Mountain Project Logo

Crack climbing after ACL reconstruction

Original Post
Emily H · · Unknown Hometown · Joined Dec 2012 · Points: 20

Hi all!

I'm two weeks post-op on an ACL reconstruction, and I'm already so antsy to get back into climbing. I've started to probe my PT re: my expected return to climbing. The problem is that neither he nor my OS are climbers, so they're less familiar with the demands of crack/OW/chimney/face climbing.

My surgeon's general "return to sports" timeline is 8 months, which seems rather conservative to me. However, he seemed comfortable with the idea of me following climbs (to limit fall potential) at 4 months, though I didn't describe the specific demands of crack climbing to him.

My PT, on the other hand, took a week to think about the foot camming motion in crack climbing, and came to the conclusion that I should give it a year and consider it an investment into rehabbing properly to achieve my future climbing goals.

I had a Bugaboos trip planned for 6.5 months post-op before I tore my ACL in the first place, and I'm pretty excited about it. But is that simply too early? Should I be canceling those plans?

For anyone with previous ACLr experience: When did you get back to climbing? (and crack climbing, specifically) If you returned to sports relatively early, how is your knee doing today?

I know that I should listen to my surgeon and PT first and foremost, but I'd be curious to know more about other experiences.

Nico C · · mt shasta, ca · Joined May 2013 · Points: 55

What graft did you get? I've had both knees reconstructed, and with my first I was asking the same questions as you. In hindsight it was a waste of time and I wish I had focused my energies elsewhere.

I realized as I got close to the 6 month "time limit" that it really does take 6 months to heal. It's not just an arbitrary restriction. At 1 year you'll get to about 75%. And at 2 years you'll forget all about the knee.

Not to be a downer but I'd say forget the bugaboos, the risk of tearing that still weakened graft is too great. You do not, and I repeat, do not want to reset the clock with another surgery having to harvest a graft from your last remaining site in that knee.

All it would take is one awkward fall on a not tight enough top belay with your foot in a crack to blow it. And then there's the heavy packs, shifting talus, punchy snow, and countless other ways to hyperextend your knee and wonder if you screwed up. No fun to go on an adventure just to worry about your knee the whole time.

Yes you could maybe mellow top rope face climb at 6 months but what's the fun in that. I'd wait till you get to 6 months and see how things feel before you make any plans. Listen to your body and don't push too hard for an arbitrary goal. Push when it feels good, rest when it doesn't. . Likely there will be setbacks in the process anyway.

Focus on your rehab, get into biking, swimming, learn new skills, and otherwise take advantage of the downtime. You have the rest of your life to climb and its a lot more fun when you're not worried about a body part. Plenty to worry about in climbing as-is! It seems like a long sentence to serve at this point but in reality the time will fly by if you let it and it'll be over sooner than you think.

Good luck!

RangerJ · · Denver, CO · Joined Jan 2012 · Points: 65

I tore my ACL/MCL in May of 2014 and had reconstruction with a hamstring graft in July 2014. From there I had lots of scar tissue complications which slowed my recovery. I had to have a manipulation to get it mobile again. I worked hard in rehab but it was still a slow process. I made my first real mountain trip with a heavy pack in August 2015. We climbed Gannett in 4 days from Elkhart Park. Hiking on loose talus and scree was a terrifying experience at first especially tired legs. The loss of eccentric strength, i.e. stepping down, makes me a lot slower, but that is starting to come back now. I think the Bugaboos at 6 months would be pushing it, unless you have a complication free recovery and a very aggressive rehab schedule.

As for crack climbing - I am back to doing nearly all the same kind of climbing (rock, ice, alpine) at similar levels as I was prior to my injury now, which is more or less 1.5 years from my reconstruction. Crack climbing was a little painful at first with some scar tissue around my MCL, but now I don't really even think about my knee. If you work hard on the strength it shouldn't be an issue long term. Your knee won't ever be quite the same again, but it also shouldn't stop you from climbing.

John Butler · · Tonopah, NV · Joined Feb 2010 · Points: 115

I had a hamstring graft ACL done in January 2006 and was in Yosemite by late summer.

Follow your PT regimen to the letter and they'll have you back on track in no time.

Those first few days and weeks are pretty tough, but the biggest thing is following instructions in order to get your range of motion back. The leg strength is the easy part.

