Monday, February 23, 2009

My Road Thus Far V - Month 6

Month 6: Jan 24- Feb 20, '09
- The first weekend of this time period, I played another game of "stop" then, the next day (sunday), after a long internal struggle, decided to give "Mini" a go. This was very high level, hard cutting, short bursts of speed, with a group of guys whose team I am planning to tryout for. So, going was a very tough decision, since I could also attend goaltimate on the same day, which would be lower level, easier to choose whether or not to go hard, and I wouldn't be showing myself for the first time to the guys who might in the future decide whether or not to cut me. I decided to give it a shot and play Mini, and it went as well as I could have hoped. I got the shit skied out of me a few times, but otherwise didn't make a fool of myself and held my own for the most part. Uninjured, I wouldn't have been too psyched, but considering I was barely 6 months our of surgery, I was content.
- This month also saw me play my first full-field ultimate, a long day of pickup this past weekend. The level was mixed, as were the games, but as the afternoon went on, two games distinctly separated themselves and my field was left with mostly men and the better men at that. I slowly increased my speed, involvement, and risk-taking, and by the end felt comfortable sprinting, cutting, and jumping at nearly full speed. The following day I played Mini again, and although I couldn't last as long before feeling mighty sore, I again felt relatively comfortable (or, as comfortable as I can expect to feel against the high level of competition).
- As Month 6 unfolded, my physical ability blossomed quickly. From playing my first competitive game on Jan 25th (and simply trying to keep up) to a game of goaltimate on Feb 22nd (where I could really push myself without worry), there was such a drastic change in knee stability, comfort and strength, in speed, reaction time, and agility, and in high-speed recovery and stamina that it's difficult to fully describe just how much better I felt. This has been my month to return to sport, without a doubt, and I am certainly glad I didn't try after 4 or 5 months like some people I've spoken to. I simply wouldn't have been able to, and the risk for re-injur, or compensation injury, would have been high.
- On Feb 17th, I had a checkup with my Physical Therapist, at which point they were basically doing a last look before they did or did not clear me to play. And they did! I wasn't that surprised to be cleared, but I was at the results of my leg diameters (they measure the muscle bulk in your legs to determine the balance of strength between your healing leg and your normal leg. The bigger the difference, the less likely they are to clear you). leg diameters:
11/7/08
2" above patella
L - [37cm] - R - [37cm]
6" above patella
L - [48.75cm] - R - [46.5cm] = 2.25cm difference
2/17/09
2" above patella
L - [37.25cm] - R - [37.25cm] = +.25cm in both legs, stronger!
6" above patella
L - [49.00cm] - R - [48.5cm] = +.25cm in ok leg, + 2cm in injured, only .5cm difference!!
- These results were very, very encouraging. Now to get back to the field!
- Going forward, the biggest gaps between me now, and me pre-injury, are my top-end speed and my jumping ability. Used to be able to touch rim. Used to have a first-step that could get me open. Both are good goals for the next two months as tryouts loom in the distance. Training now consists of running stairs twice a week with a weighted backpack (20lbs added) twice one week (Tues/Thurs), then doing sprints and acceleration work twice on the next week, alternating weekly, in addition to long pickup on Saturday and high-level Goaltimate or Mini on Sunday.

