It’s been almost two years since I had reconstructive ACL surgery. Between personal experience, those I’ve worked with, the emails and comments I’ve received, a few patterns have emerged as to what mistakes I see people making.
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Lack of mental preparation
Far and away the most common thing I get from people, post surgery, is “Oh my god! This is so bad! Is this normal? I’m so miserable. I can’t do anything. The pain is unbearable. I can’t bend my knee, my muscles are disappearing; I’m so depressed.”
I don’t expect everyone to do the amount of research I did for this. I spent over 3 months reading everything I could, talking to people and writing about things. However, if you do even a modicum of research on this topic, you should learn pretty damn quickly it’s normal to:
- Not just be down, but to be incredibly depressed after this surgery
- Not be able to do anything
- Need someone around you for a while after the surgery. I don’t mean a few hours, I mean like a couple weeks.
- Be in extraordinary pain
- Be on so many drugs you can’t see or think
- Be crying
Part of this is definitely the surgeons fault. I don’t know if it’s because the surgeons don’t want people to know how bad things are, or because they become jaded after doing so many surgeries, either way, they do a horrible job preparing people for what this surgery entails. One of the surgeons I saw sent me to his receptionist to schedule surgery without even discussing what the surgery was. I mean nothing was discussed. Not what’s an ACL, why I might need it, the length of rehab, invasiveness of surgery, time off work, NOTHING. Yes, I knew all these things already, but he didn’t know I knew them.
He didn’t even bring up the option of not having surgery. Or the fact I’d be denied health insurance in the future because of having it. If not for the law changes coming in 2014, for the rest of my life I would have severe health insurance issues because of this injury. The insurance companies take this incredibly seriously, so should you.
Part of me gets the lack of understanding; part of me doesn’t comprehend how people don’t understand a power drill will be put through their bones. Look at your leg, imagine a power drill being put through it. Is it really that hard to understand how you’re going to feel after this? “Waa, I can’t bend my leg, waa, this hurts.” No shit, a POWER DRILL was just put through it.
I’m not sure how else to get this across. My only other way is all the people I know who’ve had this done have another big theme to them. Their ACL experience is one of, if not the, worst experience of their lives. Since people love to look to athletes with this stuff, Derek Rose has said his ACL experience is the closest to death he’s ever been, and Wes Welker said he wouldn’t wish his experience even on his worst enemy. Keep in mind these are guys who are, for the most part, ACL success stories! They’re the outliers, and they still had awful times.
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Unrealistic expectations
This goes right with lack of mental preparation. If you even only briefly look around you’ll quickly find how many people are never the same again after this injury. Too many expect to have this surgery and be good as new. The fact of the matter is your leg will never be “normal” again. To reiterate, multiple holes will be drilled through your body, more than likely one of your tendons will be cut apart, it will then be either sewed back together or you’ll hope it grows back, the part of the tendon which was cut off will be screwed into your bones, one or two screws will likely be left in your body, and that tendon will hopefully turn into a ligament with time. Your leg will never feel normal again because it will never be normal again. It has been forever changed.
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That doesn’t mean you’re forever resigned to pain. You can not be in pain but have a leg that just feels weird at times. If you haven’t had surgery, this probably doesn’t resonate. For those who have though, they know exactly what I’m saying. Whether it’s their knee feels weird, it makes odd sounds, the screw moves around, whatever, there is almost always something odd remaining long after the surgery.
“But I’ll be different.”
In Thinking, Fast and Slow, Daniel Kahneman references a time in his younger days when he and some colleagues were writing a textbook. They were projecting how long the book would take and their chances of actually completing it. They pretty much all thought it would be completed, and in about two years.
Kahneman then asks the one colleague who has worked with others who’ve made a textbook, “How many of them actually finished?” The colleague was a bit embarrassed. “Maybe 40%” “And how long did it take those who finished to complete their work?” The colleague was now even more embarrassed. “I’d say the average was about 7 years.”
Kahneman refers to this as the inside and outside view. When you’re on the inside -you’re the person getting the surgery- you think the odds don’t matter for you, or that you’ll beat them. You don’t want to hear that 65% of ACL patients never return to their previous activity level. And even if you do hear it, you’re not listening, or you think you know something they all didn’t. Rather than consider the endless list of NFL players who never made it back after tearing their ACL, you instead focus on Adrian Peterson.
It’s not only a physical game; it’s a mental one too. This is what a lot of people miss when trying to come back from this. It’s not just the being able to come back physically, it’s the mental aspect. You very well could get your leg back to its former strength, have no pain, no setbacks, etc. But, you may end up thinking, “I don’t care. I don’t want to go through that again.” Honestly, that’s where I am. I was cleared at 9 months -exactly on time, had no setbacks, went out and played some sports, proved to myself I could do the entire process, then said “I’m done with this shit.” I don’t want to go through all that again. If I (or you) was a million dollar athlete I’m sure my mentality could change, but I’m not. I don’t want to do anything which could increase my chances of going through that whole process again. Physically, I’m able to go back to my previous activity level. Mentally, I’m not.
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Focusing too much on former patient’s experience
Asking those who’ve also had an ACL reconstruction can be productive, but you don’t want to rely on other people’s recounts as you’re only information.
1) Every case is different.
It’s unlikely you’re going to be able to run into someone who is having the exact same surgery as you. Here was my full surgery: Reconstructive ACL surgery with a hamstring autograft, medial meniscal repair, partial lateral menisectomy. Every word of that affects the rehab. Unless you’re talking to a person with the same procedure as you, you’re likely going to have different experiences.
2) Your sample size is too small
ACL surgery isn’t that common. So, you may only have one or two people you know who’ve also had this done. Even if you go online and read 20 different accounts, it’s still a small sample size.
