Front Stance – ACL recovery

  • Horse stance? Not bad.
  • Cat stance? Right as rain.
  • X stance? Feels fine.
  • Fight stance? Tiring but solid.
  • Front stance? Hmmm.

All through my recovery I’ve had no illusions that there would be a number of things that I wouldn’t be able to do for at least awhile. That sweep at the end of one of our knife katas, for instance, where we switch from one knee to the other. That one’s a real stumper for me these days and will probably remain that way well into next year.

What’s weird with the front stance is that it seems so easy. At least it’s easy to get down into one. It’s moving in one that is giving me fits. It’s not that it hurts, really. And the knee remains very stable. It’s more that my injured leg isn’t comfortable being in front, both when it needs to stop my momentum and when it needs to push off to get me moving again.

When I do single-person kata and I’m in control of the pace, it’s not that big a deal. But during two-person katas, when I have to keep up with someone else, it falls apart. I find myself either pulling my legs forward unthinkingly or having to gather my thoughts entirely and unnaturally around my knee. The good news is that whether I think about it or not, the knee can take moving at a pretty decent pace. It’s just very awkward.

For the time being, I think this is what the post-surgery, early-return phase looks like. Most things working well, with a few holdouts. A time of optimism and patience.

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A promising start

My first “official” class back at karate with no limitations was essentially Niage (Naihanchi/Tekki) Night for me.   My highest is Niage 3, of which learned half (the upper half) while still in recovery.  My job was to learn  the footwork and start integrating it with my handwork. The good news is that knee seems to hold up quite well to moving repeatedly in and out of horse stance (thankfully there’s almost no pivoting in these katas).  

The not so good news — and I’ve faced this problem before — is that it’s not so easy to reverse engineer (so to speak) a kata or technique once you’ve learned to do it a certain way.  In this particular case, I had trouble pausing techniques and timing my breath when making lateral transitions, because, for me,  the handwork was just one big series that I could break up as I saw fit.  Once the footwork was added, the different series became clear; I just couldn’t get myself to do them without some of them blending together.  And, of course, we all know how catching yourself screwing up just throws you off more. 

I also found that I’d typically forgotten a couple of techniques in my other advanced kata.  I thought I’d remembered the katas pretty clearly.  So much for my memory.  Most often, what I was missing would come back quickly when pointed out, but in one or two cases I had almost no memory of learning them.   Shows what seven and half months off can do to someone at my level.

Getting back to the knee, the only time I felt any pain was during some of stretches that I hadn’t done for a while.  I laid off when it didn’t feel good.   I had on my soft brace with the donut pad around the patella, which helped immensely with kneeling but also dulled my connection to my knee and left me constant unease about its status.  Yet, when I took the brace off at the end of class, everything looked fine.  I iced the knee and took some ibuprophen, and it’s felt quite good since.   

Crossing fingers and knocking on wood, it was a good start.

Clearance!

It’s official.  On October 9, I got clearance from the surgeon to “return to sport.”

And I have. Sort of.

You see, I haven’t actually been to back to a karate class since seeing the surgeon. But I haven’t been neglecting my practice, either. During my regular visits to the gym, I’ve been doing some stance and movement work, a few kicks, and yesterday I went through all (or nearly all) of my non-partner kata.

The knee is holding up pretty dang well. Some of the muscles around the knee let me know about it later (even now, I’m still icing it regularly), but while I’m warmed up it feels reassuringly strong. I won’t say that I haven’t lost a step. I definitely have. But that’s not really a bad thing for me. I’ve needed to slow down, I think.  I now have the excuse I needed to get myself to go slow. So far, I find that I’m enjoying feeling things out and noticing what feels right.

Last appointment

My last appointment was fairly uneventful. The surgeon asked me a few questions, lightly examined the injured knee, tested both knees with the arthrometer, and, after determining they have the same play, pronounced me able to start back at karate. He doesn’t see why I should avoid any pivoting motions, nor did he recommend using a brace. And based on how things have gone so far, I’ll probably only wear my old soft brace for compression and leave off the supports.

While I was there I asked him about my shoulder. He did a couple of physical tests, stated that I probably made my rotator cuff “angry,” and gave me a cortisone shot. It feels so much better, but for the next six weeks I have to refrain from doing any heavy lifting over my head.

Next class

My next class is this coming Tuesday. I’ll not miss it, and I’ll report on how it went afterwards.

In the meantime, I’m lifting weights for my knee and shoulder, doing some balance work, and grooving on the bongo board whenever I can.

Minus Two Weeks

It’s just a couple of weeks until my 6-month post-op with my surgeon. I’m guessing that this will be a mostly pro forma session. Of course, I’ll have some question about what to expect from here on out. But really my recovery seems right on schedule, and I don’t expect any surprises.

My Knee: the good, the great, and the strange

Near the end of my “six-month recovery period,” the only thing I wish were better are the muscles and tendons around my graft incision. They’re strong, but they tire out very easily and feel tight and “twingy.” The knee itself is very noisy and is nowhere near as readily flexible as the other.

