brand new TPF

[morgana]

TPF-PT  Glad you made it thru & glad that your ligaments all seem to be in good shape.  What a rough ride you had!  Glad the left leg isn't screaming and hope it continues to be fairly quiet as you start healing.

How soon is your OS thinking you'll begin PT ?  As strenuos as PT can be - how soon do you think you'll be able to begin working?

Best wishes - but remember to take it slow.  You know better than most the types of setbacks pushing too hard, too soon can cause.

[jd70]

Bo,

Glad to hear the surgery went well and that you were released to continue recovery at home!  That in and of itself is a good sign I think -- certainly better than spending many, many days in the hospital.  When will your PT start?  And how does a physical therapist go about choosing a physical therapist?

Wishing you continued improvement,
jd

[TPF-PT]

Thank goodness the soreness is about 95% better!  A couple of people asked about my exercises.  Right now, I am mostly doing isometric hip/quad/hamstring exercises.  I lie in the bed and try to "bridge", assisted straight leg raises (my wife raises the leg and I try to lower it), ankle mobility exercises, and tons of calf stretches with a sheet.  Also, before I left the hospital (where I work), I had one of my collegues loan me a NMES unit.  I apply the electrodes to my left quad and crank the intensity strong enough to cause contraction.  The parameters on the NMES unit are 10 sec on and 30 sec off.  While "on", I try to do a good quad set.  While "off", I let the muscle rest.  I do this for 10 minutes 3-5 times a day.  I am a firm believer in using NMES in an effort to treat the atrophy that occurs.  I use it with almost every one of my patients with good results.  Once I move to PWB, (I am NWB for 6 weeks) I will use the NMES during exercises.  As far as me choosing a PT...each of my collegues has expressed an interest in working with me.  I have accused some of them as using this as "pay back time".  Honestly, I want to get back to work desperately and I will probably have one of my coworkers evaluate me to get the objective measures but I don't know if I could subject any of them to having to deal with me! 

Bo

[StuDogg]

Bo,
I'm sure you know this, but just remember, LISTEN TO YOUR BODY!!!  I was amazed during those first weeks after surgery how little stamina I had.  When your body starts telling you it's had enough, don't push it.  A couple of times when I tried to push past my energy reserves, I had near misses with falls.

Good luck with the rehab and keep us updated.  Your perspective will be very interesting to read over the next few weeks and months.

-Stu

[TPF-PT]

Hello All,

Just wanted to check in.  Follow up last Friday went well.  XR look "perfect" according to the OS.  Of course, he is very proud of his work as most OS's usually are.   I have been able to get out of the house for a few hours each of the past 3 days.  I have to wear the brace locked in extension and cannot put any weight on it yet, but I can maneuver in a car fairly well as a passenger.  I am continuing with my use of estim and now have a CPM of which I am increasing 5 degrees every day.  When the CPM gets to max flexion, I'm sure I have a great grimace on my face.  My wife asked if it hurt...I tried to explain that it is not "pain", but "pressure" and the potential for pain.  I have not begun formal PT yet, but I have a lot of volunteers to help range my knee.  One of my coworkers asked if I could every range a pt's knee again?  My response was "yes" since I understand the importance.  Another question I get is "so, are you ever going skiing again?"  Yes, I hope so but our next vacation is to the beach!   I hope all is well with the other members of the club and everyone is progressing as expected.  This site has been a great help to me lately and I know that I have a long road ahead of me so I will be back frequently.  Once PT starts, I will report on my experiences as a pt and not the PT.

Bo

[morgana]

Glad things are going well for you.  You will certainly have an interesting perspective when you return to work!

Isn't it funny how people ask about returning to skiing, biking, etc?   No one would ever ask if you were going to drive again if this came courtesy of a car wreck.

[RandB]

Hi Bo,
 I've been following your story here.  My TPF was almost exactly 3 years before yours, and it sounds like our injuries and surgery were similar!  Except I was an old lady, over 50 yrs. old....
 Your post reminded me of my PT time, my therapist used the e-stim on me, too.  Not too many people here have ever mentioned it, I was wondering how common it was to use it.  There was only one time it ever bothered me, they were trying to "wake up" my uncooperative quad muscles, and they really cranked it up for ten second intervals.  I'm surprised my hair wasn't sticking straight out when they did that!   Looking forward to reading about your progress and healing.

