For my ACL recovery, I have been using an electric stimulator thigh wrap. This is a new technology which uses a special electrical stimulation contained within the thigh bandage itself. This device delivers an electrical current which stimulates the Quadriceps muscle to prevent atrophy and speed recovery by causing muscular contractions independent of effort by the patient .
Often, following orthopedic surgery the affected region undergoes wasting away very quickly. This helps prevent muscle atrophy and regains strength while the patient recovers, generally before exercise protocols begins.
This is device is great. It strengthens your quad muscles while you are at rest and unable to actively engage them. It has definitely helped speed my ACL recovery.
Here are the facts: It’s a bit painful following the surgery because they drill some holes in your shin and thigh bones. They then floss a new ligament into place and anchor it with some buttons to keep it taut. There is some swelling, bruising and stitches. You can’t walk or bare full weight on the leg for about the first week.
Primary RehabGoals are primitive:
Provide motion (i.e.) making sure your knee can fully lock straight and start to bend
Re-develop strength in your quads / thigh muscles as they quickly deteriorate.
Every surgeon has their own protocols for rehab but these are the primary objectives.
As a sports doctor myself, I knew what to expect for recovery and I knew what I had to do. It was time to get busy. I decided I had two-three weeks until I got back to the office.
I worked out a home routine for my rehab before seeing a physical therapist. The following takes around 3 hours and was done 2-3x daily.
Use CPM machine to passively move my knee into extension and flexion 10 degrees per day start at 40 degrees and progress until I hit 130 degrees on the machine.
Use the refrigerated ice compression machine to get my melon of a knee back to normal contour. 4-5X DAILY FOR ABOUT 60 MINUTES, WHILE KEEPING ANKLE ELEVATED.
Ice compression using distilled h2o & alcohol retains a 43 degree temp while a compression pump device helps reduce edema. No ice necessary! It's a self contained refrigerator unit .
Perform SLR straight leg lifts in all directions 300 reps with the lock out brace on.
Sit on a high counter and passively flex and extend my knee
Use a Kneehab thigh wrap with little electrodes to help strengthen my quads
For the next seven days, I would rest and then repeat this routine every day.
After deciding surgery was the best option for my ruptured ACL, I now had to decide what surgery choice to make.
Option 1-ACL Allograft: This option means using the tissue of a cadaver to replace the tissue torn in your knee. It isn’t as strong as using your own body tissues because its not “live “tissue. However, its performed arthroscopically, meant to last indefinitely (unlike hip replacements) , has a quicker recovery time and possesses fewer complications than other options.
Option 2-ACL Autograft Patella: This is the strongest and most resilient of the options, meant mainly for 16-40 year olds. This option means harvesting the tissue from your own body. Essentially they use your knee cap tendon, slicing vertically 1/3rd down the middle while its still attached to both your shin and knee cap (so now you are missing part of your knee cap tendon, & two fractures one at your knee cap the other at your shin). My patients who have had this surgery generally complain of knee cap tracking problems and it advances osteoarthritis change under their knee cap.
Option 3-Autograft Hamstring: In this option, theyharvest the tissue from your hamstring tendons. This tissue is where the hamstring attaches to your inner knee where it bends under your calves. Again, patients of mine who chose this option tend to have ongoing hamstring pain from the scarred tissue adhesion and back of the knee joint issues called popliteal /pes anserine tendonitis bursitis.
A friend helped me come to a decision by putting it in perspective:
“You think your active right? You think you’re in great shape. You want something that will last and endure all your activities and never ever tear again right…you hike, bike, ski…you are not a professional athlete and physically, though active, you’re 50 years old. Use the cadaver.”
That hit home as I just want to continue to stay active and remain vibrant as I try to live to at least 90. So I decided on the ACL Allograft. By using a cadaver, I would be using someone else’s tissue that’s been radiated and cleaned free from diseases, etc. Because it’s not live tissue, it’s slightly weaker but because I wouldn’t be using my own tissue, I’d heal a lot faster and with fewer complications.
The real fun began when I returned home from my vacation. After consulting with several orthopedic surgeons they confirmed what I had been trying to deny. “Bone contusions are landmark diagnostic signs that your knee is unstable & your ACL is ruptured.” I had two choices for recovery.
My ACL injury happened because my ski tip planted one direction and my leg twisted the other.
Choice 1- Do nothing. Wear a brace when I ski, hike and be careful while trail running, golfing and other physical activity. I’d have to rehab it myself or commit to a local physical therapy center and go 3x per week for the next several months and still run the risk of damaging other internal knee structures, not to mention altered gait and bio mechanical stress everywhere else.
Choice 2- Surgery.
Once you rupture your ACL research has shown that whether you have surgery or not your knee joint eventually becomes arthritic…so what’s the point of repairing it? I had to hash it out in my head for me to truly decide.
The result: a full thickness ACL tear like in the above diagram.
