This was a challenging workout. We’ve changed barbell exercises from the deadlift. This new exercise is something like the first pull of a power clean in which we pull the barbell up to the high hang position and hold for five seconds. I’m calling it a “high hang hold.” That was followed by a bunch of double push jerks and 1-arm snatches. I realized I can better work on my technique with the 12 kg bells rather than the 16 kgs.
- High Hang Hold: 225 lbs x 3 reps x 5 seconds – 260 lbs. x 3 reps x 5 seconds – 295 lbs. x 3 reps x 5 seconds
- Double push jerks: 12 kg x 200 reps
- 1-arm kettlebell snatch: 12 kg x 150 reps done continuously
- Bike ride: 1 minute on/1 minute off x 5 times repeated twice.
Last Thursday I met both my ACL surgeon and my physical therapist. Both come through Kaiser Permanente.
After my conversation with surgeon Dr. Kurt Spindler of the Cleveland Clinic, I had several important questions to ask regarding ACL reconstruction. I wanted to make sure my surgeon has thorough experience and continues to do ACL reconstructions on a regular basis. I wanted someone familiar with athletes and I wanted someone who would be closely involved with my rehab.
Dr. Melissa Koenig answered my questions very thoroughly. I feel that I’m in very good hands with her. She was complimentary and supportive of my efforts thus far to maintain as much mobility and strength as I can prior to surgery. She thought I’d do quite well.
Several workouts to document. Here they are, including one long (for this time of year), wet, tough bike ride.
- Squat: Worked up to a 3 RM at 225 lbs.
- Double 1/2 snatch: 16 kg x 10 reps x 4 sets
- Double push jerk: 16 kg x 10 reps x 4 sets
- 1 arm snatch: 20 kg x 5 reps each arm x 3 sets
- 1 arm clean jerk: 20 kg x 5 reps each arm x 3 sets
- Deadlift: Worked up to 1 RM: 265 lbs. x 3 – 315 lbs. x 3 reps – 335 lbs. x 1 – 350 lbs. x 1 rep x 5 sets
- Kettlebell rows: 40 kg x 5 reps x 3 sets
- Double jerk: 16 kg x 80 reps in 10 minutes
- 1 arm snatch: 16 kg x 80 reps in 10 minutes
- Bike ride: 20 miles
- 4/19/14: Somewhat light/easy workout. Bike ride afterwards.
- Power clean: 115 lbs. x 5 reps – 135 lbs. x 5 reps – 145 lbs. x 5 reps – 155 lbs. x 5 reps
- Squat: 95 lbs. x 5 reps – 115 lbx. x 5 reps – 135 lbs. x 5 reps – 135 lbs. x 5 reps – 155 lbs. x 5 reps – 185 lbs. x 5 reps
- I got to full depth on the squat for the first time since the knee.
- In speaking with my physical therapist, he recommended working on my knee flexion.
- A decently weighted squat is a pretty easy way to get the knee to flex!
- Superset x 3 sets
- Pull-ups: 4-3-2-1 reps each set
- Stability ball leg curl: 15 reps
- Superset x 4 sets
- ab wheel: 6 reps
- face pull: I used a thicker on each set for 15 reps – 15 reps – 12 reps – 12 reps
- Bike ride: 41 miles and it was tough! Rode from Denver to Golden, over to Morrison and back into Denver via the Bear Creek Trail. Got rained on. Cold, wet, tired and hungry by the end. Food and alcoholic beverages were quite tasty afterward.
- Split squat: 95 lbs. x 5 reps each leg – 115 lbs. x 5 reps – 125 lbs. x 5 reps x 3 sets
I don’t do these often enough. I’m glad the class instructor is having us do these. I’ll probably squat on the weekend.
- Push Press: 115 lbs. x 6 reps – 120 lbs. x 6 reps x 3 sets
- Double kettlebell jerk: 16 kg x 100 reps done in sets of 10
- 1 arm kettlebell snatch: 16 kg x 200 reps done in sets of 5 each hand. I paused at 100 reps. Tough but very doable.
- stability ball leg curl: 20 reps x 4 sets
My double jerk position needs more work. I still need better lat and probably tricep flexibility to get in proper position. It’s a work in progress and I’m making progress.
Easy/short one today. Kettlebell/barbell class tomorrow.
