Pain in the groin

Warm-up:
dynamic squat stretching

1x3 low-bar back squat (45x5, 95x5, 135x3, 155x2 then 3x185[f3])
4x5 front squat (45, 65, 95, 115)

1x15 shoulder press (45)

Pulled left hip flexor (from about 6 weeks ago) still really painful at the bottom of squats, tried switching to front squats for the narrower stance but still tweaks going into and coming out of the hole. Gonna lay off all squats for a few weeks, and roll back in slowly starting with front squats.

Guess it's a good time to get in some running and climbing technique work.

Slow and steady, perhaps

Warm-up:
single-unders
dynamic squat stretching

5x5 bench press (45x5, 65x5 then 95, 115, 125, 135, 145)
4x5 low-bar back squat (95x5, 135x5 then 185, 205, 225, 245[dna 5])

Still recovering through the tail end of a virus that kept me out of the gym the last week and a half, so took it easy today. Bench felt nice and steady, only mild twinges in the right shoulder - should have been able to up 155 or so easy. Squats were allright, but felt something tweak in my left hip on the 2nd rep and opted out of the last squat. Feels okay now but better safe than sorry.

Am going to switch over into more conditioning work, in addition to the basic lifts.

Profundus

Warm-up:
burpees, situps
dynamic squat stretching

3 rounds (95# bar):
6 deadlifts
6 barbell rows
6 hang power cleans
6 thrusters
6 pushups

Ran through a few rounds of a complex posted up at CF Sunnyvale, untimed as I haven't replaced my watch yet. Right forearm strain still tweaky, so didn't push it - HPCs in particular tend to be problematic.

Quick anatomy lesson: the flexor digitorum profundus controls finger flexion at the distal interphalangeal (DIP) joint, while the flexor digitorum superficialis handles flexion at the more proximal PIP. I'm pretty sure I have a profundus strain, as ring finger PIP flexion is fine but DIP flexion produces pain in the mid-forearm, near where the tendon inserts into the muscle.



Rest is really the only treatment, so I'm avoiding climbing for a few weeks (sorry, G).

Warm-up:
tons of front & back squats w/ bar
good mornings
foam rolling

3x5 floor press (155)
17-10-9 max rep pullups (~1 min rest between sets)

Tweaked mid-back last week cleaning, so I just wanted to move things around today.

My finger

Hey, so it's been awhile since I've posted on here and wanted to give everyone an update on what happened with the finger. I had a bone growth coming off the most distal joint of the left index finger. It was around for six months or so, and then it started hurting after workouts that used any sort of grip. At first it was just deadlifts, but eventually it included pull-ups and any barbell oriented workout. So, I got it x-rayed and it turned out to be some sort of calcified mass attached to the bone. I had it excised a week ago and just got the biopsy report today.

The mass was: Tenosynovium tissue with Fibrocartilaginous Metaplasia and Calcifications

Doc said a few things about the diagnosis, but the interesting thing he mentioned was that this sort of reaction (spontaneous bone growth at the joints) may be caused by joint stress. I'm mentioning this because I think it has to do with the way I held the bar when doing deadlifts. Towards the end of a set of deadlifts with a normal grip, The bar would slip down my fingers until it was literally being held up by the most distal joints on my fingers. I'm guessing that this was the main source of stress to the joints. So, be careful when you do those deadlifts that you've got a full grip on the bar and you aren't just holding it with the tips of your fingers!

That aside, I just got my splint taken off today. I can't properly bend the finger just yet (and I've still got some stitches in it) but I should be able to start some basic squatting soon. Man, I've been missing it. Anyway, that about wraps it up.

Damn Knee

Haven't done any gym work worth mentioning for awhile. My knee has been really killing me the last few weeks; anytime I drop to just above parallel there's an awful pain inside my right knee. It's been about two weeks already, and if it doesn't get better in another week I might consider getting it scanned or something. Maybe the problem is that I'm not working it though. I've signed up for some basketball tonight so we'll see if that mitigates or exacerbates my problem.

ACL Reconstruction

Mark arrived at my door today to announce that he wanted to join the ACL surgery club and had therefor gone and torn his ACL during a rousing game of football (that's soccer to the ignorant Americans). So, in light of this I went to look for the review articles I had read on ACL reconstruction and found that since my surgery a complete review issue was released by Clinics in Sports Medicine. I've included the important articles from that first, as it's the most recent source. But I will start by pointing out that it is clear from my reading that surgeons have their preferred methods and sometimes the conclusions drawn form the data are, by and large, opinion applied to completely inconclusive results. While I did not read any outright contradictions of the data—there was considerable wiggle room used in interpretation.

