Robs ACL Allograft Diary - MCL & Lateral Meniscus Trim Also

[Rob_W]

Week 23 & Week 24 (1 day early - final 2007 post):

12/19/2007 - 12/31/2007, Through Day 167

I started my PT sessions and cardio training going strong - I did my first 20 minute run non-stop on the treadmill (30 minute treadmill workout but first 5 minutes warmup and last 5 minutes was cooldown). My knee felt great the entire time.

I took about 5 full days off in a row for the holidays and noticed my leg/knee felt weaker when I resumed my workouts again - I guess I really need to avoid taking any extended breaks.

I'm still doing a weekly martial arts workout but still avoiding any sports related pivoting (just a few more weeks since I was told at 6 months I can start to do this type of movement again - I'm sure very carefully at first).

I've been working alot of core body workouts and alot of solo ground workouts (which really push my knee pretty hard) - I am feeling much more comfortable doing both of these.

At this point the following normal day to day activities still cause some pain or discomfort in my knee (this does not include pain from PT workouts):

1. If I walk down a flight of stairs very slowly I can feel it in my knee (if I go quicker I feel nothing so it is the slow controlled motion lowering my body weight).
2. I have slipped a few times on slippery tile floors or ice - Even if I don't fall the sudden slip does cause some pain in my knee (although it doesn't feel like I am doing any damage) - has only happened a couple times in the last few weeks.
3. Kneeling down and sitting my butt down on my heels – the pain is not from the contact with the floor but the full flexion of the knee. The contact from kneeling on floor is fine (still feels a little numb over the knee).

That's about all I can think of but hopefully those 3 things will gradually go away.

I'll post again at 6 months coming up in a couple of weeks!

[riderdown]

Hi Rob, thanks so much for the very detailed diary. It is very very helpful.

I am most concerned about getting full flexion and sitting on my heels. Can you tell me what your PT says about that? Is it likely that you can get there without pain? Is the pain from the meniscus in that area, or just the overall deal?

Thank you so much,
Steph
PS/ my surgery is this thursday

[Rob_W]

Steph,

Both my PT and OS didn't seemed concerned with flexion - they both said extension is much more important and that the flexion will come in time.  I got lucky with the extension and this was never a problem and my flexion too pretty much took care of itself - I never found I really had to focus hard on either (in terms of spending alot of extra time trying to gain either extension or flexion - flexion always felt like a problem even though it steadily improved - extension never felt like a problem because I pretty much had full extension right from the start).

I currently have full ROM and it is relatively pain free until I get to the point where my heel touches my butt - but in time that will fade too. I believe the pain is just overall because it doesn't seem any greater where they trimmed the meniscus - feels more like pressure than pain also (although there is some of both). Early on when I was initially working to gain flexion back doing heel slides that was painful (but not so painful that you can't do the exercises).

As long as you realize none of this comes to quickly you should be OK - it's when we expect to get it all back overnight we can become frustrated (luckily reading all the different post-op diaries online can give you a really good idea what to expect - I read tons of them before and during those first few weeks!).

Sounds like you did some pretty good damage to your knee so just follow closely what your OS and PT tell you to do and before you know it the worst will be over and you will be well on your way to a normal knee again! It's going to drag a little initially, but after a couple of months things will really start to fly by - you will go through periods of feeling like you will never make any improvements, but each week things will improve so just stick it out (I can remember pretty much always feeling like I would not gain any more flexion - the pressure in my knee just felt like it would never go away as I started to bend it - but then each week it improved - even knowing that I still felt that it would not improve any more - and of course it still kept improving).

Good luck!
Rob

[robbie99]

Hi Rob

Have you gone jogging outdoors on road or grass yet ? if so hows it felt ?

Thanks

Robbie

[Rob_W]

The road conditions here are terrible (snow/ice) so I have not had a chance to really try running outside (I would stay off grass regardless at this point because of the un-even surface). I have done just a few quick jogs through parking lots and it feels fine on pavement (but these are just from parking my car far away from a store and then jogging to it - maybe 1 minute at a time tops).

[cassieoz]

Hi ROB,

Jogging on the grass does it hurt for you? Do you not trust your knee holding up, or is it you don't want to hit a soft spot and risk the chance?

Im going on an aspect of some things i would do, but can you do a round house kick (side kick) in the air by pivoting on the good leg and kicking lightly with the operated one? If so does it or would it hurt? Just wondering........mine does not hurt at all but if i get quicker and flick i can feel it. Im just testing out what i can do. Im aloud to do this from my Doc but thought id ask you if you were capable.

Im also starting to condition the legs and muscles by holding a lot of kick in the air for a good muscle burn. My forms are great no worries. How is your training going?


