Saw my OS yesterday, who was very happy with my progress and with the solidity of the knee. He's mentioned a couple of times that the ultimate test of the knee's stability post-op would be to do the Lachman test on both knees eyes closed and, say, forgetting which knee was "involved" not be able to tell the difference between the two. He said yesterday on examination that I was very very close to that point. I think one key element of this would be getting the tension right during surgery, once the graft is installed. My understanding is the OS uses some kind of tensionometer to do this, but I have to think that experience, and the unique feel that an excellent OS can give this process are what make the difference between a mushy feel and a nice solid joint.
My OS is a nice guy, and you can tell he's very precise in how he does probably everything, from making coffee to tying the knot in his necktie. That's exactly what you want in a surgeon doing this kind of procedure.
However, as good as the knee feels, he wanted to caution me that I need to remain vigilant about as my PT would put it, "doing something stupid" that would cause the graft to fail. At this point, as good as it feels, I will only walk out onto a tennis court to sweep it; I won't even go out there with a racquet -- too tempting.
Friday, May 25, 2007
Monday, May 14, 2007
Nine weeks last Friday
After nine weeks post-op rehab, the news is good.
The technique I mentioned at six weeks post-op, of using a piece of pipe to break up scar tissue in my hamstring really made a huge difference. I haven't had a single hamstring tweak or pull since starting that process.
I'm now doing a series of exercises to strengthen my leg/knee, as follows:
The knee is feeling excellent. No pain at all apart from some stiffness in the morning and after sitting for a while at my desk. A week ago or so, I took to wearing a neoprene knee brace just as a reminder so I wouldn't try to do something I shouldn't. Wearing it less now, but probably should continue -- it's a very good way to maintain awareness so I don't try to pivot on the knee or etc.
So, having passed the 8 week point, the graft should be starting to strengthen after declining in strength since the surgery for 8 weeks, as my OS explained it. By July, I'm going to really be itching to get out on the tennis court.
In the meantime, my shoulder is not really improving much if at all. I'm doing rotator cuff and other strengthening exercises every day and while the exercises seem to help the short term discomfort (it hurts at first and then feels better as I continue working out), I think it'll be a serious problem when I try to serve a tennis ball. I've got a call in to my OS asking him to approve an MRA for the shoulder, where they would inject some kind of dye into the joint before doing an MRI. Now and then at my son's Babe Ruth baseball games, where I've been coaching, I'll throw the ball a bit and there's always some pain. Seems like I'm OK if I'm throwing up to maybe 25 feet or so, but beyond that it can start feeling pretty bad. Normally, I really feel it the next day too. If there's any improvement, it's very very marginal. So I just don't get it.
The technique I mentioned at six weeks post-op, of using a piece of pipe to break up scar tissue in my hamstring really made a huge difference. I haven't had a single hamstring tweak or pull since starting that process.
I'm now doing a series of exercises to strengthen my leg/knee, as follows:
- One legged bridging: Lying on back, feet flat on floor. Raise and hold knee of non-involved leg to chest, raise pelvis, pushing off heel of involved leg, raising as high as possible. Four sets of 10.
- Mini one-leg squats. Standing on platform on involved leg, with other leg hanging off platform, do four sets of 10 squats touching heel to floor.
- Hip hiking: Standing on platform or step with non-involved leg hanging, tilt pelvis so heel touches, then raise pelvis on non-involved side as high as possible. Again, 4x10.
- Forward reaches off step. Hands behind head, keeping back straight, from platform, extend non-involved leg over edge of platform and bend involved leg until heel touches floor. 4x10
- Nose crushers: Stand with feet about 6-8 inches from wall. Keeping back straight, weight on involved leg, bend only at ankle and touch nose to wall, and return. 4x10.
The knee is feeling excellent. No pain at all apart from some stiffness in the morning and after sitting for a while at my desk. A week ago or so, I took to wearing a neoprene knee brace just as a reminder so I wouldn't try to do something I shouldn't. Wearing it less now, but probably should continue -- it's a very good way to maintain awareness so I don't try to pivot on the knee or etc.
So, having passed the 8 week point, the graft should be starting to strengthen after declining in strength since the surgery for 8 weeks, as my OS explained it. By July, I'm going to really be itching to get out on the tennis court.
