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Symptoms of ACL injury?

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Last week I had a fall on the bike and hurt my knee. It wasn’t that bad and I was able to ride the rest of the afternoon. Since then I have a limp and the knee is sore to the touch on the inner facing side, basically right in the center. I thought a torn ACL would mean I would be in lots of pain and my knee would flop or do something weird so I decided to just give it time but it doesn’t seem to be getting better. It is most sore in the morning and not real good while sitting at a desk all day. There is little or no swelling. When I get home and take care of my toddler (lots of bending and carrying her) it feels better so I am not sure whether to let it rest or exercise it? Anyway I made a doctors appointment but it will be a week before I can get in so I’m wondering what might be going on. Also should I even go to my general practitioner or go straight to a knee guy (Orthopaedic ?)?

thanks

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Usually you will feel a pop when you tear an ACL I did both times. If your pain is coming from the joint line on the inside of your knee it could be a meniscus tear or a MCL injury. I would see a good doc most otrhopedic docs require a referral so you might have to see your family doc first.

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Definitely see your doc for a structural test of your knee. Even your family doc should be able to easily diagnose a torn ACL by doing a manual structural test of the joint. I've torn both of my ACLs and had both of them reconstructed. It was pretty obvious when I tore mine. I had the audible pop and the knee colapsed. Sounds like you might not be that bad off, by only an exam will tell for sure.

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Typically the GPs hardly look at the knee then order an MRI.

The better ortho guys do a good exam and don't always order an MRI. I do in maybe one out of three cases.

In the other cases, I know without spending 1000 dollars of the guys money and a day waiting at some clinic.

Wen the ACL is torn, you usually hear a loud pop, and the knee immediately swells up. Its pretty rare that you can walk normally afterward for some weeks.

Check out my post on the top of this forum for more information. There is also a ton of information on my website.

www.sandersclinic.net

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OK, thanks. Sounds like it is not the ACL. I'll go see the ortho and see what he says. I hate going to the doctor when I suspect there is nothing they can do and will just tell me to take it easy but it worries me that it isn't getting better for 9 days now.

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You need to start rehabing it, no matter what is wrong. I would reccommend the stationary bike, one hour per day, everyday for the rest of you life.

People who do that are rarely seen at the doctor, except when they take their elderly Mom or Dad there.

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That is one of the things I wanted to ask the Doctor. I wasn't sure whether I should be letting it rest or exercising it. A couple weeks earlier I threw out my lower back and could barely move. By being very careful to lift with my knees and not use my back it was 90% in 2 weeks. My knee though seems to feel better after I have been walking and bending and worse when it has been still for some time.

Thank you for the advice.

BTW - is there any reason a MTB on pavement would not work as well as a stationary one for rehab?

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I reccommend the stationary only because there is no weather related excuse not to do it. Whatever you do make surre you get your heart rate up to the target HR for your age.

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Before you go out a buy a stationary bike, you might want to look at a trainer that mounts to your mtb/road bike. I picked one up and they are great. As for knee rehab goes, the bike works great. I had my miniscus repaired (scoped) on friday. Friday night was on the mtb bike with trainer for about a 1/2 hour and have done so every day since. My knee is still sore but I regained full movement almost immediatly following the first session on the bike. I walked into the Dr.'s today to get a release for work (today is my normal day off) and they asked if I just had surgery on friday. I explained yes and they could not believe their eyes. I told them what I had been doing and they were astonished. Most of the gals there admitted they could not do that in normal health, especially after knee surgery. Here is a link to a trainer I picked up.

http://www.jensonusa.com/store/product/TR501A01-Blackburn+Trackstand+Mag+Trainer.aspx

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Thats a good device. The key is the cardio combined with ROM in a closed chain exercise. One hour per day.

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Dr. Mark:

Regarding staionary bikes following knee surgery: I know to keep my heart rate in my age target zone for cardio reasons, but what about tension for building strength and endurance?

I am 9 weeks post-op, and I ride every day between 1 to 1.5 hours. I make the point of pushing the tension to the point where I am exhausted when done. I do not drop below 80 RPM at any point during my ride.

My PT said there is no problem with this, but she does not seem to be a believer in the bike as you are. Do you see a problem with riding this hard? Should there be less tension and more RPM, or am I on the right track? So far, my leg is regaining size, strength, and this is my daily fix for keeping my knee feeling good. Even one day without the bike and my knee is stiff like you would not believe. Thanks.

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Riding this hard will pay great dividends when you return to MX

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For the bike, do you recommend flat pedals or being clipped in? I was thinking clips would be best because I would be spinning and also pulling up instead of mashing the pedals.

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clip in pedals are better than cages, which are better than nothing.

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Good to know. So, basically, you cannot ride too hard for rehab sake, correct?

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unless you get hit by a pickup truck, you can't tear your acl on a bike.

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I pulled my ACL snowboarding and the biggest pain was to try to lift my leg so the back of my foot touches my ass. I didn't tear it but I could barely walk. And its been about 5-6 months andwhen I twist my leg I feel a popping sound. Does anyone know about this?

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That popping sound is also a knee cartlage (meniscal) tear. You need to consider getting that fixed.

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Dr Mark,

I also had an ACL tear and replacement. My knee never swelled at all or turned blue. Why?

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I guess you were lucky. Most people have considerable black and blue after ACL surgery, although not as bad as a typical bad get off.

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