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Nick Hunter
08-03-2009, 01:09 PM
Nick Hunter's New Journal of Progress

Stats as of August 03, 2009
Age: 23
Height: 5'11"
Weight: 205 lbs
Training for: Rugby Union

Best Lifts (no longer current)
Deadlift: 500 lbs
Parallel Squat: 405 lbs
Push Press: 240 lbs
Power Clean: 265 lbs
Power Snatch: 205lbs

Roadblocks Corrections
ACL Tear (July 25, 2009) Pending Surgery
Meniscus Tear (July 25, 2009) Pending Surgery
Ankle Imingement (recent) Hopefully Not Surgery

Problem Areas Corrections
Post Surgery Shoulder (Labrum/AC Joint)* Avoid Benching
Weak Abdominal Strength Planks/ Ab Rollouts
Overstretched/Weak Upper Back Band Facepulls
Extremely Poor Dorsiflexion Will See PT

I started playing rugby at age 20 in college, with no athletic development knowledge and poor posture from a high school career of video gaming. I took a beating my first semester and decided to learn how to lift weights, going from 181 to 215 lbs in 9 months, progressing to the above lifts in that time as well.

I played and trained at a reasonably high level in Metro Division 2 in Canterbury, New Zealand, where I was also reintroduced to the Olympic lifts through a former Commonwealth Games competitor. I realized I loved playing rugby but was getting hurt too much, however I found it hard to fix some things and compensated with movement patterns instead. That's landed me with a knee surgery coming up and heaps of time to rehabilitate, learn as much as I can, and come back stronger.

2 year goals:
Properly and thoroughly address biomechanics, specifically knees and ankles.
Develop safe and proper deep squat form.
Build balanced and strong body with which to re-enter competitive sport.

6 year goal:
Play at Rugby Super League level.

Lifting Goals:
HB ATG Squat: 315lbs x 15reps
Clean and Jerk: 315lbs x 1rep
Ring Chinups: BW x 20reps

mark williams
08-04-2009, 04:19 PM
Hi Nick, I feel your pain on the ACL injury - how bad is the tear and what type of surgery are you having? I had a complete tear and reconstruction which is a long road back but, fingers crossed, I'm nearly there.

It's very positive that your are taking a long term view on this - my rehab has been a miserable experience because I was counting down from day one and have pushed the limit as to what my new ACL and the patela tendon (which they cut to make a new ACL our of) could take (and probably made the whole thing even more uncomfortable than it needed to be!)

You mentioned you had some difficulties which you tried to compensate with movement pattern? What difficulties did you have and what were these movement patterns you used?

Best of luck with it mate.

Nick Hunter
08-04-2009, 05:00 PM
Hi Nick, I feel your pain on the ACL injury - how bad is the tear and what type of surgery are you having?

I asked if it was complete or partial, and my physician's assistant said it didn't matter, that for all intents and purposes it was complete and that my doctor's philosophy was that if the ACL is torn at all it doesn't function right and needs a reconstruction.

I don't know which option to choose for the surgery. As far as I know, the choices are: patellar tendon, hamstring tendon, cadaver ACL. I don't know the differences between either, but I've been told the cadaver has both the fastest recovery and the worst durability. It is the only option it seems that is a ligament already, and not a tendon, though I don't know what that means or how that works.

You mentioned you had some difficulties which you tried to compensate with movement pattern? What difficulties did you have and what were these movement patterns you used?

I have two impinged ankles that for years I just assumed was poor calf flexibility. I believe my soleus and achilles flexibility is bad, but I think now that it is because the ankles are impinged. I think this because after several intensive stretching programs I realized I got some intense pains at the front of the ankle after stretching or playing, and grew to realize that my ankle just wasn't moving, as opposed to hitting flexibility problems. I felt no stretch in my calves, but the ankle wouldn't budge, and if I pushed it, sharp pain in the front.

So since that limited my dorsiflexion in the extreme, my knees have never been able to pass my toes. I hit my max lifts like this. My heels come up very early when I walk or perform footwork during play.

The movement patterns that I exhibit (which I've read all relate) are pronation at the ankles, which is an attempt to find ROM by sending the knee inside the foot instead of straight dorsiflexion, and certain motions being performed with the heel in the air where a planted heel is preferable, like getting up from a chair or walking up stairs 100 times per day. My running sends the foot rolling off its inside, rather than front to back. This sends the knee inward which adds stress and is related to ACL injuries, so I've read. Also, I squatted with a wide stance, shifting the strength from the knees to the hips, and had difficulty with olympics lifting flexibility. Shoes helped some while lifting, but don't help while playing. Cleats don't have lift.

Best of luck with it mate.

Thanks, man. I hope I fair okay.

mark williams
08-05-2009, 11:13 AM
In terms of the options for reconstruction I did a lot of reading up before having my surgery and discussed it at length with the surgeon so below is a crash-course in what I discovered.

Cadaver
-The cadaver donation does allow for the quickest recovery time because there is minimal trauma to the surrounding soft tissue and the ligament is "ready-made", but you are correct in that it tends not to be the best choice for a return to contact sport and was ruled out immediately by my surgeon as "not worth doing for our purposes" for this very reason. Plus, it doesn't always "take".

Auto-Graft
Both the hamstring tendon and patellar tendon grafts are basically a case of cutting a strip out of the harvest site (in the case of the hamstring, a very long strip then folding it over a few times), and replacing the old ligament with tendon tissue which, over time, adopts the characteristics of the original ligament.

Auto-Graft: Hamstring
The hamstring option is a good balance of recovery time versus success in that it will stand up to most stresses once it is in place and has taken root, is your own tissue so won't be rejected, and isn't as traumatic or uncomfortable, therefore making rehab easier.

Auto-Graft: Patellar tendon
The patellar tendon (which I had) was recommended by my surgeon because I specifically wanted to go back to contact sports and it is considered the sturdiest replacement. It is a lot tougher than the hamstring tendon by nature and has the added benefit of how it is attached once inside the knee (this bit I found really interesting)....
They cut the middle third of the tendon over the knee-cap but also take a piece of the insertion points at each end of the tendon - ie; a small bit of bone that it is already attached to. What you then have is a strip of nice, strong tendon with a small blob of bone on each end. They then go into the knee and drill a small hole where the original insertions of the ACL were and then put the small bits of bone into those holes. The bone that has been drilled has undergone trauma so starts to rebuild around the freshly inserted bone, so it's attachment is just as strong as the original ligament (the body is amazing!).
The downside is that rehab is longer and more painful. This is because the process of harvesting the patellar tendon is, in itself, pretty traumatic and there will be a fair amount of pain as a result of that which will slow down the rate at which you can build up the supporting muscles, simply because it hurts to do and you can't put much force through the damaged tendon for a while.

