A Climber’s Guide to ACL Replacement

Hey Steph,
My name is Lacy, I live in Bellingham, WA but I lived in SLC for a few years which is when I fell in love with the desert. I have never paid much attention to professional climbers, or skiiers, or runners…but I have ran into you a couple times in the creek and your kind demeanor and down to earth way of interacting with others really struck me, what with how well known and talented you are.

So I ended up checking out your blog and have really appreciated its simplicity and humbleness, while sharing your knowledge and skill with others, especially us women. I did a search on your blog recently to see if you had any advice for women dealing with injuries and discovered that you have torn your ACL and had it repaired. You didn’t say much about it though and I am wanting to pick your brain a wee bit more about it as I recently tore mine skiing and just got surgery yesterday (yes, Valentines Day). I had a bone tendon bone cadaver graft and apparently lost some of my medial meniscus as well. Today, I feel pretty horrible, like I won’t be able to bear weight on it anytime soon, so it is hard to imagine leading 11′s in the creek and running 50k anytime too soon. It is weird how easily our minds get wrapped up in what you can do NOW instead of focusing on what you will be able to do 3-6 months from now, which is what I need to focus on. It turns out this whole surgery thing is a big deal and I woke up this morning asking myself ‘what have I done’? Just a few days ago I was still skiing with a brace, dancing at our local 80′s night and cycling…today, I have only gotten up to pee and have a brace the size of both my thighs on. It is a weird transition.

Anyhow, I am sure you have more wisdom to share regarding your experience. I am really curious about what kind of repair you did, did you lose any of your meniscus, how you felt right after and what got you through the rough patches, what inspired you and what it was like to get back out to doing the things you love at the caliber you were before. Also, any good diet tips to fight inflammation?

Sorry if this is in anyway confusing…I am still on Percocet

Hope all is well in the dez and I hope to hear from you!

Best,
Lacy
“The only way to deal with an unfree world is to become so absolutely free that your very existence is an act of rebellion.”
Albert Camus

Dear Lacy,
Sorry to hear you are laid up, but I’m really glad to hear you got your ACL replaced, because you are now close to being all perfect again

Here is the story of my ACL replacement:
In February of 2008 (about six months after I first started base jumping), I was hiking to the top of the Tombstone, which is the cliff closest to my house, to do a jump. It was a very snowy winter and my gear weighs about 20-25 pounds, including body armor and helmet. I had it on my back, and just near the top of the cliff, I walked straight down a snow-covered slab. My feet slipped out, and I instinctively tried to ski it out, and slid down and landed in somewhat of a crouch position on the ground below, with the extra impact of the gear on my back. I heard a “pop!” and my knee felt numb yet painful. I was by myself, and after I got up I realized there was no way I could walk all the way back down the trail. I was a few hundred yards from the edge of the cliff, so I got over there, put my gear on and jumped down, landing near my truck. When I got home, I iced and took ibuprofen, and my knee hurt really bad for a couple of months. I couldn’t even walk on it for the first few weeks, but eventually it got better–I was working on a route called Concepcion before I got hurt, and when my knee was “healed” up enough after a month or two, I was able to climb it. So I figured it was sprained and had just gotten better. I did notice that I was having a hard time doing really high steps, extending my leg all the way, and pulling in with my leg like you do on steep climbing, but I just compensated. So I tried to take care of it, wait for it to get better, and then just move on and not let it worry me too much. I generally don’t go to a doctor unless I’m lying on the ground unable to move and/or bleeding profusely, so that’s why it never occurred to me to get it checked (yes, I have learned from this!).

All of this coincided with my not running like I had always done, because my dog was getting arthritic and couldn’t run. I just wasn’t having as much fun running without her, so I basically stopped trail running (my theory now is that my leg muscles were uncharacteristically weaker for those few years, making my ACL more vulnerable without that protection of strong muscles). I was feeling bothered by that knee, but probably in denial, and I was wearing a neoprene brace when I climbed, and I also started to try to get running again, because I noticed that running made it feel better. Although I wouldn’t admit it to myself at the time, I look back now and know that I avoided being in the mountains and free soloing during that time because deep down I knew I couldn’t trust my leg in serious situations.

