Climbing after acl reconstruction?

Looking for dos and don’ts of returning to climbing after ACL reconstruction. I am 3 months post surgery. Thinking maybe I can something easy in the gym. What were you able to do and when?

I'm also at 3 months and looking forward to the responses. I have an appt with my OS on 7/9, so was going to ask about easy gym toproping.

How are you feeling?

I don't recall when I first went back to the gym, but I was in no rush.  I did all kinds of rehab, but found hiking to be the most effective of all.  I began on the grounds of a local mansion that has trails that are wooded and hilly, but allow for loops under 2 miles, so I was never all that far from being able to quit.  I used poles and have never stopped using them.  I started leading outdoor climbs after about 7 months.  I was 68 at the time...

I did a lot more than *just* my ACL (also LCL, both meniscuses, and popliteus...fun), so take this with a grain of salt but I was back in the gym with my brace on a couple months after I passed my sports test and was given the go-ahead to ski. Probably about month 11, but my recovery was a full 9-12 months. I found the most disconcerting piece of it to be the feeling of standing up on a somewhat twisted/misaligned knee. It was a weird/troubling feeling, but having the brace on made me realize all was good. Only wore it a few times while rope climbing before realizing I was good to go. Bouldering is hands-down the scarier bit and I find I still can't go particularly high without a brace on. Good luck on your recovery!

Torn my acl twice in the last 2 years.

First acl:
Was back climbing at ~ 4 months, really started to get after at ~5 months. Biggest issues were getting the head game back and heel hooking. Retorn 9 months in when bouldering in Yosemite. Didn't quite have the fast twitch muscles developed yet and knee went too far into flexion.

Second acl :
Currently 7 months out. Started climbing 3 months and started going hard (for me). Ended aggravating it on a climb which put me out for a week and then a month later really messed up my knee in zion. Still fighting back from that and haven't been climbing since.

Things I learned:
-4-5 month range was totally fine, even climbing after 3 month was fine if I wasn't trying to push it so hard.
-Really focus on rehabbing first. Once climbing starts again it gets harder and harder to go to the gym on a nice day and do clamshells.
-Rehab really is a multi year effort
-Never boulder.......

Best of luck !!

Also brat could I snag that climbing plan if possible?

Beware of some of these timetables if, like me, you had a cadaver (allo-) graft.  These actually get weaker before they get stronger and take longer to incorporate because they are not vascularized when grafted.  Also for any type of graft, in addition to regaining strength, there are losses in proprioception that make one more likely to stress the knee in a bad way.  It makes no sense to rush back too quickly and end up with a failed reconstruction.  It isn't simply a matter of doing it over again; changes in the joint from the first failure can complicate a second procedure.

The variation in the time it takes to return to full activity is very large, so it is a bad idea to model your behavior on anyone else's experience, especially since, according to some studies, half of athletes overestimate their readiness.  Quantifiable progress on various functional tests seems to be the best approach, but I don't think that even in this case the test results have statistically predictive validity.

As I said earlier, I don't recall when I went back to gym climbing, but I started easy outdoor leads at 7 months and the gym not all that much earlier.  My feeling is that a concerted focus on controlled and progressive rehab needs more than 3 months, no matter what you hear about people's return to climbing activities.  For athletes who anticipate cutting and pivoting activities, these often only start at 9 months.  I know a number of people who have returned to gym climbing in 3 months or so, all of them successfully,  but I think they rolled the dice with reinjury potential and their luck held out.

Since you are not---ahem---exactly young, all healing and rehabs generally takes longer.  If it was me (and it was six years ago) I wouldn't be back in a climbing gym 3 months post-op no matter what anyone says.

rgold wrote: Beware of some of these timetables if, like me, you had a cadaver (allo-) graft.  These actually get weaker before they get stronger and take longer to incorporate because they are not vascularized when grafted.  

This actually applies to autografts, as well. Around 2-3 months the tissue is revascularizing. Additionally, the old tendon is dying off and being replaced with new cells as it becomes a ligament. I've read reports that the graft is weakest around weeks 8-12, then build from there. I think I've seen as late as week 16 for the graft being super weak. Indeed, if you Google image search for "acl graft strength over time" you'll find all sorts of charts.

 Allografts do take longer to incorporate, but it's still largely the same process.

Will be following progress on this. I am just starting to read into ACL reconstruction options after an Injury on 6/9. Have met with three knee specialists all recommending variations of a BPTB procedure, on of which wants to take the graft from my good knee which Im skeptical about.

