Dear diary,
On August 4th, I fell during an indoor climbing session and broke all the ligaments in my left knee. I was told this is the worst possible injury that can happen to a knee, except a bullet right through it.
It was a combination of hastiness, clumsiness, being overweight, doing climbing too often, and ignoring my knee’s warning signs from before.
I am starting this journal to not only document every day’s activity, but also document everything I will be doing to prepare for climbing again, so upper body and finger strength work while my legs don’t work. I intend to document every day, at least briefly, for 180 days. Hopefully in 6 months I will be at at least 80% of leg functionality.
I will also attempt any experimental treatments I can find to speed up the healing process.
The procedure
The surgery was extensive, equivalent to a full knee replacement in terms of surgical work done, but the doctors are quite sure it will be fine, IF the rehab is followed to the letter. I now have two titanium anchors holding pieces of my ligaments in place.
No extra tendons or tissues were required to patch the ligaments up, they were still stretchable and bindable, so no other wounds except a 30cm incision along the knee side of my leg.
The surgery was done by Akromion’s Prof. Dr. Hašpl, with excellent anaesthetic work by Dr. Šoštarić.
Because the surgery was so aggressive, I needed three different painkillers - one spinal tap which paralyzed me below the waist, and two nerve blockers via catheters - one below the knee on the back of my leg, another through my hip/groin area into the top of my leg. The catheters work like this (from what I understood and felt):
they first give you a local anaesthetic so they can stab you with this in a less painful way
then they stab you with a wire which conducts electricity, and drive it through the meat riiiiiight next to a nerve, electrocuting all the time. Once the leg starts twitching on its own like you would expect a frog leg to twitch on a battery, this means it is in the right place.
the wire is also a catheter which can spray numbing / blocking agent right onto the nerve which it is now next to. They did this only once for the lower leg, so spray and extract. This one lasted for 24 hours. The top one was left in, so I can get a pump infusion of the blocking agent onto the nerve when needed via this device.
The surgery was not laparoscopic, so I could not watch the butchering, but I did see some reflections in metal and it looked gruesome (I was awake).
Bandaging and stitching
I was given a static orthosis with a padding pillow inside that prevents the leg from being completely straight. This is important to prevent a patella collapse and to stop the (now newly made) ligaments from overextending and detaching - they are not giving support yet.
This is something I sleep and walk with. The only time I am allowed to take it off is when I am icing the leg, or putting it into the Kinetec, a device for automatically moving my leg, which keeps my knee from healing into a solid stationary position.
I am supposed to pull organic rubbery band aids off in 6 days, those over my stitches, and I have a checkup in 13 days (2 weeks from surgery). Proper physical therapy does not start until then, it is all about letting the fresh injuries heal until then.
Pain level
The pain varies from 3-8 on a scale of 10, depending on which painkillers I am on and which ones wear off, as well as what I am doing.
Laying down feels a lot like having kept your leg too long extended on a chair across from yours, and walking just feels very uncomfortable because of the orthosis which puts weight on what is basically a fresh and terrible wound.
It is manageable, but that might be in part due to the Oxy they are putting me on, which I am really not a fan of so will wean myself off of asap.
Sleeping is possible, but not comfortable, though I did learn that I can sleep on my side today so that might work.
Movement
I am able to do short walks if I tighten the orthosis and take it easy, so bathroom, kitchen, etc. none are a problem for now. However, it might be quite painful when I am off the heavy duty stuff, so we will see how manageable that remains.
Exercise
I will put this into a more easily trackable table later I think.
Legs
1 hour Kinetec, 0-20 degrees
1.5 hours Kinetec 0-25 degrees
Quad tightening 2 x 10
Laying on my back, I pull my feet towards me and try to lift my heels just enough to engage quads. Hold 5 seconds.
Leg lift and pivot 1 x 10
Lift the injured leg 5cm off the bed, and pivot it outwards without rotation. Hold for 2 seconds, bring it back, release.
Leg raise 1 x 10
Lift the injured leg to the height of one upright foot, keep it there for 5 seconds, lower and release.