I will summarize my reading of the articles here and then group the articles by topic and relevance. I haven't read all of these articles as I couldn't find my original list and I read a bunch of them on paper hand haven't confirmed which was which.

First, Bone-Patellar-Bone autograft reconstructions are the oldest and probably the best under most valid statistical measures of knee function recovery but have the highest rate of associated long term post-surgery (anterior) knee pain. This anterior knee pain can also slow recovery as the time to full knee mobility is highly correlated with recovery time and the extra pain associated with the BPB autograft increases this time. Further, all the recent reviews I read suggested that the current generation of alternative allo and auto grafts had statistically indistinguishable results from the BPB autograft, though at least two meta-analyses showed at least one measure that was statistical better for each of the primary auto-grafts (PBP and hamstring) and the allograft comparisons appear to be the same. The primary worry cited in the allograft comparisons is the small (order ~1:400,000 chance) that you will receive an infection from the allograft and in one report I found the median surgical infection rate for this category is 0.36% suggesting that this should probably not be a primary concern (Am J Infect Control 31 (2003)). The other concern is a very small rate of rejection due to improper treatment but the rates were similarly very low (~1:100,000 if I remember correctly). There is a major advantage to the allograft as it allows for faster transition into recovery (less additional trauma) and it can be harvested to maximize match between the grafts bio-physical characteristics and that of the native ACL. A recent class of surgeries appears to be destined to be the new gold standard: the double bundle reconstruction. This actually locates two separate graft attachment points on the femur and tibia. These dual bundle reconstructions appear to be capable of both better duplicating the natural ACLs construction and reducing rotational laxity—a problem with current grafts (but least with the BPB graft).

Below I am grouping and categorizing the reviews. I would remember that the graft comparison reviews (especially the conclusion/discussions) appear to be slightly biased towards the particular surgeons favorite technique.

Clinics in Sports Medicine Review Issue

• Clinical outcomes of allograft versus autograft in anterior cruciate ligament reconstruction
• Allograft safety in anterior cruciate ligament reconstruction
• Soft tissue allograft and double-bundle reconstruction
• Primary anterior cruciate ligament reconstruction using contralateral patellar tendon autograft
• Bone-patella tendon-bone autograft anterior cruciate ligament reconstruction
• Biology of autograft and allograft healing in anterior cruciate ligament reconstruction

Allo vs Auto Graft

• Allografts in the treatment of anterior cruciate ligament injuries
• Should allografts be used for routine anterior cruciate ligament reconstructions?
• Anterior cruciate ligament reconstruction: allograft versus autograft

Additional ACL Surgery Procedures

• Cryotherapy after ACL reconstruction: a meta-analysis
• Bracing after ACL reconstruction: a systematic review

ACL Graft Comparisions

(Orrin Sherman's review first)

• Anterior cruciate ligament reconstruction: which graft is best?
• A comparison of autogenous patellar tendon and hamstring tendon grafts for anterior cruciate ligament reconstruction
• Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis
• Anterior cruciate ligament reconstruction, hamstring versus bone-patella tendon-bone grafts: a systematic literature review of outcome from surgery
• ACL reconstruction: a meta-analysis of functional scores
• Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft
• Hamstring tendon autograft better than bone patellar-tendon bone autograft in ACL reconstruction: a cumulative meta-analysis and clinically relevant sensitivity analysis applied to a previously published analysis

Structure, Double Strand and Partial Tear

• Partial rupture of the anterior cruciate ligament
• Review article: anatomic double bundle anterior cruciate ligament reconstruction
• Anterior cruciate ligament anatomy and function relating to anatomical reconstruction

One Nasty Complication of BPB Grafts

• Indirect patella fractures following ACL reconstruction: a review

Injury Fate and Recovery Rates

• Fate of the anterior cruciate ligament-injured knee
• Return to play after anterior cruciate ligament reconstruction
• A review of ski injuries resulting in combined injury to the anterior cruciate ligament and medial collateral ligaments

Pulling and pulleys

Bouldering and toproping at Palladium today. Everybody's technique is coming along well, I can see how body positioning is coming to the fore as ED, BL, and SS increase the amount of static moves, careful feet placement, and efficient pulls. For a great review of technique, check out Eric Horst's site.

Popped the middle finger on my left hand holding a static crimp, my guess is it's a pull of the A2 pulley, maybe a partial tear but not a rupture. RICE and laying off climbing for a few weeks should help - just in time for JTree! As you're climbing more, it's good to keep an eye on finger issues - it's the most common climbing-related injury. Good general information in this article and this thread.

