I Bit the (BOSU) Bullet... [20.5 Weeks Post-Op]

Time to step it up a notch.

The money I would have been spending on PT should be going towards a gym membership or equipment or something along those lines, but I just hadn't pulled the trigger... until now! I decided a BOSU ball would be a good purchase since I'd used it before in PT, and my therapist, Drew, also confirmed it's a good tool for rehab. Not to mention, it helped to get rave reviews from fellow blogger, Andrew, and also my friend Chris who has done some of his pre-med work with ACL rehabers. And BOSU isn't just good for balance and PT, but there are tons of exercises to be done on it which help all kinds of muscle groups. My arms and abs should be very, very afraid...

My dilemma was to decide if I should buy the consumer model or the commercial model. For about the same price I could get consumer +4 DVDs, or commercial +1 DVD. (See the difference HERE). In the end, I went with the consumer one, because while I'm all about getting a more 'durable' product, I will never put it through the use that a gym would if it was used for daily classes, etc. I hope I don't regret this decision!

Ciao, Dr. S! [20 Weeks Post-Op]

From the title, I'm sure you can guess... My good man, Dr. Jeffrey Shapiro gave me the final farewell yesterday in my follow-up visit! He admitted that I came out of the gate a little slower than most, but that I've made up ground since then and am right on track. I had often looked forward to my visits with Dr. S to get such confirmation, but at the same time I'm grateful that I had a (mostly) smooth road to recovery and that I'm nearly back to normal!! This must be what Drew felt like when I ended things with him, and PT... *sigh*

Despite halting doctor and PT appointments, I'm not done yet! PT (at home) will be ongoing, as I hope to stick with doing things on my own at least 3 times a week until I can work my way back into sports. For instance, today I strapped on my soccer/UF cleats for the first time and got a taste of the field. Unfortunately tomorrow's soccer practice was cancelled, but I will be doing a workout and eventually heading up to the driving range to dust off the 'ol golf clubs too! Knowing the doctor doesn't need to see me again gives me that 16-yr-old-with-a-set-of-car-keys feeling of freedom again!

But I must share... Yesterday's 'closure' with Dr. S did end on a bit of a personal sour note. My good friend Wendy was in one of his OTHER exam rooms, getting the news that she'd torn her ACL (just like me- playing flag football!). So, as much as I would have liked to avoid my injury, I am almost glad I have the experience (and blog!) under my belt to help reassure her that she'll come through it just fine!! [You can do it, Wendy!]

The gorgeous bouquet I received from Miss Wendy... just for helping! Aww, shucks!

Things I'm looking forward to: Golfing this weekend, Yoga class starting in 2 weeks, and hopefully dusting off the frisbee one of these weekends for some good 'ol fashioned pick-up games!

'Little Things' Make a Comeback [19.5 Wks Post-Op]

Somewhere along the way in my recovery I think I stopped celebrating the 'little things'. I kept a fresh perspective of what I could and couldn't do when it came to exercising or getting back range-of-motion, but the more I think about it, that's not what I'm excited to be doing again... And as gradually as they've come, there are lots of little things I'm happy to say I do without wondering "what will this do to my knee?"...

For instance, today I woke up, got out of bed and walked across the room. Ta-da! There once was a time when that was my biggest challenge! But now I'm back to my groggy "I don't wanna get up" mindset, instead of thinking step-ouch-step-ouch as I used to hobble away from my resting place. Then it's showering. And getting back upstairs to get dressed. And putting on high heels! And yes, even taking out the trash-- because before I was helpless, and while it's not a desirable task, I can.

Next, it's pivoting on my left (surgical) leg as I get into my car (which is quite low to the ground). No more backing up near my seat, having weight on both feet and gingerly lowering myself into the seat. Plant, pivot, sit and DRIVE-- one (mostly) fluid motion! At work it's lots of sitting, but there is still getting in and out of my chair, crossing my legs, or scooting around in my cube on my wheelie chair and not feeling any pain. Ah, the little things!