That can greatly skew your perception of what this all entails. Using me as another example: I had basically no pain after my surgery. I have a couple ideas as to why, but regardless, pretty much no pain. This is an aberration. To illustrate how much pain is expected post-op my surgeon prescribed me 80 pills of percocet, all at double dosage (because I’m very tall). He told my dad, “Call me if he needs more.” That’s an insane amount of pills. How many did I take? One, which was the night of the surgery. I only took that because I was afraid a huge flow of pain was about to set in, and I didn’t want to wake up in the middle of the night when it happened.
If you’re someone using me as your reference point for pain after ACL reconstruction, you’re in for a rude awakening when you come out from your anesthesia and realize I was an outlier.
3) You don’t want to put all your faith in people’s memories
Since I brought up Daniel Kahneman, I’ll keep that theme. Kahneman has done some research on our perceptions of how painful an experience was. What’s been found is we remember pain by 1) How intense it was and 2) How it ended. Number 2 is what’s important here.
Tying this to ACL stuff: The worst part of ACL surgery is the beginning. As the process goes on, it normally gets better. You’re more likely to ask fellow ACL patients their experience not right after their surgery, but fairly far out from it. Said another way: You’re more likely to get someone’s recount a year, two, or three years after their surgery, rather than 2 weeks post-op.
Their answer is not only going to reflect things in the early stages, but also how they’ve felt recently. Plus, their recent memories are more available than their older ones. Since people tend to feel better a year, two, or three years after their surgery rather than at two weeks, they tend to mix how they currently feel with how they felt immediately post-up.
Say your friend Jon had ACL surgery. He was a mess immediately post-op, but now at 3 years post op he’s pretty good. He’s not amazing, but he can’t complain too much. You run into Jon, tell him about your current ACL issues, how you’re contemplating surgery, and what’s his advice. How did things go for him? Would he recommend it?
Because Jon feels pretty good now his first response is, “You know, it wasn’t that bad. Not the best time, but I’m pretty good now.” However, if you were next to Jon the day after he woke up and ask him how he was feeling, his response would be, “MAKE IT STOP!”
I have a client Dan who has had upwards of 10 leg surgeries, one of which was an ACL. Dan recently decided to have another leg operation. He came in about a week afterwards. “You know, every time I do this I swear I’m never getting another one. It’s like I forget how bad things are after these things. Then, once I get it done again, it all comes roaring back.”
Me: “It’s like a really bad hangover. You swear you’ll never drink again, but next thing you know it’s Saturday night.”
A much better way of learning what ACL surgery is like is not only to ask former patients, but ask those who were around them right afterwards. If Jon’s dad was his primary caretaker, ask dad what the experience was like. They’ll almost assuredly give you a more accurate description.
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Postponing physical therapy
Many years ago it was common practice after surgery to put the person on bed rest. With leg stuff you’d often be casted up for at least a month and pretty much couldn’t use the leg. Scientifically, those days are gone. We now know this is a terrible way of approaching the post-op period. The longer you don’t use the muscles the quicker and more they atrophy. You increase the person’s risk of blood clots. You also make the physical therapy phase harder as the person is starting from further behind.
Scientifically, those days are gone; realistically, too many still lay around for weeks before doing anything. If there is anything to be learned from athletes in this realm it is that physical therapy after reconstructive ACL surgery does not start a week or two weeks after the surgery, it starts the day of surgery.
There is no reason to wait. You can’t do much right after surgery, but that doesn’t mean you can’t do anything. You can mobilize the patella, wrap the leg, squeeze the quad to make sure it stays awake, as well as work on your range of motion.
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Obsessing over flexion instead of extension
If you read the comments of this post: Reconstructive ACL and meniscus repair surgery: Physical therapy days 2-11, which is about my experience, you’ll see over and over people fresh out of surgery going nuts about their lack of ability to bend their knee.
Again and again I respond, “Stop worrying about bending your knee, start worrying more about straightening it!”
I think why this happens is after surgery you may lose 10-20 degrees of extension, but 100-120 degrees of flexion. So, to the person, in their mind it’s like, “Holy fuck! I can’t bend my leg at all!” This is normal. The flexion will come with time, and there’s really no need to rush it. In fact, you need to be careful not to push it too much too soon as that can stretch the graft out. Mechanically, especially in the beginning, you will only be able to flex your knee so much anyways, due to the swelling. It’s going to take some time for all the fluid to get out of there.
Extension on the other hand, you need worry about immediately. First, there is no reason to not get all the extension back right away. By this I mean the day of surgery. You don’t have to worry about stretching the graft out with extension. Second, extension is much easier to lose in the long run. Personally, I needed to check my extension multiple times per day. And for about 6 weeks, everyday, I’d gain it back only to lose it again a couple hours later. Third, the longer you go without getting it and keeping it, the more likely you are to never get it back again. All the time I see people with a knee surgery history who years later still can’t fully straighten / hyperextend their knee.
The other thing here is returning to walking. It’s ok if you can’t bend your knee to 120 degrees, or hell even 90 degrees, that’s not going to affect walking. However, if you can’t fully straighten your knee, that’s a really bad knee to be walking on. You end up walking on a bent knee all the time, which beats the hell out of your joint. So, working on full extension helps get you back to healthier walking while obsessing over bending your knee does not. There is a progression here, and the ability to walk again is very high on the hierarchy. Certainly much higher than bending your leg.
Full, complete flexion will take months and months, and that’s ok. Stop worrying so much about it.
Which brings us full circle: If you only do even a bit of preparation, you should know not to bend your leg too soon, that you won’t be able to bend your leg, that you should be extending it, that you’re going to have a lot of pain and discomfort, etc. Just a couple questions to the surgeon will let you know this.
