Today I gave the run/walk intervals another try. I was advised by Drew to go to a track (meaning level surfaces and a nice padded course) but since there was a soccer game going on in Berkley's track infield, I refused to run around the game and provide entertainment for the ~100 people there. So, I went outside of my trainer's wishes, and hit the streets (very carefully, might I add). First, it was taking my walk from a slow, to normal, to eventually quick pace. Then, once I felt comfy, I tried running again. It felt just as awkward as the first two times, but if nothing else, it felt good to be out, trying, and breaking a sweat!
I believe the reason I can't shake the limp while running is I am (1) still having a hard time mentally trusting my surgical leg, (2) my muscle mass in my surgical quad is substantially less than my non-surgical and (3) when I do run, I am not letting my surgical leg extend out all the way, therefore I'm running shorter strides on that leg versus my 'good' leg. This overcompensation caused a little pain in my 'good' leg's hip towards the end of the run, but nothing I feel when walking or going about my day-to-day.
Otherwise I feel I am reaching a point where I actually sometimes FORGET about my 'bum' knee! It is a wonderful thing. The more I find myself putting it out-of-mind, the more I realize I am getting back to that 'normal' lifestyle I so desire. In the coming week I'll still be seeing my trainer 3x, but after that we've decided I'm ready to go to 2x / week. This can only mean one thing... PROGRESS!! :)
The last few sessions of PT have me improving by leaps and bounds, being able to do exercises I haven't touched since pre-surgery therapy. This includes more challenging balancing exercises, squats, and adding more weight (or resistance) to previous exercises. I am up to 90# on the one-leg press; I am confident I could do more, but am trying to only gradually increase the weight.
Going down stairs is getting much easier, partially due to trust in my leg and the exercises in PT that have helped me break the mindset that my leg will give out if I put the opposite one down on the next stair first. There is still some favoring going on, but it's much improved.
Otherwise, my focus has been to get my walk to normalize, and I know I am capable, but the thing most often holding me back is habit, and maybe the *littlest* tweak of pain in some motions. They said I was not letting my leg extend all the way as I worked through my gait, but I am shaking that habit. Today there was proof of this, since in PT I was put on the treadmill for ~5 minutes and Drew kept bumping it up until I was at a speed-walking pace. At first I was hesitant and favoring my surgical leg. As I eased myself into it and realized the pain that's held me back in the past was not showing itself, I was able to get a normal stride.
My big event of the day was my first attempt at running!! Drew was there to push the 'speed up' button on the treadmill until I finally couldn't speed-walk any more. I'm the first to admit, the run was not pretty (by any means), but I think, again, it was habit and a mental block more than anything, which kept me from evening it out. I didn't run long - perhaps 1 minute, but when I haven't done anything (but putt-putt) since my surgery 6+ weeks ago, 1 minute of running was plenty for me to see where I stand today!
In PT there are 2 other young ladies I see often, I believe 1 week and 4 weeks behind me (same procedure and Doc...). They were both there today, and it's hard for me not to look at them and compare myself in the way of progress. Two of us seem roughly the same, but the girl who's at 2 weeks (versus my 6 weeks) was ALSO on a treadmill today (albeit at a slower pace and a more obvious limp...). But I'm blown away by this girl's progress and have so many questions - What did I do wrong? Why isn't she in as much pain as I was? How is she asking questions like "Can I ride my bike now?" when at 2 weeks that was the last thing I wanted to do? I remind myself that everyone truly has their own schedule. I make sure to congratulate her on her progress, because we all can use words of encouragement as we work down the winding road of recovery!!
So in my continued efforts to get back to 100% (or better!) I returned to PT today assuming I'd have pretty much the same routine as normal: Ultrasound (locally @ incision), a few painless exercises and stretching, and eventually 'ice' by rubbing ice directly on my knee until it's numb! I was right on everything, but then I got a little more in the way of exercises.
At 26 Days Post-Op (just 10 days ago) I mentioned some 'upcoming milestones'...
One goal is to get back to a 'normal range of motion' , which is from zero to 130-135 degrees. Drew told me that I am within a few degrees of that as of today (Yay!) but that my 'good' leg is closer to 160, so I definitely have some more work to do!!
Another ongoing goal is to normalize my gait. Today I was told I have all the PARTS of walking normally, I just need to piece it all together in one fluid motion. I like to compare this to learning to golf -- it's not easy to do everything right at once! While I may be able to control my walk enough to appear not to have a limp, it is still a very conscious effort (hence my previous post, 'Could the limp be gone?!' not stating that it was gone!). Drew would watch me walk and of course compare- What was my 'good' leg doing that my surgical leg was not? [Answer: My surgical leg is slightly bent through the whole stride; I'm never completely straightening it out.]
