Bob's Arthrofibrosis story

[rjs1956]

Re-reading it I can see your confusion.  Place a new roll of paper towels under your knee while sitting on the floor.  This will give your leg a slight bend - like 20 - 30 degrees.  Now straigten your knee which will raise your foot off the floor.  That is a short-excursion leg extension which will utilize the tiny muscles that run along the side and just above your knee.  Doctor Folk said those are among the last muscles to get firing after a knee surgery.  As you get better and stronger at it you can add a 2-3 pound ankle weight.

[rjs1956]

Update July 13 (Friday the 13th!  ).  I received my third and final Synvisc shot on Tuesday.  My knee felt a tiny bit swollen for the remainder of the day.  The Synvisc feels like KY jelly.  On Wednesday the LeMond Revmaster equiped with adjustable PowerCranks arrived.  I spent the evening putting it together and adjusting the seat height and setting the crank size to the smallest at 85mm.  I mounted the bike and lo and behold I could get my leg around so I rode it for about 10 minutes. I spent about 20 minutes on it last night and about 7 minutes before leaving for work this morning.  My hip does hitch up a bit at the extreme flexion but I think that will smooth out over time.  As my flexion increases I can adjust the crank lengths.  As my strength increases I can also "unlock" the cranks allowing them to rotate independently.  This is the cool rehab aspect of PowerCranks as it forces each leg to rotate the pedal all the way around as the other crank can't help.

[rjs1956]

Update July 27 2007, almost 4 months post-op.  I saw Doctor Folk yesterday for my monthly visit. I was sitting in the exam room for a good 10 minutes waiting with my legs hanging over the side of the exam table so my knee was at a good 90 degres and swinging gently back and forth when he came in. Of couse his eyes went immeddiatly to my knee and he started grinning.  "That's great.  It's the first time I've seen your leg bend that far."  He said 90 degrees is a milestone since you can apply so much more leverage past 90 degrees the soft tissues really start to accelerate the softening and stretch.  He said the next month should improve even more dramtically than the last.  I asked him about what limits regaining full ROM in knee surgeries.  He said the causes are numerious and depend on the nature of the injury.  In my case the only limitation is scar tissue which, being a soft tissue, can be "remodeled" when stressed.  So if I keep using the JAS splint, the stationary bike, water fitness, step classes etc., the tissues should eventually stretch.  That's my hope anyway.  The therapist was able to push my knee to 92 degrees.

While I can bend to 90 degrees I can't do so very fast - the bend has to be pretty slow.  This means I still walk with a bit of a stiff leg.  Doctor Folk said the speed of the patellar movement will increase over time.

[Jaci]

Hi Bob,

So glad you're continuing to make progress. That's really good news.


Jaci

[rjs1956]

Update August 23, 2007, almost 5 months post-op.  I saw Dr Folk today and he was pleased with my progress.  He thought my knee was more mobile, softer and felt less wooden.  I replied that I was becoming a real boy.  He said the trend is good and he does not like to fight a positive trend so my next appointment will not be for 3 months at the end of November.  I also had a PT appointment and they were able to bend my knee to 105 degrees.  I was shown some more advanced strengthening excersizes, squats and lunges.

I continue to take classes at LA Fitness 6 days a week (step, aqua, and bodyworks).  I am up to using a 6-inch step which gives me more cardio as well as quad usage.  I also use the machines, leg press, leg curl, etc. to develop quad strength.  I use the JAS splint 3 times per day and do 1/2 hour on the stationary bike with shortened powercranks in the morning and evening.  My active flexion is getting better although I still can't "snap" my leg back - I have to raise it slowly.  I can't run at all but I can skip which is a little plyometric.  I can also jump straight up and I get about 5 inches off the ground.

[rjs1956]

Update August 29th.  Last week I think I did too many jumping jacks in step class.  I have no problem going up but the landing with legs spread caused some soreness on the arthritic portion of my femur.  I think the style of landing a jumping jack bangs the bone too much.  As a result I will no longer do jacks.  i will substitute squats with my feet no more than shoulder width apart to evenly distribute the load.  The soreness persisted for several days.  Yesterday I went back to no risers on my step and I took it easy overall. 

[Jaci]

Hey Bob,

Update August 23, 2007, almost 5 months post-op. I saw Dr Folk today and he was pleased with my progress. He thought my knee was more mobile, softer and felt less wooden. I replied that I was becoming a real boy.

Oh gosh this made me laugh! When I was being treated by Dr. F, we would joke about my knee feeling like it was filled with chunks of wood. Many months later I got a copy of all my records, office visit notes and so on. Within all the medical jargon there was a comment about the return of "woody-like chunks." It still makes me laugh everytime I think about it. Okay, I'll admit that I have a warped sense of humor; surely it's a coping mechanism from dealing with arthrofibrosis.

I think learning when to back down is a hard lesson for many of us with AF. So it's great that you figured out what caused the increased pain and decided not to just push through it.

Glad making progress.


Take care,

Jaci

[rjs1956]

My fat pad is still pretty woody feeling - like a ginger root - very fiborous although it has softened somewhat.  Thankfully the graston therapy on the fat pad was not very painful so I was happy to have that thing mashed on to soften it up somewhat.  As I use my knee more and more - on the stationary bike and the eliptical all the surrounding tissues are softening up and showing more pliability.  As doctor Folk says "it is a process" that takes time.

