ACL Reconstruction - Hamstring Graft - 1st July

[Cosmicsnuffle]

Hi Zaiem and all,

hope you don't mind if I drop in (Cosmic's Cafe runs just fine in my absence  ) ... just caught up with your thread and want to say "Hi". Love the silky smooth look on the right leg - perhaps it'll be something you continue in the future  .

Tying your feet together in bed probably isn't a good idea - your good leg won't know your bad leg's ROM.... the rotation on on your bad leg shouldn't be a problem - these grafts generally seem to be pretty resilient... I think the pain is general post op/trauma/sleeping in unusual positions for extended periods of time kind of pains.

The brace you have looks very similar to the one I bought from eBay after injury. I couldn't flex or extend - any movement was like bones breaking ... so couldn't sleep. I spent four weeks tying a pillow to the back of my leg at night to try to immobilise it, and then spotted lockable braces on the internet. Nothing quite as posh as a PT fitting though or a private casting at HQ - or stripey boxers.....

A couple of brace related tips I have seen - wear tubi-grip underneath if the straps chafe, and put a pillow between your legs when you sleep to stop the metalwork digging into your other leg!


As for the extension - everything I have read and been told indicates that regaining extension as quickly as possible is very important. I do sympathise with you about the conflicting information...I'm not sure what's worse- that or an absence of information!


Anyway, its late, and if I'm not careful I'm going to turn into a pumpkin.... maybe I'll just find time to see it squedgehog has made another guest appearance in the back garden.

Hope you have a comfy night.... Gdnight all! xx
 

[zaiemk]

Hi Cosmic

Thanks for he advice about the brace and sleeping techniques.

I'm afraid the leg isnt silky smooth any more, the stubbles coming through and its getting itchy.  I can barley bring myself to shave my face, there is no way I would make a permanent move to hairless legs - not sure how you ladies do it.  Ayesha keeps telling me I dont know how lucky I am.

Am regretting not having got my haircut before the op - its a bit overgrown now.

I had a reasonable night - still waking up at least once - the longest I can sleep is 3-4hrs and then the leg is stiff, numb, and painful all at once.  I sit up for a while - pedal the foot up and down and rub my hamstring which is permanently tight and tender.  Then I'm awake at around 6/6.30 for the day.

Lazy days - I have gone through a whole season of Monk dvds this week.  Will try and be a bit more constructive now and do some exercises to work on the substantial mid region and man boobs.

Take care all
Zaiem

[Snowy]

Sorry to hear the Vancouver weather didn't cooperate for you last time you were here - it's such a glorious city when the weather's good but when it rains, it really rains! I wouldn't want to live anywhere else, though - I absolutely love being able to live in a big city, but have the mountains, ocean and forest all right at my doorstep. Are you in the UK? I used to find the flight brutal on my own, so kudos to you for doing it with two small kids!

That's certainly one heck of a contraption you have fitted to your leg there! That looks like a specific post-op immobility brace - my Paradigm can also be locked if needed, but it's much smaller and lighter (http://is.gd/dk8EH) as it's designed for sport use. I won't be in a brace immediately after surgery, however; my OS doesn't use them.

I didn't sleep too good last night either, but that was nerves - this time tomorrow I will be in the operating theatre! 

[zaiemk]

POST OP +9 DAYS

Swelling has decreased by about 50% - some of the bruising has decreased near the graft site.  Increased darker bruising at the inside of the knee.  Sleeping a bit better past two nights.  Hamstring still very painful and tight.  Still taking paracetamol and ibuprofen regularly - especially late at night.

I am hobbling about small distances without crutches and feeling quite stable - putting weight through the leg.

I do my exercises in the morning, ice for a while, attach the brace - use crutches to get up and down stairs.  Been moving around a bit more since day 7.  Extension at 0o and flex at about 85o.  Still some discomfort and pain - the more active, the more discomfort and pain.  When the knees had enough I retire for the day - remove the brace and ice - using tubi grip for compression.

