Robs ACL Allograft Diary - MCL & Lateral Meniscus Trim Also

[Rob_W]

Day 41 – 8/27/07 (Mon):

Yesterday I did a lot of working out and really pushed my knee throughout the whole day thinking that today I would be able to take it easy. What I forgot was that today I had formal PT that I go to. Whoops!

At PT I started with heat and e-stim.  I then warmed up on the bike for 8 minutes (about 2 miles). Next I did the single leg leg press for 3 sets of 15 at 30 pounds – I thought this would be pretty tough because of all I did yesterday but it was actually pretty easy. My PT told me at this point if I wanted to do some wall squats at home using the physio ball I could, but not to do more than 3 days a week on squatting type exercises (this includes leg press) – since I do this twice a week at PT he said just once a week at home would be good.

Next I did 3 new exercises:

1. I started on the step and basically just stepped down like going down a flight of stairs (leaving my good leg up on the step), and the stepped back up. I did this about 30 times today and was told to gradually work up to 3 sets of 15 (I was basically already doing these at home already but just on a shorter step).

2. The next exercise was a standing hamstring curl with a 5 pound weight on my ankle. I did 3 sets of 15 and these were pretty easy.

3. The last exercise I did was the same 3 way balance exercise I have been doing (hold good leg out in front, to the side and then behind me for 10 seconds in each position) but I did it standing on a piece of equipment called the KAT. It is basically like a balance/wobble board but you have a little hand squeeze thing to pump up the base to set the amount of wobble it has. This too was pretty easy.

We finished with some ice and e-stim.

I took the rest of the day pretty easy because my knee was feeling pretty worked from yesterday so I skipped my home set of PT tonight (I did make sure when I went down the stairs at my house today I did it the regular way with my arms supporting most of my weight – this is getting easier already).

[cassieoz]

Hi Rob,

The balancing technique sounds like a great exercise..... and you found it easy so that's good. Your leg is sounding strong, can you notice the difference yet?

Good work

Cassie x

[Rob_W]

Cassie,

My leg is feeling great - the last week I've noticed some big improvements  - I'm at the point where I don't have to 'try' and walk normal anymore and there have been quite a few times I actually forget about the injury (as opposed to how during the first 6 weeks it seems to have been on my mind all the time).

Good luck in PT today!

Rob

[Rob_W]

6 Weeks - Day 42 – 8/28/07 (Tues):

My knee felt good today so I went pretty strong on both my morning and afternoon PT sessions. I also added in some extra practice on stairs – just walking up without touching the railings (this is how I normally do it anyhow) and down but using the railings to help support some of my weight.

I’ve noticed my walking is getting much better – I think the extra work on going down stairs is really starting to loosen up my knee and stretch out my quads (I’ve also noticed the bridging stretches my quads and I am doing some extra quad stretches on my own).

6 Weeks & 1 Day - Day 43 – 8/29/07 (Wed):

My girls started school today so I rushed my first PT session today (I’ll make sure starting tomorrow I set aside more time in the morning) – did about ½ the sets for each exercise.

Today at my office I went for a walk just to loosen up my knee during the day – I walked about ½ the distance I was going right before surgery (my knee was actually feeling just about perfect right before surgery). My walking is really starting to feel good – I finally feel that I can just walk and not have to practice walking.

I was feeling a little tired in the evening so went light on my 2nd session of exercises – I did do my bridging a little different this time, I did them on my physio ball.

I’m also starting to get myself off the floor a little differently now – I basically plant my injured right foot and get on my uninjured left knee and then basically stand straight up (looks almost like rising straight up in a lunge position).

