Integrative Health Approach to ACL Knee Surgery
/Integrative Health Approach to ACL Knee Surgery: Blending Western and Alternative Medicine for Optimal Recovery
As a health and wellness educator with an MA in Integrative health, I am always interested in supporting my body’s overall health and well-being - especially after surgery. After completing my second ACL surgery, and doing a lot of research, I realized that there was no comprehensive explanation of what to expect during the process of ACL / meniscus reconstruction, nor a reliable resource for complementary, alternative, and integrative care to support such a procedure. The following is a map of my recovery process, which includes:
Self-care practices following surgery that are supportive of your overall health and well-being
Tips on how to educate yourself based in medical professional experience, research, and self-knowledge.
A breakdown of things to expect before, during, and after surgery.
Suggestions on how to make the best of your surgery and have a healing experience.
A list of milestones to look forward to in your recovery process.
The following is based in a personal understanding of health and well-being. However, it is merely a guideline based on my own experience and does not take the place of medical advice. There is also no such thing as a standard recovery process. Your individual experience will depend on many factors and you should listen to your own body’s signals to know how to navigate your unique recovery process.
Preparing for Surgery: Empowerment, Education, Research, Health Insurance
Preparing for Surgery: Research & Education
Empowerment
With multiple procedures, constantly advancing knowledge, and a wide variety of experience levels, preferences, and capabilities amongst surgeons - it is important to be proactive in your research, questions, and requests during the process of receiving and recovering from knee surgery. Although it is a huge gift that there are surgeons who are able to perform ACL reconstruction procedures, that does not mean that every surgery has exactly the same (or long-term) result. Many western medical doctors may not be educated in the kinds of practices that can support your overall health and well-being during the time surrounding surgery. Stating your preferences and learning what is best for your body will be supported by a level of personal initiative in planning your surgery and recovery.
Necessity of Surgery
Some injuries can be healed through alternative means (prolotherapy, yoga, supplements), others require surgery. Do your research around the necessity of surgery.
Types of Procedures
If you ACL needs to be replaced, there are 3 common grafts that are used, which are either Autografts (from your own body) or an allograft (from a donor). The autografts come either from your hamstring or your patella. The allograft comes from the ACL of a cadaver. You would be benefitted by educating yourself about the various results and impacts of your choice of graft. Also research the source and processing type for an autograft. Depending on how they are treated, the allografts can be less desirable or, alternatively, may have an excess of chemicals. Ask others, read reputable / peer-reviewed journal articles, watch animated videos of the surgeries online, and speak with your surgeon.
Experience and Preference of Surgeon
It is a good idea to ask your surgeon how often they perform the particular type of knee surgery you are interested in. Some surgeons definitely have much more experience than others, especially for specific types of surgeries (i.e. patella graft or revision ACL surgeries).
Facility
Do some research into the safety, cleanliness, and reputation of the facility you are interested in using. Some facilities have higher rates of infection, for instance, speaking to their level of cleanliness.
Health Insurance We all know that navigating the insurance system can be very stressful. Try to give yourself plenty of time, it can take a long time to get calls returned and to get all of the answers you need. A few things to consider:
Finding out what is covered
Surgeon and facility and anaesthesiologist all need to be in network to receive in-network benefits.
Pre-authorization
Some insurance companies will pre-authorize your procedures, which can help you understand what will (and will not) be covered.
Staying organized: Keep notes about everything you and your insurance representatives discuss.
Surgery: What to Expect
Initial Visit
You will have an initial visit with 1 (or multiple surgeons) who will diagnose your knee
through palpation, x-rays, and MRI’s.
Intake Call
You will receive calls from the hospital and anaesthesiologist to ask you intake questions and health history.
Food & Drink
You will likely have specific parameters around food, drinking, and bathing prior to the surgery (e.g. I had to stop eating and drinking the day before the surgery, wash with a special cleanser - hibiclens, and no drinking alcohol, of course). You will likely be asked not to shave your legs and need to be careful not to cut your leg the week before surgery.
Pre-surgery Visit
You will meet with the surgeon on the day of surgery to ask any questions, confirm which knee will be operated on, etc.
During Surgery and Post-op
Surgery will likely last several hours. There will be several small incisions made around your knee. You will likely be wearing compression socks when you wake up, to help prevent excess swelling and blood clots, which you will likely wear for several weeks. You may have a drainage tube, collecting the blood around your knee.
Anaesthesia
You will receive anesthesia on the day of surgery. There are several types and procedures for this. Make sure that you keep track of what type you receive, for future reference. See more about anaesthesia below.
Follow-up Visits
This will be dependent on the surgeon, but may include 2 week, 4 week, and 2-3 month follow up visits.
Support
It is required that you have someone to drive you and take care of you immediately following surgery. I highly recommend that you find someone who will be very closely caring for you for at least one week after surgery, to help with cooking, bathing, keeping track of medication schedules, emotional support, etc.
