Week 10: Two Steps Forward, One Step Back

I've realized after this holiday weekend that my knee is definitely NOT close to be normal yet. I think it was the combination of 4 hours of driving and trudging over concrete and through slush to go midnight Christmas shopping. Oh, and I also tried to wear a pair of "normal" shoes. Up until then I had only worn my running shoes. I figured that if I could walk around at home without shoes, I should be able to manage walking in a nice pair of flats. Wrong! So now I am paying for it with a sore knee.
I am still noticing improvements. I can now use a strap around my ankle and pull my foot toward my butt. I'm within 7 inches and it seems to be getting easier each day. Someday soon, my heel will touch my but again. If I am having any trouble, it is with extending my knee. I have gotten it there with lots of stretching and sitting in "the chair" but it just doesn't stay. Also, sitting in the car, my knee stays in this slightly bent position and gets stiff and doesn't want to straighten. I think this is just going to be an ongoing battle until my strength gets better.

Week 9: 100 Pounds

Yesterday I lifted 100 lbs on the leg press... with only one leg (the one with my reconstructed knee). I am very thrilled. This means I am closer to my goal of leg pressing my bodyweight 20 times. This is a PT goal which will mean that I am closer to getting back to racing. At the rate I am going, I should hit that mark within 2 weeks.

I have been lifting for that past month and not seeing a large change in my knee... until this week. The swelling is going down. All that I have left is what is right around and under my kneecap. My muscle tone in my quad is also looking better. The leg is now looking like a slightly smaller version of it's non-injured partner. I also have most of my extension back (thanks to over three weeks of the extension chair of which I have become quite accustomed to).

Just for anyone who is wondering, this is pretty much the schedule I have been following for the past 5 weeks or so. I have a lifting routine that I do 3 days a week and a balance/functional routine that I do two days a week. It varies a bit if I have to miss a day due to school/work/doctor appointment. Weekends, I take it easy and do some light cycling, stretching and starting this weekend... backwards treadmill walking.

I am just listing my Mon/Wed/Fri strength workout this time. It is the more important of the two right now. I'll give out my Tues/Thurs workout at another time. All exercises are done 3 sets of 15 reps unless otherwise stated. Most of this is one workout although often I do the straight leg raises and wall slides at home while I am watching TV.

Warm-up: Nustep or exercise bike 10 min

Calf stretch on incline board 5 x 30 secs
Hamstring stretch (sitting up, leg out in front, sitting tall and lean forward) 5 X 30 secs
Hamstring stretch with strap (laying on your back, lift leg with strap around foot, pull down on strap with one hand and push above knee with other) 5 X 30 secs
Supine wall slide 30 times
Prone quad stretch (lie on stomach, strap around foot, pull foot towards your butt) 5 X 30 secs

Standing knee extenstion (theraband around leg above knee and attached to wall or door, lift heel and then press heel down and contract quad strongly) 3 X 25
Leg press 2 legs
Leg press l leg
Leg press eccentric (2 legs up, 1 leg down)
Heel raises off a step

Squats on a two bosu balls holding a 6 lb medicine ball
slideboard squats (one leg on ground, other on smooth surface, squat on one leg while sliding other leg out)
Hip adduction maching
Hip abduction machine
Hip flexion machine
Shuttle hip extensions (using a shuttle machine but standing and pushing back on it with one leg)

Single leg raises in flexion and abduction
Nustep intervals (switching between moderate and hard levels every 30 secs) 5 minutes
Shuttle endurance (squats on one leg) 5 minutes

Knee extender chair 18-20 minutes (depends on how long I can tolerate that day)
Ice and electric stim. 15-20 minutes

This entire thing can take me up to two hours. However, the last 30-40 is spent sitting. I wouldn't recommend this to everyone but doing this intense of a workout consistently is really starting to pay off. The results haven't come instantly and it has been discouraging going into a weight room to do this day after day and not seeing results. The important thing that I have to continually remind myself is that the healing process does not follow a straight line. It is more like a bumpy road.

Week 8: Cortisol- Not A Miracle Cure (not even close)

Well, it turns out that the cortisol shot was not the miracle that I was hoping for. For the first couple days, I thought that I might see some improvement because it looked like the swelling was decreasing. Except for right around the kneecap, it looks like I have a normal left leg. The unfortunate part is that I think the cortisol irritated the joint. Since the shot, I haven't been able to bend my knee as far. It is slowly getting better now but I won't ever do that again.

Now that I have had my knee injury, I feel like I have admittance to a special club. I have had so many people come up to me since my surgery to ask me how it happen and then tell me about their knee injuries. This morning, at Starbucks, I met a guy who tore both his ACLs in a car accident. This was back in the mid-80s when reconstruction was not what it is today so he never got his replaced. He suggested using a combination of epsom salts and hydrogen peroxide to soak the knee in. It is supposed to help with swelling. I don't have either of those but I do have a bottle of "Tired Old Ass" soak which I think has salt in it. I'm going to try that to see if it helps.

I've set 4 small mini-goals for this week
1) Achieve full extension of the knee 3 days in a row
2) Be able to get my knee within 2 inches of my butt
3) Perform 20 leg presses with my left knee at a setting of 95 pounds
4) Be able to descend the stairs at my apartment without having to lean half my weight on the handrail

Knee Watch: Day 1

It has been a little over 24 hours since I got the shot in my knee. Overall, it doesn't look that different from yesterday. I have noticed that I had less pain in my leg last night. No cramping in the calf or back of the knee. Usually I wake up around 4 every morning with it. I have also noticed that my knee has been creaking a lot more. I was exercising after work and I swear I could feel something jelly-like sloshing around my kneecap. Maybe the swelling is starting to go down.