This often ends up being a $50,000 surgery, with power drills, screws, knives, hours of anesthesia, high level pain killers, a significant degree of short term disability, minimum 6-9 months of physical therapy, you get the idea.
For Christ’s sake do your homework.
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For more information on what to do coming out of ACL surgery, or if you’re someone who needs to take a step back and reboot the process, check out my manual The most important phase of ACL rehab. Click link for more info, or click below to purchase
For those looking to get things really dialed in, check out An underappreciated aspect of ACL rehab and prevention. Click link for more info, or click below to purchase
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-Update 9/3/15- Posted the following comment:
Hey Everyone,
I wanted to let you know I put together a manual specifically for regaining knee extension.
You can see more about it and get it here: http://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
I also wrote something detailing why regaining extension range of motion quickly is so important: http://b-reddy.org/2015/09/03/why-you-dont-want-to-wait-to-regain-knee-extension-range-of-motion/
I cover extension ROM fairly thoroughly in the ACL manual, but this is more extensive than before. Also, some have asked me, “I’m more than a month out, will your ACL manual still apply?” While the answer to that is usually yes, now I have the extension manual for those are only specifically looking at that.
Hope this helps!
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-Update 11/16/15
Another post on the importance of regaining knee extension range of motion, and why you don’t want to wait to do it: http://b-reddy.org/2015/11/16/how-weak-calves-can-cause-knee-issues/
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Post-script (Update 7/1/15)
After receiving many comments on this post, I left this comment:
Dear All,
Understand this coming from a place of wanting to see people do this process better. It is not meant to be judgment, or beratement.
I’m not sure what’s going on the last week or two, but some themes that keep coming up:
1) There seems to be an overall lack of acknowledgment about how long a process this is. Many of you have probably heard “6-9 months,” which is one reason I didn’t hit on this in the article. I assumed it’d be rare to to complain about progress at 2-3 months, as it ignores the fact you have, at least, *double* that amount of time to go. But I’m seeing this more than I thought.
Plus, in reality, this is an 18-24 month process. The 6-9 month mark is more, “Yeah, I’m running again, have full ROM, no issues with walking…but it’s not like I’m playing sports without worrying about it.” FULL recovery is upwards of two years, *IF EVER.*
2) There is either a lack of reading before commenting, or a degree of denial. Because either people aren’t reading the section on “Obsessing over flexion over extension,” or they want to ignore it. So many comments here are about lack of ability to bend the knee. At 2-3 months of all things!
Part of me thinks I need to write a sequel to this post. The other part of me thinks people need to read the following paragraph from the post until it really sinks in:
“Full, complete flexion will take months and months, and that’s ok. Stop worrying so much about it.”
I made two sentences its own paragraph specifically so it would stand out. “Months and months” is not one, two, or three months. It’s MONTH*S* and MONTH*S*.
I understand this is a traumatic time for many who come across this article. But I, nor anyone, can propel your physiology into a different state. It sucks an injury from perhaps out of nowhere, can jack your mind and life up so much, but it is reality.
And if you’ve chosen the path of surgery, you’ve chosen a very, very brutal, long, tedious, depressing, handicapped, lonely, path. One in which there are no guarantees you come out better for having it. You very well could come out worse.
Much like we all degenerate with age, and need to accept it at some point or live in delusion, there are realities to tearing your ACL we all need to accept. The first step to getting over any problem is full acknowledgment of the reality of the problem. I promise many of you, if you get to this point sooner, a sense of relief will come over you.
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Carla
October 6, 2016
Hello – I’m so happy I found this site. I’m 3 weeks post-ACL (hamstring graft) and having a terrible time. I started off really positive, started PT 10 days after surgery, had a strong first session, but hit a roadblock in the second session when during a quad-shooting exercise I tried to flex extra hard on the last rep which led to an extreme sharp pain running through my knee. I started crying (I think mostly from the shock of it and thought that I might have torn something — the pain itself subsided within a minute) but I haven’t been the same since.
I’ve become a psychological barrier to myself getting through exercises, and now have shifted to an extremely negative outlook which has made me depressed, mean / grouchy to the people around me, and completely unmotivated at work (I’ve actually had to work from home this week, after already taking almost the entire first 2 weeks post-surgery off / working from home). I dread going back to PT and either struggle or avoid doing exercises at home. I realize that this mentality is only hurting me in the long run, and I’m really trying to get out of the funk but having a hard time actually doing it.
What I’m struggling with most right now is extension. I can get down to a few degrees (and to about 0 using the CPM machine), but my physical therapist flagged this as a big concern. In our last session she elevated my leg then pushed down on the knee to force extension. We’ve done this before, but this time I started to cry and asked her to stop but she continued and said I need to fight through the pain (which was intolerable, shooting pain, felt like multiple spasms going through my leg) or I’m never going to reach full extension, won’t be able to walk, and might have to have another surgery to slice the hamstring behind my knee. She then left me with the technician to finish my exercises and didn’t elaborate on the issue or offer any further advice or instruction (is this normal?). She’s asked me to take Vicodin before coming into our next session (is this normal?)
At home while I’m avoid some of my exercises I’ve made it a point to stay extra on top of extension, elevating my leg on the coffee table whenever possible and putting weight on the knee. Also doing prone hangs off the bed (max a minute or 2) or manually pushing down on my knee while leg extended on couch or bed to a point that’s uncomfortable but not crying pain.
Another thing to mention – I think I had full extension right after surgery (I was in a locked brace with my leg elevated almost all day the first few days – even slept like this) but as soon as I could bend a little I was eager to get back to my normal sleep position which is knees slightly bent on my side. I’ve been sleeping like this since — both of my PTs said this sleep position is fine but I’m reading otherwise in comments here….