My Road Thus Far IV - Month 5

Month 5: Dec 27 - Jan 23, '09
- As soon as I hit the fifth month mark I sprinted. I just couldn't wait to do it. December 27th fortuitously was a beautiful, 45 degree, sunny day in an otherwise frigid, snowy Michigan, and I jogged over to a high school parking lot to do some plyometrics and sprinting. Man, did I get tired quick, but man, did it feel good to be sprinting again. Sometimes you just don't think a day or event will ever come, you wait for so long, but then it gets there, and that joy is something you only know if you've had it. There was some discomfort, some soreness, but it felt good, the good kind of sore that I'd come to know and differentiate after all the December running.
- That month, also fortuitously, a group of buddies of mine were gearing up to play in an alumni tourney, and made a website to track their fitness level and workouts. They had made it a challenge, who could work out the most, along with a place for goals and a place for direct challenges/shit-talking/etc. This was a god-send for me, as it provided a community of like-minded, hard-working *friends* that I could talk to about workouts, ask questions, and generally feel not alone as I did box jumps in the empty dark room in the gym.
- My gym also switched ownership, and began offering early-morning boot-camp-style classes that focused on plyometrics, and I worked these hard. They were perfect. Core work, quad work, calf work, stability work. It was fantastic. Plus I learned some new stuff, and the addition of a structure (someone else timing, providing the exercises, leading warm-up) as well as other around me pushed me to go that much harder. I am thinking of posting some of the workouts here for reference.
- I also began cutting work, meaning, donning my cleats and going to a park to throw with someone (often my girlfriend) and doing a V- shaped cutting drill, cutting out, then in to her forehand side, then out, then in to her backhand side, essentailly a 150 degree cut rather than a full 180, and cutting off of one leg, then the other. This was good to do slowly and build speed until discomfort told me to stop.
- I played my first "game" the last week of this month, a game called "sto(m?)p the chump." The goal is to tip a throw into a soccer goal, thrower can't be in 6-yard box, take back line is 18 yard box, and an upside down throw hitting the cross-bar means a free penalty shot, with a goalie, from the 18 yard line, just try to score. Games to 3, or 5, or whatever. It was perfect because it was short cuts, I could be as involved as I felt comfortable, and it was finally something i could enjoy with others.

My Road Thus Far III - Month 4

Month 4: Nov. 29 - Dec. 26, '08
- Now it's getting good. I had successfully made it past the 4 month mark without any setbacks, and had substantially regained leg strength, mobility, and hadn't lost my focus.
- I began running as if it were candy and I was a toddler:
--December 1, I ran 3.4 miles in 24 minutes. (treadmill)
--December 3, 3.7 miles in 27 minutes. (treadmill)
--December 5, 4 miles in 28.5 minutes. (treadmill)
--December 7, 5 miles, outside, at a slow pace (untimed).
--December 8, 4 miles in 27'42"(treadmill)
--December 9, lifted legs hard
--December 12, 5K in 20' flat
--December 13, 1 mile in 6' flat
--December 14, 1 mile, 7'
--December 15, 5k in 20'30"
--December 17, 5k in 20'32"
--December 18, 1 mile in 5'58"
--December 20, 1.5 miles in 6:40 pace
--December 22, 1 mile in 6'40"
--December 25, 1.5 miles at 6'40" pace
- I also did a lot of upper body work, focusing on pullups, pushups, dips, core, and actually did some climbing (bouldering), never doing anything too high that I felt was out of my comfort zone.
- This month was just fun. It was all potential, like those first dates you go on with a girl when you really hit it off. I usually hate running longer than a mile, so in that time from mile 1 through the third or fourth to finish was time spent imagining the season I would have, how strong I'd be, how fast I could run and cut, how high I could jump. It is all potential that far out, and for that reason alone it was great.

My Road Thus Far II - Month 1 through Month 3

Month 1: September 5 - October 3, '08
- Swelling has reduced sizably, and range of motion is big, almost heel to rear, an inch away.
- PT has extended to include some more balance and strengthening exercises including standing on the injured leg with a slightly bent knee with an exercise band (EB from now on) around the ankle of my other leg and, with that leg straight, moving it to stretch the EB. This is done facing all compass directions to strengthen the injured leg and work on balance. Also, standing on that injured leg again, still slightly bent, move a medicine ball around your body one direction, then the other, then make a big V in front of you, raising it up to the right above your head, down to the middle in front of your pelvis, then back up to the left side. Continuing with leg press, step-ups on a 12" plyo box, and adding hip strengthening on abductor and adductor machines.
- This is what the PT called the slow months. Basically, the tendon has been taken from its blood source, and is currently deteriorating as it reconnects with a new blood supply in its new location. During this period (months 1-4), it is at its weakest, although you are getting stronger and more bored with the same old same old over and over. This is the time to be most diligent with your rehab and the most focused to not have any lapse of judgment and think "I could run/play right now." This was good for me to hear.
- The cross-country drive occured in this month, and went just fine. It definitely got stiff, but that was expected. I left September 6 and arrived September 10. I also took this month to chill a bit, the only time that I did less than I could have. I did this because I knew that I had a lot to accomplish in this time period outside of rehab (get a job to start), and that my road would be very long and wouldn't be sustainable unless I took it at a comfortable pace. I didn't get a gym membership until the last week of September.