Doing the extension, flex, and stretching exercises.  Started to use teh dense foam roller to relax the hamstring - thinking of applying heat to the hamstring - any thoughts?

Take care all
Zaiem

[tez27]

Hiya Zaiemk
Glad things are progressing nicely for you, I think you seem to be listenin to you body and doing whats best for you which is really good as I assume it would be east to over do it in the first couple of weeks.
I am pretty sure Deepak used heat on the hamstring and really felt it helped, so I wouldnt think it would do any harm and if it helps with the pain and discomfort then thats good.
Take care and enjoy the world cup finale tonight
Tez

[zaiemk]

Hi Tez

Thanks for that - I'll give it some heat tonight and get on the roller to release some tension.

Last week - countdown begins properly - have you got your list organised?

I found the last week difficult - couldnt concentrate at work - had a massive list of jobs to hand over at work - but I didnt get half way through - not really a problem as there is no one to really hand them over to - it'll all be waiting for me when I get back.  I was a bag of nerves on the inside - really wanted the op, worried something may happen and it would get cancelled again, and then worried about GA if was going to happen.

In the end nothing to get so worried about - for the staff and OS its just a routine procedure and they do about 3 a day.

Take care
Zaiem

[Lottiefox]

Hello!!

Just wandered over from Cosmic's cafe and Snowy's chill out lounge to say Hi and that I hope the recovery keeps progressing! Looks like you are making good progress, thats an impressive brace you have there and good news on the full extension. I can't purport to know much about ACLr but I can say I share the fear of impending surgery what with my foot op looming this week - eeeeeeeeeeeeeeeeeeeeeeeeeeek. 

I would say to be a little bit careful with heat too near to any swelling - heat can mean that blood flow increases and you don't want that with a swollen limb. Hjence why we're always told to ice ice baby. The foam rolling will have a comparable effect without the increased temperature as it will enhance the blood movements around and loosen up the knots. I'm a big fan! can you manage to foam roll your glutes too? They always help my knee sensations - you can find a spot that is usually just ouchieeeeeeeeeeee!

Take care!

Lottie 

[tez27]

Zaiemk
Listen to Lottie about the heat as she has reserched so much more than me and I would hate to cause you more swelling cos I thought that heat might help there is so much conflicting information out there I find it hard to keep up
I am starting to get a little jittery about next week but I should have a really busy week at work as a lot of my clients want appointments before I go off so with any luck I shouldnt have any time to think about the op. to be honest the surgery is not as stressful to me as the time at home with no work and no driving etc. How long are you planning on being off work for?
Take care Tez

[Snowy]

Sounds like I should get hold of a foam roller or two.

Very interested to hear your overall progress at nine days - so much of what you're doing seems impossible from my seat on the couch here on day two!

How are the kids handling your recovery and temporarily reduced mobility?

[zaiemk]

Hi all

Lottie - I know what you mean about the glutes on the roller - my pre-op issues were mainly to do with my lower back, upper hamstring, and hip flexors on the right side.  It really shoots down the leg when you get the piriforimis and sciatic area isolated.

Tez - I have a six week sick note and did tell work that I may be off for upto six weeks - I told my immediate manager that if things go weel I may come back sooner.

Snowy - Dont worry its early days for you yet - I was at the same point as you in my recovery at about +2-4 days.
The kids are coping - Saleem (youngest) loves jumping on my back and is having withdrawal symptoms at the moment.  The older two are just happy I'm always at home now, Ahmed keeps giving me loads of sugar - hugs and kisses.  They finish school in two weeks and I should still be home then.

POST OP + 11 DAYS

Sleeping last couple of nights has been off - as soon as I lie down my leg starts to feel really uncomfortable. 

