Hello, it's been a while since I blogged because since I last wrote, around week three, my knee has become less and less a focus of daily life! At my second physio appointment in week 5 I was given the go-ahead to cycle, and that has meant I have been able to get back to normal life - leaving the house! - in many ways. Cycling feels great, although with some slight discomfort around one of the keyhole incisions at the top of my knee - I guess where the cut went through muscle and some scar tissue has formed?! I'll ask at next PT appointment.
Apart from cycling (my comute to work and back is about 20 mins each way), I've been doing shallow squats (although I have to admit, I haven't been very committed) each day for glute strength, but I'm still not doing any other leg-strengthening exercises - PT says this should start after 12 weeks by which time the graft should have 'toughened up' (6-12 weeks is the time when it is at its weakest apparently). When I try one-legged squats (as suggested by PT), knee twinges, so I am generally avoiding that until I see the PT again.
Other than that I do feel like progress has 'plateaued' a bit - I'm walking almost normally and up to speed (some days walking feels more natural and 'flowing' than others!), I have full extension and almost full (passive) flexion - hindered slightly from a bit of swelling still. My scars are still pink but generally look ok. I'm walking up and down stairs normally (although still carefully!) The only time it aches or feels stiff is for a few seconds when I wake up in the morning - once I start moving it's fine.
Friday, 13 November 2015
Tuesday, 20 October 2015
Day 20 - thou shalt get full ROM
Yesterday, exactly three weeks from my operation, I had my first proper physio check-up. I was weirdly excited about this, anxious to know how I was doing and what exercises to progress to!
Over the last week I have stopped using my crutches. Walking is still 'stiff' and cautious and I don't feel particularly comfortable on slopes, but it seems incredible given how I felt just a couple of weeks ago. My physio therapist, however, was slightly less enthusiastic and, although he said my walking was looking pretty good considering, he prefers for people to stay on the crutches a little longer than my particular surgeon recommended. His reasoning is that it is better to get 'high quality' walking sorted with the crutches, rather than giving them up too early and learning 'bad quality walking'. He suggested using one crutch when out and about. I'm not sure how good I will be at following this advice now that I have got used to not using the crutches, and I find using one crutch sort of disrupts my walking rhythm and makes me limp more, but we'll see!
The physiotherapist seemed pretty happy with how my knee was at the three week mark. He assessed my extension and flexion and explained that the knee-cap pain I was getting recently (which has gone now by the way!) was probably due to the knee 're-aligning' itself - during surgery it is effectively disassembled and then reassembled again, so it can take a while for things to settle down.
I was expecting to be given a whole host of new exercises, especially given that it is now three weeks since my op and all my online (obsessive?) researching seemed to suggest progression to new exercises weekly. However, my PT has obviously had some more extensive training than a bit of internet browsing and has other ideas for me: get full range of movement (ROM) first, and then work on strength. And he means full ROM - the last couple of degrees of hyper extension that lift my heel off the floor, to match my other leg. Otherwise, he pointed out, if you work on strength before getting full ROM, then that strength has to be worked on all over again once you do get full ROM. Sounds logical to me! So I ahead of me I have a week of staring intensely at my foot, squeezing my quad and willing my heel lift off. The only strength to work on for the time being are my hips - I've been instructed to do the 'side-lying clam' several times a day, basically until the muscles burn so much I can take no more! Well, saves counting, I guess. This is for the hip abductor muscles, which play a role in stabilising my whole leg. I'm doing the exercises on both sides and am quite excited about the opportunity, through all this physio, to strengthen up both my legs while I'm at it!
Over the last week I have stopped using my crutches. Walking is still 'stiff' and cautious and I don't feel particularly comfortable on slopes, but it seems incredible given how I felt just a couple of weeks ago. My physio therapist, however, was slightly less enthusiastic and, although he said my walking was looking pretty good considering, he prefers for people to stay on the crutches a little longer than my particular surgeon recommended. His reasoning is that it is better to get 'high quality' walking sorted with the crutches, rather than giving them up too early and learning 'bad quality walking'. He suggested using one crutch when out and about. I'm not sure how good I will be at following this advice now that I have got used to not using the crutches, and I find using one crutch sort of disrupts my walking rhythm and makes me limp more, but we'll see!
The physiotherapist seemed pretty happy with how my knee was at the three week mark. He assessed my extension and flexion and explained that the knee-cap pain I was getting recently (which has gone now by the way!) was probably due to the knee 're-aligning' itself - during surgery it is effectively disassembled and then reassembled again, so it can take a while for things to settle down.