My goal to walk smoothly comes back to another goal I was perspicacious enough to realize over a week ago- being able to trust my surgical leg as I balance on it and at the same time go between straight and slightly bent. I brought this up to Drew today and he had me 'practice' doing this very motion. There were some new twinges of pain as I did it, and my leg was shaking (oh, how sad the weakness is!), but it was good to be forced, because I hadn't challenged myself at home just yet. I had to stop a few times and do the same motion with my 'good' leg, just to remember how it's supposed to look and feel!
And so the battle of Surgical vs 'Good' Leg continues.... As for the other milestones I'd set:
- I'm happy to say I can go up stairs without favoring my surgical leg
- I can balance on my surgical leg when it's straight (as well as slightly bent) without pain or feeling like i'm going to tip over (it's going between the two that's tough!)
- I can go down stairs with one foot per stair (though I favor my surgical leg VERY much when doing so)
- I continue to massage around the incision to get the skin to move freely over the knee cap (and I've also been using Mederma to hopefully reduce visibility of the scar... eventually)
Pic as of today (you can ignore the waffle imprint- that's from using my ThermoComp icing machine...)
And, since I may not post again before the Memorial Holiday - I hope everyone has a safe and fun weekend, and I'll try not to do anything dumb to mess up all my hard work on my knee!!
Firstly, I had another set of x-rays taken. I mentioned that I already had x-rays taken at 1 week post-op, but the assistant said she was just following doctor's orders, so we both went along with it. Since the x-rays were identical to the last set, I felt they were a waste. Perhaps there is a small percentage of patients whose titanium screws (which hold the graft in place) may shift? Perhaps I'll google that... ;)
When Dr. Shapiro entered the room, we exchanged pleasantries, and I dove right into the discussion Drew and I had about my potential tendonitis, and how we felt it was setting back my recovery. When I told him that the tendonitis was in the area of the patellar tendon (where my graft was taken from), he seemed to pause a second and cock his head in misunderstanding.
"Well, you know, pain in that area is not necessarily tendonitis. I mean, that is where we took your graft from, so of course there is going to be some pain in that area.." he said. Well, this was followed up with how every recovery is different, and launched a discussion of pain management. I told him I've been off Vicodin for some time now, and only popped some Motrin (~600mg) every now and then for a two-birds-with-one-stone throw at both pain and inflammation. Can I really tell the difference when I take it vs not? Not really. But people also told me that Vicodin would be a god-send, and while I'm sure it helped dull some pain, it wasn't all I thought it'd be either. In the end he wrote me a prescription for something comparable to Motrin and told me to take that, mostly for inflammation that could be causing my pain. I am not a fan of popping pills, but Doctor's orders!
So, after our brief discussion of my maybe-tendonitis-but-not-necessarily, Dr. S had me sit with my legs extended out in front of me on the exam table. With my leg relaxed, he carefully manipulated the knee cap and poked around a little at the swelling, which seems to be in control. Next he had a look at my extension, which we haven't measured lately in PT, but is definitely at zero, if not -1 or so. Then, he had me slide my heel towards my butt and bend the knee as much as I could. Range of motion was "great" (though I still have some work to do on that bend!)... But for now- I'm on track!
After this, I extended my leg back out, and he grabbed my lower thigh with one hand and upper shin with his other hand, and did a little jiggle-jiggle to test the stability of my ACL (I assume, anyway) and those few things wrapped up the physical exam.
Once done, Dr. Shapiro was pleased with where I was and said I was right on track. God, that was good to hear after beating myself up over the last 2 weeks about my inability to walk w/o a limp or being 'behind schedule'. I was so happy that he didn't push the thought of tendonitis on me or give me any indication of being off track in general. I have too competitive of a spirit (even with myself) to have to deal with negativity that would have come from such focus.
I had them print me today's set of x-rays (which, truly, ARE exactly like the 1-week, so I won't bother uploading) and headed for PT. Drew was glad to hear the doctor was happy, and between the three of us, I think we will all be delighted as I can focus on the coming weeks and getting back to 'normal' !!
Note: I just heard meow-ing on my porch (we do not have a cat!) and it's a black cat! I hope that's not a bad sign... !!
While I'm still at PT 3 times per week, we've been taking it easy for about a week and a half, doing ultrasound in the area of my patellar tendon and locally icing directly on the skin. I knew patience (and a positive attitude!) would be a must as I overcame this hurdle.
