If you ski long enough, chances are pretty high that you or someone you know will end up tearing an ACL in their knee. All it takes is one freak ski accident, a bad crash or a ski binding not pre-releasing when it should have, to do some real damage to your knee and tear an ACL or other ligaments in your knee.
This past winter I was on the losing end of a bad ski racing crash that ended up tearing the ACL in my left knee. The cause of the crash was due to a number of different factors (which I may write about in another post). But essentially, my lower back gave out in the middle of a GS race course, I hit a cross rut, which jolted my body forward, and I simultaneously hit my head on the snow in front of me, as my left leg got hyperextended underneath me. With all that going on my ski binding never released. At 37 years old, after skiing for 30 years, unfortunately I became a member of the torn ACL club.
I'm currently at the 10 week mark, post ACL surgery (allograft), after pre-habbing for 3 months prior to surgery. I still have a long way to go until I'm fully recovered and back out skiing again, but I've learned a lot in these last 5 months and thought I'd share some of the things I did and recommend to others who might be going through the same thing. So if you're about to have ACL reconstruction surgery, hopefully these tips will help you out to get better prepared for after surgery and make your recovery at home a little smoother and less painful.
Here are the 40+ tips you can use to prepare your home and yourself before having ACL Reconstruction Knee Surgery:
1) Crutches - Must have... don't think you can get by the first 2 weeks with just a walker or a cane (as I almost did). You really need a set of crutches to get around those first few weeks after surgery. Do your best to get them before surgery, especially if you've never used crutches before or if you have poor balance, you're older, weak or have to go up or down steps to get into your house. That way you can practice how to use them prior to surgery to get a better feel and balance for how to use them properly, as well as to make sure the crutches are adjusted to the proper height for you. After surgery you'll still be woozy, so figuring out how to use crutches for the first time (like I did) isn't such a good idea. Typically if you aren't able to get crutches before surgery, the hospital or surgery center should issue them to you (your insurance will pay for them).
Two types of crutches that you may use after ACL surgery are Walking underarm crutches or Forearm crutches. Walking underarm crutches may be a little clumsy to use at first, but they give you the ability to offset some of your body weight onto your armpits (even if this isn't always a good idea), which can take pressure off your hands and allow you to rest when standing. Forearm crutches may be a little less clumsy to use than standard crutches, but they tend to put more pressure on your hands and can take more forearm, wrist and tricep arm strength to use while getting around.
Note: Make sure to crutch proof your house by removing any slippery rugs / mats, and move furniture so there are wide enough lanes to get around your house on crutches.
2) Cane - While a cane is not necessary, it can be helpful once you start bearing weight while walking without using two underarm crutches. A walking cane can make it easier to start transitioning to full weight bearing walking. At two weeks, your physical therapist may have you transition from using two crutches to using only one crutch when you're walking outside the home. I found using just one under arm crutch to be really awkward and a bit cumbersome. This is the time when a cane can come in handy and be less clumsy to use rather than trying to use just one underarm crutch. Just remember, that a cane is used on the opposite side of your injured knee.
In my opinion, a cane is way easier and safer to use when going up and down stairs rather than using crutches. It's also a little less discreet (than under arm crutches) and can be easier to throw in your car and take along with you places.
Bed & Pillows
3) Move Bed to Ground floor - If your bed is on the second floor of your two story house, have some family or friends help move the bed to the first floor, preferably near the kitchen and bathroom. If you can't move your bed, consider renting a hospital bed. The simple fact is that for at least the first 2 to 3 weeks, you will not want (or be able) to go up and down stairs regularly (it can be painful, physically exhausting, and dangerous for your new ACL graft). In the first two weeks when you're still not fully weight bearing, you should only go up and down stairs sitting down on your butt (one step at a time). But if you need to go upstairs, make sure to put a chair at the top of the stairs, so you can get up from the top step floor easier (and safer) or to get down onto the floor to your butt. Also you'll really want to wait until you're weight bearing and off crutches before attempting to go up or down a flight of stairs while standing up (at that point you can use a cane to help you, along with using the railing). While you can certainly get by sleeping on your couch (not recommended), after that first night post-surgery of sleeping on your couch you'll probably regret not having moved your much more comfortable bed to the first floor when you had the chance.
If you do move your bed to the ground floor, be sure to bring the following to the first floor as well:
Clothes - Move any clothes you may need for the first 2 weeks near your bed, so you don't have to go up stairs to fetch what you need to wear (socks, underwear, pants, shirts, etc.). You may also want to move your laundry basket for your dirty clothes.
Extra Bed Sheets - So you can easily change your sheets in the first week, without having to go upstairs.
Toiletry bag - So you have all your needed bathroom supplies in your downstairs bathroom to brush your teeth, shave, brush your hair, put in contact lenses, etc.
- Shampoo - Usually the first 7-10 days you'll be advised not to take a full shower, so your wounds can fully heal. However, you may still want to shampoo your hair in the kitchen sink in the first week (in case you don't have a bathroom shower on the first floor).
- Towels - Wash cloths, hand towels and bath towels.
On a side note, if you have surgery during the colder months, you'll want to keep heavy blankets / comforters off of your foot, as this will put undue pressure on your knee. You can try putting on a really warm wool sock and putting your foot outside of blankets, or get an adjustable blanket support. I actually used this InteVision Knee Pillow placed vertically to hold up blankets around my feet, which worked pretty well (It's also really great for its intended purpose when you start sleeping on your side to take pressure off your knee).
4) Memory Foam Topper / Mattress - For those who may already have lower back pain (like myself) or your current mattress is worn out; I highly recommend getting either a memory foam topper for your current mattress or a full memory foam mattress like a Casper Mattress. Unfortunately, after surgery you will literally spend a ton of time lying flat on your back for 3 to 6+ weeks with your leg locked out in your post-op brace and elevated on pillows. Most likely you will be sleeping on your back the majority of the time without the ability to be move around much, as sleeping on your side will remain uncomfortable with your leg in a locked out brace and your knee sensitive to pressure for the first 4+ weeks.
The longer you sleep on your back with your leg elevated and locked out in the post-op brace, the better off your knee swelling and leg extension will be (I wore the post-op brace locked out for 8 weeks while sleeping to help retain full leg extension). If your mattress is uncomfortable or causes you to wake up with lower back pain and stiffness before surgery, you will be much more miserable than you need to be during your recovery without a good comfortable mattress. If you are uncomfortable in your current (worn out 8+ year old) mattress, do yourself a favor and invest in a memory foam topper or a new memory foam mattress (which can literally be shipped to your house in a small box. For myself, buying this 3" memory foam topper from amazon was one of the best purchases I've made in recent years, and I did this soon after tearing my ACL. Having a comfortable bed while recovering from an ACL injury and/ or ACL surgery should not be underestimated, especially for those with existing lower back pain.
5) Pillows to Elevate Legs / Head - You'll need at least a few pillows to elevate your leg(s) in the weeks following surgery to help reduce swelling and avoid blood clots. I used this Conforma memory foam pillow on the bottom as it is fairly dense, and a really soft pillow on top of the memory foam pillow to keep my knee / leg elevated and comfortable.
Also underneath my good UN-Injured knee I used this memory foam knee pillow (just DO NOT use it under your surgically repaired knee). Keep in mind you need to keep your surgically repaired knee/ leg totally straight (locked out in post-op knee brace) while sleeping for 4 to 8 weeks after surgery. Initially, I did NOT put the knee pillow underneath my good knee and began getting some lower back pain. Two days later I started using the knee pillow under my good un-injured knee and my lower back pain virtually went away for the weeks following surgery.
UPDATE: 2-10-16 Since October I've been using an InterVision Foam Wedge Bed Pillow (7.5" High) to elevate my legs / feet. I initially got it for my lower back, but it didn't work very well as I had intended to use it until I decided to put the wedge under my feet/legs, which then helped take pressure off my lower back while sleeping. In doing so, it made me realize that this triangle pillow wedge is the perfect solution to use after ACL knee surgery to prop your leg/knee/foot up with, rather than stacking multiple pillows up for your leg to rest on. Essentially, you can just stick the pillow wedge on top of your mattress or underneath your mattress (or just underneath a memory foam topper) at the end of your bed. I think using the wedge this way is actually a much better solution to stacking pillows up because it seems to prop your leg up in a straight line/angle which should help with extension, while also helping to reduce swelling. Note: I would stick to the 7.5" high pillow wedge (not the 12" high wedge, as I think that 12" would be a bit too tall to sleep comfortably). Also keep in mind, if you're taller than 6 foot, the longer version may be better InteVision Extra-Large Foam Wedge Bed Pillow (33" x 30.5" x 7.5").
6) Bed Tray Table - So for the first two weeks you'll probably be much more comfortable eating in bed with your knee straight out in front of you, rather than sitting with your knee bent in a chair around a table. If you're lucky enough to have someone serve you breakfast, lunch or dinner in bed, a breakfast serving tray will come in handy and make eating food in bed much more enjoyable. Alternatively, a bed tray can also serve as a laptop tray, in case you need to do work or want to watch a movie from your laptop in bed.
Bathroom & Shower
7) Raised Toilet Seat - If you're tall, one of the best things you can do, (besides moving your bed to the ground floor) that will make your life easier after knee surgery in the first few weeks is getting a raised toilet seat, especially if you're a taller person. This is because every time you sit down to go to the bathroom in the first few weeks with your post-op brace on you essentially have to do a single legged squat (pistol squat), using your good leg to squat down to the toilet (or stand up), as your injured leg will be in a post-op brace. So having a raised toilet seat will make sitting down and getting up from the toilet that much easier and less painful especially for individuals 5' 9" or taller, since the distance you have to squat down will be smaller.
