It has been a while since my last post as not a lot to report but those of you who’ve been following this blog for a while will know that tennis is one of the sports I’ve wanted to try for a while and was one of the goals I had for post second ACL surgery.
The running hasn’t worked out as a long-term activity (my knees, hips and back started to get too uncomfortable at different times to carry on in any serious way, so it’s now just a mile or two here or there or a warm up for a longer gym session). I have however managed my longest streak yet back at the gym at 9 months!
In May, I decided to bite the bullet and hire a personal trainer to help me step things up a bit. Katie has been working with me once a fortnight, keeping me motivated with a more varied programme of no/low impact but HIIT-style and strength workouts so I feel like I’m finally getting more active.
I’m definitely fitter and stronger than at the start of 2021 and, so long as I keep the impact down and everything is in a straight line, all is good. Lunges are still a no go and we did introduce some TRX squats a couple of months ago where you hang on with one hand and reach behind to tap the floor with the other as you squat and then reach up to tap the TRX rope as you stand up again, but that caused more knee pain the more times I did them, particularly when the movement meant twisting inwards, so that little adventure into multi-directional work has been dropped.
Anyway, just doing gym-based workouts inevitably gets dull so, with the knee behaving itself relatively well, I decided to sign up for the next FastTrack tennis course at our local club, just to give it a go, do something purely for myself and tick something off my ‘one day’ list. My daughter has recently been selected for the county tennis squad (proud Mum alert) and I’ve watched her play for years now without having a clue how to play myself so I figured it would be fun to learn the basics, then I can at least knock a ball around with her in due course.
The course took place over four weeks and took us through forehand, backhand, serve and volleying and doubles over that time.
I was very cautious the first week, and that was pretty easy given we were just hitting the ball gently over the net to each other (I say ‘to’ each other - that credits me with more sense of speed and direction than I actually have - but we all start somewhere, right?)
By week two, I was starting to run across the court more and I could feel my knee grumbling a bit but nothing too serious.
Week three, serves, was where I realised I was still subconsciously protecting the knee as the coach suggested turning more from the side into the serve (the bad knee is my front one) and my immediate reaction was ‘not a cat in hell’s chance!’ I was already starting to feel it tugging when I had to stop quickly so I definitely didn’t trust it enough to give it any real energy/power in the serve.
After completing the course unscathed, if cautiously, we booked a court as a family during the Christmas holidays to have a bit of a knock about. It was fun, even if the smallest really isn’t that interested, but I had to stop when I started getting sharp shooting pain through the knee when I was chasing after the balls.
Is that the start and end of my tennis days? No, I don’t have any ambitions to play competitively, or even socially beyond a casual knock about with the kids or friends who play a bit. I like the fact that a 45 minute session burns around 400 calories without consciously breaking a sweat as my brain’s otherwise engaged trying not to be totally rubbish. But what it has clarified in my head is that I probably will explore the brace options now.
I enjoy being active. I enjoy learning new things. And I think I’ve now confirmed that no amount of physio and strengthening on its own is going to be enough to let me do the kinds of activities I’d like to with any kind of regularity. What I didn’t want to do when it was first suggested was a) go headlong into something that could prove to be an unnecessary expense and b) go ahead and get a brace that would then need replacing when I regained some quad bulk. Plus, of course, there's no subtle way of wearing one and I didn't want to be 'Oh look at me and my poorly knee', unless I absolutely had to. I’m probably about as far as I can get with the quad building now so it looks like 2022 will be the year. How I go about getting a brace, without just taking a punt ordering online, I don’t know, but I’ll look into it and report back…
…All of which has led me to do some more reading around ACL grafts stretching and long-term ACL deficiency. There are lots of articles from the perspective of those with an interest in surgical solutions but also some interesting journal papers that provide more food for thought (I’ve dumped the latest ones in the resources pages).
This ultrasound video was a bit of an eye opener re the impact of a deficient ACL causing relatively low-level rotational instability on the meniscus, even when simply walking (visit link to see movement).
If you’ve followed this far, you’ve probably read more than your share of papers talking about forces through different joints when walking, running, jumping etc, but the figures can be pretty abstract. This is visual and all-the-more potent for it. Of course, movement often looks more exaggerated in slow motion than it is in real time - think TV replays of rugby/football tackles and so on - so it’s worth keeping that in mind when viewing. It does, however, potentially explain why my knee is almost never ‘pain free’ anymore, especially given it doesn’t take much impact these days.
I also came across this article talking about radio frequency thermal shrinkage (aka Thermal Tightening) of the ACL as a possible treatment for lax or partially-torn ligaments. More info on the rehab protocol post procedure here
Given a ‘lax ligament’ is what I’m apparently left with, is this another approach worth considering?
Welcome any other readers’ experiences of this! Is it something useful? Still experimental/unproven? Or a completely bonkers outlier in the field??
Then, of course, there's all the stem cell and plasma treatments being developed (although noted, this is mainly in regard to ACL repair etc, rather than complete reconstruction). Picking your way through what's real, what's an early-stage idea and what's BS is a bit of a minefield, and one that requires infinitely more spare time than I have. It's a constantly developing area, sometimes conflicting research papers and if you want to find our more, you probably need to approach a consultant specialising in the area, who may or may not have an agenda to push. It's great that we now have so much information at our finger tips but how to avoid being exploited while also not wanting to dismiss something that could help?
So, where to from here? I’m going to book a physio appointment at some point in the next few weeks to get a general summary of what knee pain is ACL deficiency related and what (if any) may be related to other issues that can be more easily sorted (don’t want to just lump it all together if it’s not). Then I’ll probably look at the brace options so this year’s keeping fit can be a bit more varied than last year’s. Still have the ‘what if’ floating around my head re the second opinion - just to make sure there’s nothing else I can do to fix this completely too without storing up more problems for the future but, given the ongoing pandemic and life with two ridiculously active kids, it will be a while before that one makes its way to the top of the agenda.
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