It seems after I hit 3 months post op, progress has slowed down and there are only incremental changes from month to month. So there are small improvments but things just seem to move very slowly.
Physical Therapy: I am restricted to the same exercises I listed in the last post until month 6 when I can add a few things. Here's some examples of what I'm able to do in the gym now:
35 minutes on the stationary bike on level 8
10 minutes on the elliptical
1 leg hamstring curls and leg press (I use the lightest weight on the machine when working my bad leg)
4x way SLRs w/5 lb ankle weight
Swimming-I only feel comfortable doing free style stroke since there's minimal bending of my leg. I use my good leg to push off the wall. On a good note, I'm up to abut 20 laps and feel no discomfort in my knee
Treadmill walking-10 minutes at 2.5
Pain/Stiffness/Swelling: I have no pain doing the above workouts. When I walk I still have a twinge in the graft area that I feel intermittently. The stiffness is still there especially when I wake up in the morning. But this has improved a lot over the last 2 weeks. I think in another month the stiffness will be gone. There's no position I can't do with my knee now. I can kneel on it and bend pretty much anyway I want now. It still feels a little less flexible than my good knee but I'm very happy with the result so far. I still have some swelling above the knee.
Stairs: Stairs are still my nemesis. Going down is much easier than going up. When I go up I still use one leg at a time. I think this is mostly due to weakness and I'm only allowed to do small step ups in physical therapy. I feel normal stairs are too big and might be too much for the graft at this point. According to my PT protocol I can do larger step ups at month 6 so i'll be more comfortable going up steps at that point. When going down stairs I can do them continuously alternating legs but I hold on to the handrail for dear life. With the weakness in my leg, I just feel very unstable.
Other Thoughts: Overall I'm happy with the progress so far. I feel good enough to go to Las Vegas on a New Years trip with friends...although there will be no dancing yet. And I'll still be wearing flats with my New Year's dress. Anyone who's been to Vegas knows how big the hotels are and there can be a lot of walking. I'm okay with getting around and walking through the hotels but for any significant walking down the strip, we'll probably take a cab.
December 27, 2015
December 5, 2015
3 1/2 Months Post Op
Range of Motion: I have reached full range of motion! My knee is not quite as flexible as my good knee but I consider it to be full range. I feel a pretty good stretch when I sit on my heels but I'm able to do this without much pain. So I do this for at least 10 minutes a day to continue to work out the stiffness. Here's a video showing my range of motion:
Physical Therapy: According to my PT protocol I can do many different types of exercises now. These include:
Swimming
Elliptical Trainor
Stationary Bike
Hamstring curl weight machine
Standing SLRs with a theraband
Forwards and backwards walking on a treadmill
Wall squats and leg press (no flexion past 45 degrees)
Small step forward, lateral, and retro step downs (no flexion past 45 degrees)
I am now going to physical therapy twice a week where I specifically work on exercises to strengthen my bad leg. I also work out at the gym 4 to 5 times a week where I do upper body, core and cardio exercises.
Though I can do a wide variety of exercises now, I still must avoid exercises that cause excessive shearing or overloading of the graft. Shearing motions are caused by squats, lunges, and leg extension type exercises with large degrees of flexion (that is why I'm currently limited to 45 degrees). Running or jumping exercises cause overloading of the graft.
Scar Tissue: My physical therapist suggested trying ultra sound to help break up the scar tissue. So I've been doing 10 minutes of ultra sound twice a week at physical therapy. Some studies show ultra sound can help break up scar tissue and speed healing. I've had 3 sessions of this and I feel some improvement. However, I don't know if it's because of the ultra sound or just the natural healing process, but I'll take it!
Pain and Swelling: I have very little pain now. I still feel the familiar twinge in my femoral condyle where I had the graft but I think it's continuing to get better. I still have a puffy area of swelling above my knee.
Other Thoughts: I felt good enough to attempt a shopping trip at the mall. After a couple laps around the mall and multiple stores my knee began to tell me that was enough (my wallet appreciates it). My leg started to get tired and felt weak. And my knee started to ache and swell a little more than normal. Altogether, I was pretty happy with the trip and the amount of walking I was able to do. The next day I didn't feel any worse.
Physical Therapy: According to my PT protocol I can do many different types of exercises now. These include:
Swimming
Elliptical Trainor
Stationary Bike
Hamstring curl weight machine
Standing SLRs with a theraband
Forwards and backwards walking on a treadmill
Wall squats and leg press (no flexion past 45 degrees)
Small step forward, lateral, and retro step downs (no flexion past 45 degrees)
I am now going to physical therapy twice a week where I specifically work on exercises to strengthen my bad leg. I also work out at the gym 4 to 5 times a week where I do upper body, core and cardio exercises.
Though I can do a wide variety of exercises now, I still must avoid exercises that cause excessive shearing or overloading of the graft. Shearing motions are caused by squats, lunges, and leg extension type exercises with large degrees of flexion (that is why I'm currently limited to 45 degrees). Running or jumping exercises cause overloading of the graft.
 |
| This isn't my knee but this is basically what the ultra sound machine looks like. |
 |
| There's still some swelling present. My knee cap is not quite as defined as the other one. |
Other Thoughts: I felt good enough to attempt a shopping trip at the mall. After a couple laps around the mall and multiple stores my knee began to tell me that was enough (my wallet appreciates it). My leg started to get tired and felt weak. And my knee started to ache and swell a little more than normal. Altogether, I was pretty happy with the trip and the amount of walking I was able to do. The next day I didn't feel any worse.
November 15, 2015
3 Month Reflections
Now that I'm 3 months out from surgery I have a few reflections that I want to pass along:
1. Most surgeons and physical therapists don't have a lot of experience with this surgery and the recovery. Ask your surgeon how many ACI procedures he/she has performed. I've worked with 2 physical therapists so far. Neither of them had much experience dealing with ACI patients. That doesn't mean they aren't knowledgeable and can't help you get better but I've had to be very proactive with my therapy. My PT has tried to get me to do things that conflicted with the rehab protocol I was given. Know the rehab protocol cold and don't do things you shouldn't do. Also, unless you have a PT experienced with ACI you'll get a lot of blank stares when you ask questions about your recovery. I have often wondered if certain things I was feeling were normal and haven't got real answers to my questions. I can't make an appointment with my surgeon every time I feel something weird or have a question. So I've just stuck by the mentality that if I don't have a significant increase in pain or swelling and feel like I'm slowly getting better, then things are ok.
2. Do patellar mobilization and scar massage every day. I still try to do this on a daily basis. Breaking up the scar tissue with massage has helped immensely with getting rid of the painful areas around my knee.
3. I don't feel worse after this surgery. One concern I had with open knee surgery is that it would make things worse. I can now safely say this hasn't made my knee any worse. I'm still waiting to see if it made it better though.
4. I still have swelling and my knee feels warm to the touch. I had no idea after 3 months this would be the case. Apparently this can last for months.
5. I'm looking for a new car because I didn't want to drive a manual anymore (surgery was on my left knee).
6. I can't wear heels yet.
7. I still have cracking and popping in my knee similar to before the surgery but it doesn't hurt. Sometimes my other knee will crack and pop as well but I have no pain in it.
8. When bending my knee sometimes I have painful popping sensations in the areas I have scar tissue build up. This used to scare me but now I realize it's scar tissue breaking up. At one point, I had a particularly painful "pop" but later that night it felt so much better because it had loosened up.
9. I'm still waiting for the pain in the graft area to go away when I walk. Weight bearing increases cartilage generation when the graft has healed enough support your weight. So the way I see it, pain in this area is not necessarily a bad thing. It will take awhile to go away.
10. I can ride a bike normally with no pain.
11. I can walk normally but I need to go up and down stairs one at a time with my good leg.
12. I still have aching and throbbing at night but it's more of an annoyance than anything. I typically don't take any pain medication for it now.
12. I still have aching and throbbing at night but it's more of an annoyance than anything. I typically don't take any pain medication for it now.
3 Months Post Op
Range of Motion: I am at 155 degrees. I'm just about at full range. I can now sit crosslegged on the couch do most of the stretches I used to do. However my right knee joint is still much more flexible and I think it will take a long time to regain that type of flexibility in my left knee.
