Mike Gwins ACL Rehab 101

I just wanted to share how I am rehabbing my knee after ACL reconstruction since I keep reading thread after thread of people who are concerned about how they are coming along with their therapy. It seems from my experience (had the same surgery last year on my other knee) that physical therapists and surgeons like to take the safe road and wont tell you the things you can be doing at home to make your rehab move so much faster. Here is my story so far and Ill post periodically with my progress as I go along.

Disclaimer: Everyone is different so if you move along faster or slower than I have, dont worry. Depending on your surgery and how your body handles it, some of the milestones I mention may not be attainable. Keep your head up and keep trying. I am not a doctor so the advice in this thread is purely that, advice. It is NOT gospel. I have done countless hours of research on this and am just telling my experience.

Method of injury
It was a beautiful Friday afternoon (June 24th) on the Mississippi river. I was out cutting it up on my 05 Parks 140 Biolite with 04 L Temet bindings, doing mostly big air grabs with the occasional backroll. I was getting the biggest air of my life (according to the passengers) and I was feeling right at home. Edged in for a regular heelside jump, blew up off the wake, poked out my left leg for a stiffy and when I landed, I heard this "crunch" with two distinct popping sounds. I had torn my right ACL last summer so I knew what that sound meant. It wasnt as loud as it had been the year before but as soon as I climbed in the boat and took a step on that left leg and felt it buckle, I knew my ACL at the least had been blown.

After visiting my regular doctor and then getting an MRI, my worst nightmare was confirmed, torn ACL. I then met with my surgeon and scheduled surgery for July 27th.

At this point, what you want to do is focus on extension (extending your knee out so your leg is straight) and flexion (bending your knee, trying to touch your heel to your butt) of the knee and try to get it as close to back to normal as possible. Do this by stretching both ways as far as you can and hold it for 10 minutes several times a day. Try to get on a stationary bike and put the seat as far down as you can tolerate and ride, ride, ride. Once you get your range of motion back, do some leg presses and/or squats to help regain strength in the knee.

When you talk with your surgeon, there are basically three different ways to do the ACL reconstruction that are widely used. Those are patellar graft, hamstring graft, and cadaver. I went with the patellar graft becuase it has proven to be tht strongest and best long term solution. Hamstring grafts tend to be more elastic and may not provide the needed support and cadaver tissue is significantly weakened when frozen in liquid nitrogen. These differences may be negligible and I didnt go into extremely deep comparison on them since I just decided to go with the patellar graft on my surgeons recommendation as well as the recommendation of several other doctors I spoke with (I work for a fairly large HMO).
You will also want to request a cryotherapy device. This device is a cooler attached to a knee strap that flows cold water to your knee and signifincatly helps reduce swelling which in turn will make your rehab exercises easier. Request the Donjoy Iceman. You can find more information on this here http://www.jointhealing.com/pages/productpages/iceman.html I had borrowed one from a friend to use prior to surgery. My surgeon wanted to use the Aircast CryoCuff and now having used both, dont settle, get the Iceman, its ten times better. The CryoCuff you have to drain and refill manually every 90 minutes, there is no pump to continuously run the cold water through.

Summary pre-op
Work your knee to get full extension and flexion
Work on regaining full strength in the injured knee
Decide which graft works best for you by discussing with your surgeon
Strongly request the Donjoy Iceman for cryotherapy.

Operating time:
Here is my retarded a$$ IVed up waiting for surgery.

Here are my knees pre-operation


You will be presented with a couple different options for anasthetic, general or a spinal block. Last year I chose the general and was completely knocked out for the surgery. Came out all groggy and delirious. This time I chose the spinal block and was awake for the surgery. I requested a video of the orthroscopy and I got one step higher. I was able to watch a television of the surgery while it was taking place. I gotta say, it was a trip, felt like they were just hammering on my bones with a hammer and chisel sometimes, drilling, and cutting... but it was well worth it. When we were done, I was completely alert. I had to spend an extra couple hours in the recovery room waiting to regain feeling in my lower body but that was okay. When I left, I could barely put weight on my good knee and my midsection was still completly numb. I lied to the nurses so I could get the heck out of there. I couldnt feel my jewels until hours later which is very disturbing. I had to check my pants to make sure it was still there....
Pic post-op


So, from the surgery center, I got some massive hunger since it was now after 5:00PM and I hadnt eaten since dinner the night before. Mom, girlfriend and I went to Olive garden and I ate like a maniac. Of course, against doctors orders which were to go straight home and rest. What do they know, they only went to school for like 10 years! Anyway, the knee felt great the whole time we ate, it wasnt till the ride home that I started to feel some pain.
Here I am grubbin:


Got home, typed up a schedule in MS Excel on when I would do certain excersices and when I would take meds, etc. Looks something like this:
Day 1
13:00 Start surgery
15:15 End surgery Move to recovery
17:30 Vicodin Leave surgery center
18:00 Ibuprofen Dinner @ Olive Garden
21:00 Vicodin Flexion 110
22:00 Heel prop

Here is a picture of the flexion



I wont lie, it was the worst pain I have ever felt but want that bad once you got there and held it. Get it to 110 and hold for 10 minutes. Right after you are done with that, do a heel prop. Heres a pic:



I got the pillow under my heel and the weight bag from this site. Its $100 and usually reimbursable by insurance. Its a must have in my opinion.
http://www.jointhealing.com/pages/productpages/knee_therapy.html
Buy it!
So this is pretty much all I did for the first night and next morning. Here is my schedule for Day 2.
Day 2
2:00 Vicodin
5:00 Vicodin
7:00 Ibuprofen
7:30 Heel Prop
8:00 Flexion 110
9:00 Heel Prop Vicodin
10:00 Heel Prop Flexion 110
11:00 Heel Prop Ibuprofen
11:45 PT
13:00 Ibuprofen Vicodin
14:00 Heel Prop Flexion 110
15:00 Muscle Stim
16:00 Heel Prop Flexion 110
17:00 Muscle Stim Vicodin
18:00 Heel Prop Flexion 110
19:00 Muscle Stim Ibuprofen
20:00 Heel Prop Flexion 110
21:00 Vicodin
22:00
23:00 Heel Prop Flexion 110

I tried to stay motivated and do some therapy every hour but there are some hours where you just dont want to do •••••••••• I was sleeping some in there. Dont push it too far.

Doing this, I was able to walk into my PT appointment 22 hours after surgery with NO crutches. Whenever you are walking anywhere, try to bear ALL your weight on the knee. I recommend holding onto your crutches just in case. PT was pretty worthless, I told him everything I was doing at home and I think he was speechless. He said he was going to have me do the same stuff in the office so I could either do it there or go back home and do it. I chose to go back home. He did remove the dressing and look at the incision, pic here:

He also mention to start working my quad which I had forgotten about. Try to get a muscle stimulator from your PT for this. Its a device that sends electric shock through the pads and kinda forces you to flex to deal with the shock. Heres a pic of what it looks like:



Once you get comfortable with the muscle stimulator, try to raise your leg 6 inches off the ground when the stim shocks you. Once you are comfortable with the leg lifts, put the water weight you got with the Breg therapy kit over your knee for added reistance.

That gets me to where i am right now, roughly 48 hours post-op. I am walking around with no crutches very slowly. I am removing the large brace when I do my rehab exercises and Im watching A LOT of movies. Starting to get cabin fever and cant wait till I can at least get back on the boat and watch my friends board. Ill keep posting on this thread with my progress. Hopefully this helps answer some questions out there. I have videos to go along with just about every aspect of my surgery and revoery so far. Trying to put together a little documentary that I can post when Im done.

L8R for now...