The Winter Of ACL Discontent

Although the most pain from an ACL operation occurs in the first few days, I found that my lowest point emotionally came several weeks into recovery.

The analogy I would use is the children of our friend Lisa. A number of years back, when they were very small, they looked forward to the holidays (Hannukah in their case). When New Year's Day rolled around, with snow and ice everywhere, they turned to their mother in perplexity: The holidays are over, where's the springtime?

When I was first recovering from ACL reconstruction surgery, my mental attitude, to the extent I could think through the pain, was the equivalent of uttering some choice Anglo-Saxon words and vowing, "I am NEVER going to do this again!"

But pretty quickly I could see progress, which was so encouraging. The pain didn't end right away, but it decreased, and I could do things with my leg like raise it or make visible quad muscles tighten. I enjoyed going to PT and getting good feedback on my progress. One PT intern told me she would always remember me because I was her first patient who was zipping through ACL recovery.

But then I hit a point three or four weeks after the operation when I was ready, like my friend's kids, for springtime: I wanted things to be back to normal. I had been working so hard, and hurting so much, for weeks, wasn't it time for me to be able to do normal things normally again?

It was at that point when I realized that, yes, as I had read, ACL recovery does take a very long time, and even though I had worked really hard, I had a long time and lots of work left to do. My ACL winter would last a long time, and then it would be spring.

Bending The Knee

One of the most confounding things about recovering from ACL surgery is how difficult some very simple actions become.

Take, for instance, jumping and bending the knee.

I anticipated that it would be hard for me to bend my leg in the first few weeks after surgery. (It's shocking how much enthusiasm the physical therapists, who in my clinic all seemed like the girl next door, put into bending my leg to its extremely painful limit!)

However, I didn't anticipate that, a few months later, it would be difficult to support my body weight while bending my knee. Even just a little bit.

One of the first ways you notice this is how difficult it is to descend a stairway in normal, "reciprocal" fashion (right leg goes down a step, then left leg). This is something you feel long after you've begun walking again without a brace.

One of the exercises my physical therapists gave me later in my five months with them was to stand on a step or platform, weight on the recovering leg, and simply bend the knee enough that your other heel touches the ground. It's almost embarrassing how difficult it is to accomplish. As the exercise progresses, the therapist raises the platform higher.

Now, I don't know if this diffculty is unique to having gotten a patellar-tendon graft, rather than an allograft or hamstring graft. But I have a feeling it affects all types of ACL surgeries to some degree.

The most frightening thing my therapists asked me to do is to jump a couple of inches off a platform and land on my recovering leg. (This is clearly an advanced level of PT.) My therapists said it's very common for people to feel afraid about this. For one thing, before surgery, if you jumped and landed on your knee, you would collapse painfully because your knee was unstable. For another, you've just been through the most painful period in your life, centered on this knee--so you're very protective of it. Here again, part of the issue is you need to bend your knee to absorb the shock when you land, and that's hard to do.

I got my surgery in late March, and today I'm walking stairs reciprocally without limping or needing to hold onto a rail. But truth be told--this speaks to Michele's point about it taking up to a year to get your strength back--I still feel a little weaker in my left knee walking down stairs.

Back In The Saddle

Yesterday I went back to core "karate" class, and this afternoon I went to the gym for strength training--push-ups, pull-ups, crunches, dips, squats/lunges.

I thought about running on the elliptical machine for a bit, but passed on it because I'm still feeling the effects of my cold, though it's much improved.

I also did a "multi-planar" exercise my physical therapist gave me--stand with feet shoulder-width apart, keep the weight on the leg that had the ACL reconstruction, reach back with the other leg and twist the body--net effect is you're twisting the knee with the weight on it. (Note, this is NOT an exercise for newly reconstructed ACLs, I didn't start this one until I was fairly advanced in physical therapy.)

Martial Music

Finding good psych-up music for martial arts workouts or competitions is tough when you're taste runs to Stevie Wonder and James Taylor.

Much as I enjoy "Carolina In My Mind," I wouldn't say it gets me pumped for combat.

UFC combatants tend to enter the arena accompanied to what I guess is metal music, with shrieked lyrics. One of my not-yet middle-aged classmates favored AC/DC.

Not for me.

