I am still dealing with some ankle crash aftermath as well as the chronic heel pain. Repeat MRI did show some lingering bone bruising, tenosynovitis, and a grade 1 sprain to my spring ligament. Good news is the fracture and the grade 2 partial tears did heal! I briefly made it back to downhill skiing for a few weeks, but the season is over now. I was still not walking for fun or exercise during this time, but skiing was kind of OK for shorter periods. I'll take it because I thought skiing was totally off the table this winter!
I had two options to explore about a month ago.
So on to the next idea! I telehealthed with a leading expert in all things heel/nerve pain related. His name kept showing up in countless papers I ran across. He is not in my state, but he had me to visit his colleague who is in my state! This new podiatrist does ultrasound of my fascia to measure the thickness (over 4mm usually linked with plantar fasciitis/fasciopathy) and said there is definitely thickening and inflammation present in the heel area and this is likely the source of the medial heel pain. Wow, all this time I thought it was fasciopathy where there is no "itis" or inflammation present. But in fact there was and a lot of it! Was there inflammation going on for all these years of heel pain? Maybe? Anyway, we do a 6 day trial of oral steroids. He said if I get relief, this is inflammatory in nature. If I get no relief, it's likely nerve in nature, and we go on to the next tests. I get major relief, felt like a million bucks! The next step is to get a steroid injection to the area. I've heard how painful steroid injections to the fascia can me. He does not injection INTO the fascia but NEAR the fascia. This is good news because it was not nearly as painful as I was thinking, and it is giving me relief as I type. However, I have to stay off my foot as much as possible. Not full on crutches, but no extra walking, no squats, no added weight, no added repetitions. PT has updated my routine to be more non weight bearing and we're using BFR again. I'm only a week into the new steroid injection and it's still helping. However, I can still feel some spring ligament irritation going on. The new podiatrist is hoping that restoring a normal gait thanks to elimination the heel pain will help resolve the ligament sprain issue. We shall see. He is having me do a lot of stretching of the calf which seems to not agree well with the spring ligament. If the heel pain comes back soon, he suggested an endoscopic fasciotomy next. This is surgery. Hopefully my next update will have some good news!
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I am 17.5 weeks (aka 4 months) after my ankle wreckage from a mountain bike crash. I'm already experiencing setbacks. In this entire time frame, there was only week (week 13) where I was able to walk 1 mile distances. That quickly escalated the pain and and the plantar fasciits that I stopped any extra walking and went back to biking. Biking also had its limits and I felt like I was constantly irritating things further every weekend, despite finding rides that would be mostly downhill. All the while we continued my ankle PT and overall strength training work.
The daily pain I had was becoming very crippling for me, enough for my PT and I to remove all ankle related things in the attempt to see how far we can settle things before resuming. Kind of like a slingshot effect. So we have removed ankle exercises, removed walking, removed biking and I'm trying to keep my step counts as low as possible. A 3500 step day is pretty hard to keep, but trying to stay in the 4500-5500 range. I feel like the ankle is always "nauseated" in the hindfoot. I have a perceived instability feeling, so a functional instability feeling (versus mechanical instability - it hasn't ever rolled on me again). So far a week of cutting things out, and I don't feel improvement or settling. However, I did stand a lot this weekend. The swelling is always there, it's never gone away. I am hoping I'm not in the chronic instability realm which requires surgery. They usually don't diagnose that until 12 months out from injury and extensive therapy has been tried. The plantar fasciopathy is at an all-time high. The two feed each other in the worst way. I'm sure they are related. I plan to see the orthopedic surgeon next week just to update him on how things are going and if this is OK. Perhaps they will order another MRI to see how the various things are healing (bone bruise, fracture, ligaments, sinus tarsi, etc). Well here I am, 2000 days after ACL surgery. I didn't think I'd be counting this far, or maybe I decided I would stop counting after 2000. Not sure, but I'll update anyways! I was having a decent summer ramping up my mountain biking. I still had to be mindful of how much I ramped up my vertical feet. Increasing too quickly did leave the knee a little sore, but nothing that affected my every day life, just annoying. I was feeling like I needed to test my abilities with "normal" folks, so I found a local mountain bike race to do. A week prior to my race, I had a significant crash on my bike. Ended up with an avulsion fracture, bone bruise, two partially torn ligaments (medial and lateral ligaments). I'm 