This is Part 2 of a series outlining my recovery. There’s an impressive set of information online about how best to recover from an ACL tear, but I wanted to share my own story for a few reasons. There are a few critical resources online that made an outsized difference to me that I’d like to share. I also wanted to actualize the story I wanted to tell when I got to the other side. Finally, for me it was comforting to read the journeys of others going through the same process. I hope you find this helpful and do reach out with any questions you have.
Part 2 - The Prehab [this page]
Part 4 - The Early Rehab (weeks 2-7)
Diagnosing the injury
On March 9th, my entire approach to the injury changed. I scheduled an appointment with an Orthopedic doctor without a referral; I figured the rapid muscle loss and minor instability had to be signs of something worse than a sprain. While the X-ray revealed nothing interesting, the physical exam (the Lachman test) showed I had a soft endpoint to my knee and the doctor could feel there was still fluid buildup within the knee. He had a look of deep regret when he told me that there was likely a “disruption of the ACL” and recommended an MRI. He also referred me to a surgeon colleague. All of this information was going over my head. I didn’t even know what an ACL was, let alone the implications of tearing one. It took several minutes for me to realize the gravity of the situation. As he spoke, I began to physically feel sick and wanted to disappear into the wall.
I called Leah once I was dismissed and gave her the news. The entire drive home, I felt shaken and wanted to pull over and absorb all of this. The MRI a few days later would confirm the tear, though it was unclear whether I had damage to my meniscus.
Leah shared several links to pro skier Caroline Gleich’s Instagram where Caroline shared her journey of tearing her ACL and then summiting Mt Everest about six weeks later, just days before surgery. It seemed absurd that would be possible, but I began to think that maybe the 3-week Nepal honeymoon trek we had in six weeks was still possible.
GOOD THING #1: Getting inspiration from Caroline Gleich’s IG, realizing there’s a lot I could still do with a torn ACL before surgery. Relevant links:
- Video about the Everest climb
- Speed ladder, 1 month post-surgery
- Single-leg assisted squads, 6.5 weeks post-surgery
- Two mile run/hike, 4 months post-surgery
- Cleared for skiing, 5 months post-surgery
- Skiing a long run, 6 months post-surgery
Taking action
I began to feel empowered once I focused on what was within my control. The day after learning it was possible I tore my ACL, I began icing regularly. Almost immediately, the tenderness in my IT band (from compensating for my injury) went away. I got into the mindset that I would come out of this experience stronger than if it hadn’t happened. I made a plan for documenting the journey, exercising my core and upper body, and queued up movies to watch while hitting the spin bike 2x a day. I made a note to myself that I shouldn’t feel sorry for myself any longer and I should be mindful to avoid time sinks like getting into video games or doom scrolling.
The new routine was very much like a part-time job and often mentally taxing. Exercising twice a day for 45min-1hr already seemed like a lot, but it became much more demanding when I added in the icing, heating, nutrition, hydration, work schedule etc. Still, this is exactly what I wanted.
While cycling felt great, hiking did not. A three mile hike on a hilly urban trail felt miserable. My kneecap began to feel sore after mile two and I regretted not bringing trekking poles. It was also a lot less fun than being on the bike.
Here’s a photo of me, before it became miserable, with the OTC knee brace I bought.
GOOD THING #2: I relied heavily on the spin bike to reverse some muscle atrophy, and felt quite grateful for having both the equipment and also a strong background in cycling.
I also bought an NMES device to stimulate my muscles while I was idle, in addition to the massage gun I already had. Although pricey, I heard it’d be valuable during physical therapy and my parents loved the one I bought for them years ago. Since I was in the mindset of doing whatever it took to stack the odds in my favor, I bought a bulk supply of supplements: turmeric, tart cherry, glucosamine, multivitamin, fish oil, Vitamin D, and collagen peptides. I wasn’t sure whether these would make any difference, but I knew they wouldn’t hurt. I also started to wear a mask more often while out. I wanted to do everything I could to stack the deck in my favor. I even got a week-long gym membership in Todos Santos, Baja California Sur on vacation to use the crappy spin bike daily.
Finding the right surgeon
I read up on the surgeon that was recommended to me, Dr. Robin Fuchs. I watched videos of him performing the surgery, looked into his background with professional sports teams (Yankees, Knicks, Nets), and also looked into other surgeons that were within my network. I wanted a highly experienced surgeon that specialized in minimally invasive surgery, would provide me an autograft, was part of a big network, and had experience with athletes. Fortunately, living in Seattle provided me with plenty of options and I narrowed my choice down to Dr. Fuchs and Dr. Edward Khalfayan (the surgeon for the Seattle Seahawks).
I had a week-long trip to Baja, then a visit to family in NYC, and after a few days home in Seattle, a long trip to Nepal. This limited my ability to shop around for a surgeon but I knew I’d be in good hands with either of the two I was considering. I met with Dr. Fuchs and prepared a 7-page document of questions for him and even brought my laptop with me to take notes. I could tell he liked me and he said I was doing all the right things. He specialized in bone-patellar tendon-bone (bptb) autografts, which would provide the strongest graft. He also cleared me for Nepal and said he’d do it if he was me, but couldn’t professionally recommend that I go. He insisted that I wear a functional knee brace (Donjoy Fullforce) while hiking to prevent further injury and that I take it easy while I was out there.
GOOD THING #3: Living in Seattle and having access to experienced surgeons who work with athletes. A friend of mine living in Flagstaff unfortunately has had fewer options for choosing a surgeon and physical therapist.