In a nutshell
So, in conclusion: cadaver is fine if you just want to be able to walk up and down stairs without your knee popping, or go on the odd run and recover quickly from the surgery; hamstring is fine if you are probably going to do non-contact or semi-contact sport (although it can and does stand up to full contact - it used to be the preferred method) and while you'll have to put the effort in on the rehab, you will recover reasonably quickly; the patellar tendon is the current choice of sportsmen because it is sturdier, but the flip-side is you will hurt during rehab... 8 months on and I still feel pain in the tendon itself when I push it (happily, this is diminishing:) ).

As a matter of interest - there is a process, pioneered over here I believe, which is becoming more popular with sportsmen called contralateral patellar harvesting whereby if you've busted your left ACL, they take a strip of the right patellar tendon and put it in. This cuts recovery almost in half because you can start hammering away at rehabbing the right leg almost immediately, and then rehab the left leg when the new ACL has had a chance to bed-in. Otherwise, you have to wait for all the swelling, discomfort etc to pass inside the knee (plus wait for the new ACL to have taken root) before you can start rehabbing the donor site, by which time you are a few months of atrophy down the road.

After Surgery
Whichever you choose (hamstring or patellar), the basic process after surgery is that the tendon that is now pretending to be an ACL essentially dies over the course of a month or so. So for the first month it is pretty strong (it's a tendon after all), then up to 3 months it is pretty worthless (at this point, a slip on an icy pavement can snap it and thisd period is the most hazardous time in your rehab)... from 3-6 months it starts to rejuvenate and becomes pretty much a fully-fledged ACL and from 6 months+ goes from strength to strength (my last MRI showed it to be thicker than my original ACL).

I'd suggest patellar graft reconstruction seeings how you want to get back to rugby, but be prepared to pay the price in discomfort and slow progress in the short term. Of course, I am not a professional, just an interested party with an opinion! I hope the above helps

Nick Hunter
08-05-2009, 02:50 PM
All that stuff above...

Wow. Great information!

1. For the contralateral surgery, are you basically in a wheelchair for a month being that both legs are healing connective tissue?

2. Assuming I had a high level of leg strength (not your usual soccer player who just runs and doesn't lift) will this muscle-memory help accelerate the rehabilitation? Everyone talks about how muscle can get as strong as it once was much quicker than it took to originally get there. My interest is not the knee I lost. I want a stronger one.

3. I'm trying to figure out which position to return to. Forward pack would mean more resisted effort with heavier contact, but less stepping and changing direction. It would also have a diminishing rate of return as I play higher level rugby and do not grow taller with the other forwards... back line would be far less contact and more un-touched running, but more changing directions, stepping, and agility stuff.



Chinups
BWx5
BWx5
BWx5
BWx5
BWx5

Band Face Pulls (Black band, moved further out from last time)
BLKx20
BLKx20
BLKx20

mark williams
08-05-2009, 03:42 PM
Glad you found it useful mate.


1. Not sure on exact timescales, but seeings how the donor site is soft tissue and no mucking about with drilling bones and moving stuff around, I would imagine you would be on crutches for a couple weeks - wheelchairs are avoided as far as I'm aware.

2. You're absolutely right - a stronger muscle will come back quicker because of muscle memory etc. I pre-habbed my leg as much as possible - you'll have a stronger tendon to take a donation from and you'll get your strength back quicker.
Just be prepared to lose a lot of strength quickly though. The effect is twofold - apart from having a lot of inactivity and lack of regular muscle activation causing atrophy over a few weeks, your CNS kicks in to protect the traumatised donor site and won't let your quads fire very hard for a while.
In terms of having a stronger knee, I'd say you can... sort of. I'm not sure if the ACL itself is ever quite the same (although mine shows as thicker on MRI), but where your knee is stronger/better is that a lot of your rehab will focus on proprioception (balance through feedback from muscles/tendons/ligaments etc) which is something most people don't bother with. This in itself will help safeguard from injuries because you will have better co-ordination. The potential strength in your muscle will be entirely unaffected long term.

3. You could view this as a positive - a chance to totally re-invent yourself. As you pointed out in my log, at 5 foot and a fart, I'm not your typical centre but ended up there previously because of a great scrum half being at the club I played at, but my having enough pace and strength for crash ball... scrum half could be the way forward for me though.
For yourself, don't let the injury dictate your position. At 5'11" and 205lbs you have the frame to play anywhere but the front 5. I'd go with your natural strengths - if you are genuinely pacy try back-line, if not then 6,7 or 8 awaits.

The modern game means as a back you'll be required to clear out rucks, and as a forward you'll need to be able to hit space and beat defenders so just focus on getting the knee 100% and play to your strengths.

Great book to read for rugby specific ACL stuff is Richard Hill's autobiography - one of the few English players I genuinely admired.
Although he blew his ACL out again straight after returning from a reconstruction (replays showed that it was a freak accident and nobodies ACL could have taken it) the fact he came back and played for the British Lions and that the effects of his retirement are still being felt in the English pack speaks volumes for the ability to bounce back.
More recently, Wales's Mike Philips also came back from an ACL reconstruction... when he hurt himself he was a fringe player for the Welsh side... when he returned he went to be first choice for Wales almost immediately and then onto being one of the standout players of the recent Lions tour to South Africa. He plays a particularly physical style of scrum-half which means he's forever being twisted and turned and he's holding out well.

My advice is, when you get a surgery date, sit down and plan the comeback. Set milestones and small targets to break up the 9months+ it's going to take.

George Mounce
08-05-2009, 06:16 PM
This has to be one of the most helpful discussions I've seen in quite some time, great reading guys! Good luck Nick on your rehab from your injuries!

Nick Hunter
08-05-2009, 06:47 PM
This has to be one of the most helpful discussions I've seen in quite some time, great reading guys! Good luck Nick on your rehab from your injuries!

Thanks George. I think Mark takes most of the credit so far, though! I'm glad somebody other than me is enjoying it. Chime in if you've got input as well.

Steven Low
08-06-2009, 12:38 AM
I have two impinged ankles that for years I just assumed was poor calf flexibility. I believe my soleus and achilles flexibility is bad, but I think now that it is because the ankles are impinged. I think this because after several intensive stretching programs I realized I got some intense pains at the front of the ankle after stretching or playing, and grew to realize that my ankle just wasn't moving, as opposed to hitting flexibility problems. I felt no stretch in my calves, but the ankle wouldn't budge, and if I pushed it, sharp pain in the front.

So since that limited my dorsiflexion in the extreme, my knees have never been able to pass my toes. I hit my max lifts like this. My heels come up very early when I walk or perform footwork during play.

The movement patterns that I exhibit (which I've read all relate) are pronation at the ankles, which is an attempt to find ROM by sending the knee inside the foot instead of straight dorsiflexion, and certain motions being performed with the heel in the air where a planted heel is preferable, like getting up from a chair or walking up stairs 100 times per day. My running sends the foot rolling off its inside, rather than front to back. This sends the knee inward which adds stress and is related to ACL injuries, so I've read. Also, I squatted with a wide stance, shifting the strength from the knees to the hips, and had difficulty with olympics lifting flexibility. Shoes helped some while lifting, but don't help while playing. Cleats don't have lift.

Excellent analysis there.

Like you are doing you need to focus on reseting your movement patterns. Making sure your knee tracks correctly is a big part of the solution, and this is solved by focusing on spreading the floor with the feet (hence bringing the knees back in line over the toes) in any of the heavy lifts.

Do you have any other problems with collapsing arches or plantar fasciitis? Tight calves, femoral anteversion, and other such problems are VERY common (and potentially lead to ACL and achilles tendon tears) of which I believe contributed to your problems.

Trying to do a writeup on this right now but I gotta get my applications out first.

---------------------------------------------------------


Mark: Nice analysis on ACL.

I tend to "prefer" allograft b/c I am not particularly keen on basically "weakening" the patellar or hamstring area, but they do have better durability than the allograft. All in all it's a tough choice.

The contralateral patellar seems interesting though... that might become my recommendation from now on. I'll check it out more.

---------------------------------------------------------


As for pre-ACL surgery recovery...

1. Prehab the crap out of it. Do as much strength work as possible.. strong and bigger your muscles are the faster you will bounce back with strength.

2. Also, make sure your flexiblity is adequate with full extension (straight leg) especially in flexion. You don't want to be one of those people who has to start with 90 degrees of flexion and work your way back up to 120-130 degrees with very painful stretching when you can do it relatively "easier" pre-surgery.


Post-ACL (couple things to add on top of what Mark said)

1. I would say get your feet/toes, etc. wiggling as much as possible post surgery. Any neurological stimulation, especially to the lower limbs, will help prevent muscle atrophy in the upper leg.

This is why squeezing objects with your hands when you're in a cast for upper arm/shoulder/etc. helps to stave off atrophy and recover quicker.

2. Keep up strength in the opposing leg if possible... cross-education helps prevent atrophy.

3. I'm not quite sure, but you MAY be able to start isometric work such as quad sets relatively soon after surgery. Basically get those muscles firing.. prevent the atrophy like the stuff above.

Probably not stuff like single leg balance yet... BUT you can be practicing it on your other leg... work your way up to eyes closed + eyes closed standing on the ball of your foot. Getting your body used to balancing with one leg will help when you have to do it with your other leg.. although it will be frustrating.

4. Compression stockings... wear them. The edema/swelling you'll see in your knee from the surgery will prolong recovery so let your body eliminate it as soon as possible by limiting excessive inflammation.

5. Massage... pull the swelling from the knee up towards your heart. Like compression stocks will help.

6. After any significant movement like just going to work or whatever... ICE. It really helps. A lot. You should be icing 3-5x a day for 10-15 minutes at least.

7. Diet... hopefully you eat clean as this will help speed up your recovery as well.

8. Natural anti-inflams will help too such as fish oil. Try to stay away from the pain meds and NSAIDs as systemic inflammation limiting will hinder the natural healing process that the ACL will be undergoing.


Essentially, the more strength you have after the ~4-5 month period when the ACL is getting stronger again the faster your recovery will be. You've seen people in the NFL get back to playing within a year... Same for some guys in the clinic I'm at (although not elite athletes). People have gotten 90% power back within 8-9 months is pretty good.

On the other hand, I've seen some recovery take >12-16 months in some cases just because there's so much atrophy and gaining proprioception back is poor in some cases.

---------------------------------------------------------


Whew. Hoped that helped you guys some. :)

mark williams
08-06-2009, 03:50 PM
Nice post Steven, I could have done with that when I was starting out on my rehab! I'd say my biggest issue now is that my tendon isn't back to 100% - this is as much mental as physical I'm sure, I need to work more on quad flexibility and continue the self-massage to loosen the bugger up.

Regarding the contralateral protocol, below are a couple of links (WFS) - the bottom one just mentions the guy who pioneered it (although there are a few surgeons listed as "pioneering" it...) apparently active rehabilitation is around 3 months on this.

http://www.thekneedoc.co.uk/content.asp?parentID=1&section=36

http://www.privatehealth.co.uk/news/october-2008/anterior-cruciate-ligament-in-manchester-40003/?vAction=fntUp

Steven, perhaps you can offer some specific advice for me? I had my second rugby practice this evening, again no real contact, and while on Tuesday I was just grateful to have made it through without problem, tonight I was frustrated at my sluggishness. For instance, while I was focusing on catching a high ball, I was pre-occupied with my foot placement and balance which made it hard to move quickly.. it's like I have to conciously plan my movements. I always used to be so co-ordinated and now I really struggle. Anything specific you can suggest to address this or is it just a case of gritting my teeth and waiting it out?

Also, I am struggling getting real drive down through my operated side when sprinting from a standing start, even though the strength is returning I don't seem to be able to put that power down... it is as if something is stopping me? I'm taking this to be a self-preservation act by my CNS... how do I over-ride it??!!

I hope I'm not hijacking your thread, Nick, with these questions but hopefully Stevens answers/suggestions will be of use to you later on in your rehab!

Steven Low
08-07-2009, 12:19 AM
What exactly have you been doing in your rehab to regain power? What about proprioceptive work?

I realize you might be out of rehab as well so if that's the case what have you been doing since then and what was the last things you did then?

Nick Hunter
08-07-2009, 09:29 AM
No worries guys, fire away.

Nick Hunter
08-07-2009, 10:51 AM
Had a three-hour skype session with Charles, who is trying to get me to convert my body to healthy motion so that it may thrive. He is also somewhat interested in rugby, which I am trying to convert him to, so that his body may wither and die as mine has! It was great to have a video link in the session for demonstrations and better observation.

