# ACL Rehab ??????????????????????



## traildoc (Mar 5, 2007)

I had ACL surgery 11 days ago and am curious as to the amount of time it takes to get back to doing fairly advanced riding that could entail some crashing. If anyone who has had this surgery could give me their personal experience with this surgery 
I would appreciate it. Apparently there was no meniscus damage.

My surgeon is telling me that my new patella ligament is at its weakest at four months.


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## bobo_krkk_NIN (Dec 2, 2006)

*6 months...*

Before I was on the trails and even then it wasn't real nasty stuff. About a year after surgery, I started to get comfortable with the knee. There are lots of peaks and valleys with the recovery from this surgery. Listen to your physical therapist as they have seen more recoveries than you will and probably will have examples of people that rushed back too early.

You don't look to have had a ton of atrophy on your quad yet. It seemed to take forever for me to get the quad on the repaired knee to be the same size as quad on the non injured leg.

Good luck with the recovery...

bobo


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## Albee (Jul 21, 2004)

Don't have any answers, just wishes for a speedy recovery. I hate it when one of the tribe goes down:sad:

I'm going to the doc on Thursday to find out if I have a torn lower ab, or, more likely, a hernia. But I've been able to ride with it all summer; small potatoes compared with what you're going through.

A lot of active people try to come back too soon, and wind up exacerbating their injuries. If you're as hyper as me, that could be a problem.

My advice to you: drink heavily 

Seriously, though, heal fast and heal well.


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## ebxtreme (Jan 6, 2004)

I've had both my ACL's replaced, but I went with the hamstring method for a variety of reasons.....so my healing process will likely be different.

In both instances, I was back to riding XC within 3 months (with flats - not clipped in) and was riding pretty aggressively (probably too aggressively) within 4-5 months. Based on the fact you went with the Patella graft, your healing process might vary in timing. Listen to your doc's advice!

Good luck, do lots of working out in the gym and PT and pick up some new bike vids to get you through the winter! As bad as it feels now, you'll be back to full strength before you know it.

Cheers,
EB


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## traildoc (Mar 5, 2007)

ebxtreme said:


> I've had both my ACL's replaced, but I went with the hamstring method for a variety of reasons.....so my healing process will likely be different.
> 
> In both instances, I was back to riding XC within 3 months (with flats - not clipped in) and was riding pretty aggressively (probably too aggressively) within 4-5 months. Based on the fact you went with the Patella graft, your healing process might vary in timing. Listen to your doc's advice!
> 
> ...


eb:

When you worked out on your own what seemed to be the most benefical exercise. I have started to ride a stationary bike and I was wondering how long I should ride when my leg is feeling good and nice and warmed up? Do you think icing (cold machine) and heat with a microwave heat wrap helps with healing or am I just wasting my time.


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## afuera (Jul 19, 2008)

I had mine done 16 or 17 years ago, same patella tendon graft. Crutches for six weeks, after 6 months the doc prescribed biking as rehab and said I could begin playing soccer when I was able to ride from the valley floor to the top of Mount St. Helena. (14 mi, 4800'). Thats when I got into mountain biking. I seem to remember not trusting the knee for a while and it taking about a year to get the muscle strength and size back. I remember the doc telling me that if I pushed it I would naturally favor the injured knee and probably blow the other one out. Good news is that after all this time the knee works as good as if it never happened.

good luck


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## kristian (Jan 20, 2004)

I had a patella graft too, but I also tore both sides of my meniscus. I was back on the bike riding technical trails (SoMo in Phoenix plus Sedona) three months to the day after my surgery. I combined a neoprene knee brace with my standard armor for protection and rode cautiously enough that I never actually fell on it. Drops seemed to put a lot of stress on it so I avoided them, but I rode every rock garden and roller move I could find. I was racing both XC and DH again within 6 months which is when my doc said that I would be able to START riding again. 

