[Wellsy]

I want to keep a track of this for a few reasons. I posted in NNFN but essentially fell at Stanage, landed badly, knee seemed to hyperextend maybe? And just gave out. Agonising pain for a minute or so, tried to walk, leg collapsed at a certain angle, carried off the crag. Got to A&E; no break and seemingly fucked the LCL although to what extent as yet unknown. Cannot walk, in crutches. Painful and swollen.

So that's the situation. My reasons are;

1) gives me a space to get my thoughts written and together

2) provides me with a narrative of what's happened

3) will keep me honest and maybe people will have useful tips and info

4) it may be of use to others in future.

A few things to say here; I am going to dedicate myself to overcoming this, and I will. And I will do 8A one day, that hasn't changed. I'll also make myself ideally much more injury resistant in the meantime, but I intend to use this time to get stronger in the upper body as well.

So anyway yeah. Day 1. Leg is very swollen and cannot be straightened or foot placed flat on the floor. Painful but low on the scale. However the knee has noticeably more resistance against collapsing in the weak angle, I can actually feel something trying to stop it just falling out from under me. So that's positive as yesterday it was just a dead lump.

[abarro81]

Sorry to hear that. Have you got an MRI booked in? Having heard how long it has taken some people to get one on the NHS (vs in Germany where my wife got one in 2 days after hurting her MCL while we were on a trip) it may be worth considering paying to go private to get one quick if you can afford to...

[Wellsy]

I'm going to the Sheffield Climbing Clinic this week and if they refer me to get a scan I'll definitely look into getting a private one done.

[cheque]

My other half had an NHS MRI last week, four days after her injury. That was in the process of deciding what the best course of action was to treat her displaced tibia break though (ligaments fine luckily) so you may not get that level of service if it’s just the ligaments.

Progress within 24 hours is surely a good sign.

Bear in mind you’ll go through something resembling the five stages of grief in the days following a debilitating injury. Look after yourself.

[Fiend]

And I will do 8A one day, that hasn't changed.

Tempted to boycott this thread for that soulless numerical insta-ambition 

But....brain dump incoming:

LCL sprain / tear:

The LCL seems mechanically fairly simple, it just sits there, stopping the knee bowing outwards, waiting to be injured mostly by sheer bad luck. Yours (grade 2 partial tear?) sounds a lot worse than mine (grade 1 sprain?), but then again you're young and don't have vascular issues so will probably heal a lot quicker regardless.

Go see a physio shortly. If there's lots of swelling maybe wait for that to die down, otherwise ASAP.  The test for LCL injuries is really simple - google LCL tear test for a cheery indication of how it can manifest itself (this put the fear of god into me hence being extra careful in the last 3 months). The physio should be able to diagnose the grade.

Expect that there might be other stuff going on. If there's trauma in the area, other things might have got injured even minorly. The physio I saw ran through all the knee area tests (which were fine) leaving the LCL until last (which was obviously painful / weak on the test).


Acute care:

Expect the pain levels and functionality to go up and down like a fucking yo-yo. I could walk and even body squat on mine without pain when it happened BUT in the next few days I got more pain, bits of swelling, etc, and ended up hobbling more and avoiding squatting.

Get a knee brace. I got this one: https://www.physioroom.com/product/PhysioRoom_Advanced_Hinged_Knee_Brace_Wrap_Around_Knee_Support_for_Rehab_Pain_Relief/3113/38719.html , the only downside is that velcro is abrasive side in, so if it doesn't fit perfectly you might have to put a bit of finger tape around it to stop it rubbing. The brace can make my calf feel a bit achey after exercise from the pressure on it, BUT I found it very useful to give me confidence and a safety net when doing exercise.

Get a simple elastic knee support and wear it in bed so when you're thrashing around with a massive boner working towards ticking that magical 8A, it's there to remind you to treat it gently. I found I got a fair bit of aggravation in bed because the body is more relaxing and rolling over can allow the knee to droop and produce that must-avoid sideways stress.

Rest initially, obviously. I maybe went a little bit far on the rehab initially and had to back off a bit after a couple of weeks.


Leg rehab:

Ligaments are a bit annoying as they don't do much except provide support, so unlike tendons it's harder to steadily increase stress / load through them (eccentrics, slow heavy loading, blah blah) to heal them. There might be better science about this than I know but the protocol seemed to be: Use the area, gently at first, in very controlled, non-aggravational movements, to increase blood flow, stimulate healing in the area, and keep the surrounding muscles strong to provide additional stability.