Week 7: A Large Needle Full Of Hope

I'm feeling like life is dumping on me right now. This process is so excruciatingly slow. Everyday is a fight for movement in my knee and then when I go to bed I just hope that some of it remains the next morning. Overall, I'm still moving in a positive direction. Just very... very... slowly.

I had a follow-up with my surgeon today. He says that he has not seen a knee act quite like mine. He says that I have beautiful stability but less than stellar movement and gait. Granted, I had just spent over an hour to get there so I was a little stiff. My knee only actively went to 90 degrees. Usually, I can get it to about a 100 or a little more. My extension is also lacking again after a long weekend without the extension device. He'd like to see me have full extension and flexion by the time I hit the 2 month mark on November 19.

At my best, my passive flexion has been at 3 and 1/2 inches from my butt (yesterday) and nearly full extension (last Friday). Aaron has been helping me by bending my knee each night. It took us about 25 tries to get it down that far. And that is 3 and 1/2 without screaming. Our best the week before was around 4 and 1/2 inches. I cried so loud that we worried that our neighbors might call the police for a domestic disturbance. It is slowly getting easier my hope is that by next weekend that I'll have that foot down to my butt.

To help with the range of my range, my doctor's suggested steroids. I'm not a big fan of drugs, especially steroids, but with the problems I am having with my motion I decided to take the risk. I opted for the cortisol shot since it seems to have the fewer side effects than a pill. Although long term use of steroids can disrupt and inhibit healing in the joint, risks with just one shot are minimal. It is not a permanent fix in any way. I am just hoping it buys me some time and brings down the swelling long enough for me to get the rest of the range and build up my quads a little more. Once I achieve this, it's unlikely that this swelling will come back. Now I just have to hope that this works: cortisol shots don't have a positive effect on everyone.

Unfortunately, one of the drawbacks to injecting a fluid into the knee joint space is that there is a temporary (hopefully) reduction in range for my already deficient knee. Aaron and I got it only to 8 and 1/2 inches tonight. It's not sore to the touch though and it feels like some of the heat has left the knee. Usually there is a marked difference in temperature between the two with my swollen knee being several degrees warmer. It is supposed to take a couple days for shot to fully take effect so I'll just have to wait and see how it turns out.

My Knee Still Looks Like Crap

Apparently, I have been being going too easy on myself. I've been seeing modest improvements in my knee: swelling has decreased, range and strength are returning. My quad is still quite mushy though and my knee extension is still lacking. It is time to hit it really hard.

I've realized that a lot of what has been holding me back so far has been fear. Fear that I am going to damage the graft with all this lifting. Even though I know that the only way this would happen is if I fell on it like I did when I injured it or if something flew into my knee knocking me off my feet (like a galloping Sparta dog). Today I think that I got past that fear. I pushed 160 pounds on the leg press with no problems and 70 with just my injured leg. It was hard, it felt good and I had no lingering issues afterward. I also spent 20 minutes in the extension chair (counting the time down, unfortunately, no other people nearby to talk to) and then another 20 with ice and Russian stim on my leg. I've used the Russian before. You put electrodes on two motor points on your thigh. Then you turn up the juice until you get a strong contraction. It is set to an on/off timing sequence. When the electricity is on, you try to contract your quad as hard as you can. When it is off, you relax. Amazing, after all this, it looked like I had a new leg. This looks like it will be my protocol for the next two weeks until I can get my tone and hyperextension back. Without those, it won't matter how much weight I push, I'll still have puny quads.

Week 6: Chasing Pain

If there is one thing that I have figured out over these past few weeks is that rehab is not pain-free. It is work, work, work, everyday for just a little improvement. Sometimes I wish that I didn't have to sleep so that I wouldn't stiffen up overnight. Joints like motion and if you don't have full motion it is going to keep hurting until you do.

I'm not saying that I'm not getting better. This week, I've noticed a lot less pain. I've only really been taking Tylenol before I work out. I don't know if it does a lot for pain but I'm afraid to work my knee without it.

I'm in a tough spot with my knee right now because I didn't have full range in it before I had surgery. I can get my heel to within about 8 inches of my butt (with help) before the serious pain kicks in. Last night, Aaron helped me to get it to within 4 inches. We tried for 2 inches but that was a bit too much for me. It's better than last week but we really have to keep working it because I'm running out of time and it will only get harder.

My real problem though is with my knee extension. I'm lacking a fair amount so this past week I got stuck in "the chair" again. Dale wanted to stick me in it for 20. I wanted 10, so we settled on 15 instead. Friday, I spent 18 minutes in it. The last 2-3 minutes are always the worst. As soon as the timer goes off I am lashing at the straps and kicking at the hooks that keep the device hooked to the ground to get them undone. Forget waiting for any help. One of the other interns told me that at the other clinic he was at, the longest they ever stuck someone in it was 10 minutes. I can bet on another 8 trials with this thing but it seems to be working. Saturday morning I walked the best that I have since before my injury. Even though it is uncomfortable, I much prefer it to bending my knee.

So I'm resolving to push myself harder over these next few weeks to both increase my strength and my range back in my knee. The further it gets, the less pain I've been having even though it hurts like hell when I'm working it. This was the first week that I've noticed a strong increase in strength in my legs. I can now easily leg press 40 lbs with my one leg. Range-wise, Dale got my knee bent to within 2 inches of my butt on Thursday (the closest it has been) and extension I am expecting to improve with continued use of the chair. So good improvement. I am hoping to have full range within the next two weeks.