Talking points:

* Quadriceps, Hamstrings, IT Band, Thoracic Spine, Vastus Areas, Pectoral, Deltoid, Biceps, Peroneals, Tibialis Anteriors, all need rolling via hard foam-roller or hard medicine ball. Scar tissue can build up from injuries over the years and fail to be removed by the body, contributing to tightness and misalignment.
* My shoulders appear to have a healthy range of motion, demonstrated by an easily completed "Wall Angel" exercise.
* Possible hypertonic upper traps.
* Very little ability to coordinate scapular depression, poor scapular depression strength.
* Slight kyphosis of upper back.
* Slight forward shoulder posture.
* Ankles could be impinged by bony structures, but the pain could also come from the tendons terminating at the ankle being drawn very tight, and misalignment of tissue there.
* Likely poor adduction at the hip, poor groin strength, tight external rotators, as my feet turn out extremely easily when given the chance.
* Less than desirable arch of the foot.
* Musculature composed of powerful main movers, held together by bullshit.

Nick Hunter
08-07-2009, 11:16 PM
Foam rolled calves, IT, peroneals, quads, thoracic spine multiple times. Not sure I'm doing it completely right as it's my first day. I'm using a 4" PVC pipe.

Jacob Rowell
08-08-2009, 08:11 AM
Hey Nick!

If you're in the area, swing by sometime! We're having a cookout on August 29th, more than welcome to come by and get some food. I'd love to hear about everything you're doing, looks like you're being incredibly proactive about recovery and addressing movement issues.

You were in Australia or NZ, correct?

Nick Hunter
08-09-2009, 09:40 PM
Progress on upperbody. Lower body hanging uselessly from pullup bar as expected.

Pullups (palms facing away)
BWx6
BWx6
BWx6
BWx6
BWx6
(all reps cleaner than last session as well)

Facepulls (from higher height)
BLK+YLWx10
BLKx10
BLKx28

Facepulls are getting frustrating. My rhomboids and lower traps are just not very used to direct communication and are not very strong. It's hard for me to activate scapular depression, and scapular retraction loses "feel" after a couple reps, making it hard to verify.

My goal with pullups right now is just to improve by one rep per set or one set per session every time. So next time I'll either get 5x7 or get 6x6. I'll try to do prone cobras in some of my off days to help shoulder health as well.

Nick Hunter
08-21-2009, 01:37 PM
Doctor Report

1. My surgery is on Tuesday and will be a Patella Tendon Graft.

2. I have bone spurs in my ankles. This means my lack of dorsiflexion and resulting calf and achilles tightness is due to mechanical blockage of the ankle. My only option is to get them scoped, and that's not a sure thing either. It will be discussed after the bulk of the ACL recovery is accomplished. A lack of dorsiflexion can put you at risk for ACL tears because the knee will seek that lost range of motion by tracking inside the ankle, putting it into valgus.

If the scope for the ankle doesn't seem like the best choice (it does right now) I will have to learn how to continue my training while making allowances for a permanent lack of ankle flexion.

mark williams
08-25-2009, 04:00 PM
Hi mate - according to your post in my log - you should be waking up from surgery shortly?

My memories are a looonng first night (I had surgery at about 4pm, 3 hour procedure) but major improvements the next day so take all the morphine you can!

As you know, a long road awaits, but lots of milestones along the way to keep your focus and attention in the meantime. You will plug away for months and months and suddenly, like I've found over the past 3 weeks, suddenly a wall falls down and the progress curve shoots up. I honestly don't notice my leg anymore, and even a few weeks ago that seemed impossible.

Good luck mate, and DO YOUR REHAB HARD!

Nick Hunter
08-26-2009, 03:40 PM
First PT appointment today:

Quad sets, Straight leg raises. Lots of pain. Somehow they did a nerve block on BOTH my legs rather than just the one they operated on, which has added to the frustration. Both blocks have still not worn off, so it's hard to activate the muscles, but still painful. I made good progress on extending the knee, however, and the joint itself looks good, with mild swelling and a pretty clean cut site.

Nick Hunter
08-26-2009, 04:08 PM
As an aside,

3:30PM: I am discussing with my PT how three years ago a lady had a heart attack at the wheel and crashed into my neighbor's front yard.

4:30PM: Leaving PT some Jesus lady asks if she can pray for my healthy recovery. I let her.

5:00PM: Sitting on the couch at home, I listen as a truck driver smashes my family's two cars on the street en route to crashing into my same neighbor's front yard.

Steven Low
08-26-2009, 06:10 PM
As an aside,

3:30PM: I am discussing with my PT how three years ago a lady had a heart attack at the wheel and crashed into my neighbor's front yard.

4:30PM: Leaving PT some Jesus lady asks if she can pray for my healthy recovery. I let her.

5:00PM: Sitting on the couch at home, I listen as a truck driver smashes my family's two cars on the street en route to crashing into my same neighbor's front yard.
That's pretty epic...

Nick Hunter
08-26-2009, 10:00 PM
Most difficult things so far are dealing with the medication and the emotions that come with being reduced to an immobile ball of pain and frustration. I'm either on planet percocet or lashing out at my family like an asshole.

Steven Low
08-26-2009, 10:15 PM
Ice, compression, and massage pulling the edema up!

Nick Hunter
08-27-2009, 04:36 PM
Second PT session, two days out from surgery.

1. Learned to contract the quad again and achieved a solid set of extension holds that I can still do now that I'm home. This morning I couldn't even begin to flex the knee through that pain barrier.
2. My physical therapist says theres no sense in me returning to sport unless I get my ankles fixed, as the lack of dorsiflexion is the main culprit in my collection of lower body injuries.

Nick Hunter
09-02-2009, 03:30 PM
Day 8
Progressed to weightbearing with crutches in PT. Quad sets, straight leg raises, etc, are easy now. Bumped my ankle on the table, which shook the tibia a bit and I cannot believe how much it hurt.

Things I'm proud of: I'm progressing at a speedy rate, and I haven't needed pain medication since day 2.

Things that suck: parts of my leg are still numb, the stitches hurt and itch constantly, and I'm in constant back and neck discomfort from not being able to sit right with a straight leg.

Nick Hunter
09-07-2009, 08:43 PM
Day 13

Taken some steps without crutches. Putting more weight on the leg while walking with crutches. My two-week appointment is tomorrow. I'm going to try as hard as I can to lose the crutches and see if I can walk with a brace. I'm going crazy.

