Tuesday, October 22, 2013

My experience through an Anterior Cruciate Ligament (ACL) tear, reconstructive arthoscopy and rehab with physiotherapy.

The reason for this article is not just because I have or am still rehabilitating from an ACL ( a ligament of the knee) tear but mainly to give a patients view point of the injury and the process that follows with it. When I got diagnosed with an ACL tear I looked it up on google and you tube. Found a lot of of information and even videos by people who have gone through this experience but sadly none of the experiences were from India. That is when I decided to document the full process and put it online so that in the future there is information about the whole process from the Indian perspective. Actually I have not seen a detailed article on this by any patient all over the world. Most people have just put up their videos documenting their recovery. Hope this article helps those who have to get the ACL reconstructed to get a detailed idea of what to expect and what not to. It is also my chance to thank all the people that have helped me get through one of the most testing times in my life.I have always trained and been super active not able to do anything for 3 months now really was very testing for me. 

Before we go further I would like to mention that the article is based on my experience and not necessary that everyone may experience the same things. My exercise routine and rehab through physiotherapy was planned keeping in my mind my fitness levels and my need to build up muscle with synchronization to my bodies response to the surgery. I have followed what my Doctor and Physiotherapist thought was best for me. Always follow their advice, they know best. Please do not try what I did without consulting your doctor first.

I was planning on posting this article the day I start walking and have my knee checked by the doctor. Today I was out running errands being close to the hospital where I got my surgery thought of taking a picture of myself with the hospital for the article. My physio happened to be there at the hospital and said lets finish meeting the doctor now. Well was really nice to meet the doctor and hear him say that the ligament is very stable and well set however I need to work on my gait and build my quads up a lot more.

I would like to thank my family and friends who have stood by me and been very supportive through this stage of my life. I would like to thank my students who have shown so much concern and have been picking and dropping me from home to class and back in their cars. I would like to thank the auto rickshaw drivers who usually can be very painful but seeing a man limping they became human and were helpful in my daily trips to and fro for physiotherapy. My personal training clients who have been checking up on me and awaiting for me to train them again. This may sound crazy but I would also like to thank the 15 year old boy who for no reason came and stood on the narrow state highway with his cycle causing me to meet with the accident. The last 3 months have really been testing for me but also have given me time to introspect and look at life in a way I had never thought of, it has improved my will power by many folds and most importantly am now ready to teach anyone with any physical disability.

                    Took the pic today at the hospital when I could ride my bike and walk without the brace.
Dr. Naresh my orthopedic surgeon is a wonderful person and a very good orthopedic surgeon. He explains the complete condition to the patient very well and is very professional in his approach. I had seen an operation theater before at Yashoda Hospital when my father was admitted there but I can say for sure that operation theater at Dr. Naresh's hospital is any day much better and really well planned and equipped. Thank you doctor for all the care and treatment that I received from you, the other doctors, nurses and all the other staff at the hospital.

                   Outside Mr. Bharatram's clinic on the first day of physiotherapy after the surgery.

Mr. Bharatram is a physiotherapist and runs a clinic called Body Mechanics. Aptly named as he is truly the best mechanic for the human body I have ever come across. He is very down to earth, dedicated and personally looks over the treatment of each patient even though he has many assistants. I refer to Mr. Bharatram as doctor out of respect for his knowledge and skill. Mr. Bharatram is a good friend of mine whom I have been associated with him for about 2 years now. In  my 28 years of training I have never needed a physio but have come across numerous physio's and sports doctors locally and internationally I can from my experience say that Mr. Bharatram is top notch and one of the best in his field. He truly understands a persons injury and the best treatment that will suit the person according to his body and fitness level. Over the last 2 years many from Jukaado have visited him and we are very happy and feel secure knowing we have a physio like him to fix us up so we can train again. Thank you doctor for all your care, concern and treatment. All the staff at Body Mechanics are very good too and really do take care of the patients. At Body Mechanics you feel you are being treated by a team that is not working there but is there to help all get back their health, they all display genuine desire to serve.

                                  Body Mechanics - Jukaado's official Physiotherapists

ACL Tear - My Experience.

I had met with an accident near Bapatla on 22nd July 2013. There was no immediate swelling so I knew there was no fracture. However I got an x- ray done once I got back. Went to Dr. Bharat and he started me with physiotherapy as the leg had swollen up a lot in the next few days. The swelling made it difficult to diagnose if the ligament was torn. 3 weeks later when the swelling reduced he sent me for an MRI scan which confirmed an ACL tear. The next day I had an appointment with Dr. Naresh and was asked to come back after a week. A 4 week gap is usually preferred from accident date to surgery. I was made to start some exercises pre- surgery so as to build some muscle back which I had lost. A week later Dr. Naresh said we can complete your surgery tomorrow. Many videos online show patients walking normally the next day of the surgery without any brace or any support. This is what raised my hopes but sadly reality is very different. I do not know if the videos posted by patients and clinics online are genuine but they surely fooled me in to believing I would be back in action in a day or two.

