Hello ACL Warriors I’m Annette, fellow ACL survivor. I’m currently 36 and working in Special Education. My career background began as a paraprofessional (classroom aide and 1-on-1 aid) in a school specifically teaching children with special needs. I have worked with kiddos ranging in age from 3 years old to 22 years old and assist with a variety of disabilities.
I have gone through college pursuing a degree in Psychology. Beginning my Master’s program was really something of an impulse purchase. I knew I wanted to continue working with the special needs population and Applied Behavior Analysis instantly seemed like the right fit. I won’t go into a lot of detail about the field but the quick explanation of ABA is that it’s a series of skills for professionals and parents to manage challenging behaviors. It’s a “bag of tools” to determine why challenging behaviors occur (e.g. hitting, running away or refusing to follow directions) and the most effective, evidence-based method of addressing those behaviors. This field also teaches alternative behaviors and functional living skills. For example, every time a child is asked to brush their teeth they tantrum for 12 minutes. We might learn that the child doesn’t like the taste of the toothpaste. So we would teach the child to first say, “I don’t like that taste” and we’d explore alternative flavors until one was found to be “acceptable” to the child. Then, we would observe how the child brushes their teeth and teach to them brush as we should (accuracy, thorough, pressure, etc.).
I currently work for a mental health company that provides services to children diagnosed with a disability, in their own homes. We teach a variety of functional communication, self-help and daily living skills that fit each child’s individual needs.
What's your ACL story?
My ACL story is probably fairly common. I’m an athlete “light”…if there is such a thing. I’ve been playing volleyball since I was in middle school and haven’t looked back. I’m not skilled enough to have played in college or in serious competition. So, my local gym has some “rec” nights where they’d open the gym for a few hours and we’d play. I’d been playing in this setting for roughly 2 months and gaining some of the definition back to my body after being out of the sport for a bit.
April 20, 2016: I jumped to spike, landed, and something popped. It felt like a rubber band snap and I heard it. Internally. If you’ve ever been underwater and cracked your knuckles, it was that sound. It didn’t hurt at all. I remember thinking something pretty big was going to be wrong with my knee and was just waiting for searing pain. This next part always makes me giggle when I think of it. I stopped, turned around on the floor and slowly sat on the floor. I lay on my left side clutching my left knee repeating the word “NO, NO NO”. Not screaming or anything, just “nope, something is wrong”. After a minute, I began to cry. My teammates helped me to the side and I had to fill out the paperwork from the gym.
Someone pulled my car to the door and I got in and drove home. I immediately called my mom and told her I was hurt and something was really wrong with my knee. Still, nothing ever hurt. It was really unstable and my kneecap hurt if I pushed slightly on it (don’t do that, it was stupid…)
I actually went to the ER the next day. They put me in the lovely immobilizer brace. X-rays were clear of fractures and obvious major damage. I was referred to the local orthopedic surgeon and scheduled an appointment. The MRI confirmed a complete tear of the left ACL with LCL strain. There was no break to the bone (which can happen), and the meniscus looked to be in good condition based on the MRI.
So, this seems to be where some docs vary a bit in their treatment. My surgeon told me I had 2 options right from the start.
(1) Don’t operate at all. Many people choose not to have surgery or live in areas where surgery is not an option. The knee will learn to stabilize itself as best as possible, but I would likely continue to have some difficulties. He would recommend PT and support braces. The biggest surprise to me was that he estimated that I would need a full knee replacement within 10 years if I chose no ACL repair. The lack of support was likely to continue to damage the joint.
(2) Reconstruct the ACL with my own tissue (patella tendon graft) or donor tissue from a cadaver. My surgeon said if it were him, he’d opt for donor tissue and that was my first thought, but I went home to do some research. I had lost some initial flexion and he wanted that back before surgery. I was sent for 2 weeks of pre-op PT and could give him my decision at that follow up visit.
So, I dug through all my old anatomy textbooks and learned that the patella tendon isn’t a huge structure. They would harvest about 1/3 of the tendon from the center of the same knee and that would be my new ACL. I opted for donor tissue because I didn’t like the idea of needing to rehab 2 areas of my knee. I had this idea in my head of competing progress and I just wanted to focus on one thing. I didn’t want to have any additional weakness, setbacks or lasting effects. I wanted to set myself up for the most success I could and I felt this was the best choice.
When I went to one of the final pre-op PT appointments, I wanted to know what I would need to do when I returned home after surgery. What exercises should I be doing in those 2-weeks? My physical therapist instructed me to do quad contractions and leg raises as soon as I could after surgery. Do them as pain, stiffness, weakness would tolerate and build up to more. Those would help jumpstart my recovery once I officially began recovery PT after surgery.
Surgery was a few weeks later and I’ve never loved ice more. I named my ice machine “BOB”. Yes, you’ve read that right. Battery Operated Boyfriend. Truly heels over head in love with this gizmo. I had to rearrange the couch a bit so I had some support behind the knee joint. The first few days were the toughest for me. I had a nerve block so my entire left leg was dead from groin to toes. I had some trouble adjusting to being non-weightbearing. Once I could feel my foot, I was still 95% non-weightbearing and would leave my foot on the ground. It was so heavy with all the wraps, the brace and the ice machine bag….no way I could hold it up for long.
Jumping ahead a bit, 2-weeks later I had stitches removed.
What was the hardest part of the experience?
The hardest part for me was adjusting my expectations. My surgeon was upfront with me that it would be a long recovery (8-12 months). I just kept thinking “I heal fast, I’ll be fine in 5”…..I was not. Every ounce of that year-long recovery was accurate and maddening. At first, progress was pretty quick - at least for me it was. I gained full flexion and extension pretty quickly, but I was surprised at what a hit my quads took. I was only out for 2 weeks and he didn’t even operate on my quad…how could it possibly be this weak?!?!