Month 2: Oct 4 - Oct 31, '08
- This month I continued to take it relatively easy. I continued to do some workouts (hitting the gym for leg press, all balance stuff from above, etc), but didn't enter with the drive I later found. This was to preserve a level of sanity, as I knew my drive/determination would increase exponentially as soon as I went full-bore, and I felt it was simply too early to enter that mindset. In addition, I would go crazy when all I could do at the gym was weights stuff, without any more "speedy' stuff i was used to and enjoyed, like running, plyometrics, jumping, etc. During this time period I also got a job, got my car broken into, got my car stolen, and saw half my new company get laid off. Crazy times. I was focused elsewhere.
- Swelling was down markedly, and stairs were becoming much less of an issue. Not that they ever really were much of an issue, but there was simply an expected soreness each time I stepped up, and this was noticeably decreasing.

Month 3: Nov. 1 - Nov. 28, 08 [I measure months as 4 weeks, not simply the length of the month]
- During this month I began to be much more focused. I knew I could run at the 4 month mark, and this gave me something to prepare my legs for, in terms of strength and stability. In addition, I had an occasional training partner, a friend of my girlfriends' who also tore her ACL at nearly the same time, who also was very consistent in her training and rehab. I hit the gym diligently and really worked on building my quad strength. I also started my PT appointments in my new locale, and was cleared to begin a walk/job program on a treadmill mid-month. This was exciting and gave me something new to do in the gym, making gym visits much more attractive.

My Road Thus Far I - Injury through Month 0

I was very curious to track my progress against others', since by nature people have the need to compare. I wanted to be ahead of the curve, even though it meant nothing, since only my own progress and ability made any real difference. But it did help mentally, so I write this down in the hopes of providing some semblance of structure against which another fellow-sufferer of an ACl tear can work.

Injury: July 27, '08
- on defense, force is flick, guarding handler near front of stack, playing slightly off to force side. IO flick to my man, I sprint to stop the continue backhand break. As I try to shut it down, I turn laterally to face my man and put on a mark, still moving laterally towards the break side. Plant my foot (heel first) to stop the successive inside out flick break, knee bows out laterally so that my knee in essence moves out over the right ankle, chunky noise in my knee, hit the ground in high level of pain.
- was able to march forwards from squat position, leading trainer to believe ACl not torn, potentially PCL or some other knee ligament. proceed to drink.

Doctor Appt: July 28, '08
- Doctor checks out knee, thinks ACL is torn, orders MRI

MRI: July 29, '08
- Taken, wait for results

MRI Results: July 30, '08
- ACL torn, all else is fine. Surgery scheduled.

Surgery: August 8, '08
- Patellar Autograft route. They were gong to give me a spinal block and allow me to watch the procedure, but then renegged on that, saying it the surgery could take longer than the spinal block might last. Knocked me out.
- When i awoke, they were pretty harsh, and made me dress myself, which was pretty tough as I couldn't move my leg, could barely tell what was going on, and didn't know what I Could/Couldn't do. I kind of wish I had videotape of this, I imagine it took me forever.

Post-Op Weekend: August 09/10, '08
- Tons of chilling. Did not need to poop for like once until like a week later due to vicodin. Got off Vicodin by Monday since I didn't need it and it made me so constipated. Made sure to invite many, many friends over to watch movies, since I could use pity to get them to do shit for me. Played lots of video games, ate ice cream. Wrote innumerable alphabets with my big toe lying on my back with my leg up the wall to spurn blood flow throughout my leg and reduce swelling. On crutches all the time, 0% weight bearing.

PT Begins: Monday, August 11, '08
- First of many. Because my surgery occurred so quickly after injury, and I had been training hard throughout the summer, I entered PT with lots of latent quad muscle, and this helped immensely. I could immediately do straight leg lifts well, and although my quad had difficulty firing, when hooked up to electrode stimulators, it performed well and showed very good potential. My road was nicely paved due to the quickness of my surgery.

