My ACL Journey - The Middle of Rehab (Part 5)

This is Part 5 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 1 - The Injury

Part 2 - The Prehab

Part 3 - The Surgery

Part 4 - The Early Rehab (weeks 2-7)

Part 5 - The Middle of Rehab (months 2-6) [this page]

Part 6 - Late Rehab (months 7-10)

This section of “middle rehab” covers the beginning of month 3 until the end of month 6 post-op. Initially, there was a slowdown in the rapid progress I’d been experiencing from early rehab. I was still progressing, but no longer in big leaps. I needed to mentally shift how I thought about my rehab as a result. As the summer turned to fall, colder/rainy weather, family obligations, Covid, and travel impacted my rehab and morale by limiting how active I could be.

Mental state

It was easy to motivate myself in the first eight weeks of rehab. I was seeing improvements every other day, which deepened my commitment to stick to the prescribed plan. In month three, the PT visits began to feel the same: I was doing the same exercises with the same effort as before and the monotony set in. At the three month mark, it felt like five or six months had gone by. Of course, I knew that if I compared myself to a few weeks ago, there was a clear improvement in my movement quality and confidence. Still, I could no longer rely on the instant gratification to excite me.

I thought back to my earlier promise to myself, that I needed to come back stronger. I knew that this meant more than just bigger, stronger, and more capable leg muscles. It also meant identifying what I wasn’t doing pre-injury that I should have been doing. The first thing that came to mind was meditation. I’m a fairly intense person, so I’ve been reluctant to try sitting down and quieting my mind for, even a few seconds. I decided to make a real effort at it and was convinced after a few sessions. I’ve been at it for months and have made it an essential part of my mornings. In addition to having better quality sleep, I also find myself less quick to become frustrated at throughout the day.

My friends also told me about the legendary comeback of Adrian Peterson (AP), one of the greatest running backs in American football history, after he tore his ACL. I found the story inspiring and also went down a rabbit hole of looking for other pro athletes who recovered from ACL reconstruction like Tom Brady, Lindsey Vonn, and Zlatan Ibrahimović. Everyone online focuses on the size of their quads and hamstrings, but few people talk at length about how a strong mind is what separates normal or weak recoveries from the incredible recoveries. Everyone heals differently of course, but everyone also has the ability to push themselves to their own (safe) limit and I believed most people don’t even get close. I started to believe that this is what made elite athletes special. It wasn’t the million-dollar team or infrared sauna sessions. It was the power of will to follow through on a vision.

Regardless of how true that statement actually is, I believed it. I also believed that I likely would have healed faster if I was younger, but I wouldn’t have had the knowledge base about how different factors (e.g., hydration, sleep, nutrition, stress, consistency, etc) influence that recovery. There are dozens of pro athletes (e.g., Megan Rapinoe, Héctor Bellerín) who have said that the ACL rehab is the best thing that’s ever happened to them; they describe it as a gift. That initially seems absurd. Losing a year just to gain back muscle you spent a lifetime building? It seemed genuine and not something they said for the cameras. They all mentioned growing from the experience: refocusing their priorities, diet, resilience, and perspective. I recognized that I could either come out of this rehab regretful about what happened to me or I could see it as a wake-up call, a major pivot point in my life that I look back on decades later with pride. I’m going to live through this rehab anyway, so I might as well make the most of it.

During this phase of rehab, I was interviewed by Greg Louie, DPT (known on Instagram as @the_ski _pt). In that chat, I shared more about my mindset towards rehab. Find it here: https://open.spotify.com/episode/2EkLKYW1lcZQxS51DOyg0r?si=8493a3c566d74bf0

Diet

I already had a healthy, balanced diet, but I probed to see if there was room to push further. This wasn’t directly aimed at improving my ACL recovery; it was more around the vision of coming out of this setback on a higher level. I started to learn about glycemic index and glycemic load of different foods. It was a term I was vaguely familiar with, but never bothered to really learn about. I gave up on white rice, something I grew up eating multiple times a day in a South Asian home, and swapped over to brown rice. It definitely isn’t as tasty, but it makes me feel better and now I prefer it.

I also addressed my afternoon snacking by swapping to eating only one-ingredient snacks (nuts, blueberries, apples, etc). After a long bike ride where I’ve burned 3,000 calories, I throw down a protein shake I made myself rather than pig out at a restaurant on the drive back. It sounds like my life became a lot less fun, and from one perspective it has, but it’s a worthwhile tradeoff. My friend Greg likes to say, “Once your body has experienced what feeling really good is like, it’s hard to go back.”

Exercise

The exercises I did at physical therapy were focused on hypertrophy, stability, agility, deceleration, max speed, and eventually pivoting. Here’s a set of video clips that shows what the progression looked like:

I loved the balance exercises, which were initially a weakness for me even on my good leg. I bought a bosu ball just to practice more at home. Rehab was always top of mind for me: during breakfast, while waiting until my pancakes were ready to flip, I’d do bodyweight squats and lunges. I got so used to doing them that I’d need to do dozens before I’d feel a burn.

