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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Nikolina
April 5, 2017
Hello all,
I am 6 months post op and I had ACL repair as it was a clear tear and I had some meniscus clean up. I was going to physical therapy regular first 3x then 2x and 1x a week plus gym when I could. Now my muscles are nowhere where they should be and I had top change physical to a different place. ThE first therapy would be pushing me even though I had a lot of pain when now the therapy tells me that they should not do that as they need to find exercisers that I don’t have 6-7 pain on a scale to 10. I’m not talking about soreness -we should all know what’s that. Anyway, the issues that I’m having is rightness around my whole knee, if I try to walk faster it like tightness up so fast and sharp around it it hurts. I’m not even walking normal without some limping. I am not running as I do half limp half run. The physical tells me that is all probably cause my muscles are sleeping and they r not strong enough, but idk what to think our do anymore. I’m thinking about getting another MRI but I know I can’ go through all this again. Also, sometimes I have full pain in my patella and ACL area but like 2-3 pain. Did anyone have any experience like this or above anything could help?
My range of motion is good and that was never the issue, I can bend and extend all the way. One other thing is that my leg is inflammated every morning I can feel it and when it tightness as well. It does not get swollen but I feel the inflammation in the back of my knee bad and that never goes away. I do ice it every night now with new therapies but I didn’t use to for the past 5 months. Thank tog for the help all!
Appreciate it!
reddyb
April 7, 2017
Hey Nikolina,
Sorry to hear about the trouble you’ve had. I’ve hit on this point a bunch already, but where I’d be looking at is where your new therapy office seems to be- how you’re progressing your exercise.
For instance, you mention walking faster / jogging, but you’re unable to walk without a limp. If you have trouble walking slowly, the idea of walking faster / jogging shouldn’t be considered.
If you were doing painful exercise multiple times a week for that many months, the knee may need some serious time to calm down. It is possible there is something still going on in there, but if you’re not having catching or locking of the knee, and your orthopedist has been assessing you roughly every other month as they should have been, this should have been carefully looked at already.
The patellar pain is common. Will publish a post about this eventually. In a hamstring graft patient, it’s pretty much always due to a stiff IT band / Tensor Fascia Latae / Rectus Femoris-
https://b-reddy.org/2012/03/04/the-best-damn-it-band-stretch-ever/
https://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
With a patellar graft one has to consider healing from the drilling. Some tenderness there can persist for a long time.
Nikolina
April 7, 2017
Thanks for the reply.
Well, so I’ve been going to new PT for 3 weeks 2x a week now and I do stuff on my own too. The difference is that I do exercises that don’t hurt me but what sucks is that I’m doing stuff that I’m way way behind, like I don’t run anymore, no lifting, nothing cause I have pain when I lift and I look horrible when running lol.
The thing is I don’t have any locking or giving out, but I did not have those issues before the surgery either. I had pain in my ACL and that’s where I have pain now when I try to walk normal and extend the leg all the way or if I would try to put my body down on 1 leg there is no way u could do that from so much pain. 🙁 I guess 1 thing is that my leg is still 2x thinner than the other one so o do know that is still week but idk what to think anymore it’s lime I threw 6 months away or PT messed me up or the survey was not good, but the surgeion has been doing this for 24 years and when they do ACL tests it seems fine.
New PT said if they don’t see any progression in some weeks I can do MRI, but it seems like it’s all guessing what is it and idk anymore it sucks.
reddyb
April 9, 2017
The surgeon should have an extremely good idea if there is an issue with the ACL tension wise, such as if it’s too loose.
Based on the leg being that thin, trouble walking, pain with knee extension, these are indications physical therapy has not been good enough, but this is where a thorough assessment comes in. Very hard to give much advice in a scenario like this. Need to work with the person directly.
And there is always the chance the MRI could reveal something else going on.
Sorry for the tough time. No easy answer in a situation like this.
Pip
April 16, 2017
Hey thank you so much for this article. My husband is eight weeks into recovery and reading this article has helped us both get over some of the mental setbacks that come with the surgery. Great read!
reddyb
April 18, 2017
You’re welcome!
Rob H
April 17, 2017
Hi,
Great Article, I read this pre surgery, but I wonder if I took it all in at the time….
