ACL Recovery – 15 Things I’d Do Differently

This might be another side-venture from my usual travel topic but ‘that post’ about my ACL surgery has fast become one of the most popular on this site. Not only have people told me it’s been a huge help, it’s offered a place for people to share their own stories and, in doing that, help each other.

Mountain path leading uphill

Back to my recovery.

I’m writing this post because, over two and a half years on, I’m still not as recovered from my surgery as I want to be. Rupturing my ACL while in the Caribbean is by far one of my worst travel experiences. But I’m still working very hard on my recovery. In fact, I feel like I’ve progressed more in the last 3 months than I have in the last 3 years. Perhaps it’s because I’ve found an amazing new physiotherapist. Perhaps it’s all of the learnings of the last three years finally coalescing.

I’m deeply aware that many people screw up their knee, have surgery and get back to normal life. No drama. But my experience didn’t go like that. Why? Probably some of the mistakes below. Probably my perfectionist nature where anything under 100% recovery wasn’t going to cut it. Probably both.

Either way, I’m writing this in case you also haven’t had a ‘surgery-return-to-normal’ experience. Or, if you’re about to have surgery and want to take some tips for how to have a speedier recovery, what I’ve learned might help you. 

So, here’s my list of things I’d have done differently after my surgery to recover faster and better. It’s starting as a list of 15 but life has taught me that my knee is on a journey. So, there’s every chance I’ll be adding to this list as I continue to learn. Some of it will be very personal to me and you might think – duh, obvious but please be kind – sometimes we need to walk through the woods to see the trees. In my case, I needed to bang my head against a few tree a few times before I realised what I needed to do.

Also, if you have any of your own tips, please do share them in the comments below. 

This post is part of a series. You may want to start here.

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1. Better pre-habilitation before surgery

Indiana Jo hiking up Machu Picchu in Peru
Ok, I probably wouldn’t have hiked the Inca Trail again – not with all those steps but I could have pushed myself more.

You’ve probably been told to work on your leg and knee strength before surgery and in my head I thought I was doing precisely that. In reality I wasn’t doing nearly enough. Why?

First, a practical issue – my knee was locked up and it took me months to get it bending again.

Second, fear – that locked knee was terrifying. In hindsight, I’d done the damage so pushing myself to get more mobile, more quickly would have been the smart thing to do. 

Third, and this is critical – ‘go do pre-hab’ wasn’t nearly prescriptive enough for me. Knowing my knee bone was no longer connected to my thigh bone (or something like that), I wasn’t sure what I could and couldn’t do. I’d already had a nasty fall after rupturing my ACL, so I didn’t want to add broken bones to the list. The few exercises the physio gave me were basic. Once I got range of motion going, I went out and did a bit of running and some work at the gym but I could have done a lot more had I known what the hell I was supposed to be doing.

How you can do it differently: There’s still very little useful info on the interwebs about ACL prehab. This is the most useful article I’ve found. But even this is off kilter – it confuses a sprain with a tear and predicts surgery might ‘sideline you for month’. Wouldn’t it be nice if it was only months? Personally, I wouldn’t do much of the jumping and landing exercises either (detached ACL and all that), but it’s a decent starting point if you’re looking for pre-hab exercises.

In addition, I’d:

  • get a specific set of pre-hab exercises from your physio;
  • get a specific list of what you can’t do (just to be safe);
  • hit the gym and, once you’ve got range of motion and basic strength back, hit the weights progressively harder – many of the strengthening exercises I’m doing now (hamstrings and quads) were possible even pre-surgery and would have saved me a heap of time and pain down the line;
  • get on the static bike and progressively turn that resistance dial up…up…up. 

2. I’d have pushed to have my surgery quicker

Yes, there’s only so much we can control when we’re on a public healthcare waiting list but I waited 9 months for my surgery. During that time, I didn’t chase them once to see what was going on. Having had my pre-surgery health checks in May and then not hearing anything further until September, I’m convinced I got missed or skipped. Coulda-shoulda-woulda isn’t a helpful way of thinking but if I’d followed up, maybe my surgery wouldn’t have been forgotten (if it was), or I’d have made myself known as a cancellation candidate. Of course, psychologically, I felt better putting it off but it only ended up delaying the inevitable and impacted on my overall recovery time. 