On strength exercises at PT, I’d always choose the harder weight when given the option. If there was an exercise wanted to quit on, my mind would flash to a scene of me on skis about to make a turn, imagining that it could go one of two ways: I’d either injure myself or make the move. That visual helped push me to complete all of my sets.

You never want to fail because you didn't work hard enough.

- Arnold

My PT began return-to-sport testing at 5 months and 2 weeks, just to get a baseline to compare against when we would test again the next month. I was surprised at how much I was able to do, but there was definitely a gap in confidence with my operated leg.

All of this was really enjoyable for me, in large part to the efforts of my physical therapists at SPT, providing variation and making it fun. I also finally accepted that resistance training had something to offer me and began to learn about concentric vs eccentric movements, how to train for power vs strength vs hypertrophy, and how I might balance that with my endurance goals. I even started to daydream about the workout splits I’d have in a year. I was fully invested into my training.

Body

My un-operated leg continued to grow stronger and grow in size. We weren’t isolating my operated leg, which was of course notably smaller. I knew it could take a year at least for them to be symmetrical again, but it wouldn’t take a year to match the strength.

I made sure to keep working on my upper body and core, which I had no excuse to skip out on. I looked and felt strong because of this. I’d often be shocked when I’d realize how little time had passed since the surgery. Fortunately, I had a shift in perspective: I had been thinking "Damn, I'm only 3 months into this rehab. It's taking forever" and getting quietly impatient. Instead, as I daydreamed about skiing, I began to think "Damn, 3 months have already passed. I only have 6-9 months* left to get strong before my return to skiing."

*This was of course assuming 9mo-12mo return to sport clearance, which may not be the case.

At week 14, my PT told me to stop wearing the Incrediwear knee sleeve during our sessions. He said it was a crutch, and indeed everything felt 5-10% harder without it. After just a few days I preferred not wearing it for training and only relied on the Incrediwear for long flights or car rides when I’d be idle.

Activity

My rehab took place over the summer, and I was hoping to get some adventuring in without introducing too much risk. Mostly, I biked on road and eventually on gravel. I knew gravel carried greater risk, but I tried to control my speed on descents to a reasonable level. My PT would have preferred I stay off the bike altogether, in case I needed to make a sudden stop and landed on my leg, but I felt confident in my bike handling.

I did do a 7mi (1,800ft ele) hike at week 11, but only because a friend was visiting. I moved at a normal-slow pace and the descents were the most challenging mentally. I wasn’t yet cleared to run or jump, but I did go to a swimming pool a few times to practice those movements in a safe manner.

Someone asked if I’d sign up for a race or an event as a milestone to look forward to. I personally thought that was a bad idea, since I couldn’t be sure of my condition at that date and may pressure myself into doing something simply because I signed up for it. Even if I was ready, the competitive environment would likley lead me to do something I shouldn’t. Instead, I made adventure plans for the weekend just days before based how fatigued I felt. One of my favorite rides was a scenic 62mi (5,500ft ele gain) loop near Mt Rainier that I did on week 14. I felt like I could’ve biked to the summit that day (if that was possible), but left some gas in the tank because I still needed to do my at-home PT the next day.

I delayed in clearing myself for mountain biking, since the speed at which I’d have to limit my riding would be far too slow to have any fun. By month six, my PT (off the record) told me I could start mountain biking, but crashing could be a major setback. I’m planning on sticking to the greens and blues, and avoiding wet, slippery days.

I’ll also be heading back to the climbing gym for some top-rope action and potentially even lead climbing. I’ll avoid hard bouldering for at least a full year, given the constant impact of jumping down.

Rest days

I didn’t plan for any rest days on my legs since the surgery, except for days when I was in flight to the east coast or internationally. I could only get away with this by modulating my load to ensure I had enough of a gap between ‘heavy’ days (i.e., days that I went to PT or the big mileage bike rides).

All of this was possible with very good hydration, proper sleep, and foam rolling twice a day. I wanted to ensure that my fun days on the bike did not need to be shortened, so I needed to make sure I was on top of everything else.

Rest days were limited to circumstances beyond my control, like when I caught Covid or I had severe jetlag from traveling to Bangladesh. If I needed to ease up on the legs, I still worked on stretching, light spin bike and went more intensely on the upper body and core workouts.

Concluding thoughts & looking ahead

I’ve had a very strong recovery so far and my nightmares of re-tearing my ACL during rehab have quieted down after trying out some advanced movements. My PT tells me he suspects I’ll be back to skiing in February (9 months post-op). This aligns with what I expected; I’ll have a very measured approach to returning to skis, which I can outline in my next writeup.

In the meantime, I’ll be working on (1) advanced pivot exercises at PT, (2) sprinting to build fast-twitch muscle fibers, (3) picking up activities I put on hold like boxing, climbing, and mountain biking, and (4) continuing all the good things I’ve been doing on diet, mental health, training, and time management.