Hopefully I don’t sound like a broken record. But this week, I’m writing more about my torn ACL and MCL, surgery & recovery, and how nutrition has played a big role in it. I often judge ideas for nutrition posts by the amount of questions and interest I get from my own clients, and they’ve asked quite a bit about what you can do to protect, preserve, and heal ligaments & tendons. And, for the last 11 weeks, I’ve been healing both. These sort of posts were invaluable to me before my surgery so I could see a little of what to expect, and continue to serve as a great encouragement to me while rehabbing. Today, I’ll start with a summary of my nutrition rehab journey, and then during some of the weeks to come, I’ll highlight individual nutrients in more detail, and explain what the research and anecdotal experiences say about them. Here’s the summary.
Recipe of the week: Nutrients to Heal Tendons & Ligaments
- High Protein. I’ve aimed for 80+ grams protein (1.5+ gm/kg body weight) per day from various sources, and usually have ended up @ 100+ grams.
- Gelatin. Gelatin is made of tendons, ligaments, bones, and hooves of animals (delicious, right), and is thought to improve the health of these human tissues as well.
- Vitamin C. Vitamin C is a key player in collagen formation, repair, and health.
- Undenatured Whey. This has served as a dense protein source for me, and an antioxidant booster (it can increase the body’s production of glutathione, a natural super antioxidant.
- Turmeric & Ginger. Nature’s great anti-inflammatories have helped me control pain and throbbing, and are supported by research as healers of ligaments (unlike NSAIDs which can initially inhibiting healing).
- MSM/Glucosamine/Chondroitin (Move Free). The nutrients in this supplement support joints, cartilage formation, and ligament/tendon health.
- Calcium/Magnesium/Vitamin D. These nutrients are important for many everyday body functions, nerve function, and tissue repair among other things.
- Essential Oils: I’ve used arnica, turmeric, ginger, and lemongrass for anti-pain and anti-inflammation properties. I’ve used peppermint to improve bloodflow healing (it’s a vasodilator).
My Timeline & Progress:
On January, 29th, I turned sharply while backcountry skiing on a steep roller in variable snow conditions…while I didn’t crash or fall, I heard a loud, nauseating “pop” while turning. I then fell over, and after trying to stand again twice, I realized something was really wrong with my knee. On each attempt, it moved from outward to inward (towards my other knee), outward and inward, and then I crumbled to the ground.
During the next week, I learned that I tore my ACL completely and strained my MCL to a full grade 3 tear. We decided to wait for almost 6 weeks before having surgery, at my surgeon’s recommendation, in hopes that my MCL would heal itself (while a full ACL tear cannot really heal on it own, mostly due to lack of bloodflow within the kneecap, a MCL has bloodflow and has the chance of healing.
I set about to begin prehab on my quad muscles, all the while resting and rehabbing my MCL in a brace, and hoping for healing. I regained some quad nerve “firing” and strength, and gained back my knee flexion and some knee stability while awaiting surgery. Before this experience, I did not realize that trauma to the knee causes the nerves and muscles in the upper leg and lower leg to stop “firing” and communicating with each other, likely as a way to protect the knee by not letting you really use it. I would have to regain this firing and muscle response after the injury, and then again after the surgery.
On March 10th, I had knee surgery, and I went into it not knowing if my MCL had healed enough (it needed to be down to Grade 1) to be left alone, or if I would wake up with a cadaver graft for my MCL. The original MRI had also shown small tears on my mensicus that would have to be “cleaned up.” During the pre-op process, I also decided on what sort of graft I would use for my new ACL, whether a cadaver, hamstring tendon, patellar tendon, or a less common option, the quadricep tendon. As an avid backcountry skier, trail runner, climber, and mountain biker, it was a tough decision. And after a lot of research, weighing the pros and cons, and much discussion with the surgeon I chose, I went with the quad tendon. It’s a strong tendon that will recover well. And as a female athlete, I will likely always have an imbalance in quad strength vs. hamstring strength, so I didn’t want to further this imbalance while using the hamstring tendon. Furthermore, now that quad tendons are used as full soft-tissue only graft sites without use the patella bone, there wasn’t much of a downside to this choice for me.
During these last 5 weeks, I’ve now been in full-blow ACL surgery recovery – because, as I’d hoped, my MCL healed to a Grade 1 before surgery! And, by the time of surgery, there wasn’t even any meniscus damage to clean up. The MCL was big news to me, since it meant a quicker recovery overall, and only 5 days on crutches immediately after surgery vs. 6 weeks. I’m not sure how a mom of 4 and owner of 2 businesses would manage in crutches for 6 weeks. Here is some of the breakdown on my journey so far:
Post-op Days 1-3: The day immediately after surgery, I experienced very significant pain. I’ve had 4 completely natural child-births, and would still call this “very significant pain.” When I woke up that morning, it was obvious to me that my nerve block had worn off. I took my percocet every four hours (1 pill) + tylenol every 2 hours, + turmeric and ginger and still the pain was enough to make me grunt f-bombs with every crutched step to the bathroom, right there in front of my mother (sorry mom!). In hindsite, I would take the upper range of painkillers – 2 every 4-6 hours rather than 1 every 4 hours. But thankfully, the pain was much better on Day 2 post-op, and cut down even more by Day 3. By Day 4, I was no longer on any pain killers except 1 tylenol pm at night.
