6 Months Post-ACL Surgery (Round 2)

[I've since written a series on ACL reconstruction surgery prep, recovery, training, and back-to-sport protocol. See here for the full series.]

"So how's your knee doing? Are you bouldering yet?"

In short, my knee's doing as good as it can be for having had 2 surgeries, I've just started roping, and I won't be bouldering for at least another year.

I feel like I fall short of portraying the fuller answer except to those who understand the mental and physical repercussions of surgery. People see me all the time in the gym (12-15hrs a week with PT), I'm stronger than I've ever been, and I've been killing it with strength building and PT. But you won't come out of surgeries like ACL reconstruction perfect.

80% of the day I don't think about my knee, but every step down tall stairs, hiking, or climbing, I'm consciously contracting my leg muscles. My knee doesn't feel like nothing...it doesn't hurt, but it doesn't track completely normally either. After working out, it'll feel just a little bit more different.

squat training

I can deadlift 145lb, squat 110lb, do near perfect kettlebell swings, but can't raise my ankle up past 90 degrees to my butt, or hold it there in isometric contraction for more than 15 sec. My surgical leg feels like it's nearly as strong as my other, but it's still 1" smaller around. It's amazing how your body compensates for weak muscles, and I'm just extremely glad I'm self-aware and dedicated enough to target strengthening my hamstring.

deadlift training

I watch others fall from bouldering or watch contact sports on TV and cringe on every impact. My knee hurts, like phantom pain, and I know I'm not ready for prime time myself. But, I get stellar marks from the surgeon and PT, and really surprised looks from the few who've also had ACL surgery. So I guess my knee's doing awesome, but awesome isn't pre-injury status.

hangboard training

I'm dealing with the mental aspects of post-surgical life much better this surgery than last. It's been almost 2 years since I first tore my ACL. Yes, I'd love to get back to bouldering, and it sucks, but it's the long road that counts so I can be climbing with Jeremy for the next 50 years. I've honestly really enjoyed strength and fitness training, and feel healthier and know I'm the strongest I've ever been. I know more about mobility, how my body responds to different workout stimulus, how to train for injury prevention, and that I can handle the long journey when other setbacks happen.

While the long road to recovery sucks, I've been viewing it as a large project to conquer, rather than viewing it as "when can I climb." I spend 3hrs a week in PT plus another 10-12hrs working out on my own. It takes a long time of dedicated work to build muscle and significantly increase strength and power. I love navigating through large projects, and it's really motivating to see the difference from contracting my quad for longer than 3sec to doing pistol squats on a bosu ball why my therapist throws medicine balls at me.

I get a lot of surprised looks when I say I'm still a year out from bouldering again, often followed by comments to "just have a positive attitude" like other athletes in recovery. I've written before about the details of graft healing--ACL reconstruction isn't a surgery you jump back from once your muscles are ready. The graft, which is my hamstring tendon, actually dips in strength from 1-3months post-surgery, then slowly makes its way back. And you can't significantly move that dial. Going back to sport before the graft is ready is playing a Russian Roulette risk game. I really believe without the long-term stress I had from work from the first surgery, I'm on a much better trajectory this time, but even professional soccer and football players take a season off before going back to sport in full.

hangboard training [above: typical graft strength to healing time trajectory, source]

Here's my full rehab protocol through month 6.

Surgery through Month 3

  • Brace: Full post-op cast for 1 month then down to a smaller brace through month 3.
  • Can't do: any impact, running, side to side movement.
  • Exercise: stationary bike, bodyweight exercise, started light kettlebell work, a lot of single leg work to decrease the strength deficit.

Month 3 - 5:

  • Brace: Only when needed like during hiking and highly discouraged when not needed.
  • Can't do: impact like jumping.
  • Exercise: running to my heart's content, rowing machine, hiking, barbell squats and deadlifts, heavy kettlebell. Workouts were intense to build muscle mass and strength.

Month 5 - 6 (now):

  • Brace: Only when needed.
  • Can't do: extreme impact like bouldering and contact sports.
  • Exercise: Started climbing on rope, but no twisting motions like drop-knees or cracks; offwidths scare me. Still running. Weightlifting workouts mostly replaced by agility, jumping (of my own propulsion), and single-leg hopping.

Previous Post on ACL surgeries, knee anatomy, and recovery: