Physical Therapy, Exercise, Careful Training

I'm feeling a bit encouraged about my prospects of continuing to train, with modifications, post ACL tear.

I've been to three physical therapy sessions, and have been good about doing my PT exercises twice daily. Compared to working out, the PT exercises don't feel like they're doing much, but they are clearly doing something to strengthen the muscles around my knee and give me more range of motion (a limitation imposed by the meniscus tear).

I've gone on the elliptical machine at the gym at work three times. I'm using it because there's a limited motion and there's no impact, but I can still get a good cardio workout.

I have also now taken three classes in my mixed martial arts school. I have been very careful about kicks, and my knee has been fine. It's good to see my friends and instructors and to continue to get a workout.

One of those workouts was a private class with our school's Joshu, a young (20s), very skilled martial artist and a friend. We just worked on form for punches and kicks (again, being careful not to do anything that would torque my ACL-less right knee). I had developed a way of throwing round kicks that involved a lot of leaning and turning in order to avoid punches. He worked with me to move my hips independently of my shoulders, which should speed up the kick, allow me to focus more on the target, and I think put me at less risk of torque injuries to my remaining good leg. It will take time to undo prior habits.

I'm not going to spar until I get a knee brace, which I plan to order from my doctor when I see him in three weeks.

My plan continues to be that I will not get ACL reconstruction surgery. I needed ACL reconstruction four years ago to get my black belt. I don't believe I need the ACL reconstruction if I am training for fun and fitness, and if I am very careful.

There's some precedent.

There are, I realized, two women in my school who ruptured their ACLs and who continue to train wearing braces. They're both excellent athletes; they'v had mixed success training in their condition.

One is a second-degree black belt who has been without one of her ACLs for many years. She's one of those amazing Gumby-like types who's about a foot taller than me but can kick me in the head. I haven't seen her on my abbreviated training schedule, but when I do, I will definitely talk with her about how she takes care of her knee. She does some sparring; she doesn't do grappling. Mostly she takes the "core" classes that are bag workouts.

The other fellow student offers a bit of a cautionary tale. She's also a good athlete and is a former cop. However, she did injure her other knee a few months ago--I believe while sparring--and has some discomfort in her daily activities.

That's what I don't want to do.

So for now, it's PT and patience for me.

Facing Uncertainty with Patience

It's going to take patience to work through this ACL tear and figure out what I can and should do.

On Friday morning, I got the diagnosis from my doctor--complete ACL tear in my right knee, plus meniscus damage.

My leg isn't painful except when I bend it too far (meniscus) or I step in a way the knee becomes unstable (ACL). It's more my brain that's sore.

My doctor, who had performed ACL reconstruction surgery on my left knee four years ago, said Friday morning he expected that without an ACL, I could run and eventually probably even sprint--which I'd been doing lately for conditioning. The day before, I had gone on an elliptical machine for 22 minutes, and my leg felt fine at the time. It was a little sore an hour later, which a naproxen took care of. My doctor thought that activity was fine, and said the knee is still healing from the initial incident.

However, while running is okay, he thinks that martial arts would put me at risk of further damage to the knee, which is unstable without an ACL, because martial arts involves torquing the knee. A knee brace wouldn't help with torquing.

I don't want to have ACL reconstruction surgery again. I simply can't afford the time away from work and life it would require right now; in any case, the doctor said the knee needs to heal before surgery, so there's no rush.

The reason my head hurts is that, while I don't want to do ACL surgery, I also do want to continue training.

My martial arts instruction got me into shape; it taught me to face up to my fears; to face up to conflict instead of avoiding it; that getting hit just means I'm still in the fight; that I can protect myself. These are all extremely important things to me, body and soul.

I could maintain my conditioning even if I gave up martial arts. But I would be leaving behind a crucial part of my life if I had to give up my school due to my injury.

I have decided to respond with patience.

I'm going to do physical therapy for a month to strengthen the muscles around the knee to compensate for the lack of an ACL. I'm going to discuss with the therapist, or perhaps even a physiatrist, what activities I can safely do.

I'm going to very carefully try to take certain martial arts classes. On Friday evening, I took a "core" class that entails a bag workout and physical and strength conditioning, but no sparring. I was very careful; my knee was a little sore afterward but fine. Oddly, one of the most difficult things in class was some of the stretching at the beginning.

I'm going to have to leave grappling behind, which I'm fine about.

I would like to carefully, carefully try out sparring, including being selective about partners. I will probably be boxing more than kickboxing--a shame since my kicks were pretty good.

I'll see how my leg does. I'll talk about my situation to doctors and others (including a remarkable classmate who does train without an ACL).

I'll give it time.

"Complete Tear of the Proximate Anterior Cruciate Ligament...."

"MRI of the right knee demonstrates a complete tear of the proximate anterior cruciate ligament with osteochondral impaction injury of the lateral condyle and bone contusion of the lateral proximal tibia. Complex tear of the posterior horn medial meniscus involving both aeticular surfaces with associated posteromedial capsular sprain and small joint effusion"

MRI

I got an MRI for my right knee this evening. I'll get the word from my doctor Friday morning.

My knee is definitely stronger this time around than last--it can hold me up without pain to do push-ups. So I'm thinking partial tear, maybe.

Meanwhile, I'll try out the elliptical machine at the gym at work tomorrow. And a low-key martial arts class Friday. Sensei said he would give me a workout that kept my knee safe.

three Letters

My doctor, after examining my leg today, uttered my three least favorite letters: A C L. He suspects a tear. Not to mention meniscus damage. MRI on Wednesday. I feel downcast--but still determined to find a way through. One thing I don't want: Another ACL reconstruction.