Anyways, my questions is this.. I’m 8 weeks post op. Acheived extension day after surgery, without issue. I did lose some extension at 4 weeks, as I began to work on flexion at the PT’s direction ( think they forgot about extensions for the week) its now back to normal.
However, I’m now experience what I can only call looseness, Whenever I walk (even in a straight line) I feel something in the outdside of my quad on my knee, feels almost like its going to pop out of socket. no pain, just a weird weird feeling.
it did make a proper crunching noise, and swell a little bit 2 days earlier. as i was going up some stairs, and again at the gym 2 days later (after a the majority of a good workout) i’ve been icing everynight since to make sure everything is ok.
i’m in no pain or anything likethat. but its a weird uncomfortable feeling, and i got a little concerned and depressed when it happened at the gym…..I have noticed a new pain (i had it awhile back, at around 3-4 weeks with pain i nthe back of my knee on extension. im not too concerned abotu that, as i think its just part of the ongoing process.
cheers. Rob.
reddyb
April 18, 2017
Hey Rob,
It’s common to feel weird things as you go through the process. Especially around the phase you are, as you’re starting to move considerably more.
It’s always good to check in with the surgeon (should be happening anyways), where they’ll be assessing the graft through x-ray and their hands. If the surgeon isn’t saying anything about the graft, you should be good there.
What’s most common here is there is still fluid in the knee, and that causes all types of weird sensations as it moves around. It compresses areas, maybe gets quickly “caught” somewhere before flowing out, may be more viscous at some times than other. (Going to try and detail this in an article someday). One way or another, you feel things in that knee you don’t feel in others.
Proprioception gets disturbed here as well. That is, the ability to know exactly where the knee is in space. Couple this with the fluid causing the knee to feel e.g. out of place at times, and there’s a small double whammy there. The knee feels different because what’s going inside it IS different, and it feels different because the mind-body relationship has been disturbed. The brain is getting used to a new piece of biological hardware, things have been cut and taken out, etc.
Pat
April 19, 2017
Hi there. I’m 3 months to the day post-op for ACL reconstruction and medial meniscus repair on my right knee. I got injured playing street hockey back in Sept 2016, but didn’t get correctly diagnosed until January (thanks MedExpress…). They used a hamstring autograft from the same knee. The meniscus tear was small and in the “white zone”. They put a single stitch in the tear, but said it was up in the air whether it would heal or not. Figured this would be better than taking out a large portion of the meniscus at this stage (I’m 27). Surgery went well. I was on crutches for only 2 days then walking in a straight brace for 10 days. After that I was in an unlocked brace for 3 more weeks. Very minor pain. I really only felt it when I’d get up after laying down for an extended period of time. Like the blood was rushing down my leg and making it feel heavy. I started physical therapy the day after surgery and was bending to 90 degrees with full extension. They said I was one of the better cases they had ever seen….
Then a month in, everything went downhill. The incision along my tibia where they took the hamstring tendons opened up and started draining blood and pus. I went to MedExpress again, and they diagnosed it as cellulitis. Put me on Keflex and sent me on my way. Once again, MedExpress mis-diagnosed me. I followed up with my surgeon and he sent me straight to the hospital and had surgery the next day to drain the abscess that formed under the wound. Cultures revealed that I had a staph infection (thankfully not MRSA). I spent 5 days in the hospital and found myself back in a straight leg brace for a week. They also put a PICC line in to give me continuous IV antibiotics for 6 weeks. Had to carry my pump around with me everywhere. I avoided quiet places at all costs because the pump was pretty noisy and would cause people to stare. We never determined what the cause of the infection was, though I suspect it was due to not using stitches close enough together and they were taken out at 10 days, so my wound didn’t heal properly. Probably picked up the bacteria at PT. After the second surgery, my stitches were left in for three weeks. This was only the second infection my surgeon had seen in over 15 years of doing ACL reconstructions. Needless to say he was very paranoid and checked in with me very often to make sure everything was healing properly. I also had a home nurse come once a week to change my PICC line dressing and check my incision. The surgeon didn’t let me return to PT for another two weeks after surgery in order to minimize stress on the incision.