Today at work I had to cut a strip away from a very large piece of paper from the plotter. Given the size, I figured the floor was my best work space. So this meant squatting down (and getting back up!) and also some kneeling (*gasp*)! I am still cautious when kneeling and putting weight where they took my graft from, but it turned out to be a surprisingly normal feeling!

Regarding my PT-at-home: jumping is getting easier but still challenging. I can run on pavement w/o additional soreness. I even completed a yoga DVD (complete with child's pose!) on an 'off' day, and there were lots of movements I am proud to be able to do again, no matter how simple.

Monday (8/31) is another follow-up with Dr. Shapiro, and Wednesday (9/2) has a high potential of being my first soccer practice! [Despite being given the OK to 'practice' last time I saw Dr. S-- I've still been sticking to PT routines. I may be eager to get back out there, but I want to feel confident first...]

Have a wonderful weekend!

How I Broke Up With PT [4 Months Post-Op]

Tomorrow I will be 4 months post-op. If you're an avid reader (or, recap HERE) you'll know my Doctor gave me the impression I only had a 4 month recovery (or, perhaps he meant 4 months of PT?…). I was skeptical then, and now that I'm here, I still know I'm not at 100%, but I'm doing what I can to get there.

Over the weekend I got yet another medical bill, and while I am blessed to be insured, I'm also blessed with a mathematical mind. Is what I'm paying for in PT really worth it anymore? Before I used to tell myself that having someone guide me, albeit 1x per week, was worth any cost to know I'm on track. However, the last month or so was very hands-off for Drew, and even regarding equipment use- aside from the 1-leg press and a BOSU ball here and there, most everything I can do at home. So, I approached Drew yesterday as I came into PT, asking "Is it OK if this is my last visit?" Drew gave me a long look and asked, "Are you breaking up with me?!"

We did some L-to-R comparison of lunging, jumping, balancing on each leg individually, as well as measured circumference at my knee, lower and mid thigh. Here's how I see my progress as of today:
Strength ~ 90%: For instance, I can 1-leg press pre-surgical weight, but it's still a little shaky. Which brings us to...
Control ~55%: It is still difficult to absorb the impact when jumping and landing on my surgical leg. Controlling the motion of something like a 1-leg squat is very difficult and borderline painful to do as I work into deeper bending. I think toning the muscle around my knee as I get it back will help improve this.
Mass ~85%: I still have mass to regain in my L quad, but even the mass I do have is not as solid as my R leg. I know this will come in time, but as trainers have told me along the way, I have further to go than most people based on the large size of my non-surgical quad!
Endurance ~95%: I might be guessing high, but if my knee were miraculously healed tomorrow, I think my endurance would be pretty good. Although I might take that down to 90% or so when I think of playing the full duration of a soccer game with minimal subs, or the continuous sprints of ultimate frisbee.

Now that I'm PT-free I can consider my options (what unattached girl wouldn't?!). Buy some equipment for home exercise, like a BOSU ball? Or spring for a gym membership to have equipment at my disposal? Or go to some open swims at a local pool for some 'low impact' jumping to work on control? I know I can always call Drew for questions, pointers, or help… plus he provided me with a few pages of exercises to keep working on. Any way I work it, I'm pretty confident I can do this on my own now.

Sorry, PT… It's not you, it's me. ;)

Fine Tuning My Knee [3 Month 1 Week Post-Op]

"How's your knee?" ... It's a loaded question that I get all the time. I think most people are just being nice, but if you care to read, here are some extra specifics.

Being over 3 months out, I figure I'm more than halfway to recovery. At my last follow-up appointment with the surgeon, he said we're looking at a 4 month recovery, which normally I'd be super excited about. However, seeing as how I'm not a professional athlete (surprise!) I believe I'll be taking the full 6 months before I decide to commit to a sports team, perhaps subbing once in a while before that. We'll see-- I want to be steady and confident before I go out on a field and act timid and end up doing something dumb because of my fear.

