ACL & Meniscus Journal: Pre-Operation + Prehabilitation

The Injury

I started going to the bouldering gym (Seattle Bouldering Project) more often around the beginning of this year. It’s a lot of fun since a few of my friends and co-workers do it, it’s physically demanding and flexes your problem-solving muscles, it’s easy to track how you’re advancing, and the bouldering gym is awesome — admission includes access to the regular gym and fitness classes, and there’s cheap drinks and food. I’m a beginner doing yellows and started going 2-3 times a week. I pulled the trigger by buying some sweet shoes and wanted to put my gear to use.

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The 10th circle of hell. #notbitter
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My sweet kicks.

One fateful President’s day (I should’ve known better than to do anything this year given our clown of a president), I went to the gym with a friend from Penn and her co-worker. I was downclimbing from a yellow that slanted outwards, which made it hard to stay close to the wall. There weren’t many holds either, and I fell from around 15 feet above the ground without bracing myself (thankfully, there are 1 foot thick pads on the ground!). I felt a pop and sharp pain in my knee then crumpled to the ground.

Honestly, the injury itself didn’t hurt too much — it felt pretty numb and limp. My friends and staff members came to the rescue and helped me to feet. Immediately, I felt my knee give out — (if you get queasy, skip this) it felt like the bones were sliding out of place, and I crumpled to the ground again. I had to lean on people in the place of crutches, until we got to the Urgent Care center at Swedish and I received crutches and an immobilizer. X-rays said nothing was broken so I thought I was in the clear. I remember my friend telling me about her sister’s ACL + meniscus injury in the waiting room and distinctly thinking, “That sucks, but that won’t happen to me”. Oh, the irony. Huge shoutout to Stephanie and Chase for driving me around, taking care of me, and checking in on me!

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The immobilizer doing its job.

 

After that, I stayed at home for a bit and thought I could wait it out. It got super swollen and bruised after a day, and I had to continue using crutches to walk. Friends fetched me groceries and things I needed (thanks Chika, Sabrina, Christina, Synthia, Michelle!!), and drove me to work (s/o to Katrina, thank you for living in Modera and having a great automobile, thanks Gabe!!). My knee was all bent out of place, but I didn’t really know what the symptoms of an ACL injury were, or really anything about knee injuries. It was only after a week when it didn’t really get better (although I was down to one crutch and limping) that I decided to see a primary care doctor (I saw a chiropractor/sports doctor after who didn’t think much of it right after the injury — oops, wrong doctor to go to! Still trying to figure out who does what…#adulting).

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Look at how cool and pro I look!

Immediately, she ordered an MRI. I was honestly surprised (and annoyed since MRIs are expensive, but obviously I was focusing on the wrong things then) that I needed one, since nothing felt broken. The MRI said something completely different. DUN DUN DUN.

The Diagnosis

Here’s what my MRI said:

  1. Completely torn ACL
  2. Partially torn MCL
  3. Severerly torn LCL — spoiler alert: I twitched during my MRI this didn’t happen but thinking it did happen caused me some mental stress
  4. Laterial and medial meniscus tears

When I received the results, the first thing I thought was “who knew there were so many CLs”. My next thought was “oh shit”. What I knew about ACLs up until then — when you got a torn ACL, you had to go under the knife then you rocked a huge-ass robo brace for a while and missed a season of sports.

My next step was to find an orthopedic surgeon (I straight up went to Yelp – lol – and found Dr. Lawrence Holland — he had raving reviews and also treated the Seahawks/Mariners/Sounders ayyyy). I scheduled an appointment and Google’d furiously until then. What turned up wasn’t pretty. Before, I was frustrated and impatient that it wasn’t getting better after a few weeks. I was floored, disappointed, and really, really depressed that this would now take 6 to 9 months to get fully better.

I canceled my work obligations — attending a diversity conference in San Francisco and speaking on a panel at SMX West, a search engine marketing conference — which I was looking forward to (I later realized I could’ve totally attended both, just walking a little slower/on crutches). On top of that, my gurl Jane is getting married to Jim, and we’re throwing down in Austin for her bachelorette party over Memorial Day weekend. I 200% want to attend that, and be able to have one (or two) drinks!

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Recovery goals.

The good news was that after my appointment with Dr. Holland, he said that my LCL was actually fine — hallelujah! I moved around my leg a bit in the MRI machine since I was unable to keep it straight then, and the results were slightly blurry and most likely mis-read from some angles.