[StuDogg]

I've been getting e-stim at the end of every session, too.  When I'm done, my knee just feels "stronger" than before.

[TPF-PT]

I was able to officially start PT last week.  It is very strange going to my clinic and being treated as a patient.  One of the other directors is acting as my therapist and I am doing my best to stick to the role of patient and not direct the PT sessions myself.  Of course, I do offer suggestions!    What I have learned is, self preservation is a very strong instinct and it is difficult to overcome!  What I am referrring to is trying to move through the adhesions that have formed in my knee.  When my PT does it, I feel the "pop" and then instant relief, but when I try to do it myself, I cannot quite get through the roadblock.  While passive movement is extremely important immediately following surgery, I still have to remember that my surgery was only on 2/12 and the fractures are still healing.  The last thing I want is a hardware failure so we have started a technique called "low load, long duration stretching".  I get into a position on the side of the table with my left leg (operative side) hanging off the edge while we apply fairly intense ultrasound to the quad in order to heat up the muscle tissue.  This lasts about 10-15 minutes and really seems to make a difference.  That reminds me...the greatest barrier to knee flexion I have is an amazingly tight quad which actually started about 3 years ago.  I was playing rec league softball with a bunch of 22 year olds and had a significant injury to my left quad and separated my left shoulder.  This injury happened during my first at bat of the season which appears to be a trend for me.  I ruptured my left vastus intermedius (one of the quad muscles) and had a grade 2 separation of my left acromioclavicular (shoulder) joint.  I, being the "old man" on the team could not let the youngsters see me quit, so I played the entire season that way!  BIG MISTAKE!  The left quad was extremely tight even before the TPF so now, I am paying for it. 

As far as ESTIM goes...I am a firm believer!  Prior to working in a sports clinic, I was on faculty at a PT school where I taught and worked in a spinal cord injury research lab.  We used estim with ALL of our patients with tremendous success.  These patients had suffered "incomplete" spinal cord injuries so the cord was damaged, but was still capable of carrying signals from the brain.  We would stimulate several muscle groups while the patient was walking on a treadmill that had a harness system to help support their weight.  Almost every one of the patients demonstrated significant increases in the ability to activate and control the muscles.  In my current practice, I use estim with EVERY knee patient in order to reactivate the quad following injury or surgery (which are the same thing).  I have been using it everyday myself.  I set it up to stimulate for 10 seconds and to be off for 15-20 seconds for a total of 10-12 minutes.  I increase the intensity to some point between muscle activation and pain.  If it hurts, it will be counter-productive but you want to get a good, strong muscle contraction.  During the stim, I do either quad sets or straight leg raises (these activate one of the quad muscles since it crosses the knee and the hip joint).  If any of you are using estim in the clinic, see if the PT will let you increase the intensity yourself.  I have found patients typically turn it up a little stronger than the PT since they feel in control.  Make sure you ask the PT if the estim is for muscle activation or for pain control.  If it is being used for pain control, you SHOULD NOT turn it up to the point of contraction, but just to the level of a "good tingle".

I think I may have rambled on enough for this morning.  Good luck to all and have a great day!

Bo

[TPF-PT]

AAAAGH!!!  My ROM stinks!  I can only flex to 85degrees with max effort/discomfort.  Extension is OK though.  I have my 6 week F/U on the 25th.  Hopefully my OS can explain this since I have racked my PT brain in an effort to correct my ROM.

[StuDogg]

I think it took me close to six weeks post-op to reach 90 degrees.  Once I did, I got to 120 very quickly.  I'm still about 10 degrees short of complete flexion.  I think this will improve as the residual swelling goes away.  Remember, some of the limitation is due to your body healing.  No amount of work can speed that up. 

