I decided to write another post in light of the situation that I am currently in. This is all I have to say... If you ever experience and ACL tear (especially if you plan to have surgery) run to a physical therapist. Preferably, both before and after surgery. I was in a tricky spot because I was in the middle of moving when I should have been doing pre-op work. However, after surgery, it is my opinion that Physical Therapy is NOT an option. It is a necessity. Unfortunately, your surgeon may not know this or believe this. I feel that in my case, I made a huge mistake of listening to my doctor. He doesn't like to send people to therapy right away because there is the risk of hurting the graft. When talking to him, I didn't think that I was doing too badly. I'm just a little slower than average, I was told.
Sure, if you don't receive therapy right away, you can still make a full recovery. However, the amount of pain you will go through is going to be much, much worse. What happens is after 4 weeks scar tissue starts to lay down more quickly. Once that happens, all you can do is push through it. I have noticed a big difference coming into my fifth week. My leg is harder to bend, like thick taffy. Today, I asked Dale to bend it for me because I have been having difficulty getting it very far on my own. I'm telling you, it hurt. I cried a bit, chewed through a towel and gripped the table so tightly that my shoulder and chest muscles wouldn't stop quivering. I'd like to think that I have a decent pain tolerance. You don't do marathons and Ironmans without one. But this type of pain is different. It feels much like it did when I first injured it. Also, because it is hard to relax, your hamstrings will start to guard making the motion harder to get. Still, I guess I am not the worst of the worst cases. Dale says that the barrier is still soft so it is easier to get through. Sometimes, it is hard and that is when he has had to put all his weight into it (to the point where he is black-and blue from pushing). But getting the motion in the knee is only part of the solution. Keeping it is the other. Every day that you will work at it, you will gain a certain amount of motion. However, overnight, things will stiffen up and you'll be back to square one. So going through the process of having someone bend your knee is not a one-time deal. It is a daily process. Since, mine has gotten so bad, I'm working against the clock to get the motion back and get through the scar tissue before it hardens even worse. THis means more days on the table having my knee forcibly pushed into a new range. Unfortunately, this is a scene that is too commonly seen among PTs. I've been told that over my 16 weeks at the clinic I will probably see other cases similar to mine. Although it can't be totally prevented, some things can help:
1. Pre-operative strengthing and work to get full knee flexion and extension back
2. Post-operative physical therapy. The clinic that I'm at sees their patients the day after surgery.
3. Following the guidelines set by both your surgeon and PT. (Weight-bearing restrictions, completion of home exercises)
There are certain cases where getting range back after surgery isn't possible. I'm thinking of one person who isn't allowed to bend her knee much for th first four weeks. Still, she has good leg strength and started physical therapy immediately afterward.
This has been my first experience with an ACL injury both as a person and as a student physical therapist. I wish I had known more going into this process because maybe I wouldn't be in the position I'm in now. I wish I would have demanded to be seen by a PT starting the day after surgery. In Michigan, by law, you can't go and see a physical therapist without a doctor's prescription. This is different from most other states where there is some form of direct-access to physical therapy. It's kind of funny how all these issues that we have talked about in school are currently hitting right in the face.
I'll recover. It is just going to be a very tough couple weeks ahead. As Dale has said to a collegue, "She'll let me bend her knee because she wants to be able to run again."
Friday, October 24, 2008
Week 5: Yay Aaron!
My husband, Aaron, finished the Detroit Half-Marathon this past weekend. His finishing time was 1:45. I thought this was great since he had to start at the very back of the pack in section T and have to pass many much slower runners and walkers. In past years we have run the marathon and we are typically in the first section right behind the wheelers and handbikes. This was an interesting experience for me because I was there only as a spectator. I don't usually go to races to watch. My knee still gets pretty sore at times so I had to be careful and limit my time standing on the concrete. Detroit has this people-mover system that links various areas of the downtown area. After I left him at the start (only a couple blocks from our hotel) I jumped on and rode it to the GM headquarters. After getting coffee (I always have to know where the nearest Starbucks is) I got to wait for the runners to exit the tunnel from Canada. In the Detroit Marathon, a good part of the first half of the race is run through Winsor, Ontario. The runners start in Detroit and go over the Ambassador Bridge. From there, the route goes along the Detroit river to the tunnel which the runners take back to the other side. I have raced the Marathon many times. It has such a great variety of sites on the course and the view from the bridge is always beautiful because you are going over as the sun is coming up. Spectacular.