I guess I’m wondering a few things:
– Did I start PT too late? (10 days out)
– Did I screw myself by not focusing more on extension right after surgery?
– Am I screwing myself by sleeping knees bent? If so how should I sleep (brace on? Leg elevated? both of these seem so uncomfortable) and why are my PTs telling me sleeping like this is fine (should I ditch them?)
– Is my PT pushing me too hard or am I being a (cry) baby? I know PT is hard and you have to fight through but continuing to push when I’m crying in pain seems a bit much…
– Is it normal for a PT to tell you to take Vicodin before coming in?
– At 3 weeks out, how concerning is it to not yet have full extension? Should I be worried about needing further surgery as my PT warned?
– Is it possible to reach full extension + hyper extension in the coming weeks or have I missed the boat?
Any insight others have on struggling with extension + pain and being hyper-emotional in PT, or answers to any of the above questions, please let me know. I’m reaching a point of serious depression and missing excessive amounts of work, which is not the place I want to be in.
Appreciate any advice and really appreciate this forum!!
reddyb
October 9, 2016
Hi Carla,
-Ideally, PT is started the day of surgery. Realistically, many do not start until ~2 weeks post op. Normal does not mean optimal though.
-The more you sleep with your knees bent, the more you have to offset this when you wake up in the morning. It’s up to you how much harder you want to make your mornings.
-Pain is not necessary in physical therapy. Discomfort, yes. Pain where you’re crying, no. This is perhaps the most covered topic in the comments here.
-Your PT is telling you to take vicodin so you don’t feel the pain of e.g. them pushing on your leg. If you need vicodin to make it through a PT session, to make it through an exercise, I’ll phrase it this way: I wouldn’t be doing that, and probably would have left that therapist.
-Three weeks is very unlikely too long to regain extension. Though again, ideally it’s accomplished the day of surgery. The longer it doesn’t happen, the harder it will become.
-The most common reason for not regaining extension at this phase is not doing enough physical therapy wise.
I’d either read the comments here some more, and or check out the ACL rehab category: https://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/ and or the ACL manual: https://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
There is also a regaining knee extension manual: https://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
Everything you’re asking has been addressed, most of which in step by step instructions, and in more detail (pictures, video, etc.) than can be provided in a single comment.
Sarah
October 9, 2016
Hi Carla I was in a similar position to you but had acl and mcl reconstruction from hamstring. I was in pain and had a very swollen stiff knee for up to 6 weeks. In hindsight I should have given myself a good 6 weeks off work I’m at work now but only part time until November. i can now walk without a limp and am only starting at a pt next week. I have had phsyio twice a week up to the this week and doing plenty of exercises at home. I still cannot get a full flex but I’m nearly there. First 5 weeks I was miserable crying couldn’t sleep and so depressed and popping pain killers like tic tacs now that I am more mobile in feeling great and I’m not taking pain killers at all now. I would recommend trying a different physio you are paying them for a service. Chin up this blog really helped me get through that first month 🙂
gboller2014
October 14, 2016
Carla…I hope that b-reddy doesn’t mind me adding a few additional thoughts…so here they are:
Everyone is different. Everyone’s ACL recon is going to be different. So many variables — age and physical condition of the patient, type of graft, other damage/surgical procedures in the knee, etc….
In my case, I had nearly full flexion right after surgery. But at 3 weeks-post, I was +3 from full extension. But my surgeon reassured me that was ok — he said I started a few degrees + of full extension because of scar tissue built up from previous knee injuries and surgeries. But now, 20 weeks-post I am minus one on extension. It’ll come. Don’t worry. You are soooooooooo early in the rehab process. Go easy on yourself — you have a long way to go yet.
As much as possible, I prop my leg up on something (e.g., a football on a chair in front of me) to continually force my leg into full extension. This might work for you as well. I’m still doing this at 20 weeks-post!
Everyone’s tolerance for pain is different too. For me, the pain was the strongest during the first three weeks. But the knee then is still swollen and angry, so that’s normal. It’ll calm down. Stay on your anti-inflammatories (I did the 800mg Ibuprofen 3 x a day), and ice the knee regularly. My PTs taught me a nice trick for creating your own ice gel pack: 3 C. water to 1 C. rubbing alcohol. Put in a ziplock bag; double bag it in another ziplock and freeze. Works great!!
It’s important to note that the purpose of PT is to help you regain motion, flexibility and strength; it’s NOT to cause you pain. If they are doing things that cause you too much pain, and don’t adjust their protocols, find another PT team.
Yes, the depression during ACL rehab is very real. It’s a long, arduous process — filled with setbacks and frustrations. But rest assured that others are going thru it with you. Reach out to other ACL patients in your rehab — share stories and experiences with each other…make new friends. I certainly found a lot of support from people in my rehab clinic!
Hang in there!! Each week in rehab gets you closer to feeling better and stronger and more confident in your leg! You’ll do it!
Hugs…
reddyb
October 16, 2016
Thank you for sharing your thoughtful comment.
Lori Butler
October 7, 2016
Question…just came across your article, you hit it dead on. I tore my ACL/Menescus 2 yrs ago skiing. Got through every..was feeling pretty good, still couldn’t bend my knee..but decided to try riding a bike. Felt great right after, but then an hour later, my knee kept acting like it was going out right under me and I have sudden sharp pain. I don’t feel like I over exerted but it feels l8le bone on bone when it happens. What the hell did I do?? What are your thoughts?
reddyb
October 9, 2016
If the knee is giving way on you, I’d see an ortho. Worth having the meniscus and ACL checked.