A lot of climbers tape their fingers, but the evidence that it helps is equivocal. One study that looked at cadaveric hands found that taping adds no strength to intact pulleys, and some suggest that taping prevents your soft tissues from gaining strength. Caveat though - partially torn pulleys could well use the additional support under load. UPDATE: great find by Brian of a study by a German group suggesting that taping with pressure applied over the PIP joint is more effective for A2 injuries.

Bonus: here's a discussion of the alternative belay method Brian was talking about. In the end, use what you feel most comfortable with - and don't drop me (or anyone else)!

Stretching and Kneading

PT today was, again, really good for the hip-flexor and IT band. The IT band has what feel almost like 'knots' in places it definitely stretches and feels more mobile after the work. The hip-flexor stretch is just really good.

10min elliptical
Calf stretches and raises
Step downs 3x10
Karaoke 4x20m
Laterals 4x20m
Squat jumps 3x20
One leg hops (left) 3x10
Adductor 3x10 @ 90#
Contra kicks four ways, balance pad, 3x10 @ 10#
Left leg lunge (bozu)
Left leg wall ball supported squat

Hip feels more flexible and the patella is gliding better. Been told to lay off the leg work for a couple of days, so I guess it's upper body and core for a bit.

Crazy PT

I switched to one of the other PTs who I've been working with. She is a professional body builder and has the strength to really stretch my hip flexor and get into my IT band.

10min elliptical
adductor 3x10 @ 140#

left leg isolated work, 3x10:
leg raise @ 40
leg press @ 130
leg curl @ 2x45#,1x40#

3x10 step down
calf stretches
left leg lunge (bozu)
one leg wall ball supported squats
contra kicks 4 ways, 3x10 @ 10#

karaoke 4x20m
laterals 4x20m

squat jumps 3x20 for speed
one leg hops 3x10

foam roller for IT band 2min

The PT really got into my IT band and smoothed it out. It felt like getting rid of knots in a tight muscle. Then she really opened up the hip flexor! It was like having a new leg (or at least hip join) afterwards! Felt good. But the whole thing was tiring...

PoTential

Simple but good PT today.

5min forward elliptical/5min reverse
IT band rolling + PT work on patella mobility, IT band and hip flexor
3x10 one leg hopping
3x10 step-downs
3x20 squat jumps
3x10 one leg leg press @ #90
3x10 lunge (Bosu)
3x10 one leg wall-supported squat
3x10 (four ways) opposition kicks

Knee felt better today, which I attribute to the stretching in yoga and by the PT. Now that I'm allowed, time to really build muscle--but only if I can keep up the stretching. My hip flexors and IT band are still super tight.

Knee Recovery Review

I had a followup appointment today with the surgeon (actually a Fellow who was his assistant) and he declared the knee tight and the reconstructed ACL strong. The left quad is still less than 80% of the right quad and that is one of the markers that can keep me from full activity (specifically long runs, cutting and twisting--so no serious Aikido yet). But, I should be able to close that gap in the next month or two at the most. I can do everything else now and should work on quad, hamstring and calf strength... so more squatting is definitely in the cards. Also, yoga is a definite go. The PT road may be coming to an end soon.

A Little Hopping PT

10min treadmill 7@4.5mph, 3@6mph
Squat Jumps 3x20
Karaoke 6x3m
Laterals 6x3m
One Leg Hopping 3x10
Step Excercise (Speed/Agility Training) 3x1min
Step Jumps 3x1min
Step Downs
1 Leg Calf Raise @ #120
Abductor 2x10 #180, 1x10 #120
Lunge (Bosu) 3x10
One Leg Squat (Wall Ball Supported) 3x10
Two Leg Squat (Wall Ball Supported, Bosu) 3x10
Contra-Kicks (Ballance Foam) on Cable System #7.5 3x10 all four directions
IT Band Rolling

Bending the Knee in PT

So I told my PT that I had done 400m of walking lunges and did she keep me from doing lunges? No! But, she did allow me to skip the crazy jumping--which would probably have been bad.

10min fast walk on the treadmill with 3 min jogging
5min rolling the IT band
2x10 calf raises
3x10 back lunges
4x10m sideways run
3x10 Tensor Fascia (with green Theraband), both sides
3x10 one-leg wall-squat
3x10 gel balancing with leg extension

I was told that I really need to focus on technique when I do exercises to keep the pelvis aligned and even engagement of the leg muscles. (Mostly to reduce the tightening of the IT band and hip flexor as well as engaging the glutes more.) She did a lot of stretching work on the lateral fascia today--attempting to allow the patella to float more freely. All in all another vote the get back to yoga.