How you can do it differently: Find out who holds the surgery appointment list (someone in the admin team at the hospital) and get their number in your phone. Make a casual ‘just checking in’ call every few weeks. Make yourself known. Don’t get forgotten. If you can ‘drop everything’ for a cancellation, let the list-holder know. And if you can comfortably afford to have it done privately i.e. more quickly, I’d go for it.

3. I’d have got on (and stayed on) the static bike

Indiana Jo Hiking through mud in Nicaragua
I don’t always make the smartest decisions…like this hike up a volcano in Nicaragua with just a pair of Teva sandals on.

Go on the bike…use the bike…try the bike…are you doing the bike? Bike. Bike. Bike. So many times, my doctors, physio, friends and strangers all told me to use the static bike to help strengthen my leg muscles after surgery. Did I use the bike? Did I hell. And this is one of the most obviously silly decisions I made. Head. Banging. Trees. Woods. Repeatedly.

My reasoning was I hate the static bike. Boring with a capital BORING. I’m a runner. If I want to burn so few cardio calories, I’ll get on my yoga mat. It just wasn’t in my brain to do bike work. But, you know what, years – yes, years – after the masses advised me to get on the bike, I finally relented (after trying everything…anything else), and, what surprise, it worked. Yes, I still find it boring but as far as working all the correct leg muscles goes, you can’t find a better low-impact, strengthening exercise to help you recover. If only someone had told me that, eh :/

How you can do it differently: I use the bikes at my gym alternating between 10 minutes on the upright bike and 10 on the more lie-back (official name recumbent – had to Google that) bike. I tend to go for resistance (strengthening) over speed (cardio) training. 

If you can hack it for longer without dying of boredom, do it. If you do suffer from boredom, I’ve been using Audible books to get me through (all the power music just makes me want to run).

Alternatively, you can buy a bike relatively cheaply for home. As a non-bike fan, I didn’t want to end up with an object that will become a clothes horse but if you think you’ll stick to it, buy an exercise bike for home. Better still, buy someone else’s unused clothes horse from eBay.

4. I’d have got the best professional physio I could afford immediately after surgery

I live alone, have no dependents, have a decent enough income and my main outgoings are biscuits and travel. That means I can afford private physiotherapy. So why I persisted with the free public health physiotherapist when I had serious doubts about his efficacy, I don’t know. After the initial free sessions (six in total), I did absolutely zero in terms of physio. I just tried to get back to my normal running and yoga activities, thinking it would just take time. Experiencing pain and issues doing both and convinced my knee was buckling inwards (my free physio had replied ‘it’s one of those things’), I should have booked myself straight in for more physio from someone better skilled/or with more time available to deal with my specific issues. But no, I persisted, stubborn (and cheap) as I am. 

What happened is I eventually injured myself (bursitis) two years after surgery and was laid up for months recovering. I at least credit myself with finding a private physio at that point when I could have put myself back on the free physio waiting list.

Although my ‘bursitis physio’ helped immensely, I still wasn’t making the progress I wanted. Cue: physio number 3. Dealing with elite athletes (yes, feel free to actually laugh out loud), I knew that if anyone could get my knee back to full strength, it was him. And, so far, I’ve come on in leaps and actual bounds from just three sessions with the new guy.

How you can do it differently: If your recovery is not where you want it to be, and post any initial stint with a physiotherapist, get more physio sessions booked. It can take time to find the right person so don’t be afraid to change therapists if one isn’t working out for you.You don’t need to spend a lot of money. Often my sessions are over a month apart and I have a programme to work on in-between so it’s reasonably cost efficient over the course of time. 

If you don’t have/want to spend the money on a private physio, get on any public health schemes you can.

Timing can be crucial – I wonder now if I’d have got full over-extension back (I have some hyper mobility) if I’d jumped into more physio straight away.