Surgery is scheduled next Tuesday with the one I liked most but starting to think I should slow the whole process down a bit and reschedule the surgery. Was given this diagnosis last week:

FINDINGS:
Meniscocapsular separation at the posterior body/horn junction of the medial meniscus.
The lateral meniscus is intact.

Torn anterior cruciate ligament. Intact posterior cruciate ligament.
Low-grade sprain of the medial collateral ligament.
Low-grade sprain of the fibular collateral ligament. The biceps and conjoined tendons are intact. Intact popliteus tendon. Mild edema surrounding the posterolateral corner ligaments concerning for posterolateral corner ligament injury. Iliotibial band is intact.
The quadriceps tendon and patellar ligament are intact.
The muscles and tendons of the pes anserinus group and semimembranosus are intact

Minimal chondral fibrillation along the inner aspects of the middle third of the medial femoral condyle. Patellofemoral and lateral compartment cartilage is intact.
Small knee joint effusion without significant synovitis.

Small impaction fracture along the posterior lateral tibial plateau with 3 mm of cortical depression. Small impaction fracture along the posteromedial tibial plateau with 2 mm of cortical depression. Low-level edema along the superior tip of the fibular head.

Thanks, everyone, for your (cautionary) recovery stories! My recovery has been so challanging for me that my highest priority at this point is not re-injuring.  

A couple things happened since my original post, which, if it happened just prior, I would not even been asking the question. One is that I subluxed the hip on the affected leg just putting on a shoe, hahaha. This is how weak that leg is now. I had to scale down the PT enough to realize I should not consider climbing yet. I also had a visit with the OS who cleared me for biking but not climbing. Said to wait 2 months until my 5 months follow up. My PT, who is a gym climber, said that there is too much play in the brace to rely on it holding the joint in place. It has to be the muscle.

Also, my OS disagrees with the above statements on the timing and strength of the graft (he means autograft). He claims that at 3 months the new ACL is as strong as the original and stronger than original in 6 months.  

Beth Caughran wrote: I'm also at 3 months and looking forward to the responses. I have an appt with my OS on 7/9, so was going to ask about easy gym toproping.

How are you feeling?

Hi Beth,

Prior to hip incident, I thought I was doing reasonably well.  I stopped by at the climgin gym and tried some easy routes unroped just to see if I can do it. I was easier than I expected. I am walking without the brace. Flexion is almost normal but extension only goes to zero degrees (I normally hyperextend to about -10). So my gait is still off due to the difference in that between the two legs. I am handling uneven and slanted surfaces much better. I have managed to swim and kayak for the first time a week ago. I am hoping to do some easy hiking tomorrow. I am not yet sure if I can bike. Just really uncertain about stopping but I think I am close. 

What about your progress?

normajean wrote:

Hi Beth,

Prior to hip incident, I thought I was doing reasonably well.  I stopped by at the climgin gym and tried some easy routes unroped just to see if I can do it. I was easier than I expected. I am walking without the brace. Flexion is almost normal but extension only goes to zero degrees (I normally hyperextend to about -10). So my gait is still off due to the difference in that between the two legs. I am handling uneven and slanted surfaces much better. I have managed to swim and kayak for the first time a week ago. I am hoping to do some easy hiking tomorrow. I am not yet sure if I can bike. Just really uncertain about stopping but I think I am close. 

What about your progress?

Oooh I'm jealous you're released to hiking and biking! I'm not allowed to do either per my protocol until 5mo for biking and 6mo for hiking. I've got normal extension (since pretty much week 2) and just recently got enough flexion to pull my heel to my butt. I can almost sit down on my heels; probably another few weeks. I'm mostly living in the gym - 30 mins on the recumbent with high intervals, upper body program, leg press, bulgarian split squats, one-legged deadlifts, then 2k of rowing. Getting discharged from PT in a week, since insurance cut me off. Very anxious about starting running progression without supervision. Also, I have to wear a sport brace for 1 year, which is annoying. Just my OS' protocol. I don't wear it in the house.

Beth Caughran wrote:

Oooh I'm jealous you're released to hiking and biking! I'm not allowed to do either per my protocol until 5mo for biking and 6mo for hiking. I've got normal extension (since pretty much week 2) and just recently got enough flexion to pull my heel to my butt. I can almost sit down on my heels; probably another few weeks. I'm mostly living in the gym - 30 mins on the recumbent with high intervals, upper body program, leg press, bulgarian split squats, one-legged deadlifts, then 2k of rowing. Getting discharged from PT in a week, since insurance cut me off. Very anxious about starting running progression without supervision. Also, I have to wear a sport brace for 1 year, which is annoying. Just my OS' protocol. I don't wear it in the house.