I was expecting to be given a whole host of new exercises, especially given that it is now three weeks since my op and all my online (obsessive?) researching seemed to suggest progression to new exercises weekly. However, my PT has obviously had some more extensive training than a bit of internet browsing and has other ideas for me: get full range of movement (ROM) first, and then work on strength. And he means full ROM - the last couple of degrees of hyper extension that lift my heel off the floor, to match my other leg. Otherwise, he pointed out, if you work on strength before getting full ROM, then that strength has to be worked on all over again once you do get full ROM. Sounds logical to me! So I ahead of me I have a week of staring intensely at my foot, squeezing my quad and willing my heel lift off. The only strength to work on for the time being are my hips - I've been instructed to do the 'side-lying clam' several times a day, basically until the muscles burn so much I can take no more! Well, saves counting, I guess. This is for the hip abductor muscles, which play a role in stabilising my whole leg. I'm doing the exercises on both sides and am quite excited about the opportunity, through all this physio, to strengthen up both my legs while I'm at it!
Monday, 12 October 2015
Day 15 - Frankenstein's monster
Today is two weeks from my operation - the clips were taken out 5 days ago and I could finally inspect my scars! They are quite Frankenstein-esq at the moment because the metal staples leave dots either side of the scars, but I think they will fade to nothing. I've been using a bit of coconut oil on them to moisturise, as well as arnica oil around my knee in general - although I'm not going too crazy with that as the scars aren't fully closed (still scabby). There's plenty of debate about whether coconut and arnica oils really have any clinical benefit but I find it comforting any way!
My knee is still a bit larger than the other one but generally not redder or warmer. Yesterday I was walking around the house without crutches - not quite normal gait yet but feeling much more confident. I think there is a lot to be said for listening to your body - I just found that suddenly I felt ready to leave the crutches to one side, it wasn't something that I had to force. I'll still use them on stairs and outside for now, although two weeks is when my surgeon said to start weaning off them. I'm not sure how long the 'weaning' period is supposed to last but I guess my knee will tell me!
I'm still getting the knee cap-ish pain when going into and out of full extension, but it is less sharp than it was initially. I haven't heard when my first physio appointment will be yet but will get a letter this week I hope! For now I'm just carrying on with the first-stage exercises, although getting more than 90 degrees flexion.
My knee is still a bit larger than the other one but generally not redder or warmer. Yesterday I was walking around the house without crutches - not quite normal gait yet but feeling much more confident. I think there is a lot to be said for listening to your body - I just found that suddenly I felt ready to leave the crutches to one side, it wasn't something that I had to force. I'll still use them on stairs and outside for now, although two weeks is when my surgeon said to start weaning off them. I'm not sure how long the 'weaning' period is supposed to last but I guess my knee will tell me!
I'm still getting the knee cap-ish pain when going into and out of full extension, but it is less sharp than it was initially. I haven't heard when my first physio appointment will be yet but will get a letter this week I hope! For now I'm just carrying on with the first-stage exercises, although getting more than 90 degrees flexion.
Tuesday, 6 October 2015
Days 7, 8 and 9
The last three days have seen me able to sit in the passenger seat of a car (no longer any excuse to lounge on the back seat!), go out and socialise a couple of times, manage to wash my hair again and, today, start shuffling around the house without my crutches! Well, not so much shuffle but very slow and deliberate baby steps, and with a limp because the 'swingy' bit of each step doesn't quite feel like what my knee wants to do yet! I find the kitchen is a good location because you are never far from a worksurface to hold on to if needed! It is a very weird sensation and requires concentration to make sure the muscles remember what they are supposed to be doing. Without the right co-ordination at the right time, the whole leg feels like it might buckle - really makes you appreciate how amazing muscles are most of the time!
Apart from the short bursts of activity or socialising in the evening, I am sat on my bum in the living room with my leg up (occasionally with ice), working on my lap top for most of the day. Surprisingly I haven't got cabin fever yet and I haven't been itching to get some exercise, which I thought I might do by now. I suppose a lot of that has to do with my (conscious and subconscious!) mental preparation - I'd thought about the decision to do this so much and done so much research that I fully understood what I was letting myself in for (or at least I think I do!) and knew that it was going to entail a period of downtime. I was very fortunate that the date of my operation coincided with the end of (a busy) summer and shortening of the days (fewer opportunities for outdoor fun!), as well as a new phase in my PhD work which will basically require me to sit and transcribe interviews for a couple of months. For the wintery evenings ahead I was full of intentions to chip away at a backlog of reading I should do, until some friends lent us two box sets of 'Homeland'. Something tells me that is going to be bad for productivity!