A year and a half later, I was doing a jump with my brother, and I had a perfectly normal, soft landing. I took one step as the canopy touched down, and my knee went “pop!” and felt all numb and weird. I was leaving for Europe for a month of base jumping, so I iced it and took ibuprofen and rested it for a week. It got better, but was almost completely unstable. I couldn’t walk in a narrow trail with one leg in front of the other, because it would buckle. I thought, “what an annoying sprain this is!” And when I got home, my brother finally suggested that maybe I should get my knee looked at, suggesting it could be something simple to repair, like meniscus damage. So I finally did, and the doctor pulled on my knee once and said, “You have no ACL.” I was pissed! I still blame my brother for tricking me into going to the doctor by making me think it was going to be some easy little orthoscopic clean-up

Looking back, I think I must have had a partial, almost full, tear back in 2008 on top of the Tombstone, and completed the tear a year and a half later when I had that uneventful landing. I was not able to get surgery just then when I was diagnosed, as my dog was in her final stages of spinal arthritis and had to be carried a lot and intensively nursed. So I got one of those Donjoy braces and waited until the next fall (when she had passed away). Like you, I found it a weird reality. A few weeks beforehand I was flying a wingsuit off the Eiger, and then I was trail running in Moab the day before my surgery…hours later, I couldn’t stand on my leg! Mentally it was really hard for me to schedule being injured, and go do it to myself on purpose. However, after two years of functioning without the ACL, I really knew how great it would be when I was 100% again.

I got a double-bundle hamstring graft which is a slightly harder recovery, but supposed to be super bomber when complete. I got mine a few days before my birthday, which was spent in bed with that up-and-down motion machine The injury I had before this was a pelvic fracture, which was extremely painful, so I was ready mentally for pain and recovery. I didn’t find the ACL surgery all that painful….what was hard for me was the fear during the recovery process, because as I’m sure you know, there are endless horror stories about people re-tearing the graft even up to 6 months after surgery. Usually when recovering from an injury, I just do as much as I can all the time. With the ACL recovery, I was totally petrified of doing something wrong and tearing the graft….especially because the two causes of injury I had seemed completely unimpressive and undramatic to me. It’s not like I was skiing a hundred foot cliff, or catching a crampon on a slope, or sliding a thousand feet into a crevasse. I was WALKING.

Although I’d been climbing, base jumping, skydiving, skiing and running without an ACL for over two years, I didn’t have any meniscus damage. I think I was really good at guarding it and protecting it without even realizing for a while–in fact, a bone density scan showed that my right hip bone was almost twice as dense as my left, indicating that I’d been putting twice as much impact on the right side of my body for all that time. This is another reason it was really good to repair it, because over time that kind of imbalance can not be good for the body. I know I never fully extended my left leg for a really long time, or weighted completely it on uneven terrain, or pulled in hard with it on a climb, because it would basically rubber-band and feel like it was turning inside out. I was able to crack climb at my limit where I was standing down on both legs, but I was not able to climb as well on steep stuff because of being unable to pull in hard with my leg. So in a lot of ways, I was able to manage without the ACL, but it was holding me back.

I was pretty happy about the opportunity to do some serious upper body training while my lower body was coming back. I went to a physical therapist a few times, but spent every day (literally) at the gym in Moab, as soon as I was up and moving better (3 weeks to a month after surgery). I would spin on a bike with no resistance, and do the simple rubber band exercises and inclined leg press machine (with no weight). Then I would do lots of lat pull downs, and all the normal upper body stuff I like to do in the weight room. As my leg got stronger, after 2 months, I started rigging up one of those aerobic step boards in the gym under the pullup bar. I put a shoulder-length sling on the pullup bar above me for assistance, to grab like a subway strap handle, and I would work on just stepping up and down on the step, and eventually trying to step onto the board and then down off the other side and backwards again, over and over. I also worked on one leg squats on the step–using assistance for the repaired leg. I would alternate that with pullups. So I was pretty happy, because I was getting REALLY strong in the upper body from all the training, and it made me motivated for when my leg would be better. I also walked a lot, on flat dirt roads–at first just 10 minutes very slowly because it hurt so much, but gradually up to 30 minutes and then an hour. I would not walk down hill AT ALL. EVER. Because of course I was petrified of tearing or stretching the graft.

I started climbing on my wall in the backyard with my Donjoy brace on about 3 1/2 months after surgery, and I was really scared. I just used the left leg very little, and didn’t do anything where I thought I would fall. At 4 months, I started running on completely flat dirt roads, because of course I was still petrified about stretching or re-tearing the graft. But my surgeon told me that if I did not go downhill AT ALL, and did only in-line motion (running), I would be okay. Running seemed (and still does seem) like the best thing I could do for my leg, and I still believe that my hiatus from running (combined with lots of impact from taking up skydiving and base jumping, landing the parachutes) was the cause of my tear. During all this time, my left leg muscles were much much smaller than the right leg.