I finally got my PICC line out on April 3rd and am for the most part right on schedule with rehab, even though I missed a few weeks (I missed another week due to my insurance not authorizing visits. Apparently I was doing TOO good…). I only have one PT visit left due to limits by insurance, but I think I’m moving along quite well. Have nearly full pain-free ROM, though a bit of stiffness here and there.
reddyb
April 21, 2017
Hey Pat,
Thanks for sharing your story. Sorry to hear you found yourself in that rare infection group. Unfortunately one of the realities of any surgery. As you hit on, some surgeons can go a career barely ever seeing one.
If it’s any consolation, believe Tom Brady had an infection as well. Sometimes helpful to see an example of somebody who went through something similar, and came out of it ok.
If you end up needing more help once your PT runs out, you may be interested in this: https://b-reddy.org/2013/06/20/the-remote-client-process/
Good luck!
blindablenda
May 11, 2017
Three days out of surgery and I’ve had an incredibly positive experience. I had surgery at 5pm, at 9am the next day I was with the physio. I was up on my feet and walking immediately. The pain is manageable. I am more mobile than I expected, more positive than I believed I would feel, and in less pain than I was sure I’d be in. It’s by no means a pleasant experience, but after walking around for 12 years with a horribly injured knee, I’m hoping this will be the first step (heh) towards gaining stability and quality back in my life. My goal is to hike the trails in my area without my knee giving way, and hopefully accomplish a multiday trek sometime in the next few years. This is a long, slow journey and I am ready for what’s to come and prepared to put in the physio work. Bring it on 🙂
reddyb
May 12, 2017
Hey Linda,
Where did you have surgery? This is incredibly rare, yet it’s great to hear! That’s the way to do it.
blindablenda
May 12, 2017
I am in Australia. I spent two nights in the hospital post-op, so the morning after surgery I met with the hospital physio, who was fantastic. She worked with me a twice a day for those two days I was there, going off my surgeon’s recommendations. ‘Motion is lotion’ was what I was told. I was advised to get up on and feet and walk (with hinged brace), weight bear on the operated leg, and religiously follow my prescribed exercises since the biggest risk is having the leg lose range of motion and/or experience muscle loss. I also did a lot of physical prep before surgery at my surgeon’s recommendation, which I’m sure is helping too.
I begin with a private physio next week.
reddyb
May 14, 2017
Good quote to live by!
Hope things keep going well for you. Glad to hear you’re off to such a great start.
Anthony
May 18, 2017
Wow this page has cheered me up about my ACL surgery recovery 😉
I had no choice but to have it – it was that or never be able to run / jog again let alone play tennis / football etc (although I might leave football off the cards now). This was opp number 2 after complete tear of my ACL, grade 2 tear of MCL, torn meniscus, dislocated knee cap, and a fractured femur.
I know 3 people who have severed their ACL and had replacement – all 3 were back to sports after about 12 months and made full recoveries although one actually tore his ACL again… opps.
There is no point setting your aims as just making it workable is there? or internalising that really it might not every get better. While I think its good to be honest I think this is overly negative although I appreciate how important the early days after and how you can’t stop doing physio at any point! I am at it every waking moment in some form.
You have to aim for a full recovery to get anywhere near where you want to – you can’t aim half way. I think some people reading this might think what is the point.
reddyb
May 19, 2017
Hey Anthony,
Appreciate the comment. I know there are a ton of them at this stage, but I think you’d find everything you’re saying has been agreed with. That said, there is a difference between aiming for something and expecting something. Aiming for full recovery is something to do, absolutely. Expecting to everything to be the same as it was before is a different story.
Expectations tend to set emotions. For instance, those who expect surgery to be a cake walk tend to get blasted by a roller coaster of emotions once they wake up. Those who expect a tough time tend to have an easier time.
(You can see this in many arenas. Many believe entrepreneurs who are more pessimistic do better than optimists. (Can google “pessimistic entrepreneurs” and see what pops up.) Or as I once heard a friend quote, “I like not having goals. It means I can’t be disappointed.”)
I understand what you mean by the potential perception of the post, but nobody, certainly not me, is saying “aim for a half recovery.” If you read my ACL diary, or the ACL manual, I think you’ll have a hard time finding somebody who put more into the process. But the fact remains there are limits to replacing inherit biology. For instance, while I’m fully recovered activity wise, my knees don’t always feel the same.
Hope you get back to all the activities you want to!