In the meantime, my shoulder is not really improving much if at all. I'm doing rotator cuff and other strengthening exercises every day and while the exercises seem to help the short term discomfort (it hurts at first and then feels better as I continue working out), I think it'll be a serious problem when I try to serve a tennis ball. I've got a call in to my OS asking him to approve an MRA for the shoulder, where they would inject some kind of dye into the joint before doing an MRI. Now and then at my son's Babe Ruth baseball games, where I've been coaching, I'll throw the ball a bit and there's always some pain. Seems like I'm OK if I'm throwing up to maybe 25 feet or so, but beyond that it can start feeling pretty bad. Normally, I really feel it the next day too. If there's any improvement, it's very very marginal. So I just don't get it.
Friday, April 20, 2007
6 weeks post-op
The hamstring is still very tender. I did manage to go two days in a row before pulling it yet again reaching casually to pat the dog one afternoon. In fact, it's gotten bad enough that I have a nasty looking bruise on the back of my leg that I didn't even notice until my PT session yesterday.
So now I'm working with a new PT on my knee: John P. He had me sit on the floor with a 4 foot long piece of 4 inch plastic pipe under my involved leg and then showed me how to roll the pipe against my sore hamstring to break up the scar tissue and help stretch it out. This hurt like hell, but I could feel it doing the job. The big lump I had on the back of my thigh was nearly gone after this session. He said I need to do this 2x/day. So, in one session, my new PT, John, is already giving me a way to deal with the hamstring that didn't occur to the PTs at Fallon.
The other thing I like about this PT shop is that while I'm booked for 30 minutes, I sometimes spend 90 minutes there, a lot of the time doing exercises that John tells me to do, or sets up for me. He might be treating three people at once, but I never feel neglected. The atmosphere in the big therapy room is collegial, funny, and supportive. We were all commiserating with a woman who was having an intense and clearly painful massage session on her hip by one of the senior PTs. Pain is basically a way of life for everyone there, either from a treatment perspective or as a patient dealing with its effects every day. They seem to get that, appreciate it, and moreover, accept it, which makes it easier for all to deal with it. We acknowledge it, work on it, and in the end accept that it's a part of our lives at this point. For a lot of people, it's a constant presence or force in their lives. I have it easy compared to a lot of these folks.
So now I'm working with a new PT on my knee: John P. He had me sit on the floor with a 4 foot long piece of 4 inch plastic pipe under my involved leg and then showed me how to roll the pipe against my sore hamstring to break up the scar tissue and help stretch it out. This hurt like hell, but I could feel it doing the job. The big lump I had on the back of my thigh was nearly gone after this session. He said I need to do this 2x/day. So, in one session, my new PT, John, is already giving me a way to deal with the hamstring that didn't occur to the PTs at Fallon.
The other thing I like about this PT shop is that while I'm booked for 30 minutes, I sometimes spend 90 minutes there, a lot of the time doing exercises that John tells me to do, or sets up for me. He might be treating three people at once, but I never feel neglected. The atmosphere in the big therapy room is collegial, funny, and supportive. We were all commiserating with a woman who was having an intense and clearly painful massage session on her hip by one of the senior PTs. Pain is basically a way of life for everyone there, either from a treatment perspective or as a patient dealing with its effects every day. They seem to get that, appreciate it, and moreover, accept it, which makes it easier for all to deal with it. We acknowledge it, work on it, and in the end accept that it's a part of our lives at this point. For a lot of people, it's a constant presence or force in their lives. I have it easy compared to a lot of these folks.
Wednesday, April 11, 2007
Fallon PT: You're Fired!
At my last session, my PT let on that she and the junior PT who's been working with me are a bit "bored" and clearly are not sure what to do with me. I get the sense they're accustomed to working with elderly and sedentary patients. It's not like I'm a marathoner or anything, but this is an indication to me that I need to find someone else. The guy I've been working with on my shoulder, who has a lot of experience working with real athletes, has been excellent, so I'm switching the remainder of my PT sessions to him. The first four weeks post-op have been fine with this group, but it's time to step it up and move on.
It's the hamstring, stupid
So the lesson is, and the reason my doctor hedged a little on deciding whether or not to use my hamstring for an autograft is this: The hamstring autograft is going to take a long time to heal.
I keep pulling / tweaking my hamstring with very painful results doing very ordinary things like getting out of bed or getting up from a chair. At present, I can only curl about 2 lbs. lying on my stomach using ankle weights. At the gym, I use the low cable with a velcro cuff and can only partially curl 2 lbs. It's frustrating since the knee otherwise is feeling excellent. I can see that this is going to take a while - a long stretch of systematically greater weight and persistent stretching to get it back. I can't imagine cycling the hills around here with the hammie in its current state. I'd have no climbing strength, especially from the saddle, as opposed to standing up on the pedals.
I keep pulling / tweaking my hamstring with very painful results doing very ordinary things like getting out of bed or getting up from a chair. At present, I can only curl about 2 lbs. lying on my stomach using ankle weights. At the gym, I use the low cable with a velcro cuff and can only partially curl 2 lbs. It's frustrating since the knee otherwise is feeling excellent. I can see that this is going to take a while - a long stretch of systematically greater weight and persistent stretching to get it back. I can't imagine cycling the hills around here with the hammie in its current state. I'd have no climbing strength, especially from the saddle, as opposed to standing up on the pedals.
Friday, April 6, 2007
4 weeks post-op today
Range of motion continues to improve, along with strength. I've got very close to 140 degrees of flexion. Not much pain to speak of at this point, and the knee feels mostly stable. Now and then just moving around the kitchen, I'll get a little twinge from just lifting my leg and having the knee turn a bit. In general, it feels best when the quads are loaded. Unloaded, the knee sometimes feels wonky.
I'm doing regular workouts at the gym, including squats (yesterday, comfortably with 65 lbs. on the squat rack), also low cable adductor/abductor, leg presses, calf extensions, leg flexor raises, and sessions on the stationary bike. I haven't yet had the time for an aerobic session, but the knee feels plenty strong enough for it.
So, the knee progresses well, but the shoulder, not so much. Had a vigorous PT session day before yesterday, and it's quite sore, and feels worse actually. The fact that I can't tell at this point if I'm making progress or not is a bit discouraging, since the knee is better every day. I recently re-upped for quite a few more PT sessions on the shoulder, but it might be time to re-evaluate. I've been working this now for two months actively, with a brief hiatus for the knee surgery and while I'm definitely gaining strength in the back of my shoulder it's far from being in a tennis-ready state. What I need to see is a steady time line of progress, where the knee and the shoulder are both ready for tennis at more or less the same time later this year (October?).
I'm doing regular workouts at the gym, including squats (yesterday, comfortably with 65 lbs. on the squat rack), also low cable adductor/abductor, leg presses, calf extensions, leg flexor raises, and sessions on the stationary bike. I haven't yet had the time for an aerobic session, but the knee feels plenty strong enough for it.
So, the knee progresses well, but the shoulder, not so much. Had a vigorous PT session day before yesterday, and it's quite sore, and feels worse actually. The fact that I can't tell at this point if I'm making progress or not is a bit discouraging, since the knee is better every day. I recently re-upped for quite a few more PT sessions on the shoulder, but it might be time to re-evaluate. I've been working this now for two months actively, with a brief hiatus for the knee surgery and while I'm definitely gaining strength in the back of my shoulder it's far from being in a tennis-ready state. What I need to see is a steady time line of progress, where the knee and the shoulder are both ready for tennis at more or less the same time later this year (October?).
Friday, March 30, 2007
Three weeks post-op
This week, I've finally returned to a more or less normal workout regimen. I'm now alternating upper and lower body workouts with miscellaneous knee and shoulder rehab exercises on each day. Yesterday at PT started doing what you might call side lunges on the involved leg. Also did alternating lateral raises on each side to help improve balance and prioprioception in the involved leg. I was surprised doing these that I'll have to work a bit to regain a good sense of balance on the leg.
The PT cleared me for riding a stationary bike for as long as I'm comfortable. To this point, I haven't put in more than 15 minutes. After a session the other day, I was a bit sore afterwards, but that could be the resistance training too. I pushed 50#, barely, with the involved leg, being careful not to flex or extend too far. It might be better to go down to say 45# and shoot for more reps.