That being said, I was 26 at the time and now I look back at that as being young and foolish. I never crashed on it (luckily) and I'm glad I never got to find out if it would have held up to a serious digger. On the positive side, I don't think that riding aggressively early on had any detrimental effects on the long term strength of the graft, or my recovery as a whole--my knee is still very solid for biking and skiing 8 years after the reconstruction. 

Obviously, your actual mileage will vary, but I would say to play it by ear--listening to both your PT, your Doc, and your knee itself. When you do start riding again, use armor to protect your knee, and don't take any unnecessary chances. As I mentioned above, drops will cause strain, as will extended out of the saddle climbs. Good luck with your recovery!


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## Eerie (Jul 9, 2004)

Did you not get an appointment with a Pyhysical Therapist??? I find that hard to believe. If not, go see one! That's my first bit of advice. 

I had the patella graft myself just over 10 yrs ago. My second piece of advice is listen to and follow the directions your PT gives you!!!! When the PT says walk on pavement, walk on pavement. When they say walk on grass with no hills, walk on grass with no hills. DO NOT GO MTN BIKING, those risks are not something you want to subject your newly repared knee. 

Your PT will provide you with proper activities to restrenghten that leg in the timing and manner such that it does not compromise your new ACL. Accept that PT will be painful. Stretching that patella will be painful. Single leg squats, ahh single leg squats. I also have a deadspot on the outside of the patella incision, it's no big deal.

Eerie


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## jibmaster (Sep 28, 2006)

I have been through two acl injuries on my right knee and a miniscus injury on my left knee. I had my acl replaced with a cadaver's acl a couple of years ago. I'm 39.
I was riding my bike on flat trails 3 weeks after surgery. Took almost a year before I was back to normal though. After that, I have never been stronger. More fragile for sure, but I trained HARD the first 6 months after surgery.
A year after surgery, I did my first 10k ride.
A physical therapist is a must for the first few months. They have all kinds of toys to play with. My favorite was the current pool. You swim against the current. Feels great!
After that, I was a die hard member at my local gym. Still am. Leg extensions, curls, calf etc...
Biking is just what you need - in a few weeks.
Start out S L O W.
Be patient. No jumping off the bike or falling. Road riding is prolly best, but I couldn't kep off the trails. I have some excellent flat singletrack just out my door...
Stay off the clipless for a month or so.

Then again, I'm not your doctor/therapist.
Your situation is bound to be different.
Turn this situation into a positive and get in the best shape of your life!


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## bobbotron (Nov 28, 2007)

Eerie said:


> Did you not get an appointment with a Pyhysical Therapist??? I find that hard to believe. If not, go see one! That's my first bit of advice.
> 
> I had the patella graft myself just over 10 yrs ago. My second piece of advice is listen to and follow the directions your PT gives you!!!! When the PT says walk on pavement, walk on pavement. When they say walk on grass with no hills, walk on grass with no hills. DO NOT GO MTN BIKING, those risks are not something you want to subject your newly repared knee.
> 
> ...


This is great advice. I second starting a PT regime.


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## mlepito (May 1, 2007)

11 days and no rehab yet? You should have started as soon as you could get to the PT. Have you been doing the home exercies they give you at the hospital? You can start them from day one. 

It takes 4 months to get back to decent mtb. The bone has to regrow around the graft. It may take up to 6 months if you harvested your own ligament. I'm sure there are people who started earlier. They are lucky they didn't re-injure it.


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## traildoc (Mar 5, 2007)

mlepito said:


> 11 days and no rehab yet? You should have started as soon as you could get to the PT. Have you been doing the home exercies they give you at the hospital? You can start them from day one.
> 
> It takes 4 months to get back to decent mtb. The bone has to regrow around the graft. It may take up to 6 months if you harvested your own ligament. I'm sure there are people who started earlier. They are lucky they didn't re-injure it.


mlepito:

I started my own PT the day after surgery. I built a 30 degree plywood ramp one foot wide and three foot long with a two foot wide base that I put in my bed to elevate my leg. I developed my own CPM technique by putting the foot of my good leg under the achilles tendon of the bad leg and drawing my injured leg back and forth to about 90 degrees. I did this on and off for hours with icing. So far so good. I started riding a stationary bike on the fifth day and today I started walking by shortening my crutches three inches in case my leg collapsed (it didn't). What do you think?