Physical Therapy: I started swimming this week! My rehab protocol says at month 3 I am allowed to start swimming. I used to swim a lot before my surgery since this was one of the ways I could get a great workout despite my knee injury. I didn't feel comfortable just jumping in the pool and swimming like I used to. So I use a pull bouy between my legs to mostly work my arms. I practice my kick with a kick board. My leg is extremely weak so I could only do 3 laps kicking. It was also hard to stay in a straight line since my good leg was overpowering my other leg. Here are my workouts for the week:
Sunday
Physical Therapy: I started swimming this week! My rehab protocol says at month 3 I am allowed to start swimming. I used to swim a lot before my surgery since this was one of the ways I could get a great workout despite my knee injury. I didn't feel comfortable just jumping in the pool and swimming like I used to. So I use a pull bouy between my legs to mostly work my arms. I practice my kick with a kick board. My leg is extremely weak so I could only do 3 laps kicking. It was also hard to stay in a straight line since my good leg was overpowering my other leg. Here are my workouts for the week:
Sunday
- 20 mins arm bike
- 25 mins stationary bike (level 5)
- 3x10 reps leg press, hamstring curl, leg extension on good leg
- 3x25 reps abductor/adductor SLRs (3 lb ankle weight)
- 20 minutes stretching
 |
| Feels great to get back in the pool to swim |
Monday
- 5 mins stationary bike (level 6)
- 3x10 reps leg press
- 3x10 reps toe raises
- Rolling stool hamstring curls
- 3x15 reps BAPs board
Tuesday
- 20 mins arm bike
- 28 mins stationary bike (level 7)
- Upper body weight lifting
- 20 minutes stretching
Thursday
Pain and Swelling: I still have mild swelling about the knee cap. This hasn't changed much since last week. I still have pain near the graft site like I had before the surgery. I feel like it is getting better overall but some days it feels worse than others so its hard to tell.
Other Thoughts: I feel good enough to take a work trip involving a commercial airline flight which I will be doing next week. I feel comfortable about sitting on a plane and getting through the airport. However, I'm screwed if I have to quickly get to a gate.
 |
| I use a pool bouy like this lady since I don't feel ready to use my legs to really kick |
- 30 minutes swimming w/pull bouy
- 3x laps gental flutter kick w/kick board
- 20 mins arm bike
- 30 mins stationary bike (level 7)
- 6x30 reps SLRs (3lb ankle weight)
- Core work
- 20 minutes stretching
Pain and Swelling: I still have mild swelling about the knee cap. This hasn't changed much since last week. I still have pain near the graft site like I had before the surgery. I feel like it is getting better overall but some days it feels worse than others so its hard to tell.
Other Thoughts: I feel good enough to take a work trip involving a commercial airline flight which I will be doing next week. I feel comfortable about sitting on a plane and getting through the airport. However, I'm screwed if I have to quickly get to a gate.
November 6, 2015
11 Weeks Post Op
I no longer need the crutches! It feels great to not have to use a walking aid anymore.
Range of Motion: I made it to about 140 degrees this week. I
almost have full range of motion. Before having this surgery I was very flexible since yoga is a hobby of mine. One of the worries I had concerning this surgery was losing flexibility in my knee joint and not being able to do certain yoga poses or only being able to do them on one side. I'm not sure my knee will ever really be the same but I'm hopeful that I'll be able to regain the type of flexibility I had before. Once I regain full range of motion, I'm going to start practicing yoga poses to further increase flexibility.
Scar Tissue: I had two painful areas on my knee due to scar tissue which was causing me pain when I walk or exercise. It is starting to feel MUCH better this week. I feel like I'm breaking it up with the range of motion stretching and massage.
 |
| You can see how much smaller my left leg is |
=
Range of Motion: I made it to about 140 degrees this week. I
almost have full range of motion. Before having this surgery I was very flexible since yoga is a hobby of mine. One of the worries I had concerning this surgery was losing flexibility in my knee joint and not being able to do certain yoga poses or only being able to do them on one side. I'm not sure my knee will ever really be the same but I'm hopeful that I'll be able to regain the type of flexibility I had before. Once I regain full range of motion, I'm going to start practicing yoga poses to further increase flexibility.Scar Tissue: I had two painful areas on my knee due to scar tissue which was causing me pain when I walk or exercise. It is starting to feel MUCH better this week. I feel like I'm breaking it up with the range of motion stretching and massage.
Physical Therapy:
I'm not spending as much time doing range of motion stretching this week since I almost have full range. But I make sure to at least spend 20 minutes working on knee flexibility after my workout. Here are my workouts for the week:
Monday
I'm not spending as much time doing range of motion stretching this week since I almost have full range. But I make sure to at least spend 20 minutes working on knee flexibility after my workout. Here are my workouts for the week:
Monday
 |
| BAPS (biomechanical ankle platform system) board: I move side to side on this to work on balance |
- 20 mins arm bike
- 25 mins stationary bike at level 5
- Rolling stool for hamstring strength
- Upper body weight lifting
- 20 minutes stretching
Wednesday
- 20 mins arm bike
- 25 mins stationary bike at level 5
- 5x30 reps SLRs (3 lb ankle weight)
- Core work
- 20 minutes stretching
- 10 mins stationary bike at level 6
- 3x10 reps hamstring curls
- 3x10 reps total gym at 90 degrees flexion (I can only use my good leg to push up)
- 3x15 reps double leg BAPs (for balance)
- 20 minutes stretching
Walking: By the end of the week I can walk with a normal gait without crutches. I still walk fairly slow. And I have to be careful not to pivot or twist on my bad leg.
Pain: The pain in the evening is better this week. I feel like my body has adjusted to being back at work and on my feet more. However, I still have pain that is similar to before I had the surgery. I feel it every time I walk. It's not especially painful but I can tell the graft has not hardened to a point to where my knee pain will go away. The skin around the incision is very tender. I think this is due to all the stretching. As I reach full range of motion the incision needs to stretch pretty far to accommodate the increased range of my knee joint. This has caused irritation and the scar to become raised in some places.
Stiffness and Swelling: Although my range has improved a lot over the week I still have stiffness. I feel the stiffness as I move my knee through it's entire range of motion. I still have slight swelling which is mostly above the knee. I can also feel spongy areas when I press around the knee cap. I can actually feel the fluid moving around in the joint. Along with the scar tissue this is also causing stiffness.
 |
| The atrophy in my left leg is much more noticeable when I'm sitting in a chair. My knee cap is still hard to identify from this angle due to swelling. |
November 1, 2015
10 Weeks Post Op
This week I had an exciting first! I'm now able to shower standing up. Up until now I've been using a shower chair or taking a bath.
Range of Motion: I feel like I am struggling with range of motion. The goal of my PT protocol by week 10 is full range of motion but as of last week I was only at 105 degrees. So this has been the focus of my PT this week and I've really ramped up the amount of stretching I do. My therapist suggested I get at least 5x 20 min stretching sessions a day. These are some of the stretches I do:
I can now ride the stationary bike continuously and fast enough to get the machine to turn on. I will be increasing resistance and endurance over the next couple of weeks.
A Note on Scar Tissue: Scar tissue is a natural part of healing after surgery. Unfortunately it causes stiffness and pain until it's broken up. The amount of scar tissue produced and where it collects can be different for each person. After open knee surgery scar tissue can form around the incision and deeper inside the joint. I have a very painful area on the inside and at the bottom of my knee. I can feel the knot and this is where I have the most pain when walking and doing exercises. So I have declared war on my scar tissue. Ways to break it up include range of motion stretching exercises and massage. I'm already doing a lot of stretching and now I manually press on it each night to try to break it up.
Physical Therapy: I now go to PT 3 times a week. On days I don't go to PT I do my own workouts at the gym. I also started electrical stimulation (e-stim) of the quads. During e-stim, electrodes are hooked up to the quads and when current is run through them, the muscles contract. This helps build muscle strength and decreases pain.
Here are my workouts for the week:
Saturday
Pain and Swelling: I have a little more pain this week. It's mostly at night and my knee aches and throbs. I think this is mostly due to being back at work. I'm a lot more active than I have been anytime in the last 2 months. Although I try to sit at a desk most of the day, I spent a lot more time on my feet this week. The swelling has gone done a little from last week and it almost gone.