Some songs I have found that work with my middle-aged taste for psych-up music include:

Street Fighting Man (Rolling Stones)
Lucky Town (Springsteen)
Pride (U2)
Higher Ground (Stevie Wonder)
Mr. Jones (Counting Crows)
The Contender (Theme from the TV show, by Hans Zimmer)
and, of course, Gonna Fly Now (Theme from Rocky, Bill Conti)

Enlargement

Before martial arts, my weight was over 215, pushing 220.

The least I've weighed in middle age was before my tournament and black belt test, when my weight got down to 190 or, I think before the tournament, 188 (at age 48). I'm six-foot two. Interval sprints were a big factor in getting my weight down that low. I now find sprints hard to do because they hurt my knee and my feet.

I gained weight after my ACL operation, even though my left leg was visibly atrophying. When I got back to martial arts classes, I brought my weight down to around 194, where I had been before the operation, though it has fluctuated widely.

This morning I tipped the scales at 202.5. At most, the gunk in my sinuses could account for only a pound or two. (Yeah, gross, I know.)

Now, I have been doing more strength training, with a personal trainer and on my own, and that probably accounts for some of the weight gain--muscle weighs more than fat. But not all of it. At 51, I don't grow muscles like a teenager.

It's the holidays, and I've been eating.

At this point, I don't know what my fighting weight would be. More about fighting weight in a moment.

In terms of weight divisions: At a student competition my school holds, I figure I could easily (when I'm not sick and it's not the holidays) make the 185- to 204-pound division--the same division I was in at 48. (This weight includes equipment, which maybe adds four or five pounds.)

In amateur boxing, I figure I would be a Heavyweight (up to 201 pounds). I don't think I could make it down to light heavyweight at 178 pounds.

In IKF amateur kickboxing, I'd currently be, gulp, a heavyweight, or if I trained hard and got below 195, which I think is definitely possible, a cruiserweight.

In mixed martial arts, I'd be a light heavyweight (185 to 205).

But really the question is not what division I can squeeze into, but what is a good weight for me to be at. And right now the answer seems to be a bit in flux. I'll see what happens to my weight when I'm feeling well, I'm working out more regularly, and I"m not eating my way through the holidays.

Merry Christmas From Aetna

I just opened a bill from my physical therapists. My last session was in August.

It seems Aetna, my insurer, hasn't paid them a dime--the bills were denied. So either they want me to get Aetna to pay them, or I can pay them $3,583.

You can be sure I'll call Aetna today to wish them the very Merriest of Christmases as well.

Addendum: Upon calming down and examining the letter more closely, I saw that the payments weren't made from June 19 through the end of rehab on August 7 (my ACL surgery was March 27, and I started rehab two days later). I called Aetna, which said it sent a check on Dec. 6--three days after my therapists sent me their letter. So this little issue should be resolved--phew!

Key ACL Recovery Suggestions

As I think back on recovering from ACL surgery, some specific suggestions occur to me.

1. Showering: Get a plastic lawn chair, put it in the shower, and shower sitting down. This is really important. If you shower standing up, you risk slipping and wrecking your brand new ACL.

2. Vicodin: People at my work joked that I would be hallucinating on Vicodin. I wasn't; instead, the big side effect was that I was (there's no delicate way to put this) constipated, big time. Every body is different, but what my PTs and doctor suggested, and what worked for me, was drinking prune juice. It tastes awful, and sometimes it takes a couple of doses, but it's worth it. I just threw the prune juice out last week, I hadn't used it since, but for a week or so it was truly my friend!

3. Friends: Put your pride aside and tell your friends you need them to visit. If you attend a religious institution, tell the people there you need visitors--that's one of the things those institutions are set up to do (in my case it was a Unitarian Universalist congregation). When my wife had to go back to work after taking some time off to care for me, friends came by to help me with things like getting into and out of the continuous passive motion machine (which may not be used much anymore, from what I hear, but I did find it helpful), or refilling ice for my knee. And they just talked. It did my spirit so much good to have friends drop by. I still want to hug them every time I see them.

4. Exercise: As a martial athlete, when your body says you can start, begin doing push-ups, crunches and other exercises that won't strain your knee. You'll feel good about yourself when you can start working out again, even on a limited scale. The key phrase is "when your body says you can start."