I would still need surgery for my ACL and meniscus though, so I scheduled one ASAP. Because of the length and position of the ACL, it cannot regrow on its own. Instead, a tissue graft is taken from elsewhere (either an autograft — patella or hamstring — or allograft — cadaver) and screwed into your tibia + femur where your ACL used to be. It then becomes an ACL ligament (– wtf? #science #wow #nature). I chose to get a hamstring graft, since your hamstring can regrow, Dr. Holland said I had a huge hamstring (BLUSHING), and patella grafts, though stronger, can lead to knee pain especially when kneeling later.

Friday, April 21st, 2017 is the big day!!!

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Lots of shit can go wrong.

Also, it’s totally possible for you to live functionally without your ACL. But being 24 and wanting to be more active, I wanted to get things surgically repaired (also, having meniscus damage complicates things) and get back to jumping and pivoting without second thoughts.

Preparing for the Surgery

Physical Therapy

Before you get your ACL + meniscus repaired, you gotta take care of the other CLs. Thankfully, most re-grow and repair themselves depending on the severity of the injury. My immediate pre-operation prehabilitation goals were to —

  1. Regain full ROM (range of motion)
  2. Get dat booty strong — quads, glutes, and calves to be more specific
  3. MCL healed

I went to Vida Integrated Health (would recommend, 5/5) in Madison Valley, and started doing balance exercises and lunges. They felt silly at first, and pretty frustrating because I went from being a ClassPass fiend to doing exercises that I see Chinese seniors doing in the park in the mornings. However, they helped me understand the injury more thoroughly, gave me structure to regaining strength and balance, and hooked me up to sweet ice/massage machines. A sampling of my hardcore workout:

  • Bike for 8 minutes
  • Lunges — front/back, side/side, lateral, with arms by side and arms up/down
  • Step-ups + step downs
  • Walking — literally, walking.
  • Fast walking — what what
  • Core exercises — planking, up dog to down dog
  • Barre exercises — good for the booty!

When not at PT, I do the following —

  • Elliptical at level 15 incline, level 10 resistance for 30 minutes or biking for 30 minutes at level 15-20 resistance
  • Bicep curls and tricep extensions
  • 20 lunges on each leg
  • 20 weighted squats
  • 100 sit-ups

Other adjustments —

  • Get used to sleeping with pillow under calf (NOT knee) – surprisingly hard since you have to sleep on your back and keep your leg straight
  • Having to ice or elevate your knee after exercising
  • Popping ibuprofen like skittles (but a medically appropriate amount!!! Not endorsing OTC drug abuse)
  • Using a compression sock/light knee brace sometimes
  • Not running/jumping/exercising vigorously — le sigh
  • Being super careful about walking outside — not taking huge steps, getting used to walking up/down stairs, not stumbling/tripping for obvious reasons

PT is a roller coaster ride, where you go from being super proud of what you can do that you couldn’t do last time, but realizing where you’re still limited. I remember doing a lunge exercise and being elated, but then feeling sharp knee pain when I tried to do a one-legged hop 5 minutes later.

Logistics

  • I’m blessed in so many ways, and one of them is that my mom is flying out for 2 weeks to look after me – hurrah! Definitely make sure you have someone to take care of you for a week after surgery, when it’s the most painful and you can’t move/drive easily.
  • Get an ice machine (I invested in renting the Gameready system which provides icing and compression) or many ice packs — I’ve also been using this guy.

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    Delighted.
  • Stock up on ibuprofen, Aleve, Tynenol etc.
  • Take time off and ask to work from home
  • Get a CPM (continuous passive motion) machine if your surgeon prescribes you — it moves your knee for you and keeps the blood flowing, although some other surgeons think that there’s no need for it and it can increase the chances of tearing somethingImage result for cpm machine
  • Schedule follow-up appointments with surgeon and physical therapist
  • Get some supplements, if that’s up your alley – fish oil supplements, lotion (Vaseline for scarring, bone/cartilage lotion), multivitamins, etc. It probably doesn’t help much and a bit of the placebo effect going on, but even doing little things can help you feel more in control of the situation.
  • Get crutches, if you don’t already have that
  • Figure out things with insurance — e.g. your insurance might limit your physical therapy appointments, so you want to save many for after the operation

Day Before/Notes to Self

  • Wash self with anti-microbial soap
  • Remove jewelry — earrings
  • Teach mom how to use Uber/Lyft lol
  • Bring crutches to surgery
  • Mark knee with Sharpie
  • Stop taking Tynenol/Ibuprofen
  • Stop eating at 12 AM
  • No wearing perfume + lotion
  • Set alarms for taking pain meds
  • Don’t wear contacts — nvm, thanks LASIK
  • After surgery
    • Get post-op protocol from surgeon after surgery
    • Pick up prescription painkillers after surgery (some surgeons may allow you to do it before!)
    • Focus on extension + keeping knee straight, not flexion

Mental Strength

This section is long ‘cuz this was my first major injury and I have a lot of feelings. No, I’m lucky not to be an amputee or cancer patient. But who wouldn’t be mildly depressed if you went from being active and outside every day to sitting on your butt?