                                            Took this pic to mark my surgery date.
I was given an epidural anesthetic injection which meant I was numb dead waist down. Was hoping to see the surgery since I was awake and in my senses but they put a screen and all I could hear was them talking and the sound of the drill ( I guess) which was used to drill through my shin bone and thigh bone. After surgery I was kept in the post operation care unit. This may sound funny but I actually did this. Dr. Suman the anesthesiologist for my surgery came to the post op care and told the nurse to shift me to my room once I get my leg movement back. Now crazy me remembered the movie - Kill Bill, where Uma Thurman talks to her toes to get rid of the effects of the anesthetic and I started staring at my right foot and said wiggle your big toe, wiggle your big toe. You know what it works!!!! The first person to meet me was Dr. Bharat who came and started talking of all the crazy things I do as part of training. It really motivated me to get back again. I did not have any pain in my left knee which got operated but it just felt heavy and swollen. Was discharged the next day and I limped home. It feels very heavy for the first few days especially when u try to stand up or walk you suddenly feel like loads of fluid is flowing into your knee. I had promised Dr. Naresh that I would take complete bed rest for the next 5 days which I did. Sunday I had my first set of staples/ stitches removed and was asked to come back after 15 days from the surgery to remove the remaining. 
                                         The staples which were removed 15 days after surgery.
I was asked to do the following exercises - leg raises, side raises and hamstring curls. It is very important to get the range of motion back after surgery.  My body is use to high intensity of workout however I started slowly and within a week this was my exercise routine -
   1 set =
100 leg raises in one go with holding few counts.
100 side raises in one go with holding few counts.
I use to do about 5 - 6 sets daily through out the day and 2 sets of 30 -50 hamstring curls in a day. This exercise repetitions is very very high and when I informed the surgeon and the physio both were not too happy. My physio called me up and asked me not to do any more than this. So please do not follow this unless your doctor tells you to. Icing is very very important. Just ice the leg every few hours there is nothing like too much icing. In the last 3 months have iced my leg so much that if we could collect all the ice I have used we can form a pretty big iceberg. 

I had to stop going to my school (Hillside Academy) and truly started to miss all the students especially the naughty small ones. Had even stopped my personal training clients after the surgery. The complete left leg was kept in a rigid brace which prevents any movement of the knee and is used to prevent any sudden load or twist to the healing knee. After 5 days of total bed rest I was going mad at home. Felt like a wild tiger suddenly locked up in a small cage. I felt I needed an outing regularly doing something I love to keep me in a good frame of mind. So I started going to my evening class which is 3 times a week and is just 2 -3 minutes from home. Students would pick me up by car and drop me back home by car too. 
After 15 days from surgery Dr. Naresh was not happy with my range of motion as I was not able to even bend 60 degrees ( full leg bending range is 130 degrees). I was asked to start physio therapy and started it from the 18th day. The first week a machine called the stimulator was used to stimulate and re-activate my quad muscles. I have very muscular thighs thanks to my crazy training ways. During my intermediate days I did 1500 squats daily for about 6 months. The result I could never get a ready made jeans to accommodate my gigantic thighs. Then reduced my squat training and took on running and cycling to tone them down. 
The above pic was taken from a distance during a 10km run in December 2012. It is visibly evident of the well toned thighs and their definition even from a distance. Now I lost all this muscle on my left thigh and had to build it back again which is no easy task.

After a week Dr. Bharat started me off on a machine called the Pilates Reformer. This felt really nice as I could exercise. This machine does wonders in just a week I went from bending 60 degrees to bending almost 90 degrees without any pain too. Have been doing 4 different exercises on the pilates reformer along with my previous exercise routine. I was and still am virtually eating, icing, exercising and sleeping one after the other all day. Sometimes when I wake up at night also I realize that sub-consciously I am moving my leg up and down. It seems funny but I guess my desire to get back my mobility is so high that even without me knowing my body was exercising in my sleep. Today I can easily bend more than 100 degrees thanks to Dr. Bharat and the pilates reformer.

On 20th October I completed 3 months from my accident and 2 months from my surgery. My brace is now removed am moving around cautiously without the brace and have also been allowed to ride my bike. Getting permission to remove the brace and ride my bike really boosted my confidence and motivation. Wish to get back to teaching at my school (Hillside Academy) and my personal training clients but I need a week to re - learn how to walk. The legs being tied up in the brace for two months have made the muscle forget to walk and will come back in some days. 

It is sad but true most people in our country get scared of surgeries and have this real strange attitude - " Till it works or can be managed avoid it" ( jab taak chalta hai chala lo baad mein dekkh lenge).
No one likes to get operated on but if the body needs it then delaying or avoiding it is foolish, the apt saying for such people would be - " Penny wise and Pound foolish." Well my advice has always been train as crazy as you can but never at the risk of your health and if your body needs medical attention never delay it for anything in the world.
I have a long way to go but I am reaching there a step at a time and reach there I surely will!!!!!!!


  1. After ACL tear Surgery one should follow the instruction given by the doctor to recover from surgery. ACL tear

    1. Anjlena Julie, I agree with you on that. I have just followed what my physio and doctor have guided me through. Any change of routine that I have thought of, has always been run through my physio first.