Wow: 5 months for biking and 6 months for hiking! Is he super cautious or just aware of what your hiking and biking may look like? My OS was clear about no MTB.  

I went on my first hike this morning and did 2 miles on a pretty uneven and rocky terrain. It was definitely not my ideal for the first hike but I was super slow and cautious so I did really well. It seems that my proprioceptive feedback just turned back on. Two weeks ago still had issues walking across a slanted driveway. 

Your gym program sounds great! Makes me want to kick mine up into the next gear. I’ve been wondering when my PT would stop. It seems that now is too early. 

normajean wrote:

Wow: 5 months for biking and 6 months for hiking! Is he super cautious or just aware of what your hiking and biking may look like? My OS was clear about no MTB.  

I went on my first hike this morning and did 2 miles on a pretty uneven and rocky terrain. It was definitely not my ideal for the first hike but I was super slow and cautious so I did really well. It seems that my proprioceptive feedback just turned back on. Two weeks ago still had issues walking across a slanted driveway. 

Your gym program sounds great! Makes me want to kick mine up into the next gear. I’ve been wondering when my PT would stop. It seems that now is too early. 

I think my OS is relatively conservative. But, I've a few friends who have gone to him and they've all had very successful recoveries, so I tend to listen to what he tells me! 

Glad you got out hiking today! I am very jealous, but at least I'll be returning in time for Colorado's fall color season.

Beth Caughran wrote:

I think my OS is relatively conservative. But, I've a few friends who have gone to him and they've all had very successful recoveries, so I tend to listen to what he tells me! 

Glad you got out hiking today! I am very jealous, but at least I'll be returning in time for Colorado's fall color season.

I’ll trade Pennsylvania hiking for Colorado any day! Definitely a good idea to listen to the doc. Good luck with your recovery! 

Bumping the thread to give an update, in case anyone in the future is searching (like I have, through just about every ACL thread ever posted).

I saw my surgeon today. This coming Thursday will be 16 weeks since I had my BPTB graft. Although I'm doing very well, he will not release me to climbing, even in the gym. The guy has a biomechanics PhD on top of his MD, so I'm doubly inclined to listen to his advice. Reasoning being, that I need to build more strength before returning to sport. Going in with a weak quad will put excessive strain on the graft, which is still ligamentizing.

Here's a pretty good rundown of guidelines for RTS, as well as injury rates when the contralateral and operative quads differ in strength: https://theprehabguys.com/how-do-i-know-when-i-am-ready-to-play-again-return-to-sport-testing-for-athletes-following-acl-reconstruction-surgery/ 

Mid-October will put me about 6.5 months out from my surgery. That's when I'll have a sport test with the PTs at Howard Head, followed by an appt with my ortho to evaluate whether I can return to climbing, including ice climbing, trekking, and glacier mountaineering. Trying to keep my eye on the prize is really difficult, especially during the summertime when most of my friends are summiting cool peaks and climbing every other day. But it's all about optimal results, and being able to do my sports for as long as I'm able.

My new "outdoor activity" has been walking well-kept dirt roads and collecting trash, which seems hunky-dory.

Thanks for the update Beth. Kinda bummer on the climbing but based on my reading he is well within the norms with his decision. I'm sure top roping would be fine until you make that 1% of movement that is not ok.

I am now 6 days post-op BPTB. Big news for me is some reduced swelling (grapefruit vs volleyball) and that I can knock out aroung 15 leg lifts at a time though not 100% straight. Still have not tried walking but looks like that is on some peoples agenda at this point.

Did you wear an adjustable ROM knee brace when you started walking?

Beth Caughran wrote: 

My new "outdoor activity" has been walking well-kept dirt roads and collecting trash, which seems hunky-dory.

I'm 14 weeks out today. I've been road running ("running"). the other day I was on a family friend trip with my boyfriend and we "hiked" to a lake at a ski resort. It was maybe a mile to two miles out and back. I forgot my sticks. I was so slow, and incredibly freaked out. I knew it wasn't a great idea but he helped me through the worst part because I NEVER WANT TO TEAR MY ACL AGAIN. Holy smokes this has been quite the experience. I could have stayed home, but I'm about to lose my mind. Just started riding the bike outside, except now with the heat wave in SLC I'm back on the trainer inside. 

In the beginning i was eager to run and climb. Now I'm happy to be road biking and running and have stopped asking about climbing. This recovery is a marathon, not a sprint, and I literally have to say that out loud to myself like every day.

Can't wait to TR those plastic 5.8s. :) 

Parker H wrote: Thanks for the update Beth. Kinda bummer on the climbing but based on my reading he is well within the norms with his decision. I'm sure top roping would be fine until you make that 1% of movement that is not ok.