My repaired knee was soon stronger than the other.

Mike F · · Arden, NC · Joined Jul 2007 · Points: 56

Echo the above comments. ACL reconstruction (hamstring) Nov 11, trip to the winds July '12. That said, my knee still felt kinda weak on the hike in, and didn't feel 100% normal until the 1.5-2 yr mark. I never notice a difference now save some soreness at the incision site and partial numbness in a few spots.Take your time, you'll be back before you know it.

rgold · · Poughkeepsie, NY · Joined Feb 2008 · Points: 526
ekh6929 wrote: I had a Bugaboos trip planned for 6.5 months post-op before I tore my ACL in the first place, and I'm pretty excited about it. But is that simply too early?
The average pro football player needs 54 weeks to return to pro football after ACL surgery---according to foundrysportsmedicine.com/p….

You already know from my post to your other inquiry that six months could be pushing it in terms of the physiology of tendon incorporation. See, for example,

youtu.be/GoC00OslhJE

As for the doctor's opinions, some reading might be of interest:

Some relevant reading at drdavidgeier.com/when-athle….

A few quotes:

A 2010 survey asked NFL team doctors what percentage of NFL players return to play. 90% of the physicians answered “90% – 100%.

A study of NFL players who underwent ACL reconstruction showed that only 63% returned to play in a regular-season game within two seasons after surgery. A study of high school and college football players showed similar results. 63% of high school football players and 69% of college players made it back two years after surgery. Only 43% of them had returned to preinjury levels.

Finally, a 2011 study of competitive athletes in a variety of sports showed that only 33% of athletes had returned to their sports at their preinjury levels 12 months after surgery.

Strength, motion, and neuromuscular control of the hip and knee in multiple planes, and for both legs, can all predict the risk of reinjury. All of them can be improved with training, however. This process can take as little as four months, but it can require 12 to 24 months. It is vital not just for preventing injury of the ACL graft or the opposite knee’s ACL. The work is crucial to getting that athlete back to playing at his former level. These are the criteria we are starting to use.

I think that mountaineering (as opposed to cragging) poses extra risks, because you might just have to push through something that doesn't feel good (for instance, as a giant lightning storm is approaching). You are young and have many years of Bugaboo trips ahead of you if you don't totally eff up your knee. I'd wait until next year if I were you.
John Butler · · Tonopah, NV · Joined Feb 2010 · Points: 115

Moreover, listen to your doctor and physical therapist, and not the internet :-)

Dan Crusoe · · Grand Blanc · Joined Feb 2016 · Points: 0

Being a physical therapy student, I'll echo that you need to be careful. Honestly, though go to a local gym or some type of tight knit climbing community and ask if they know of any physical therapists that climb or if there are any they would recommend. I'm not saying that who you are seeing is a bad PT, it just helps if you have someone who knows exactly what you will be needing. Healing time can be extremely variable. The most important thing in the beginning is range of motion. Once you have good range is is a lot easier to layer on strength. Research shows that there will most likely be strength deficits still at a year, so work hard on that. But I would also contend that you could probably get away with strength deficits while climbing. The biggest limiting factors will be pain and range of motion.

Emily H · · Unknown Hometown · Joined Dec 2012 · Points: 20

Thanks everyone. I know that I should listen to my surgeon and PT, but two surgeons (my own and another from an earlier consult) both suggested that I could be climbing or at least following at 4-5 months, which is a slight difference of opinion compared with my PT's advice.
Re: graft type, I ended up getting a tibialis tendon allograft, because the surgeon removed my hamstring tendons and decided that they were too small, so he discarded them. :'(
It's tough to feel ready to run and climb at 3 weeks and be forced to wait many, many months!

Jimmy Downhillinthesnow · · Fort Collins, CO / Seattle, WA · Joined Mar 2013 · Points: 10

Medical student climber here. The usual mechanisms of injury for an ACL tear are either a direct blow to the knee (think Tom Brady) or a "cutting" motion where the foot stays planted and the femur continues to move laterally and forward on the tibia. You're unlikely to receive a direct blow to the knee climbing, but the lateral/anterior pressure on your knee joint is pretty much exactly what happens during a foot jam. It's a relatively static force, but would still stress the knee, especially the LCL.

