Part 9: Months 3–6 — The Danger Zone of ACL Recovery
Key Moments
- Top Roping Inside
- Top Roping Outside
- Lead Climbing Outside
- Running Outside
- COOR Study
Helpful Things I Did or Wish I Did
- Waited Longer Until Climbing
- Stationary Bike
My Story
The 3–6 month period is where many people — myself included — start to feel almost normal again. But ‘almost’ is a dangerous word in ACL recovery.
Back to Climbing
Around the 3 month mark I had made great progress, had full range of motion, was building up strength and so was starting to feel close to normal. I knew I couldn’t return to soccer or skiing yet but I felt like I could return to some safe version of climbing.
So after three months I started top roping the easiest routes inside. I tried to never do any dangerous moves (heel hooks, etc) and I was mostly successful. That confidence I built up led me to try top roping outside, mostly driven by the fact that my core climbing group was starting to do a lot of outdoor climbing this year and I didn’t want to miss out. During the first few outdoor climbs there were plenty of warning signs this was a mistake including the hikes to the walls being difficult and my knee being in pain after climbing. But it is so very easy to ignore such signs!
COOR Study
I continued down this path of top roping indoors/outdoors until things really accelerated after my 6 month followup with my surgeon. He told me my knee was looking great and I was on a good recovery path. I just needed to keep being safe and keep building up strength.
He also told me about The University of Utah doing a study on ACL surgery outcomes. I was easily swayed to join the study because my surgeon told me they were looking for young and active ACL surgery patients who were looking to return to high level sport. This flattery completely worked on me of course.
The study measured the symmetry in my knee, leg, hip flexibility and strength, my jumping ability, and also included a psychological examination.
I got my results (included below) which showed I was indeed on a great recovery path but there was a long way to go physically. And the psychological component clearly showed how fragile my mental state was.
Smith Rock
Things escalated when my fiance and friends planned a surprise four day climbing trip at Smith Rock, Oregon. Smith Rock was my top climbing destination but I reacted poorly to the news because I didn’t feel ready yet for a climbing trip like that, and I was beyond stressed trying to launch my startup. However, I really wanted to climb Smith and my friends put in a lot of work planning everything so I agreed to go.
I decided to rip the bandaid off the first day by setting a 5.9 called 9 Gallon Buckets (my first ever outdoor sport route). I had a visceral fear of heights growing up so even without my ACL injury I’ve had a real journey getting over the fear of falling while sport climbing but every move I did on this route felt like I was risking my knee snapping in two.
I got to the top and felt a palpable mix of pride, fear, and relief. I made my way to a picturesque river overlook and broke down in tears. Ironically later that day I met and chatted with a woman who was also recovering from a torn ACL and had also broken down in tears. We discussed why we were having such strong reactions and agreed it was partly relief and partly intense frustration at how hard we had been working to recover physically and mentally and yet how far away we were from prior to our injuries.
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I thought that it would help if I pushed myself through a harder climb and so for my next route I did a 5.11 which required me to fall around 8 times on the crux of the climb. But I figured it out and felt immense gratitude and pride.
A Step Too Far
That was where I should have stopped but alas, humans (especially this one) are silly. The next day was a Saturday and so it was much more crowded. We found a route at the grade we wanted but it was quite the scramble to get to it. Again there were plenty of signs to stop what I was doing. The loudest of which was I was really struggling to get down from a (small) rock I scrambled up and needed a teenage boy to hold my hand to help me get down.
The spot where the routes were was magical and the routes looked perfect but the best route was missing the first bolt. Continuing my bad decisions I climbed up about 15 feet without protection to clip the second bolt. A completely idiotic decision but I survived.
Next I doubled down because we climbed over Asterisk Pass (an exposed class four scramble) to get to the other side of Smith Rock. I was completely exhausted by this point and my knee was hurting like hell. I literally have no idea how I survived this because my biggest problem was my lack of coordination and control with my right leg; I struggled to actually place my foot where I intended, which was super dangerous. But my fiance helped me with every step and somehow I made it.
It became really clear how precarious the whole day was because as we were hiking home through aptly named Misery Ridge (beautiful but quite the hike) my knee kept buckling and I ended up falling into a patch of brambles because I didn’t have any strength left.
Moral
Looking back, it’s hard to believe I let it go that far — but I also understand how easy it is to let risk creep in one small decision at a time. But I know how easy it is ignore warning signs and gradually expose yourself to more risk until you’re suddenly in a situation that seems obvious in hindsight but felt incremental in real time. Sunk cost fallacy is a real thing and so is survivorship bias.
Your Action Plan
Understanding Graft Strength
This is the most difficult period of your ACL recovery in terms of making good decisions. That is because 3–6 months is a sweet spot where your graft is at its weakest but your knee/leg start to feel strong again. Essentially what happens at the 4–12 week period is that your graft is remodeling at a cellular level, but you won’t feel how weak it is. I’ve included a graph below, which you need to really internalize.
Communicate To Friends/Family
One of the best things I did during my recovery was send that graft strength graph (and the accompanying article) to friends & family. This helped mitigate people asking me to play soccer, climb, ski etc. Even though you tell people you can’t return to the twisty sports until 9–12 months, they will see you walking around like normal, lifting weights, running and think you must be healed.
This 3–6 month period is the riskiest point in your whole recovery and it’s just not worth going through the surgery and that initial rehab again! One blog that really helped me was https://patchworkandpebbles.com/acl-surgery-part-1/ where the author re-tears her ACL after 9 months. I highly recommend reading her story.
Return to Sports
What you can do within this 3–6 month period is plot out hypothetical points for when you can return to some version of your sports. I was always pestering my surgeon about when I could return to a safe version of climbing and he gave me some good advice about this.
He told me that it was up to me to determine what a safe version of climbing is for my stage of recovery. Until 9–12 months I just had to minimize twisting and impact. His key point was that for him even with a fully healthy knee skateboarding would likely result in injury. But Tony Hawk recovering from an ACL injury could likely skateboard (within reason) completely safely.
So for me I had to work with my physical therapy team to figure out when different moves and types of climbing would be safe. I’ll talk about my return to climbing plan more in my next post.
Prepping for Return to Sports
Once you have your return to sports plan mapped out it’s time to work on getting your knee and body ready. At the 3–6 month mark that likely predominantly means building up muscle strength (leg day every day) and doing a lot of stationary bike still. We also did a lot of balancing/coordination work during these months in PT.
What I Learned
You’ll feel ready before you actually are. The 3–6 month mark is a trap: strength returns, but your graft is still weak. It’s way too easy to overdo it without realizing you’re gambling your whole recovery.
Next Up
Months 6–9 were a turning point: I finally got back into real climbing, took a big trip to India, and accidentally skipped physical therapy for six weeks — a mistake that seriously set me back. In the next post, I’ll share what it took to rebuild, both mentally and physically.