Anthony
May 19, 2017
Re optimism vs pessimism I don’t know how you would measure that to be honest? how can any one for certain say that being pessimistic is a good thing in business. I did google it but can only really find opinion rather than hard and solid evidence – not saying it is wrong mind just more that I have not really found any facts. Would find it really interesting to see if you have any links on the subject? However from experience I have always found that being nearer to the middle and having a measured approach with a mixture of both optimism and pessimism gets the best results all round; optimistic enough to take required risks but pessimistic enough to know that nothing is a given, research must be completed, and each goal has to be SMART (personally I think it is really important to have goals!). That said I am yet to meet a good sales person who is not wildly optimistic! 😉
RE your cake walk point and I know you touched this with the blame on the surgeon but the two consultant surgeons that performed operations on me were quite up front about what it would be like and how difficult it was going to be, for example I was told that even though I might make a full recovery it was going to likely be sore on and off for the rest of my life and that the physio would be relentless, painful, I would have set backs and best case it will take me 9 months to be doing anything other than strait running etc etc. In addition when you complete the forms going in for consultation it is required that you have care following on from your operation; ie they know that your going to have someone who can look after you post opp. I don’t know if it is different in the UK from the US but this kind of set my expectations at the start and it was a choice to have the surgery based on the information I was given. So personally I was never in a position to expect it to be easy – but as you say every one has a different injury, different surgeon, and a different experience.
For me the thing that keeps me motivated is seeing the little differences every day, be able to bring my heel off the ground, seeing all of my muscles starting to fire and regaining control, aiming for small goals every day / week. I was very active before my injury so in some ways I have swapped my gym, tennis etc for this… less social mind lying on my living room floor on my tod than playing tennis at the club with some mates… ho hum.
Anyhow thank you for the reply and all the info – I am going to read your ACL diary and manual and will take what ever I can from it!
b-reddy
May 21, 2017
The entrepreneurship reference was only meant to be an anecdote, though re-reading it I could have worded it better (will edit it). Not sure you can have hard evidence in a soft science, but regardless I’m certainly not up to date on any entrepreneurship literature. As you hit on, a middle ground, like in most arenas, is probably ideal. Was only trying to make the point blind optimism isn’t.
Healthcare is extremely different in the UK compared to the US. Here we’re still debating whether everybody should even have it!
Congratulations on the progress you’ve made. Small steps add up over time.
Anthony
May 21, 2017
Thanks for the reply Brian! and for all the info on the site! 🙂
b-reddy
May 21, 2017
You’re welcome. Thank you for reading.
Michelle R.
May 23, 2017
I am about to get a cadaver acl replacement Thursday. I have never had surgery not broken a bone. I have been doing pre-habits before the big day. It’s painful and mentally challenges everything I thought I was. Just laying on a mat just to lift my leg while flexing my quad..I think back of the movie Kill Bill, when Uma Therman tells her toes to wiggle..and it takes many frames for that to happen.
Soo..that’s exactly what I am doing. It’s depressing and it is very difficult. I’d like to think before my acl injury I had fortitude. But this my friend, is a whole different level. I was naive to think I will be back at work in two weeks, since I do not have paid time off.. Reading this article has not only validated my fear, but has given me somewhat relief. Of where this all will be.
It will not be easier. It will be straight up difficult.. but thank you for this. Best of wishes to anyone going through this.
-M
b-reddy
May 26, 2017
Hey Michelle,
Good reference with Kill Bill!
I hope your surgery went well. Glad to hear the article gave you some relief. Depending on your job, you may be surprised how quickly you can get back. One thing to keep in mind is to not let yourself lay on the couch for too long. Mentally, that can take a toll. If you can sit with your leg up on another chair, you may be ok at work quicker than anticipated.
Good luck!
b-reddy
May 26, 2017
Hey Everyone,
A lot of people have asked 1) about my own knee and what I’m able to do 2) about being able to hike after this surgery.
I thought this might be helpful:
https://b-reddy.org/2017/05/22/how-i-trained-for-the-steepest-day-climb-in-america/
Sarah
May 28, 2017
This really helped. I am 11 weeks post ACL and medial meniscus repair. I have been really stressing about regaining flexion – I can manage 95 degrees only. I was focused on extension for the first 6 weeks, which I did achieve but I am still limping and walking with a semi bent knee. At this stage I am regretting that I did not do more research. I didn’t explore the non-surgery option as I I think I just got swept away with what appeared a straight forward fix – all good in 6 months. I also did not account for how expensive the physiotherapy would be – the allowance on my insurance ran out long ago.