Most of the pain seems to be on the bottom front of the kneecap, supposedly where they take the bone away and sew up the patellar tendon. Ouchies. I just want to be able to weight train again at this point. I am going to have huge legs for the rest of my life.

Ben Moskowitz
09-07-2009, 09:26 PM
Just to reiterate what Steven said,
Holy ****

Good luck with the recovery!

Jacob Rowell
09-08-2009, 04:56 AM
Recovery sounds like it's progressing. Hope all is going well.

Nick Hunter
09-08-2009, 06:53 PM
Hey thanks, guys.

I saw the doc today and am walking without crutches (albeit slowly and with a limp) for the first time in two weeks! It seems like a long road back to being a real athlete, but I'm excited for all the little progress I get.

Nick Hunter
09-10-2009, 07:26 AM
Days 15 and 16

Doubled up PT days, working the stationary bike (just for ROM) and very light leg press, in addition to normal quad sets, straight leg raises, and extension hangs.

Flexion at about 100 degrees as of day 15. Extension at about 3 degrees still, 5 or 6 when I wake up in the morning...

Nick Hunter
09-17-2009, 03:24 PM
Day 22

Am using more weight on the leg press, and nearly walking without a limp, though there is still tightness in the joint that makes that a challenge. I tried using the leg press that lets you lean on your back and slide down on your own bodyweight today.

After getting through a psychological hurdle on the sit-down leg press with a single leg where I pushed a light weight through a complete ROM, I ran into a painful feeling that closely resembles the tweaking that used to accompany my knee bailing for the last three years. This really pissed me off. I'm worried there's something that went unfixed.

mark williams
09-22-2009, 03:07 PM
Hi Nick - glad to see you're making progress!

Keep an eye on that "feeling" you experienced but try not to over-analyse at this stage. This is very rich coming from me as when I was a week off crutches and was still having pains and the odd click I was convinced something had gone wrong etc etc... my knee feels "loose" - did he tighten things up enough?... why does it hurt so much, should it still be hurting like this?... why does it feel like it's going to lock?... etc etc.

The fact is, your knee will never be the same. FACT. Your knee will never feel the same again. ALSO FACT. You will, however, not notice the difference any more unless you really focus, after a certain point.


Give yourself a chance.

The healing processes that are going on right now are many, and don't just relate to the new ligament bedding in, or to the tendon repairing itself (after having it's middle third cut away!)
There are proprioception issues (nervous feedback from various mechanisms around the joint that help you with subconcious spacial awareness and balance), plus a lot of atrophy in all muscles around your leg, not just the quads (although you'll be hyper-aware of them after that butcher had his way with your tendon!).

The bottom-line is that you have a brand new leg that you are learning about all over again. How it works, what it will do, what it won't do - and while over the years full use of this leg has been a sub-concious affair, for the next few months it will be a concious one. This means you will feel sensations that previously, were so common-place your CNS didn't bother to make you aware of them. Ie; the torque in the knee when you twist on it - the shift in ground level as you walk etc.

What I'm trying to say (and making a long-winded hash of it!) is that it becomes very easy to over-analyse what you are feeling and worry yourself unnecessarily. Don't over-reach, do only what the physio says you can do - but do it hard!

Sounds like you're doing well to me mate.

Rock on - rugby awaits!!!:)

Nick Hunter
09-22-2009, 08:37 PM
Can't wait, Mark. I miss it a lot. I will just meditate that this is only week 4 I just finished.

Nick Hunter
10-14-2009, 02:39 PM
Well, progress? It's hard to tell.

Almost Week 7

There is still a lot of crunching and jump-skipping of my kneecap in the same general angle during extension. This causes some pain, and the knee also has sharp pain inside the joint while weight bearing (squatting, leg pressing) during any flexion or extension.

My surgeon is insisting that there is nothing else wrong with my knee besides the ACL they fixed. No plica, no cartilage damage. He says there may be some scar tissue causing the unsmooth tracking, and that my quad is not sufficiently recovered to control the kneecap well enough to bear weight without pain. He suggest doing my exercises anyway, even if I am knowingly compensating through motions in order to avoid pain. I am obsessed (naturally) with the notion that there is some sort of permanent damage to my knee that is going unrecognized, however.

Perhaps it is that everyone's track is different, but I would have thought I could stand up off the couch with equal unconscious force able to be applied through each leg by now.

My doctor also prescribed an anti-inflammatory to help the swelling, which is still present. However, after 4 days of use my gums were bleeding all day long and I was wiping coagulated blood out of my mouth in the mornings.

On another note, my NSCA CSCS materials came in the mail today.

I have completed and taken notes on Chapter 1.

Nick Hunter
10-14-2009, 03:22 PM
5min on the bike

140lb Leg Press
1 set x a billion reps of various degrees of flexion


I noticed that if I squeezed my entire leg as hard as possible all the way through a rep, the knee cap didn't crunch or jump around nearly as much, or hurt nearly as much, and I could go down lower, (to about 90 degrees)... I was super psyched.

Then I walked back up the stairs and each step hurt like crap... what?

Steven Low
10-14-2009, 06:00 PM
Is there imbalances in your leg? Medial-lateral or anterior posterior?

Tight muscles in the hip/ankles and/or limited mobility?

Nick Hunter
10-14-2009, 08:13 PM
Steven,

I have had bone spurs in my ankles for somewhere in the neighborhood of 10 years. My ankles flex about 5 to 10 degrees past 90, and that's it. Consequently, my calves can't be but so loose. I believe my hamstrings are also somewhat tight, but I used to be quite strong in the back squat and deadlift. Idea?

Steven Low
10-14-2009, 08:28 PM
Is the maltraction medial or laterally, or like into the bone kind of thing?

Nick Hunter
10-14-2009, 08:33 PM
To make up for the lack in ROM from the ankle, the knee tracks inward into valgus as the ankle pronates.

Steven Low
10-14-2009, 08:51 PM
Is this when it rubs in valgus, or when you try to track it properly straight?

I have nearly the same amount of ROM in my left ankle that you do due to an ankle injury I never rehabbed right. But I don't have any problems sprinting and such. You need to retrain correct movement patterns. More would be nice but not always possible.

Nick Hunter
10-14-2009, 09:00 PM
The knee hurts whenever it's weight bearing at around 75 degrees flexion now, valgus or not. I.E. Squatting down, stairs, getting in the car. I walk on my toes a lot to avoid valgus, especially around the house or up stairs. Otherwise my heels come straight off the floor. It's a strange gait. The knee gets about 15 degrees more flexion in a regular walking step, and all at once at the end of the step.