Honestly, I found most of the recovery pretty fascinating. When I had no balance standing on a cement floor, I’d giggle. The twinges of pain when my physical therapist would use her torture devices to break up any scar tissue, I’d wince, but with fascination. How can such a tiny woman inflict so much pain?!
The bit of frustration I found was that I felt that I was discharged too soon from PT. I knew how to run and jump, but not with these spare parts as my ACL, and not after a major surgery like this. I wish I would have pushed harder a year ago, so that I wouldn’t be back in PT now.
I’m working with a personal trainer at my gym to get my health back on track and help with my knee. There’s some instability and I don’t think I know enough to do it alone. So I asked for help.
How did you stay motivated?
Not being motivated wasn’t an option for me. Recovery wasn’t an option. Physical therapy and “homework” were part of the package…so I did it. I never felt like skipping PT but there were certainly days I wished I scheduled later in the day.
Going back to mud runs was a big motivator for me (Tough Mudder 2017!). I didn’t do all the obstacles. Hardly any in fact. Even before this injury I’m pretty good at being able to identify my physical limits. I know I cannot cross monkey bars without my feet on the floor or climb on top of them. I know I will not be able to scale an 8-foot wall without a boost from a step or a support beam.
Doing mud runs after knee surgery was no different. Well maybe a little. Now, it seems as though I’m a chicken and afraid of re-injury. I am overly cautious to avoid another year-long recovery.
Mental hurdle here….I need to learn how to resign to the fact that I may tear my ACL again, or some other injury. Go down the slides, jump in the mud and stop being afraid. Being afraid leads to try to plan for every slip, fall and jump anytime in life and that’s just not realistic. I can’t plan for EVERYTHING. We all have that touch of OCD, we want to control things and I’m certainly no different. THIS is my biggest mental hurdle to overcome in this entire journey.
My inner nerd was also a big motivator. While reading up about what to expect with surgery and recovery I found a few people who had documented their experience and decided to do the same. I wanted to be able to look back, when things were really hard, and see how far I’d come. No better way to do that than with data. I tried keeping pain log, food log, exercises before PT, and meds.
What advice would you give other athletes on the road to recovery?
Remember the cliché phrase, “everyone’s surgeon and recovery are different”. Some people are up and walking without crutches days after surgery and some take months to ditch the aids. Hinged braces vs. straight immobilizer brace and how long to use it. Take a shower or keep it dry?
- Do as much “homework” before surgery as you can. Don’t wait until the day before or after and post in a social media group asking “I just had ACL surgery, what now?” You should know some of those answers beforehand.
- Try out different spots in your house because you’ll be spending several days in that spot. Recliner, couch, bed...heck, even the floor.
- You’ll probably need some help in the first few days to carry a drink for you, maybe bring food and even help move your leg if you have a nerve block.
- Fill your prescriptions prior to surgery so you can just go home and crash. Ask for nausea meds. Sometimes pain meds can make you sick, even if you’ve had them before. This is not the time to try a mad sprint for the toilet.
- The first couple of days you might be sleeping a lot but what do you want in your “spare time”. Bring your book, iPad, trashy magazines…whatever you need. Set up your space prior to surgery.
- Inquire about an ice machine during rehab. Remember BOB? I never thought of it before but it was a lifesaver. Being strapped to an ice pack 24/7 was great. I never had to worry about replacing packs in the freezer or remembering to do it. I’d save the cold water from the bucket and drink it later. Seriously, ask about an ice machine.
- Physical therapists have a recovery protocol they follow (which varies slightly) to determine when you get to run, jump, drive, etc. Make your expectations clear that you want to be able to perform a specific skill before you’re discharged.
- If you feel you’re not getting answers or results from your treatment team (surgeon, physical therapist, pain management, etc.) SPEAK UP. Nobody knows how you’re feeling unless you tell them. You have to advocate for yourself.
Do you think this experience has change you as a person?
Yes and no. In a lot of ways I’m still exactly the same. I just have new battle wounds and spare parts holding me together. Physically, I don’t look much different. I am mentally different and didn’t really notice it until writing all this down. ACL surgery and recovery blows. It’s a quick surgery but it takes so long to recover and get back to your “normal”. I knew it would be long and hard but I wasn’t prepared for the emotional rollercoaster that came with everything. I’d have moments or days where I’d be weepy and an absolute monster to be around because I’d think “shit, maybe this is my new normal” and that was the saddest thing to realize. I knew I wouldn’t be exactly the same (and secretly had fantasies about having bionic superpowers) but to think I wouldn’t be as good as I was before….that’s hard.
My view of what it is to be fit and healthy has changed a bit too. I have certain physical attributes that I associate with myself. To be fit I should look like this and to be healthy I should eat that. The term “fit” still includes certain physical attributes but also how things feel physically. So, my knees are equally strong when I can go up and down stairs without one leg feeling different than the other - when I can do baby squats and have both legs fatigue at the same depth.
I’ve gone back to playing volleyball a few times as my work schedule would allow and it’s weird. I didn’t expect to be afraid of playing but there was huge hesitation for me. I didn’t run for anything, diving/kneeling wasn’t going to be an option and jumping….please. I was a useless teammate and thankfully everyone was so kind and understanding of my being a deadweight player. Trusting my body to do what it previously could do and trusting that my treatment team really did know when I was ready is still really hard.
When I can return to volleyball without concern and perform at the same level I was before, then I’ll consider myself recovered. As I balance out my strength and regain my confidence I’ll be able to trust my brain and body again.