How to find a good physiotherapist:

The $64 million question. And I’m not sure I’m qualified to answer except here’s what has worked for me:

  • Use a sports physiotherapist rather than a generalist.
  • Find someone who has had proven results with with ACLs – my guy regularly rehabilitates footballers (yes, you may laugh again).
  • Make sure they understand what your sports goals are – getting your knee overall well versus having the strength to run will require a different recovery regime (I know from experience).
  • Assess how confident they are – assuming your PT isn’t full of bluster, find someone who is confident they can get you to where you need to be versus someone who accepts ‘we might not get there’. Of course, you need to be realistic but with my same knee, 4 physios had different views on whether I’ll be able to run properly again. Clearly, I want to work with the person who says ‘that’s possible’.
  • Make sure your physio is able to record progress – until my current PT, all measurements of my progress were done by look and feel. ‘It looks better. Does it feel stronger?’ With my new guy, he has a machine that tests my quad and hamstring strength. I get exercises. I do them. I’m re-tested. I like being able to see recorded progress. Or not. One of my muscles isn’t getting as strong as quickly as the others (hamstring on the injured leg, unsurprisingly). Solution: work harder on that muscle.
  • Tell your physio about your lifestyle. If you work 16 hours a day and travel 2 days a week, he or she needs to know so you can have realistic exercises. I have ‘travel compatible’ exercises for when I’m on the road and can’t hit the gym.
  • Check reviews – it ‘s pretty easy to do online these days.

5. Not ignored the running pain…for years

Injured knee before ACL surgeryin splint on the left and in kinetic tape 2 years later
Some days I don’t feel like I’ve made much progress at all. On the left, the brace they gave me in hospital in Puerto Rico after I bust my knee. On the right 2 years later – bursitis from running.

I developed what I call my ‘running-injury-recovery cycle’. I’d decide I want to get running again, go running, continue three times a week for 3 weeks. By week 4 I’d be injured (typically hip pain and then bursitis). I’d then rest for a few weeks before starting the cycle again. Upshot – I never progressed. In all that time, I barely managed a 5k before injury struck. Bursitis was the last straw that took me to a physiotherapist. In hindsight I should have gone sooner.

My current physio and all his wonderful metrics tells me my leg muscles are not only too weak and out of whack with each other (uneven muscle strength across the legs), my knee was buckling (as I knew), which collectively put me at high risk of injury. I’m lucky I didn’t hurt myself more. I now have a muscle strengthening plan in place and running is on the cards – first test run in a couple of weeks. 

How you can do it differently: If you feel pain, yes, RICE (rest, ice, compression, elevation) but don’t ignore it. Get it checked out. It may well be fixable. Or yelling ‘I’m about to break even more’.

6. Worked on a progressive physiotherapy programme

Let’s be honest, physio exercises are dull. We squat, bridge and lunge for the first few weeks but after that our efforts slacken off. A month ago I took my theraband to Miami and was motivated enough to lie on a hotel floor (that smelt of vomit from previous guests) and do my physio exercises. But I was motivated because they were new exercises with a new plan.

A few weeks later, I couldn’t be arsed to do the same exercises when I was so fiercely procrastinating against doing work that I was cleaning inside my fridge. Solution: Work with your physio to get new exercises at regular enough intervals that they don’t become boring. This has the added advantage of helping you progress – you’ll do more and improve your recovery.

How you can do it differently: Schedule your physio sessions around 4 weeks to 6 weeks apart – that’s the amount of time when my interest in a set of exercises starts to wane. 

If you and your physio are doing your work properly, your exercises should get gradually harder. Or, at least different. If something hasn’t produced results in a month, time to try a different exercise?

Get your physio to help you switch it up. Bored of lunges? Do squats. I currently have three different ways of strengthening my hamstrings (TRX at the gym, sliding discs at home and low tables in hotels – my three natural habitats covered).

7. Pushed myself more on the weights

Views over Verbier mountains with outdoor picnic table
This trip to Verbier around 2 years into my recovery was an eye opener – I opted for the relaxed version of the trip and skipped all the active activities. A real sign I’d stopped pushing myself.

I realised the other day that I’ve been leg pressing the same level of weights at the gym for decades. Yep, decades. Talk about a fixed gym mindset. It’s like I decided once I got to a certain weight level, that was enough effort, thank you very much. But it turns out that by gently pushing myself I can achieve more (who’d have thought it). And at a time when I can use all the leg strength I can get, it’s a good lesson to learn.

How you can do it differently: Keep an eye on what you’re achieving with your leg weights and gently, gently (I’m doing .25 of a kilo extra each time), see if you can push yourself a bit more. Just don’t go wild – this is designed to improve not ruin your recovery.

8. Kept up my cardio fitness (at the gym)

You probably have the sense by now that I like to run. Ideally outside. So, unless I’m doing that, cardio is off the menu. Which isn’t the smartest move during after ACL. I wish now I’d been more strict, making myself maintain some kind of cardio fitness even when I couldn’t run. Actually, especially when I couldn’t run. Because now, facing the idea of running in a couple of weeks time, I’m almost as terrified about how my stamina will hold up as I am about my knee. Needless to say, I’ve become a bit more focused at the gym, hitting the cross trainer in the past few weeks instead of just ambling along on the bike willing every minute to be over.