The ankles will be fixed with surgery.

Steven Low
10-15-2009, 03:06 PM
How bad is the atrophy in the quads? How about the hamstrings strength?

Nick Hunter
10-15-2009, 07:00 PM
I think the atrophy in the quad is significant. I think the firing is worse, though. I used the leg press the other day and woke up the next morning and my glute was sore but my quad wasn't. It's also hard to feel much of what IS there firing sometimes.

Nick Hunter
10-16-2009, 07:19 PM
Neutral Grip Lat Pulldown
50lb x12
100lb x10
120lb x10
125lb x10

Seated Incline Band Row
XYZ x15 (w/ 5s hold per)
XYZ x15 (w/ 10s hold at end)

Interval Cycling (20breaths slow, 30 breaths sprint)
4sets after warmup

Nick Hunter
10-16-2009, 07:38 PM
Maybe somebody can defeat or validate my logic here:

1. I have had crap ankle flexibility since before I started weight training. I have never had dorsiflexion that would allow my knees to pass over my toes in a squat because of ankle bone spurs.
2. I have at points been quite strong in the dead lift and wide-stance back squat. These were two lifts that did not require much ankle flexibility.
3. A wide-stance back squat and powerful dead lift, trained often, result in a well-developed posterior chain. Glutes and hamstrings. These exercises, trained at the exclusion of movements that directly target the quads, could create a hamstring-quadricep muscle imbalance.
4. This study (http://www.ptjournal.org/cgi/reprint/68/6/961.pdf) shows that in the ACL insufficient knee the hamstring-quad ratio is typically higher due to a weakened quadriceps.

Theory: a much stronger pair of hamstrings than quads (when the ratio is typically reversed) could be the result of a life of motion dominated by posterior chain musculature. This ratio of forces on the knee could be contributing to my risk for ligament injuries, and my acute knee pain that is usually felt when my heels leave the ground and where quadriceps would usually dominate knee extension.

Developing ankle mobility (via surgery and PT) and focusing on training the quadriceps through any pain-free methods possible until they are AT LEAST AS strong as the hamstrings could be key in ridding me of knee pain and knee injuries.

Steven Low
10-16-2009, 08:20 PM
I am not sure why the study indicates what it does, and I am not sure why quad atrophy is more prevalent after ACL surgery either. I am going to look into this..

ACL injuries are usually the result of inwards tracking, quad dominance, limited ankle and hip flexibility.

Tight/strong hamstrings often protect the ACL in some aspects. For example, if there is anterior movement of the tibia relative to the femur (such as the anterior drawer test), the hamstrings can take over to prevent damage to the ACL.

I have personally never seen an injury in the clinic I work at.. though we've not had many ACL injuries.. of someone with an overdeveloped posterior chain having such an injury. Every single ACL case I've seen that wasn't really due to acute injury had a combination of pronating/flat feet, quad dominance, fairly weak hamstrings, and inward tracking knees.

I have extremely weak quad in my right leg due to my knee injury, and a strong posterior chain (30" vert, 9'+ broad, ~12s 100m) and I haven't had any problems so far. I'm focusing on rehabbing it. Need to keep up with my isometric quad sets because movement aggravates it in some respects.

Thus, I do not think a strong posterior chain relative to anterior chain based on my experience both observational and personal contributes to the preponderance of ACL tears. However, I do think weak quads can contribute to some instability leading to maltraction in the patellofemoral area (which would be your current problem).

Nick Hunter
10-16-2009, 08:27 PM
Bah, I thought I'd had a stroke of genius. Back to the thinking room.

Thanks, Steven!

Nick Hunter
11-02-2009, 07:18 PM
Two more weeks out. No change. This is now a full month without progress.

I'm thinking of finding another doctor for a second opinion.

Nick Hunter
12-03-2009, 11:26 AM
I got a new physio on Wednesday that I'll be seeing 3 times per week. I have a lot of confidence in him already.

His take:

My kneecap is mishandled and is tilted (x-ray shows this) laterally, which is irritating the cartilage of the patella and femur by rubbing its own little groove where it shouldn't. The pain comes from this repeated grinding.

My hamstrings and calves are ridiculously tight, and these two muscle enhance the amount of pressure or tension between the kneecap and the femoral groove.

My quadricep is weak from the surgery, and needs to be strengthened with alternate methods that do not irritate. The stronger it gets the better the pull will be on the patella.

My particular ACL graft came from the kneecap and patella tendon. The trauma from that also has a negative effect on my patellofemoral mechanics.
---

He is confident we can get everything all fixed up by loosening up the lateral areas on the knee and thigh, using better exercises to strengthen the quad, and getting the backs of my legs to approach normal flexibility. Worst case scenario he says is that my doctor may have to go back in and file down the patella or something. I should know if things are on track in the next month or so.

Steven Low
12-03-2009, 11:50 AM
I wrote this... for people like you:
http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/

I suspected the kneecap thing was patellofemoral syndrome/chondromalacia patellae. I guess it's verified now.

With the above link you can do your own soft tissue work as well if you need to.

Utilize eccentric exercise for your quads!

Nick Hunter
12-03-2009, 10:12 PM
Hey Steven,

I read that. I'm interested in a fair bit of it. Funny thing is that with my bone spurs, I barefoot walk in the barefoot running gait. My feet often land in the middle or front, and my heels leave soon after.

The valgus tendency of my knee IS due to flattening of the arch during dorsiflexed movements. At 23, would you say, assuming I got rid of these spurs, that I'm young enough to retrain better stronger foot-leg movement patterns and structures?

Also, why is it that in therapy, I can do no resisted leg extensions at all, but I can do resisted hamstring curls relatively pain free? Does this have to do with the hamstring's pull on the lower leg not being channeled through the patella?

It seems most people's descriptions of PFPS pain are dull or achey pains after activity or while doing activity. Mine is acute and severe. If it lasted any longer than the instant it takes to buckle me, I would need to be on a morphine drip.

Also, since this is cartilage irritation, would it make sense to just go ahead and start taking a joint complex again? G/C/MSM?

Thanks for the link, some great stuff to think about in there.

Nick

Steven Low
12-04-2009, 09:01 AM
Hey Steven,

I read that. I'm interested in a fair bit of it. Funny thing is that with my bone spurs, I barefoot walk in the barefoot running gait. My feet often land in the middle or front, and my heels leave soon after.