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## dobbs (Jan 12, 2004)

I would also see if your insurance will cover a good knee brace. Mine got me a custom carbon fiber job that allowed me to get back on the trail with a bit more safety. I used it for maybe 4-5 months. Then you can get back to your world class uphills sooner.


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## ebxtreme (Jan 6, 2004)

traildoc said:


> eb:
> 
> When you worked out on your own what seemed to be the most benefical exercise. I have started to ride a stationary bike and I was wondering how long I should ride when my leg is feeling good and nice and warmed up? Do you think icing (cold machine) and heat with a microwave heat wrap helps with healing or am I just wasting my time.


For me, I was in a constant motion machine for a full week (on the couch) for 8-10 hours a day. I started PT probably no more than a week after surgery, but I've heard of folks starting even sooner. One thing to consider is that you need to get full flexion and extension back as soon as possible or scar tissue will make that super hard. I worked on that with my PT during evrey session.

For exercises, I was doing seated leg press for my quads (which had atrophied terribly) and the hamstring curls (laying on my belly) since I used the hamstring method both times. Also, after regaining a little strength, I would balance on my bad leg and do slight bends while extending my other leg in front, side and back. I'd also get a muscle stimulator on my leg to help work the muscles out a bit.

FYI, I was told by my PT and ortho not to do leg extensions (where you sit on a bench with your foot on the floor and raise weight with your leg). This exercise puts a lot of stress on your knee joint whether it's been repaired or not and is generally not a good exercise for your knee.

Once I got stronger and further in my recoveries, my PT would hook me up to a rubber band and we'd resistance training with me pulling him forward, backward and side to side.

Worth noting is that I rode a stationary bike a LOT from the get go.

Cheers,
EB


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## traildoc (Mar 5, 2007)

dobbs said:


> I would also see if your insurance will cover a good knee brace. Mine got me a custom carbon fiber job that allowed me to get back on the trail with a bit more safety. I used it for maybe 4-5 months. Then you can get back to your world class uphills sooner.


dobbs:

I blew the ACL on July15th. at the Whistler Bike Park. After the injury I went o the local recycle center and bought a brace for $15. I had been icing for with a bag of peas for 4 days to get the swelling down.

After getting the swelling down I started riding my downhill bike on the paved trails around Whistler wth the seat elevated as high as it would go. As my leg loosened up I drop the seat to get better range of motion.

After six days I went back into the park and started riding and caosting downhill trying easy little jumps. I then went onto Ebay and bought a Donjoy Armor knee brace for $171.
I had it shipped to Whistler and when I got it about two weeks after the injury I started using it.

I called my doctor and told him I thought I had blown my ACL and he made an appointment to see a surgeon on 9/5. So I stayed in Whistler until 8/28 to ride in the park and build up my strength for the surgery. When I got home to the Bay Area I rode my 6" bike until the day before the surgery which was 9/18.

I think the strengthing before the surgery helped out alot in my recovery so far. I am an old guy and don't current work so I can spend a lot of time lookin up ACL rehab exercises on the internet.

But this forum has helped give me an idea as to possible recovery timing from those people who have actually gone though the surgery. If I can obtain full range of motion through riding a stationary bike aren't I taking care of the scare tissue problems?


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## rockman (Jun 18, 2004)

Sorry to hear about your knee. That sucks.

I had an acl repair with the patellar tendon graft 20 years ago. These days it's mostly the same surgery just less invasive and the healing time is shorter. The biggest thing, as menitioned by previous posters, is rehab. The balancing bit on a board/ball is really good for those little muscles around the joint. Leg extensions get a bad rap for putting stress on the joint but if you have access to one that limits the range of motion I found that extensions with that last bit of range of motion was really good for the bottom quad tie-in. That is, the last few degrees before full extension and not the full 90. Keeping those hammies strong as well as working the quads. 