Keep in mind, if you have 1' (foot) or more of empty space on either side of your toilet, you should consider getting a raised toilet seat with handles so you have something stable to grab onto when you sit or stand up. Just make sure you secure the raised toilet seat properly before surgery. You can also just get handle rails that go around a toilet. Having handle rails to grab onto to help you sit down or get up from the toilet will make your life much better in the weeks after surgery.
Note: Shorter individuals may also benefit from a raised seat, but it's possible that the extra height of the raised seat could end up being more awkward for someone with shorter legs while wearing the post-op brace in the locked out position.
8) Miralax for constipation - Surgery, anesthesia, and the pain medication taken after ACL surgery can all cause constipation for a variety of reasons. So just in case you start getting constipated after the first day or two, you'll want to at least have a laxative like MiraLAX at the ready.
9) Toilet paper - Make sure you stock up on toilet paper and place it in an easily accessible bathroom location. You won't want to go up or down stairs searching for toilet paper when you really need it!
10) Baby wipes - Since you won't be able to shower for the first week or so, baby wipes can be a nice alternative for staying fresh.
11) Shower seat - Once you are allowed to begin taking showers, you'll be much safer sitting down on a non-slip shower seat or bench while showering. The last thing you want to have happen is to slip and fall in the shower. Standing for a short period of time in the first two to three weeks can often cause your knee to swell, so being able to sit down while showering is recommended. Also keep in mind, if you don't have a walk in shower and only have a bathtub shower in your house, it will be very difficult to get your involved leg over the side of the bathtub in the first few weeks, so having non-slip seat in the bathtub may allow you to sit down to get over the side of the bathtub easier.
12) Sticky non-slip bath rug / mat - A wet floor can be super slippery and very dangerous on a leg that can't support itself very well in the first 3 weeks after surgery. And you really don't want a slippery bath mat or rug to slip out from under your already unstable feet. So make sure when showering you use a non-slip bath rug that you can step onto when getting out of the shower, that won't move around. Otherwise you may find yourself crawling out of the shower the first time you shower because you're scared you might slip and fall. Also, a non-slip bathtub mat or shower mat to use inside your shower or bathtub should also be considered, especially if you don't use a shower seat.
Groceries, Food & Drink
13) Groceries - Stock up your fridge, freezer and kitchen cabinets with plenty of groceries before surgery. The last thing you'll want (or be able) to do is go grocery shopping in the first couple weeks after surgery. Hopefully, you'll a have a family member or good friend helping you pick up groceries in the first few weeks after surgery. If not, you should really stock up on food so you can get by for 2-3 weeks without needing to go to the grocery store. If you will need to go to the grocery store early on, then make sure you get your doctor to issue you a handicap parking permit for your car, which will make getting to work, or going to the grocery store a whole lot easier. Otherwise, use a grocery delivery service in your area with the help of Instacart, or alternatively use Amazon Prime Pantry to get some needed grocery supplies.
14) Cooking - In the first 2 weeks, you will not want to stand around cooking for any length of time while using crutches with a swollen knee. So if you don't have anyone cooking for you in that time frame, then you'll really want to have a lot of food dishes already prepared (microwave ready) that you can take out of your refrigerator or freezer and quickly heat up in the microwave if needed. Cold foods that you don't have to heat up also work really well. Be sure to have fruit at the ready like bananas, clementines, blueberries, strawberries or fruit salad. Hopefully, you'll at least have someone around for the first 3 to 4 critical days after surgery that can help with cooking your meals and serving food to you in bed while you're still hopped up on pain medication. You'll really want someone cooking / serving meals to you those first few days. I had a family member around for the first 4 days, but due to a family emegency, after that I was pretty much on my own for the most part (other than groceries and being driven to PT in the first two weeks). So if you don't have someone close to you, you can always hire a person to come in for a few hours a day to cook meals and help out (or even go grocery shopping for you)... similiar to home care services that come in for the day to help out seniors/elderly.
15) Snacks - It's good to have some of your favorite snacks by your bedside for those times when you get hungry in the middle of the night or during the day, but don't want to get up. My personal favorites are Honey Stringer Organic Energy Chews, and Blue Diamond Smokehouse Almonds. I had both of these snacks, along with a bottle of water, clementines and bananas within an arms reach at all times, but any healthy (or somewhat healthy) snacks will do.