What I didn’t expect was how mentally tough this would be. The first big mental obstacle I had was being really depressed and anxious, which keeping to myself/staying home because crutches were a pain in the ass and researching like a MOFO did not help. While it’s a major injury, there are many things that could be a lot worse in life, but I couldn’t help but feel as if I would never get better and fixate on what I couldn’t do. As I gained mobility and was able to go outside, do things, see things, I felt a lot better. But I wanted to prepare for post-surgery recovery and being mentally stronger in general, so here are a few things I did and tips I was given.

  • Accepting how much the current situation sucks and not denying it.
  • Our ability to deal with setbacks is determined by 3 P’s — personalization (attributing things solely to yourself vs. to external circumstances/others), pervasiveness (negative thoughts from one event trickle into other areas), and permanence (thinking this is forever). The 3 P’s were defined by Martin Seligman, talked about by Sheryl Sandberg in her moving commencement speech about coping with her husband’s death, and mentioned to me by Lisa Peng haha. Recognizing where my perspective was unhealthily imbalanced helped me think more realistically. Be on the lookout for Option B by Sheryl Sandberg and Professor Adam Grant (thanks for responding to my e-mail!!!)
  • Keeping a journal to document your physical progress and mental state — a helpful exercise, in general, is to write down all your irrational thoughts, identifying why they’re irrational, and countering it with a realistic thought (discussed in this book which has been recommended by numerous therapists). A sampling of my crazy thoughts —
    • I can’t believe people are worrying about their boyfriends or lack of boyfriends and work and what to wear when I’M CRIPPLED (pervasiveness, being the center of the world — but I am, right? 😉 )
    • I’m never going to walk or run or jump again (permanence and having as much forethought as a goldfish)
    • I’m so pathetic for injuring myself when I’m not even an athlete or great at bouldering and it’s all my fault. (personalization and needing “accident” defined)
  • Getting therapy — Microsoft thankfully covers 3 counseling sessions every year, and I took one of these to see a professional therapist for the first time. She also helped me identify where I was blowing things out of proportion or penalizing myself for what was an accident.
  • Reaching out to your support network — thank you to all my buddies who talked to me, told me it would get better, and listened to me whine/complain (thanks to EVERYONE – Jing/Connie/Peng/Clara for Facetiming me, Lindsey/Karthi/Katrina/Sabrina at work, Jamie/Katrina/Gordon lmao I think you guys heard the worst of it, Anand, etc). Talking to PT/med friends helped (TY TY Mel and Kevin and Julie for giving me advice and listening to me) who have seen a wealth of injuries. ACL injuries are very common and aren’t too even too high on the gnarly shit spectrum. They put things in perspective for you and tell you it’s going to be okay
  • Getting outside of your house/apartment – crutches/braces don’t have to keep you from going outside and doing things. 2 weeks after I was injured, I organized and ran College Puzzle Challenge Beta for around 120 employees at Microsoft. TY to Karthi, Phil, Jason, and the rest of the team for pulling it off!
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CPC 2017 @ UW #underthecpsea haha get it
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Brunching #normalpeoplethings #basicgirlthings #andAnand
  • Doing sedentary hobbies/things you can do — as a result of not being as mobile as I’d like to be, graphic design, photography, drawing/painting, playing guitar, watching TV (The People vs. OJ and 13 Reasons!!!), and reading have been my go-tos.
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    Made some laptop stickers for CPC!

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    Drew a b-day card for Xtina — would you buy? #sharktank
  • Listening to recovery stories of athletes, who’s very livelihood depends on their knee being able to function excellently — Lindsey Vonn, Alex Puccio, Derek Rose (poor guy), and some celebrities — Drake (not so much listening to his story as his music and knowing he once too got ACL surgery), Aubrey Plaza (who is just hilarious and went to a bachelor party right after surgery), Kim from Matt and Kim (who just tore her ACL a few weeks ago too) etc.

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Resources that Helped

Nina Elise – ACL Hamstring + Cadaver

Clarice Guido – ACL Hamstring + Meniscus

Yes Knee Can – ACLr Hamstring and Meniscus

b-reddy – Lots of ACL advice

KneeTalk forums on Knee Guru — there are tons of surgery diaries here, so you can look for someone who fits your exact injury + age/gender + graft choices

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