Other Thoughts: This was my first full week back at work. My work is very understanding and I was lucky to be able to take so much time off. So now, no more 2x workout sessions a day. It's difficult to balance work and PT. Getting the 5x range of motion sessions in each day is tough. Luckily I can do some of the stretches while sitting at my desk or take a break in my office. Rehabbing from this surgery could be a full time job but that's not realistic for most people. I rarely have any time during the day when I'm not working or doing some sort of rehab. In the evening when I would be relaxing on the couch, I'm either stretching or trying to rub out my scar tissue.
Range of Motion: I feel like I am struggling with range of motion. The goal of my PT protocol by week 10 is full range of motion but as of last week I was only at 105 degrees. So this has been the focus of my PT this week and I've really ramped up the amount of stretching I do. My therapist suggested I get at least 5x 20 min stretching sessions a day. These are some of the stretches I do:
 |
| I pull on my ankle until I feel a stretch |
 |
| I try to move my ankle towards me |
 |
| I am trying to sit on my heels |
Unfortunately the saying "no pain, no gain" does apply for increasing range of motion. During these stretches I go to the point of discomfort then press a little farther so I'm at about a 5 on the pain scale. I try to hold it for a minute then relax. I do this several times for each stretch. Although it's painful to do the exercises, I feel better after doing them because I'm less stiff. After this more aggressive approach I am now up to 125 degrees by the end of the week. It feels good to be making progress.
I can now ride the stationary bike continuously and fast enough to get the machine to turn on. I will be increasing resistance and endurance over the next couple of weeks.
 |
| Scar tissue is unavoidable after surgery but it can be broken up |
Physical Therapy: I now go to PT 3 times a week. On days I don't go to PT I do my own workouts at the gym. I also started electrical stimulation (e-stim) of the quads. During e-stim, electrodes are hooked up to the quads and when current is run through them, the muscles contract. This helps build muscle strength and decreases pain.
Here are my workouts for the week:
Saturday
- 20 mins arm bike
- 20 mins stationary bike at level 2
- 3x10 reps leg press, hamstring curl, leg extension on good leg
- 4x15 reps 4-way SLRs on bad leg (3 lb ankle weight)
- 4x 20 min knee stretching sessions through out day
- 20 mins arm bike
- 20 mins stationary bike at level 5
- Upper body weight lifting
- 4x 20 min knee stretching sessions through out day
- 15 mins stationary bike at level 5
E-stim of the quadricep - 20 mins arm bike
- 5 mins SLRs/5 mins quad contractions w/ electrical stimulation
- Rolling stool for hamstring strength
- 4x 20 min knee stretching sessions through out day
- Core work
- 5x 20 min knee stretching sessions through out day
- 20 min stationary bike at level 5
- 20 mins arm bike
- 3x10 reps hamstring curl/leg extension on good leg
- 3x25 reps abductor/adductor SLRs on both legs (3 lb weight)
- Rolling stool for hamstring strength
- 10 mins SLR w/e-stim
- 4x 20 min knee stretching sessions through out day
Thursday
- 5x 20 min knee stretching sessions through out day
- 15 mins stationary bike at level 5
- 3x 20 min stretching session through out day
Walking: I am now down to just one crutch which I barely put any weight on. I use it mostly just in case I stumble or to help with stairs. I still walk pretty slow and think about each step I take. I have to concentrate on making sure I'm walking with a normal gait and not limping.
 |
| 10 weeks post op |
Pain and Swelling: I have a little more pain this week. It's mostly at night and my knee aches and throbs. I think this is mostly due to being back at work. I'm a lot more active than I have been anytime in the last 2 months. Although I try to sit at a desk most of the day, I spent a lot more time on my feet this week. The swelling has gone done a little from last week and it almost gone.
Other Thoughts: This was my first full week back at work. My work is very understanding and I was lucky to be able to take so much time off. So now, no more 2x workout sessions a day. It's difficult to balance work and PT. Getting the 5x range of motion sessions in each day is tough. Luckily I can do some of the stretches while sitting at my desk or take a break in my office. Rehabbing from this surgery could be a full time job but that's not realistic for most people. I rarely have any time during the day when I'm not working or doing some sort of rehab. In the evening when I would be relaxing on the couch, I'm either stretching or trying to rub out my scar tissue.
October 23, 2015
9 Weeks Post Op
 |
| I am excited to be able to wear pants! |
No Brace! Starting this week I do not have to wear the brace anymore. Without the brace I have to be especially careful to avoid twisting or pivoting on my bad leg since that can damage the graft. But I'm still moving pretty slow with the crutches so that shouldn't be too difficult.
Range of Motion: I continue to ride the stationary bike and do stretches at home for range of motion. I am up to 105 degrees by the end of the week. Here is a video of what it's like to ride the stationary bike at week 9:
Physical Therapy: This week I am allowed to start weight bearing as tolerated. What this means is my graft is strong enough to support my full body weight so I can ditch the crutches when I feel able to walk normally.Here are my exercises for the week:
Monday
- AM
- 20 mins stationary bike
- 4 way SLRs w/BFR cuff - 30 reps 3x15 reps w/30 secs rest between sets (2 lb weight on ankle)
- 5 mins treadmill walking (1.0 speed-I have to hold onto the sides since I can't put full weight while walking yet)
- PM
- 15 mins stationary bike
- 20 mins Alter G treadmill - 60% at 1.5
- 20 mins range of motion stretching of knee
- AM
- 15 mins stationary bike
- 4 way SLRs w/BFR cuff - 30 reps 3x15 reps w/30 secs rest between sets (2 lb weight on ankle)
- Practice walking up and down stairs with 1 crutch and cane
- PM
- Pool therapy-3x laps walking, 3x laps backwards walking, 3x laps side stepping, 3x laps march walking, 2x laps flutter kick
Wednesday
- 30 mins arm bike
- 15 mins stationary bike
- core work
- 3x 30 min knee stretching sessions for range of motion
- 3x 30 min knee stretching sessions for range of motion
 |
| This is about how fast I walk with 1 crutch. |
Walking: By the end of the week I am down to using one crutch for short distances around the house. I still need two crutches for longer distances. I concentrate on every step with one crutch to make sure I'm not excessively leaning to one side since this can cause neck and back pain. Also the stiffness makes me want to limp so I have to focus on bending my knee normally when I walk.
 |
| Week 9. The contours of my knee cap are not as noticeable as my right leg due to swelling and effusion still present. |
The pain I had last week in the graft site is still there but I only notice it in the Alter G when I'm walking faster than with the crutches. I don't feel it standing or walking with the crutches or the cane.
Sleeping: This is the first time since the surgery that I feel I can sleep in a normal position. Sleeping without the brace is wonderful and I have enough range of motion that I can bend my leg enough to sleep how I used to before the surgery. I still wake up in the middle of the night sometimes with throbbing and aching but it usually goes away if I switch positions.
Other Thoughts: I feel better mentally about the surgery this week than last week. I'm trying not to focus on every little pain in the graft area. I've accepted that it might be a few more weeks until the symptoms I had before the surgery go away. It's a mental boost to be almost walking without crutches. And getting rid of the brace is one step closer to "normal life."
October 17, 2015
8 Weeks Post Op Dr Appointment
I went back to see my surgeon at 8 weeks because I was worried about the pain in the graft area. As I started to put weight on my leg I was having the same pain as before the surgery. My surgeon said this was probably normal and pain moves around after surgery. Ultimately, it's way too soon to think about graft failure. He said I'm really not going to know if this surgery was successful until 10 more months down the road when I start running again. At some point the pain should get better and I need to be more patient. He didn't think what I was experiencing should prevent me from continuing the rehab protocol and working toward 100% weight bearing over the next few weeks.
I found some interesting information about the recovery process published by the company who cultures the cartilage cells. Genzyme is the company that created Carticel, which is the name given to the cartilage cells after they are grown and cultured in Genzyme's lab in Boston. It is impossible to create the exact same type of cartilage that lines the major bones of the body. However, Genzyme has been able to create a substance that closely resembles actual cartilage by using a person's own cartilage cells. This substance is called Carticel and is the only FDA approved product to repair articular cartilage. However once the cells are ready for implantation they are in liquid form and must harden in the body to work. There are some studies which say the graft continues to harden for a period of 5 years but after 18 months the graft should be strong enough to support high impact sports.
Genzyme published a Carticel rehabilitation guide which has some great info. I skimmed it the first time but then I went back and read it more closely. I found something that eased my worry over the pain I was feeling. The guide says it is during the remodeling phase which occurs between 12 weeks and 32 weeks that patients typically feel improvement of symptoms.
I highly recommend reading this guide prior to surgery. It's located here: REHABILITATION GUIDELINES - Carticel
So if you're like me and you worry A LOT about how the graft is doing...stop! You will drive yourself crazy. As I've been reminded by my surgeon and therapist many times, this is a long process and improvement occurs incrimentaly over many months and pain is normal. To put things in perspective, according to my rehab protocol my goal at 9 months is to walk 2 miles at 15 min/mile pace. But if you have extreme pain or locking or catching of the knee during motion at this point in the recovery that might indicate an issue. So bottom line, you'll probably know if something is really wrong.
I found some interesting information about the recovery process published by the company who cultures the cartilage cells. Genzyme is the company that created Carticel, which is the name given to the cartilage cells after they are grown and cultured in Genzyme's lab in Boston. It is impossible to create the exact same type of cartilage that lines the major bones of the body. However, Genzyme has been able to create a substance that closely resembles actual cartilage by using a person's own cartilage cells. This substance is called Carticel and is the only FDA approved product to repair articular cartilage. However once the cells are ready for implantation they are in liquid form and must harden in the body to work. There are some studies which say the graft continues to harden for a period of 5 years but after 18 months the graft should be strong enough to support high impact sports.
Genzyme published a Carticel rehabilitation guide which has some great info. I skimmed it the first time but then I went back and read it more closely. I found something that eased my worry over the pain I was feeling. The guide says it is during the remodeling phase which occurs between 12 weeks and 32 weeks that patients typically feel improvement of symptoms.
I highly recommend reading this guide prior to surgery. It's located here: REHABILITATION GUIDELINES - Carticel
So if you're like me and you worry A LOT about how the graft is doing...stop! You will drive yourself crazy. As I've been reminded by my surgeon and therapist many times, this is a long process and improvement occurs incrimentaly over many months and pain is normal. To put things in perspective, according to my rehab protocol my goal at 9 months is to walk 2 miles at 15 min/mile pace. But if you have extreme pain or locking or catching of the knee during motion at this point in the recovery that might indicate an issue. So bottom line, you'll probably know if something is really wrong.
October 16, 2015
8 Weeks Post Op
Range of Motion: I am up to 100 degrees. Range of motion continues to be a slow progression and something I have to work at multiple times a day. I have been doing at least 3x 30 minute sessions a day of motion exercises. I do this at home typically while watching TV. The stiffness bothers me a lot and I'm looking forward to being able to move my knee normally. I am now allowed to use the stationary bike with no resistance to help with range of motion. At the beginning of the week I wasn't able to get a full revolution so I would go as far as possible then reverse direction and go backwards. At the end of the week I can get a full revolution but with much difficulty and lifting the hip on my bad leg.
Physical Therapy: This is my last week before I am weight bearing as tolerated so my therapist added some partial weight bearing activities outside of the pool to prepare me for walking. One of the new exercises was walking in the Alter G Anti-Gravity treadmill. Basically this machine creates a vacuum around your legs and lifts you up so you are putting only a percentage of body weight on your legs. You can choose what percentage of body weight you want to exercise with. I started at 20% body weight and set the speed at a crazy 1.5 (40 min mile). I felt some pain in my knee but it was mostly unstable, weak and stiff. At first it felt like it was buckling and giving way. By the end of the week I was able to walk with a normal gait at 50% body weight and a speed of 1.5 with slight discomfort.
I also spent a lot of time in the parallel bars placing some weight on my knee and using my arms to hold myself up. By the end of the week I was able to walk back and forth using one arm to hold myself up.
My exercises this week included:
Tuesday
Pain and Swelling: In addition to the normal post surgical pain around the incision I have pain on the inside of my knee similar to what I had before the surgery. I noticed it for the first time during the partial weight bearing activities. The pain isn't bad enough to keep me from doing the exercises but this concerns me because I'm worried something is wrong with the graft. I thought once I started walking I wouldn't have the same pain as before. My therapist has tried to reassure me that this is normal. There's still a lot of healing going on and the nerves need to get used to the graft. However, he thought it was a good idea to talk to my surgeon prior to proceeding with further weight bearing activities.
Other Thoughts: Overall this week has been frustrating due to the new pain on the inside of my knee. It is bothering me more mentally than physically though. The thought of having a graft failure is stressful. Up to this point I felt the recovery was going well but I seem to be on a downward portion of the emotional rollercoaster of recovery. I'm just not sure I should be having pain where I had the graft at this point. So I'll see what my surgeon has to say and go from there.
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| Alter G treadmill. This lady looks much happier than I was in this machine. |
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| Parallel bars for learning to walk |
I also spent a lot of time in the parallel bars placing some weight on my knee and using my arms to hold myself up. By the end of the week I was able to walk back and forth using one arm to hold myself up.
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| This is what I feel like trying to walk |
Tuesday
- AM
- 20 mins on the Alter G treadmill-20% at 1.5
- 4-way SLRs and quad set contractions with Blood Flow Restriction (BFR) cuff-1x30 reps/3x15 reps w/30 secs rest between sets (2 lb weight above knee)
- 15 mins stationary bike for range of motion
- PM
- Pool therapy for gait training-3x laps walking, 3x laps backwards walking, 3x laps side stepping, 3x laps march walking (neck deep water with flotation device barbells)
- AM
- 20 mins on the Alter G treadmill-30% at 1.5
- Weight shifts in parallel bars
- 15 mins stationary bike for range of motion
- PM
- 20 mins on the arm bike
- Weight shifts in parallel bars
- 15 mins stationary bike for range of motion
- AM
- 20 mins stationary bike for range of motion
- 4-way SLRs and quad set contractions with Blood Flow Restriction (BFR) cuff-1x30 reps/3x15 reps w/30 secs rest between sets (3 lb weight above knee)
- Weight shifts and partial weight bearing in parallel bars for gait training
- PM
- Pool therapy-3x laps walking, 3x laps backwards walking, 3x laps side stepping, 3x laps march walking (chest deep water with flotation device barbells)
- AM
- 20 mins stationary bike
- 5x15 sets of SLRs (2 lb weight on ankle)
- Weight shifts and partial weight bearing in parallel bars
- PM
- 20 mins on the Alter G treadmill-50% at 1.5 (the machine said I burned 31 calories during this exercise. Almost half a cookie...awesome)
- 20 mins stationary bike
- Partial weight bearing walking with crutches and a cane outside in grass, sand and different surfaces
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| 8 weeks post op. The thigh atrophy is less noticeable. I attribute this to the BFR training. It slows down the atrophy and allows me to retain some quad strength. |
Pain and Swelling: In addition to the normal post surgical pain around the incision I have pain on the inside of my knee similar to what I had before the surgery. I noticed it for the first time during the partial weight bearing activities. The pain isn't bad enough to keep me from doing the exercises but this concerns me because I'm worried something is wrong with the graft. I thought once I started walking I wouldn't have the same pain as before. My therapist has tried to reassure me that this is normal. There's still a lot of healing going on and the nerves need to get used to the graft. However, he thought it was a good idea to talk to my surgeon prior to proceeding with further weight bearing activities.
Other Thoughts: Overall this week has been frustrating due to the new pain on the inside of my knee. It is bothering me more mentally than physically though. The thought of having a graft failure is stressful. Up to this point I felt the recovery was going well but I seem to be on a downward portion of the emotional rollercoaster of recovery. I'm just not sure I should be having pain where I had the graft at this point. So I'll see what my surgeon has to say and go from there.
October 14, 2015
7 Weeks Post Op
Range of Motion: This is the first week without the CPM and my moral has soared. It feels so good not to be chained to that dreadful machine all day. Now that I'm out of the CPM I have to do range of motion exercises on my own. Here's a video of one of the exercises I do:
Overall, this week has been frustrating for range of motion. I was stuck at 90 degrees all week. My therapist put me in the biodex machine to force my knee to bend past 90 degrees. This machine is good for passively bending knees.
I got to about 95 degrees with difficulty. Once again I've had to adjust my expectations for this surgery. After my scope I got full range of motion back very quickly. I have to keep reminding myself that this surgery was much more invasive and that range of motion is a long process. Scar tissue that formed after the surgery and swelling along with fluid in the joint (effusion) makes range of motion difficult. Once the effusion goes down it will be easier to bend and as far as the scar tissue, I just have to break that up physically by doing the range of motion exercises.
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| Biodex Machine |
I got to about 95 degrees with difficulty. Once again I've had to adjust my expectations for this surgery. After my scope I got full range of motion back very quickly. I have to keep reminding myself that this surgery was much more invasive and that range of motion is a long process. Scar tissue that formed after the surgery and swelling along with fluid in the joint (effusion) makes range of motion difficult. Once the effusion goes down it will be easier to bend and as far as the scar tissue, I just have to break that up physically by doing the range of motion exercises.
Physical Therapy:
My workouts this week were the same as last week:
Monday
Monday
- AM
- 20 minutes on the rowing machine w/one leg (other leg sits on the ab dolly and rolls back and forth)
- 4-way SLRs and quad set contractions with Blood Flow Restriction (BFR) cuff-1x30 reps/3x15 reps w/30 secs rest between sets (no weight)
- PM
- 20 minutes on the arm bike
- Upper body weight lifting
- AM
- 20 minutes rowing
- Leg extension, hamstring curl, and leg press on GOOD leg w/BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- Pool therapy for gait training-3x laps walking, 3x laps backwards walking, 3x laps side stepping, 3x laps march walking (I do this in neck deep water with flotation device barbells to put minimal weight on my leg)
- AM
- 20 minutes rowing
- 4-way SLRs and quad contraction sets with BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- 20 minutes on the arm bike
- Core work
- AM
- 20 minutes rowing
- Leg extension, hamstring curl, and leg press on GOOD leg w/BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- Pool therapy-3x laps walking, 3x laps backwards walking, 3x laps side stepping, 3x laps march walking
- AM
- 20 minutes rowing
- 4-way SLRs and quad contraction sets with BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- 20 minutes on the arm bike
- Upper body weight lifting
I am doing better with the BFR as well. I do not have any light headedness or dizziness anymore. I just feel intense muscle fatigue and burning while exercising with the cuff which is normal. I am seeing amazing results with this on my good leg. I can't believe how much stronger I am after just a couple sessions. My good leg used to fatigue very quickly while on the crutches but I now feel like I can stand on it all day.
Pain and Swelling: I now have minimal pain with the SLRs. It's mostly just stiffness that works itself out after the first few sets. I'm still doing the scar massage and patellar mobilization. With the scar massage I has some very tender places. The worst is the scope incision on the inside of my knee. I can feel a lump that is most likely scar tissue so I press on this pretty hard to try to break it up. I also feel a lot of pressure in this area when doing range of motion. I had a scope done in conjunction with the open knee surgery. This was to check out the knee and make sure everything was good before the surgeon opened it up. I believe my surgeon used the same incision as last time so that is the reason for the lump of scar tissue. The swelling is the same.
Sleeping: I am sleeping normally now. It still takes me awhile to get comfortable with the brace. I am looking forward to not having to sleep with that soon.
Other Thoughts: Life on crutches sucks. The crutches are starting to wear on me. Everything takes more time: Getting ready in the morning, fixing meals, going to the bathroom. I don't do a lot of my daily rituals that I used to do such as spend time fixing my hair or putting on makeup. You can't carry anything on crutches so I have a little bag with me that I wear on my back to carry things. And when you drop something it is a whole event to pick it up. On a good note, after 7 weeks my triceps and good leg are very strong and I have much more endurance. I feel like I can crutch a fairly far distance without getting fatigued.
Sleeping: I am sleeping normally now. It still takes me awhile to get comfortable with the brace. I am looking forward to not having to sleep with that soon.
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| Picking up a water bottle |
6 Weeks Post Op Dr Appointment
I had my 6 week post op appointment with my surgeon. My biggest concern was whether or not the fall at 5 weeks injured the graft. My surgeon basically told me the same thing as my therapist. He did not think it damaged the graft since there was no additional swelling, pain, bruising, or catching during range of motion. However, there is no way to know for sure. An MRI would not show anything at this point. And I really won't know if the graft is successful until a year down the road when I try running.
I also asked about the swelling and warmth on my knee since this really hasn't changed much since surgery. His answer was that it is normal. The swelling won't go down until I start walking and really using the muscles around my knee. At that point the muscles will begin pushing fluid through the joint and I should start to see some improvement. The warmth I feel in my knee is a normal part of the healing process.
Overall, I was satisfied with the appointment. It was a little frustrating to hear I'll have to wait many months to know if the graft was successful but that is just the nature of this surgery. My surgeon did remind me that there's no reason to think that it won't work since success rates are good and I'm not experiencing anything out of the ordinary.
I also asked about the swelling and warmth on my knee since this really hasn't changed much since surgery. His answer was that it is normal. The swelling won't go down until I start walking and really using the muscles around my knee. At that point the muscles will begin pushing fluid through the joint and I should start to see some improvement. The warmth I feel in my knee is a normal part of the healing process.
Overall, I was satisfied with the appointment. It was a little frustrating to hear I'll have to wait many months to know if the graft was successful but that is just the nature of this surgery. My surgeon did remind me that there's no reason to think that it won't work since success rates are good and I'm not experiencing anything out of the ordinary.
October 11, 2015
6 Weeks Post Op
Range of Motion: This is my last week with the CPM!!!! I have religiously sat in the CPM 8 hours a day for 6 weeks and it's been the worst part of the recovery for me. Being able to sit in a comfortable position and move around will be a huge mental boost. I reached 90 degrees by the end of the week. The last 5-10 degrees never got comfortable and I cringed each time the machine reached that range. It's not so much painful but incredibly stiff which causes the discomfort.
Physical Therapy: Here is my weekly workout schedule:
Monday
I am concerned about the swelling though. It really hasn't gone down since the surgery. My knee cap is still unrecognizable. On the photo to the right you can't see kneecap definition like I have on my good (right) leg. I ice 2-3 times a day and it helps with the pain but doesn't have much effect on the swelling. My therapist says swelling may stick around for months and probably won't resolve until I start walking and really using my muscles. At 6 weeks the atrophy of my left thigh is starting to be noticeable.
Sleeping: I am able to sleep through the night most nights. My brace is now locked out at 90 degrees to I can sleep on my side and bend my leg. If I do wake up in the middle of the night I experience throbbing and aching that sometimes prevents me from getting back to sleep. I feel this in the morning when I wake up but it goes away once I start moving.
Physical Therapy: Here is my weekly workout schedule:Monday
- AM
- 20 minutes on the rowing machine w/one leg (other leg sits on the ab dolly and rolls back and forth)
- 4-way SLRs and quad set contractions with Blood Flow Restriction (BFR) cuff-1x30 reps/3x15 reps w/30 secs rest between sets (no weight)
- PM
- 20 minutes on the arm bike
- Upper body weight lifting
- AM
- 20 minutes rowing
- Leg extension, hamstring curl, and leg press on GOOD leg w/BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- Pool therapy for gait training-3x laps walking, 3x laps backwards walking, 3x laps side stepping, 3x laps march walking (I do this in neck deep water with flotation device barbells to put minimal weight on my leg)
- AM
- 20 minutes rowing
- 4-way SLRs and quad contraction sets with BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- 20 minutes on the arm bike
- Core work
- AM
- 20 minutes rowing
- Leg extension, hamstring curl, and leg press on GOOD leg w/BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- Pool therapy-3x laps walking, 3x laps backwards walking, 3x laps side stepping, 3x laps march walking
- AM
- 20 minutes rowing
- 4-way SLRs and quad contraction sets with BFR cuff-1x30 reps/3x15 reps w/30 secs rest between sets
- PM
- 20 minutes on the arm bike
- Upper body weight lifting
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| Thigh Atrophy and Swelling at 6 Weeks |
Pain and Swelling: I have no additional pain from the fall. I can move my leg around with minimal pain however I am still careful and slow when I move it. If I move it a certain way I still get a sharp pain mostly on the inside of my knee. The incision is healing nicely.
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| 6 Week Incision |
I am concerned about the swelling though. It really hasn't gone down since the surgery. My knee cap is still unrecognizable. On the photo to the right you can't see kneecap definition like I have on my good (right) leg. I ice 2-3 times a day and it helps with the pain but doesn't have much effect on the swelling. My therapist says swelling may stick around for months and probably won't resolve until I start walking and really using my muscles. At 6 weeks the atrophy of my left thigh is starting to be noticeable.