16) Drinks (bottled) - Stock up on bottled drinks.... because trying to carry a glass of water or milk while using two crutches to get around doesn't work well. So while you're on crutches you'll want to have drinks that are in bottles or cans, and can be carried in a bag while walking with crutches. Drinks such as bottle water, bottled Gatorade, bottled juice or even cans of soda. Keep in mind, sugary drinks like soda and gatorade will make you have to pee more often and can cause inflammation, so you should try to avoid sugary drinks (or sugar in general). A small refridgerator or cooler next to your bed can make your life a little easier, as well as help keep drinks, food and ice cool.
17) Plastic food containers - If you won't be having anyone help you with meals and are not being served meals in bed, then be sure to have a bunch of plastic food containers w/ tops that you can put your hot food / meals into. This will allow you to carry food in a plastic bag while on crutches to wherever you eat your meals. In the first week or so, you'll probably feel much more comfortable eating in bed with your leg off the ground, rather than around a dinner table.
18) Backpack and/ or Plastic grocery bags - While on crutches you'll need some sort of bag to carry your meals/ drinks/ silverware to and from the kitchen to your bed. Plastic grocery bags or a backpack can work well for this. To carry smaller things, a fanny pack may also come in handy for times when you are not wearing pants with pockets or you could use a hands free crutch carry bag that attaches to the side of a crutch.
Medical & Physical Therapy Aids
19) Rolled Gauze & Sterile non-stick pads - Hopefully, you will have set up a Physical Therapist appointment 2 to 3 days after your surgery, at which time the PT should change your blood soaked gauze pad for you that's wrapped around your knee. If not, you will need to change the gauze / pad yourself within 3 days post-surgery and probably a few more times within the 2 weeks after surgery. So make sure you have some Rolled Gauze and Sterile non-stick pads (3" x 4") on hand that you can use.
20) Ice Gel Packs / Ice Bags / Ice cubes - If you aren't lucky enough to be issued a Knee Cyro Cuff ice machine by your doctor, then you'll certainly want to have a number of ice packs and bags that you can alternate as you use them (and freeze them). I'd recommend having at least two Ice Gel Packs (6" x 10") and one or two Ice Bags with plenty of ice cubes you can use so you can alternate use throughout day and night. You may also want to try the O2 Cold and Compression Knee Wrap which comes with a really nice ice pack that fits around your knee. Along with the ice packs, it's a good idea to have a thinner towel on hand when using the Ice Gel Packs as it's not recommended to place gel packs directly on your skin for a long period of time. You could also keep a personal cooler next to your bed, so you don't have to get up during the night for cold ice packs (or cold bottled water).
21) STIM Tens unit - An electronic stimulation pulse massager is highly recommended to help reduce swelling around your knee (or get muscle activation after initial injury) and can be a great complement to icing. The truMedic TENS unit electronic massager works really well and in my opinion felt just the same as the larger STIM unit used at my Physical Therapist office.
You just need to be aware that after surgery your goal will be to reduce swelling, so you want to make sure you DO NOT put the Tens unit up on a setting too high where you start getting muscle contraction in your quad. You only want to see muscle contraction while using the Tens unit if you're trying to get the quad muscle to fire after injury and get it working again, not to reduce swelling. Instead, using the truMedic TENS unit, you'll want to use the "Knead" setting (which will feel more like mini pins and needles) and only set it on a power intensity that is comfortable enough for you to handle, but not to the point of being painful.
22) Foam Roller - A foam roller is really great to use whether you had ACL surgery or not. It's typically used to massage stiff muscles, break down scar tissue and improve your range of motion by rolling out or putting pressure on targeted areas of the body, such as on tight hamstrings, calf muscles, quads or back. But a foam roller can also come in especially handy after ACL surgery for performing Heel Prop exercises in order to loosen up your hamstring and get your leg extension past 0 degrees.
23) Stretch Out Strap - While you can certainly use a large bath towel for stretching out hamstrings and other muscles after surgery, a Stretch Out Strap makes it much easier to get a proper stretch. The stretch out strap has multiple loops on the strap allowing you to grip it better and perform various stretches that you wouldn't be able to with an ordinary bath towel. The green stretch out strap is also the same strap you will use at Phyiscal Therapy.
24) Compression Knee Sleeve - A compression knee sleeve like the CEP Ortho+ Compression Knee Sleeve can be really beneficial to help reduce swelling in the weeks after surgery and beyond. It can also add more stabilization to your knee when you start walking around without the functional sports knee brace. If the functional sports knee brace you get is sized a bit larger when you first get it due to having lost lots of muscle in your quad and calf muscles after surgery, you could wear the compression knee sleeve underneath the brace to give you a tighter fitting and more stable knee brace, but it will make it harder to bend your knee.
When you get your functional sports knee brace, ask the fitter for a neoprene undersleeve, as this can also make a knee brace fit slightly tighter and is also helpful if you're leg is between knee brace sizes. It can also help keep the knee brace feeling more comfortable, as well as keep your leg warmer.