6 Weeks & 2 Days - Day 44 - 8/30/07 (Thur):

I went to PT today. Started with heat and E-stim and then continued to warm-up with 8 minutes on the bike (1.9 miles). I then did 2 sets of single leg leg press at 30 pounds and a 3rd set at 35 pounds. Next I did my 3 different step exercises – step ups, step downs and straight up and down. I then did my standing hamstring curls with the 5 pounds ankle weight.  Next I did my 3 way balancing (5 sets of 30 seconds) on the KAT. I then did 2 new exercises:

Exercise #1: The first exercise is bridging on the ball (which I had already started to do on my own, but this version is more difficult). I would lie on my back with my heels up on the ball. The firsts step is to raise your butt so there is a straight line from your shoulders on the floor, to your butt and through to your heels (you should look like a straight plank of wood). Next you pull your heels to your butt bending at the knees and driving your hips straight up (at the top of this position you want a straight line from your knees to your butt and through to your shoulders on the floor) – this motion will roll the ball towards you, you then extend the feet away from you (this rolls the ball away from you) and you are in the straight plank position again, and then relax back down to the floor. I did 3 sets of 15 although on the 3rd set I got to the point where I just bridged to the plank and back down again.

Exercise #2: The 2nd new exercise I did is another new balancing exercise (I was told to just do one balancing exercise per training session and just pick from the various ones I have). Stand on bad leg, hold a weight in opposite hand (just 2 pounds) and then bend forward and set the weight on floor, hover for a moment, then pick up weight and stand back up. I can rest in between or do as many as I want without putting my good leg down (I was also told to mix up trying to bend my leg to lower myself which works the knee more, or just bend more at the hip which works the hamstring more.)

I was also told that I could start doing a balancing exercise that I was doing pre-op where I place two books on the floor about 2 feet in front of me, and spaced about 3 to 4 feet apart (so they are out at 45 degree angle from me). I then stand just on my injured leg and bend down and touch the book to my right with my right hand (I am told to put it as far away as I possible can so I really have to reach for it), then I stand back up (not touching the other foot to the floor), and then I do the same but this time my left hand touches the book way to my left, I then stand back up (again without ever touching the other foot to the floor). I then repeat this 9 more times on the injured leg (without ever touching down). That is one set, and I am to do 3 sets on each leg (so a total of 30 reps on each leg). Those were the reps I was doing pre-surgery so I imagine I can do less now to start and check my balance during the sets if I need to.

I finished today’s PT session with some calf and hamstring stretches and then e-stim and cold.

Later today I was doing some shopping (with a lot of walking) and I find I am now walking faster than most people rather than slower than everyone! I’m also finding that I am starting to forget that my leg is injured every now and then!

I ended the day doing my weight lifting routine and then an easy session of PT since my leg was still tired from my earlier session.

[Rob_W]

6 Weeks & 3 Days  - Day 45 – 8/31/087 (Fri):

My leg was really tired and sore from yesterdays PT so I took it easy on my first session (I just did 1 set of each exercise) and completely skipped my 2nd set – I did do some of the easier warm-up exercises with the martial arts class I taught today.

I did my stationary bike mid-day (before teaching) and pushed myself pretty hard – I rode for 20 minutes and did 6.7 miles (167 calories) and took it up to resistance level 8. I was also able to walk up my basement steps the normal way right after biking, normally it hurts right when I am done so I walk up just with the good leg first each step.

6 Weeks & 4 Days – Day 46 – 9/1/07 (Sat):

My knee was feeling better today, but still slightly sore from Thursday’s PT session (the balancing exercises where you drop the weight and pick it up and the bridging on the physioball really worked my leg hard since it was the first time I did these).

I took it a little easier on my first session of PT today and just did 2 sets of each exercise instead of 3. I also ended skipping my 2nd session today because by the end of the day my leg just didn’t quite feel up to it.

Today I used my rower for 15 minutes (121 calories) and rode my mountain bike for the first time on my street today for about 5 minutes (this is easier to do than my stationary bike). Directly after I did my rowing I did some heel slides just to see how the flexion is coming along and I got the ball of my foot to line up with the center of my opposite knee – and that is the furthest I have done it.

I also went for a walk in my neighborhood that I have not done for a while – it took me 5 minutes today and it was very easy, last time I did it was 2 weeks ago and it took me 12 minutes.

6 Weeks & 5 Days – Day 47 – 9/2/07 (Sun):

For PT I decided I would take it easier again today – my knee is feeling more rested now but I am pushing it pretty hard on the rower and bike so thought I would back off on the PT slightly. For my first session I just did 1 set of each exercise (more for a warm-up) and for the 2nd session later in the evening I did 2 sets of each (I felt like I could do more but my knee was feeling so good I thought I would just rest it a little more).

