are different units for various parts of the body) is a sleeve that wraps around your leg and is connected through some tubes to a main unit.  On the main unit there are easy to use controls and a compartment that holds ice water.  After setting the duration of your session, intensity of compression, and temperate, the unit then pumps air into the sleeve to compress your leg while at the same time pumping cold water to the sleeve as well.   The compression and icing of your wounds are supposed to help with pain, inflammation, and speed up recovery.  I’m not sure if I healed faster, but it absolutely helped with inflammation and stiffness.  Renting the Game Ready unit for 2 weeks was an added expense, but it was completely worth it.

After 48 hours I was finally able to remove the bandages and shower.  My wife and I were both very grateful for that first shower. 

Starting on the road…
Physical Therapy started for me the Monday following surgery.  For my first three session (Monday, Wed, and Friday of the first week) I went to visit Lee at his office in Orthology.  For the first three weeks we had a clear set of goals.  These were: 

  • Achieve full knee extension with no pain
  • 45-90 degrees knee flexion (bent) with hip flexion (creased hip)
    • While doing this we avoided bending the knee while the while the hip is straight
  • Getting the quadricep (thigh muscle) to contract.  Either manually or through electric stimulation
  • Normalize gait as much as possible with and without brace
    • This is important so not to build other issues in the body from compensation
  • Regain enough leg strength and stabilization to stop the use of the knee brace and crutches
  • Reduce all swelling that could contribute to decreased muscle contraction and mobility
  • Reduce any joint and muscle pain.

 

During the first three sessions there was still so much swelling, from recently being cut up, that my physical therapy sessions were a form of maintenance to help enhance healing. 

 

The first three sessions contained these elements:

  • Trigger point release of the rectus femoris (middle thigh muscle) and IT band
    • Getting the rectus to relax was important.  This muscle was in a heightened state of protection because the graft came from this muscle and tendon.  If it didn’t relax, it would have been hard to obtain maximal contraction.
  • Retrograde massage on quad and anterior tibialis with the leg elevated to reduce swelling
  • Patellar mobilization with superior and medial glides
  • Reducing extensor lag with the encouragement of strong quad contraction to be practiced during Single Leg Raises. Which I was already good at since I was practicing them from the time I was in the hospital
  • Russian electronic-stimulation (see the pic below to see what this looks like) of the quad. This was done with the Delaware protocol and the knee kept at 45-60 degrees of flexion
  • Hip stability exercises
  • Gait re-Training



After the first week I knew I would be going crazy not being able to do jiujitsu, or any sport really.  To battle the mental craze, I would inevitably incur, I designed an upper body hypertrophy (muscle gaining) program.   I apparently designed this program well because I have since gained 10-12 lbs and all my shirts fit a lot tighter.  The program called for 3 days a week of upper body exercise that I could do lying down or hanging.  By designing it this way I was ale to avoid the use of my legs and could still exercise.    During these workout days I also sprinkled my physical therapy correctives in. 

To summarize my week, I did therapy exercises 5-6 days a week and I did my lifting program 3 days a week.  I ended the week with 1-2  days of rest during the weekend.

At the end of this article I will list the rest of my therapy exercises I had for next 2 months.  If you’re interested in the hypertrophy program I used, you can email me at [email protected]

Here is a quick video of my gait 2 weeks after surgery.  It isn’t perfect, but I was well on the road to recovery.

Mindset & Mental Struggle
Having the right mindset during recover is important.  Staying positive and motivated while holding myself back, so that I didn’t over-do it was difficult.  I had never had a surgery like this before, and I didn’t know exactly what to expect.  Everything I was experiencing was new, and at times could be alarming. I was improving rather quickly, but there are always setbacks, especially mental ones.

In the first two weeks there was a lot of fluid and inflammation in and around the joint, I had of course recently spent two hours getting cut up and having holes drilled in me, so this is understandable.  The fluid moved from my lower leg to my knee and back, the disconcerting part about this movement was the way my knee reacted.  There was so much fluid that when it moved from my lower leg and into my knee it completely changed the way my knee moved, and the way the surrounding muscles felt.    When the fluid was in my lower leg I would have better knee mobility and less muscle aggravation in my calf and hamstrings. This happened throughout the day and changed depending how often my leg was elevated.  The part that was hard for me to wrap my head around was that even though my knee moved better with the fluid in my lower leg, the fluid needed to be higher up in my leg so that my body would flush the fluid out.