Organization
It is important to take a lot of notes (or even record conversations) before and after the surgery. Stay organized, making a document to keep track of names of surgeons, contact information, appointment times, types of medication, medical opinions, etc. Using google docs helped me to keep everything in one place.
Day of Surgery: Making the Best of it
Anaesthesia
After my first surgery, I was terribly sick for the week following surgery, primarily because of the anaesthesia. On my second surgery, I received an IV of propaphal (without gas), and then a “block” which is more like local anaesthesia. I was much less nauseous the second time.
Stress and Anxiety
I suggest having a close friend or family member with you, enhancing your feeling of safety. You can also consider bringing guided meditations or soothing music into the hospital with you to listen to before you go under anaesthesia. You can download meditations on iTunes specific for pre-surgery.
Joy and Humor
You can still be creative, positive, and playful - even through a process of surgery! I suggest making something to give to the hospital staff (my mom and I made muffins) to make a personal connection and to slow people down (hospitals are commonly fast-paced and stressful, anything you can do to support the health and mental well-being of the staff will ultimately support you, especially when you are unconscious!). You may choose to have your family member film your strange utterances upon waking from anaesthesia, or paint your face, or whatever your unique expression may be!
Recovery & Self-Care
Medications: All prescription pain medication is likely to have at least some side effects and create a burden to your organs and tissues. My strategy was to minimize the use of painkillers, without creating so much pain that I could not sleep, function, or progress with my recovery goals.
Narcotics: I was on percocet (a narcotic) for the first 3 days, and tramadol (opiod) for 2 days after that. Then I switched to tylenol for a few days.
Anti-Nausea: I was also taking an anti-nausea pill along with the percocet and tramadol, which helped.
Tylenol: Tylenol is now well known to have a damaging impact on the liver, especially when taken in high doses or for long periods of time.
NAC: The supplement NAC is supposed to help support the health of the liver when taken concurrently with Tylenol. I aimed to minimize my tylenol use and use an alternative.
Side Effects
The side effects I experienced included nausea, itching, confusion, fatigue, hallucinations, spasms / myoclonic jerks, lack of appetite, and a sensitive stomach.
Length & Amount
I suggest taking as little prescription medication as possible. Not doubt, you will need it, however - you may find that you can wean yourself off of it much quicker than you (or the doctors) expect. Find a balance between managing your own pain and taking enough pain killers to be able to function and take care of yourself. I was only on prescription medications for about 5 days.
Alternative: Cannabis Tincture
I received my knee surgery in Colorado, where it is legal to purchase Cannabis. I found that using a small dose of Cannabis Tincture (an oil taken under the tongue) which was low in THC (the element that causes you to feel “euphoric”) and high in CBD (the element which is calming and pain-relieving), was as effective as tylenol without any of the side effects. I used it prior to sleep about 4 times and once a day for about 4 days after I stopped using the biomedical prescriptions.
Icing & Heating
Surgeons and Physical Therapists alike will encourage you to ice your knee liberally. Many alternative practitioners (e.g. Traditional Chinese Medicine) will also tell you that alternating icing and heating is advisable (after initial primary swelling has subsided, which is likely to me after 1-2 weeks). The heating is encouraged in addition to the icing to promote increased flow of new blood to the tissues, which is the primary way in which the body naturally supports healing.
Touch / Bodywork
Massaging the knee and the leg (or the whole body for that matter!) will help to: remove toxins, increase lymphatic flow, support circulation, relax tension, reduce pain, support nervous system function, reduce buildup of scar tissue, and raise awareness about the area. Therapeutic massage and other modalities (e.g. Rolfing and Trigger Point Massage) are very helpful post-surgery.
Natural Pain Creams
Using natural pain creams, such as Traumeel or homemade pain creams with essential oils (e.g. peppermint, wintergreen, balsam fir, copaiba, clove, tangerine) supports the tissues and encourages massage.
Movement
Although movement may feel like the last thing you can imagine doing, it is very supportive to your healing to move in whatever way feels safe to you (even if that is simply wiggling your toes! I was able to move many other parts of my body - supporting blood flow and pain reduction. Bending and straightening your leg is recommended as tolerated.
Physical Therapy
Not all PT’s are alike. Call ahead of time to research the experience level and style of
your physical therapist. Be sure that your physical therapist has the plan prescribed by
your surgeon. Passive range of motion activities will start soon after the day of
surgery. Quadricep and hamstring activation, as well as knee extension, are the
primary focus in initial recovery.
Chair Yoga & Yoga Therapy
Although most yoga classes offered today would NOT be appropriate for people post-surgically, there are some classes which are designed for this. Check to see if there are any in your area. Call ahead of time (or better yet, go to the class before your surgery to check it out) and speak with the teacher about the style of the class and their experience with post-surgical people. You should be doing very gentle poses, supported with a lot of props and modifications, primarily on the floor of in a chair. There are a number of gentle chair yoga videos online as well. Supporting the mobility of your hips, ankles, spine, pelvis, and shoulder joints will benefit overall healing and comfort.