5+ weeks post injury and it's going to take a while. I don't need surgery, but I am braced. As the ortho sugeon put it, "Kind of like baking a cake: we have all the ingredients to heal, but we just need time to let it bake longer." Good points. I was on crutches for 2 weeks. I am able to ride a stationary bike without much resistance as of last week. I was OK'd to bike outside too, but it has to be flat and easy and I have to keep my midfoot on the pedal. Ankle has some instability, so I just have to go slow. This had taken a toll on my ACL leg muscles. I am getting set up with Blood Flow Restriction cuffs with my remote PT so we can get the quad going. I hope to be ready to downhill ski by the winter, but we shall see how the ankle goes. Single leg work on this side is still limiting. I am happy I have this remote PT, he is also programming my ankle rehab too. Mentally, I'm doing OK. There is a huge difference mentally when it's a true accident, versus an overuse injury/poor decisions kind of injury. I am not as sad when it's a true accident. Sure in hindsight I would have changed my pressure tire and slowed down, but it was an accident. I am keeping busy at home. Prior to this latest accident, I was in the process of getting ready to run AGAIN after a bout of plantar fasciopathy AGAIN and a Achilles tendon issue. We were doing some plyometrics in my remote rehab and I felt I could maybe start 30 seconds of running with walking in between. It felt so close! But now I will have to start that over again. This is exactly how plantar fascia issues start up for me - periods of deconditioning where all the tissues lose capacity. I have to say, the past few July's have always had something significant happen to me that sets me back. I guess that's when summer fun is at its peak and I go and get hurt! One year I had a terrible IT band issue that also lead to plantar fascia pain. Another year I broke my ribs while hiking. Another year I had a posterior tibial tendon issue that halted all hiking. Photo from a trip to Wyoming. I was very limited in what I could do (I mostly looked after our old dog), but this overlook we could drive to had the best sunsets and wildflowers. Recap on my last 2000 days, going in 100 day increments, plus a next 100 days prediction:
It has been several months since I posted last! I had 4.5 months of skiing this season, 3+ months of it was downhill skiing at resorts. It was a great season in all! I averaged a ski day every 3.5 days. Stats for this winter:
I am pretty happy with that! I went into it as if "this is the best it will get" just in case something every happens and I can't ski again. Heaven forbid, but it was the motivation that got me out as much as I could. I didn't ski very many back to back days, I generally allowed the knee to rest after a ski day. Longest ski day was about 6 hours, then the knee would start to feel it, but I started with only 1-2 hours of skiing. I got to ski with my nephews (ages 10, 15) for the first time ever and that was quite a memorable experience. It was on my bucket list! Still hard to believe I had a real ski season and it was so much fun! So happy I persisted and skiing is back in my life! I feel like I could do it until I'm 70. Now that ski season is over, mountain biking season is ramping up. I try to ride 2-3 times a week, on top of my lifting days. I still have some plantar fasciitis and Achilles tendinopathy going on (one in each foot). My ACL Coach is adding in special days just for managing these feet issues. I have a goal to be back to trail running this spring. I can run downhill for about a mile and it's not making the feet too bad, but can't run uphill yet without setting off irritation. But I feel we're getting close! the PF has been going on 8 months now, Achilles maybe 4 months now I missed my 1900 recovery day marker (it was about a month ago), but I predict by day 2000 I will be back to trail running and even backpacking! Feet are the current hold up! Day 2000 will be early August 2022. My PT gave me the OK to start 50% intensity downhill skiing!!! Formal tests are still coming, but this was music to my ears to hear I could start! Hard to replicate skiing 100% in rehab, but I can tell I was prepared. This last phase of ski conditioning has been exactly what I needed. I can't believe there are people returning to the slopes and don't even do this phase, let alone agility. My first day at the resort was great! I had no nervousness, no anxiety, no jitters - I was READY 110%! All that mental visualization work of getting on and off the lift really worked. Turns all came back to me immediately. I did a few runs on the magic carpet and knew I was ready for the chair lift. Turning felt good, could hardly feel my A22 brace, couldn't tell my legs apart until the ACL side started to get muscle fatigue a little sooner. I did have some knee discomfort after, but nothing that prevented me from rehabbing the following week. By the 2nd and 3rd downhill days, I had hardly any knee discomfort, was feeling great other than fatigue in the legs! Wow, what a journey to get here! 4 years and 11 months post op. I am trying to ski 2-3 days a week. Tonight I will go night skiing after work! Still kind of surreal I am here!