The PT cleared me for riding a stationary bike for as long as I'm comfortable. To this point, I haven't put in more than 15 minutes. After a session the other day, I was a bit sore afterwards, but that could be the resistance training too. I pushed 50#, barely, with the involved leg, being careful not to flex or extend too far. It might be better to go down to say 45# and shoot for more reps.
Tuesday, March 27, 2007
Up to 130 degrees
At PT this morning, my therapist was impressed with the ease of my pedaling stroke. I went in cold and my knee flexion was 120, about the same as two days ago. After pedaling the bike for about 5 minutes, flexion measured out at 130. He had me do some leg presses, the first I've done since surgery, and was able to very easily push about 80 pounds, being careful not to straighten the leg or flex too far.
Before my injury, I could push my own body weight (170) without too much trouble. Hamstring was sore later in the day. Best to combine workout, stretching, and ice. Friday is two weeks post-op, and on 4/12 I see my orthopod again. I'm still using crutches when I leave the house, but I'm hoping I can give these up in another week or so. Also, I'm hoping to get cleared for riding an actual bicycle soon. Leg strength is the key to health -- that is my conviction.
Before my injury, I could push my own body weight (170) without too much trouble. Hamstring was sore later in the day. Best to combine workout, stretching, and ice. Friday is two weeks post-op, and on 4/12 I see my orthopod again. I'm still using crutches when I leave the house, but I'm hoping I can give these up in another week or so. Also, I'm hoping to get cleared for riding an actual bicycle soon. Leg strength is the key to health -- that is my conviction.
Monday, March 26, 2007
A bit sore today
During my workout yesterday, did my usual low cable leg exercises (abductor, adductor, etc.) and then also threw in a set of very conservative squats on the squat rack, with no added weight. Was careful to keep the back straight and the knees over the feet (sticking butt out behind), and not going too low. Also was able to ride the bike for 10 minutes and get the rpm's up to about 70. Earlier this week I was just barely able to turn the pedals over. As a result, I am sore today, especially in the hamstring at the graft site. But a little icing and ibuprofen should take care of that.
Yesterday, I iron-transferred the following onto a t-shirt:
Yesterday, I iron-transferred the following onto a t-shirt:
It's the year of pain
Get used to it
Get used to it
Friday, March 23, 2007
Careful of the hamstring
In the last day or two, I've tweaked my hamstring a few times with very painful results. One time, I was just pulling on a shoe, another time I got up from a chair too quick. The trick is to avoid putting any real pressure on the hamstring until it fully heals.
Pedaled a stationary bike at the gym today for ten minutes not even fast enough to turn the bike on really, but enough to loosen up the joint very nicely. Then did three sets of low cable hip adductor, abductor, and leg lifts (quads) at low weight settings without too much trouble. It was easy enough to ride and do the exercises, that I should be able to increase the duration and intensity on the bike next time, and the amount of weight I'm pulling on the cable machine.
Pedaled a stationary bike at the gym today for ten minutes not even fast enough to turn the bike on really, but enough to loosen up the joint very nicely. Then did three sets of low cable hip adductor, abductor, and leg lifts (quads) at low weight settings without too much trouble. It was easy enough to ride and do the exercises, that I should be able to increase the duration and intensity on the bike next time, and the amount of weight I'm pulling on the cable machine.
Thursday, March 22, 2007
Pedaled a bike today
Went into PT this morning feeling a little tight. First thing I did was get on the stationary bike and use it to stretch the knee. After a few minutes of stretching, I was able to do a complete pedal stroke, so I then pedaled the bike for another 5 minutes or so. It was great to get to this point, since now I can go to the gym and start working on the bike. Afterwards, knee flexion measured out at 120 degrees, 10 degrees more than two days ago. After stretching and icing, the knee felt pretty good. Excellent progress, very pleased.
Tuesday, March 20, 2007
PT today
Knee flexion measured out at 110 degrees today. I feel pretty weak in my hamstring, but that will improve. I'm now doing leg lifts, adductor, abductor, and stretching 2x/day. Also, I'm going to step up the icing to try to get the last bit of swelling to go down so I can get some more flex in the knee.
The PT put me on a stationary bike today, and while I couldn't actually pedal a full cycle, I'm pretty close. Their recommendation is to use it for now as a way to stretch, and before long I should be able to pedal continuously.
The PT put me on a stationary bike today, and while I couldn't actually pedal a full cycle, I'm pretty close. Their recommendation is to use it for now as a way to stretch, and before long I should be able to pedal continuously.
Monday, March 19, 2007
Day 10
Doing well, though I'm still not consistenly getting a great night's sleep. I'm finding it tough to get settled for some reason. However, my knee flexion continues to improve. I'm well beyond 90 degrees, say about 110 at this point, and walking around is pretty routine. I'm not having any significant pain at all, just achiness after doing my exercises, or if I've been walking around a bit. When I leave the house for any significant walking around I take my crutches which just help me take some of the weight off the leg. I'm also not having any trouble with the rehab exercises so I'm really hoping to be able to pedal a stationary bike this week. If so I can start going back to the gym.
Had my first day back at work today, and found it pretty tough to sit at my desk for very long before the knee got sore. I think I'm still tight enough that sitting for some time, even at less than 90 degrees flexion, I get a little sore, which makes concentration a little tough. So I'm still icing the knee a couple of times every day, after which it feels better.
Had my first day back at work today, and found it pretty tough to sit at my desk for very long before the knee got sore. I think I'm still tight enough that sitting for some time, even at less than 90 degrees flexion, I get a little sore, which makes concentration a little tough. So I'm still icing the knee a couple of times every day, after which it feels better.
Friday, March 16, 2007
First week post-op
Had the best night's sleep yet since the procedure a week ago. The knee was feeling a little tight so I took an 800mg ibuprofen before getting into bed. Also, with the sutures out and the ace bandage and knee brace off, I was finally able to get comfortable. Felt great.
This morning I combined my knee exercises with shoulder rehab, and even swung a racquet a bit. It's been 4 months since I played tennis, and I'm definitely missing it. The shoulder felt pretty good. It had been bothering me a lot the week leading up to knee surgery so I knocked off the shoulder exercises altogether. I had just been overdoing it I think. The break really helped.
Next week I'm hoping to be able to start working the knee on the recumbent bike at the gym. I need to burn some calories doing something real or risk fattening up, which will only put my knees at further risk.
This morning I combined my knee exercises with shoulder rehab, and even swung a racquet a bit. It's been 4 months since I played tennis, and I'm definitely missing it. The shoulder felt pretty good. It had been bothering me a lot the week leading up to knee surgery so I knocked off the shoulder exercises altogether. I had just been overdoing it I think. The break really helped.
Next week I'm hoping to be able to start working the knee on the recumbent bike at the gym. I need to burn some calories doing something real or risk fattening up, which will only put my knees at further risk.
Thursday, March 15, 2007
6th day: Looking a lot better
This is starting to look like a good knee. That's 90 degrees of flexion, baby! and no more Frankenstein staples.
New 4-strand ACL image
Here's an image of my new 4 strand ACL. Each strand is very distinct. This was created by taking a length of my hamstring tendon and folding it twice into a 4-strand graft. You can also see how tightly it fits into the guide hole at the top right of the image frame. The PCL crosses behind the ACL from top left to lower right.
Do you have imagery from the inside of your body?
Do you have imagery from the inside of your body?
Sutures removed
My orthopod had me in today, a day early because of a snow storm coming tonight and tomorrow. They removed the sutures and the staples, and I came away with a CD of arthroscopic still images of the procedure.
My doctor also explained that the ACL is at present probably 150% the strength of my ACL prior to injury. He said that this strength actually declines over the next 8 weeks or so, as the graft develops a blood supply and so on. At 8 weeks, he said it would have about 75% the strength of a normal ACL, but that the knee would feel very good. A lot of people who have the procedure might wonder at that point why they couldn't return to normal athletic activity, but it's important to allow the healing process to continue, and not to risk re-injury by doing anything too vigorous too soon. He also sat with me and talked me through the arthroscope images.
My doctor also explained that the ACL is at present probably 150% the strength of my ACL prior to injury. He said that this strength actually declines over the next 8 weeks or so, as the graft develops a blood supply and so on. At 8 weeks, he said it would have about 75% the strength of a normal ACL, but that the knee would feel very good. A lot of people who have the procedure might wonder at that point why they couldn't return to normal athletic activity, but it's important to allow the healing process to continue, and not to risk re-injury by doing anything too vigorous too soon. He also sat with me and talked me through the arthroscope images.
First PT visit
Saw my physical therapist for the first time yesterday and came away very encouraged. My quadriceps strength is still very good, flexibility is also good. You start losing strength and muscle mass very quickly if they're not used, but especially when you spend a lot of time in bed. My PT thought I'd be playing some tennis this summer, which could be one of two things: Either she assumes tennis is like croquet, or she thinks I can progress rapidly.
Didn't sleep well last night, but did manage to do so without my brace. I had started off with the brace on, but it was pressing against my ankle bone and really irritates the incision above my knee. For some reason, that incision is the most bothersome. After wearing the brace for a little while last night, I just took it off. I don't think I'm going to injure myself in bed. I think the main risk is taking a fall. My quadriceps is in good shape which is what will protect the stability of the knee.
Didn't sleep well last night, but did manage to do so without my brace. I had started off with the brace on, but it was pressing against my ankle bone and really irritates the incision above my knee. For some reason, that incision is the most bothersome. After wearing the brace for a little while last night, I just took it off. I don't think I'm going to injure myself in bed. I think the main risk is taking a fall. My quadriceps is in good shape which is what will protect the stability of the knee.
Tuesday, March 13, 2007
Post-op day 4
Yesterday, walked without crutches to and from the kitchen, slowly, but steadily and with no pain. I wouldn't do this, of course without the knee brace, which helps stabilize the leg and gives me some confidence that it won't collapse under me.
I had two 800mg ibuprofen tabs yesterday, one in the morning, one at night. Otherwise no pain meds necessary at all. Now and then I do feel a sharp twinge at the incision highest on my leg, but if I stay relaxed, it doesn't bother me at all.
Back on the CPM this morning, my butt is getting permanently numb. Even so, my goal today is 70 degrees. With the ability now to walk around, I'm thinking rehab should probably include some walking with crutches on a smooth surface, like at a mall, so I'm going to check with my PT tomorrow.
I'll be seeing how well I can get in and out of a car today, including a test to see if I can drive. Our Subaru, which is a manual shift, is out of the question, but the Corolla should be no problem.
I have always hated being injured, but this is a little different knowing recovery is long term. I just hate crutches -- these things will kill you.
I had two 800mg ibuprofen tabs yesterday, one in the morning, one at night. Otherwise no pain meds necessary at all. Now and then I do feel a sharp twinge at the incision highest on my leg, but if I stay relaxed, it doesn't bother me at all.
Back on the CPM this morning, my butt is getting permanently numb. Even so, my goal today is 70 degrees. With the ability now to walk around, I'm thinking rehab should probably include some walking with crutches on a smooth surface, like at a mall, so I'm going to check with my PT tomorrow.
I'll be seeing how well I can get in and out of a car today, including a test to see if I can drive. Our Subaru, which is a manual shift, is out of the question, but the Corolla should be no problem.
I have always hated being injured, but this is a little different knowing recovery is long term. I just hate crutches -- these things will kill you.
Monday, March 12, 2007
Post-op day 3
Good progress so far. Up to 61% flexion on the CPM, and started moving around the house on my crutches and putting some weight on the leg, and it's feeling very good. I'm now off Percosets and switching to ibuprofen for the little bit of residual pain and to reduce swelling. I'm not feeling a lot of pain except for some achiness when I wake up, and I think that's mainly the result of swelling overnight and not being able to use the Cryo/Cuff.Got the dressing off this morning and had a look for the first time at the leg. There are actually four small holes, plus the long stapled incision beside the shin. I haven't yet seen the video or any stills of the surgery, so I'm not yet sure which holes were used for what.
One thing that surprised me is that I was sure before removing the dressing that I had an incision on the lower back of my thigh where I assumed they harvested the hamstring graft, but there's nothing there! I've felt some real tenderness there. I'm guessing the long incision is where they did this work, but I can't quite figure out how that would have worked. I'll have to get the whole story later this week when I have the stitches/staples removed. The incision that is the most sensitive is the one at the top, highest on the leg, but it's mostly just surface tenderness.
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