How you can do it differently: You may not be able to ski/run/play football but if you want to get back to it, you’ve got to keep your cardio up. I get it – gyms and cardio machines are duller than dishwater but they’re also the safest gateway back to your chosen sport. Commit to a regular cardio workout when you’re doing your strength and physio training. And no, a brisk walk or vinyasa flow on your yoga mat probably isn’t going to cut it. 

9. Invested in regular sports massage earlier on

One of the biggest barriers to me pushing myself after my surgery has actually been my leg muscles. Locked up would be an understatement. It wasn’t until, errrr, around year two that I really started to address this and wow did it hurt. Not knowing enough about anatomy and injury, it didn’t occur to me that my legs muscles could get themselves into such a state. Sure, I did some yoga and all that jazz but compared to a torturer…I mean sports masseuse…sticking the pointy finger of doom into the middle of your muscle to get it to release, the yoga was no more effective than a tickle with a feather.

How you can do it differently: Try a sports massage fairly early on in your recovery regimen. Just a few months after surgery I spent a month in Thailand and let the Thai ladies loose on my legs. I was nervous but they were careful and, though painful at the time, the regular massage worked. Keep it up (I didn’t). As we work to re-strengthen and regain proper function in our legs, our muscles can tighten to the point they’re hindering our recovery. 

Be aware, it needs to be a sports massage. Hot stones won’t be as effective, sorry.

At home, I also use these ‘miracle balls‘ – they help to release tight muscles while you sit on your backside watching TV. Bargain and effective for £15/$20. I use mine several times a week.

10. Worked towards recovering my ACL for all of my sports at the same time

Woman with surfboard at beach in Santa Teresa Costa Rica
I spend most of my surf time in the water not on the board but I’d still like to give it another go.

I’ve tried to get back to my sports on a ‘favourites first’ basis which has put running and yoga at the top of my list. So it was only recently I’ve started to enquire about other things I like to do or want to try – hiking (volcanoes are a particular favourite), surfing (I’m terrible but would like to improve), aerial yoga, K08 and getting back to Krav Maga. Some of those sports are going to be more achievable than others. And though I like that I’m specifically strengthening my legs for running, if I’d been a bit broader with my activity list, I could have gone on with some of the other sports in the meantime rather than being so single minded about my recovery and focus. Undoubtedly, this would have helped my overall strength and fitness.

How you can do it differently: Give your PT a list of all the sports you enjoy or want to try and see which they recommend tackling in the meantime while you work on full strength for your favourites.

11. Managed my weight (and pity picnics) better

“Fine, if I can’t run and still don’t have the flexibility to do the yoga I want, I may as well sit on the sofa and eat a packet of biscuits.” If you’ve suffered with weight increase generally or as a result of what I like to call pity picnics, I get it. Before I screwed up my knee, my emotional outlet was running. Take that away and I turned to biscuits and their salty cousin, crisps. Coupled with a reduced level of activity overall and it didn’t take long for me to gain weight. The problem is, it took me too long to lose it. And I’m still not 100% there.

I’ve had a challenging year emotionally (my mum died at Christmas) and the pity picnics have been an increasingly frequent occurrence. But it’s literally the last thing I need. So, over the past few months I made a dedicated effort and as a result I’ve said goodbye to over a stone in weight. I’ve stalled a little but I’m determined to push through and lose the last pounds I never used to carry when I was able to run. 

How you can do it differently: Mainly this was about mindset for me. First, I had to accept that that waiting until I could run to lose the weight wasn’t realistic. I had to lose the weight first. I identified my weaknesses (previously cited biscuits and crisps). I then had to apply some pretty serious willpower and stop putting the damn things in my mouth. It came down to: which do I want more – to be able to run without the extra weight on my knee, or the biscuit. Sure, sometimes the genuine answer meant throwing a chocolate digestive in my mouth but I started doing it as more of a treat than a 3 p.m. appointment with half a packet.

12. Tracked my recovery better

Indiana Jo Hiking in Cocoa Valley in Colombia
I don’t always do the right planning – like turning up to hike the Cocora Valley in Colombia during rainy season.