I finally made it to the last rehab stage! The plantar fascia issue delayed things about 2 months, but we're in it now. I've completed 8 weeks! 4 more weeks left! PF is not resolved, but it's currently at a point where it can handle the rehab demands.
I am thrilled to say the knee is handling all this quite well. I was so worried how it would do! I do have some extra fatigue in the legs, so going for a mountain bike ride after work at the beginning of the program was not really doable. Legs wanted to rest. Now at 8 weeks into the program, I can still go for a ski tour on the same day as rehab. There is lots of tempo work, fast twitch muscles work, rate of force development, etc. Legs are feeling strong and good. The Achilles did start to bark at me after increasing my volume and intensity of change of direction sprints, but it's starting to settle down. So the plan is to complete the last 4 weeks of this final ski conditioning phase. Then my PT will have me do some testing again - strength tests, hop tests, psychological readiness tests. Then we'll plan a segue into skiing approach. I've got my season pass already! I hope I can ski at least 2x a week to get things adapting, small dosages but frequent. So thrilled I am getting so close to downhill skiing!!! A bit of a sad state over here. I thought I was going to start the LAST stage of ACL rehab - the sports specific conditioning phase. I found my DPT, signed up for it, paid for it, did all the assessment test videos, Zoomed with my two PTs together. BOOM two setbacks. Well one of them resolved so that is good (tweaked back). But the other is lingering and will likely be here for a while. Plantar heel pain / plantar fasciopathy is here once again. I've dealt with is many times before during this recovery. It doesn't come on from too much running, it comes on after a period of rest, but then I try to resume walking first. Rest like 3 weeks of taking it easy due to a highly irritated IT after a monster hike kind of rest. The plantar fascia is highly sensitive and can get irritated with the lowest of miles. It's like it deconditions in just a few weeks and I have to reintroduce the foot to everything all over again. So that is where I am now. I was out of the highly acute pain stages, and then I went to try to run on a better day only for it to flare up in 1 minute. So currently trying to get it to calm down again where I'll resume some walking. I'm still doing heavy calf raises, calf stretches, foot exercises, etc. I won't be able to begin this final stage until the foot is resolved and I'm back to running. The program includes running so foot needs to be resilient! Today is day 1700. Time to summarize my progress in 17 easy steps! Along with a prediction for days 1700-1800.
In elated news, I have finally moved into the sports specific conditioning phase of ACL rehab! This is the last and final stage (pending any return to sport tests)!!!! I can't believe I made it here. My PT agreed I could move into this phase now. Normally it's all a continuum with the same PT, but my PT doesn't do this phase (for skiing), so I'm working with a new PT Dr. Ravi Patel of The ACL Athlete. He offers 12 week remote coaching using his PT, DPT and CSCS experience to create a program just for the client at any stage of their recovery. In fact we all Zoomed on a call, Dr. Ravi, my PT, myself, just to be sure we're on the same page. Mick my PT will zoom again in December to talk about milestones and testing, so he'll be there in the background while Dr. Ravi does the day to day programming. If you can believe, I am still technically "under rehabbed" this far out even after all that work. Will I suddenly be considered "fully rehabbed" in 12 weeks? Maybe, maybe. Will I have more setbacks in 12 weeks? Maybe, maybe not.