A few other tips that really helped:
- I bought an ice-machine before surgery (~$150) and knee adapter pad. This allows you to continually ice without using melting ice-bags. It’s been awesome for swelling and pain reduction, and I think it will be useful in general for recovery after training.
- I, and many of my clients, swear by a tea called Smooth Move by Traditional Medicinals. Any time you use pain killers like percocet, you’ve got to do everything you can to avoid constipation – stay very hydrated, use a stool softener each day, eat a diet high in fiber, and in my opinion, drink Smooth Move 2-3 times per day. It works well!
One thing I wasn’t prepared for was how difficult a time I was going to have sleeping. Up until post-op day 12, I couldn’t really move my leg without using my hands. So, every hour or so, I’d wake up and feel anxious and trapped because I couldn’t really move well. I also felt clausterphobic in the compression hose, and this did not help sleep (yes, I’ve diagnosed myself with food/leg clausterphobia, and apparently I’m a bit of a headcase;) I couldn’t roll to a side without considerable effort. Lack of sleep, day after day, can really take it’s toll. The Tylenol PM only offered a bit of relief, melatonin didn’t seem to help, and finally I tried Zyqull. I’m not necessarily advocating for the use of a sleep aid in general, but sleep is oh-so-important to the body and especially to any kind of recovery, and I knew it was worth it to get sleep. Zyqull has been necessary for me to sleep through the night, and it has been a great help.
- A Home TENS/STEM electrode thing. Not only does this help with nerve firing, but the massage mode is great when I’m doing home rehab – it sort of distracts me while I push through flexion. Well worth the $25 for me.
Weeks 1-2: Although rehabbing a knee can be terribly painful, it has been a great distraction to have purposeful training in rehab. As an endurance athelete, I’ve trained myself to embrace some pain, and I actually missed it before this rehab began! I’ve tried to do my all rehab exercise sets 2-3 times daily, followed by icing with my ice machine. I took 2 full mostly off of work, and had help with the kids and household stuff during this time, so I could take the time to get all the rehab in and begin to form the needed habits. I mostly focused on reducing swelling and getting my knee to extend fully (flat) at first. Next, we worked on more and more flexion, and quad strength. By the end of week 2, I was at 90 deg flexion.
Weeks 3-5: By week 3 I was at 114 deg flexion. From there, I kept working towards the 110-120 deg number, so I could turn the pedals of my
bike. This was a big goal for me, because I knew spinning the bike would feel great and get my legs going a bit again. The main point is to continue to increase Range of Motion on the bike, not really strength or endurance just yet. During the end of week 3 I could turn the pedals with a raised seat (about 1 inch above normal). After more work on flexion, I’ve been slowly lowering my seat to increase the flexion required. Now, at week 5 post-op, my seat is a good 8 inches below normal, and spinning this low, while painful, has really helped keep me knee loose and increased flexibility. So, I’m definitely at greater than 125 deg flexion, although my Physical Therapist is out of town this week so I’m not sure on the exact number. I couldn’t be happier with her, and I would highly recommend Dr. Patty Pennell at Back to Motion Physical Therapy to anyone in the Denver Area. I’ve also focused on continued quad strength and have added hamstring curls.
Of course, having a successful surgery and great physical therapist have been the most important parts of my rehab journey, but I have no doubt that nutrition has played an important supporting role. I believe it contributed to the quick healing of my MCL, meniscus, and continued healing of my new ACL and quad tendon graft site. I am excited to follow this post with more information on each nutrient and research that supports it. And mostly, I hope these posts can encourage and provide some information for any athlete who finds him or herself in my position.
What’s more, within the next 4 months I’ll finish an update on my Nutrition for Healing After Orthopedic Surgery ebook so that others can find all this information, including specific doses and brands of supplements, sample meal plans, and nutrition full recommendations from pre-surgery through the post-op phase. One of my favorite things about being a nutritionist is knowing that most anything I go through or challenge myself with only makes me a better, more understanding, and well-educated practitioner. Although I never wanted to understand ACL surgery quite this well, I might as well make lemonade out of
these lemons and share what I learn.
If you find yourself facing orthopedic surgery, take heart! My kiddos and husband have continued to be my best support with plenty of laughs (the medicine), fun plans, and help. I am oh-so-motivated by my thoughts of singletrack, backcountry slopes, and climbing mountains…and sweat, I miss the feeling of sweating! If you’re on this journey with me, keep doing your best to keep your head up and get through recovery healthier and stronger. Let yourself have down days, too…those are definitely part of the journey. And in all cases, have confidence that your nutrition is vitally important.
Fuel Your Ride. Nourish Your Body.
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