So it's been a few weeks since we did one of these. The initial plan was to do a post every couple weeks detailing Bec's progress and how she's feeling with everything. For those of you who have been following on Instagram you will have seen we were posting workouts and updates most days up until around christmas.
Then Christmas and new year happened, a much needed break from social media and working online. This was always the plan anyway, however what then happened was the next phase of rehab for Bec was a lot more frustrating than we had planned. Nothing went wrong, but because of a lot of soreness around her patella and the front of her knee in general, it meant that she couldn't workout as much as she wanted to and it meant that progress was much slower than in initial weeks. It should be noted that this is generally the case with ACL rehabilitation, the first couple weeks are all about getting the swelling down and recovering range of motion and naturally during that phase progress can feel quite quick and significant. But once those early gains are made the next few weeks can often be frustrating. You are still limited with that you're able to do exercise wise, partly because of pain and soreness, and partly because there are still limitations on what you are allowed to do. After the 6-8 week mark the ACL graft effectively starts to die (1), it's called necrosis, this is normal and it is part of the remodelling process, but it means that for a time the graft is vulenrable to damage and it means that you should be careful with the exercises you choose. In addition, Becky had some work done on her meniscus and had been told to avoid any loading of the knee past 90 degrees flexion for around 12 weeks which further limited her exercise selections.
All of this added together meant that often training was quite frustrating and it really wasn't helpful for her to be filming and posting about her progress because often it felt like it wasn't going well at all and it would get her down - even though it was and we will touch on that shortly! Plus, my excuse is I have been disgustingly ill for most of 2020 so far and meant Becky has been training by herself a lot.
Anyway, with all of that being said, Becky has still been working hard and has stuck with the plan. Just because she has been limited with what exercises can be used doesn't mean that progress still can't be made with the basics. Her exercise program of hitting each of these exercises 2-3 times per week:
1. Bodyweight Squats, but only to parallel.
2. Push ups
3. Step ups, only stepping UP on the injured side not down (lowering down was still too painful).
4. Pull ups
5. Single leg dips (slowly introduced these at around 10 weeks post op, as with step ups they were very sore initially).
6. Single Leg RDLs to work the hamstrings and balance.
7. Hip thrusts for the glutes
8. Rowing on a concept 2 erg or riding a Watt bike for the steady state cardio or interval training.
9. And calf raises to keep the calves strong. Often with knee injuries calf injuries are extremely common in the rehab or return to sport phase because the quads and glutes of the injured leg are weak and thus the calf gets overworked, so it's important to keep them strong too.
Check out the gram for videos on these exercises!
Often Bec would need a day off after hitting a gym session, soreness and sometimes swelling would be elevated so she would need to just stick to some lighter cardio and make sure she iced and elevated her knee - it's important to note that this is NORMAL, if you're getting swelling soreness, and even clicks and clunks during the first 1-4 months (and even sometimes after if you've had a lot of work done like Bec) that is par for the course and doesn't mean you should avoid training, just be smart and listen to your knee. You know you're doing too much if you start to take steps backwards and start to struggle with the normal things. For Bec, she knew she needed a rest because she would struggle not to limp just walking around the flat and she'd have swelling and more pain than usual.
With that being said here is a little account from Bec over how the process has felt the last few weeks:
"I definitely struggled with feeling like I had to prove something after the first initial month/ 6 weeks. I really wanted to rehabilitate well, be a good example given that I am a Physiotherapist and for some reason I felt like I needed to be one of those people that absolutely smashes their rehab and makes everything look easy. Every single time someones asked 'oh are you limping?' I feel so dissapointed that it looks like I may be struggling. That means at times I have been really stroppy in the gym, snapped at people when I can't do something and had a few tears here and there. Getting my range of movement back seemed easy but doing any exercises that put strain through my patella tendon actually felt so painful I just had to stop. It has given me a whole new sympathy to people who get really severe anterior knee pain or tendon pain. You cant bully your way through those problems I can tell you that now.
What has been great however is every small accomplishment. I loved the gym and doing strength training before this operation, but it reminds me how much I love every little victory. The first lunge, the first single leg squat, the first time your heel can touch your bum again feel like such epic achievements. It makes me want to get better and better and I can say now, after 12 weeks, I can see some of the light at the end of this rehab tunnel. Im super excited to start some plyometric exercises, running and hopping. I dont want to do this though until im super happy with my strength. I dont want to cut corners. It finally feels like the tendon pain at the front of my knee is starting to settle down I feel like the best bits are coming up soon. "
Bec has stayed the the course, she has worked through that early stage frustrating part, and is now 14 weeks post-op. It's during this phase of rehab that things start to get a bit more intense, this is because that phase I told you about earlier where the graft dies, well over the past month or so the graft has begun a remodelling phase where it starts to recapillarise and, essentially, it starts to turn into the new ligament that will stabilise Becky's knee. This means that, to keep it is simple as possible, we can now start to add more variety into her training as we have to take less care over the graft. Overall though Becky's training will still be limited by how much pain she can put up with through her patella.
We have started to add some knee loading into the mix with goblet squats, she's started to add some more lunges in which were too painful before, and we have been able to load her deadlifts up again. In fact last week Bec hit 70kg (more than her bodyweight) for 3 reps!! Not bad considering her 1 rep max before the op was 95kg.
The next few weeks we will add as much of her programming as possible to the instagram and facebok pages and as always all of your support is extremely helpful and helps Becky through. So please comment, share and make sure you tune in for the next one!
Cheers Team!
Feel. Move. Perform. Better.
Aspire Performance.
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