Cassie x

[Rob_W]

Cassie,

Currently the grass is covered with snow so I really can't test it out - but my thoughts are I don't think I would take the chance of running on grass yet because of the uneven surface and the chance for injury I imagine would be quite a bit higher (my OS also told me stick to paved roads or a treadmill at this point - that was 1 month ago).

I don't seem to have any problems doing light kicking if I stand on my good leg and kick with the injured leg - I haven't tried kicking hard yet and will wait for a while - but I can go through the motions pain free.

Training is going well - I feel almost 100% when I train but I am still keeping it light (I am keeping the resistance level down around 30-40% - I did push one workout pretty hard last week, at least 50% but don't plan to do that again for another couple weeks or even a month - just really testing out the knee a little - felt good but still want to play it safe).

Glad to hear you are still doing well!

Rob

[Rob_W]

6 Months Post-Op:

Technically this Thursday (January 17) will be 6 calendar months, but today is 26 weeks post-op.

Since my last update two weeks ago things have pretty much been more of the same.

I did do one really hard workout on January 2 where I grappled pretty hard for about 30 minutes.  When I was done I was sweating, breathing very hard and felt slightly nauseas since I haven't done any hard grappling workouts in so long. My knee felt really good during the workout, but then for the following 4 days or so it felt pretty worked. I made sure that I avoided anything that would stress my knee too hard but I know I did put it under more pressure than I had planned.

I then did another 30+ grappling workout on January 13 but this was much more controlled and I made sure to really keep all twisting pressure off of my knee, and I also didn't push myself nearly as hard as the last session.

For my PT workouts I am still slacking a little - I am supposed to be doing 5 days a week with 2 days off and I am probably doing 4 days with 3 days off. I also have not been hitting the treadmill as much as I should be (but I am still substituting other workouts like the grappling sessions and some additional plyo workouts).

Overall my knee feels really good. I'm already starting to feel like I will be ready to go back to my martial arts classes as I was doing before but still plan to wait because I know that even though my knee feels like it can do it, it is not ready (I am going to do my best to stick to the doctors orders and not start my real training again until around April/May).

[Rob_W]

28 Weeks (6.5 months post-op):

I was going to wait until 7 months to do my next update but just got back from PT so figured I would do an update today. I had not been to PT in at least 6 weeks and the last time we checked my strength my injured leg was at 75% of my good leg. Today my injured leg was measured at 100% the strength of my good leg!! My PT has released me at this point and basically told me to just keep doing what I am doing (and to contact him if I had any questions). If I wasn't doing martial arts he said he would have released me months ago. He gave me a few new exercises to start to work into my training (some cutting/pivoting exercises) and I updated my exercise journal with these (link in signature below).

I was telling my PT that overall my knee feels great. I did tell him I think I can feel some pain where they trimmed the lateral meniscus. If I stand on my injured leg with all my weight on it, it feels fine, but then when I shift the weight off of it I feel a momentary dull ache in that area (not always - but sometimes). He said he hears this alot and it is normal and will gradually diminish.

The past 2 weeks (since my last post) have been good. I have been doing some good martial arts workouts twice a week now (some lasting over an hour) and am realizing just how out of shape I have become in the past 8 months. One 3 minute round of sparring has me sucking wind and my muscles are aching (I take long breaks after each round now) and a 30 minute session of grappling also leaves me pretty exhausted (although I am already noticing improvements in my conditioning just in the past few weeks).

I've been doing pretty good with my regular PT home sessions but I have been slacking a little on my treadmill & bike workouts (I prepare taxes for a living and am getting slammed already). I still manage to get at least a weekly cardio workout in but I would prefer to be getting at least 2 each week. On the treadmill I am doing 30 minute sessions and am up to a top speed of 8.5 mph (no problems at all running).

That's it for now - I will update again at 7 months.

[robbiepapenfus]

Hey Rob!

Thats great news! Sounds like the knee is doing extremely well. I had a CMI (Menaflex) implant 11 weeks ago. The knee is also feeling great.

I am looking at returning to running 6 months post op, and I have been told that I can return to soccer 9 months post op. Although this will be towards the end of my soccer season, so I might just rest and strengthen the knee properly a little longer and return to soccer next year.

Regards,
Robbie

[Rob_W]

Robbie,

Glad to hear your recovery is going well. I agree with you on possible just resting up and continuing to strengthen the knee rather than jump into the very end of the soccer season.

Good luck!
Rob

[cassieoz]

Hey Rob,

Thats wicked.....i read your last post at the end of Jan which was your 7 month mark and im so happy for you!