Having the fluid move up and down my leg, and the way my body responded to it was mentally exhausting. Once I was able to wrap my head around it, and let go of my anxiousness, everything was fine. The biggest help I received to combat the fluid came from the superlative Dr. Anna Folckomer (check her IG account @drafolckomer).  Acupuncture is an extremely under-utilized tool in recovery, and Dr. Anna is one of the best practitioners in the world at using functional anatomy to enhance her treatments.  With Dr. Anna’s amazing treatments, the swelling went down very quickly, my muscles were active and relaxed when needed, and she has also made my incisions so much less impeding on the function of my knee.  If you ever must have surgery, and you are in the New York City area, including Dr. Anna on your recovery team is a must.   

The last thing I have to say about mindset is to be consistent.  Most of your physical therapy exercises are boring and repetitive.  By doing your exercises 2-3 times a day 5-6 times a week you will see the most improvement.  Even if you aren’t perceiving any improvements going through the motions are necessary.

Resources:
Physical Therapy: Lee Scantalides -  [email protected]
Accupunture: Dr. Anna Folckomer  - [email protected]
Surgical Inquiries: Jon Cosgrove - Twitter Handle: @JohnCos_ATC 

 

Physical Therapy Exercises prescribed by Lee Scantalides
2/28
Heel slide on stability ball with yoga block: 3 sets of 10 reps
Prone HS curl: 3 sets of 10 reps
Seated knee flexion (quad stretch) 
Wall Squat to 90 degrees only : 3 sets of 5 reps 
Step Ups ~10 inches box :3 sets of 8 reps
Adductor Magnus pendulum Stretch by Immaculate Dissection : 2 mins of quality motion
Single Leg Balance into PRI style Single Leg Deadlift by Kento Kamiyama
3 mins
Single leg calf raises (towel under big toe): Up to 30 reps 

Knee Flexion: pre-tx 114 degrees & post-tx 118 degrees. 

3/6
Heel slide on stability ball with yoga block : 3 sets of 10 reps
Prone HS curl : 3 sets of 10 reps.
Seated knee extension with band :  1 min holds 3 sets of 5 reps 
Wall Squat to 90 degrees only : 3 sets 5 reps 
Step Ups 12 inch box : 3 sets of 8 reps
Sing Leg Balance with trunk rotation :  1 min holds 2-3x.
Single Leg Calf Raise (towel under big toe) : 30 reps. 

Knee Flexion: pre-tx 124 degrees & post-tx 126 degrees. 

3/13
Seated knee extension with band : 1 min holds 3 sets of 5 reps 
Air Squat : 3 sets of 8 reps
Step Up 14 inch box : 3 sets of 8 reps 
Single Leg Balance with head rotation/knods : 2 mins
Knee Flexion: pre-tx 135 degrees & post-tx 138 degrees  

3/20
Goblet squat with slow foot-focused lowering: 3 sets of 10 reps with moderate weight
TRX pistol squat with R heel on the ground - Not below 90 degrees : 3 sets of 8 reps 
Yoga block single-leg reaches : 10 per side 

138 degrees of flexion post-tx
Approved for boxing 

3/27
FRC wall stretch and isometric lift off  : 1 to 2 sets of 5 reps
Goblet squat  : 3 sets of 8 reps - 24-26kg
Bulgarian Split Squat : 3 sets of 8 reps - 16-18kg
Yoga block single-leg reaches : 10 per side 

138 degrees of flexion post-tx

4/3
FRC wall stretch and isometric lift off  : 1 to 2 sets of 5 reps
Goblet squat  : 3 sets of 8 reps - 24-26k
Bulgarian Split Squat : 3 sets of 8 reps - 16-18kg
Yoga block single-leg reaches : 10 per side 
 




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