I must say I'm having a bit of writer's block to describe just how I've come to ask myself... Could the limp really be gone? It comes down to this- up through this morning (I think!), I still couldn't seem to stop favoring my surgical leg. However, this afternoon I was on the phone and decided to take a short walk down the street and back. I was walking with control, but the pain was minimal if anything, and I realized I could walk normally!
Perhaps it helps that I was just doing PT at home and stretching. Or maybe it's that I was distracted with conversation. But this little triumph had me excited, so I had to share!
Meanwhile tomorrow is my 5 week follow-up with Dr. Shapiro. I'm looking forward to getting his opinion on my progress, and moving on from here!!
Bear with me, and let me preface by telling you a few parts of my day ...
I realized that as I walked around work I thought of statements I might blog, (similar to how I always think of captions for my photos, for those of you who know me!). Sadly, one statement that came to mind today was, "I am feeling a sense of disappointment [frustration? defeat?] with every step I take." What?! Did I just think that? True- it is hard to ignore my slow pace or pain every few steps, but DEFEAT? C'mon now. Lighten up, Louie.
Then, checking my (personal) email at work (shh!) I received today's dictionary.com 'Word of the Day': Abnegate which, has a second definition of "to relinquish; give up." You might think in my original state of rut, I would have thought, Gee, how fitting! But, I looked at that and asked myself, is that what I'm doing? Of course not. But where did I fall on the scale from frustration to giving up?
At some point my new boss came by and mentioned my knee. He said, "Aren't you some kind of super-jock?" Ha! I may not fall in that category, but there's few sports I won't try. I had to laugh at this rep I didn't realize I had at work...
I eventually left work and headed for PT, and as I hobbled to the front door, I saw a girl being dropped off with immobilizer on her leg and crutches under arm. "When was your surgery?" I asked. "Yesterday..." she said. Ahhh... I remember being there, and the pain just to stand. I felt for her as I held the door and helped her meet her trainer- my good friend, Drew.
A few exercises into my routine, another girl asked me how far along I was, as she was 3 weeks out. "Your scar looks great!!" she told me... Well, that was awfully kind of her!
OK, ok, ok... enough with the stories. I am not sure when, but at some point in the day, negativity started to crumble from my mentality, little by little. I now found myself in my (currently) dreaded position: being asked to 'walk the runway' for the trainer. Despite my hopes, I did not miraculously shake the limp. But this time I was not barked at on how to fix my gait either, which was refreshing. So it came to the next question... Now what?
I confronted Drew about the whisperings of tendonitis from last session. He would not (and I guess, could not) officially tell me I have it, as that is my doctor's call. However, when asked, he said, "You definitely [catch/pause] maybe have tendonitis." Enough said. He said around 10% of people get it (I'll have to research...) and that it's not that anything was done wrong, that it just sometimes happens. I could ask a million questions- did he push me too hard? Did I take my PT at home too seriously? Did I work through pain I thought was normal, but it was over-use? No matter- I now have direction that "if it hurts, don't do it." I'm going to bend that and say, if it feels good, do it! - which I thought a a nicer tone to it!
So for now, that's exactly what I'll do. At PT we continue to do ultrasound in the area of my patellar tendon (which I read, is a way to treat tendonitis) and ice is rubbed directly on my skin near the incision instead of a wrapped ice pack after PT. Other than that, the only way to 'treat' tendonitis is rest, only do the exercises which don't pain that area, and be patient. Isn't it ironic that being patient is the fastest road to recovery? :)
The incision is healing nicely, and I am sure to massage it whenever I think to, which will help loosen the skin (as it's still quite stuck in place) and break up scar tissue beneath it.
Focus continues to be on evening out my gait. I keep thinking it's mental; that I am just not trusting my leg. However some pains can not be ignored (even after popping a Vicodin pre-PT) and just when I feel I'm improving, I get the same pain (more shooting than general) in the area of my patellar tendon, and my body goes back to the exaggerated limp.
Also, today I was given so many directions to correct my stride as I walked the imaginary red carpet for my trainers: "Let your leg straighten out before swinging it forward." "Bend your knee more." "Pull your surgical leg forward more quickly before you step on it." "Go faster." "Hold your shoulders way back..." My head was spinning and frustrations were mounting as I couldn't seem to do what they were asking. Walking the runway was neither glamorous nor fun. I really was (and am) at a loss.