I was worried at first that I had missed Aaron because I didn't see him when I though I would. He was wearing red so that I could spot him but unfortunately, a number of racers were also wearing either red or orange so it really didn't help that much. When he did come out he was pretty easy to spot in the crowd. He was the only one zigzagging and cutting long diagonals through the crowd in an attempt to pass. He spotted me and yelled something about me finding my coffee. I cheered him on and then headed back to the people-mover to get to the finishe before he did. After getting lost, I managed to make my way to Mile 13 just minutes before Aaron turned the corner on his way to the finish. Not too bad for someone with a bum leg, huh?
I was glad to go and see him run this. He was really excited and had a great race. It also made me sad because I couldn't be out there with him running. It has now been almost 2 months since I have ran and I miss it so much. It's frustrating, but I know that I will be out there again.
Monday, October 20, 2008
Week 4: Just Shy Of Average
I had another Doctor's visit today. Overall, it was positive news. The swelling has gone down a lot. The only area left is a ring around my actual kneecap (and probably some underneath). I have neutral extension and could move my knee past 90 degrees for the exam. I can move it much farther but it is an hour to the Dr.'s office and my leg tends to stiffen up during car long rides.
The negatives are that my quads are a mess and my progress is just on the lower end of average. Why? Who knows, my doc told me. Everyone is different. Prior to this, I've always healed really fast from scrapes, pains and even a shoulder sprain. But I'm getting older and with the stress of being able to start clinicals, maybe it is affecting things.
I have been working out a ton now. I probably average 1-2 hours a day of stretching, weight-lifting and icing of this leg. Dale has helped me with the strength-training aspect. I have been doing the leg-press, hip flexion machine, calf raises among other things. It has become part of my learning experience here at my clinical. Anything that gets put on a patient, also gets done to me. One example is this thing called "the chair". Apparently, at the old clinic, it sat in the middle of the room so everyone could see you squirm. Basically, it is a device that forces your knee into extension. You sit in the chair with your foot up on another chair. There are straps that go across your knee and hooks that attach to a board on the floor. After you are strapped in, the straps are tightened forcing your knee into extension. It hurts a lot like a bad muscle pull. Basically, your hamstrings will fight for about five minutes, after that, they relax and the straps are tightened again. In total, you start out sitting in it for 10 minutes working up to 20 minutes in total. I'm told that you're leg goes numb if you sit in it that long. Normally, this thing is used for people who cannot completely straighten the knee. I was put in it more for educational purposes (I guess this is what happens when your clinical instructor is former military)
Also, I had the privilege of having Dale bend my knee. It was a miserable feeling but not as bad as the chair. I didn't feel like crying but it hurt. In the beginning, I just kept saying, "Please Dale, no. Don't do it." I was on a table in the gym with about 5 other people (staff, interns, other patients) watching me. It is sometimes a little embarrassing. I'm a coworker and at the same time a patient. I can't fuss or break down because I'm being watched on both sides. I've got to be tough. Everything I'm doing must be working because I'm not limping like I was two weeks ago and I'm starting to see a little new muscle. I'm told that I won't see a lot of strength gains for at least 4 weeks.
The negatives are that my quads are a mess and my progress is just on the lower end of average. Why? Who knows, my doc told me. Everyone is different. Prior to this, I've always healed really fast from scrapes, pains and even a shoulder sprain. But I'm getting older and with the stress of being able to start clinicals, maybe it is affecting things.