My thought process:
If I have surgery my knee still wears out prematurely, according to medical literature However, If I do nothing my knee will also prematurely wear out because of the instability.
Most current research, that I found was based on people who ruptured their ACL as young adults, 30-35 years old on average. So when they reach the age of 75 that s 40 years of wear and tear. I don’t care who you are, 40 years of wear and tear is a normal act of degeneration.
Personally, I’m a young 50 year old active kind of guy. My activity levels are quite different than say most 30-35 year old’s. also, by the time 40 years pass I’ll be 90 years old.
A few days later I made my decision; I was having surgery.
The point of the following blog entries is to share information about a very common knee ACL injury and the consequences of such by giving a unique perspective that could only come from a doctor who specializes in rehabilitation.
If you know someone with a ACL injury, then please share this info as I believe it will prove invaluable.
It was a picturesque day out west in the Canyons of Utah and I was skiing, enjoying life to the fullest.. It has just snowed 14 inches of light powder and I was thinking how grateful I am to be skiing, enjoying the scenery, and breathing in the fresh air with my family. Then, it happened. While trying to avoid some bushes, I had a momentary lapse of muscular coordination. For a split-second I became hesitant in my natural ski rhythm and wham; my ski tip got caught on that bush I was ever so carefully avoiding. I clumsily fell while trying to grab and protect my knee. And then, I felt it. It was as if I was in slow motion yet there was nothing I could do. I felt the dreaded “pop”!
I held back my tears as I knew what a disaster it is to internally injure your knee joint and the enormity of what was about to follow.
It was Christmas week and doctors’ availability is quite limited. No radiology centers are open and if they are, it’s only for trauma situations. Five days after my fall I finally managed to have a MRI .
The radiologist on duty called to give me the good news “You ruptured your ACL. Happy New Year! Good luck let me know if there’s anything else I can do.” While those may not have been his words verbatim, I couldn’t help but to notice the lack of empathy when telling me of my condition.
The diagnosis had been made. Now came the options.
In this post I designed the most up-to-date scientific core stabilization routine. In the past everyone has been concerned about just strengthening their core; here you will learn that “core endurance ” is far more important than core strength .
The fact is core stabilization has been spoken about and written about by so many people from so many professions that it has essentially lost its meaning. I’ve kept the information below simple. Here are some basic “core” principles:
1. A spine devoid of all muscles and tendons will buckle with as little as 20 lbs of compression. (That’s right, herniated disks, torn ligaments, etc. )
2. It’s more important to have spine muscleendurance vs strength. Only 10% maximum strength is required to fully stabilize your spine. Furthermore, a lack of core torso extensor endurance is a predictor for future low back trouble. For all my earthlings out there, this means that a lack of endurance in this region is a predictor for those who will either get back pain or who’s back pain will continue to linger.
3. Lastly, balance of endurance among all your core muscles (the front, rear AND flanks) is superior to just building endurance to the lower back.
You essentially need to build a balanced set of abdominals, side flanks and rear spinal extensor muscles rather than just building strength in one region.
Here are the numbers/ratios:
Flanks:Must be equal in endurance side-side, .05% difference
Abdominals:Should never be greater that 66% endurance of your spinal erectors
Flanks/Spinal erectors:Should never approach anything greater than 77%
I arranged the following Core Endurance routine to help you navigate your endurance program.
There is a sequence to this workout so please use my guidelines for order and time required. I hope this program will prevent future low back problems.
1. Front plank: 90 seconds only or 6x 15 seconds
2. Side Bridge: 90 seconds or 6x 15 seconds left & right sides
3.Single Leg Bridge: 30 seconds each side
4.Ab-Curl: 30 seconds each side
5.Bird Dog: 120 seconds, alternate 15 seconds per side until time is achieved
Sleeping all night, yet still waking up exhausted? Waking up three or more times during the night? You are not alone.
These are all common sleep complaints, however, that doesn’t make them any less aggravating.
Did you know that what we do during the day influences our ability to sleep at night? So what’s a bleary-eyed person to do…
You can make a few simple changes during the day to sleep solidly all night.
1. Deprive Your Senses a Little
A quiet, dark room is essential to a good night’s sleep. Use blackout curtains to keep the room darker or a Tempurpedic sleep mask to block out lights possibly being used by loved ones. These masks are very comfortable and really do keep the light out of your eyes.
To drown out the sounds of the street, the neighbors, or a snoring bed mate try using a white noise machine available at Brookstone, or a fan that hums.
2. Limit Fluids
Too many liquids will effect how well and how long you sleep. Try not to drink too much before turning in. Generally, limiting liquids in the four hours before bed can help cut down the number of nighttime strolls to the bathroom.
3. Forget Food
No, we don’t mean all day; we mean right before bedtime, particularly anything that’s heavy, greasy, spicy, sugary or caffeine-laden, or otherwise “disturbing” to your body. Give your body at least two hours to digest your last meal of the day so when it’s time for bed, the focus can be on falling asleep, not processing that cheeseburger and fries you just ate.
