ACL Surgery, Muay Thai, and the Long Road Back

Last May (2017), I was injured while doing a combo at Muay Thai – a jump jab that rebounded off a rear leg kick for some added momentum. I landed, my right leg collapsed, and there was a rather stomach turning pop when it happened. Those of you who know me well are fully aware that I am a “walk it off” kind of person. Well, I couldn’t walk, and my abs were spasming while my training partners relocated me out of the middle of the mat, got ice for me, and elevated the leg. After laying down for a while, I stood up (albeit shakily), hobbled about with care (See! Turns out I could walk), then proceeded to drive myself home. I spent a couple days on the couch icing it and taking ibuprofen. It started feeling better. No bruising and minimal swelling. I tried to go back to class about a week and half later, and it was instantly obvious I was trying too much too soon. When I say that, I mean my right leg wasn’t stable in warm up. So I just punched for the whole class and started only coming on my days to teach. My training partners did the demos on those days. It was disappointing, but this is not the first injury I’ve worked through. Fast forward, a couple weeks, and I was pushing through super intense pain in my calf. Pain to the point that I was thinking, “Hey maybe I broke my fibula again.” (2008 accident that involved my skateboard, a mini ramp, 4.5 hours sleep, and an off balance rock-fakie) A trip to my primary doctor ruled that out, and after jerking on my legs to test ligaments and tendons, he believed that I had torn a stabilizer calf muscle. An ultrasound would confirm, but with a high deductible insurance plan and a year that changed over in June, I opted not to have it until life became worse, or we at least moved into a new insurance year in case extensive treatment was necessary. I really didn’t want to meet the deductible twice on the same injury. Fast forward again, about six weeks, a couple trips to the message therapist, and many laps in the pool later, the pain was much improved, and I’d been slowly adding Muay Thai drills back into my routine. I was back in class, going about 90% when an easy switch kick during some timing drills put me back on the floor again. I guess in hindsight this wasn’t my first clue that something was terribly wrong.

Official Diagnosis by an Orthopedic Surgeon and Imaging: Detached ACL

Treatment: ACL Reconstruction Surgery and Physical Therapy

Treatment Duration: Minimum 6 months

General Attitude: Well this sucks.

If you’re reading this far and have found yourself in a similar situation, let’s talk honestly about the road back. I’m actually not going to discuss surgery itself or the first few months following because honestly, there is a lot of information regarding ACL surgery, what to expect right after, and how to deal with it. But what I do want to talk about is that period between 3.5 and 6 months post surgery. This is the time frame where things become super frustrating again, a bit dangerous, and rather uncertain, especially if you train anything physical, whether that is Muay Thai or any other sport. Every body is different, and your body’s experience will be different from mine. However, here are a few things that the doctors, therapists, and others may not have told you yet and you might find surprising.

Hemosiderin Stains

At my four month check, I asked my doctor, “So what’s the deal with these bruises and when are they going away?” His response: “Well they’re not bruises and never.” I bruise pretty easily anyway, and after surgery I had bruising that stretched from the base of my knee all the way down into my ankle on the interior of my leg. This was because to anchor my new ACL they had to drill through the bone. Doing so causes bleeding, and bleeding, bruising. Apparently, when bruising is really bad, the iron in your blood can stain surrounding tissue and cells as the body breaks the blood down. So if you’re 3-4 months out and you’ve still got a “bruise” but it isn’t sore even when you poke it, your body has likely tattooed itself with the iron pigments from your blood just so you don’t forget your experience. (Like you were going to anyway.) Congrats.

It’s Really Easy to Overdo

At 3.5 months, I got permission from my PT to go back to Muay Thai to punch and elbow a standing bag. I was told not to do much foot work, but arm strikes, as long as I wasn’t going more than 50-60% or so, were okay. I was so excited. I jumped at the chance (figuratively) and went back. I was careful. I left several classes with a tired knee but no pain. The following day however, it would be sore and stiff. After a day or two, this would subside. This is actually pretty normal. But even though I was doing things right in training, this didn’t account for the other parts of my life. For example, one week toward the end of month three I did Muay Thai on Tuesday, PT on Wednesday, Muay Thai again on Thursday, ran into my Dad’s recliner on Saturday (bashing the bad leg of course), and slipped on a wet leaf on the porch that same Saturday. That Sunday, my leg hurt so badly, specifically down in the calf again, I contacted my doctor. I was terrified I had torn up the graft because the leg had not hurt that way since I demolished the original ACL. But turns out, I had just really overdone, and my calf muscles were trying to compensate. I had a specific muscle in my calf that was supremely peeved and tight. Even if you’re doing everything right in training, doing life is challenging to a 3.5 month old ACL, so remember that and be sure to cut it some slack.

Paying Attention to Your Body Is Essential

As an expansion of the above point about overdoing, this time period is when you really need to learn to pay attention to the signals your body is sending you. One night in the shower during month 4, I realize that I was standing with all my weight on my left leg. Having drug the injury around for a couple months before it was diagnosed and repaired, I had adjusted my normal to accommodate the weakness, but once it was repaired that was doing me no service. It was actually holding me back. I had to force myself to be conscious of what my body was doing and why. This is also applicable when it comes to training. If your knee is fatigued, even if it isn’t hurting, it’s time to stop and rest. When muscles are fatigued, you run a much greater risk of injury. Listen to your body. Challenge yourself, but when it’s time to rest, rest.