Back then, it was a year recovery for me and more like two years before I was telemark skiing without fear. Current recovery time for acl repairs is in the 6 month range with the patellar graft taking the longest. It takes a while just to heal from harvesting the graft.


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## mlepito (May 1, 2007)

If you're going to do your own rehab, let's do it right. (I recommend seeing a PT for this)

Start with static contraction of the quad in full extension. Hold 10 sec. Relax 20sec. 10 times. 
Passive range of motion using the other leg to help or a stationary bike. Use ice 20 min after.
Straight leg raise with the knee extended. 10 times slow.

When you can do that with no issues, move onto these:
straight leg raise with 5lb sand bag weight. Move to 10lbs as able to.
straight leg abduction while laying on side with the same weight. 
Striaght leg extension while laying on stomach. Same weight.
Continue with bike, when at full range of motion add resistance.

Then these:
leg exensions with sand bag.
leg curls with sand bag.
Continue with abduction.
step up then down on step. 6inches

Then these:
step up then down on step 12 inches.
double leg squats no weight
static seat against wall 30 sec.

Then these:
if you can do 100 double leg squats with no weight- single leg quarter squat. 
Leg press, and curls
bike with good resistance
Wobble Board to get balance back. 
cross over steps for coordination.


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## mlepito (May 1, 2007)

*I pushed post too early*

These exerciese are to be done in their respective groups. Do not move into the next group unless all exercieses can be done with little to no difficulty.

However, these exercises work best when passive range of motion, muscle work, and ultrasound is performed in conjunction by a PT or sports medicine doctor. I don't recommend doing your own rehab. You should have visited the PT 3 days after surgery.


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## traildoc (Mar 5, 2007)

mlepito said:


> These exerciese are to be done in their respective groups. Do not move into the next group unless all exercieses can be done with little to no difficulty.
> 
> However, these exercises work best when passive range of motion, muscle work, and ultrasound is performed in conjunction by a PT or sports medicine doctor. I don't recommend doing your own rehab. You should have visited the PT 3 days after surgery.


mlepito:

I did go to PT four days after surgery, and I am going again the 5th. maybe for the last time. I am hoping to get enough information to do this myself after that. My health provider is in Cali and I am going to be in Arizona for a couple months. I do have a rehab proto call from a friend which goes out 16 weeks, who just had the same surgery a month ago. I do belong to a gym in Arizona and hope to do all the recommended exercises there.

Pray for me.


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## Petro55 (Mar 28, 2007)

*6 months*

I was back on my bike in 6 months but the hardest part is to stand up and ride. When you stand up there feels like there are no muscles in your leg to keep it straight. It is great rehab to ride your bike. To be really back in action and stand and pedal it was probably over 13 months. Good luck and work on that flexability!


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## thefugitive (Nov 21, 2004)

I blew my R-ACL in 1999 and had a good brace fitted to my knee (CTI2) and biked, surfed, skateboarded, snowboarded and wakeboarded with it until 2001 when I got the allograft (cadaver tendon). Dr found me a good one from a very unfortunate young man... Since there was no tendon harvested from elsewhere in my knee and I walked into surgery with a strong leg the rehab time was quick. I had an appointment with PT day after surgery for consultation. He had my doing the static muscle clench for 10 secs thing that day, hurt like a mofo! Then once my clenching got stronger (5 days) it was on to the stationary bike with the seat all the way up and using my good leg to increase the range of motion in the bad. I was back to work in two weeks with a limited range knee brace on and light duty. I was on a plan that pretty much parallels what mlipito spelled out, back on a MTB at about the 3 month mark riding the street in front of the house. Month 4 light trails, started pushing my skate around. By the 6 month mark I was cleared by the ortho and the PT for pretty much whatever but I had a severe lack of confidence in that knee even though it felt fine. I was dong everything I did before just at a lower level. I’ve gotten over it and I would say I’m back to my old self….

Good luck and like everyone says get to a PT….


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