Current Abilities:

• Walking without a limp (including speed-walking)
• Running (slight limp when I'm slower, but the faster I go, the less I limp). I have not tried a dead sprint yet, but really, what's the rush?
• Going up stairs- Very even and seems controlled. Even taking stairs 2 at a time doesn't seem to show much weakness.
• Going down stairs- I can still feel the unsteadiness in my surgical leg as I move my non-surgical leg to the next step down. While some days it seems easier than others, there isn't a time I've gone down stairs and 'forgot' about my knee.
• Jumping- When jumping on both legs (think: jumping rope) I can feel my right leg doing more work the longer I jump. When jumping on just my surgical leg, it's still not developed enough to accept the impact of the jump like my other leg does.
• Bending/Straightening- I can bend my knee so my heel touches my butt, though I'm still not confident when squatting all the way down and using my body weight to bend it. For straightening, there is some uncomfortable feeling when it gets close to hyperextending, but I think I need to keep working to make sure I don't lose range of motion there. My kneecap also seems to 'catch' or 'pop' every so often when I go from straight to bent, but it's not painful.

Current Focus/Exercises:

• Doing PT at home: I've been a lot better with this since my birthday, keeping a promise to myself to do my part in my recovery. I take 1-2 days off per week, but otherwise try to run every other day, and on the in-between days I'm doing more pointed exercises like lunges, step jumping, shuffling... etc.
• Physical Therapy with Drew: I am happy to announce I'm back up to my pre-surgical 1-leg press weight, as of a week ago! It feels good to be 'back to normal' in that sense, even though it doesn't translate to a 'back to normal' leg as a whole. PT will continue 1/week at least through the end of this month.
• Quad Strengthening: Lunge, lunge, lunge!!
• Calf/Knee/Jumping: Lots of jumping and quick shuffling to build up not just my muscle, but also the motor skills to be using the muscles AND moving at the same time. One exercise I do- Stand on L leg at a step with R leg resting up on step; In one jump, land with R leg beneath you, and at the same time lift L leg to touch up on step; Alternate which leg you land on (and which touches the step) after each jump, and do this as fast as you can for 30 seconds. I find this is a great gauge of how 'steady' my surgical knee is underneath me, as well as controlling that leg as I quickly touch the step through the repetitive motion.
• Jumping on one leg: Being able to balance just isn't enough. Trying to jump and accept the impact (as I mentioned before) is a whole new game. In PT on my own I try to jump forward in a straight line on just my surgical leg, and land softly. I still have a ways to go here.

Drew told me that the exercises I still feel 'unsteady' doing are the ones that are the last to come back, so I'm well on my way to recovery. Also, I have another follow-up appointment with Dr. Jeff Shapiro next Monday afternoon, and I expect more good news there!

My First 1-Mile Run [2 Months Post-Op]

Since my last PT visit, I hadn't made much time to get in quality exercise for my knee over the weekend. I blame being preoccupied, but a little of it was laziness. Over the weekend there was a lot of walking and standing, and the 'ol knee held up well. Occasionally an ache would find it's way around my knee, but nothing too painful. Either way, I was looking forward to today, since my last PT visit was finally a break from the monotonous routine I'd been doing.

Today's surprise was the 'timed 1-mile run'. As an ex-cross country runner and being an athlete in general, I know I used to be able to easily run 1 mile. Plus, I've done previous sessions of run-walk intervals in PT, covering more than 1 mile, but today's challenge was to do 1 mile running, and at a decent pace. So, once I'd done an 8 minute warm up on the elliptical and stretched a little, I headed for the treadmill. Drew was not over my shoulder during the run, so I didn't burn myself out on it, but I did make sure to turn up the pace from previous PT runs (from 6.0 to 6.5). I finished in ~9:30, and for my first mile back after knee surgery, I am OK with that! (Plus, I know I could have gone faster if I had to, but I still had a full slate of PT ahead of me!).

The run left me whipped, but as usual, I felt really good about it once I was done! I did a handful of other exercises (including shuffling side-to-side between cones; also pushing off side-to-side in a speed skater fashion on a slip board) which had me working on sideways movements and adding in a little squat motion as well. It's good to know I'm getting to a point where it's not all about the range of motion in a straight line!