I did 25 minutes on my bike today and rode 7.8 miles (192 calories) and took it up to level 9 today (no pain at all), and again walked normally up my stairs when done.

Today I started to get into my car better, and I am getting out of my car completely normal. I also feel much more comfortable while driving – before I would get in with a straight leg, get my heel in a certain spot and then just rotate the ball of my foot back and forth from the break to the gas. I wasn’t able to bend the knee and pull the foot towards me and then easily get my foot back into position (it was really painful) but now it feels normal. In fact, my knee felt so good I let my 5 year old daughter sit on my lap and steer the car (on a private street with no one around of course - she actually drives great - I think it's all the driving she does on the Gamecube and Wii).

I tried kneeling down on a carpeted floor today – first on all fours and then just on my knee’s – I didn’t move around but was surprised that it didn’t hurt.

Lastly, I am really starting to walk down stairs better. I still keep my hands on the railings and support some of my body weight, but I make sure on the very last step I just step off normally and it feels pretty good.

* I've decided to also start an online exercise journal to track all of the exercises I have been assigned at PT (and a few I do on my own that my PT has OK'd) and also at what stage I started to do them:  http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=38562.0

[cassieoz]

Fantastic Rob!!

You sound like you have everything where you want it. Exercising, burning calories and leading normal life. Having no pain in certain movements must feel so good and not to notice them is even better! I cant wait to start more of the PT work to build muscle and control swelling. This im scared of!

You daughter sounds cute! I did the exact same thing at her age and when i could reach the peddles on my mum's lap i controlled them too and before you knew it i was driving around our block of land when i was 11! Great fun!

Im just about to check out your other site. Hey you should write a book 

Cassie x

[Rob_W]

Thanks Cassie - I really do feel great right now.

I posted something similar to this in your thread but I really think one of the keys has been to listen to my knee and take breaks from my PT when my knee is telling me to (it seems to know when I should take a break even when I don't). I've kind of figured out the difference between pain that I feel I should work through, and pain that is telling me to lay off. I often will drop the number of sets down to 2, or even 1 instead of 3 - and occasionally I will just skip a workout altogether. I then find I come back even stronger for my next sessions. I'm also finding as I do more day to day real life stuff (like tons of walking, or taking my mountain bike out for a ride) I adjust my PT exercises to reflect this so I don't over do it.

As for writing a book.... Nahh - I do enjoy taking notes and posting them here (others posts have helped me alot early on so hopefully I can do the same for anyone struggling at any point in their recoveries and just want to read what someone else has gone through - especially in that first week when you have many sleepless nights). You should see my martial arts notes - I've been taking notes on every class I take, and every class I teach since the mid 80's!!!

Rob

[cassieoz]

Wow would love to see that! You really sound like you are dedicated to everything you do whatever it may be!

I read your other post and thought it was great! I am a little ahead of some days but i think by you getting some meniscus taken out is probably the difference between our knees! Im completely weight baring with no pain at all. Most exercises i do is no pain only aches but like i said in my post i will find a routine at the gym to keep me motivated as i think im slipping a bit especially getting bored with repetition! I know once i start the more vigorous stuff it will set me back and this is where i need to learn and pace it all out.

Glad all is good for you and your week 6 which is amazing. You should be running by the 3 month mark which is the so called protocol?

Well done

Cassie x

[Rob_W]

6 Weeks & 6 Days – Day 48 – 9/3/07 (Mon):

Today I just did 1 set of my PT exercises. In addition I took my mountain bike out for about a 20 minute ride. Later in the day I jumped on my stationary bike and did a 5 minute warm-up (1.7 miles) and then my upper body lifting routine.

Today was the first day I started walking down my back office stairs without using the railings for assistance. These steps are a little shorter than normal steps so they are a little easier to do. The knee felt tight but not really any pain. I can also walk up them 2 at a time now.

7 Weeks – Day 49 – 9/4/07 (Tue):

7 Weeks today!

Today was pretty uneventful.

I did both sets of PT exercises at home today.

I took a few short walks at my office today just to get up and loosen up the knee every so often – walking is still no longer a problem. I would say I am back to exactly how I walked before my injury.