I also got a Biodex test. Last one was 14 months ago. I am very surprised to see that my numbers did NOT go up. All of my weight lifting numbers have gone up in the squats, leg press, thrusters, deadlifts and more. I've also began trail running, and did 5 months of agility. I've also added 3 more leg sessions into my week, so 5 leg sessions per week (some are doubled up). All in all my legs are working harder, feeling stronger, doing more, but the Biodex test didn't reflect that. It was sad. Both my PTs said not to worry though. Numbers still are good, but still work to do. On a bummer note, my plantar heel pain has come back. It came on after my double set back (trauma to left knee, ITB on right knee) where I had 3 weeks down time and not running or hiking. Once I brought back in running and hiking, it started to creep in again within a week, despite pretty low mileage over all. I've been here before and it's so annoying. No one trick really alleviates the pain, it just takes a while to settle even with many tricks being implemented. I also tweaked my back about a week ago, doing a weighted seated barbell good morning. It was really hindering pain for about 3 days, then gradually started to improve. This injury plus my plantar heel pain has delayed my start to the last rehab phase. I'm just keeping in touch with my new PT. He wants all this resolved before we start. Right now I don't even know what it looks like, and I'm sad that I have to wait some more, kind of harshing my mood with this all again. I missed my day 1600 summary, I'll add that to the end of this post. I did end up getting an MRI for my opposite knee from the blunt force trauma. Turns out the bone was all fine, and it's just anterior soft tissue swelling. Just going to take time. I'd say it's maybe 90% better at week 16 post initial accident. That's a long time for no actual damage! In late July, I did a really big hike, like super steep and super long. I knew it was a bad idea, but in the end I started up some IT band issues on my ACL leg. It start during the long decent, about half way down the mountain. All in all the hike was about 8 hours long. Not a great idea when I was just coming off a long downtime period with no hiking. Anyway, that's my current situation. I cannot run on roads right now (I was earlier, but it would set it off again). I miss trail running, hard to believe I was running 1 hour on trails back in May! I will get there. This pushes back my return to sport testing as well. Early in the year we were thinking July, but too many setbacks happened. Maybe it will be September? I meet with my PT this month. I would like to segue into the sports specific training. Skiing is like 4 months away. Most remote coaching plans for this stage are 12 weeks long. I want to get a jump on it because I know there will be set backs! I don't know how this transition looks just yet, hopefully I'll have a better game plan by the end of this month! Biking post IT band flare up - there was a time it was bad even flat road biking was not good! Because I missed my 100 Day Summary on day 1600, I'm going to recap it here now, with my day 1600-1700 predictions at the bottom!
Well that didn't last long. My good streak that is.
I seem to have a pattern. Good streak happens, I am happy with my activities and level of effort, feeling confident, maybe a new milestone happens (like trail running) and BOOM another setback. Typical. Not being pessimistic, it's just how it's been. Over nine weeks ago my bike fell on my knee. It was during the Teton biking trip. The bike dropped from well above my head, so quite a bit of force. It was really sore afterwards, but I managed to run a week after it happened albeit with some soreness. Activities resumed, but I could manage the soreness (this is the non ACL leg). I guess I had "too big of a week" because I got a pretty bad flare up. Puffy kneecap, tenderness, stiffness, pain; felt much like patellofemoral pain but with more swelling. This derailed things for over 3 weeks and it's still not over as I type this. At the 3 week mark, I did see an ortho surgeon. His Dx was:
Bone bruises typically resolve in 12 weeks, but if it's not feeling better or I have another flare up I am to go back in 3 weeks where they may schedule an MRI. It's already set, and I can cancel if I'm feeling better. He didn't think there was any ligament damage despite having some soft tissue pain/tenderness as well as the kneecap. The week that set this off started with my 29 mile birthday bike ride (my previous post). Then by the end of the week we had a great 4 day trip in Idaho with hiking, biking and a little running. I thought my knee did really well over all, I didn't have too much extra soreness. But when I returned home, I did question if I should resume with Wednesday rehab run or not because of the residual soreness I had in the non ACL knee. I think that may be what I need to watch for - if I'm questioning the activity in the first place due to pain, then maybe error on the side of don't do it. Even with the bone bruise but before the flare up, I had some plans that had to be removed from the calendar. I wanted to backpack over the 4th of the July. I wanted to a triathlon in July. I wanted to do a mountain bike race which is this weekend. No crazy distances, but I felt I could totally do them and not be dead last (nothing wrong with dead last), and have fun. They were all local events. Those are off the table now. I think the disappointment finally a little planning/dreaming and then it was taken away is the sad part. I found it very hard to plan and didn't let my self plan for a long time due to the disappointment, but I actually felt ready to plan out something. Didn't work out. For the last 3 weeks I couldn't hike, lift, bike, or even walk without pain. This was pretty sad. Now I'm out of the flare up and I can hike and resume some rehab, just no double legged squats yet. I cannot run yet due to increase in pain, and I'm not sure about biking yet. I may find that out soon. |
AuthorA 45 year old active female who tore her ACL in January 2017 (at the age of 40). Reconstructive surgery in February 2017 with bone-patellar tendon-bone autograft. Archives
November 2022
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