25) Ankle Weights - 2lb or 5lb pound ankle weights can be helpful for at-home rehab once your leg starts getting stronger. You can use the 2lb ankle weights to add extra pressure when doing heel props or prone leg hangs for working on leg hyperextension. You can also use ankle weights to add extra weight when performing exercises like straight leg raises, leg extensions, hamstring curls or hip abductions.
26) Resistance Bands - A Resistance Band Loop set can add extra levels of resistance to your at-home leg exercises. You can use resistance band loops for exercises such as lateral band monster walks, clam exercises, squats, bridges, hip abductions, high steps, and many other proprioceptive exercises. Once you gain back more strength, a 40 to 80lb Pull-up Resistance band can be helpful for doing standing terminal knee extensions.
27) Spin / Recumbent Bike / Rowing machine - Cycling (or rowing) before or after ACL knee surgery can be one of the safest exercises for your knee to help it regain knee flexion. However, in the first 6-8 weeks after surgery you should avoid biking too much as it can place too much repetitive stress on your graft as it is healing, especially if you have an allograft. After the first 4 weeks you may feel like you can cycle for up to an hour or more a day, so talk to your physical therapist as to whether or not you should be cycling that much. As a general rule try not to do more than 15 to 20 minutes of cycling per day.
Biking is good for endurance and regaining flexion in the early days after knee surgery, but in my opinion I have not found it great at regaining optimal leg strength, proprioception or regaining back the critical VMO muscle. You will have to put in some seriously long, hard, uphill miles on the bike to get real lasting strength back that you will have lost after surgery through biking alone. For the most part, biking is an aerobic exercise and only when you start sprinting or doing more up hill riding does it start becoming an anaerobic exercise. But to regain the muscle you lost after surgery, you'll really need to focus a lot of your attention on anabolic leg exercises, which means strength training in the gym.
Once you can start walking after the first few weeks, start to do it progressively as much as possible, as this will help a lot with reducing pain, regaining proprioception, and also help with strengthening the leg muscles in the first few months after surgery. Just make sure you have full leg extension, and walk with proper form or else you'll elevate your risk of re-injury. You can substitute biking when walking / hiking / jogging does not feel good or as a 10 minute warm-up. I would NOT worry about trying to run until you get the "OK" from your PT or doctor and your leg muscles have the proper strength to support proper running form.
NOTE: I found standing pedaling (stand-up) on a spin bike or standing pedaling on a mountain bike (w/ a short stem) to be really helpful when transitioning my knee/leg into jogging or running.
28) Suspension Straps - TRX Suspension straps can be really helpful in gradually regaining stability and strength in your leg post-op. There's a number of different knee rehab exercises you can do using suspension straps to progressively get your knee stronger after surgery. Just a few supported suspension strap exercises include: squats, front squats, lunges, reverse lunges, bulgarian split squats or single leg pistol squats. I really wish I had bought a set of suspension straps to help with rehab in the first few months after surgery and beyond. But I've since picked up a pair of Nayoya Gymnastic Rings, which I can setup and use in a similiar fashion to TRX suspension straps.
Clothes & Shoes
29) Slip-on shoes - A pair of slip-on shoes can be really convenient to wear in the first few weeks after surgery in my opinion because they don't have shoe laces to tie and can be slipped on more easily. You will not want to wiggly your foot into shoes or bend over to tie shoe laces, so slip-on shoes can make life a little easier and less painful following knee surgery. I wore a pair of Merrell slip-on shoes that I already had as they are comfortable, lightweight and can be worn during the early phases of physical therapy. In general, I think zero drop shoes or slip-ons (that do not raise your heel up) are the best to wear for recovery/rehab/walking around, as the zero drop shoe platform is more natural and seems to put less stress on the knee.
If you have high arches or want better foot support you may also want to consider getting a pair of moldable insoles like the Sole Softec Footbed. I've started using Sole Insoles in all my footwear and ski boots and highly recommend them if you have high arches and want a more comfortable shoe support for your foot. Alternatively, if you have low arches, a wide foot or want a more natural feeling shoe, you may prefer a Zero Drop shoe like the Altra Instinct Walk Shoe or the Altra Provision 2.0 shoe, as they can give you a more stable feeling while walking due to a wide toe box and zero drop shoe platform.
Once you get back in the gym and start performing more weight lifting type exercises like high bar squats, deadlifts, leg presses, split squats, etc. a good pair of crossfit or weight lifting shoes can be beneficial and help with stability and power while performing many leg exercises. For a great all-round crossift shoe that can be worn during PT or weight training, consider the Reebok Crossift Nano 6.0. For a more specific weight lifting shoe that offers great stability when performing compound leg exercises like deadlifts consider the Reebok Crossfit Lite TR 2.0. The Crossift Lite TR 2.0 may not look like the coolest shoe, but after ACL surgery it has many of the characteristics in a shoe that can really offer some advantages while performing stationary leg exercises, like a wide forefoot, stable heel and flat sole, while also being really comfortable. However you would not want to do any prolonged walking, jogging or running with it. Alternatively, a shoe like the Converse Chuck Taylor is another good option to use. Eventually, you may want a more Squat specific olympic weight lifting shoe with a wedged heel and extremely hard sole, like the Reebok Legacy Lifter.
