ACL Rehab and next year's goals

Triathlon Forum
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Hello All -
I’m seeking some advice, as I recover from surgery to replace my right ACL and start to think about next year.

After lots of varied sports activities, I started doing triathlons this summer, at the ripe young age of 35. It was a lot of fun - both the races and the training. I did one olympic-ish distance triathlon in Vermont and had a dissapointing bottom-third finish. (I had to walk a lot of the first half of the run, not because I was tired but because my butt and lower back were seizing up).Then I did a sprint distance, ran well and finished top-third overall. I signed up for a 1/2IM in September, and training was going well. I expected to finish, and had vague thoughts of doing so under 6hours. My thought is that I could make a damn good MOPer. I was looking forward to the 1/2IM and, if it went well, hoping to do a full IM next year. My thought is that, long-term, 1/2IM is the pace for me (previous results notwithstanding), but I’d like the experience of doing the full thing.

In August, though, I tore my ACL; had surgery in mid september. There’s now a new ligament in there (an allograft). They also had to take out around 1/4 of my meniscus. Rehab seems to be going well, but my right leg is really weak. It’s visibly smaller than the other leg. I’m told this is normal, and that I can have a full rehab in as little as 6 months. Riding on a trainer & swimming well before that. And doc says that I can hit the racing season hard next year.

My question is, what are appropriate goals for next year? Will I be able to get enough training time in before spring races? And would it be completely psycho of me to expect to be able to do an IM next fall? There are two unknowns here - my rehab and my ability to do the longer distances - so I’d like to get any advice I can.

Thanks,

-Charles

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hmmm… i’m going to “bump” this in the hopes that someone out there has some advice on the matter… anyone?

3

Keep with the rehab and do your home exercises. The simple exercises really work. Make sure you gain full extension soon if you haven’t already done so. The flexion will come. Work on your balance and proprioceptive exercises. The ones where you balance on one leg and then progess to balancing on a wobble board and so on. Close your eyes and balance.

Your strength will come. Work own getting good VMO contraction(the inner quad muscle) and strength. Just in case if you have graft problems, wait a few months and then set your high goals. As long as you have no complications and aren’t having patella femoral pain, you should be ready for later 2006 Ironmans. You should not have any problems with early season short races after March. Since some of the meniscus was removed, you may have some patella femoral pain later in life. But you would of probably had PFP pain without the injury. Listen do your doctor and therapist.

Most younger athletes fully recover from ACL reconstruction. I still consider you in the younger age group.

Good Luck and Speedy Rehab!!!

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Charles,

I consider myself an expert on this subject since I’ve had 2 ACL repairs (1/knee). I had ACL/Meniscus repair 10/1/03 and I did my first race in June of '04. By the end of the '04 season I had done 3 Olympic races and a 1/2 IM. I struggled all season with the running because I was trying to get back to previous form and the leg muscles and tendons were not ready for this level of exercise. I was definitely pushing the envelope and I ended the season with a 4:34 1/2 IM time but I had to shut it down for 2 months after in order to recover from the season. The only reason I mention my 1/2 IM time is that I was really pushing the knee and if you’re not going to be pushing for PRs then you should be OK. One thing to consider, I had a meniscus repair which requires a full month of non-weight bearing. If you didn’t have a meniscus repair and you were able to weight bear right after surgery then you’ll be a lot better off than I was. it’s amazing how much your leg atrophies in a month.

As far as a full Ironman, I would definitely not recommend it. It can be done but I don’t think it’s the wise thing to do. If you come from a long distance running background then it’s more do-able. I finished my first Full IM 20 months after my surgery.

Hope this helps. Good luck with the rehab.

Greg

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Thanks to both of you for the advice. It would take a lot more than a new ACL for me to finish a 1/2 IM in 4:34, but I do want to be able to finish one. But I think the advice on waiting a few months before setting my goals makes sense.