Walking - was fine for me from the start, on the flat and for normal distances. Over a month or so I built it up to rougher terrain (with the knee brace for support / back-up), and I did find that that improved my rehab quite a bit, the knee would feel "worked" after some walks but better overall and subsequently. Obviously it's being guided by the severity of the injury and being careful not to aggravate it.

Running - you must be fucking kidding don't even think about it.

Cycling - might be possible but do you really want to give the last remnants of your soul away??

Gym membership - get one. Really useful (essential for me) for have a good choice of gentle / stable / controlled leg rehab options, as well as general conditioning. I did quad raises, hamstring curls, and leg presses on the machines, with light weights and very controlled, a few times a week. No it's not nearly as cool as deadlifting a car inside some grotty shed but the machines seem very "safe" for rehab in the right plane of movement.

Stretching - hope you didn't do much glute stretching because that will be impossible. Some general stretching will be fine, again the "simplicity" of the LCL should make it obvious what movements to avoid.


Arm stuff:

1. Don't jump right in to going too heavy on the arm exercises as compensation training.
2. - 10. See 1.
It's worth considering that firstly your body will be trying to heal a lower limb injury so might not want to spare resources / energy to keep niggles and tweaks at bay when you decide that fingerboarding 3 hours a day 6 days a week is the best way to get through this. And secondly you'll be changing your routine to include less climbing and more pure board / finger / arm training, so you'll have to adapt. It might be sensible to DECREASE the total training (including previous climbing) load for a couple of weeks then build it back up to normal, then increased levels.


Psychological stuff:

I'll just dump this here again as I'm getting lazy after the fucking essay above:

http://fiendophobia.blogspot.com/2021/11/strategies.html

I've found there are definitely limits to this but as a whippersnapper just getting into climbing with only the first (?) time-off-climbing, you hopefully will find it manageable after the initial shock.

Also....

Elden Ring just came out so that might get a fucking hammering.

As will your bumhole, on most bosses 

[Fultonius]

Shite news mate, knees are a nightmare.

If it's properly giving way, it's potentially a sign there's some other shit going on that just the LCL. ACL and/or postelateral corner (poplitiofubular ligament and other lesser bits of unnamed ligament nonsense) sound like they might be involved.

I smashed my PCL, PLC and LCL in a car crash about 12 years ago. Just starting to get some signs of mild arthritis behind my kneecap now but otherwise its been pretty solid after the surgery.

If I can give any recommendations: do all the physio (it sounds like this won't be an issue for you), try to find the best local knee specialist you can. Preferably one who does both private and NHS. Pay for the consultation (£120-£150ish) and then hope you can get transferred onto their NHS list, or get a recommendation from them of a good NHS surgeon. It'll be £10k plus if you need surgery privately.

You might be lucky and it's not too bad and you don't need surgery.

I did a blog while doing my rehab:

http://pcl-rehab.blogspot.com/?m=1

[Wellsy]

Thanks for all the kind words and advice

I should say at this stage I don't know how bad it is. It could be more than the LCL, and something could have snapped rather than torn or been pulled acutely. I don't know whether I'll need surgery or anything like that. I'm preparing myself for that possibility. It certainly seems bad. Hopefully at some point however it can get to the point of being fully or at least mostly usable for bouldering. I shall take it day by day in the meantime.

[mrjonathanr]

Wise. Hope you get some good news mate

[Moo]

This isn't the end of your climbing don't worry.

The amount it becomes useable for bouldering again is directly related to how much you enjoy bouldering.

[Wellsy]

That is encouraging, thank you

[Fiend]

The amount it becomes useable for bouldering again is directly related to how much you enjoy bouldering. the severity of the injury, the success of any surgery / rehab, your body's propensity to healing well, the amount and steadiness of physio / rehab you do, the care with which you regain full functionality, and an amount of luck.

Obviously Puntonious is your man for reference about getting back to bouldering after serious knee injury / reconstruction. I don't know about LCL yet as I'm been extra careful, but as far as my MCL tweak in 2020 goes, I was able to do normal bouldering after maybe 4 months, and after 5-6 months I was comfy taking some proper falls of reasonably meaty stuff without even thinking about it.

https://youtu.be/_Q3vjkTwkcI?t=62
https://youtu.be/Qpad6yhFZF4?t=8

^^^ timestamped dismounts were exactly 6 months after.

I've not had any problems since apart from the occasional very mild "old man" style ache if I've walked a lot on it.

Indoors, by carefully "front-pointing" and avoiding twisting, I could do low level stuff / sit-starts / board training to standing height much earlier. Except I couldn't because I'd fucked my elbow ofc 

[Moo]

I would echo what fiend said about overcompensating on the training front while your knee is injured. Everyone only has so much capacity for training / physio, so I’d prioritise getting healed first and then do anything else on top of that.

Just out of interest what did you fall off ?

[Wellsy]

Bullworker. A 6B I was trying as a warmup. Came off the top, fell badly, leg just twisted out and then it was just agony.

I'll be careful with resources but I absolutely must train. If I don't I'll go completely insane.

Also I should absolutely shout out to my mates Tom and Jack who literally carried me off the crag, drove me to A&E, were generally ace and sent me a get well soon food hamper today.

[Fiend]

Christ that's some bad luck, Bullworker finishes at tops out at just above head height 

No-one is saying don't train. We're saying "do train*, but don't immediately drastically increase the training load as compensation for being injured, when your body is healing another injury and you'll be switching to a different activity balance". Think how completely insane you'd feel if you popped an A2 or wrenched an elbow tendon as well... ...and yes we're nagging lol.

( * - actually, maintaining some of your standard training now would be sensible to avoid trying take any disproportionately large leaps from a too-low training base later on.)

Hope the food hamper was nice!

[Wellsy]

I need the nagging. I'm new to all this sort of thing! I will train. I trained today. But I'll take it easy

[Fultonius]

I initially thought I'd train loads, but getting the physio done and life just taking longer when in crutches etc. Meant there were long periods where I did less. One thing I found out was that one fingerboard session every 10 days seemed to keep any decline to a bare minimum.

Twice a week seemed to have small gains.

[moose]

I remember listening to a podcast on how fast we lose fitness (during the full lockdown, when exercise was limited to a walk from home).  It summarised lots of studies where some athletes were forced to take bed rest for months, while others were allowed limited exercise (e.g. by NASA to recreate the effects of space missions).  IIRC it concluded that while doing nothing was pretty calamitous, around 20% of normal training load significantly reduced decline - and that was for both endurance and strength sports.  Generally, after a long lay-off, you'll end up a fair bit worse, but it won't take much to come out of it at least a semblance of your former self and well placed to recover quickly. 

I think this was the podcast:

https://play.acast.com/s/realscienceofsport/fitnessadaptationandreversibility-howfastdowelosefitness-fitnessresilience.

[Wellsy]

Day 2 - morning

Swollen and a bit painful. Feeling slightly steadier using the leg (assisted with a crutch for safety) as long as it is aligned directly, any twist of the right toes out and the knee in feels like it would give out under weight immediately. Slept more soundly, although yesterday evening I was not doing well psychologically.

Not sure how much I trust about this assessment from Saturday. Going to make copious notes about pain locations etc for Friday.

Did a pullup session (3x5 weighted, 3x8 wide grip) and that made me feel a bit better.

[SA Chris]

I don't think any load bearing is a good idea at this stage, even as a "just testing"?

As someone who has had the whole gamut of assorted injuries, suggest you start thinking of a few other things you would like to do / try to do/ learn to do rather than "must train for climbing!".

[Wellsy]

I'm just going off the advice I got at the hospital which was to try and weight the leg and get used to using it as soon as. I will say that it's not painful and it definitely seems to help with stiffness and such to walk around a bit with a crutch to assist that leg.

But you do make a good point, and yes it's time to probably find other things to do sooner rather than later.

[Fiend]

https://ukbouldering.com/board/index.php/topic,31220.msg634634.html

This might be of use, especially the bits about sewing, and painting toy soldiers 

[SA Chris]

I did think of that thread..

[Wellsy]

Day 3 - feels better today though still unstable and weak. Swelling is almost gone. Keen at this point to know whether I'll need surgery, hopefully not. But definitely hurts a lot less and feels stronger than before.

[monkoffunk]

Just on the MRI thing, you will need one for sure, and it should be quite quick in NHS. I’m almost 6 weeks down from dislocated patella and had one within 4 weeks if injury, which is quite good considering that any surgery for me would be to prevent recurrence, and would have nothing to do with regaining functionality short term.

[Wellsy]

I've got an appointment with the knee clinic at Northern General in 3 weeks so hopefully that'll include a scan.