Sorry, back to the knee. It is feel generally better each day, easier to manoeuvre, less swollen and stitches not pulling so much, but on Sunday (day 7) I think I over did the physio a bit and have suffered since: I got a bit obsessive with trying to get the same extension as my other leg, so spent a while doing the exercises which press your knee into full extension, clench quad and I tried very hard to get my heel to lift off, too. Did this a few times through the day and it seemed to be going well. However, the next day I found quite severe pain on the inside and slightly below my knee cap doing the same exercise, and especially when trying to bring my knee out of extension and into a heel slide. So I'm not sure whether I over stretched something, irritated or inflamed something, pinched something or something has just got tired from having to compensate for my quads and hamstrings not quite behaving as they should! I have laid off those exercises since and carried on with everything else with no problems. I will have my first post-op check-up tomorrow so will be able to ask. Must try not to cry if I have to do the move and it hurts....
Apart from the short bursts of activity or socialising in the evening, I am sat on my bum in the living room with my leg up (occasionally with ice), working on my lap top for most of the day. Surprisingly I haven't got cabin fever yet and I haven't been itching to get some exercise, which I thought I might do by now. I suppose a lot of that has to do with my (conscious and subconscious!) mental preparation - I'd thought about the decision to do this so much and done so much research that I fully understood what I was letting myself in for (or at least I think I do!) and knew that it was going to entail a period of downtime. I was very fortunate that the date of my operation coincided with the end of (a busy) summer and shortening of the days (fewer opportunities for outdoor fun!), as well as a new phase in my PhD work which will basically require me to sit and transcribe interviews for a couple of months. For the wintery evenings ahead I was full of intentions to chip away at a backlog of reading I should do, until some friends lent us two box sets of 'Homeland'. Something tells me that is going to be bad for productivity!
Sorry, back to the knee. It is feel generally better each day, easier to manoeuvre, less swollen and stitches not pulling so much, but on Sunday (day 7) I think I over did the physio a bit and have suffered since: I got a bit obsessive with trying to get the same extension as my other leg, so spent a while doing the exercises which press your knee into full extension, clench quad and I tried very hard to get my heel to lift off, too. Did this a few times through the day and it seemed to be going well. However, the next day I found quite severe pain on the inside and slightly below my knee cap doing the same exercise, and especially when trying to bring my knee out of extension and into a heel slide. So I'm not sure whether I over stretched something, irritated or inflamed something, pinched something or something has just got tired from having to compensate for my quads and hamstrings not quite behaving as they should! I have laid off those exercises since and carried on with everything else with no problems. I will have my first post-op check-up tomorrow so will be able to ask. Must try not to cry if I have to do the move and it hurts....
Saturday, 3 October 2015
Day 6 - stiff stitches
My stitches - or clips I think they are - are beginning to tighten and the plastic dressings over them pull my skin taught. This gives an unpleasant 'tugging' sensation when I walk and makes the physio exercises a bit uncomfortable! I have to wait until Wednesday until the dressings come off ... I think I'll feel ready for it by then!
Other than that all is fine, I've been at home all day but am venturing out to socialise for the first time since the surgery tonight! (Ironically, to a Ceilidh - I'll just be watching!).
Other than that all is fine, I've been at home all day but am venturing out to socialise for the first time since the surgery tonight! (Ironically, to a Ceilidh - I'll just be watching!).
Day 5 - More beach time
Not too much new to report today, except that my knee gradually feels better each day - I'm more comfortable moving in bed, can put weight on it (although not walking without crutches! Just tiny shuffles) and generally feel reassured that it is actually 'solid'!
Another trip to the beach to lie in the sun was the highlight today. I could get used to this! It was nice to just watch the world go by - adults, kids, dogs, horses all enjoying the beach. A kind lady offered my her beach chair while she took her dog for a walk. Seeing as I had already manoeuvred myself down onto the sand and getting back up is a bit tricky I decline, but it was nice of her to offer!
The exercises I'm doing (4 times a day, lying on the floor) are
- Extensions (straight leg, contracting quad and trying to pull toes toward me and push knee down) x 10
- Towel under knee and press down with heel and quad/hamstring muscles x 10
- Put something under heel and let knee fall down, gently push and hold for five seconds and then release x 10
- Heel slides (sliding foot towards bum until leg is bent 90 degrees) x 10
- Heel slides sitting on a chair x 10
Obviously these are just my instructions - you should follow what you've been told by your surgeon/physio as I think it varies a lot depending on the type of surgery and whether you had any meniscus repairs.
Another trip to the beach to lie in the sun was the highlight today. I could get used to this! It was nice to just watch the world go by - adults, kids, dogs, horses all enjoying the beach. A kind lady offered my her beach chair while she took her dog for a walk. Seeing as I had already manoeuvred myself down onto the sand and getting back up is a bit tricky I decline, but it was nice of her to offer!