I have been working out a ton now. I probably average 1-2 hours a day of stretching, weight-lifting and icing of this leg. Dale has helped me with the strength-training aspect. I have been doing the leg-press, hip flexion machine, calf raises among other things. It has become part of my learning experience here at my clinical. Anything that gets put on a patient, also gets done to me. One example is this thing called "the chair". Apparently, at the old clinic, it sat in the middle of the room so everyone could see you squirm. Basically, it is a device that forces your knee into extension. You sit in the chair with your foot up on another chair. There are straps that go across your knee and hooks that attach to a board on the floor. After you are strapped in, the straps are tightened forcing your knee into extension. It hurts a lot like a bad muscle pull. Basically, your hamstrings will fight for about five minutes, after that, they relax and the straps are tightened again. In total, you start out sitting in it for 10 minutes working up to 20 minutes in total. I'm told that you're leg goes numb if you sit in it that long. Normally, this thing is used for people who cannot completely straighten the knee. I was put in it more for educational purposes (I guess this is what happens when your clinical instructor is former military)
Also, I had the privilege of having Dale bend my knee. It was a miserable feeling but not as bad as the chair. I didn't feel like crying but it hurt. In the beginning, I just kept saying, "Please Dale, no. Don't do it." I was on a table in the gym with about 5 other people (staff, interns, other patients) watching me. It is sometimes a little embarrassing. I'm a coworker and at the same time a patient. I can't fuss or break down because I'm being watched on both sides. I've got to be tough. Everything I'm doing must be working because I'm not limping like I was two weeks ago and I'm starting to see a little new muscle. I'm told that I won't see a lot of strength gains for at least 4 weeks.
Monday, October 13, 2008
A Little Inspiration...
I felt that I needed a little help on my road to recovery. Some superhero power will due. I had this idea prior to getting my surgery but had put it on the backburner because I couldn't decide between Wonder Woman or Supergirl. The Amazonian won out. After the rough week I have had, I decided that I wanted to get inked as a reminder of where I've been and where I can be in time. I chose just a simple black and white version because my back takes a lot of abuse from the sun and colors fade faster. As you can see from the photo, I still have my summer tan lines.
I'm feeling a little better after today. My clinical instructor is helping me with my rehab goals (he'll be my go-to person so I can do my PT on my own time). The swelling is also going down more after spending most of the weekend off my feet. I can now clearly see the entire outline of my kneecap! That, and I'm starting to see a little new muscle in my right quad. It's the little successes that matter most right now.
Saturday, October 11, 2008
Post-op Week 3: The Lowest Point (I Think)
I have been pretty down this past week. Unfortunately, there hasn't been a lot of good news about my progress. But it is what it is, and hopefully I have just reached a short plateau and will start seeing some real improvement soon.
At my Doctor's visit last week (Oct. 2) he thought that I was doing pretty well for only being two weeks out and gave the OK to start my clinicals the following Monday. So I did part-time (20hrs) and I love, love, love it. I am at the Ann Arbor Medsport complex. It is such a cool clinic. They have a huge gym, a room for post-surgical patients, a casting room, a pool, batting cage, basketball hoop. You need it, they have it for rehabbing sports injuries. The funny thing is that about half the people being seen at the clinic have had some sort of knee injury. My clinical instructor, Dale, has been in the profession for 18 years and has worked all over. I'm totally confident that I'll learn a lot from him.
One clue that I had that things were not going well for me was my clinical instructor. Dale is concerned about the state of my quads. Their shot. For example, I went to the pool on Wednesday and realized that I had forgotten my goggles. No sweat, I thought. I'll just kick back and forth for a while with a kickboard instead. Honestly, if I hadn't had that board, I would have sunk like a rock to the bottom of the pool. I haven't felt that uneasy in the water since the time I had to swim through a rapid on the Colorado river.
I'm lucky that I am in such a great place right now working with an instructor who has probably seen thousands of ACL injuries. So if he says something isn't right, then it isn't. Dale has been immensely helpful: giving my new stretches and exercises to try. I knew it was definitely serious though when yesterday he hooked me up to the Russian stim. Russian stim is a form of electric stimulation that is primarily used to get a strong contract out of a muscle that is too weak to do it on its own. In my case, my wasted quads. I had two large electrodes placed on my thigh, one over the VMO (medial thigh) and one across the top of the thigh. Then before he upped the power, he told me that I couldn't cry. All, I can say is that this hurt like hell. I have been hooked up to electric stim in one of our patient care classes (I've even been given a nice electrical burn because of it) but I have never had to endure it for 20 minutes. It would cause my muscle to contract for 10 seconds and then let off for 30 seconds. When the contraction is occurring, you also have to try to contract your quad on your own and try to push the back of the knee into the table. At first I thought, how am I going to make it through this? What I found though was that your body does adjust to the feeling and after a while, I was even able to turn up the amplitude a bit on my own. Apparently normal muscle should be able to handle a normal amplitude of around 80. I am around 55. Also, I noted, the harder you push down into the table and contract the muscle on your own, the less it hurts as well.