Lori Butler
October 10, 2016
Thank you for getting back to me! Would you graciously elaborate on seeing the Ortho? I have learned more from you and your articles than anything a Dr. told me. After two years, as mentioned, I was actually feeling confident and better. No issues really other than a constant stiff knee, (better that than the previous recovery). The bike ride, wasn’t long, it actually felt good, I was given the all clear at my last visit that the ACL/Meniscus were properly healed and strong. This feeling I’ve had since the bike ride, is as I am walking, (often the dog) or any length of distance, I experience a sharp sudden quick pain and then I have to stop, and “walk it out”, sometimes it works, sometimes it doesn’t. Since it isn’t constant, it catches me off guard and I feel like I am going to fall. Any idea what you think may have caused that? Do you think going to the gym and using an exercise bike might correct whatever the issue is? I really don’t want to go back to the Dr. and spend $100’s for a visit….Thank you in advance.
reddyb
October 11, 2016
If you were a client of mine, I would say “See an orthopedist, tell them your knee is catching / giving way / feeling unstable (however you need to describe it).”
My idea is something with the meniscus or ACL could be going on. There are certain things I don’t mess around with. When someone’s knee is giving out on them, that’s one of them. (If someone has a torn ACL, I need to know that as their trainer.) A good ortho can test the ACL in like 15 seconds. It’s a very simple test for them, and one they’ll automatically do with a history like yours, describing the sensations you’re having.
A bike won’t correct this. Exercise can significantly help instability, but it depends on the person how far that can take them. And like I said, if one of these things is going on, you really want to know that when exercising the knee. Nobody but an ortho, and potentially a MRI, will be able to really tell you. It could be something else (e.g. the development of a plica), but it is an art diagnosing these things. One where another pair of eyes is almost always needed.
Lori Butler
October 12, 2016
Thank you so, so much. I will heed your advice. Keep doing what you are doing. You speak well and you exhibit a wealth of knowledge. I’m a fan!
reddyb
October 14, 2016
You’re welcome. Thank you for the nice words.
Shelly Watters
October 13, 2016
You article is GREAT, I wish I found it 20 months ago when I had my ACL recon.. I question I’m having is that my knee is now getting “hinged” and making popping sounds. Went to ortho and had MRI and they said I have scar tissue and have to meet with a surgeon. Is there anything can do at home to start breaking down this tissue or just wait? Thank you!
reddyb
October 16, 2016
Thank you for the nice words Shelly.
I’d check this out: https://b-reddy.org/2014/07/14/whats-up-with-the-noise-my-knee-makes/
Claire
October 14, 2016
Gboller your comments are spot on! Everyone is different. I am not 6 months op, I had swelling for months after the op. It was just the way my body reacted. The pain went but on waking, after physio, work or the gym it would swell. It hindered straightening and bending my leg but I kept on woth the anti inflammatories and now have good ROM
And I have been told there can still beore improvement in the next 6 months. The gent who set up this blog did a good thing because 3 /4 months in the misery struck no one appreciates what it’s like the frustration unless you’ve been through it. Good luck both, kerp going!
Ivan Chorney
October 14, 2016
Hey Brian & fellow ACL’ers,
I’m now 1.5 years out from ACL recon & lateral meniscus repair, medial menisectomy. I’m pretty much able to do everything except sitting on my heals comfortably when doing yoga but I have a lot of achiness which seems may never go away and my I bend (flex) and extend my knee joint it sounds like rice krispies in my knee – a ton of crunching a crackling. Also, if I am seated at work for a little while with my knee bent and stand up to walk I usually have to limp away for a bit until I can straighten my leg out completely and walk normal.
I am wondering if you’ve heard of other instances of these symptoms and what your thoughts are or if others out there are experiencing them? Thx guys & gals
reddyb
October 16, 2016
Hey Ivan,
Noises: https://b-reddy.org/2014/07/14/whats-up-with-the-noise-my-knee-makes/
Sitting: https://b-reddy.org/2014/08/22/how-sitting-kills-your-knees/
Jon
October 19, 2016
Thank you for this excellent resource and your attention to answering so many questions.
I had hamstring graft ACL reconstruction 5 days ago, and you are right that the surgeons don’t give us much info regarding expectations – most of what I found out I had to ask specifically to prompt an answer.
My surgeon gave me a Zimmer brace (keeps the knee locked straight) and doesn’t want me seeing a PT until after my first follow up with him at the 2 week mark. Until then, I was told to keep the knee in the straight brace and only take it off a few times a day to bend the knee as much as I could and flex my muscles a bit.
– I’m able to straighten my knee to about 0, but I can’t get any hyperextension. This was the case even before surgery (I didn’t know about the importance of extension at the time of injury, but PT helped me get back to 0 before we hit a plateau). I was hoping I would be able to get that hyperextension back after surgery, but there is no change. What do you think is the problem?
– For the past 2 days, the back of my leg (specifically the top of my calf and the bottom of my hamstring) have been extremely tender to touch/massage, and just generally very painful. At first I was worried of a blood clot, but there is no redness, additional swelling, or hotness to touch. It now feels like it was overstretched by extension – the sensation is similar to when you have a strained muscle and you try to stretch it hoping that will help but it makes it worse. Is this normal? It’s basically the only painful area in the knee right now
– I seem to already have a lot of calf muscle atrophy, and I seem to not be able to flex my upper calf muscle in the same way as I can my uninjured leg. I also have general difficulty flexing my other leg muscles (quad, hammy, calf) to achieve a complete hard contraction. Is that normal at this stage?
Thank you
reddyb
October 21, 2016
Hey Jon,
Thank you for saying thank you.