Therapeutic Swimming Pools
You will need to wait until your incisions have closed to be submerged in water (which could be 3-4 weeks after surgery). You can also wear waterproof transparent bandages (e.g. Nexcare) after that time to keep incisions protected. Being in the pool can feel freeing after weeks of limited mobility. Your physical therapist can guide you towards the appropriate movements (which will be limited, such as walking with hand rail support and bending and straightening the knee).
Healthy Eating
Healthy eating is more important than ever when recovering from surgery. The following is a list of foods and drink I found ideal during recovery. Your immune system will likely be working overtime, so it is a good idea to support it.
Fresh, whole fruits and vegetables
Bone soup
Fresh juices with: beets, carrots, ginger, sea vegetables, apple, orange, kale, parsley, celery, lemon
Teas: Ginger Tea for Nausea, Natural Laxative Tea, Tummy Tamer Tea
Coconut Water (can loosen stools)
“Neutral” foods, such as foods with no spices, or bland foods such as gluten free macaroni and cheese
Natural Whole Foods Supplement, such as Vitamineral Greens or Green Vibrance
Collagen for join support
Meditation
Meditation is widely known to reduce stress and pain, calm the mind, support the function of the nervous and immune system, and aid in the healing process. Choosing to spend some of your recovery process paying attention to your breath or the sensations arising in your body (rather than watching movie after movie), can support you in responding to the needs of your body.
Optimal Healing Environment
Your environment has an impact on your recovery process, as well as your mental and emotional state. Consider these factors when designing your recovery environment:
Sunshine & Fresh Air
Pleasant noises
View of Nature or Plants
Calming smells, such as lavender or peppermint
Community support (asking your friends to send you love letters)
Joy and Humor: I suggest decorating your crutches. This shifts most interactions beyond sympathy to encouragement and positivity.
Detoxing from Anaesthesia & Medications
The following are ways that you can support your body in the detoxification process after surgery.
Castor Oil Packs
Lemon Essential Oil & Grapefruit Seed Extract (a few drops in water)
Ionic Foot Bath
Therapeutic massage (with an experienced practitioner)
Fresh, clean foods (no red meat, processed sugar, alcohol, corn, soy, processed foods, wheat, etc)
Acupuncture
Cooking with turmeric
Infrared Lights
More and more people are using infrared lights to support healing. I found these to be incredibly relaxing and calming. Much the the impact of acupuncture, I felt deeply calmed by the use of infrared lights, which are purported to support the basic cellular metabolism and healing.
Tips / What to Expect
Stairs: Trying to navigate stairs is tricky after surgery and on crutches. Try to avoid stairs all-together for at least 1 week after surgery. Have others support you if stairs are necessary. When you do go on stairs, it’s “up with the good, down with the bad”
Everyone experiences different levels of pain, swelling, and fatigue. You can expect at least some of all three.
Milestones
Post-surgery
Showering: Expect to give yourself a sponge bath the first day or two after. Set up a folding chair in the shower. Get help and try to use a floor-level shower, rather than trying to step into a tub. You will likely be given a water-proof stocking to wear over your leg for the first several weeks.
Eating: Depending on your response to anaesthesia and pain medication, as well as your level of pain - you may have a reduction in appetite after ACL knee surgery. If you are nauseous, you can talk to your doctor about anti-nausea medication. You may do better with bland foods. Be sure to eat something (even if it is a cracker) when you take your medication.
Bending and Straightening your leg: This is a bit different for everyone. You may be restricted to bending your knee no more than 90 degrees for the first few weeks, to keep your knee safe. It is important to work towards full flexion and extension overtime. The sooner you can get full extension, the better. Complete flexion and extension can take several months, due to tighteness, protection, and swelling,
CPM machine: Although some doctors do not use the CPM machine at all, those who do will likely suggest that you use it for 4ish weeks.
Sleeping on your side: The first few weeks after surgery, you will likely not be able to sleep on your side. A good reason to practice gentle chair yoga during your recovery.
After initial recovery
Removing incision tape (usually after 2ish weeks, depending on level of bleeding)
Weight bearing & Crutches
30% weight bearing (after 1st week) / 50% weight bearing (after first few weeks)
Walking with one crutch (3-4ish weeks)
Walking with no crutches (2ish weeks after you start walking with 1 crutch)
Driving: If you have an automatic car, you will be able to drive short distances as soon as you are no longer on pain meds and as tolerated by your knee. If your car is manual, you will need to work with your physical therapist to manage pain and build strength enough to use the clutch, which may take several weeks.
Running: It will likely be about 4ish months before it is safe to return to activities such as running.