What scares me is that the two people working with me at PT can't seem to figure out how explain the intermittent pain I'm getting and one of them mentioned the possibility of tendonitis today, which, honestly, has me a little freaked out. With overuse being the primary cause of tendonitis, even hoping I don't have it, I wonder if 'powering through' the pain in hopes of a speedy recovery may actually be hindering my recovery??
Tomorrow I will be 4 weeks post-op, and while I knew it was far fetched (even my surgeon uncle said so), I remember Drew telling me I would be running around 4 weeks. I can only hope that statement was made as incentive, and that it doesn't mean that I'm doing something wrong.
I have my 5 week follow up with the Doctor in 1 week (though I did see him briefly today as he made a random visit to the PT area) and hope to have this settled by then, or at VERY least, be able to get some answers as to where I am in comparison to his other patients at this point, and how I can stay (or get) on track.
But I can say that I am in a better place now. Yes, I am still limping, but I am feeling improvement (or, lack of pain I was feeling before) and am working more on balancing on my surgical leg while it is straightened to gain confidence in my leg as it teeters on the edge of locking/straightening or being just slightly bent. Once I feel good there, I think it will really improve my walking.
While I am physically improving, I am also grateful for the support of others who have either been through (or, will be going through!) this type of procedure, as well as those around me who continue to care about my well-being and encourage me to keep at it! I'm sure I'm not the first person to have moments of frustration and weakness in my recovery, so all I can say to those of you who might experience the same thing -- it will get better! I just hope I can remember my own advice as I continue on!
A few points of interest-
- I am no longer on a steady diet of pain medication, as of ~3 weeks post-op. I still pop something before heading to PT, but otherwise think keeping Motrin handy should be enough to curb most discomfort.
- I have no pain in standing for longer periods of time. (Immediately after surgery, this was what caused the MOST pain in normal day-to-day!)
- I will be returning to work tomorrow (mainly sitting at a desk all day) and while I was capable of returning a week ago, due to a temporary lay-off (don't worry, it's just a week here and there!) my start date was pushed back. I was grateful for the extra week of being able to stay home and focus on recovery.
- The most pain I have is in the region of my patellar tendon. Mostly it's caused by the simple motion of straightening the leg from bent, but without any support (As in, if sitting with legs dangling off a chair, trying to lift my foot so leg is straightened out in front of me). Similar to pain felt when trying to do 'straight leg raises' while lying on my back. [Note: I am not sure if this pain is because my graft was taken from this area, or if this occurs in all ACL reconstructions?? I assume the former...]
- Getting my bend to ~135° (considered 'normal' range of motion)
- Walking and climbing stairs w/o favoring my surgical leg
- Going down stairs w/o having to put both my feet on one step before descending the next stair
- As mentioned, focus on balancing on my surgical leg while it's straightened
- Eventually be able to balance on surgical leg w/leg straightened and remain balanced as I work into a slight bend
- Breaking up scar tissue in the area of the incision to allow the skin to move freely over my knee cap
- Continue to ice, elevate and massage around knee to reduce swelling and break up scar tissue
Perhaps returning to work will bring me some new challenges (I am thinking sitting in one spot for a bulk of time will end up with a lot of fidgeting so my leg doesn't stiffen up too badly). Either way I am looking forward to a change of pace and starting my return to a 'normal' lifestyle!
And, some photos of my progress. Enjoy!
I can now bend my knee to this angle somewhat (I say that lightly...) comfortably:
Since I'm a big fan of trying to keep positive, I drove to PT today with my music cranked, windows down, and saying to myself, "Today will be great!" Monday was a tough PT for me (summary: on the verge of tears the whole time with various frustrations; and oh yeah, the pain!) but Tuesday I felt like I was starting to get trust back in my walk, and didn't seem to be limping as much. I thought I'd walk into PT today and wow them with my improvement!
I posted before, and it was to describe the troubles I'm having in getting a normal gait. I know this is all part of the process of recovery, but as of today (Wednesday) the task seems daunting again. My trainer spent 1.5 hours with me today trying to problem solve, and I must say, his actions and conversations make me think I have him stumped. First, it seemed I was having trouble with extension. However a few exercises later it became clear that I have no additional pain, nor problem, in getting my surgical leg completely straight. Then, it was a backwards-skateboarding sort of motion on the treadmill, which didn't seem to loosen me up any more or get rid of the pain I was feeling. If this particular pain is normal, Drew did not verbalize that!
We did an ultrasound to send waves of heat deep into my knee to help break up scar tissue and "promote healing", and I was told I may feel less pain immediately after treatment. Honestly, I didn't feel a difference (...and they said I was on a 'high' setting!). Then, when icing, instead of putting a cold pack on my leg (which is typical), we took a block of ice and rubbed it directly on my knee near my incision, and kept the cold localized in the area I feel a 'twisting pain' when trying to walk. Once done with these treatments, I tried walking again, and with a numb knee and my poor walking habits, I still couldn't seem to shake the pain.