Sleeping: I am able to sleep through the night most nights. My brace is now locked out at 90 degrees to I can sleep on my side and bend my leg. If I do wake up in the middle of the night I experience throbbing and aching that sometimes prevents me from getting back to sleep. I feel this in the morning when I wake up but it goes away once I start moving.
October 7, 2015
5 Weeks Post Op
Range of Motion: According to my rehab protocol I am now able to increase the CPM from 40 degrees to 5 degrees per day until I get up to 90 degrees. This week 5 degrees a day has proven difficult so I usually increase the CPM 5 degrees every other day. I am now at 70 degrees and the last 5 degrees are very stiff. I am now allowed to unlock my brace to 30 degrees and will continue to unlock it more as range becomes available.
Physical Therapy: I am still limited to the same few exercises: 4 way SLRs with weight above the knee, quad sets, patellar mobilization, and scar massage.
I've set into a routine where I do BFR on my bad leg Mon, Wed, and Fri and my good leg on Tues and Thurs. I am still not allowed to lift weights or do any other exercises on my bad leg so I just do the 4-way SLRs. I do 3 exercises with my good leg with the BFR cuff (leg extension, hamstring curl, and leg press).
Pain: My overall pain this week is good. I'm totally off the Percocet. I still have pain around the incision when I have to lift my leg to move but it's manageable. I still wake up in the middle to the night with throbbing and the occasional spasm.
Sleeping: Much better this week. I can now lay on either side and switch positions much easier. But I still have to be careful how I move my leg. If I move it wrong I get a sharp pain on the inside of my knee. Since my brace is unlocked now it will allow me to bend a little so it's easier to get into a comfortable sleeping position.
The Fall: At the end of week 5 I had my first serious fall. I was icing at PT and there was a fire alarm so I had to go down the stairs. I stumbled on the last stair and fell forward. I caught myself with my bad leg. My knee bent and stopped at 50 degrees because that's where my brace was locked out at. I put my full weight on my leg and jammed my knee pretty good. My first thought was "OMG I just ruined the graft!" Then my second thought was "Ow that hurt." My therapist immediately grabbed some ice and called my surgeon who was in surgery so he left a message. I was terrified I had ruined my surgery. After an hour or two I calmed down a bit. My therapist said he thought is was ok since I didn't have any additional swelling, bruising or pain. If something was really wrong I would have felt it. My surgeon called a few hours later and concurred with my therapist and he said I didn't need to come in unless things got bad later that night. I felt about the same that night but I was still very worried that some damage had occurred.
The consistency of new cartilage at various stages:
Physical Therapy: I am still limited to the same few exercises: 4 way SLRs with weight above the knee, quad sets, patellar mobilization, and scar massage.
BFR: This week I have been introduced to blood flow restriction (BFR) theraphy which I do in conjunction with the SLRs. BFR is a new therapy that has been developed in the last 2 years and there's only a few places in the US that does it. However, the results and studies are very favorable. BFR involves exercising with a tourniquet. The science behind BFR is that when a person exercises with limited blood flow to a muscle it allows the person to lift very light weight but still get the same effect as lifting heavy weight. For instance a person that leg presses 200 lbs would instead apply the tourniquet and leg press only 20 lbs to get the same benefits without wear and tear on the joints and muscles that is caused by lifting heavy weights. This is good for people with injuries such as myself that are unable to put weight on joints and have surgeries with long healing times. Additionally, there are added healing benefits. As a result of BFR, the body produces human growth hormone which speeds healing. Here's how it works: An ultrasound is used to find out what pressure completely stops the blood flow. This is done by raising the pressure on the tourniquet which is similar to a blood pressure cuff and recording the pressure at which a pulse can not be found. Then the BFR cuff is set to 80% of that value during exercise so the blood flow isn't completely cut off. For each exercise you do a set of 30 reps then 3x sets of 15 reps with 30 secs rest in between each set.
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| This is a picture of the machine where you set the pressure in mm HG. The cuff is attached to the machine which continually inflates/deflates the cuff to maintain the selected pressure |
I've set into a routine where I do BFR on my bad leg Mon, Wed, and Fri and my good leg on Tues and Thurs. I am still not allowed to lift weights or do any other exercises on my bad leg so I just do the 4-way SLRs. I do 3 exercises with my good leg with the BFR cuff (leg extension, hamstring curl, and leg press).
BFR is pretty miserable. The first day I felt light headed, dizzy and almost passed out. There was an intense burning sensation in the muscle being exercised. The first exercise I tried was leg extension on my good leg. I was lifting 5 lbs but it felt like 100 lbs. I wasn't able to complete all 4 sets on the leg extension. But as with anything new, I'm sure it will get better with time.
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| This person is doing SLRs with the BFR cuff on. This is what I spend a lot of time doing. |
Pain: My overall pain this week is good. I'm totally off the Percocet. I still have pain around the incision when I have to lift my leg to move but it's manageable. I still wake up in the middle to the night with throbbing and the occasional spasm.
Sleeping: Much better this week. I can now lay on either side and switch positions much easier. But I still have to be careful how I move my leg. If I move it wrong I get a sharp pain on the inside of my knee. Since my brace is unlocked now it will allow me to bend a little so it's easier to get into a comfortable sleeping position.
The Fall: At the end of week 5 I had my first serious fall. I was icing at PT and there was a fire alarm so I had to go down the stairs. I stumbled on the last stair and fell forward. I caught myself with my bad leg. My knee bent and stopped at 50 degrees because that's where my brace was locked out at. I put my full weight on my leg and jammed my knee pretty good. My first thought was "OMG I just ruined the graft!" Then my second thought was "Ow that hurt." My therapist immediately grabbed some ice and called my surgeon who was in surgery so he left a message. I was terrified I had ruined my surgery. After an hour or two I calmed down a bit. My therapist said he thought is was ok since I didn't have any additional swelling, bruising or pain. If something was really wrong I would have felt it. My surgeon called a few hours later and concurred with my therapist and he said I didn't need to come in unless things got bad later that night. I felt about the same that night but I was still very worried that some damage had occurred.
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| These pics were taken during an arthroscope to show how long it takes for the graft to harden. This demonstrates why non weight bearing during the first few weeks is important to prevent damage. |
The consistency of new cartilage at various stages:
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after 1 week like WATER
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after 3 months like YOGHURT
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after 6 months like DOUGH
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after 9 months like CHEESE
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and after 12 months like RUBBER
October 6, 2015
4 Weeks Post Op
Range of Motion: I am at 40 degrees on the CPM which is pain free. At the end of week 4 I will begin increasing flexion again slowly working toward 90 degrees. The CPM is really wearing on me. With 2 PT sessions a day I spend just about every free moment in this damn machine. I really am starting to despise it. It is hard to get comfortable with my leg in the machine and body is starting to hurt from laying on my back all the time.
Physical Therapy: My exercises still consist of 4-way SLRs, quad sets, patellar mobilization, and scar massage. I am able to lift my leg completely on my own and have no issues "getting it started." At the end of the week I am able to complete 5x15 sets of 4-way SLRs with 10 lbs strapped above my knee. The first set is the most painful but as my leg warms up it gets easier.
I also started pool therapy this week. I will be spending an hour in the pool on Tues and Thur to practice walking with a normal gait. The exercises were very basic on the first day. I stood in water up to my neck and held a flotation barbell in each hand underwater to decrease the amount of weight on my legs. Then I walked from one end of the pool to the other. I tried backwards walking and also side steps. I was pretty miserable in the pool and close to tears. My leg was highly unstable and the water was moving it around causing pain. Walking was difficult since I am not bending much yet and extremely weak. Also, I had a lot of mental difficulty putting any weight on my bad leg. It physically hurt but I was more concerned with the thought of damaging the graft since it is still in liquid form at this point. My therapist had to explain at that depth and with the flotation devices I was only putting 20 lbs of my total weight on my leg and it wouldn't hurt anything.
Though my first pool experience was unpleasant I had to laugh a little as I had images of the movie "Cocoon" while I was struggling to do the most basic tasks in the water.
