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.

PT Routine Shake-Up [8 Wk 2 Day Post-Op]

I passed my 8 week mark on Tuesday and am cruising to 2 months post-op this weekend, on June 14. On Monday I went to PT and pretty much did my whole routine without any pointers, new exercises or even manipulation/ stretching by Drew, my therapist. Even though I did some treadmill time and feel my strides are becoming more even, I was disappointed at the lack of personal attention and was glad that I’d gone down to 2 visits / week. However in yesterday’s PT, Drew decided to mix it up for me, and it felt good to try new challenges, even if it left me whipped afterwards!

First, we skipped the 10 minute warm-up on the bike, since initially this was used to help get back range of motion and in later weeks, loosen up the knee w/o putting too much weight on it. Instead, I did 8 minutes on the Elliptical (Drew said to be sure I was a little tired and breaking a sweat when done), and after some calf and hamstring stretches, it was over to the treadmill. There I did 15 mins of alternating between speed walking and a run. I am gaining lots of confidence here and am sure I could have run longer, but didn’t know what else was in store for me.

The most entertaining, by far, was using the Bosu Ball, which is basically an inflated exercise ball, sliced in half with a hard plastic board across the flat. I had to stand on the flat part, meaning the half-sphere was towards the ground, and I had to balance on it, or risk falling off! I have never used a Bosu Ball, so I was very cautious. At first I thought the goal was simply to stand and balance, but then we added squats, which would mean having to distribute my weight evenly across both legs. I looked kind of like THIS, but kept my hands out in front of me for more balance. My surgical leg was a little shaky, and this was intensified by the Bosu Ball, making it even more difficult!

30 squats later (and, a careful dismount of this potentially dangerous piece of equipment), my surgical leg was ready for solid ground again!

I thought I’d be sorer today because I felt like we really pushed it (and, mixed it up, finally!) but perhaps the soreness will be another day behind. Or, maybe I’m further along than I thought, and ready for some more challenging tasks!

Other items of note:

• With the exception of an anti-inflammatory now and again, I haven’t had to pop pills for pain much since about mid-May (1 month post-op)
• The skin to the outer side of my vertical incision is still a giant numb spot, maybe 2/3 the size of my palm
• While I’m still able to ‘forget’ about my knee sometimes, I have noticed an aching feeling that comes about sometimes just when sitting
• More often I am able to get in and out of my car by pivoting on my L leg, instead of getting in or out of the car with both feet on the ground first
• I take the stairs up and down to my 2nd floor desk whenever I can, and going up remains pretty even while going down still requires some strengthening to even it out
• I can walk w/o limping, but if I’ve done a lot of activity or walking in any given day, my limp creeps back to a quite obvious favoring by days end
• I touched my butt with my heel! While standing I was able to grab my ankle and (with my foot slightly pointed/ while wearing tennies) was able to bend my knee so far as to feel my shoe hit my butt! (I even showed an assistant at PT just so someone else could share my glory!)
  
  What’s wrong with getting excited about the little things? :)

No Pain, No Gain [3-4 Days Post Surgery]

Time to bust my butt. I already talked of my first Physical Therapy visit, which was no cake-walk, but also was understanding my mental limitations when it came to rehab. Between that Wednesday afternoon and now (Saturday afternoon) I have learned even more about my abilities (physical and mental) as well as had some mini-accomplishments, including getting outside (today is GORGEOUS!) and taking my first shower! (I am not sure who is more excited about that last one - me or my caretakers, Eric and Sandy! hehe)

Let me give you a quick insight into how things are going here at home. My go-to spot is the living room couch. I have not ventured upstairs to the master bedroom, so I've made this my spot 24/7. I have slept surprisingly well! Within reach I have my crutches, some snacks, puzzles, the laptop, my camera (of course!), water and meds. The coffee table has been moved so the room is open in the middle, and I use this open space to do my PT at home; as shown here:
[Laying on my belly, I am using my non-surgical leg to try to bend my surgical leg to regain range of motion]

Also nearby is the ThermoCompression Unit, which is a machine which cycles 43 degree distilled water/alcohol mixture through a cuff which velcros around my surgical leg. In addition to the cold mixture, it also pumps air into the cuff (alternating, slowly making the cuff more and more tight around my knee). This is similar to the Game Ready unit the same company provides, but I do not have to continuously add ice to it to keep it cool. Here is a pic of me while icing/compressing using the ThermoCompression Unit:

[I try to do this 20-30 minutes each hour when possible. Control unit seen on the TV tray table]

So, that's really my daily grind. Yesterday (4/17, 3 days post-surgery) was my second PT visit, and while I understand, "No Pain, No Gain" , I also would never wish this upon anyone else. (I have also admitted that I am happy girls can get away with more tears in situations like this, because the 2nd PT was quite more difficult and as tough as I thought I was, I donated my share of tears...) Here was the routine:

(A) In seated position with legs in front of me: 15 Electric Shocks via 2 electrode pads (roughly 2"x3") placed on surgical thigh to force muscles to contract for 10 seconds (then rest for 50 seconds).

(B) Lying on back, keeping surgical leg straight, lift heel off ground and lift ~2' from ground. 3 sets of 10 (I had some assistance from Drew on first set because my brain was having a hard time telling the muscles to work.

(C) Lying on stomach, Drew forced my surgical leg to bend to ~75 degrees. This was by far the most painful thing, done 3 times. I was crying and moaning the whole time, and I felt bad for anyone else who had to witness it!

(D) Without crutches, I had to walk ~80'. This was truly learning to walk again. Drew had to walk backwards in front of me, with his hands out so I could use them for balance. This was not as awful as the forced leg bend, but since walking forced me to put weight on my surgical leg and try to get muscles to fire and work, this was the second most difficult task.

(E) My walking destination was an exercise machine which puts you in a sitting position with your legs in front of you, slightly lowered. Each foot is on an independent pedal/step, and as I extended my right leg, it would force my left (surgical) leg to bend, and for 10 minute

s I did this back and forth pushing to work on range of motion in my surgical leg.

(F) Walk (with 10% help from crutches) to where I iced my leg for 10 minutes using the aforementioned 'game ready' machine.

This may be one of the few times I have to pat myself on the back for pushing through the pain and working towards the greater goal of getting my leg back to normal! *pat, pat* But I can't discredit the encouragement of Sandy (who watched the torture occur), as well as all the kind words that you all continue to give me. Thank You!

And, after that windy entry, I'll breeze through the last few points...

I TOOK A SHOWER!! hehe Thanks to a little pre-planning, including a removable shower head, this was the basic set-up that allowed me to clean up!

[To avoid falling, I had the aid of a little stool. I am allowed to get the incision area wet, but am avoiding it as best I can to keep the tape on which will help the scar heal better!]

Some pics of the wound- Here is 3 days post surgery:

And here is 4 days post surgery (today) which has shown the very first signs of any bruising, on the inside of the knee (tho it is yellow, and not black-and-blue):

And finally, I can not discount how GORGEOUS the weather is today (low 70's I've heard!), and what great encouragement that is to want to get outside! So, to continue to work on my walking, I took to the streets (ok, just our sidewalk...) and practiced!

I might be slow, but this is just the beginning of my comeback! Yippee!! ;)

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