So, I wish I was writing to say, Hey, more improvement today! But in actuality, I must say this post is more of a release of my frustrations in my lack of improvement. I know it's a tough road ahead, and I'm not giving up, but knowing walking is my next 'big thing' to overcome makes the frustrations mount as I go in to PT and can't find hint of improvement. Additionally, the incision seems to be stuck in place (skin doesn't move freely over top of the knee/cap area, so there must be scar tissue to break up) and even after going through ~5 minutes of torture/manipulation by Drew today, he didn't get it to loosen any more. How am I supposed to manipulate it at home and see improvement, when there's no way I can inflict that much pain on myself??
To think back on the recent physical pain and mental frustrations I have gone through gets me worked up all over again, and it really is turning into a [negative] vicious cycle. I know I can overcome it, it's just a matter of how.
Just over 3 weeks out, I am still proud of how far I've come and the pain I've tolerated, but I am ready to conquer that next step... this time, without a limp...
So now I am closing in on 3 weeks post-op, and in yesterday's PT I again felt the pains of the forced bending (not sure what degree we got to but I hope it was 120!) and the frustrations of the most simple uses of my leg, which just aren't coming naturally. However, I have been improving every day (some days more than others!) and I'm now being told to work on 'walking'.
I have officially eliminated the use of crutches (even when going on somewhat uneven terrain) and have been walking in a controlled, slow and short-strided manner. I realize this is not how I want my gait to look when I'm done rehab-ing, but as they say... Baby Steps!
When asked to walk by my trainer yesterday, I made a conscious effort to stand upright (instead of look at my feet) and just walk evenly. Drew called me out on it immediately, telling me to speed up (I was going frightfully slow) and to stop trying to 'control' my stride. I followed directions (like the 'perfect princess' I said I'd be in PT) but there was an über-uncomfortable feeling below my kneecap, and at the times when walking requires balancing on the surgical leg at the sensitive position between completely straight and just bent, I felt like Bambi again.
"Let's put you on the treadmill," Drew said. Wha?! Didn't I just prove I'm not even ready to walk 'normally' yet? But sure enough, I climbed on and Drew took the belt speed up to what is probably a normal walking pace... but I looked like a pirate trying to speed-walk on my brand new peg-leg! Oh, and of course there was the return of the aforementioned pain below the kneecap (in the area of the patellar tendon).
This limping pirate look may have brought Drew back to reality, as I just couldn't seem to go with the 'flow' of the treadmill. So, for 5+ minutes I instead stood with my right leg off to the side of the treadmill belt, and at a much slower belt speed, would put down my left foot and 'walk' with my left leg. (I looked like I was skateboarding now) This allowed me to gradually put more weight on the leg as I got more comfortable, and my new task was to work on taking longer strides and stop avoiding straightening my leg all the way before 'pushing off' and lifting the leg up again.
Unfortunately, I do not have a treadmill or stationary bike at my disposal, so I am unable to work on such activities (and range-of-motion exercises) at home. This didn't stop me from going out today (Saturday) in the lovely noon-day sun and walking ~5 blocks. I tried to follow all of the tips and directions that Drew had given me, but in the end I know it still looked 'controlled' if not limping, because I had a friendly passer-by ask, "Are you OK?"
I compare this attempt at walking to learning to golf. There are so many things to remember when you learn to swing a club: head down, legs slightly bent, grip a certain way, twist your body a certain way, backswing so your arms do or don't bend too much... you get the idea. It's just a little overwhelming to try to remember it all and follow it all to a T. Same goes with this whole 'walking' bit. No matter that I've walked plenty in my lifetime, when it no longer comes 'naturally' it's truly an effort to make walking an effortless motion!
So, while I know I still have a ways to go before strangers aren't concerned for my well-being due to my unconventional walking style, I am making improvement, and that is all I can ask for now!
And because pictures are fun:
Day 16 post-op: I 'cleaned up' the incision area before re-taping. Looks good w/ the exception of the zig-zaggy part at the lower kneecap Day 18 post-op: OK, not a flattering pic at all, but for the sake of comparison, this is a pic with legs in the air, slightly bent and completely relaxed. Note the swelling still obvious to the sides of the knee and lower thigh/knee area. Also, major muscle mass difference in the thighs (lower portion of picture) which I hope to reclaim when this is all over!!