Five months after surgery, I decided to start climbing outside. I climbed at Shelf Road the first time, and then at Indian Creek. I was more worried about the descents than the climbing, and wore my brace and used ski poles for months on the hikes and made everyone else carry the heavy stuff, even though I was comfortable leading. I also decided to start skydiving, with a really big canopy, and to only jump if there was good wind to make the landings soft. Landing was really scary for me. Six months after surgery, I started base jumping in Moab, and it may have been too soon, because I was terrified landing. And the fact is, that a year and 4 months later, I’m still having mental struggles with landing a parachute, because I have a bit of a mind f#$% due to that final incident where I had a nearly perfect landing, but completed the tear of my ACL. Somehow it’s worse than if I had torn it in a gnarly, dramatic accident, because deep down inside I have this subconscious idea that my ACL must be made of glass or something…. If I have any doubts about the speed of my landing, I tend to slide it in, lifting my left knee up off the ground, instead of trying to run out the landing. I still have the instinct to protect it. This really annoys me, because I think I should trust my leg by now. However, you just have to keep on keeping on, and little by little the fear gets better.

11 months after my surgery, I stopped wearing my Donjoy brace for jumping, and I also stopped doing a lot of my leg strengthening exercises. I noticed that my left leg didn’t feel as strong as my right, and it felt kind of vulnerable too. I went to Europe to base jump, and I noticed that the more I hiked uphill, the better my leg felt. When I got home, I started doing leg exercises again and running, and at almost exactly a year out from my surgery, I had a really bad landing in mud after a base jump. My leg bent all the way (though inline) and went POP! I couldn’t walk for a couple of days, and was in a complete panic that I’d torn the graft. After two weeks, I went back to see my surgeon, certain it was torn or stretched, because it was a much harder impact then my two original incidents and my leg was still hurting. As it turned out, the ACL was fine. I’d hurt the muscles all around my knee, but not the ACL–it’s not made of glass after all! And the leg strengthening exercises do work to protect the ligaments. My muscles hurt, but they did what they were supposed to this time.

After that scare, I decided to keep wearing the brace for low base jumps (which tend to have the hardest landings), and to be really aggressive with leg exercises in the gym. Now when I’m doing my pull up workouts in the gym, I alternate my sets with inclined leg presses, hamstring curls, and that strange donkey-kick machine. I also started a habit of doing lunge steps across the gym from one place to the next, rather than walking, and that is great. Now it’s been a year and 4 months since my surgery, and my repaired leg feels as good as the other one. In reality, the graft is probably stronger than my other one. The hardest thing for me is the residual mental fear of tearing it, but that is fading over time.

Climbing and running seem like the best things you can do for leg strengthening and flexibility, and they were the first things I was able to start doing in my recovery process. Yours should be faster too, since you have the cadaver graft. For inflammation, I just used that ice machine they give you all day and all night. I am an obsessive icer, so I would go to sleep with it on, wake up and refill it, and ice most of the day. That’s probably excessive. But it’s good to always feel like you are doing everything for recovery. I didn’t have any place to swim during my recovery, but I would have loved to walk around the shallow side of the pool and gradually start lap swimming, because I did that when I fractured my pelvis and it was great.

I went into the recovery period expecting it to take forever, and that I would get so many things done during all this forever stretching out before me. So I was actually shocked at how quick 4 months came around, and then I was suddenly getting back to all my activities–I don’t know where all the time went. I guess most of it went in the gym, since I was there for three hours a day Once I started doing things with a repaired knee, I realized just how bad it had been before when my ACL was missing. I finally realized how much I had been favoring and protecting my left leg, for over two years. It’s amazing to feel comfortable again bopping around on uneven terrain, and to really trust my leg in rough environments, because I really didn’t for a while. Climbing steep limestone now, I realize that I couldn’t even use my left leg for pulling in during that whole time period, so I was almost climbing with one leg before I got my knee fixed. So it was definitely worth it, and as usual, it reminds me of how incredibly fortunate we are to live in a world where surgeons can give us new ligaments. If I’d been born in a different place and time, I would have had to adjust myself to that unstable knee for the rest of my life.

Be patient, and be psyched that you are going to have a perfect new leg much sooner than you think.
Steph