-Presumably, the surgeon removed anything blocking full extension. (Would be shocking if they missed something like that.) To where then it depends how long you’ve gone without extension. If you’ve gone a while, then something as simple as the hamstrings stiffening up could be the cause. Regardless, if you’re dedicated with this, doing long duration holds, you should be able to get it back pretty quickly. Or at least see noticeable improvement quickly. Say within a week max. As I’ve pointed out here, overwhelmingly the reason for this not happening is not doing what’s necessary. 30 second stretches for instance, won’t get the job done. We might be talking 5-10 minute stretches. (Every hour, every day, for multiple months…)
Discussed and shown more thoroughly in the following manuals-
https://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
https://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
-Sounds like that’s where your graft was taken. Typical incision for the hamstring graft is on the medial (inside) of the knee, right around where the calves and hamstrings meet one another. Can be quite painful around there after things were cut off :). A strain is partly the correct interpretation. There are grades to a strain. 1, 2 and 3. A 3 is when things have torn. In other words, recovering from this is like having to also recover from a torn tendon / muscle.
-Normal, but not desired. I hit on this in the ACL manual, such as quad activation, and hit on things to look out for when walking to help get the calves back in the “Other 23 Hours” manual (both linked above).
You can also see more about the calves and the knees here: https://b-reddy.org/2015/11/16/how-weak-calves-can-cause-knee-issues/
Farrah Stewart
October 24, 2016
Thank you.
My problems began March 29th of this year (work injury), and my surgery was 9 days shy of 7 months. I have been doing research through this entire period, and had prepared myself for the pain aspect. But one thing that everything I’ve read lacked, was the mental placement you might be in.
I think I’m doing fairly well. Considering I’ve never had stitches, IV’s, or even been admitted to the hospital before, the pain can be managed. I have percocets, but only take one in the morning because my leg is aching from lack of movement. The side affects of the meds alone could seem in need of treatment, it’s crazy!
It is hard though, trying to stay level and not get agitated. You really are alone, even with your family helping out in so many ways. I’m so thankful for them, but it is very hard for me to ask for help. I hate being dependant, and you really have to be or you’re just making things twice as hard on yourself.
I find reminding myself that, ‘hey this is only day 4,you’re doing great. Stop being so hard on yourself’, with a few breaths really helps my outlook on things.
I do worry I’m not extending enough, I’m trying my hardest without overdoing it, but it’s very stiff and sharp. I do manage by scooting myself on my heel or by removing pillows and letting gravity do it. I think I have more issues as I passed out while dressing to leave the hospital and fell. My surgeon assures me that it didn’t damage my hamstring graft, but recommended heavier icing.
Sorry, I tend to ramble, and it does go back to being alone in your situation. But if people are reading this page, they are somewhat where I was and/or am.
Thanks again for taking the time to create these articles!
Best of luck everyone.
reddyb
October 25, 2016
Thank you for the comment Farrah.
You and me both!
Too true.
One of the first things I did when waking up, once allowed, was go to the bathroom. I got up and immediately nearly took a header. After doing what seemed like a miracle (using the toilet), I got in the car and my dad drove me home. Upon getting out of that car I started crutching and immediately went “D…d…DAD!!!” as I nearly fell again.
You would think somebody would have said “Hey, be careful walking until the medications wear off.” Which, you know, could be hours! But nobody said a word. Seemed like if I fell my way out of the hospital that was good enough for them, so they could move on to the next patient. For outpatient stuff, I’m not sure anyone realizes how quickly they want you out of that bed until you’re the one in it.
That’s another reason I personally didn’t keep going with any of the opiates. Falling was suddenly my biggest fear. The first time I took a shower I nearly fell again, but luckily caught myself on the curtain.
Farrah Stewart
October 25, 2016
My nurses assured me the passing out wasn’t the medications, but as soon as the surgeon came in to check on me again(He wasn’t letting me leave until after he came from his next surgery as I had hit my head and bent my knee in the black out), he assured me it was. They had also given me a block, so I felt nothing, except my toes. What did they really expect. My mom’s disabled with back problems, she couldn’t catch me. Ah well.
I’ve not been steady enough to shower one legged, so I have to sit. It’s tedious, but I’m not risking it!
Today was a but of a set back in pain. I took my daughter to her basketball orientation last night, and boy do those chairs do nothing for your stiff and swollen limb. It’s been very angry today, but I know there will be bad days mixed in.
I find humor really helps. I had to have Auto and Allograft as my hamstring was thin(Thankfully only a shaving of my meniscus). Seeing as it’s my left knee, I’m left handed, and it’s a medical procedure… We’ve dubbed my cadaver tendon ‘Marie Curie’. Brings a little humor and lightens things up, albeit, a little morbidly. (I’ve been told my sense of humor is such, so fitting.)
reddyb
October 28, 2016
The times when you’re forced to sit in something you’re not used to can be tough. There was a time I was driving a particular car and I couldn’t put the seat back enough to get my leg straight while also reaching the pedal. So I had to sit with my leg pretty bent, in traffic. Took me a few minutes to get out of the car after that one. Like you said, those things may happen.
Haha, there are many times a joke I think is funny others have said is “morose.” You may want to check out Seinfeld’s Comedians in Cars Getting Coffee. He reveals some more of his dark side in there, as many comedians have. Could be a good way to be distracted at times.
Soraya
October 30, 2016
I love this!! Such raw truth. I wish i had of come across this before going in for my meniscus and acl knee reconstruction (hamstring graft). Everything is spot on, they definitely dont prepare you enough for afterwards, both physically and mentally. Like shit i didnt even know there’ll be a screw in my bone forever until getting my xrays after the surgery!
Im now just over 3 weeks post-op and everything is going well so far. I can fully straighten my leg and have a 90° degree knee flexion. My only problem is i get sharp pains every now and then around my meniscus area and just below the knee cap where the screw is. But im assuming thats normal and its still only early days so im not to concerned.
reddyb
November 1, 2016
Glad you liked it.