The valgus tendency of my knee IS due to flattening of the arch during dorsiflexed movements. At 23, would you say, assuming I got rid of these spurs, that I'm young enough to retrain better stronger foot-leg movement patterns and structures?

Most likely.

Do you have purely flat feet or just compressing arch? Compressing arch is fine.. that's what it's built for to take the the stress. Flat feet/pes planus/etc. where the arch is flat all the time is something that may or may not be corrected depending on how long it's been there.

Also, why is it that in therapy, I can do no resisted leg extensions at all, but I can do resisted hamstring curls relatively pain free? Does this have to do with the hamstring's pull on the lower leg not being channeled through the patella?

Well, once the ACL ruptures the quads get extremely weak (knee doesn't need that protection anymore) and the hamstrings tighten up (to take over for the ACL).

I believe it also is partially due to the fact that you had some patellofemoral/chondromalacia there where it hurt to do stuff.

It seems most people's descriptions of PFPS pain are dull or achey pains after activity or while doing activity. Mine is acute and severe. If it lasted any longer than the instant it takes to buckle me, I would need to be on a morphine drip.

If it gets bad enough it can be like that.

Also, since this is cartilage irritation, would it make sense to just go ahead and start taking a joint complex again? G/C/MSM?

Thanks for the link, some great stuff to think about in there.

Nick

I would definitely suggest that.

Nick Hunter
12-04-2009, 02:36 PM
Most likely.

Do you have purely flat feet or just compressing arch? Compressing arch is fine.. that's what it's built for to take the the stress. Flat feet/pes planus/etc. where the arch is flat all the time is something that may or may not be corrected depending on how long it's been there.
Compressing arch. I think it' just forced to the ground as the ankles pronate and the tibia rotates to avoid the spurring.



Well, once the ACL ruptures the quads get extremely weak (knee doesn't need that protection anymore) and the hamstrings tighten up (to take over for the ACL).
How does quad strength relate to ACL protection?

I believe it also is partially due to the fact that you had some patellofemoral/chondromalacia there where it hurt to do stuff.
This has got to be the source of the pain, yes?


If it gets bad enough it can be like that.
Is there anywhere I can read about treatment of cases of PFPS that are like mine?


I would definitely suggest that.
Started on it today. Taking 3 pills (1 serving) twice to three times per day.


in bold...

My physical therapy went like this today:

HEAT + weighted extension: 10mins
Upright bike: 10mins
Hack Machine 1/4 Squats: 3x15 (super painful if further than 1/4)
TKE: 4x10 (did these with good intensity)
Waist band forward leaning 1leg 1/4 squats: 3x15
Hamstring curl machine: 3x15 (moved up in weight)
Bosu step up/down: 3x15 (leg dumps rather than lowers)
Bulgarian Split DB 1/4 Squats: 3x15
Circle-to-circle 1leg jumps: 3x10
Raised Ladder sidestep: 1x10 (down and back)
Mild stretching
Kneecap manipulation
Ice

Nick Hunter
12-09-2009, 02:55 PM
Knee freaked and bailed in therapy today. Despite the stretching. Only thing that makes sense to me at this point is that it happened after I'd done a bunch of quad stuff. Maybe the quad couldn't hold it together. Whatever.

If nobody can figure this shit out I'm going back to church.

Nick Hunter
12-18-2009, 01:07 PM
3 weeks therapy and no change. Better quad strength, better hamstring strength, better flexibility, and no change at all in pain.

Therapist says my kneecap tracks laterally and the lateral structures are very tight. When my quad flexes the kneecap actually seems to jump over the condyle. Like a quarter sitting on the edge of a table. I have a doctor's visit monday, and my therapist is reccomending that my doctor consider debridement, cleanup, or lateral release.

Possible that this lateral riding of the kneecap combined with heavy sports and heavy squatting over a long period has produced this pain. Make sense, as the weightbearing pain happens at a point almost precisely above a parallel squat. Who knows. I am scared of more surgery, but at this point I'll never play sports, bodyweight squat, or wlak up stairs right again. No other choice.

Nick Hunter
12-21-2009, 04:00 PM
Scope scheduled for January 5th.

Steven Low
12-25-2009, 07:42 AM
Yooo, I apologize for forgetting about your log. I definitely would've tried to help you out here the past few weeks.

Hey Steven,

I'm due for another operation on the 5th of January. Something I wanted to run by you though, is this:

I have noticed during therapy that whenever I do hamstring curls in therapy I do not have knee pain. These are done relatively heavy (10RM) for multiple sets with just the injured leg, are through a FULL ROM, and produce no pain. If there is structural damage causing this pain how could it not present during this full ROM exercise? You've been helpful so far. Thought I'd throw that at you.

If you do indeed have some patellofemoral syndrome/chondromalacia patella (if I remember correctly), then the tightening of the hammies during leg curls is going to take pressure off of the patella-femur articulation. Thus, no pain.

For most people (1) strengthenin the hammies is one of the critical things to strengthen to rehab patellofemoral including (2) getting the knee tracking right over the toes, and (3) vertical during squats (box squats) to get proper hamstring involvement and lessen the load on the quads which is why Kelly Starrett recommends this if you've seen his vids.

This should definitely be a part of your rehab, although since you have had an ACL surgery you don't want the quad/hams to get too out of balance since you have a lot of quad atrophy. Basically, you're going to have to work in the last 20-30 degrees of ROM a lot to help strengthen that VMO with your quad work, and keep working the hammies. IMO.

Basically, if it were me I'd put off your surgery more and JUST do strengthening in the latter 10-20 degrees on ROM like TKEs (this feel fine correct?). Also, since you're probably getting a lot of lateral quad/tight IT band and TFL contribution, we'd start having you do some partial squats with a band around your knee to help get the glutes activated during the movement.

I would strongly suggest adding some specific glute work as well as using manual massage to loosen up any tender/trigger points in your vastus lateralis, IT band, and TFL.

Steven Low
12-25-2009, 07:57 AM
Most likely.

Do you have purely flat feet or just compressing arch? Compressing arch is fine.. that's what it's built for to take the the stress. Flat feet/pes planus/etc. where the arch is flat all the time is something that may or may not be corrected depending on how long it's been there.
Compressing arch. I think it' just forced to the ground as the ankles pronate and the tibia rotates to avoid the spurring.