I am now 6 days post-op BPTB. Big news for me is some reduced swelling (grapefruit vs volleyball) and that I can knock out aroung 15 leg lifts at a time though not 100% straight. Still have not tried walking but looks like that is on some peoples agenda at this point.

Did you wear an adjustable ROM knee brace when you started walking?

Yeah, it's fine until it's not! I'm ok with doing what doc says. How often in adulthood do we have someone that says, "Here, this is what you need to do and for how long. Now do the thing."? It's a little refreshing, in a way! 

Glad to hear your swelling is going down and you're cranking out the SLRs!! I was not walking at 6 days but I was "weight bearing as tolerated". Took me about 5 weeks to get off both crutches. By week 7/8, I was motoring around real good.

My OS prescribed me a brace before my surgery, actually. Initially, I saw an ortho here in Colorado Springs, who had me wear a neoprene brace with a hinged metal bar in it. I broke that puppy in about a week. The brace I got at Steadman is the Ossur CTi. Very supportive, but not quite enough to prop me up at work (I'm a cook) before I had the operation. I have to wear it for one year post-op. I don't wear it in my house, but I do wear it basically everywhere else. It seems like a good design.

Also, feel free to DM me anytime during your recovery, if you need someone to talk to. I've experienced so many weird sensations and had all sorts of interesting existential crises.

Good luck on your continued recovery!

sclair wrote:

I'm 14 weeks out today. I've been road running ("running"). the other day I was on a family friend trip with my boyfriend and we "hiked" to a lake at a ski resort. It was maybe a mile to two miles out and back. I forgot my sticks. I was so slow, and incredibly freaked out. I knew it wasn't a great idea but he helped me through the worst part because I NEVER WANT TO TEAR MY ACL AGAIN. Holy smokes this has been quite the experience. I could have stayed home, but I'm about to lose my mind. Just started riding the bike outside, except now with the heat wave in SLC I'm back on the trainer inside. 

In the beginning i was eager to run and climb. Now I'm happy to be road biking and running and have stopped asking about climbing. This recovery is a marathon, not a sprint, and I literally have to say that out loud to myself like every day.

Can't wait to TR those plastic 5.8s. :) 

Oh man. I know all these feels so much. If I go by my protocol matrix, I'm technically cleared to begin running on Thursday. But, I think I'll delay a few weeks to get stronger, as much as I was looking forward to it. I sooo know how you feel about losing your mind! I keep telling myself that I "get" to go work out in the gym, where there's air conditioning, and all my poor, sucker friends have to suffer in the heat. Ha ha. 

Man, what I wouldn't give for some plastic 5.2s even, at this point! Best wishes for your health! Feel free to DM if you want to chat.

Beth Caughran wrote: Bumping the thread to give an update, in case anyone in the future is searching (like I have, through just about every ACL thread ever posted).

I saw my surgeon today. This coming Thursday will be 16 weeks since I had my BPTB graft. Although I'm doing very well, he will not release me to climbing, even in the gym. The guy has a biomechanics PhD on top of his MD, so I'm doubly inclined to listen to his advice. Reasoning being, that I need to build more strength before returning to sport. Going in with a weak quad will put excessive strain on the graft, which is still ligamentizing.

Here's a pretty good rundown of guidelines for RTS, as well as injury rates when the contralateral and operative quads differ in strength: https://theprehabguys.com/how-do-i-know-when-i-am-ready-to-play-again-return-to-sport-testing-for-athletes-following-acl-reconstruction-surgery/ 

Mid-October will put me about 6.5 months out from my surgery. That's when I'll have a sport test with the PTs at Howard Head, followed by an appt with my ortho to evaluate whether I can return to climbing, including ice climbing, trekking, and glacier mountaineering. Trying to keep my eye on the prize is really difficult, especially during the summertime when most of my friends are summiting cool peaks and climbing every other day. But it's all about optimal results, and being able to do my sports for as long as I'm able.

My new "outdoor activity" has been walking well-kept dirt roads and collecting trash, which seems hunky-dory.

Thank you for posting the link. Lots of great info and stats.

sclair wrote:

I'm 14 weeks out today. I've been road running ("running"). the other day I was on a family friend trip with my boyfriend and we "hiked" to a lake at a ski resort. It was maybe a mile to two miles out and back. I forgot my sticks. I was so slow, and incredibly freaked out. I knew it wasn't a great idea but he helped me through the worst part because I NEVER WANT TO TEAR MY ACL AGAIN...

In the beginning i was eager to run and climb. Now I'm happy to be road biking and running and have stopped asking about climbing.  

Exactly how I feel!