30) Shoe Horn - Essentially, you will NOT want to wiggle your heel into your shoes, as this side to side wiggling will not feel very good on your knee. A shoe horn will allow you to slip straight into just about any shoe, without the side to side movement that occurs when you wiggle into shoes. If you can't borrow an old shoe horn from your parents or grandparents, then it's definitely worth picking up your own. Note: A flexible longer shoe horn (16" or above) will make it easier to use without having to bend over.
31) Breakaway Pants and/ or Shorts - Tear away warm-up pants, loose fitting sweat pants, or shorts that will fit easily over the top of your bulky post-op brace can come in handy to wear after surgery and for physical therapy sessions.
Books & Entertainment
32) Books & Magazines: It's good to have some books and / or magazines to read while you're recovering. I highly recommend reading Kelly Starrett's best-selling book Becoming a Supple Leopard 2nd Edition as it is a great reference book to "Improve your athletic performance, extend your athletic career, treat stiffness and achy joints, and prevent and rehabilitate injuries—all without having to seek out a coach, doctor, chiropractor, physical therapist, or masseur."
33) Laptop / iPad - You'll definitely want some sort of laptop, tablet device or smart phone for mindless entertainment, especially if you don't have a TV near your bed. You also may need an extension cord to plug in your laptop and/or smart phone for charging. Having access to Netflix or Amazon Instant Video can also help keep you entertained, as you'll have plenty of time on your hands while lying in bed to catch up on some episodes of your favorite TV shows and/ or movies. An inspiring movie to rent on amazon that I highly recommend is Meru with renowned alpinists Conrad Anker, Jimmy Chin and Renan Ozturk.
Work & Bills
34) Take Time off from Work - Take at a minimum of 3 weeks off from work and focus primarily on rehab, but preferably take at least 4 to 6 weeks off, even if you work a computer / desk job. If you need to work, do it from your bed at home using a laptop. If you go back to work earlier than 3 or 4 weeks, you'll just be very uncomfortable at work and probably very unproductive as concentration will be lacking. Typically, at around 3 weeks you will get your functional sports knee brace, so having at least a week to rehab and get used to getting around with the functional knee brace will be beneficial for your recovery. Also sitting in an office chair for any prolonged period of time with your leg bent in those first six critical weeks, without your knee elevated will lead to swelling, worse leg extension and a longer recovery time. Getting full leg extension and keeping it, is critical in the first few weeks and months after surgery, so do everything you can to avoid sitting at a computer desk with your leg bent for extended periods of time, as this can be detrimental to your long-term recovery. So the longer you can take off work, or work from bed on your laptop, the better off your knee will be in the long run.
35) Pay Bills - Pay any monthly bills you have for the month following surgery. That way you won't have to worry about writing checks for the upcoming month.
36) Pet Food - Don't forget about feeding your pet! Make sure you have at least a few weeks of cat or dog food on hand.
37) Litter Box - If you have a cat, be sure to have plenty of kitty litter. If you're the person who will be cleaning the litter box, make sure it's in a easy to reach location on the first floor.
38) Dog Walker - If you have a dog, and don't have a fenced in yard, then you will absolutely need to have someone walk your dog for you, for at least the first 4 to 6 weeks (and possibly many more weeks depending on how big or active your dog is). If you have a dog that pulls while on leash, then definitely consider getting a dog harness to use once you’re physically able to start walking your dog again. It’s much easy to control a dog on a walk and keep them from pulling when using a harness rather than a simple dog collar. In the early stages of recovery you will not appreciate being jerked or pulled around by a dog with pent up energy.
Pre & Post Op Tips
39) Shave Inner/ Upper Thigh Leg Hair - Before surgery, for guys especially, I recommend shaving or buzzing off your inner and upper thigh leg hair (even if you don't have too much). For myself, about a week after surgery I found the post-op brace foam irritating the heck out of my inner thigh, due in part to some upper/inner thigh leg hair (which I don't even have a lot of) and possibly due to the nerve block I received prior to surgery. Two and half weeks after surgery, I finally took an electric hair clipper and shaved the hair around my upper/inner thigh and after doing so the sensitivity and irritation on my leg from the post-op brace started going away. I just wish I had shaved it off before surgery as this irritation became super annoying especially while trying to sleep with the post-op brace on. In all honesty, it almost became more annoying than any knee pain I dealt with after surgery. Alternatively, I've heard that some people wrapped up their thigh with ace bandages to keep the foam brace from itching and iratiating their leg.
Keep in mind, for those who have yet to have ACL surgery, on the day of your surgery, a nurse will use an electric hair clipper to buzz off any leg hair that is right around the top portion of your knee, but they typically do not shave the hair off your entire leg.
40) Set Alarm to take Pain Medication - After surgery, stay ahead of pain by setting your alarm every 4-6 hours (and throughout the night) to take your pain medication. I was given Oxycodone to take and would wake up throughout the night to take the medication when my iPhone alarm went off every 4-6 hours. I feel this totally helped keep my pain level really low. If you don't do this, you'll most likely end up waking up anyway due to pain and be in much worse shape. It's much better to stay ahead of your pain, than trying to suppress pain after it really starts hurting. I took oxycodone regularly every 4-6 hours for the first 4 days, then only 1 oxycodone just before sleeping for 3 days, and after that I never had to take any more prescribed pain medication or over-the-counter medication.
41) Pain from Blood Rushing to Leg - To help avoid or lessen pain from blood rushing to your leg when standing up in the first few weeks after surgery, try to always take off the post-op brace and do leg exercises / stretches for at least 5-10 minutes to get the blood flowing before standing up (especially in the morning after just waking up). I wish I had done more of this in the first 2-3 weeks after surgery.
Overall, the most pain I ever experienced after surgery was when I started weight bearing walking, but the pain never got much higher than a 2 or 3. However, the pain might have been even less if I had taken more time beforehand to warm up my leg and get the blood flowing each time I needed to I stand up from bed in the first few weeks. Once I started putting weight on my leg while walking (2-6 weeks after surgery), I would get some medial knee pain, but I eventually figured out that if I tightened my core while walking, I would get virtually NO medial knee pain.
Everyone is different as far as how much pain each person experiences after surgery. You may experience very little pain, like myself, or you might experience a world of hurt. Either way, the pain will go away and you will begin to get better. You just need to stay vigilant and continue to do your exercises and stretches daily (multiple times per day), and you will continue to progress day by day, week by week.
42) Self Doubt & Strength - Even with minor setbacks or feelings of doubt, just keep at it... You'll have good days and some bad days (and possibly a few times you're going think you re-tore your ACL). Just make sure to keep active and stay consistent while working out 6-7 days a week. If I stopped working out for a day or two, my knee typically felt worse off, especially the following day.
Try not to worry too much if you're not healing faster than someone else you know did or read about on an internet forum. Everybody heals differently, everyone goes into surgery with their legs and body in different states of physical condition, and everyone loses muscle mass differently before and after surgery.
But with that said... do your absolute best to get your injured leg as STRONG as you can before surgery. And after surgery work as hard as you can to progressively rebuild the strength in your quads, hamstrings, glutes, hips, calves, adductors, abductors and core, and get them STRONGER than they have ever been! Your recovery will depend greatly on the strength in your leg.
So make sure you focus primarily on single-leg exercises that strengthen your involved knee / leg. Otherwise it's very easy to unconsciously strengthen your good leg more than your bad leg, while putting more stress on your good knee. For instance, don't start doing HEAVY weighted back squats until both leg muscles are in balance, otherwise you will just unconciously stress your good knee and risk getting patellar tendinitis in your good knee... this can also lead to a huge muscle imbalance in your opposite leg (as well as knee pain in your good knee). So make sure you start with primarily incorporating single-leg exercises into your PT routine in order to get your involved leg quad/ VMO muscles as strong as your good leg (for example: single-leg press, physio lunges, single leg lunges, bulgarian split squats, stagger stance split squats, step-ups (without pushing off w/ good leg), reverse step-ups, Poliquin Step-ups, Petersen Step-Ups, single-leg hamstring curls, etc.).
UPDATE 12-29-2016 A huge mistake I made in my rehab and in my training over the years was not really focusing enough on the ECCENTRIC portion of any given exercise. The quadriceps muscle group in particular contracts eccentrically when you descend stairs, hike down a hill, put the brakes on to stop or while skiing down a mountain. Eccentric strength absorbs force. Concentric strength on the other hand will help with walking up stairs or hiking up a hill. To put this in perspective, I could walk up stairs relatively well in the weeks following surgery (in part because I was pushing off my good leg when stepping-up), but still to this day have not been walking down stairs all that well (still a little wobbly at times). So when rehabbing your leg after surgery make sure you focus more of your time on the eccentric contraction when performing any given exercise rather than the concentric. For many exercises when rehabbing you can use a slow controlled tempo of 3 or 4 seconds on the eccentric contraction of the exercise (i.e. when lowering weight or lowering your body when you squat) and usually around 1 second on the concentric contraction. Keep in mind, fast eccentric training (plyometrics) should typically be reserved for the competitive time period once you're leg is back to full strength. Leg exercises that you should really focus on the eccentric contraction when rehabbing include: body weight squats, cyclist squat, slant board squats (double or single leg), eccentric leg presses (single leg), lunges (forward, side). To read more about the benefits of Eccentric training check out this article from strength coach Charles R. Poliquin: The Role of Eccentric Training in Building Maximal Strength. Also see this Mountain Athlete article on Training "Fast" Eccentric Leg Strength for Alpine Skiing. END UPDATE
Overall, the stronger your leg muscles are going into surgery (and in the weeks following surgery), the faster you'll be able to make a full recovery after surgery. Just don't forget, you break down muscle in the gym, but you grow muscle and get stronger by eating enough healthy food in the kitchen and getting plenty of sleep every night.