While I did have to go down in weight on the one-leg press today by ~10#, I was fine with exhausting my leg muscles to the point where they were shaking throughout that exercise, and others. Lunging is still difficult to put the weight evenly through my surgical leg, but practice makes perfect, right?

Next Monday (just shy of 10 weeks post-op) I'll see the Doctor again and make sure I'm on track!

I haven't posted pics in a while, but then again not much is changing. Swelling seems minimal, the incision is healing up nicely, and the definition in my legs is coming back, little by little. The only thing I might ask about is the dark spot that still remains on the back of my knee where I had dark bruising after surgery. I am sure it's normal, but just out of curiosity.

Walking the Runway [27 Days Post-Op]

Today I returned to work, and while it was nice to get back to a 'normal' routine and see some familiar faces, it was a short distraction before I headed to PT in the early evening.

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.

Bruising, Driving, Pain and Ditching the Crutches [6 Days Post Surgery]

I have heard of people getting bruising all the way down their shin and around their knee (seems normal since there was a saw, a drill and 2 screws in the mix of the procedure) but I hadn't seen too much of that on myself until recently.

Since pictures are worth 1000 words, here are some shots which show a little of the bruising, as well as my improvement in getting my knee to bend at home. [Remember, the Day 6 goal was 90 degrees per my Physical Therapist, Drew...] The swelling and tightness within the knee was what was keeping me from bending any further:

4 Days Post-Op:

5 Days Post Op:

6 Days Post-Op:

Now, granted, the pic above of 90 degrees was taken after PT, but to my credit, I did try at home that morning, and got to ~85 degrees and was delighted! As you can see here, on my way to PT I was able to get myself into the car and also crack a smile. Clearly I did not know what was waiting for me behind PT #3...

I arrived in my immobilizer and on crutches, and made my way so I could unwrap everything as I sat on one of the padded PT tables.


First, sitting upright with legs extended in front of me, I did 45 reps of using a belt around my surgical foot to pull the heel towards my butt, causing my leg to bend, then using my leg to push back out to straight. This is an easy way to 'warm up' the joint, as shown here during my at-home PT:Next, it was extend and bend time. I was lying on my back with legs extended as Drew massaged the lower thigh and knee-cap area. It was a cross between being painful and a relief. This manipulation lasted about 30 seconds, before he stood up (I was laying around his waist level) and he then leaned into my knee, forcing my leg to straighten as much as possible. In my opinion, I thought he was trying to bend my knee backwards, and this surprise pain caused me to flop around a bit. But it was nothing compared to PT#2's forced bend. I was then asked to flip over on my stomach, and got further massage on the back of my knee. In my few visits I knew this to be the prelude to a very painful forced bend, so already I was getting anxious. He did distract me though, by massaging the bruised area on the back of my knee (pictured below) which hurt a bit, but not terribly. Then, the moment I'd been dreading.

I am not sure where he places his hands, as I get into a foggy mentality at that point. But needless to say, he pushes my knee to bend beyond comfortable (or even uncomfortable) limits, into the screaming, gasping, never-felt-pain-like-this-before range. This is not meant to scare anyone, but I would not have wanted to watch this being done to myself or anyone else. Even though I was in an open PT area with other recovering people around me, I had no ability to limit the noises and cries coming out of my mouth. I actually cried/yelled, "STOP-STOP-STOP-STOP-STOP!!!" as he continued to bend my knee. Eventually, he did stop (this forced motion probably took all of 15-20 seconds, but felt like an eternity). My only saving grace was that instead of doing this 3 times, as he had done on Friday, he only did it once.

Drew told me he bent it to 95-100 degrees. I'm all for working towards a successful recovery, but be HONEST with me, man! If you're expecting more than 90, don't tell me 90! 5-10 degrees may not SEEM like a big difference, but trust me, I could feel every little degree (and the people around me could HEAR it!). There was an older man on the next table over who tried to make me feel better saying he's been through the same thing, but unless I heard his cries of pain, words didn't offer much consolation at that point. What I needed were Kleenex and more Vicodin....