- jump rope and mobility work
- Power clean: 115 lbs. x 5 – 135 lbs. x 5 – 145 lbs. x 5
- Double kettlebell snatch: 12 kg x 20 – 16 kg x 20
- Double kettlebell windmill: 16 kg x 5 reps x 2 sets
- Jump rope intervals: 4 x 45 seconds
Done and Done.
Several days gone by and I’ve had several good workouts. I did some power cleans for the first time since the ACL and everything felt fine. I also rode up Lookout Mt. in Golden, CO and again, things felt good. Here’s what it all looked like:
- Power cleans: 135 lbs. x 5 reps x 5 sets
- Knee was stable.
- Weight felt fine.
- Front squats: 135 lbs. x 2 x 5 reps
- Easy/light day for squats
- Front squats are more challenging than back squats but that means I can load myself lighter.
- Good mornings: 135 lbs. x 6 – 145 lbs. x 6 – 155 lbs. x 6 – 165 lbs. x 6 – 175 lbs. x 6 – 185 lbs. x 6
- Heaviest on GM I’ve gone since the knee.
- I do these on light days, deadlift on heavy days.
- Kettlebell snatch: 16 kg x 40 reps – x 50 reps – x 30 reps = 120 reps total
- Super set: 3 sets
- 1-leg squat: 30 lbs x 7 reps
- cable anti-rotation: 15 lbs x 3 seconds x 10 reps
Lookout Mt. from the air. My favorite climb.
Bike ride up Lookout Mt: about 2 hrs/20 miles.
- Tough ride but good.
- Early season climbing is always an eye-opener.
- Knee felt fine.
- Lunch and beers afterward! Yeehaw!
- Jump rope & mobility work
- First time for any jumping since the knee.
- 5 x 50 reps
- Circuit: 8 rounds
- Weighted pull-ups: 20kg x 4 reps
- Kettlebell swings: 32kg x 20 reps – 36kg x 15 reps – 40kg x 10 reps for all remaining sets
- Push-ups: 10 reps – 3 reps plyo push-ups – 10 reps – 3 plyo reps – 10 reps – 3 plyo – 10 reps – 10 reps = 59 reps total
- 1-leg hops: 20 reps
- This was a moderate workout. I went at an easy pace and worked until I was moderately fatigued.
This past week I was successful doing power cleans, jump rope, and 1-leg hops. This is fairly aggressive stuff and everything held together well. I’m very pleased.
Surgery is scheduled for May 1. It’s a little tough to contemplate after seeing so much quick progress since the initial injury. That said, I’m ready to get fixed up.
It was a good workout today. I returned to the Tuesday/Thursday barbell & kettlebell class at the Glendale Sports Center. I really love this class but I haven’t been going because I probably haven’t yet been ready. But lately I’ve felt very solid so I figured it was time to give it a run. I haven’t done anything very powerful recently and I wasn’t sure how it would go with the kettlebell exercises. Can’t know ’til you try it though.
- Squats: Worked up to 175 lbs. x 3 reps x 3 sets
- Most weight I’ve done since the ACL
- Can’t go quite as low as before but this is no surprise. I’m still below parallel.
- Press: Worked up to 115 lbs x 3 reps x 3 sets
- 2-handed Bent-over kettlebell rows: 16 kg x 10 reps – 20 kg x 10 reps – 28 kg x 10 reps
- Kettlebell double push-jerk: 16 kg x 10 x 10 reps for 100 total reps.
- Knee felt fine.
- Technique is rusty.
- Kettlebell 1-arm snatch: 16 kg x 20 reps (10 one hand then 10 in the other hand) x 5 sets for 100 reps.
- Felt fine!
- Probably will do a few tomorrow. I need to build some callouses on my hands.
- Farmer walks: 32 kg
I’m very tempted to try a barbell power clean some time soon.
- Road bike ride: About 20 miles
- tempo ride
- Done at a “comfortably challenging” pace.
- Great day to ride. Felt good.
Oh joyous day! I did several sets of back squats! I love me some squats and it felt like a big breath of fresh air doing them. First time for barbell squats of any kind since the knee went out. I got down to a fairly respectable depth (just below parallel.) The knee felt pretty good. There was some tightness/bruised-type feeling on the outside of the knee but only at the deepest depth. I followed that with deadlifts and some other fun stuff. Here’s what it looked like:
- Squats: 95 lbs. x 5 reps – 115 lbs. x 5 reps – 135 lbs. x 5 reps, 5 reps, 10 reps
- Life affirming!