The great part is that the joint is rock solid. There’s no bouncing or ‘tricking’. I can go up stairs two at time at pretty quick clip and change directions at an easy run almost without thinking. I can get down fairly low in all my karate stances, and when warmed up can even kneel comfortably (though getting back up can be a slow and arduous process).

The strange thing is that, in some ways, my injured leg is stronger, has better balance, and can extend higher than my good leg. And I mean a lot higher. My left front kick now reaches up a good 8+ inches higher than my right. It kind of blows my mind how easily it does it. Gotta be all that extra stretching since March. A bonus, no doubt, even if hard won.

My Shoulder: the bad, the good, and the strange

The last time I did an in-depth update I was making good progress swimming. Well, that’s on hold, because a number of weeks ago I strained my shoulder enough to make swimiing impossible and some of my karate difficult. I may have to drop lap swimming altogether.

The good news is that, after a couple of weeks of resting and several more of some targeted weightlifting, the pain is now limited to occasional twinges. I’ve never really liked weightlifting but I’ve come around to its great benefits beyond body-building for its own sake. I’m not out of the woods yet here, but I’m definitely beter than I was.

The strange here is that the swimming may not be to blame. Because of my knee, I’ve been going through my Niage (Naihanchi/Tekki) handwork in a high stance. When my shoulder started hurting, doing some of the in-to-out strikes became nearly impossible. However, when I got well enough to practice in a good, deep horse stance, the pain all but disappeared. Maybe swimming was the original cause, but it is possible that high stances aren’t great for certain kinds of techniques. Yet another reason to stay low.

Staying the course

Aside from adding weightlifting for my shoulder, I’m still doing pretty much the same exercises several times a week, with more weight or for longer periods. The best new thing I’ve started doing is squats on the Bongo-Board at my gym. Bong-boarding is simply just fun and does the same things as the balance board, only better. Since I’m not likely to build one at home, I’ve put it on my wish list for impending birthday.

Until my appointment with the surgeon I’m back to karate once a week. There are still many things I won’t do. But there’s still plenty to do, and I left my last class with a worn-out but happy knee and a nicely sopping gi. Bliss.

ACL Poll – Graft type

Perhaps the best thing about the various ACL blogs that are out is the chance to see how the experiences of other ACL recoveree differ from each other, and yet how they also seem to lead to the same result.  

In this spirit, I thought it might fun, and maybe helpful, to post a series of entirely unscientific polls about things like graft choice, braces, PT, and recovery stages, and ultimately return to sport.    Ideally, it’d be best to use something like SurveyMonkey or GoogleDocs’s polling feature to create a multi-question survey where you can filter responses.  But I don’t expect to get a very serious sample out of this, so this’ll just be for curiosity’s sake. 

If you have any particular questions you’d like to ask, feel free to post them in a comment and I’ll try to create polls for them.  Enjoy.

ACL Graft Technique
( polls)

Week 17, ACL Recovery

Cue Pomp and Circumstance and don your cap and gown.  I have graduated from physical therapy.

I got the word from my PT:  yesterday’s appointment was on the very last of the 90 days allowed by my insurance company without another prescription from a doctor.    Which is okay, really, because I seem to be doing very well.   I’d already cut back to PT appointments to every 3 weeks, so I’ve been pretty much on my own anyhow.  And my PT seems very pleased with my progress.  Just to prove to me how well I’m doing, she took me into the squash courts at the gym and first had me run forwards and backwards, then in an “S” pattern, and then in a zig-zag pattern, cutting one way and then the other.   It wasn’t all out, but I was out of breath afterwards.  And guess what?  No bouncing bones!  Five months ago, I would have been down on the ground after one cut.

Back to Karate

Now does this mean I’m all healed and can begin practicing karate again full tilt?  Absolutely not.   My flexion is still not as natural as my other leg.  I still have a teensy bit of swelling.  And the muscles around my knee have not fully healed just yet.  

But . . . I have strapped on my big post-op brace and gone to karate a few times over the last few weeks.   A couple of our black belt instructors had been encouraging me to come and help out with lower belts.   Starting as low as green belt, we are asked to show white belts new techniques as part of our own training.   There’s nothing like teaching to bring some aspects of karate into new focus, so I was very happy about the idea.  Plus, I’ve started learning the hand parts of two new katas. 

Mind you, I’m not using my legs.  No kicks, no pivots, no pushing off, and no stance work.  (Well, maybe just a few easy-paced front kicks and some slow, high movement.  But no pivots, and nothing strenuous or fast!)   I am starting to suspect that I could do some of those things.  But, honestly, I’m not mentally ready for it, I’m probably still very vulnerable because of the weak muscles, and I see no reason to rush ahead just yet.   I’m helping a little and learning a little, and that’s actually really cool right now.