[CRWDDYZ]

Wow...I wish I could have had some ESTIM treatments. They sound amazing.  I had a displaced TPF, cadaver bone, a screw and two pins and a plate installed.   I was NWB for 3 months and 2 weeks, OS told me that would be the case from day 1.  Then I here people going PWB at 6 weeks...amazing.  I here of PT starting soon after surgery....I did not get a CPM machine until 12 days after surgery and PT did not start until 32 days after surgery.  I am 44 years old and in not to bad of shape.

When I finally got to PT my ROM was 97 degrees and I do not recall my extension...maybe 15 degrees.  I was told I was doing very well to be at those numbers starting out in PT.  Everything has went very well, so maybe it was the right progression for me. 

Just keep working it and it will imrpove.  I was amazed out how much PT helped me and I did my exercises 3 times a day at home for the first two months of PT.  After that I went down to once or twice a day.  I am now doing them once a day at home. Most of the PT I am doing at the clinic cannot be done at home as I do not have the equipement I am using there, so I stick with what I can do at home.  4 1/2 months now and all is going well still.

I have a question for you though.....I am walking with no limp if I focus while walking.  I'll still limp if I get lazy or tired, but try not to let that happen.  I have almost no pain.  I attend PT Mon, Weds, Fri.  I usually have pain in my knee following PT and some of the next day, but back to almost no pain by the time I arrive at PT the following day.  Then the pain cycle starts again.  When I get to the weekend with no PT, my knee is feeling excellent.  I feel as though if I was not continuing with PT that my knee would heal and I would ave no pain at all and thus, no limp at all.  My ROM is 130 flexion and 0 extension.  PT is now working on strength building.  Also, most of the PT is now balancing and slight squatting type exercises done on one leg (my injured leg of course) and this causes ankle pain that I do not have on non-PT days.  PT has given me ankle exercises to strengthen my ankle.  My ankle was not injured in the accident.

At times I want to quit PT due to the pain cycle it is causing and see if the pain goes away total.....what is your suggestion/advice ?

Thanks and take care,

Gary

[TPF-PT]

Gary,

I suspect that your ankle exercises are to address stability/proprioceptive deficits that commonly occur after a period of altered gait.  One question about the ankle...is your PT performing any manual therapy on your ankle as well as exercises?  The ankle is an extremely complex joint and it does not take much to make things difficult so if you were my patient, I would be performing manual stretches (glides specifically) in an effort to normalize the kinematics of the joint during gait.  As far as the pain cycle is concerned, I would ask if you could change your program up a bit to see if it changes your pain response.  If so, it would be appropriate to incorporate different exercises into the routine.  Given where you are are in your recovery and the long duration of NWB, I would steer you towards endurance training activities in addition to strength.  Endurance training can be as simple as walking on a treadmill or, if the weather is nice, simply walking at the park.

It sounds as though you are progressing nicely considering your injury.  Keep up the good work!

As far as my situation, I have learned SO much over the past 3 months about recovery.  Since I had never really had a serious injury, the only reference I had was based upon my patient's experiences.  I can honestly say that I have had to work through all of the frustration, pain, depression, pain, loneliness, and did I mention pain that everyone on this board has and these experiences will make me a much better PT. 

Bo

[TPF-PT]

I had my 6 week post op checkup this morning.  Xrays look great and I am released to PWB.  In my conversation with the OS, he asked if I was able to return to work yet and my reply was I will not be allowed to work as long as I have weight restrictions.  He then said 1.5-2 weeks PWB then WBAT so I should be able to return to work in a couple of weeks!  I suppose I would not instill a lot of condfidence to my patients if I was hobbling around on crutches (cane, maybe)!  His advice was continue with the stationary bike as much as possible, get in the pool, and to continue to work ROM (we can be more aggressive). 

By the way, my wife has given me a timeline for my recovery since she has already booked and paid for our next vacation...we are going on a cruise at the end of summer!  I think my knee will be able to handle sitting on deck and drinking margaritas!

Bo

[jd70]

Bo,

Congrats on making it to PWB!  That's great news, and I hope the next 1.5-2 weeks flies by for you.

jd