Recovering from ACL surgery is a marathon, not a sprint. It takes time, just stay consistent, take it step by step, and you'll get your knee back to full health and back to doing the things you love to do.
IMPORTANT UPDATE 4-5-2016: One thing I didn't note in my post above, but is probably one of the most important, is to make sure you pick a really good / highly recommended "sports" Orthopedic Surgeon to perform your ACL surgery. You want a doctor who specializes in knee surgery and performs ACL surgery often (daily/weekly).
If you're not sure who the best knee doctors are in your city, then try to find out what sports knee doctors your Minor League or Major League sports teams use in your area. You can also ask just about any adult ski racer or ski coach and they will probably know who the best ACL knee doctors are in your town. I found out it's often hard to get in to see a second doctor after you've already consulted with a first doctor... It took me 5 weeks to finally be able to get in to see a second Orthopedic surgeon, after initially going to a different doctor whom I did like, but I knew far more friends and ski racers who had successful operations with the second Othopedic surgeon who I choose for my surgery. However, because I decided to switch doctors, it set me back a bit and I didn't have surgery for 3 months after my injury.
If I could do things over, here's what I would do in that first week, just after tearing my ACL:
- Find out the best Orthopedic surgeon(s) in your area by talking to friends, family, phyiscal therapists, other atheletes and coaches and make an appointment with him/her.
- I would have started formal Physical Therapy (PT), right away (first week) after initially tearing my ACL. Get a prescription for Physical Therapy from your doctor. Do NOT wait or try to do PT on your own. You start losing critical muscle mass very quickly after injury, as your muscle begins wasting away. The key to a fast, successful recovery is keeping as much muscle mass in your leg as possible before and after surgery. Focus on getting the swelling down, and getting in to see a Physical Therapist to receive the proper treatment.
- If I could have looking back, I would have had surgery ASAP...within the first 2 weeks, especially since I had very little swelling. That being said I wasn't mentally ready for surgery at that point. Unfortunately, I was diagnosed with a partial tear based on my MRI, which to be frank is kinda of a mind-fuck. I struggled back and forth with the idea of having surgery on my knee... I wasn't totally sure if I needed surgery due to it being diagnosed as a "partial" tear and the fact that I was starting to feel better. The lack of laterally stability in my knee, and it buckling randomly while hiking finally made it clear to me in my mind that I needed surgery... It did take a lot of back and forth for me though. Once I had surgery, the ACL was shown to be pretty much fully torn and just hanging by a couple threads, so there's no doubt I would have done more damage to my knee if I hadn't gone through with surgery.
- Professional atheletes don't wait months for surgery to fix a torn ACL, why... besides the fact that their livelyhood depends on being healthy as soon as possible, one critical reason is because you lose way too much muscle in your leg the longer you wait for surgery even with a good prehab. In Europe, doctors seem to do things a little differently... Aksel Lund Svindal (one of the best ski racers in the world), had surgery 2 days after tearing his right ACL at the downhill in Kitzbuehel this year... 9 weeks after surgery his quads looked nearly identical (https://www.instagram.com/p/BDjHmWVts5I/?taken-by=asvindal). Ted Ligety (also one of the best ski racers in the world), tore his ACL this year, flew home and had surgery in the U.S. two weeks after injury (but he did debate whether to have surgery in Europe soon after his injury). Here's his quad 6 days after surgery (https://www.instagram.com/p/BB0skGCpSzm/?taken-by=ted_ligety).
- The more muscle you lose around your leg/knee prior to surgery, the harder and longer it will take to make a full recovery after ACL surgery. It's critical you do everything you can to not lose your quad / VMO muscles. Make PT and strength training an absolute priority before and after surgery! I can't stress this enough...
Hopefully, the tips above will help make the recovery process a little bit easier for those of you who are about to go through an ACL reconstruction or some other type of knee surgery. If you have any other tips, questions or suggestions that might help out others, feel free to share them in the comments below... I still have a long way to go in my recovery process, so I'd love to hear them!