Every heard the saying ‘what gets measured gets done’? Or, more specifically, if you write down your goals, they’re more likely to be achieved. It’s been proven. And I knew this, which is what makes it so frustrating that I didn’t think to apply this approach. Instead of having goals and targets, I let my recovery amble on. Which is probably why I’m writing this post nearly three years after my repair. 

And, d’you know what, even as I write this, I don’t have specific goals set. Not measurable ones. So, that’s my next task after I hit publish on this post. 

How you can do it differently: Make a list of your goals. Discuss it with your physio. Put that list somewhere you can see it. Check it often and revise it as necessary. We don’t always hit our targets 100% but you’re 100% more likely to hit something you’re aiming at (run 10ks without risk of injury) than some idea (I should run again) that floats vaguely around in your head. 

13. Set deadlines for my progress

What I like about my new PT is that I know where I’m heading and, most importantly, by what date. I know that for the next 4 weeks, I’m trying to make my hamstrings more solid than Mr Schwarzeneggers’. I know that if I manage to do that (or do the best I can – he’s got some very fierce hammies), I will try to run. I will try to do it across the space of 40 minutes with the view to being able to run outdoors on my own for 20 minutes the following week. 

Without tough but achievable deadlines, I’ve not made as much progress as I’d have liked.

How you can do it differently: Put some deadlines on your plan and make yourself accountable. Deadlines will also help you spot any flaws. While you might be working towards a goal in one month, are you realistically going to hit the gym every day if you’re on honeymoon for two of those weeks?

14. Invested in motivational gadgets and fitness kit

Hiking into the Grand Canyon
Kit aside, looking at old photos of some of my best hikes is pretty motivating. Like that time I hiked below the rim of the Grand Canyon – not a lot of people do that.

I love a gadget – nothing motivates me more than new kit. When I couldn’t sleep years ago, I went out and bought a Fitbit to track all the sleep I wasn’t getting. Not exactly motivating, confirming how little I slept each night, but it at least helped me understand why I was so goddam exhausted all the time. I now use my Fitbit to motivate me to get fitter (cardio) and lose weight during my journey. 

How you can do it differently: The best gadgets I’ve bought for my recovery are:

  • a set of smart scales. Not only do they track my weight loss, I can see my muscle mass increasing bit by bit as well as my bone density and water levels – all measures of a healthier, fitter me (not sure how scales can measure this? Answer: it’s science not magic). It’s often the prospect of stepping on those scales than makes me push harder at the gym or remove that 6th…ok, 7th biscuit from my mouth. 
  • Training gadgets – I’m not talking about anything expensive (all under $20) – sliding discs (to work on my hamstrings), miracle balls (to unlock my muscles), dumbbells (for some quick lunges during a work break) and a gym ball for all sorts of fitness fun including gentle flexion during the early days.

Yes, it’s my inner child demanding new toys to play with but if those toys are helping me get fit and strong, I’m happy to continue to indulge her.

15. Woken even morning to ‘You Better Work B*TCH’ by Britney

Tal Volcano in the Philipines
Though the memory of hiking Taal Volcano in the Philippines is good motivation too. Don’t know about Taal? It’s ‘an island within a lake, that is an island within a lake that is on an island.’ So, a lot of boats and a lot of islands.

Ok, I’m only partly serious (though Britney’s song is often enough to get me to the gym when I’m not in the mood). My main point is, I would have applied a bit more tough love. It can be hard getting fully recovered but I’m not a stranger to hard work. And this really is one of those times where effort and outcome are directly correlated. 

How you can do it differently: Persist. Persist. Persist.

So, that’s my list of things I would have done differently to help my recovery. Got any extra tips and suggestions? Let me know in the comments below. 

Interested in some of the photos you saw in this post? I wrote about a few of the destinations here:

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Author - Jo Fitzsimons

Hi, I'm Jo, the writer behind Indiana Jo. In 2010 I quit my job as a lawyer and booked an around the world ticket. As a solo female traveller, I hopped from South America to Central America, across Asia, the Middle East and Europe. It was supposed to be a one-year trip but over a decade later, it's yet to end. I've lived in a cave, climbed down a volcano barefoot, spent years as a digital nomad, worked as a freelance travel writer, and eaten deadly Fugu. Now I'm home, back in the UK, but still travelling far and wide. You can find out more About Me.