So how did I get in this position. I have been thinking about this today and I have 3 possible reasons.
1. It was a month between the injury and surgical dates so my quads were wasted before I got the reconstruction done. Add another insult such as surgery on top of that and my quads are really, really gone.
2. I got off my crutches too soon. I was feeling pretty good. No pain pills (not even Tylenol). But the added pounding from walking (in addition to weak muscles) means that the swelling isn't going down very fast leading to less mobility.
3. I am an abnormal case. My doctor doesn't normally send people to PT right after surgery. He says only a small number of patients that he has treated have had this problem. He says that he doesn't like to send people right away because of the issues of failure with too aggressive of PT at the beginning. Normally, he waits a few weeks and then sends them if he feels they need it.
So I am kind of in a tight spot right now. I have about 4 weeks from date of surgery to when scar tissues starts to form which is going to make moving my knee more difficult. I am starting to run out of time. I talked to my doctor yesterday and he is going to be having his office send a script for PT to a clinic here in Ann Arbor (Medsport it is!!!) I have also put myself back on crutches to try to get the swelling to go down faster. Also, I have Dale who told me yesterday that if my knee isn't bending well enough by Monday then he is sticking me in a room and bend it for me. One of the techs, Rachel, told me that they do that so you can scream and cry as loud as you want. I don't think that I can make it through something like that without crying.
So this weekend, instead of enjoying the homecoming festivities at CMU, I'll be spending it iceing and bending and exercising and re-icing my knee. In addition, I'll be listening to the Webcast of the Hawaiian Ironman because with all the cable channels that I have, there isn't one that carries the race live. Of course, there is about a dozen channels with football.
At my Doctor's visit last week (Oct. 2) he thought that I was doing pretty well for only being two weeks out and gave the OK to start my clinicals the following Monday. So I did part-time (20hrs) and I love, love, love it. I am at the Ann Arbor Medsport complex. It is such a cool clinic. They have a huge gym, a room for post-surgical patients, a casting room, a pool, batting cage, basketball hoop. You need it, they have it for rehabbing sports injuries. The funny thing is that about half the people being seen at the clinic have had some sort of knee injury. My clinical instructor, Dale, has been in the profession for 18 years and has worked all over. I'm totally confident that I'll learn a lot from him.
One clue that I had that things were not going well for me was my clinical instructor. Dale is concerned about the state of my quads. Their shot. For example, I went to the pool on Wednesday and realized that I had forgotten my goggles. No sweat, I thought. I'll just kick back and forth for a while with a kickboard instead. Honestly, if I hadn't had that board, I would have sunk like a rock to the bottom of the pool. I haven't felt that uneasy in the water since the time I had to swim through a rapid on the Colorado river.
I'm lucky that I am in such a great place right now working with an instructor who has probably seen thousands of ACL injuries. So if he says something isn't right, then it isn't. Dale has been immensely helpful: giving my new stretches and exercises to try. I knew it was definitely serious though when yesterday he hooked me up to the Russian stim. Russian stim is a form of electric stimulation that is primarily used to get a strong contract out of a muscle that is too weak to do it on its own. In my case, my wasted quads. I had two large electrodes placed on my thigh, one over the VMO (medial thigh) and one across the top of the thigh. Then before he upped the power, he told me that I couldn't cry. All, I can say is that this hurt like hell. I have been hooked up to electric stim in one of our patient care classes (I've even been given a nice electrical burn because of it) but I have never had to endure it for 20 minutes. It would cause my muscle to contract for 10 seconds and then let off for 30 seconds. When the contraction is occurring, you also have to try to contract your quad on your own and try to push the back of the knee into the table. At first I thought, how am I going to make it through this? What I found though was that your body does adjust to the feeling and after a while, I was even able to turn up the amplitude a bit on my own. Apparently normal muscle should be able to handle a normal amplitude of around 80. I am around 55. Also, I noted, the harder you push down into the table and contract the muscle on your own, the less it hurts as well.
So how did I get in this position. I have been thinking about this today and I have 3 possible reasons.
