I need your experience with coming back from ACL tear

morpheus

thankfully, not mine.  I'll try to keep this on the shorter side.

very good friend of mine caught the tri bug over the last few years.  tho my times are rarely impressive, he sometimes will ask me for some guidance just based on my time in the game. 

very healthy guy, good overall fitness, good stubborness and stick-to-it-tiveness for long distance stuff.

last Nov, he jumped in to the IM world by finally signing up for his first one, IMFL.

very excited.  until 4 weeks later when he was told his ACL had blown when playing paintball with his kids.

successful surgery in mid January.  diligent about rehab.  spinning on trainer for a more than a few weeks now.  started outdoor riding 3 weeks ago.  and started some Galloway type jogging ~2 weeks ago.

over coffee, we talk about his plan, or lack thereof, and his goals (mainly, just to finish).

It won't surprise you that its the running that we can't seem to peg.

the biking will be fine.  he has a good fit and will be used to 'time in the saddle'.  not too worried about that.

I have NO CLUE as to what to suggest for the running.  He knows he has to time this right, err...perfectly.  Not too much now but enough to finish a IM mary without traumatizing this knee.  Come back too soon, and something gets hurt (knee or, more likely, some other overuse injury).  come back too conservative and 26.2 will look like a 50 miler when he's 3 miles in.

 

Help me, help him...

 

thoughts? suggestions?

 

Note: no liability here, guys.  he knows I'm bringing this up here just for ideas.  then he'll kick around a few and build from there.

I expect he'll see some of the EN action at IMFL when I bring him along.  wouldn't be surprised if he joins the team at some point.

good people kindof guy.

 

thanks all!

filarl

I had a complete ACL tear in 1999, with surgery to graft in my own Patella tendon. Since he's jogging already, sounds like he's coming along very well - does his PT agree? Anyways, the big things to be extra careful about are steep uphill/pushing too difficult a gear on the bike and steep downhills and slippery surfaces when running. Since he's doing IMFL, there's probably not too much concern about steep hills or black ice:-) I suggest that he work closely with his PT on how much he can handle for another 1-2 more months and then work into an IM specific plan- FL isn't until November right? Once I got the free-and-clear to run as much as I wanted from my PT, the only problems I had where from slipping on ice and having to exit my office building in ladies dress shoes via many floors of stairs during a minor fire incident (have him keep an old pair of sneakers in his desk at work if this is a possibility) I never had any ACL-related problems from simply running too much or too hard and I've been running pretty regularly ever since including IMLP and a marathon (lots of other issues though!) My bet is that he'll be fine!

And again be mindful to stay away from the "stupid" stuff - like running down carpeted stairs in dress shoes when in a hurry, etc!

Jenn Edwards

Complete ACL tear (hockey) with own tendon replacement.  My $0.02, I would agree with Linda that the PT insight is critical.  It's not so much the "up and down" of the running it will be more the "left to right" stability stuff that will be critical.  FWIW. Good luck!

morpheus

Yep, PT is pretty happy with where he's at. And has given the green light as long as he's conservative....

And that's what we've been talking about. It's not really the knee that is causing the increased sphincter tone. It's more like 'how much?' and 'how quickly to progress?' Cuz it's my belief that it will be some other kind of compensating or overuse injury that going to bite him if he's not patient/diligent/lucky.

I'm preaching the 'less is more' school stuff. (Not necessarily EN intensity for him, just 'less is more' for a while)

Frequency / volume / intensity. I'm suggesting steadily building frequency with lo volume, at least up until or thru July.

Keep in mind, he's like most of us, average MOP'er. Not a pure bred runner. 5'9'', around 167 lbs right now. very competitive, soccer background.


I know you guys can't give me 'the answer'. Just keep throwing your thoughts this way. And I'll absorb it for when he asks again, next time.

morpheus

And Linda, I've advised him that he has to put away the high heels for the season.

new2703

Couple questions: 1. what kind of approach ( patella tendon graft, hamstring or cadaver graft. 2. Is range of motion equal on both sides? Even slight discrepancies in range can have an impact on running mechanics. Does he have equal quad strength on both sides? What kind of running is he currently doing?

Steve Ross

Hi Chris my 2 cents worth on the ACL guy. My past hx in the knee department has been an ACL replacement in 1990 with 4 other knee operations over the last 40 years. As well I work as an orthopedic surgical nurse so I know first hand how invasive surgery is on the body. Post op I have been there as well. The PT advice on being conservative and yours "less is more" approach is the only way to go. As you alluded PT guy happy so his ROM(flexion / extension) of his knee are normal or as close as pre surgery(priorty #1). Stubborness can be a good trait to keep him on tracK to rehab. As the knee joint is a hinge joint swimming, cycling, and running are normal to what the joint is suppose to act. The side to side movements not so good on the knee such as all racket sports, soccer, and other quick lateral movement sport efforts at this point and time in rehab.

Four months out and he is running "wow" the graft is still not healed in yet, does he run with a Gen 2 brace for support. If his graft shifts or does not hold up it will upset the balance of the knee creating other traumas and issues such as menicus tear. As he exercises his knee will alway's have some degree of swelling post exercise. It takes time to rehab from that before moving on to have quality workouts. So in saying all that the earliest return to full sports is six months post op with these bench marks 1) 80% quad and hammy strength 2) full ROM,3) minimal swelling,4) good stability, and be able to do some light running(already doing). So that brings him up to Let's say first of Aug only 3 months out from IMFL. He should invest in a good trainer to direct him on running, PT guy only around for so long if he has the perfect rehab. My advice is to postpone his IM goal until he can just focus on his IM and not both! But that is just me, good luck on your guidance for your friend! I did not run for 6 months but I biked huge numbers, eliptical and strenght trained. I was forced not to run because I was in the military at the time. When I started back up I was up to running 10 km no issues because I took my time and listened to my body. I was not a marathoner or tri guy in that part of my life.

 

morpheus

starting to think that his running plans may be a little overly ambitious.

time for more coffee talk.

I am positive that he will be at IMFL. I don't think there's any way that he 'chooses' to DNS, short of an injury.