Well, once the ACL ruptures the quads get extremely weak (knee doesn't need that protection anymore) and the hamstrings tighten up (to take over for the ACL).
How does quad strength relate to ACL protection?

I believe it also is partially due to the fact that you had some patellofemoral/chondromalacia there where it hurt to do stuff.
This has got to be the source of the pain, yes?

If it gets bad enough it can be like that.
Is there anywhere I can read about treatment of cases of PFPS that are like mine?

I would definitely suggest that.
Started on it today. Taking 3 pills (1 serving) twice to three times per day.


OK so...

1. Yeah, that's the definition of valgus. IMO it would probably be better to get surgery for THAT rather than the femoral pain. I stated why in the article, but I'll go over it again. When your knee goes valgus the lateral quads, TFL and IT band are recruited strongly to help stabilize the knee. BECAUSE they are getting strengthened and tightened, your glutes and VM/VMO are suffering badly. So your kneecap is tracking off to the side as the imbalanace grows bigger.

Basically, if you can't get any good ROM in your ankles, and you keep going valgus that is the problem. Not the stuff at the knees.

2. Before the ACL ruptures, the body makes everything tight (quads, TFL, ITband, hammies, etc.) to protect it from damage. However, after it ruptures and depending on what kind of surgery they did, there's going to be major atrophy of the quad because of the trauma.

3. Yep, PFPS/CP is the source of the pain, but not the source of the dysfunction as we explained.

4. Add in .5g/10 lbs of fish oil as well. If you're not getting a lot of vitamin K from veges then supplement some as well (because of the blood thinning issue).

There's a crapton of inflammation, so you need some strong anti-inflams like fish oil. Depending on how it goes you may want to add in some NSAIDs as well. Combined extremely strong anti-inflam effects.

Are you eating Paleo?


in bold...

My physical therapy went like this today:

HEAT + weighted extension: 10mins
Upright bike: 10mins
Hack Machine 1/4 Squats: 3x15 (super painful if further than 1/4)
TKE: 4x10 (did these with good intensity)
Waist band forward leaning 1leg 1/4 squats: 3x15
Hamstring curl machine: 3x15 (moved up in weight)
Bosu step up/down: 3x15 (leg dumps rather than lowers)
Bulgarian Split DB 1/4 Squats: 3x15
Circle-to-circle 1leg jumps: 3x10
Raised Ladder sidestep: 1x10 (down and back)
Mild stretching
Kneecap manipulation
Ice

Full ROM extensions won't help you at this point. Like I said earlier you're gonna have to work VM/VMO a lot... maybe even get some e-stim on it while you're holding each contraction to help get them active and stronger quicker. TKEs et al in that ROM are going to be the best.

If you're going valgus during any of these exercises that's a no-no. I'd rather you not do an exercise than go valgus because anytime you go valgus that's exacerbating your problem.

If I was your PT I'd probably hammer your VL, TFL, and IT band with massage every time to loosen them up. At least 20 minutes most likely of massage there.


Of course, I'm not even in PT school yet so what do I know...

Nick Hunter
01-20-2010, 12:09 AM
Nick vs. Surgery, Knee Edition: Round 2

My new doc seems heaps more comfortable in his diagnoses. He suspects cartilage lesions and plicas, and in his experience the MRI isn't good at finding those. His reputation is phenomenal, so I'm feeling good about this. One week to go.

Nick Hunter
01-21-2010, 05:44 PM
At least I'm putting on some muscle. Will ramp up # of sets now that I've found ones I want to focus on. Surgery shouldn't complicate anything as all of it's upper body so far.

Bench Press: 165x10 :will up to 3 sets at highest weight
Lat Pulldown: 145x10 :will up to 4 sets at highest weight
Prone Rear Delt Laterals: 12x15 :will up to 4 sets
Reverse Hyper: 160x15 :will up to 4 sets

Neck Harness: 35x15 :will up to 4 sets
Wheel Rollouts: BWx20: will up to 4 sets
External Rotations: 15x20: will up to 4 sets

Nick Hunter
01-28-2010, 09:13 PM
Plica resected, cartilage treated. Two fractures, one in kneecap, one in femur.

Nick Hunter
02-05-2010, 12:32 AM
Doc says he expects full recovery! Looking at about 3 months with therapy he reckons. Shit, that's nothing to me anymore.

Still some sharp pain in the knee and still very weak. Only thing I can do with it is walk. Here's the history breakdown:

Cracks in kneecap and femur cartilage go to the bone.
Massive amounts of scar tissue buildup around fractures.
Pressure from activity creates pain from the nerves in the bone.
That sharp pain inhibits the quad, causing a shut-off.
Quad shut-off mid-cut in sport causes loss of knee stability.
Knee goes valgus, and ACL tears.
During ACL reconstruction patella mechanics are altered.
During ACL rehab, quadricep atrophies significantly.
With a very weak quad the kneecap sits much lower in the groove.
Inflammation and lower patella mean more frequent, harder contact between patella and femur.
Progress stalls.
*Scar tissues cut out, cartilage smoothed.
*Begin therapy to cease inflammation and strengthen quad.
*As quad strengthens, patella will rise in groove.
*Symptoms should dissipate.

Nick Hunter
02-08-2010, 02:39 PM
Learned that Chondromalacia was Grade III. That is a thinning and degradation of cartilage that can go down to bone. Bone is the sensitive area of pain. Grade IV is bone on bone.

Surface was scraped to induce bleeding, which will help build new (albeit inferior) cartilage where the holes are. That takes about 6-8 weeks to happen. Working on building back Quad strength to take pressure off kneecap. Still somewhat unsure how this happens, scientifically.

This road to recovery has been amazing in terms of the difficulty and the level of knowledge and patience I've developed. Hopefully this is the beginning of the way out.

Nick Hunter
04-25-2010, 02:36 PM
April 25...

So almost 3 months out.

Doctor wrote me back and said 3 months was "see some improvements in symptoms" but that it oculd be a year before I feel normal again. Fuuuuuck. I definitely feel improved from say, January, it's just amazing how long this shit takes... had nothing worth posting for a while.

Anyway, my accomplishments so far are:

Ran two miles last week.
Did some band-resisted leg extensions with full ROM the other day. Could be a sign of healing?

Upper body coming along, too.

Bench 210x5
OHP 165x5, 135x10

Nick Hunter
04-27-2010, 10:11 PM
How do you tell your knee that you're moving on without it?

Strict Press

45x10
135x3
155x1
185x1 (+10 PR)
200x1 (+25 PR)