Pain: I don't have much pain when I'm not moving my leg. When I need to get up, it's sore to move around but much better than the previous weeks. I don't need to lift my leg with my hand or have some else move it anymore. When I need to move I flex my quads and move my leg where it needs to go. The constant use of my quads has caused some muscle fatigue but no extra pain. Another issue that has come up is the soreness in my neck and back. I spend a lot of time in bed mostly in the CPM and my body is not used to being in the same position all the time. The only saving grace is I get up and go to PT twice a day. Also my arms and wrists are sore from the crutches. I'm guessing this will go away as I get stronger.
Sleeping: Sleeping has not changed much since last week. I can only sleep on my back or side with my bad leg up. Changing positions is still an event and I have to move very carefully. When I've been sleeping for awhile and then have to change positions my leg has stiffened up and it's more painful. Sometimes my quad muscle contracts when I'm asleep. It's sort of like a spasm. It's quite painful and wakes me up. This happens because my body is still getting used to having my quad fire again. I can't wait until this stops.
Other Thoughts: Overall this week was difficult more mentally than physically. I am a month out of surgery and it's becoming apparent how slow this recovery will be. It is hard to stay positive but I keep reminding myself how far I'm come.
Physical Therapy: My exercises still consist of 4-way SLRs, quad sets, patellar mobilization, and scar massage. I am able to lift my leg completely on my own and have no issues "getting it started." At the end of the week I am able to complete 5x15 sets of 4-way SLRs with 10 lbs strapped above my knee. The first set is the most painful but as my leg warms up it gets easier.
I also started pool therapy this week. I will be spending an hour in the pool on Tues and Thur to practice walking with a normal gait. The exercises were very basic on the first day. I stood in water up to my neck and held a flotation barbell in each hand underwater to decrease the amount of weight on my legs. Then I walked from one end of the pool to the other. I tried backwards walking and also side steps. I was pretty miserable in the pool and close to tears. My leg was highly unstable and the water was moving it around causing pain. Walking was difficult since I am not bending much yet and extremely weak. Also, I had a lot of mental difficulty putting any weight on my bad leg. It physically hurt but I was more concerned with the thought of damaging the graft since it is still in liquid form at this point. My therapist had to explain at that depth and with the flotation devices I was only putting 20 lbs of my total weight on my leg and it wouldn't hurt anything.
Though my first pool experience was unpleasant I had to laugh a little as I had images of the movie "Cocoon" while I was struggling to do the most basic tasks in the water.
Pain: I don't have much pain when I'm not moving my leg. When I need to get up, it's sore to move around but much better than the previous weeks. I don't need to lift my leg with my hand or have some else move it anymore. When I need to move I flex my quads and move my leg where it needs to go. The constant use of my quads has caused some muscle fatigue but no extra pain. Another issue that has come up is the soreness in my neck and back. I spend a lot of time in bed mostly in the CPM and my body is not used to being in the same position all the time. The only saving grace is I get up and go to PT twice a day. Also my arms and wrists are sore from the crutches. I'm guessing this will go away as I get stronger.
Sleeping: Sleeping has not changed much since last week. I can only sleep on my back or side with my bad leg up. Changing positions is still an event and I have to move very carefully. When I've been sleeping for awhile and then have to change positions my leg has stiffened up and it's more painful. Sometimes my quad muscle contracts when I'm asleep. It's sort of like a spasm. It's quite painful and wakes me up. This happens because my body is still getting used to having my quad fire again. I can't wait until this stops.
Other Thoughts: Overall this week was difficult more mentally than physically. I am a month out of surgery and it's becoming apparent how slow this recovery will be. It is hard to stay positive but I keep reminding myself how far I'm come.
3 Weeks Post Op Dr Appointment
I have my first post op appointment with my surgeon at 3 weeks. The appointment was very short and the Dr. looked at the incision to make sure it was healing well and there was no sign of infection. I'm good to go in this area since I'm healing well.
I do have an area which is completely numb near my incision. It's about a 1 in x 1 in area to the left of the incision. Apparently this is fairly common. Over the next few months I should regain feeling as the nerves repair themselves. According to my surgeon some people never regain feeling but it typically doesn't bother them.
One pleasant surprise after this surgery was I had no sutures to remove. The incision was closed with internally dissolving stitches and surgical glue. So that was nice not to have someone poking around the tender skin to remove sutures.
I do have an area which is completely numb near my incision. It's about a 1 in x 1 in area to the left of the incision. Apparently this is fairly common. Over the next few months I should regain feeling as the nerves repair themselves. According to my surgeon some people never regain feeling but it typically doesn't bother them.
One pleasant surprise after this surgery was I had no sutures to remove. The incision was closed with internally dissolving stitches and surgical glue. So that was nice not to have someone poking around the tender skin to remove sutures.
3 Weeks Post Op
Range of Motion: After week 2 I am supposed to go up to 40 degrees on the CPM. I did 35 degrees the first 2 days of week 3 then got up to 40 degrees. 40 degrees was a little painful at first but the pain improved throughout the week.
Physical Therapy: After week 2 I am allowed flat foot weight bearing (FFWB). All this means is when I'm standing straight I can touch my foot to the ground but I'm not really allowed to put any weight on it. When I crutch around I still have to keep my leg off the ground. It's nice to let my foot touch the ground so I'm not doing a constant balancing act. But I have to be more careful than ever not to accidentally put weight on it.
My knee exercises still consist of straight leg raises (SLR). I can now do the leg raises without the brace and add light weight above the knee as I get stronger. I do the leg raises 4 ways to work my inner/outer thighs and my glutes. For the most part I can do the leg raises on my own but sometimes I need my therapist to help me get started and lift my leg. I have a fairly strong quad set now. I am able to contract my quad and hold it. However, when I contract my quad I am unable to hyperextend my knee and lift my heel off the ground like I can with my other leg.
Pain: SLRs are still very painful and the scar massage and patellar mobilization makes me light headed and dizzy. With the SLRs I sometimes can't get my leg to lift because my brain knows it will cause pain and shuts down my muscle. So no matter how hard I try it won't move. That's when my therapist helps me out and lifts for me so I can get started. I still take the occasional Percocet to help sleep at night.
Sleeping: I am finally able to sleep on my side. I can only sleep on the side with my bad leg up though. If I try to sleep on my other side my knee begins to throb and my foot falls asleep. It takes me about 10 minutes to arrange all the pillows and get in a comfortable position for sleep. I sleep with a body pillow between my legs so that helps me get comfortable with the brace. My brace is still locked out a 0 degrees so sleeping with my leg perfectly straight is still awkward.
Other Thoughts: By the end of week 3 I felt good enough to take a short trip into town to go to Starbucks. Though the exercises during therapy are painful all the motion is helping with the overall pain control and I feel stronger. Moving around is much easier and I now feel very confident on the crutches.
Physical Therapy: After week 2 I am allowed flat foot weight bearing (FFWB). All this means is when I'm standing straight I can touch my foot to the ground but I'm not really allowed to put any weight on it. When I crutch around I still have to keep my leg off the ground. It's nice to let my foot touch the ground so I'm not doing a constant balancing act. But I have to be more careful than ever not to accidentally put weight on it.
My knee exercises still consist of straight leg raises (SLR). I can now do the leg raises without the brace and add light weight above the knee as I get stronger. I do the leg raises 4 ways to work my inner/outer thighs and my glutes. For the most part I can do the leg raises on my own but sometimes I need my therapist to help me get started and lift my leg. I have a fairly strong quad set now. I am able to contract my quad and hold it. However, when I contract my quad I am unable to hyperextend my knee and lift my heel off the ground like I can with my other leg.
Pain: SLRs are still very painful and the scar massage and patellar mobilization makes me light headed and dizzy. With the SLRs I sometimes can't get my leg to lift because my brain knows it will cause pain and shuts down my muscle. So no matter how hard I try it won't move. That's when my therapist helps me out and lifts for me so I can get started. I still take the occasional Percocet to help sleep at night.
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| My leg is laying in the CPM in this pic. This is the scar at the end of week 3. There is still quite a bit of swelling but you can make out the sides of my kneecap. |
Other Thoughts: By the end of week 3 I felt good enough to take a short trip into town to go to Starbucks. Though the exercises during therapy are painful all the motion is helping with the overall pain control and I feel stronger. Moving around is much easier and I now feel very confident on the crutches.