Lastly I started walking down my home stairs a couple of times today without using the railings - I only do a few steps here and there. These are harder to do than my office steps but I am getting there.

7 Weeks & 1 Day – Day 50 – 9/5/07 (Wed):

Today I went to PT. We started right off on the bike for a 10 minute warm-up – I was told I don’t really need the heat and e-stim to get the leg warmed up at this point. Next I did the leg press with just my injured leg and did 3 sets of 40 pounds (just 10 reps each set since we increased the weight today).  I then worked my Step - Mini Squat and Step - Step Down exercises (I was told I no longer need to work the step-up exercises). Next I did a new exercise (Chair walking) which I describe below. I then did the balancing weight pick up exercise followed by the physioball bridging exercise.  I ended doing some hamstring, calf and quad stretching (the quad stretch is new - see below) followed by some cold and e-stim (he said I probably don't need this anymore but if I had time to do it anyhow).

I was told at PT I can drop down to 1 exercise session per day and when I feel strong to really push myself.

Lastly the swelling in my knee is almost gone and the muscles are coming back nicely – my legs are starting to look the same again. My PT said the remaining swelling could take up to a year before its 100% gone.

I ended the day coaching a group in martial arts - I am still doing 95% verbal coaching and staying on the sidelines to be safe (a couple of 220+ pounders almost crashed into me while fighting but I saw them coming and got out of the way).

***

New Exercises (these are also detailed out with the rest of my exercises in my exercise journal):

Chair Walking. Sit down on a rolling chair and just using your injured leg extend it as far forward as you can reach, and then put it on the floor and pull so you roll the chair forward. Do about 20 reps of that in one direction. Turn around so you are facing the other direction and use your good leg to pull yourself back. I am starting with 3 sets in each direction (so 60 reps with each leg). I was told on one day do exercise 23: Standing Hamstring Curl and exercise 25: Physioball Bridging, and on the next do just this exercise – no need to do all 3 on the same day.

Prone Quad Stretch with Belt. This description is to stretch your right quad. Lie on your back as close to the edge of a table (or bed/couch) as you can get without falling off to your right. Pull your left knee towards your chest and hold it with your left hand. Drop your right leg off the side of the table and loop a belt around the foot/ankle and grab that with your right hand. Now just pull with your hand so you pull your foot towards your butt and get a good stretch in the quad (position your knee so you feel like you are stretching the quad more than just working ROM in the knee). Hold for a minimum of 30 seconds. He told me this is about the best stretch you can do for your quads.

[Rob_W]

I decided that I would e-mail my PT some video clips showing the type of martial arts training I would like to get back to so he would have a good idea of my goals (he sees a lot of sports patients but not as many martial artists).

I specifically picked 4 different clips that represented a lot of the type of training that I do and also these clips show the training at a light to medium level of resistance (the bulk of my training is done at light to medium resistance levels and this is what I would start back at).

He said he was very happy to see the clips and will be structuring my re-hab program to help get me back into these activities.

Below are the following clips I sent to him with brief descriptions of what’s on the clip (if you are interested in checking them out). Just click the link and it should pop up a video clip in the window (You can also right click and save, and then watch) - I know for sure the latest version of Quicktime will view these files - http://www.apple.com/quicktime/download/:

1. Standup 1: This is the first aspect of training I figure I can get back into. The two guys in the clip are going very light and that represents how I train about 50% (or more) of my standup training.

Standup 1 Clip

2. Clinch 1:  This clip shows the clinch range and the two guys in the clip are going at about 50% resistance level (or slightly less) – again, I do this type of drill at this resistance level quite a bit.

Clinch 1 Clip

3. Clinch 2: This clip also shows the clinch range but strikes and takedowns are added. Again, these guys are going pretty light and controlled and the bulk of my clinch training with strikes and takedowns is at this level.

Clinch 2 Clip

4. Ground 1: This clip shows the ground portion of my training (specifically Brazilian Jujitsu). I train this type of training almost every workout and I would say the bulk of my workouts are done at the level of resistance demonstrated in this clip.

Ground 1 Clip

[cassieoz]

Hey Rob,


I tried doing this and it didn't work for me. I tried both ways. It comes up as apple quick time and i have to download it. So tried doing that and could not find anything but movie trailers and music ipod things. Im sure im not doing this right.