The exercises I'm doing (4 times a day, lying on the floor) are
- Extensions (straight leg, contracting quad and trying to pull toes toward me and push knee down) x 10
- Towel under knee and press down with heel and quad/hamstring muscles x 10
- Put something under heel and let knee fall down, gently push and hold for five seconds and then release x 10
- Heel slides (sliding foot towards bum until leg is bent 90 degrees) x 10
- Heel slides sitting on a chair x 10
Obviously these are just my instructions - you should follow what you've been told by your surgeon/physio as I think it varies a lot depending on the type of surgery and whether you had any meniscus repairs.
Friday, 2 October 2015
Day 4 - Beach knee
Today I'm feeling pretty good (although I said that yesterday but later found myself snivelling like a toddler at bedtime, with a tired leg and delayed mild shock that I'd actually had an operation and my knee had been cut into and poked about). However, today I am feeling pretty good - I took one ibuprofen this morning and haven't needed one since, knee is looking slightly less lumpy through the tubi grip and I'm consistently getting 90 degrees flexation (I can almost sit at a table normally!). It's not easy though! To hold my leg in that bent position while lying down makes my quad muscle really ache! The weirdest thing is trying to do whole leg raises. It feels as though I have to do it through the power of my mind. Just getting lift off feels impossible! I think it has to do with engaging the area where the hamstring was harvested (it's a bit bit weird to talk about your own leg being 'harvested' isn't it?!). The initial lift-off moment makes the side of my knee twinge a little, and the leg just says 'let's not do this'.
Extension doesn't seem to be a problem, although my heel doesn't lift off quite as far as the other leg. I haven't really had to work at this at all - when I woke up from the op my leg was straight and I was told very clearly that extension is the most important thing initially, so I've been keeping it straight (usually with something underneath my calf or ankle) whenever I'm resting. Getting it straight again after bending isn't a problem, but fully squeezing my quad to try and get the heel to lift and push the knee down further makes the base of my knee cap ache, around two of the incisions I think.
The best thing today was going to the beach (oh, and washing my hair!) and walking a bit further than I have done before with the crutches (with bare feet on sand!). I found that walking a bit further lets me get into the rhythm, relax and use my leg a bit more normally. I can put more weight through it now, having realised that I actively have to push down and back when I step with the operated leg - i.e engage muscles! - in order for it to feel 'normal'. Which makes sense - no wonder it feels wobbly if I'm not actually engaging muscles. It's quite a bizarre phenomenon having to re-activate muscles that were all fine and dandy before the operation. It's not that they've had time to waste or get weaker, it's just that they say 'no thanks, not today'.
And the sunshine, that was good! Who'd have thought that on the 1st October we would be in shorts and t-shirt lying on the beach, me doing my physio exercises and Tadas reading a book. It felt like a good idea to soak up the rays while we could - vitamin D is essential for absorbing calcium and I've got some bone tunnels to fill....
(Incidentally, I think I expected to feel some kind of sensation inside my knee - either the fact that bone had been drilled, or the new ACL itself - but I don't feel anything like that (which I'm glad about!). The main sensation comes from the surface incision sites, occasional twinges at the back of my knee where the muscles/tendons are (presumably because of the tendon harvest), and tightness when I bend (from the swelling)).
Extension doesn't seem to be a problem, although my heel doesn't lift off quite as far as the other leg. I haven't really had to work at this at all - when I woke up from the op my leg was straight and I was told very clearly that extension is the most important thing initially, so I've been keeping it straight (usually with something underneath my calf or ankle) whenever I'm resting. Getting it straight again after bending isn't a problem, but fully squeezing my quad to try and get the heel to lift and push the knee down further makes the base of my knee cap ache, around two of the incisions I think.
The best thing today was going to the beach (oh, and washing my hair!) and walking a bit further than I have done before with the crutches (with bare feet on sand!). I found that walking a bit further lets me get into the rhythm, relax and use my leg a bit more normally. I can put more weight through it now, having realised that I actively have to push down and back when I step with the operated leg - i.e engage muscles! - in order for it to feel 'normal'. Which makes sense - no wonder it feels wobbly if I'm not actually engaging muscles. It's quite a bizarre phenomenon having to re-activate muscles that were all fine and dandy before the operation. It's not that they've had time to waste or get weaker, it's just that they say 'no thanks, not today'.
And the sunshine, that was good! Who'd have thought that on the 1st October we would be in shorts and t-shirt lying on the beach, me doing my physio exercises and Tadas reading a book. It felt like a good idea to soak up the rays while we could - vitamin D is essential for absorbing calcium and I've got some bone tunnels to fill....
(Incidentally, I think I expected to feel some kind of sensation inside my knee - either the fact that bone had been drilled, or the new ACL itself - but I don't feel anything like that (which I'm glad about!). The main sensation comes from the surface incision sites, occasional twinges at the back of my knee where the muscles/tendons are (presumably because of the tendon harvest), and tightness when I bend (from the swelling)).
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