2 Weeks Post Op
Daily Routine: I have settled into a routine. I wake up, eat breakfast, and get 1 hour in the CPM. Then I go to my morning PT session. After PT I come home and get another 2 hours in the CPM, eat lunch, then go to my afternoon PT session. I get home around 3 pm and immediately jump in the CPM for another 2 hours. I typically take a break around 5 pm and take a shower or do other small chores. I eat dinner then spend the rest of the evening in the CPM typically watching tv or reading.
Range of Motion: I have reached 30 degrees on the CPM and it is relatively pain free. First thing in the morning it is very stiff and I have to work up to 30 degrees but by the end of the day I'm relatively pain free while doing it.
Physical Therapy: My morning PT session focuses on my knee exercises. I am very limited to what I can do due to how fragile the graft is. I am still focussing on trying to contract my quad. I have been able to do this but it is weak and I can only hold the contraction for a few seconds then I lose it. I also do straight leg raises (SLR) with the brace on. I need help from my therapist to lift my leg and lower it. However, he applies the minimal pressure so I am still using my muscle. The straight leg raises are extremely painful but I am able to work through the pain by focusing on breathing.
In addition to the quad sets and SLRs I now do scar massage and move my knee cap around (patellar mobilization) to break up scar tissue. My therapist does this for me but I will begin doing it myself at home when I can stand the pain. Also I have a hard time finding my kneecap due to the swelling. I attached a video of me doing patellar mobilization and scar massage at post op week 7.
Pain: I am off Percocet for the most part. I take it occasionally at night to help sleep. The Percocet has been tearing up my stomach so I am determined not to take it unless I really need it. My pain level is much better than the first week.
Sleeping: I still have trouble getting comfortable at night. I still have to sleep on my back since lying on my side is still too painful. I usually wake up around 3 am with painful throbbing but I am able to drift back asleep sometimes. I am supposed to wear the brace at all times unless showering, in the CPM, or at therapy for the first 8 weeks. It is bulky so that partly contributes to my issues getting comfortable at night.
Other Thoughts: I am able to move around easier. Getting in and out of the car is much less daunting. I only shower every 2 days since it's a pain in the ass and I'm worried about falling. Sometimes I just don't have the energy. I haven't felt up to going out and doing any activities yet.
Range of Motion: I have reached 30 degrees on the CPM and it is relatively pain free. First thing in the morning it is very stiff and I have to work up to 30 degrees but by the end of the day I'm relatively pain free while doing it.
Physical Therapy: My morning PT session focuses on my knee exercises. I am very limited to what I can do due to how fragile the graft is. I am still focussing on trying to contract my quad. I have been able to do this but it is weak and I can only hold the contraction for a few seconds then I lose it. I also do straight leg raises (SLR) with the brace on. I need help from my therapist to lift my leg and lower it. However, he applies the minimal pressure so I am still using my muscle. The straight leg raises are extremely painful but I am able to work through the pain by focusing on breathing.
In addition to the quad sets and SLRs I now do scar massage and move my knee cap around (patellar mobilization) to break up scar tissue. My therapist does this for me but I will begin doing it myself at home when I can stand the pain. Also I have a hard time finding my kneecap due to the swelling. I attached a video of me doing patellar mobilization and scar massage at post op week 7.
My afternoon PT session focuses on the rest of my body. I do some form of cardio such as an arm bike or one-legged rowing. Then I do exercises which focus on my core and upper body. The afternoon PT sessions are my choice to go. I was very worried about losing my fitness level due to this surgery. My therapist is fantastic and works with me to maintain my overall level of fitness. The rehab center I go to has a full gym so my therapist helps me get into weight lifting machines and designs exercises for me that I can do despite crutches and being locked out in a bulky brace. Being able to workout the rest of my body and stay in shape has helped me more mentally than physically. Exercise is such a big part of my life and I am glad that I can keep some level of fitness.
Pain: I am off Percocet for the most part. I take it occasionally at night to help sleep. The Percocet has been tearing up my stomach so I am determined not to take it unless I really need it. My pain level is much better than the first week.
Sleeping: I still have trouble getting comfortable at night. I still have to sleep on my back since lying on my side is still too painful. I usually wake up around 3 am with painful throbbing but I am able to drift back asleep sometimes. I am supposed to wear the brace at all times unless showering, in the CPM, or at therapy for the first 8 weeks. It is bulky so that partly contributes to my issues getting comfortable at night.
Other Thoughts: I am able to move around easier. Getting in and out of the car is much less daunting. I only shower every 2 days since it's a pain in the ass and I'm worried about falling. Sometimes I just don't have the energy. I haven't felt up to going out and doing any activities yet.
October 5, 2015
1 Week Post Op
Day 1: My leg is locked out at 0 degrees with a brace that extends from my hip flexor to my ankle. Underneath is a dressing over the incision and an ace bandage wrapped around my entire leg. I have a cryo cuff under my brace and over my bandages. This cuff plugs into a cooler filled with ice and circulates cool water throughout the cuff. The cryotherapy helps a lot with the pain and swelling. I was pretty much hooked up to the ice machine 24/7 during the first 3 days after surgery. I have pain anytime I move but it's managed with the Percocet. I can't move my leg on my own so I either have to pick it up myself or have someone lift it for me.
Day 2 and 3: These days were pretty much the same as the first day except my pain was worse. It maxed out at a 7 if I wasn't quick enough with the pain medication. I needed 2 Percocets every 6 hours around the clock. Moving is still difficult and I only get up to use the bathroom. Showering still seems like too difficult a task.
Day 4: I felt a little better today. The pain is better and I'm down to taking 1 Percocet at a time. I took my first shower which was extremely difficult. Moving is a challenge and I needed help to get set up in the shower. I wrapped a plastic bag around my leg since I haven't removed any dressings yet. After the shower I felt light headed and weak and had to lay down for awhile.
Day 5: Pain is a little better today. My rehab protocol directed me to begin using the constant passive motion (CPM) machine today. I am supposed to use this 8-10 hours a day. To use it I place my leg on the machine and use the hand controller to set the desired degree of flexion. According to my protocol I am supposed to bend 0 to 30 degrees for the first 2 weeks. During my first attempt I realized 30 degrees was too much so I started at 10. I immediately needed a percocet as I started the motion.
Day 2 and 3: These days were pretty much the same as the first day except my pain was worse. It maxed out at a 7 if I wasn't quick enough with the pain medication. I needed 2 Percocets every 6 hours around the clock. Moving is still difficult and I only get up to use the bathroom. Showering still seems like too difficult a task.
Day 4: I felt a little better today. The pain is better and I'm down to taking 1 Percocet at a time. I took my first shower which was extremely difficult. Moving is a challenge and I needed help to get set up in the shower. I wrapped a plastic bag around my leg since I haven't removed any dressings yet. After the shower I felt light headed and weak and had to lay down for awhile.
Day 5: Pain is a little better today. My rehab protocol directed me to begin using the constant passive motion (CPM) machine today. I am supposed to use this 8-10 hours a day. To use it I place my leg on the machine and use the hand controller to set the desired degree of flexion. According to my protocol I am supposed to bend 0 to 30 degrees for the first 2 weeks. During my first attempt I realized 30 degrees was too much so I started at 10. I immediately needed a percocet as I started the motion.
Day 6: Today was my first day at physical therapy and my first day outside. I did not do any exercises at PT. My therapist just took a look at the incision and bended my knee a little. My knee pain was excruciating when he bent it but subsided after he stopped moving it. I will start exercises tomorrow. My plan is to increase the CPM 5 degrees a day until I get up to 30.
Day 7: This is my best day so far. I did not need any Percocet during the day even in the CPM. Instead I take a Naproxen in the morning which is a strong anti-inflammatory. At PT I am working to reactivate my quad muscles. After knee surgery the quad muscles stop working as a defensive mechanism. When the quad contracts it moves the kneecap. The brain shuts down the quads to protect the kneecap from moving so it will not produce pain. It is a medical enigma as to why this happens but the first step after major knee surgery is to regain quad control. I was not able to contract my quad yet but it was only the first day of trying. Today was also the first day I removed the dressing and took a shower. It was good to let the water run over the incision. Once again the shower was exhausting and upped my pain level. Sleeping has been difficult. I am a side sleeper but I can only sleep on my back because it is too painful to try to lay on my side or move my leg. I need Percocet to fall asleep. Usually I wake up in the middle of the night and my knee is painfully throbbing. The throbbing is due to the swelling which is significant. My knee is twice the size of my other knee.
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