PT carried on in challenging fashion, as I was forced to walk the ~80ft to a bike in the corner w/out brace or crutches, and it was all about being able to put full weight on the surgical leg, which I didn't think I could do w/out it giving out from under me. I had to trust Drew. I had to trust the guy who just put me in the most pain of this whole experience. Talk about a wild inner monologue.

I made it to the bike, where I used the force of my right leg to work on range of motion (ROM) for my surgical leg. Slowly I worked my leg forward and backward around the 'U' made by the lower portion of the pedal revolution, until I could finally make a full revolution with just a little pain.

After that it was more walking, some balancing, some marching in place and finally, icing my knee at the end. I was exhausted and in pain, but at least it was all over.

I went to leave, immobilizer on my leg and crutches under my armpits. As I said goodbye to Drew he looked at me with wild eyes and said, "What are you doing?!" and he motioned to an assistant, "Take those crutches away from her! No more crutches!" I became protective of my supportive crutches and responded, "OK, OK! I won't use them! But I'll carry them myself!" and hobbled my way to my car, where my crutches still sit.... So it's official, I've ditched the crutches!

There are no 'goals' for Wednesday PT, and Drew did say he promised not to beat up on me too badly every time, but perhaps every other time. I don't know what that means, but I did admit to him that if it is necessary for recovery, he can do whatever he wants (what was I THINKING?!). Maybe next time I'll bring a flask.... !

For further comparison to previous days, here are some shots from Day 6 Post-Op:

Back to Basics, PT [1-2 day post-surgery]

Knee Surgery. Patellar Tendon Graft. ACL Reconstruction. Arthroscopic Surgery. Bone Saws. Drilling into my bones. Two titanium screws holding the graft in place. All of this is BEHIND me!! The fact that I have avoided some pretty normal side effects (nausea, extreme pain included) I continue to consider myself blessed to be feeling how I am right now! But let me take you back to 4pm yesterday, as I gingerly crutched myself into the Physical Therapy room where I'd done pre-hab before.

I skipped sign-in, in hopes of finding a seat where I could elevate my leg again. The worst pain has been when all that blood goes rushing to the knee area at first stand!! But it tends to subside, slightly, enough to be tolerable. But I didn't see Drew, my physical therapist, right away, so I laid out on a table until someone told me to move. Our first steps were to remove the immobilizer (which I'd only worn when in the car from the hospital, and now, on the way to PT) and then to undress the wound. There was an ace bandage from my mid-calf to mid-thigh, and under that, a layer of gauze. Around the knee was additional gauze and tape covering the incision sight. Once all of this was peeled away, it looked a lot like this:

As you can tell, I haven't taken the time to shower, as the doc's and my initials are still on my surgical leg!! But the wound was a lot 'prettier' than I expected, as I assumed there'd be more bruising, and perhaps oozing, in the area of the cut. I hear the bruising is on it's way, but otherwise I had minimal additional bleeding, and while this is good for clean-up, it may mean there's extra work for my body to do to relieve the swelling. No worries!

So, at this point I was fully exposed and thought Drew would give me a few pointers on how to be a little more mobile, give me a few things to do at home (simple, like wriggling my toes on the surgical leg), perhaps clean up my wound a little, and be on my way. In these assumptions, I was WRONG. Time to make me work!

First a baseline. I could get my leg completely straight, which is great. As far as bending, I could only get to about 35 degrees. Goal: 90 degrees by Monday (5 days after this visit). As a matter of fact, Drew said if I can't get it to 90 degrees by Monday.... HE will. Yikes.