Sounds like you’re on the right track! Those are normal sensations. If you’re getting regular catching / locking by the meniscus area / in the knee, that’s something to bring up, but sharp pains here and there otherwise are common. Down the line, the screw area might always be a bit tender to touch, but shouldn’t be something you’re too aware of on a daily basis.
Always a good idea to run it by the doc though. If nothing else, it’s reasurring for them to say “Oh yeah, a lot of people feel things like that.”
Fi Fi
October 31, 2016
Thank you for this. I read it initially post op and thought this won’t be me, but it was. I did mine skiing, also twisted meniscus and partially tore medial collateral or as surgeon told me a’full house’. This injury took me to my mental limits and I’ve often said if you aren’t mentallly robust it could easily bring on a break down. I, like you focussed on extension, balancing my ankle on pillows and letting gravity eventually pull my knee straight, not painful nor relaxing either. I’m 18 mths on, only been back working it out 2 months but working it hard, aches and twinges have eased with muscle developing around it, but it still swells under pressure and is up and down and can get stiff a few times a week. I’m still waiting to take this knee for granted to stop thinking how’s the knee, can I do this. Playing football with my son, standing in goal always brings on swell and twinges with the pivoting but I won’t let it stop me. My next mission is to get full rotation, can kneel up and very near down if it’s not swollen but want to get my heel to bum, to be able to stretch out my front thigh after a work out by pulling my ankle in, can’t get close right now any tips? One thing for certain is that I will never ski again, couldn’t, wouldn’t ever risk putting myself or the family through this again!
reddyb
November 1, 2016
Skiing provides quite a bit of ACL stories, though I did recently write something about the differences coming back to it compared to other sports: https://b-reddy.org/2016/10/19/understanding-differences-in-return-to-play-in-different-sports-after-an-acl-tear/
You can see a discussion in the comments between me and a commenter / researcher Jonathan. We discuss knee flexion some there. While he and others have gotten some good results trying to get the butt to the heels, I’m not a fan in how this is often done e.g. on hands and knees, like a yoga type pose.
I prefer something like this:
Find it’s easier on the knee initially. Being on the hands and knees can be fine at points, but kneeling on a sore knee is often uncomfortable, if not painful.* When trying to stretch an area, being relaxed can really help. Pain is not relaxing.
*There are ways to do this without being on the knees as well. Shins touching but knees not:
(Range of motion is discussed thoroughly in the ACL guide.)
However, one is still having to hold their weight on their hands to some degree, which is never going to be as relaxing as laying on the back.
NIkolina
November 4, 2016
I like everything I have read here, except how the knee will never be the same. I hope that will not be true in my case (but we all do lol) Anyway, I had ACL repair 6 weeks ago and I guess I was very lucky that they were able to stitch me up inside.
I am able to bend, straighten, walk without the brace around the house. My question is: The clicking in the knee just started when i bend and straighten it, will that always be ther or will it go away once the muscles are back up? Also, I have some pain sometimes where the tear happened, I hope that is normal as well? And the last question, since my ACL repair is I guess a little better than a reconstruction, did anyone else have that and what is the recover time and how does it feel when you go back to playing sports?? Thanks a loT!!!
reddyb
November 6, 2016
-Impossible to know if the clicking will always be there. More info on knee joint sounds here: https://b-reddy.org/2014/07/14/whats-up-with-the-noise-my-knee-makes/
-It’s common to have weird pains and sensations. This is covered many times in the comments if you want to see many other mentions of it.
-Repairs are making a small comeback (https://b-reddy.org/2016/04/06/is-there-about-to-be-a-revolution-in-acl-surgery/) but unless some (very) new research has come out, the evidence is strongly in favor of reconstructions. Repairs have been avoided for decades due to how poorly they perform, in favor of reconstructions. You may want to double check you had a repair and not a reconstruction. Repairs are *extremely* unusual, though many clients of mine have thought they had a certain thing repaired, only to realize it was actually a reconstruction (or with the meniscus a meniscectomy).
Nikolina
November 6, 2016
Thank you for the reply. I read a lot about ACL treats and reconstructions, but I could not find much about repairs. I Did have a repair as I guess I was very lucky and the tear was clear of the bone so they just put it back in place (well stitched it up). They said that my case is very rare and good but I haven’t been able to find anyone that had that case. I just hope it will be better than a reconstruction like they say.
Brad Whiston
November 7, 2016
Hello, well I have made some big mistakes on my ACl recovery, currently 18 months post op.
I had both menisci done as well as a hamstring graft for the ACL so was off of my feet for 3 weeks after the op and on crutches for 6 weeks. Around about the 6th week I bent down to pick up a piece of wood and felt a pop in my hamstring, followed by lots of bruising from the ACL to the top of the muscle, no swelling in the knee i may add. I was told it was most likely scar tissue that had popped.
I work offshore in the oil and gas industry so getting back to work and earning money was important, I did a little bit of physio but after that I just went back to work.
So I basically skipped the physio, a year later and I was squatting again, leg curls etc, anything that made the hamstring contract would indicate how weak it was, felt like it could pop any sec, it hasn’t.
So in the last 6 months I was able to run, cycle, weight train anything which meant my knee was doing forward and backward movements. I could sprint which I could feel my hamstring but it was OK.
Finally back in August I decided to have a 15 min kick about with a football. Just running, doing step overs and taking shots with both feet ( felt really weird kicking with my right leg still feels like im dragging it a bit).
Anyway it hurt a bit after but nothing not normal, that night walking home it locked straight twice which it had never done before, like the menisci had now swollen and caused it to lock up, my knee swelled again and my hamstring felt sore.
Basically I realised my leg was not ready for that kind of sport.
I intend to pay for physio and sports rehabilitation for the next 3 months to try and improve the issues.
I just really feel my hamstring is really weak, when I feel both at the same time its like the middle of it is completely gone on my weak leg. I did some high knee sprinting up stairs to see what happens recently and after 6 steps the hamstring just locked into cramp, so there is definitely some issues that need addressing with it.
Is the different problems I am having normal?
Is my hamstring normal or do you think there could be an issue there?
Any recommendations?
Kind regards
Brad
reddyb
November 8, 2016
Hey Brad,
This really requires a good assessment -it’s good you’re going to be hiring a physio- but my initial inclination would be you skipped all rehab, yet of late you’ve been trying to do extremely intense activities e.g. sprinting.
As an example, rehab for the hamstrings after this surgery starts with something this low intensity:
The difference between that and sprinting is about as wide of a gap as it gets in stressing the hamstrings.
So your hamstring is likely normal for what it’s been exposed to. A solid, structured, likely long duration (3-6 months minimum), incremental, exercise program is probably in order.
Personally, during periods of more intense sprinting I also have felt a sensation like the hamstring locked. It was very strange. It’s like somebody grabbed my hamstring and wouldn’t let it move. Few minutes later though and I’d be fine. Knee didn’t have a problem. It was pointedly the hamstring, right around where it was cut off.
It was random, and really only happened if I was sprinting. I did have it happen one time when walking 9 months post-op. Probably a few times when walking after that, from years 1-3 post-op. But the most noticeable, “I have to stop moving now” times were sprinting. And doing so for something like 40+ yards. Running hard in basketball or tennis wouldn’t do it. Nor would it happen if I was doing some stairs at a moderate pace, or running for five miles.
I’m not aware of anything out there about this, such as anything in the research, though I never looked too much into it. It was so transient for me, nobody I’ve worked with has had the issue, and it hasn’t happened to me in a couple years (though I haven’t done all out sprints for 40+ yards in a while either), but it’s likely one of those things where enough patients have had it happen for others to say “Oh yeah. That’s happened to me.”
reddyb
November 8, 2016
Also more info on hamstrings here: https://b-reddy.org/2012/05/21/thoughts-on-hamstring-curls/
reddyb
November 8, 2016
Interesting. Thanks for letting me know.
nita
November 5, 2016
Hi, thanks for the post! I’d like to share my experience as it seems it was much different to yours. I’m 1.5 weeks post surgery and while it hasn’t been a picnic, it hasn’t been bad either. I’ve had almost no pain, was able to walk unaided (slowly!) at day 4, am only a couple of degrees off full extension and at about 100 degrees flexion. Im not an athlete, I sit down to do my job and pre op my activity level was a cycle or run every other day. (It was stand in for netball that got me). I’m over 30 so my surgeon has advised its a full12 month rehab; I’m under no illusions, this year is going to be tough. I also realise that I’m very lucky to have had the experience I’ve had rather than what most people seem to go through but I hope my story gives someone else a small amount of hope.
reddyb
November 6, 2016
Hey Nita,
Thanks for sharing.
As for me, believe you misread the article. It’s not about me. It’s about The biggest mistakes ACL patients make. Also mentioned in the article how I didn’t have the pain that is common. My experience is in the diary here: https://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/ where I go over having full extension within hours after surgery, how I was surprised at how smoothly things went for me, etc.
Hope your recovery continues to go well.
Renee E
November 9, 2016
Thanks for your insight. I’m 5 weeks post-op. I had a right knee full-thickness ACL tear which was reconstructed with my hamstring. I also had two medial meniscal tears and during surgery the orthopedist discovered a full tear of the meniscus root (which he actually was able to repair). I’ve been a leg brace locked in full extension since surgery with a week to go. I haven’t experienced much pain. I also haven’t started physical therapy yet. I’ve only been given hamstring strengthening exercises. Due to being in a full-extension brace for so long 24/7 I’m begging to feel like an invalid. I’m only 5 feet tall and my brace extends from my groin to my ankle so I’m unable to dress or even bathe without help. I haven’t been able to sleep in a bed since surgery because I can’t find a comfortable position and have been relegated to a recliner. I never realized what an emotional toll this would take on me.
reddyb
November 11, 2016
Hey Renee,
If it’s any consolation, those are all normal circumstances for this surgery. The fact you had a meniscal repair should bode well for you in the future. But the lack independence can really be a downer. It made me very angry at times needing my dad to help me put socks on for nearly two weeks. He didn’t want me having to climb stairs -I was renting a second floor room in a house- so we stayed in a hotel for nearly two weeks too. I of course appreciated it, but it drove me crazy my dad had to do that. (Unless you’re experienced on crutches, you probably want to be avoiding stairs anyways.)
Made me fully realize those who don’t have empathy for the disabled are likely sure to have never been around them, or gone through it themselves.
At five weeks post op, really try to get into some physical therapy. That’s a long time to go.
Good luck.
Laura
November 11, 2016
I completely feel for you as I am 5’1″. My boyfriend, mom, and friends had to help me go to the bathroom, change my clothes, and maneuver anywhere for the first week to 10 days. Keep engaging your quad as best you can. I’m still on crutches as I had a full meniscus tear as well. Quad engagement and leg lifts when you’re feeling adventurous. (With brace). Keep your chin up!!!!
Renee E
November 13, 2016
Thank you Laura. This Friday is my next appointment and I am hoping for an adjustment to my brace and hopefully start physical therapy. I have been doing both quad engagement and leg lifts… I work for a coroner’s office and my biggest concern was a DVTs, so even if it was just flexing my foot, I’ve been moving the leg in some since day 1.