Week 17 Benchmarks

Exercises (all prescribed by my Phyiscal Therapists)

  • Warm-up: Stationary bike, or Elliptical, or Step Machine for 10 minutes
  • Aerobics.  Running, 1/2 mile.  Swimming, 1/2 mile.  And now some cutting drills :-)
  • Weight machines: Abductor, Adductor, Single Leg Press all at about 120lbs. Hamstring curls still at justt 17.5 lbs.  Each about 2 sets of 10-15 reps.
  • Balance board and TheraBand pad exercises, as before.
  • Lunges on the squishy half-circle Bosu ball, about 25 each leg, holding 10-lb. weights in each hand.  Side lunges onto the Bosu that go into a horse stance, also with 10-lb. weights.
  • Hopping with both feet onto a step and then hopping off to the other side and rotating 180 degrees in the air.   Trying to stay light on my feet.
  • Stretches!

Flexion

  • Full flexion when warm.  I can now start off my flexion stretch by reaching around with my hand instead of using a rope.

Walking/Navigating Stairs

  • Back to my old ascending two steps at a time, when feeling good.

Swelling

  • Negligible swelling.  However, I do notice that my injured leg shows a sock mark after extended wear, where my good leg does not.  Very weird.  

Karate

  • Still trying to do some kata in my head every day.
  • Still using flash cards to keep sharp on techniques. 
  • Practicing hand movements for our all our Niage (Naihanchi/Tekki) katas, and began learning part of two-person kata form (hands only) that I’ll need to know for black belt.
  • Prompted by an e-mail from a long-time black belt in Tang Soo Do who recently tore his ACL,   I’ve been doing some research on the various Kwans that were formed into Tang Soo Do and tracing their roots and much of their kata back to China and Japan.   Nothing new to the world, just new to me.  Always good to know where you come from.

A Big Week 12

That Mental Thing

My life has been full of terrible misfortunes most of which never happened.”
— Michel de Montaigne

First off, I have to state that, recoverywise, the last two weeks have been great.  Nothing but progress, physically.

Mentally, though, I have spent a lot of time worrying about the knee.  Too much, considering the evidence.  Of course, the joint seems stable.  It just still feels weird and weak.  I haven’t had any of those occassional subluxations that I did before surgey, so it’s really just a muscle thing.  Still, I haven’t really challenged the knee (and won’t just yet), so I have doubts.  They’re more niggling than gnawing, but I have found myself engaging in what I know are pointless tests of recovery, like watching the injured knee when going down stairs to see if it wobbles more than the other.  Or standing on one leg to detect whether I can feel the tibia going more forward than it should.   Like I could really get a good read by just eyeballing it. 

I don’t want to make too much of this.  I have noticed I am not alone in experiencing these fears and doubts midway the through process.  You see it time and again in blogs and in message boards.  I even read about one ACL recoveree whose distraction led him to self-administer a Lachman-like test with, I gathered, a rope and a drawer.  (Where’s an arthrometer when you need it?)  The description was vague, so I don’t know exactly how the person did it.  I understand a video of it was posted somewhere, but based on the reactions, I thought it better not look for it.  

The moral of this is, it’s natural to fear the worst, but mostly it’s for naught.  During ACL recovery, you’re constantly asking the knee to go a little further, to do a little more, so it’s no surprise that it constantly feels off.  Come to think of it, it’s a lot like karate.  Because you’re always refining your technique or learning new stuff, it often feels like you’re getting nowhere.  You’re always at the edge of yourself.  


And now for the good news . . .

Full Flexion!

Yep, that’s right.  I got my heel to my bum earlier this week after a good warm up.  They’ve been apart for more than four months now, ever since that fateful Blech Thursday.   The effect is still only temporary; by the time I’m ready to go home or get to work, the flexibility is gone.   Still, it is SOOO cool to be able to actual sit in a kneeling position, if only for a brief minute or so.

Running Man

I can run now, too.  That is, my therapist is making me run.  Sort of.   I can only run straightaways.  Which, on the 1/16 mile track at the gym, means I do this spastic series of 10-second runs in the straights and 20- second walks around the curves, interrupted every so often by a full walking lap until I hit a half mile.  It must look really silly and kind of pathetic.  And what’s worse, it really tires out my injured knee.  After a couple of laps, I feel like the calf and foot are just going to fall right off.   Honestly, I’d rather be swimming, but I know this is important.

Home Balancing Act

While I getting some nice e-stim and ice at the end of my last physical therapy appointment, I overheard one of the therapists explain to a patient new to the balance board that people either hate the thing or want to go home and make one for themselves.  

Which was funny, because I had made one just a few days before.  In truth, I probably wouldn’t have done it just for myself, but my wife needs to use one, too.   She’s been a runner for as long as I’ve known her, but during the past few years she’s been dealing with the aftermath of three meniscectomies and hasn’t been able to run much. (We currently have just one good knee between us.)  She isn’t able to get to our gym everyday.  So, one $7 piece of plywood and a half-hour of labor later, we had one serviceable balance board ready for squats.  My sons love it, and even Nurse Josephine got a little curious about its construction (she’s the black blob on the left).    And now I can help my wife work on her balance and proprioception by tossing her a ball while she wobbles, and she can do the same for me.  It’s a new stage in our relationship :-)

Week 12 Benchmarks

Other than full flexion and running, there’s not much new to report.  Basically I’m doing the same stuff as as Week 10.  It’s just really a matter of doing it a little better, a little longer, or with a little more weight.