[rjs1956]

Update Sep 11, 2007 - Still gaining flexion slowly but surely.  I have not had it officially measured but I would guess I am past 110.  Added the Stairmaster 15 minutes at level 3.  I am able to leg press 55 pounds with my weak leg - up from 35 pounds.  The leg curls are getting easier as well as I can bend my knee on the machine fast enough and far enough that it looks pretty normal.  I am doing a lot of squats as well.  The Celebrex really helps keep my knee feeling loose.  When I forget to take it my knee feels noticibly stiffer.  Driving to Durham North Carolina to see the jazz guitarist John McLaughlin on Thursday so I may stop in at Steadman Hawkins and get measured.

[rjs1956]

Update Sep 16 2007 - Stopped to see the therapist at Steadman Hawkins in Greenville on my way to Durham to see John McLaughlin in concert.  She said my knee felt real loose so she pushed and pushed and got me to 130 degrees.  I was able to pull it back to 121 on my own with just the hamstrings.  Since I was at 105 degrees on my last visit I gained 25 in just three weeks.  I hope to have full flexion by my next official visit at the end of November.  My fast flexion is getting better and better as well.  I still don't have enough strength to support my weight while bending my knee walking downstairs but walking upstairs is getting easier and easier.

[rjs1956]

Update Sep 20 2007 - I went for a bike ride outdoors for the first time.  I rode a distance of over 4 miles however half was uphill so I was only working my knee for about 2 miles.  But it felt good.  My next ride I will go for a more level route.  I am doing the power cranks on the stationary bike every day but with the pedals in true power crank mode - which means they operate independently - your legs have to work continously to keep peddeling; you can't let one leg rest while the other does the work.  And you have to work the entire crank revolution.  So after a few minutes of non-stop excertion you have to rest the burning muscles.

[joew]

Bob,

I was just wondering if you have any pain from the patellofemoral arthritis?  Or did the bleeding create fribrocartilage so that really isn't an issue now.

Joe

[rjs1956]

Great question.  As I understand it my arthritis is isolated to a fraction of my patella and femur although Dr Folk told the physical therapist that the cartiledge on the rest of my patalla is pretty thin.  The bone bruise was about the size of a quarter and I coud see that about 20% of the inner side of my patella was noticibly thinner in the sunset view X-ray.  All this to say I never had a lot of pain.  I would call it discomfort.  If I did straight leg lifts there was a point mid-way through the lift that I would call painful but only like a 4 on a 1-10 scale and that was only for about 15 degrees of the arc.  I just always chalked it up to "weak knees" and I imagined my tendons were thin or some other soft-tissue problem.  That is why the OS got so bad - I never had enough pain to slow me down so it wore deeper and deeper into the bone over the years.  The bleeding did create fibrocartilage so I hope after my rehab is mature my discomfort levels will be less than before but now I am aware of the condition and I am more sensitive to things that can irritate the bones.  For example I've found that jumping jacks causes the OS area to feel sore the next few days so I substitute squats when the rest of the class is doing jacks.  I am still too weak in the quads to walk downstairs without going a bit sideways.  My biggest problem is still getting my muscles to transition quckly from contracting to relaxing so when I walk I still feel pain under my petalla right after I transition the weight to my good leg and my bad leg has to quickly relax and kick back. It does not relax quick enough so the patella does not glid forward as it should and it gets pressure causing pain. It is getting a bit better each month but I still am a bit stiff-legged.  I've been told it is partly a nerve issue as the nerves tell the muscle to contract and relax so I try and practice contracting and relaxing my quads as quckly as I can.  As I get more and more flexion and the tissues around my knee get softer and more supple it is all coming together.  I am hoping by the end of the year to be 90% back to normal.  With the JAS splint am close to hitting its max so my heel is about 7 inches away from my rear.

[rjs1956]

Dec 1 2007 - 8 months post-op.  I had a 3-month interval checkup with Dr Folk this past week.  I was measured at 144 degrees flexion and still 2 degrees extension.  He was very happy and impressed with how far and fast my knee has improved and wanted to know my secret.  I told him I am doing 2 spin classes, 2 step classes, and 2 bodyworks classes per week at LA Fitness.  After every class my knee feels better than before the class.  He cradled my leg and bent it back and forth feeling for the joint action.  He said the knee feels "happy" (not irritated) and to keep doing what I'm doing and come back in six months for the final visit.

I just started a 10 week 3 visits per week program at a local chiropractic clinic.  At each visit I get a spinal, hip and leg adjustment, some "trigger point injections" in and around my bad knee which consist of a 2% lydocain and "Zeel" which they describe as a natural non-steodial antiinflamitory.  I've had two shots so far and have not really noticed much.  The visits also include some massage therapy on the back and hips which lasts aboout 15 minutes and is right on the edge of pain although overall they feel pretty good.  After 6 weeks I will get a shot of Supartz every week for 5 weeks.

I still have a small hitch in my walk from some patellar pain as I bring my leg forward from behind.  If I walk slow and exagerate the step, as if I'm stepping over somthing, I only feel very mild stiffness.  I have no pain at all on the bike or doing step classes which is a bit odd.  I would have thought walking would be the easiest motion.  I am still not running or playing tennis.  I can press 75 pounds with my bad leg up from 35 pounds 3 months ago. Dr Folk commented that as my quads get stronger the pain during walking should go away.

[Janet]

Bob: It sounds like you are doing great. Good for you! You've been so diligent and focused about your rehab. I also found walking to be much more painful and spinning or riding the bike. Of course, walking is a weight bearing activity, which riding isn't. Before my TKR, I used to walk by bending my leg back, then swinging it back around to the front for the next step. All my damage was in the articular cartilage/bone of the patella.

Keep up the god work!
Janet