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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 33 match between different practitioners' conclusions for the same patient; in other patients, practitioners were in almost perfect agreement with each other. (Speaking of guarding, Lachman's test is considered much more reliable when performed on anesthetized subjects, which I haven't yet tried on myself.) I'm scheduled for an MRI in about a month. I don't expect the MRI to necessarily answer all my questions, no matter what it shows. In the meantime, I'm celebrating the ever-increasing confidence and comfort I feel in my knee. And meanwhile, I've been using my super-brace less and less, with today (Day 20) being my first 100 percent brace- free day. Still feeling great. We'll see what the coming month brings. Notes 1. D. Guenther et al., "Treatment of Combined Injuries to the ACL and the MCL Complex: A Consensus Statement of the Ligament Injury Committee of the German Knee Society (DKG)," Orthopaedic Journal of Sports Medicine 9, no. 11 (2021), https://doi.org/10.1177/23259671211050929. 2. D. Jiang et al., "Injury Triggers Fascia Fibroblast Collective Cell Migration to Drive Scar Formation Through N-Cadherin," Nature Communications 11, no. 5653 (2020), https://doi.org/10.1038/s41467-020-19425-1. 3. Toni Lange et al., "The Reliability of Physical Examination Tests for the Diagnosis of Anterior Cruciate Ligament Rupture—A Systematic Review," Manual Therapy 20, no. 3 (2015): 402–11, https://doi.org/10.1016/j.math.2014.11.003. Til Luchau is the author of Advanced Myofascial Techniques (Handspring Publishing), a Certifi ed Advanced Rolfer, and a member of the Advanced- Trainings.com faculty, which offers online learning and in-person seminars throughout the United States and abroad. He and Whitney Lowe cohost the ABMP- sponsored Thinking Practitioner podcast. He invites questions or comments via info@advanced-trainings. com and Advanced-Trainings' Facebook page. DAY 20 Good news, and potentially bad news, on the path to ski-accident recovery. The good news: My MCL injury is making an amazing recovery. The things that were so excruciatingly painful less than three weeks ago now feel nearly normal, both to touch and to use. The first couple of days, just getting off the bed was an epic challenge that would leave me shaken, perspiring, and ashen from the pain. Fast-forward to these last few days, when a four-mile hike with my son, over uneven ground, and in the dark, evoked almost no soreness and left me yearning for more. The potentially bad news: My orthopedic-assessment appointment finally came, and the physician's assistant (PA) who examined me was sure I have a ruptured anterior cruciate ligament (ACL). And his news-delivery skills sucked, in my opinion: "Whoa, your ACL is totally torn. Wow, I'm so sorry man, that's really a bummer. You're almost fershur going to want ACL surgery, and then a long recovery, six, no, probably nine months, before you're back." Maybe he even said, "Sorry, dude." Granted, I'm probably a tough customer, and to be fair to the poor guy, my annoyance with him as the messenger was mixed with my clear dislike of the message. I didn't want to think my ACL was torn, even though I knew there was a decent possibility that it was injured along with my MCL (and maybe my medial meniscus too). As the outer tissue layers have healed and become less painful, deeper sensations of guarding, sensitivity, and pain have come to the fore. A drawer test was negative at first (a good sign), though maybe just because there was so much guarding then. Now (in my opinion at least), the test is more ambiguous, my PA's certainty notwithstanding. But I'm biased. After all, it's my knee! Strange, though, how my bias bounces around. I'm still watching myself with amazement as my own certainty pendulum swings back and forth between extremes, starkly inf luenced by the latest diagnosis. Sometimes (like after the PA consult), I'm absolutely resigned to the "fact" that my ACL is blown out; other moments (like after a different practitioner's assessment of "not much difference" between the two knees), I think maybe it's probably just a grade 1 or 2 strain. This f luidity of my inner reality isn't that different from outer-world knee-assessment results: In one systematic review, inter-rater reliability of the best manual ACL test (Lachman's) "ranged from slight to almost perfect." 3 That means in some cases, there was almost no TECHNIQUE VIDEO: "KNEE JOURNAL" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch!