14 Workouts

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:

4/10/14

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

4/11/14

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!

4/12/14

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.

4/8/14 Workout

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.

4/5/14 Workout

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 really want to know what predicts ACL reconstruction failure or success so that we can improve our outcomes.” – Dr. Kurt Spindler, MD – Cleveland Clinc

In the course of scouring the Internet for any and all information on ACL injuries and rehabilitation, I came across a research summary titled Predictors of successful ACL reconstruction found. The research comes from the Multicenter Orthopaedics Outcomes Network (MOON), led by Cleveland Clinic’s Kurt Spindler, M.D. Dr. Spindler is the Vice Chairman of Research in the Orthopaedic & Rheumatologic Institute, the Director of Orthopaedic Clinical Outcomes, and the Academic Director of Cleveland Clinic Sports Health. MOON consists of 17 surgeons from seven institutions. The researchers wanted to establish a “gold standard” for ACL reconstruction and rehabilitation. A related project is the Multi-center ACL Revision Study (MARS). I got to speak with Dr. Spindler recently. He gave me a lot of good information on several topics. After speaking with him I feel very well informed on what to know and what to ask as I start to navigate my way to a new ACL.

What are the big takeaways from the research?

Choose the correct type of graft. (An allograft comes from a cadaver. An autograft comes from you, either as part of the patellar tendon or hamstring.) There are advantages and disadvantages to both. Age and activity level are important factors. For teenagers and twenty-somethings, the autograft is best. I told him that I’m highly active and I intend to return full-bore to my activities. He said the autograft (either hamstring or patellar tendon) is right for me.
First-time ACL reconstructions perform much better than second reconstructions. Be patient. Do the rehab correctly and don’t rupture the repair!
Pick a skilled surgeon, one who does a lot of reconstructions and does them frequently.
Do the rehab! (I intend to make my rehab a religion.)

To what degree should I stay off my feet and avoid activity? Is it safe to do any type of activity? If so, what?

Pain should be my guide. If it hurts then stop.
I can exercise to whatever degree I’m able, so long as it’s gentle work and pain free.
I can use an exercise bike, paddle around in a pool, do squats (unweighted obviously) and any other sort of work that I can tolerate.
Avoid fast movements and twisting.

In speaking with surgeons, what questions should I ask?

How many repairs have you done?
How many repairs per year do you do?
On whom have you done them? Athletes? Kids? Sedentary people?
How involved are you in the rehab program? Will I just receive a handout of exercises to do or will you monitor my progress and adjust the program as necessary?

Is there an ideal rehab protocol?

Dr. Spindler said there wasn’t a strict protocol that’s best. Every injury and every individual will progress differently and rehab must be adjusted accordingly. He directed me to the evidence-based MOON rehab guidelines.

How soon should surgery follow an ACL tear?

The knee should have good ROM.
Swelling should be down.
Good muscle function should be present.
The patient should be able to walk.
A long wait increases risk of further injury.

What should I know about miniscus damage? In the case of a damaged miniscus, how much can be salvaged?

Tissue with good blood flow can be salvaged.
Overly damaged tissue without blood flow should be excised.

What should I know about ACL repair using a bioenhananced scaffold technique?

At this time, there doesn’t appear to be any advantage to using this experimental technique.

He told me I had several favorable factors on my side:

I’m athletic.
I don’t smoke.
I have a good BMI.

One variable that I can’t control is the amount of damage to the knee. My MRI said I have a partial tear and some damage to the MCL. I’ll learn more on Thursday when I meet with an orthopedist. Thank you to Dr. Spindler and the Cleveland Clinic for the interview. This has been a huge help to me and I hope it helps someone else with a bad knee.

ACL News & the 3/31/14 Workout

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…

3/31/14 Workout:

Deadlift:
- 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
- Windmill: 16 kg x 5 reps
- RNT band split squat: no weight x 10 reps
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.

Great Technique Videos: Overhead Press & Pelvic Tilt

I’m a big fan of the deadlift and the overhead press. Both exercises train movements that are vital for all of us who live on a planet with gravity. With the deadlift we pick up something heavy off of the ground. The press has us putting something heavy overhead. Both exercises feature minimal equipment (typically a barbell), they train the whole body and they require all sorts of balance, stability, mobility and coordination. While we could argue all over the place about this, I tend to think these two exercises give the most bang for your workout buck. If I were condemned to an eternity of being able to do only two exercises, I’d pick these.

Sometimes these movements are performed in a less-than-optimal way. These two videos do a great job of showing how to correct problems with each exercise.

3/28/14 Workout

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

3/26/14 Workout

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.

3/24/14 Workout

I managed six miles on the exercise bike today which felt pretty good. Less than a week ago I could barely turn the crank at all. I plan to add 2 minutes each time

Bike: 13 min./3 mi. mostly at level 5
Super set 1
- Pull-ups x 2 reps
- Push-ups x 2 reps
- Repeated 2 and 2 for 5 sets as fast as possible then took a brief rest
- Repeated this whole pattern for 10 minutes
- accumulated 40 reps of each exercise
Super set 2
- Stability ball leg curl: 10 reps x 4 sets
- Face Pull: 40 lbs. x 15 – 55 lbs. x 12 – 90 lbs. x 10 x 2 sets
Super set 3
- Tall kneeling lift: 20 lbs. x 10 reps x 2 sets then switched to 1/2 kneeling lift x 10 reps x 2 sets
- split squat x 10 reps x 2 sets then switched to step up on left leg x 10 reps x 2 sets
Bike: 15 min./4 mi. 104 watts; mostly at level 5

I intend to add reps to the leg exercises and time to the bike. I will track time, mileage, resistance level and watts on the bike. I am pleased to be progressing!

3/21/14 Workout

The knee is moving a little better. It’s still tight and I’m not ready to pogo or hopscotch yet but I’ll take what I can get. Here’s what I did today.

Circuit 1: 3 rounds
- Press: 105 x 3 reps
- Band walk
- Terminal knee extension (TKE): 20 reps
Circuit 2: 3 rounds
Circuit 3: 3 rounds
- TRX row x 10-15
- TRX ab fallout x 10 reps with a 3 second hold

This is all still fairly miniscule

Denver Fitness Journal

All Things Health and Fitness by Kyle Norman, MS, CSCS, FMS, RRCA Running Coach

Observations