If you want to rest easier tonight, eat a lighter dinner or eat your normal amount but eat at least three hours before your bedtime. This insures the digestive process is well under way and starting to wind down before you hit the sack. Eating too close to bedtime forces your body to work overtime, digesting well into the late night hours, yielding gas, bloating and indigestion when you should be resting.
Think a late night snack won’t hurt? Skip them too. Refined grains and sugars before bed can raise blood sugar levels and overstress the adrenal glands involved in hormone regulation. This hormone roller coaster can contribute to waking you up throughout the night as hormone levels fluctuate.
4) No TV in Bed
After a draining day of work, sleep is the first thing on your mind – but the last thing on your schedule. After all, you’ve got more than a thousand cable channels to scroll through, not to mention your computer screen, iPad, cell phone and countless other diversions. Even when we hit the sack, we stay awake, getting progressively more tired and setting the stage for a restless night.
Exercise is one of your best defenses against insomnia, but just don’t do it too close to bedtime. Studies show that people are more likely to stick to a routine if they exercise first thing, so if morning is your sweet spot, keep up the good work. If you are NOT a morning person, then slip your workout in about four to six hours before turning in for the night.
7) Take a Nap or “Meditate”
You might think that a nap would make you more likely to stay awake all night, but it actually can have the exact opposite effect. Grabbing a nap whenever you can (or the non-sleep equivalent, anything that allows you to close your eyes and relax body and mind) prepares you for a good night’s sleep.
8 ) Know What’s in Your Medication
Ask your doctor if you are taking any medications that may be contributing to your sleeplessness.
Common sleep stealers are; antihistamines, diuretics, anti depressants, decongestants and many, many more!
This August, we were proud to have our very own Dr. Amico partake in training athletes for the 2012 NYC Ironman. Watch our video and read below so you can hear about Dr. Amico’s experience at this monumental triathlon.
“Last summer when Ironman announced that they would be hosting the US Championships in New York, the buzz surrounding the event was immense. Many of my patients were able to secure their entry into an event in which 2500 slots sold out in 11 minutes. Then the training began. It’s always fun to monitor the progress of athletes as they train for an event like this. It is also a great honor for me to be trusted to be able to treat and help my patients as they prepare for their races.
In the early spring I was named co-lead of the ART Ironman treatment team. Along with Dr. Mark Stoebe from Montana, I was leading a group of eighteen top notch Active Release Providers in treating competitors in the days leading up to the race. We worked on many individuals from all over the world. Some competing in the first Ironman and others whom have done multiple races. Ailments included minor aches and pains to biomechanical dysfunctions, which we tried to remedy before race day.
On race day, my team arrived at the finish line around 1pm and prepared to work until midnight. Our job was to triage athletes as they finished the race. In other words, perform a quick and thorough evaluation of the finishers and decide if they needed medical attention or were okay to recover on their own.
The fun part about the day was my ability to triage some of my own patients whom I have watched train and sacrifice for the last eight months to achieve their goal. I could see it in their eyes how happy they were to actually know someone at the finish who was there to help them if need be. It was awesome to see how appreciative all the finishers were, but to have my patients go out of their way to introduce me to their families, because they felt I made a difference in their preparation and ability to have a great race, was beyond words. As the race ended at midnight, my team had supported over a thousand people as they became Ironmen and Ironwomen. Overall, it was a great experience and I look forward to leading another group of providers next year.” -Dr. Amico
The debate of whether to stretch or not, is a heated debate. The verdict in our opinion is two fold:
1) Its hazardous not to stretch!
2) Never stretch before activity
The above statement might seem at odds with each other, however, both are correct. It is hazardous not to stretch, however, we recommend stretching AFTER activity. Stretching will not necessarily make your muscles longer , however it will make you feel more limber . It will also help alleviate muscle adhesions that build from the micro trauma of activity and help prevent future muscle strains .
The problem is, when you stretch before activity, you run the risk of “de-activating” the muscles which creates an environment for injury. Pulls, strains and tears ! So, what does one do to prepare for activity if we recommend not to stretch ?
This is why we created W.E.RUN the App designed to warm up athletes, runners and triathletes prior to taking it to the streets. The W.E.RUN app is loaded with pre-set warm ups for swimming, biking and running as well as a video library that teaches you how to perform not only the dynamic movements but an entire section dedicated to stretching as well as core strength exercises .If you’d like to download our app, click the link below:
Below is what we call the Essential 5, these are the 5 most common areas which influence recovery from running and cycling. Check out the pictures for ideas on how you can stretch each of these essential areas!
1) Hip flexors (Quadriceps, TFL and Psoas)
2) Hip Hikers (Quadratus Lumborum & ITBAND )
3) Hip Stabilizers & Rotators (Piriformis & Glute medius)
4) Hamstrings (Semimembranosis/tendonosis and biceps femoris )