Hiking/mountaineering recovery for partial ACL tear

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September 14, 2020 at 5:20 pm #45052

kocanez
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I posted here about a week ago (thanks for the response!) about a suspected meniscus tear; both the PA I saw and I were surprised to find out today that it is actually a partial ACL tear.

The PA recommended I do PT for at least 4 weeks and then re-assess. I will see the MD and start PT tomorrow (re-start, just finished PT for achilles tendonitis about a month ago..).

Do you have any experience with hikers/mountaineers returning to sport w/this injury *without* surgery? Everything I’ve read says that most athletes are not successful w/o surgery, although I am guessing most of these are people who are doing things at a quicker pace where it is easier to twist things the wrong way (downhill skiing, bball, soccer). Although steep/rocky/slippery/icy trails and carrying extra pack weight are a different set of challenges..

I often feel like when I tell providers I hike, they think it means I am going on a stroll in the park on an even surfaced dirt road (one trainer I had suggested I wear a fanny pack after I hurt my back… I told him I didnt think my snowshoes and crampons would fit), not 10+ miles and several thousand plus feet of elevation gain on steep, rocky, slippery trails in 4 seasons w/5-30 lbs of gear on my back (30 for backpacking).

Any tips or thoughts are always appreciated! Also if you know of any PT/coaches in the New England area that specialize in uphill/mountain sports, I would also be interested (I live in Mass. and do most of my hiking in NH).

thanks in advance!
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Posted In: Injury & Rehab

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Pete Dickinson MS,PT on September 18, 2020 at 3:01 pm #45163

You can definitely return to a high level of sport activity with an ACL injury. Some partial tears can still give a stable knee depending on your inherent joint stiffness. The issue is whether you have instability, episodes of giving way, with your chosen activities. These symptoms can cause tearing of the meniscus which you want to avoid. You also don’t want to have an ‘episode’ in the backcountry where you pivot, and lock your meniscus leading to an evacuation situation.
As always, listen to how YOU are responding to the injury.
Cheers,
Pete

Participant

flohud49 on September 18, 2020 at 5:27 pm #45171

In March of last year I completely tore my left ACL while backcountry skiing. There was little swelling at the time and I skied myself out with a simple Ace bandage around the knee. Initially, I, too, suspected I’d sustained a meniscus tear. The extent of the injury wasn’t fully revealed until I had an MRI, about two weeks later.

I elected not to have surgery and began a program of PT and strength building exercises. I started hiking again in the summer, was climbing by August, and, with a stout Kevlar brace, resumed skiing last winter. I initially wore the brace hiking and got some benefit from it on downhill sections. After a few months, I found I could leave it at home and just rely on trekking poles. This summer I’ve done a number of scrambles in the Cascades and the knee has held up, that is, no pain and no “trick knee” instability.

My therapist showed me a variety of exercises that I continue to do and I fully believe they made all the difference. In brief, make sure you’ve got an accurate description of the injury, work with a PT, and don’t let up on the exercises. I incorporated mine with my regular warm-up/Base period workout.

Best wishes for your recovery.

Participant

kocanez on September 18, 2020 at 9:05 pm #45179

Flohud- thanks so much for your input! Glad to hear that you were able to get back to hiking, climbing and skiing. Did you have any significant cartilage damage ?

Pete- Thanks. I actually just got my MRI results electronically and it also lists a full thickness cartilage tear (specifically ” Full-thickness chondral fissure in the medial patellar facet”). The doctor didn’t mention this during my visit when we looked @ my MRI together, which I’m surprised about. from what I understand, this likely further complicates the rehab process. I am 35 so Im doubting it is degenerative.

What are your thoughts and experiences w/full thickness cartilage tears in addition to ACL tear (mine was deemed low grade/grade 1 ).

thanks again!

Participant

Pete Dickinson MS,PT on September 19, 2020 at 5:46 pm #45203

Your chondral fissure is not a ‘meniscus tear’ which ‘should’ not add to instability. The location on the patella does lead to greater awareness of patellar loading during quad dominant activities. Posterior chain strengthening is appropriate for both the patellar chondral injury and the grade 1 ACL tear. I would recommend giving conservative care (non surgical) a shot, with your athletic background you have the best chance possible adapting to this injury.
Cheers,
Pete

Participant

kocanez on September 24, 2020 at 4:12 pm #45396

Thanks Pete! Your input is much appreciated. I’m plugging away at PT.

A couple follow up questions:

1. In your opinion, is a spin bike harder on the knees than a “Regular” stationary bike? I was thinking of buying a spin bike prior to the injury; I’m worried I might “outgrow” the regular bike in 6 mo or so (if all goes well..) and want something that can handle more speed and resistance. Any thoughts?

2. Any recommendations for keeping up some level of conditioning while still “taking it easy”? The PT I’m seeing is recommending I stay off it except for short walks or bikes (I’m in 2nd week of PT; about 1 month after initial injury and ~ 2 wks after it significantly worsened). I’m doing 15 min walks ~4-5 days a week, mostly for my sanity..

thanks in advance!

Participant

Pete Dickinson MS,PT on September 24, 2020 at 9:56 pm #45403

Yes, keep your sanity!! A spin bike is fine, the heavier flywheel is just something you have to be aware of when decelerating after an effort or with stopping. I use my regular bike on a smart trainer, no way I’ll outgrow it:) The chondral injury takes a LOT of time to heal, and the bike with low loads is a great way to help ‘polish’ the surface. To really load aerobically, the ski erg or deep water running is the way to go.
Cheers,
Pete

Participant

flohud49 on September 24, 2020 at 10:19 pm #45404

There were sprains identified in collateral ligaments and some bruising, but no cartilage damage. Similar to what you’re doing, I started exercise with walking and cycling, including spin classes. About four weeks after the accident I began gradually ramping up PT/strength exercises, as well as stretching. It wasn’t an instantaneous come-back but there was steady improvement over a period of months.
Best wishes,
Frank

Participant

kocanez on September 25, 2020 at 10:41 am #45412

Pete– If you haven’t outgrown it, I must be doing it wrong! What kind of bike do you have/do you have any recommendations? I want something I can do spin workouts on eventually.

Flohud- thanks for the info. Looking forward to more progress!

Participant

Pete Dickinson MS,PT on September 26, 2020 at 8:08 am #45430

I use my regular road bike on a Tacx neo smart trainer. There are many software/web programs that offer great training for this method. For a large flywheel stand alone bike with power meter, you’re looking at more money.

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Hiking/mountaineering recovery for partial ACL tear