I'd imagine that face climbing would be fine at 6.5 months, depending on how well your rehab goes. Crack climbing would be riskier, but I imagine the approaches in the bugaboos would be more of a limit as opposed to following a route, especially if you're wearing a brace. I don't see a reason why you'd need to wait longer to climb opposed to other sports, since even sports like tennis put a great deal of stress on your knee via abrupt starts/stops.

There are a lot of doctors who climb. Hopefully someone will reach out to you via this thread. Good luck!

rgold · · Poughkeepsie, NY · Joined Feb 2008 · Points: 526

That was pretty much my experience (leading face climbs at 7 months). I got rid of the expensive custom brace pretty quickly; it is awful for climbing and hard to wear hiking for long periods of time. But if I was going to be hiking on possibly unstable boulders with a pack---at 6 months no less---I'd definitely have been wearing that brace.

I've become a big fan of poles. I didn't use them before ACL surgery but now both trail-run and hike with them. A super light pair fit in a summit pack and can be used for gnarly descents

S.Mckinna · · Cañon City, CO · Joined Nov 2010 · Points: 1,725

Glad to hear you are in the recovery phase now! Things will only get better from there. I would have to agree with james sledd's comments about climbing around the 6.5 month mark. Also the comments about the hiking in the bugaboos. If it was me I would cancel my trip because I feel like I would be slowing my partner down attempting to do long and involved hiking and climbing. I pushed it a couple of times around the 6/7 month mark and began wondering if I was going to make it back to the car/camp without stopping and taking a long rest.
Those mountains aren't going anywhere so hit them up when you are stronger. You will enjoy the trip that much more if you are not thinking about the knee.

S.Mckinna · · Cañon City, CO · Joined Nov 2010 · Points: 1,725

Oh yeah!!! I love me some poles!!!

Melodie · · Unknown Hometown · Joined Dec 2016 · Points: 0

I tore my ACL twice from bouldering.  The first time was a fluke in the gym, my feet 5 ft off the ground, and the second time was because I went back to bouldering at 9 mo post-surgery and took a normal fall--my graft just wasn't ready yet.  Needless to say, I've been doing intensive PT (more like serious personal training in terms of weight lifting, kettlebells, plyometrics, etc.).  I'm 15mo out of my 2nd surgery with my own hamstring, am sport climbing, and butt-dragging-back-slapping bouldering.

I've been a huge advocate about ACL surgery information for climbers since there's so little info out there, and I personally felt that if I had had more info, I wouldn't have torn mine twice.  

I've got a comprehensive ACL surgery guide at http://www.patchworkandpebbles.com/acl/.  It covers everything from pre-surgery graft choice, to logistics post-surgery like showering, to the graft healing process (necrosis, ligamentization, etc.), and rehab for back-to-sport climbing.  Please take a look--I hope it helps!

I've also got a survey at goo.gl/o23rf9, capturing data about which graft people chose and after what time periods they went back to TR, sport, lead, bouldering.  It would be great if those of you who went through surgery share your data (it's like 10 multi-choice questions)!  I'll publish results on the ACL guide.

Jon Nelson · · Redmond, WA · Joined Sep 2011 · Points: 8,196

That's a great idea about the survey, Melodie. I hope you get lots of data. 

When your survey asked about running and jogging, I assumed this covered even very short distances (e.g., 100 feet, which is about all I do). But you might want to quantify the distance range in the question. 

Getting back to the original question - My surgeon and assistant were both climbers, and they warned me against bouldering and doing foot jams for a year. 

Rosalieva · · southshore MA · Joined Jul 2014 · Points: 5

Melodie!!your site was one of the first I read when I realized I was facing a new acl..super informative! I'm getting the slice in a week! I do 50-80 mile hiking days in 24 hours and am big into hard long trad days so yah none of that for a year is my personal choice..no falls and no toes jams . Their really is no hike or climb worth going through this shit...I'd say 6 months post op to do the bugaboos is risky..you grafts to new and your body has lost its ability and proproception. Also it's not just you at risk you have a partner and if you get screwed he is also in danger 

Guideline #1: Don't be a jerk.

Injuries and Accidents
Post a Reply to "Crack climbing after ACL reconstruction"

Log In to Reply

Join the Community

Create your FREE account today!
Already have an account? Login to close this notice.

Get Started.