Learning more
Once I knew I was looking at an ACL reconstruction, I threw myself into learning as much as I could and finding a community. Given how common the injury is, there was quite a lot. I skipped any Facebook groups that advocated for healing without surgery. While that’s possible, it’s extremely rare and it seemed like most of the people in those groups were delusional.
The best groups I found were on Facebook (ACL Recovery Club) and Reddit (r/ACL). Both exposed me to stories of people from around the world (although primarily in the US) who were in different stages of recovery. On the /ACL subreddit, sorting by top posts of all time gave me some inspiration for what a strong recovery could look like. Seeing the daily feed of questions helped me absorb how to think about the various setbacks I’d encounter. Reading the comments left on each person’s post helped me feel like I was part of a community.
I wanted to take this a step further and create a cohort of those having surgery in early May, which is when I was scheduled for. I ended up making a group chat where we each shared our stories, fears, and challenges while comforting each other. There were folks from different countries, some getting the BEAR implant surgery, and some having waited years to get a surgery date. Throughout the process, I became immensely grateful for being in a position where I had good private insurance and plenty of choices for surgeons. It seems the UK and Canadian healthcare systems have wait times of months or more. I was also exposed to stories of people who couldn’t afford the operation in the US, or weren’t able to take more than a day off of work for recovery from their physically taxing job.
I struggled to share the news of my torn ACL with friends online, mostly because I didn’t want to relive the day I got injured. I was glad I finally did though. Several folks shared their own ACL reconstruction journey, some having had the surgery two or three decades ago. I learned quite a lot from these friends, many of whom are the type A optimizers like I am. Finally, the best resource I came across for comprehensive information has definitely been the ACL Athlete Podcast hosted by Ravi Patel. Dr. Patel has a great energy and put together some excellent episodes that are pretty timeless, so be sure to dig through his archives. I binged through hours of his content.
GOOD THING #4: Finding a community that understood my journey within my friends and strangers online. I became immensely grateful for what I had.
Travelling
On April 2, I returned from Baja and NYC and noticed that my quad was weaker and before those trips. I hadn’t kept up as diligently with my prehab routine when I was away. Leah and I were questioning whether doing a 3 week hike at high altitude was a great idea. Fortunately, the Nepalese government made a sudden declaration that all foreign hikers will need to hire a guide. We were happy to pay higher tourism fees for visiting Nepal, but we found this rule to be pretty stupid and didn’t want to be guinea pigs. We cancelled our trip and scrambled to think of something else. Leah suggested we go on a bike touring trip and within a day we settled on Corsica.
I can confidently say that I didn’t know much about Corsica and have never done a self-supported bike tour, but I was excited about this new plan. I did a day of biking outdoors on mostly flat ground and a day of questionable mountain biking in Baja. Both times I felt pretty capable even while wearing a functional knee brace. I knew cycling was the best thing I could be doing for my prehab as well, and Corsica has plenty of steep hills to challenge my quads.
The biggest challenge ended up being the flight, which was a long 16hr session each way of standing up every hour and bringing attention to myself doing elaborate stretching exercises. Fortunately, stepping onto the flight with a knee brace signaled to other passengers that I was nursing an injury. I brought a refillable ice pack that I could strap to my knee while sitting, which I’d ask the flight attendants to refill every few hours. This made a massive difference and helped relieved the pressure I’d feel in the knee. My surgeon also recommended I take aspirin to prevent a blood clot.
Overall the trip was a huge success. I felt as strong as ever and had zero discomfort or soreness while biking. We completed 480 miles (42,000ft of climbing) of biking with touring gear strapped onto us. My quads were looking strong and nearly identical in size. I also now had memories to think back on while I’d be laying in bed.
GOOD THING #5: Doing prehab by biking for 5-8 hours a day in hilly terrain for three weeks. Although I have a strong (but recent) background in cycling, I forgot that it would be the best prehab I could do until I saw this reddit post.
Meeting with PT
I arrived back home two days before surgery, which only gave me one day to meet with my physical therapist and ensure he was a good fit. After some great advice from my friend Zander who also had ACL surgery years before, my criteria for a PT was that they be part of a modern facility that was easy to get to, focus on me only during the session, participate in the activities I do (mtb, ski, climbing, etc), push me hard during rehab, and be savvy with blood-flow restriction training. Nelson Thai was all of those and a great communicator. He also had his own ACL reconstructed so he was familiar with what I’d be going through. Although my surgeon didn’t want me in PT until at least a week later, Nelson gave me a set of at-home exercises. Since I already had an NMES device, much of what he would’ve done for me in that first week I’d be able to do on my own.
GOOD THING #6: Meeting with the PT beforehand, even for a day meant that all the check-in paperwork and meet-and-greets would be done. I also went home with a set of exercises to do during the first week, and felt confident that my PT was a good fit for me.
Quad size, just before surgery
My PT measured my quads the day after my bike trip and the day before surgery.
Left leg (uninjured): 51cm
Right leg (injured): 48cm
My flexion on the injured knee was at 135 degrees before I felt some stiff pain and I was able to easily get to 0 degrees of extension. This was the case prior to the bike trip.
Part 3 - The Surgery
In Part 3, I’ll share what it was like preparing my home for surgery, the costs of the procedure, scheduling PT, my pain levels, and time off of work. Link to be pasted here once I finish typing that up.