- Felt very solid.
- Deadlift: 155 lbs. x 3 – 205 lbs. x 3 – 225 lbs. x 3 – 2625 lbs. x 3 – 290 lbs x 3 reps
- 1-arm kettlebell clean & press: 16 kg x 10 reps each arm – 20 kg x 10 reps each arm
- Ab wheel roll out: 7 reps x 3 sets
I followed this workout with intervals on the bike: 1 minute on/1 minute off x 5 sets followed by several minutes easy pedaling, then I repeated it.
I saw a non-surgical orthopedist yesterday and he walked me through my MRI. It wasn’t the worst news in the world. There were no bad surprises. I do have a grade III sprain aka a fully torn ACL. I have a grade II sprain of my MCL. No surprises there. The good news is my minisci are intact and undamaged. That’s great news! There’s also no bone damage. I’m really happy about both of these things. Surgery will be required but this injury could’ve been quite a bit worse.
I told him about my activities (staying as active and mobile as possible so long as I’m not in pain) and he approved. He said most people who get this type of injury sit down, prop up their leg, and move as little as possible. The muscles whither and their movement suffers. They go into surgery in bad shape and they come out worse. Recovery takes much longer under these circumstances.
This is no good. I’ll meet both meet with a surgeon and start physical therapy in two weeks. Some people have expressed exasperation and frustration at the pace of this process. I’m not one of them. I’m not the only guy wandering around Denver with an injury and this isn’t life threatening. I’m grateful that I have insurance, I don’t have some awful, exotic injury or illness and I’ve got people around me who can help. Anyway, the doc said surgeons typically wait on the surgery for two reasons: 1) We want to reduce swelling as much as possible and 2) We want to restore as much range of motion as possible. This stuff takes time and there’s no way around it.
ACL information & Dr. Howard Luks’s excellent blog:
Got a call from Kaiser and apparently the MRI indicates I don’t have a fully torn ACL. There’s evidence of a big sprain (which is a type of tear) and some damage to the MCL. I don’t know about any damage to the minisci.
On the surface, this sounds good. I’m not certain though that a partial tear is much better than a full tear. Of course I got online and started looking up partial tears and such. I found the site of Dr. Howard J. Luks, MD of New York. His blog is incredibly informative and I got a lot of useful information on all things ACL-related. There’s this post on partial ACL tears which discusses the difference between an ACL reconstruction and an ACL augmentation:
“The difference between an ACL reconstruction and an ACL augmentation is fairly simple. During the process of an ACL reconstruction we will reconstruct or replace the entire ruptured ligament. Anatomically, the ACL is composed of two separate bundles and a complete reconstruction will compensate for both of those bundles. In an ACL augmentation, you have only sustained a partial tear. That means that a portion of your ACL remains intact and might be normal. Many high volume ACL sports medicine orthopedic surgeons are capable of reconstructing only the torn portion of the partial ACL tear. This leaves the normal portion of the ACL alone. There are many advantages to an ACL partial tear augmentation over a full ACL reconstruction. While the discomfort, and the nature of the surgery is virtually identical – – – it is far more likely that someone who undergoes an augmentation will have a much more natural feeling knee when all is said and done. The reason for that is because the normal ACL has certain nerves within it. Those nerves give the brain certain feedback as to the position of the knee joint. It turns out that those nerve fibers are quite important. If we preserve the intact portion of your ACL, then we are preserving those nerve fibers and hopefully preserving the integrity of your knee in the long run.”
Perhaps an augmentation is in my future? I’ll have to ask about that on Thursday when I meet with an orthopedist.
Another post, 4 Tips to Prepare You for ACL Surgery, included (you may have guessed) these four tips:
- The technique for performing an ACL reconstruction has evolved significantly. Over the last few years nearly all high volume ACL surgeons have gone to an “anatomic” approach. That means that during ACL surgery we put the new ligament in exactly the same position your native ligament was. Believe it or not, that’s not how we were originally trained how to do it. The older technique was easier… which is likely the reason why some surgeons still use it. Take Home Message: An “anatomic” reconstruction has become the gold standard. It is a more technically challenging procedure, so be sure to review with your surgeon what technique they plan on using.
- Volume matters ! An ACL surgery is a technically challenging procedure. ACL surgery should be performed by those of us who are experienced ACL surgeons. Take Home Message: Be sure to find a surgeon that performs a fair number of ACL reconstructions each month… not a few each year.
The Dark Side of the Moon?
- When we reconstruct the ACL we need to create a new ligament. We can choose to use your hamstring tendons, a piece from your patella, or a donor graft from cadaver tissue. Different grafts are better suited for different situations. Women tend to be “quadriceps dominant” so a patella graft might better suit their needs. A patella tendon graft might be better suited for high level contact athletes. A hamstring graft is a strong graft well suited for most all activities. The research shows that a cadaver graft in a young active person should probably be avoided due to a high failure rate. Take Home Message: One graft does not suit all needs for people considering ACL surgery. Be sure to do your research and talk to your surgeon about your goals so the proper graft can be chosen.
- If you have suffered an ACL tear, you are at very high risk for re-tearing the ACL in the same knee — or tearing the ACL in the other knee. Many people have a predisposition due to a “neuromuscular” impairment. (I hate big words too) That basically means the way you jump, land, pivot, etc needs to be evaluated to correct your biomechanics to diminish your risk of requiring another ACL surgery. Take Home Message: Physical therapy is an absolutely critical part of the overall recovery process. Finishing up with a formal neuromuscular evaluation may play a role in diminishing your risk of a second ACL tear.
The first point about the anatomical graft was news to me. I’ve read a lot on ACL repairs and that bit was new to me. I’ll definitely have to ask about it when I see the doc. On to other things…
- 155 lbs. x 5 – 205 lbs x 5 – 225 lbs. x 5 – 245 lbs. x 5 – 265 lbs. x 5 x 2 sets
- Used the sumo stance
- Knee never buckled.
- Felt good!
- Super set 1: 4 sets
- step-up on plyo box: no weight x 10 reps
- pull-ups: 20 kg kettlebell x 5 reps
- Super set 2: 4 sets
- Ab wheel: 5 reps x 3 sets
Everything felt decent. Went up in weight on the deadlift and felt fine. I tried the sumo stance a while back and the knee wanted to cave in. Today it didn’t. Good.
Today I repeated the pull-up/push-up superset for 10 minutes. Last time I did this for sets of 2 reps on each exercise and did as many as I could in 10 minutes. I accumulated 40 reps. This time I did 3 reps on each for 10 minutes and I got 57 pull-ups and 54 push-ups. Then I did some other stuff. Here’s how it all went:
- super set 1
- pull-up x 3
- push-up x 3
- AMRAP (As many reps as possible) in 10 minutes
- super set 2
- anti-rotation cable press: 15 lbs. x 5 sec hold x 5 reps x 5 sets
- Y-T-A-W shoulder patterns: 10 lbs x 5 reps x 5 sets
- Reactive Neuromuscular Training (RNT) band split squat: to exertion (15-20 reps) x 2 sets
- My right knee often wants to cave in since there’s no ACL to help stabilize it.
- This exercise is done to help create more knee stability.
- I use high reps (10-20) for endurance and pattern repetition rather than strength.
- I try and do something like this every day, ideally throughout the day. I’m “practicing” more than I’m “working out.”
- It looks like this, but instead of a person holding a band, I looped the band around a nearby support.
I got in another bike ride yesterday of about 10 miles. Felt good! Seems to help loosen up the knee. I walked my dog along a trail next to a creek. I managed to successfully navigate various rocks, roots and other things that typically appear near trails. More evidence of success. Here’s my workout for today:
- Rower: 1000m
- Warm-up circuit: 3 x
- Band walks
- 3D lunge: Can’t really do this full bore but did what I could.
- 1 – leg squat: Can’t go very deep on right
- Deadlift: 135 lbs. x 5 – 155 lbs. x 5 – 185 lbs. x 5 – 205 lbs. x 5 – 245 lbs. x 5 reps x 2 sets
- by far the heaviest weight lifted since the ACL tear
- felt good!
- Super set
- Stability ball leg curl: 12 reps x 4 sets
- kettlebell windmill: 35 lbs. x 5 reps x 4 sets
- Step-ups: no weight x 12 reps x 3 sets
I love deadlifting and today it was very enjoyable to lift something moderately heavy. Tomorrow is pull-ups and push-ups.