Blasted post vacation with PT

10min treadmill at 4.7mph with a brief jog

wall supported squats on the DOSU 3x10

Balancing on gel with Straigt-leg pull 3x10 four ways

Backward Lunges 3x10

Jogging and jumping on trampoline 2x30s each

Jump as high and hard as you can for 20s x3

Calf raises

I was out of shape or the jumping was more brutal that I remember. I just was hitting muscle exhaustion at the end of each set and she was yelling 'keep going!' Lots of stretching and lifting to do this week to catch up.

Jumping for PT

Today they had me really working my use of stabilizers and working deceleration with the knee.

10min treadmill @ 3.6mph
5min foam rolling for IT band
3x60s jogging on the mini trampoline
3x60s jumping on the mini trampoline
3x10 front sliding lunges (uses a cool PT torture foot-slider thing... really made you work)
3x10 back sliding lunges (using cool PT torture foot-slider)
3x10 heel step-down (basically stand on a platform with one foot and slowly lower the other heel to the ground keeping body straight... this also really showed my knee weakness off)

3x10s high jump-fast as possible
4x30m sideways walking

Amazing how different the heel step-downs were. Oh, and my hip-flexor was super tight today.

Burpees! (ok, not really... but Jumping PT!)

So, I'm on my own for weights now. And were now at the point where I can consider Bikram Yoga!

10min treadmill @ 3.2mph (a fast walk, almost jog)

Fast as possible high jumps!! 3x10s
Cross leg sidewalking (4x~30m)
Wall supported squats on BOSU ball 3x10
Back lunge 3x10
Standing leg extensions on gel with balance pushes (theraband) 3x10, four ways

They did some mobilization and my patella is better as is my IT band, but they suggested that I should really just get a foam roller to constantly work on it. Given that Kenway clearly will be regularly needing it for his lower back, perhaps I'll get on for the lab... And I was jumping. Felt odd. Actually they wanted me to do fast-as-possible for 20s but I was to hesitant about landing on the knee. Lots of protective instincts have been built up. Felt good throughout though, so a milestone non the less.

So, boys, when do you want to do a Bikram Class? It's been hot and humid enough out that you should be physically prepared... and I'll ask about doing light weight thrusters/pushpress for next week if this weeks jumping is ok. Seems like those shouldn't load the kneed any more.

And now for something completely different: PT

10min stationary bike @ L9, 90RPM

IT band stretch using foam roller

Leg extensions 3x10 45#
Leg press 3x10 130#
Leg adductor 3x10 80#
Leg abductor 3x10 80#
Knee raise 3x10 80#
Hamstring curl 3x10 50#

Wall/ball supported squats 3x10 with elastic between knees standing on BOSU
Backward lunges 3x10
Gel balancing with straight leg raises (theroband)

Lots of mobility work today and stretching again. I have noticeably greater flexion than a few weeks ago, but the improvement is slowing (as you'd expect). The last few degrees are going to take a while. Doing the squats on the BOSU was interesting. This is all about getting me to use my stabilizers and improve balance. They have told me I'll be starting things like jogging on the treadmill next week...

Oh, Whee PT!

10min stationary bike @ L9, 90RPM

IT band stretch using foam roller

Leg extensions 3x10 45#
Leg press 3x10 130#
Leg adductor 3x10 80#
Leg abductor 3x10 80#
Knee raise 3x10 80#
Hamstring curl 3x10 50#

Wall/ball supported squats 3x10 with elastic between knees
Backward lunges 3x10
Gel balancing with straight leg extensions (theraband)

Lying straight leg raise (4 ways) 3x10 5#

The straight leg raises (while lying down) really get harder with an extra pound. Felt better all around today, but the balancing is more difficult now (they are making me take my shoes off).

PT When Slow

10min stationary bike @ L9, 90RPM

IT band stretch using foam roller

Leg extensions 3x10 45#
Leg press 3x10 120#
Leg adductor 3x10 70#
Leg abductor 3x10 70#
Knee raise 3x10 70#
Hamstring curl 3x10 50#

Wall/ball supported squats 3x10 with elastic between knees
Backward lunges 3x10
Balancing on gel will doing straight leg extensions (with theroband)

Definitely felt being ill today. More stretching, especially working on maintaining lateral movement of the patella. They are worried about asymmetrical tension on the knee and especially the patella creating problems down the road.