From here it was a series of seemingly simple exercises for my leg, but it was my mind that took the real toll. I consider myself somewhat tough, but I was so scared that certain motions or movements would hurt, that limited me more than anything else. So whether it was trying to bend or straighten, or trying to use my quad muscles to move my leg, I had a VERY difficult time. And, being scared had me pretty emotional as well- I had to trust that Drew wasn't (a) asking me to do something I couldn't do and (b) if I required his support in moving or lifting my leg, I had to know he wouldn't move or twist too fast, or worse yet, drop my foot or leg unexpectedly. Of COURSE, he was 100% trustworthy, and knows what he's doing, but I felt so vulnerable, it was, again, just mentally tough for me.

This doesn't mean all the exercises were a piece of cake. We did about 5 or so, all just working on firing my quad muscles, or gaining range of motion, sometimes using gravity as an aid, when I couldn't get muscles to fire. (Some more detail available in the 4/15 PT entry of ACL calendar, found in the links to the righthand side...).

All of this reminded me... don't forget to BREATHE. I found myself not relaxing when I needed to, or holding my breath as I did something strenuous. I am lucky to have had an upbringing where I was often told to 'take a few deep breaths' and I will definitely be calling on those skills as I challenge myself in PT in the coming weeks.

Drew tells me I'll be running in 4 weeks. My orthopedic surgeon uncle said this is a very aggressive recovery, so I will follow directions, but don't plan to be a hero and try to get out there before I am good and ready. I am still assuming 6 months before I can get back to what I really love - those organized team sports!

But at home, while there are times of discomfort, I am getting so much support from Eric and my family (and his!) and it's been pretty seamless. I hope to continue in this fashion, and while there are sure to be times of difficulty, I will still manage to try and keep a light heart about it all. Thanks to my great friends and family, I have lots to keep me busy (and, fatten me up as I sit on the couch! hehe) and I am so grateful for that!

Next PT visit is tomorrow (Friday, 4/17) at 4pm. Until then, I'll work on exercises at home, and keep a positive outlook. How could I not, in this atmosphere? ....
But I can't say it enough... THANK YOU to EVERYONE for your amazing support!! xoxo

Physical Therapy [22 Days Pre-Surgery]

Eric and I have coined my early visits 'Prehab' since it's a completely different focus than my rehab will be, post-surgery.

I arrived promptly before 7am and waited patiently in the lobby. At about 7:10 I decided no one was going to get me, so I went into the PT area and found Drew, the trainer. Note to self: Sign in, walk in, and get things started on your own if you don’t want to be waiting around next time!

After a 10 minute warm-up on a stationary bike, Drew took a look at my leg to see if straightness had improved since our initial meeting. Since I’d been doing the exercises he’d given me previously, I knew it was improved. He watched my gait as I walked the runway, and while it feels different in my left knee, my stride is even and balanced. From there we did a handful of things. Calf stretches, hamstring stretches, straightening my ‘surgical leg’ against a resistance band which went behind my knee, and calf raises. Easy-peezy lemon-squeezy! But as I thought my visit was winding down, he added just a few more exercises. First, surgical leg one-leg-press (he had me try it out when the weight was at 30#, but promptly raised it to 150# once instruction was over…!). This was more like the work level I expected at PT! Then, as a last gift and promise of soreness to come, I had to lie on a padded table on my non-surgical side with a 5# weight around my surgical leg ankle. I remember my mom doing ‘leg lifts’ like this when we were younger, while watching TV. Since I haven’t done these in… years, and I now had this fun 5# weight added, this was by far the activity that caused the most burn! 3 sets of 15, and I thought my leg was going to fall off at the butt! I laughed to myself wondering how this helped my knee exactly, and wondered if maybe my new friend Drew had decided for me that there were some other ‘problem areas’ for me to work on?! :)

Once I was done, I reminded him I’d be back on Wednesday morning at 7am. “Oh, and I did have one question. Can I go to the range and hit some golf balls before my surgery?”

“Absolutely not. That’s just the twisting and pressure you want to avoid in your knee before surgery.”

[With my tail tucked between my legs] “Well, I figured it wouldn’t hurt to ask.”

This sudden stop of all sporting activities is going to be a lot harder than I thought. Meanwhile, at least I’ll have PT to focus on, and perhaps I can get back into yoga while I’m avoiding those impact sports I love so much.