So much of what you have said rings true for me. Anyway just wanted to say thanks for the post – it has helped to know more if the reality of the situation.
b-reddy
May 30, 2017
Hey Sarah,
Sorry to hear about the tough time you’re having. Hopefully you’re finding some more answers now. The insurance issue is unfortunately too common. Barring being extremely familiar with the process, it’s something which is hard to understand pre surgery as well, regardless how much research a person does. I can use myself as an example. Considering my exercise science background, I didn’t envision needing another pair of eyes much, if at all. And I certainly didn’t think I’d need to fly somewhere to find a pair of eyes I trusted.
Add all that in with the fact trying to get a quote for cost is notoriously difficult, most people end up needing more therapy and time than they realize, even professional athletes!, and you have a tough scenario. (Perhaps a little bit of solace for you.)
As far as walking, this may be helpful: https://b-reddy.org/2015/11/16/how-weak-calves-can-cause-knee-issues/
kesha
June 9, 2017
I know this is about the knee, but does this apply to the shoulder as well? if someone has shoulder instability/laxity and is prone to dislocate easily, should they start passive range of motion early after anterior capsule shift/bankart repair? I’m consulting the surgeon soon for the procedure but as i’ve asked before he recommends 3 weeks of healing before any movement for shoulder/knee repairs.
b-reddy
June 11, 2017
Shoulder repairs are much more sensitive to tearing / failing in the early phases of recovery than ACL. (I don’t know bankart repairs off the top of my head, but I know cuff repairs can be quite tenuous.) One has to be very careful generalizing recovery. You want it to be as specific to that surgery as possible. For instance, shoulders are more complex as they have other degrees of range of motion not needing to be considered with knees. External and internal rotation being notable. Internal rotation can be fine, but external can be risky due to the relationship between external rotation and humeral anterior translation.
My experience as also been shoulders are not as sensitive to losing range of motion as knees are. Where going some time with reduced range of motion, if not immobilization -though beneficial longterm immobilization is rare- is not as big of a deal.
For most, going with the surgeon’s recommendation is the way to go, as they know better than anybody how *their* and *your* repair was. The trouble most fall into is taking what is commonly (at most) a few weeks of immobilization, then somehow ending up taking months and months to get full range of motion back. They get into therapy too late, their therapist is too conservative, fear builds after being immobilized, etc.
Jarrod gentry
June 10, 2017
Acl meniscus surgery on 3 23 17 had very little swelling no brusing took pain meds for 1st week on crutches for 1 week went back to work after 1 st week light duty therapy 3 days a week and at home will be released back to work with no restrictions on 6 26 17 I’ve had no pain it was one of the easiest things I’ve had done it was nothing like all the stories I’ve read I have all my range of motion back I must be an exception to all the stories I’ve herd 42 years old
Murad
June 12, 2017
When you say ACL meniscus, did you mean you had ACL recon and meniscus clean up?
Nice work.
When I had my meniscus done seven years go it was the same. Hardly any pain and back on the bike in five weeks.
ACL recon last December was a totally different ball game. Knee is scarred at the graft site and now I struggle with stairs and have no meniscus at all. Have just got used to the pain after six months.
D. Nicole
June 14, 2017
This is my 2nd time around (Right ACL in 2000, Left ACL/Meniscus in 2016) so I have a great deal of knowledge, but I struggled with this time around bc I fell 2 weeks after surgery and broke my wrist. Yes, I hit the lottery; a knee brace and a cast all at once. Now, I’m at the point where I am struggling with pushing myself during workouts bc I’m totally afraid I will pop something. When it was just the one knee that was done, I could compensate with my left and baby my right… Now, I am so focused on both that I can’t focus on anything else. I needed a little encouragement today and this page has helped… thank you! I am at the point where my body has fully healed, released by the docs, and the mental battle can be so overwhelming. It was so nice to hear that I am not alone in the “Mental Olympics” of recovery.
b-reddy
June 16, 2017
Oh man, sorry to hear that. That easily could have happened to me. The first time I got in a shower I slipped and barely caught myself with the curtain.
Glad to hear the page has been helpful :). You’re certainly not alone!