1. It was a month between the injury and surgical dates so my quads were wasted before I got the reconstruction done. Add another insult such as surgery on top of that and my quads are really, really gone.
2. I got off my crutches too soon. I was feeling pretty good. No pain pills (not even Tylenol). But the added pounding from walking (in addition to weak muscles) means that the swelling isn't going down very fast leading to less mobility.
3. I am an abnormal case. My doctor doesn't normally send people to PT right after surgery. He says only a small number of patients that he has treated have had this problem. He says that he doesn't like to send people right away because of the issues of failure with too aggressive of PT at the beginning. Normally, he waits a few weeks and then sends them if he feels they need it.
So I am kind of in a tight spot right now. I have about 4 weeks from date of surgery to when scar tissues starts to form which is going to make moving my knee more difficult. I am starting to run out of time. I talked to my doctor yesterday and he is going to be having his office send a script for PT to a clinic here in Ann Arbor (Medsport it is!!!) I have also put myself back on crutches to try to get the swelling to go down faster. Also, I have Dale who told me yesterday that if my knee isn't bending well enough by Monday then he is sticking me in a room and bend it for me. One of the techs, Rachel, told me that they do that so you can scream and cry as loud as you want. I don't think that I can make it through something like that without crying.
So this weekend, instead of enjoying the homecoming festivities at CMU, I'll be spending it iceing and bending and exercising and re-icing my knee. In addition, I'll be listening to the Webcast of the Hawaiian Ironman because with all the cable channels that I have, there isn't one that carries the race live. Of course, there is about a dozen channels with football.
Wednesday, October 1, 2008
Week 2: More Work, More Doubt, and a Computrainer on Order
This week, I took my first steps to get myself back into shape. I got my membership at the local pool here in town. I am a bit slow. I can't push off the wall with both feet yet (the force is too much yet). I plan on building up slowly swimming 3-4 times a week so I can join a masters swim class in November.
I have been spending approximatley 30 minutes a day working on bending and strengthening my knee. I do quad sets, leg lifts and mini squats. In addition, I'm back lifting to strengthen my upper body. I'm also doing ab and core work as well.
I was pretty lenient on myself the first week after my surgery. This second week I have been expecting a lot more. Even though I'm progressing, I stll feel like it isn't enough. I'm impatient to be back to "normal". I realize that I'm putting a lot of unnecessary pressure on myself. A lot of this added pressure is due to the fact that I am planning to start my internship in physical therapy next Monday. I can't say that the staff at my college has been entirely supportive throughout everything. They have been able to arrange for me to start late and do the first two weeks part-time. Still, when I talk to any of them, I get the impression, that they don't think that I am up to it (which is a bit amusing since none of them have seen me in person). I think that I am doing as well or better than anyone who has been through knee surgery within the last two weeks. Their doubt only fuels the fire that is pushing me to get better.
Monday, Aaron and I went to Dearborn to put an order in for a Computrainer. After weighing the pros and cons, I decided that if I am going to only be allowed to ride a bike all winter, I want something that I know will keep me motivated to stay in the saddle.
I have been spending approximatley 30 minutes a day working on bending and strengthening my knee. I do quad sets, leg lifts and mini squats. In addition, I'm back lifting to strengthen my upper body. I'm also doing ab and core work as well.
I was pretty lenient on myself the first week after my surgery. This second week I have been expecting a lot more. Even though I'm progressing, I stll feel like it isn't enough. I'm impatient to be back to "normal". I realize that I'm putting a lot of unnecessary pressure on myself. A lot of this added pressure is due to the fact that I am planning to start my internship in physical therapy next Monday. I can't say that the staff at my college has been entirely supportive throughout everything. They have been able to arrange for me to start late and do the first two weeks part-time. Still, when I talk to any of them, I get the impression, that they don't think that I am up to it (which is a bit amusing since none of them have seen me in person). I think that I am doing as well or better than anyone who has been through knee surgery within the last two weeks. Their doubt only fuels the fire that is pushing me to get better.
Monday, Aaron and I went to Dearborn to put an order in for a Computrainer. After weighing the pros and cons, I decided that if I am going to only be allowed to ride a bike all winter, I want something that I know will keep me motivated to stay in the saddle.
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