I really want to see this!

Cassie x

[Rob_W]

Cassie,

If you have the latest quicktime you should be able to download it somewhere on your computer, then run quicktime and choose open file, after that just point to the location of the file and it should play. In all honesty, I think you will see my martial arts training is probably the exact opposite of what you do so if can't do it just picture some boxing, then grabbing onto the person and wrestling them to the ground (with some strikes and knees thrown in for good measure), and once on the ground working to submit them with chokes, arm locks, etc... I stay away from kicking which is probably what you specialize in!!

Rob

[Rob_W]

Day 51, 7 Weeks/2 Days, 9/6/07 (Thur):

I had a hard session at PT yesterday so today I was going to take it easy since I go to PT again tomorrow. I then got a call saying my PT’s wife delivered (we knew it was going to be any day now) and that they had to cancel my appointment for tomorrow. I then decided that I should really push myself hard today since I won’t be going to PT tomorrow (but forgetting that I just pushed myself hard yesterday).

So I ended up doing my regular set of PT exercises (with extra reps and some extra sets), then working going up and down stairs for a while (with minimal touching of the railings), and then some extra flexion for a while.

My knee felt really good during the exercises but about 2 hours later I started to get some pain in the front/medial part of my knee where one of the portal incisions was. It actually hurt slightly each time I took a step. This is the first pain I have had in my knee in a while (while not exercising) – I think I have been almost forgetting that I had surgery 7 weeks ago and I should still expect some pains here and there. I iced for a while and then took it easy and after a couple of hours my knee felt good again.


Day 52, 7 Weeks/3 Days, 9/7/07 (Fri):

I woke up today and my knee felt tired and still slightly sore (some of the pain I got yesterday had come back – although just a hint of it).

I rode my bike for 15 minutes (5.1 miles and 85 calories). Later I decided I was going to take my first full day off from my PT exercises just to give my knee a little break since I had to coach a class tonight and then I was going out afterwards with friends for a while.


Day 53, 7 Weeks/4 Days, 9/8/07 (Sat):

My knee was feeling back to normal today so I again pushed myself pretty hard on my PT exercises.

Later I went for a 20+ minute bike ride on my mountain bike (on the streets – no off road). It feels really good to pedal hard, I am getting the bike into the highest gears (It’s a 21 speed and I am getting up to about 17 or 18) and having no problems with that amount of resistance (I’m on mostly flat ground – no steep heels).

[Rob_W]

Day 54, 7 Weeks/5 Days, 9/9/07 (Sun):

Today was a pretty busy day (for me and my knee). I started off with a 15 minute bike ride (5.1 miles and 130 calories) and then coached a martial arts session (I actually am able to start coaching by showing some stuff and not 100% verbal because I feel much better on my feet and moving around alot – I am being careful however).

I later did my upper body gym workout and then all my PT exercises.

I had to setup a computer at my mother-in-laws house today and actually was able to knee down on the hard wood floor!

Overall my knee felt pretty good today.


Day 55, 7 weeks & 6 days, 9/10/07 (Mon):

Today I decided I would take a break from my stationary bike and I did some rowing (I try to do 1 rowing session each week, and 4 biking sessions). I rowed for 15 minutes (132 calories) and my injured knee felt perfect, and ironically I actually had a few slight twinges of pain in my good knee.

When I was at work I took 1 walk during the day to just get up and loosen up the knee and overall my knee felt great.

I worked myself really hard during my home PT session today.

Lastly, my PT let me know that I now only need to come to him once per week for my office PT session – he says since I have all the equipment at home and do a good job on my own there is no need for me to keep going twice a week.


Day 56, 8 weeks, 9/11/07 (Tue):

8 Weeks today!!

I went a little easy on my PT today since I have my office PT visit tomorrow. Today was also my day off from biking/rowing so overall a pretty easy day.

I am now going downstairs the regular way every time, but I still use the railing to support myself most of the time (at least a few times a day I don’t however). I’ve also noticed that sitting down for long periods of time without getting up to loosen the knee is becoming less and less of a problem (I have not noticed any additional swelling – and in fact pretty much since surgery I have not had my knee flare up, it just keeps getting smaller and smaller – it seems to have leveled off with just a few hints of swelling left).