Hip raise 1 x 10
Turn on the healthy side, and support the injured leg with the healthy one. Raise the injured leg to hip height, hold for 3 seconds, drop and relax.
Knee and glute squeeze 1 x 5
Laying flat on the back, put an object between the knees. Squeeze it without rotating the ankles, and at the same time squeeze glutes. Hold for 5 seconds and release.
Upper Body
none today
Food
I am not yet sure how much sustenance I will need, but I think triggering autophagy with intermittent fasting, just like I did so far, one meal per day will be beneficial, especially if that meal is protein-heavy so it gets fully used up by the body to heal.
I expect to still be able at least one or two 48 hour fasts per week for longer autophagy, but I will prioritize feeding the wound.
If you had and recovered from a similar injury, please drop a comment on this newsletter 🙏
hi bruno, i had the pleasure of meeting you and doing a little interview with you in paris, we even talked about climbing!
I share with you my way of healing following a tear in the internal lateral ligament of the knee following a heel lock in grappling.
I spent 2 months limping, I refused any immobilization. During the first month the pain was intense from the break of the foot. In the evening I would freeze my knee by rubbing the ice cube along the tendon. Daily I did not reduce my number of daily steps (around 10,000).
Having a personal training rather physio from my profession, I know that it is better for all healing to leave the limb in motion because it promotes blood flow and encourages healing of the injured area.
My daily sport being also climbing, I dispensed with the gym during the first month (I was just doing pull-ups at home). Stopping physical activity is very bad because you lose all the ghormonal benefits linked to the practice, and in particular those that can inhibit the pain felt in the short term. In addition, the practice allows you to stay in a positive mood and not to relive the fact that you are hurt, in these moments the mind is very important.
The second month I started mobilization exercises for my knee. (I think you are not yet at this stage of mobilization, and these exercises have been valid for me with my qualities, my faults, my mind and my pain tolerance)
On the ground:
-seated holding the leg fully extended for 10 seconds (10x)
- on a flat stomach bring the heel to the buttock 20x (10x)
-on the side, 10 adductions (bring the leg inwards)(10x). It was the hardest for me given my lesion area
This circuit every day for 1 month
The third month I started standing exercises (but I don't think you're there yet given your unfortunate injury...)
I haven't changed my diet in any way. Being an athlete for years, I make sure to have a fairly high protein intake every day. Amino acids also help tissue healing. do not deprive yourself of meat, fish, and eat eggs (I eat between 3 and 5 a day, every day).
2 years later, I do the sports I want, I always climb at a good level and my knees accept torsional movements very well without pain. When you can, I invite you to do bi-weekly stretches, during 30-minute sessions, only dedicated to the flexibility of the lower limb. It also helped me a lot to regain confidence in my damaged knees and in my support.
Finally, as soon as you can do without it, I invite you not to take painkillers, because the knee (like the shoulder) are joints with many degrees of freedom, and you will see that in the long run term you will have to "do with" a pain, an embarrassment at least, unfortunately.
2 years later, I still get up in the morning with terrible pain in the previously damaged ligament. Small hack, I sleep with a pillow between my legs (you'll see it becomes essential as you hurt at first, then you'll get used to it).
Finally I wish you a lot of courage because being injured is really shit. Do not lose morale really! Do everything to come back better, and above all ask yourself the reasons why all this happened (but it seems that you have already drawn up the balance sheet of all this). This will help you avoid making the same mistakes.
Good luck and speedy recovery. Sincerely
2019 i had a kitesurfing accident and broke my acl and the meniscus, i had so much pain after the surgery i needed to take painkillers for 1 month. after 2 month and the physiotherapy, i started training with sleds (reverse sleddrag, bearcrawl) and sandbags, less eccentric more concentric work with a very low skill level to get the most possible pump and dot have the risk of pain or injury like with normal barbell squats.
it took 2,5 years, but now im pain free and much stronger than before.
most important advice, work hard and be patient, there will be ups and downs, but the macro trend will go up.
you will learn a lot about your body and how it works in this process.
good recovery and i wish you the best