Oh and yes, I’m doing my exercises. They’re a bit dull, but I keep up. I actually saw some definition in my inner quad this morning, for the first time in a few weeks; very exciting.

thanks again,
-charles

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I had ACL surgery in the mid 80’s. It was the “middle third” process. The surgery, rehab and physical therapy then was pretty primitive compared to now.

Back then it did take a while for me to bounce back, but he following year I did have an OK triathlon season with about 14 race finishes, all of them sprint or Olympic distance. I did a lot of cycling to rehab the knee, had some success in cycling (4 or 5 state championships) and then concentrated on bike racing for a while.

My knee is 100% now, but I did have some follow-on surgeries for scar tissue, etc. For years, the appearance of my post-operative (left) leg is very different than my right leg, but they boh work OK- as good as they ever did. Since my knee surgery I’ve done at least 60-90 more triathlons, four big adventure races, three ultra-distance running races and skiied, snowboarded, surfed and other stuff- no problems.

Check out the difference in the size of my legs in this photo from the Marathon des Sables in Morocco in 1999:

http://www.bikesportmichigan.com/editorials/images/Tom-MDS.jpg

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I’ve had both ACL and meniscus surgery (on separate occasions, though I’m only 21). My ACL tore several years ago - I had a graft from my patellar tendon as the replacement. Approximately 2 years later I tore my medial meniscus, and had approximately 50% of it removed.

About 4 years after the initial surgery, my legs still don’t match perfectly. I’m active, I ride, I ski, I’ve lifted weights religiously. I’ve been through rehab 3 times. Admittedly, I had a lot of complications, but despite excellent doctors and therapists, I’m resigned to the fact that my legs may never match.

The biggest problem has not been the imbalance, as functionally my legs are identical. The problem I’ve noticed, and you may as well, is the lack of meniscus. That little bit of padding makes an enormous difference when doing any activity where vibration and impact occur. That includes running, unfortunately. Things hurt that never did before, and it’s not because my legs aren’t as strong (because even my bad leg is better than my good one was at the time of the first surgery).

A bit of advice:
Be patient in rehab. Push yourself as hard as you can, but don’t try to work miracles. Healing happens on its own schedule, even if your muscles are strong, some things just take time. NFL players may rush back after surgery, but that’s because they have such a limited career window. You’ll want to avoid future surgeries as a first priority (trust me! I’ve had 5)

Stretching is the most useful thing you can do. I highly, highly recommend yoga as you progress in your rehab. I’ve found it to be invaluable.

Tempting as it may be, “excercise bike” does not mean “excecise on your bike.” It took 3 therapists to finally drill that into my head. Perhaps the indoor trainer would be OK, though.

…

I played in a lacrosse game 6 months to the day from my surgery. I wore a brace - and did for most things for a year or two. I’m sure that you’ll find that cycling and running (since triathlon running involves no harsh cutting) won’t require a brace, at least once your muscles are strong enough. I had my surgery on September 25, and played on March 25. It can be done. It may be difficult to subject your knee to running anything longer than Olympic distances for some time, though. Your body will let you know.

oh, and one more thing - I’m sure someone gave you some vicodin or equivalent. Save a few. One after a rough training session never killed anyone, and it sure as hell helps when your knee decides to swell up and tylenol, ice, and elevation just don’t fix the fact that it hurts like hell sometimes.

Good luck!

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What good advice you’ve received here, many from people who have experienced what you are going through. I have one piece to add. I’m a deep muscle massage therapist and I specialize in sport injuries and chronic pain. Your hamstrings, and possibly also your quads, have multiple spasms because of the tear. It would help you to go to a qualified massage therapist as a part of your rehab program. You need to flush out lactic acid that has formed in the muscles, and draw in blood to nourish the muscle fibers.

The therapist won’t go in the area of the surgery, but the easing of tension in the hamstrings will take strain off the back of your knee joint. It can only help, and it certainly won’t hurt your healing process.

Wishing you well,

Julie Donnelly