I’m starting to catch myself doing things that I shouldn’t be doing – like pivoting (usually when wearing socks on a hardwood floor), jumping up and off the last step going up stairs, chasing my girls around while playing with them (basically jogging), etc. My knee feels so good that I keep forgetting that I had surgery and start to do these things and then remember and stop.

I went 9 weeks from my initial injury to my surgery, and have noticed that the recovery from surgery has tracked those initial 9 weeks pretty closely. The first few weeks the post-injury recovery went much better, and now these last few weeks I feel my knee is better than it was at this same time post-injury (if that makes sense).

That’s it for now – I know I still have a long recovery ahead of me and there will still be ups and downs, but so far things are going great!! 

[Rob_W]

Day 57, 8 weeks & 1 day, 9/12/07 (Wed):

I went to PT today and had a good session. I started with a 10 minute warm-up on the bike. I then did the leg press (single leg) for 3 sets of 15 at 40 lbs (this is getting easier – and less painful). After this I worked a variation of the step-up exercise where I used a much higher step and worked on driving myself hard up onto it and then back down (details of this are in my exercise journal added onto the regular step-up exercise). I then did some laps of chair walking around the office. I then started a new exercise (that I was doing pre-surgery) – the lunge (see below for details). I then did some K.A.T. 3 way balancing, book touching balancing and also a new balancing exercise with the band (see below). I finished with some physioball bridging, hamstring stretching and quad stretching. No swelling so I skipped the ice.

At PT I mentioned that I am starting to do things accidentally that I problem shouldn't be doing (see last post, day 56) and he told me that is a good sign and that I probably would not hurt myself doing them. He then said that 1 or 2% of the people could do damage doing those movements, and since you really don't know if you will be in that 1 or 2% you still need to be careful.

New Exercise: Lunges with Dumbbells. This is an easier version of the lunge because you start in the lunge position and just fall and rise in this position (rather than stepping into it and out of it). He had me work it with my injured leg forward for every set, and not my good leg forward yet. Make sure your lead knee does not bend forward past your toes. Lower yourself to as far as you feel comfortable. He said at this point it was probably more of a balance exercise than a quad strengthening exercise due to these modifications. The goal is to work for 3 sets of 15.

New Exercise: Balancing – With Exercise Band. Anchor one end of the exercise band to something about waist high (you could tie it on a bed post or something). Back away so there is tension in the band. Hold the band with the same side as the injured leg. Now standing on just the injured leg bend forward and reach towards where the band is anchored (this will start to take tension off of the band), and then straighten back up and at the end of the movement you do the ending motion of a row pulling your hand towards your waist with your elbow sticking out behind you and your closed fist palm is facing up. The goal is to work for 3 sets of 15.

I taught a martial arts class later this evening and my knee felt great (almost as if I had not worked it out hard).


Day 58, 8 weeks & 2 days, 9/13/07 (Thur):

Today I did my PT session and also my upper body gym workout.



Day 59, 8 Weeks & 3 days, 9/14/07 (Fri):

Today I took my girls to the play ground and to the beach. I did a lot of walking and my knee felt great. By the time we got home I started to feel like I was coming down with a cold.

Since I wasn’t feeling great I just did 1 set of each of my exercises today and skipped my bike riding.

I then taught a martial arts class and took it easy for the rest of the evening after that.


Day 60, 8 Weeks & 4 days, 9/15/07 (Sat):

I seemed to have shaken the cold I felt like I was coming down with so I worked my leg hard doing my PT exercises today – but I did skip the bike to just be safe and not work too hard.

I have not checked my flexion measurements in a while but my injured leg is within 2 inches (pulling heel to butt) of my good leg so almost back to full ROM.

I am going downstairs regular all the time now (still needs work and I still gently touch the railings), and I can go upstairs 2 steps at a time easily (even immediately after biking – which used to be tough to just go up 1 step at a time).

I’m really excited to get back to doing some real workouts again (martial arts) but will obviously hold off because I know I could damage my leg if I jumped in too soon. I will wait for the OS to OK me (which I am sure will still be a while).