Ice and Epsom Salts Are Your New Best Friends

Ice is very important following training when you’re rehabbing an ACL repair or reconstruction – whether that training is sport specific, PT itself, or the strength/flexibility program you’re following at home. It will become less critical the further out from surgery you get, but as you start working more of your old training back in, don’t forget to ice afterward. Swelling and inflammation puts pressure on all the components surrounding. You don’t want further damage. If you haven’t already invested in a good ice wrap, do so ASAP. I have one for the knee that contains three ice packs and fully ensconces my knee in a brace-like wrap. I’d literally fight you over it if you tried to take it. Conversely, if you haven’t just finished a training session or workout, epsom salt baths (as hot as you can stand them) work wonders. I don’t know why the salts help relieve fatigued muscles and joints, but they do. Don’t neglect ice or the hot salt baths. They are essential tool in recovery.

Massage the Scar Tissue

You’re likely going to have significant scar tissue, and the best way to regain your range of motion and flexibility is to help it break down. Once the incision has healed and you’re not in danger of breaking it open, start massaging it at least once a day. Rub Cocoa Butter into it. Yeah, yeah, I know it’s what pregnant women use on stretch marks, but they use it for a reason. It works. I’m not one to be bothered by scars. They serve as a reminder that I’ve done things over the course of my life, but when they interfere with my movement, we’ve got a problem. Messaging the whole knee, focusing on the incision and surrounding will help. I’ve still got a little scar tissue left, but the scar from my elbow surgery in 2006 left a much larger scar (literally, it looked like someone had laid a rope across my arm for over a month), and now, no one notices it unless I point it out.

Really Big Gains Slow Down… Abruptly

Up until about four and a half months, I gained a lot of ground. My legs stopped looking so awkward because of size difference. I could walk longer without getting tired. I could finally walk normally. I was getting stronger, and I could make it through full Muay Thai classes (still only working punches and elbows). But at my 5 month check, the circumference of my quad and hamstring had barely changed in a month’s time. That was disappointing. It was even more disappointing when my therapist measured again four weeks later and I had only gained three tenths of a centimeter! (I had a two centimeter difference at 5 months.) The last ground is the hardest ground to gain. Don’t let it surprise you. Just like Muay Thai, you just have to keep pushing.

Get the Gym Membership If You Don’t Already Have It

If, like me, your training happens in a martial arts school, then the place you go doesn’t have equipment like stationary bikes, ellipticals, treadmills, or weight machines. Sure, at school we have dumbbells, plates, kettle bells, and medicine balls, but when recovering from ACL surgery you’re going to need some of that other stuff. I got by with simply going to PT for months. However, when my gains slowed down and I still wasn’t cleared to run – much less run outdoors on ground that is unlevel and probably a sidewalk, I realized I wasn’t going to keep improving unless I got some better access to equipment. I needed the equipment to get me to the point of running down the sidewalk or road. In hindsight, I should have done this months before I did. But better late than never, and now I’m not going to PT nearly as often.

Secondary Injuries Are Likely

If you’re still training, albeit in a modified way (and you should still be training), your whole body is out of kilter because of the weak knee. This puts more stress on everything else. During month 5, I sustained a secondary injury to my left knee. My doctor believed it to be a minor cartilage tear. It didn’t require any invasive treatment – just rest, ice, and ibuprofen, but it did set me back several weeks because I couldn’t train or complete the PT program the way I would have without it. In month 6, I tweaked my back. It wasn’t a major injury, but it certainly was enough to slow me down for a week or so. Being aware that other muscles and limbs are taking more strain than normal is important for avoiding and minimizing secondary injury, especially the closer you get to normal. Pay attention to your PT. He/she has you on a strengthening program that works in a particular order, one that will minimize the risk of secondary injury, and be sure your PT is aware of other training you may be doing in your specific sport. He/she will make recommendations and set limits that are needed.

Stay Engaged

Don’t lose contact with your sport/art/whatever you may call it, whether that is Muay Thai, skateboarding, football, Spartan or Ironman runner, etc… Staying engaged helps keep you from getting depressed. It also keeps your goal front and center visible, if that goal is to return. Staying engaged really is two fold – stay engaged with your training partners and also stay engaged with your school/instructors/trainers . I was fortunate to have a training partner that stayed actively engaged with me from the very beginning. Arlie checked on me, she drove me to PT when my husband was at work, she took me out to lunch, and she encouraged every step forward and every rest I had to take. Especially in the early days when I wasn’t released to to any training, we talked a lot about Muay Thai, about her progress, and about how the leadership team was coping with my absence. (And heads up, if you are in a leadership role and you’ve done your job well, encouraging your training partners and other students, they will step up to take up slack, just like Arlie did for me. That’s a really good feeling.) Talking about her progress and the challenges she was facing with training helped me not fixate on my own struggles and fall into a pit of self-pity. I owe much of my recovery (though it is not yet complete) to her friendship. Also stay engaged with your instructors and trainers, my Arjarn (Muay Thai Grandmaster) was happy to have me at school training in the capacity I was allowed as soon as I was allowed. Even before I was allowed to train, I was still attending testing and other school events. It really made a difference because I didn’t get isolated.

It’s a long road back from ACL surgery, and I’m not completely back yet, but I have come a long way. If you’re on the way back as well, I hope you now know a little more about what to expect and how to deal. I hope it all goes well for you, and if you’re recovering from a different injury, I hope some of this has helped you too. Some is certainly applicable to all debilitating injuries regardless of body part involved. Stay safe, and stay strong. You’ve got this.

At a Muay Thai test post surgery. Photo by Austin Caine.

Check out some more awesome Austin Caine photos here.

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