Month 0: Aug 8 - Sept 5, '08
- Each week meant a bit more weight born by my leg, less by my crutches. 0% first week, 25% 2nd, 50% third, 75% fourth, done. I was off crutches by September (none too soon). This was important for me personally as I had initially planned to move west, driving, about a month previous, but these plans were obviously delayed with the injury. I had to wait until I could sit, unmoving, for 8-10 hours (driving), and this would've been impossible in that first month, unless i took half hour to hour-long breaks to elevate, compress, and ice my knee to decrease the swelling that occurred during the day walking around.
- Mobility was never much of an issue. I immediately had good mobility, and by week 2, I was about 3 inches from touching my heel to my rear. This was far ahead of schedule, and I was told to simply not push it and I'd be just fine there.
- I grew to love the electric stim machine quickly. It's just an incredibly strange feeling to have something firing your muscles FOR you. I constantly jacked up the stim to the max when the therapists weren't looking. They said it didn't matter, that the more the better as long as you can stand it.
- My favorite device was the GameReady. It's a compression sleeve that velcroes around your knee and about 4 inches above and below. It is hooked up to an ice-water pump, so it basically is fastened around your leg then slowly gets tighter and tighter and colder and colder and feels amazing. When you're done they take it off and your knee went from pontoon to resembling a knee again.
- The scar was never an issue either. My brother had SERIOUS issues with his cut-- it got infected, a thread got stuck in his skin and caused issues, and at this point looks much worse than mine (he tore his acl about a month before me). Mine healed beautifully, and is only looking better.
- PT itself focused on a bike ride, the leg press, calf raises, lots of calf movements with a resistance band, an exercise where you put an exercise band behind your knee and, standing, it pulls away as you stand and straighten your leg, followed by electric stim and some GameReady. On my own it was focused on swelling reduction and resistance band work.

soreness v pain II

Now a few weeks after my soreness v pain query, I've been able to experience the feeling a few times and have come up with some (personal) deductions:
1- Some soreness of the patellar tendon is acceptable. In other areas much less so. This is because the acl graft, as well as the two bones segments acting as anchor points, were removed from this portion of my knee, and it is still healing.
2- Soreness elsewhere definitely warrants closer inspection. After playing pickup then goalty back to back a while ago, there was soreness _within_ my knee, hence my pulling the reins a bit and slowing down, allowing it to heal fully and for any soreness/pain in that portion of the knee to subside.
3- Some workouts tax the knee (especially the patellar tendon) more than others. Stair workouts certainly do, as they repetitively stress that tendon.
4- Goaltimate, with its multi-directional cutting & short burst speed focus, has often left my patellar tendon feeling utterly pain free. Further, it feels tight to begin with, but seems to slowly "loosen up" as the game wears on, and I can only deduce that there is some tightness to the tendon as it heels and that it actually does become a bit looser with the exercise and multi-plane stress that comes from cutting in multiple directions (rather than 1-dimensionally simply going up stairs).

None of this is brain surgery, but certainly helps me to feel more comfortable with certain soreness/tightness sensations within the knee, and to know how to loosen up in pre-game situations. Basically, I would most like to do hard, small-field cutting in any pre-game situation, with drills like 3v3 keep away in a small box, or Mini, or simply suicides, probably to conclude a warm-up session that began with a decent run/dynamic stretching.

It's been less than a month since my first competitive game (High-level Mini on Jan. 25), and already I feel much, much better, both in terms of knee stability/dependability, and overall speed/quickness/stamina. The main facets still absent from my game are top-end speed and jumping ability, which I am working on by varying between 2 stair workouts per week vs. 2 cleated speed workouts per week. I believe that much of what I have now can be attributed to the work I did in January, so hopefully February's efforts will show themselves in March/April. Fingers crossed.

Tuesday, February 3, 2009

Soreness V Pain

This weekend, played 3 hours of pickup on Saturday and about a solid hour of Mini on Sunday.

At pickup, I slowly accelerated speed, cutting, and jumping, until by the end I was nearly at max on all 3. It felt great, and I wasn't sore at all that evening. The next day i was definitely somewhat sore in my patella, and as I played Mini, felt more sore as I went on. I was on a team that held the court for about 8 straight games (losing the 8th, which sucked, because it was not only my fault, but would've allowed us to make a rule for the rest of the day).

However, afterwards, I felt quite sore, and the following Monday, was much more sore than ever. I was actually worried. However, that Sunday night/Monday morning, i had also not slept at all (guessing the post-superbowl decaf wasn't actually decaf at all).

Hypothesis-- sleep, and not just rest, is HUGE in muscle and ligament recovery. Sleep more and stay healthier? Obvi.

But, my query rests more in what constitutes soreness (acceptable, almost good, denoting pushing to a good limit, and extending that limit) vs pain (bad, denotes crossing threshold from helpful to hurtful training).

Investigation continues this evening on a stairs workout-- will the knee be fine my mid-workout per usual, or will soreness/pain persist? Time will tell.