I know what you mean about being out of shape sparring......i did some today and felt the same.

I wrote a new topic in the cruciate ligament section asking for some help about if i should go back to TKD or not..........im seriously torn!!!!!

I'd love to find out my strength percent in my knee maybe that might help me too decided on whats right.

Anyway please take a read at what i have written and hopfully its enough to get some kind of answer im looking for. I wish my PT was a little more specific!!!

x

[Rob_W]

Thanks Cassie - It feels great to be almost back to normal again (I know I still have a long way to go, but at least I feel normal 95% of the time).

I did respond to your post - Glad to hear you are doing well and that your biggest problem is you feel so well you want to go back to doing everything you did before - good problem to have - I feel the same way :-)

[Rob_W]

7 Months Post-Op:

All is going great!

I’ve been pushing my knee pretty hard during my home PT sessions. On my stationary bike I have finally got up to the point where I can hit the maximum resistance (level 20) for about 1 minute – no pain at all in the knee but just incredibly hard to pedal. On the treadmill I am up to running at 9mph (which is closing in on a full sprint for me) – my treadmill maxes out at 10mph so if I want to push past that I will have to wait for nicer weather so I can run outside.

It’s funny because when I do my treadmill work I definitely get some pains in my lower body but not in my injured knee – I can often feel some ankle pain, or hip pain, or even knee pain in my good knee but my injured knee feels great (I assume this is due to the intensive focus primarily on this part of the body – although I do make sure I am doing full body workouts at least twice per week).

I’ve been pushing myself harder on all of my plyometric exercises (explosive jumping exercises) and also focusing on exercises that require me to make sudden changes in direction (cutting motions). In addition I am making sure I am working leg extensions on a weekly basis (this is all in addition to my regular home PT routine that I still do at least 4 times per week).

My martial arts training has been going great also. My knee doesn’t really seem to bother me much at all while training (I will say that if I do a medium to hard grappling session I do get some mild pain in the lateral side of my knee for a few days following the session - I am thinking this is from the trimmed meniscus however) – I am still not pushing it 100% (more like 50-70% I would say) but it just feels great to be training again on a regular basis. I can’t believe in about 8 weeks I should be back training in regular classes again (the last actual class I took was in May of 2007 – currently I just do workouts on my own with some training partners I really trust – this way I control all aspects of what we are working on and can make sure my knee stays safe).

Even though I have full ROM in the knee I still find it painful when I am kneeling down and I sit my butt all the way onto my heel (it’s more pressure than pain actually) – this is one of the positions while grappling that I still stay away from (I don’t want to be in this position and then have someone’s wait suddenly shift into me). In addition I am not doing anything with takedowns yet or anything that attacks my leg (all the various leg locks in grappling). My standup training (basically boxing with limited kicks) feels fine too – I don’t have a problem with the movement so I can pretty much do anything (that is when my conditioning allows me too).

That’s it for now.

[Rob_W]

8 Months Post-Op:

I'm posting 2 days early but figure not much will really change in that time.

Do to my main job (tax preparation) I have definitely slacked off on my PT exercises over this past month. I would say on average I am doing 1 cardio session per week which is typically a 30 minute run on the treadmill and part of this is doing 10 mph sprints (my treadmill doesn't go any faster so now I will start to work on adjusting the incline). I am also doing between 2 and 4 knee specific PT exercise sessions per week as well as at least one decent martial arts workout per week (mostly grappling).

I sent my PT an e-mail asking him at this point how often should I be doing my knee specific PT sessions and he sent back the following:

Once you hit that 6 month post-op time frame as long as you are physically active and the knee does not interfere with your activity level, you do not need to keep up with the routine. The idea of the surgery and rehab is to get your knee to the point of full functioning. That being said, the exercises are just good exercises from a conditioning stand point so you could always integrate them into your weekly workout.

Below are the areas I am still working on:

I still get a dull ache where they trimmed the lateral meniscus for a few days after a good grappling session (it only aches for a moment if I lock my leg out straight, flex the muscles, put my weight on it and then gradually take the weight off - other than that I don't really notice it).

I am still finding easily getting my heel to my butt when kneeling down and sitting all my weight back on my heels a challenge - I can do it, but it doesn't feel great (as I posted before - it's more pressure than pain at this point that is making this uncomfortable).

I can still feel my knee when going downstairs if I go slow and controlled (just a regular walk down I don't notice at all). I can actually run up and down flights of steps at this point and carry heavy objects upstairs without a problem.

Overall my knee still feels really good and I am looking forward to going back to my regular grappling classes in about 1 month I hope (the last class I took was in May of 2007 so almost a full year ago).

That's it for now!