I spent the next few weeks doing all the prehab things… squats, lunges, RDLs, BFR, and massively loaded my quads to make as much muscle gain as I could. I took a weeklong trip to Canada to spend some time with my family and work with USA Weightlifting at the NAOS2 competitions. This was going to be my last trip of the year since I was planning on having surgery soon after. My dad is a very slow walker with a chronic knee injury as well, so I thought keeping his pace was going to be easy.  

At this point, I had full knee ROM and was moving quite normally. The only pain I had was if I tried to hyperextend my knee or sit back on my heel with all my weight. We were crossing the street and my dad picked up his pace suddenly because there was a car coming. I quickly followed and I felt a huge pull into the back of my knee. The pain lasted over a minute and my family had to wait a second for me to recover. I thought I was doing pretty well up to that point. That was a humbling moment for me and my knee…my Dad’s knee was in better shape than mine. 

Being the stubborn person that I am, I told my family I was fine and we continued the day going to the Capistrano Suspension Bridge, climbing stairs, going up and down hills, walking miles in the forest… and at the end of the day I knew I needed surgery. My knee was more swollen than it’s ever been, I felt unstable when walking downhill, and moving too quickly obviously flared things up. 

I looked cute that day though….and nobody can tell that my knee was F’d. 

9/17/2022

I have been working with the USA Weightlifting Medical Team since 2017 and it is my absolutely favorite thing to do. I get to reunite with old friends, meet new friends, and work with weightlifting athletes! When there is spare time, we usually teach each other new things, and this type of collaborative learning is the best thing EVER. 

During this event, most of the medical team were Sports Docs and Fellows and they all brough their portable ultrasounds. They used me as a demo did ultrasound on my knee to show me where all my swelling was.  

This is when I learned that most of the swelling was sitting above my kneecap, in the quad tendon. When I flexed my quads, the fluid traveled from the quads into the joint and posterior knee, causing pain in the back of my knee when I hyperextend or sit on my heel. IT ALL MAKES SENSE NOW. So instead of icing the back of my knee where it hurts, I started icing the top of my quad and the swelling went down immediately. Major clinical pearl and something I will tell all my future patients.  

Thank you Dr. Mike Galbraith, Dr. Alex Jacobsen, Dr. Erin Barnes, Dr. Kendra Kemmet, and Dr. Chelsea Stanford. 

Black (water-swelling), white is layers of tissue quad on top. 

The post 3 – My ACL Journey – The weeks before surgery appeared first on MOTI Physiotherapy.

Dear ACL, 

Choosing the right surgeon is not a difficult task and there are more components than having the “best surgeon.” These are the list of things I look for when choosing a surgeon that is right for me: 

1. Am I comfortable with this surgeon. Do they answer all my questions and do I have a feeling of trust and comfort when I am around them? Are they confident with their answers and do they back it up with research? Are they very adamant about one way or are they open to other methods, and if so why? 
2. What is their interest, specialty, and how many surgeries of that type do they do a year? 
3. Does you insurance cover their services ? If you have a PPO, is their entire team (including the anesthesiologist) in network with your plan? Is open enrollment around the corner and do you want to change your plan to accommodate your surgery and post surgical and rehab appointments? 

I am fortunate to have many friends who are orthopedic surgeons. I went to see Dr. Nima Mehran at Kaiser, who quickly got me a knee MRI, and confirmed I had a proximal ACL tear. In the MRI images, my ACL is torn but still sitting vertical and he stated I could maybe be a candidate for a repair but most likely a reconstruction. I consulted with a couple other of my ortho surgeon friends, and a close friend of mine, thought an ACL repair could be possible while others thought I might as well do a reconstruction since I am having surgery anyways.  

I spent 4 days going back and forth between the pros and cons of a repair vs. recon. I am a very decisive person, and this was the first time I could not make a decision. I spoke to my colleague and boss, who eased my mind by advising me that I should try the repair and then if it’s not possible, do a reconstruction.    

I made a chart on the two types of surgery to help me make my decision. 

I knew I wanted a quad autograph reconstruction because I wanted to avoid any type of anterior knee pain, I want to be able to kneel for my job, and I have very strong quads to harvest from. I also do not participate in any high impact or cutting sports so I don’t necessarily need a BTB (Bone-tendon-bone patellar autograft). 

And after discussing this with many colleagues, friends, and surgeons, I decided to aim for the repair but be ready for a reconstruction if the ACL is unrepairable. Surgery was scheduled for 9/27/22. 

The post 2 – My ACL Journey – ACL Repair vs. ACL Reconstruction appeared first on MOTI Physiotherapy.

Dear ACL,  

I can’t believe the thing I love to rehab the most is now going to be the thing I will have to rehab myself with. The ACL is one of the most unique structures in our body, with the ability to resist sagittal, frontal, and traverse plane forces in our knee. I have been fortunate enough to work in the sports field my entire career and have become an expert at ACL injuries and rehab post-op reconstruction. With my experience and passion for ACLs, I feel like I am one of the best sports physical therapists in the LA region to rehab ACLs. 

I decided to take Lee Taft’s Speeds course to increase my bag of knowledge on return to sports and how I can further enhance my ACL athlete’s rehab as they return to their respective sports. This course is learned by doing and on the second day, I felt confident in my movements. We were working on some agility, fake cutting and pushing off in order to change direction quickly. My friend and colleague Kirk, told me to square up, fake right, cut left. I faked right but my foot was not completely planted, while still on my forefoot, I felt my left knee cave in and a giant POP. Kirk told me he thought I dropped my cell phone on the ground, but it was actually you, my ACL. 

Fast forward to that night, my knee was mildly swollen but I still had most of the range. Hyperextension and weighted end range flexion hurt the most. I could walk on it, but it felt very unstable, like a baby giraffe. Lachman was mildly positive and Pivot shift was not tested because I guarded too much. Negative McMurry and Thessaly test.  

[A little history on my left knee.]  

10 years ago, I was training for a mud run and I strained the back of my knee running on the beach on the sand. There was pain in the posterior knee with end range extension for a few days and it felt like my upper gastroc was strained. Two weeks later my knee felt great, and I did the mud run…and strained the same spot again. Symptoms were the same and lasted a couple days. A few years later, I got my USA Weightlifting Coach Certification, and I was practicing my clean and jerks. I hyperextended my L knee on accident during a lift and flared up my knee in the same way. This year, I stood up and pivoted from my coach and re-aggravated the knee, and then re-aggravated it again walking 35 miles on the cobble stones of Rome. Throughout the 10 years since that first mud run injury, I would consistently work on my hip mobility, my hip stability and strength, and maintained a healthy lifting regimen. However, the L quad was always 1 cm smaller than the right and my L glute was weaker than my R.  

I believe I had sprained or partially tore my L ACL this entire time and this time, it broke up with me completely. 

The post 1 – My ACL Journey – When you broke up with me… appeared first on MOTI Physiotherapy.