Getting full extension and flex past 90o, but its hard to hold and stressful on graft sites. Did some small balancing attempts on the leg today and it felt OK.  Hobbling about a bit better and trying to correct gait/posture.   Using the one crutch as I just use it for reassurance and getting up and down the stairs rather than full weight bearing through crutches.  So no stress on shoulder.  Regular ice ongoing - I've eased back on the meds (NSAIDS), but due to increased activity my leg is achey at the end of the day - so back on the meds.

The staples at the thigh (graft and harvest site) are really tight with a lot of redness around where the skin is pulling tight.  I go to the clinic on Thursday (15th) to have them clipped out - hoping fro some feedback on what the clinical perspective is on the incision sites and how far I push with the flex.

PT appt came through from local NHS PT dept - 28th July - thats nearly four weeks post op - and its only for a PT assessment.  I am really annoyed - the local PT dept does have a bad rep and my experience when I was initially diagnosed with ACL rupture was that they were willing to do as little as possible.  I will keep the appt but have lifted a few ACLR rehab protocols from a few websites and will use those to increase my range of exercises from week 2 (15th July) - even if it means going to the local gym.

Also got the OS follow up appt - 20th Aug - just over 7 weeks post op.  If everything is going OK - not so bothered about this one.  Also, can get in earlier if I feel I need it by calling the hospital/OS.  I would do my PT at this hospital, but its an 80 mile round trip.

Take care all
Zaiem

[ouch09]

Zaiem,

Great to hear that you're making progress, but surprised that your first physio appointment will be so late after your op. I also had the urge to start my rehab at my local gym on my own, but was warned against this by my physio last week. Maybe you could call your physio dept & request an earlier appointment - saying you're willing to take a cancellation is a good trick  If this doesn't work, I would make a one-off appointment with a private physio - check that the physio is trained to deal with ACL rehab first, since not all physios are.

Are you still using your brace ? Do you find it slips down - I do, which is very annoying 

I applied & continue to apply heat to my achilles tendon, which is NOT hot to begin with. The advice given by my physio last week is :

1. Apply ice to swelling
2. Apply heat to a tight muscle or tendon to loosen it up. Heat as Lottiefox says increases blood flow.

I believe for your hamstring, you want to decrease blood flow (swelling). I apply ice to my hamstring, but only for a few minutes, given the problems I caused by applying ice to my calf.

Good luck for your appointment on the 15th & let us know how it goes.

cheers,

Deepak

[Snowy]

That does sound like a really long time out for the PT appointment. I would echo Deepak's advice about getting a one-off appointment with a private physic and at least getting a few sets of exercises and a protocol for what you should be doing over the next 4 weeks. There are plenty of simple exercises that you can work on by yourself to ensure that you keep making progress.

I hear you on the issues with the staples - even at 3 days post-op I'm finding that they restrict my efforts to bend the leg and push down into extension. I'll also be curious to hear how you find the removal on the 15th, as I've heard that it's not very pleasant in comparison to removing stitches.

[zaiemk]

POST OP 2WEEKS

Hi All

Had the staples/clips cut out today - I am a bit of a wimp when it comes to this sort of thing.  I spent the time that the nurse was cutting them out gritting my teeth and with my hands on my eyes.  Most of it wasnt that bad, but the really tight ones (15) on the thigh were 'uncomfortable'.  Its an odd feeliing - the staples pinch the skin together so when they use the snippers it feels like a pinch and then a release.  If they are a bit more embedded its like a needle being removed.  Its all on the surface so its not too bad --like I said, bit of a wimp.  Some bleeding at the thigh so the nurse applied some dressing to that incision - the bleeding was from the staple being removed rather than the incision.

I've been moving around the house without crutches for the past two days.  Even attempted the stairs with a 'normal' climb and descent yesterday - not a good idea - felt the strain at the graft sites - especially up the side of the thigh.

I'm not using my brace very much - it rubs at the incision on the thigh.  It does make me feel a lot more stable and there is less chance of me doing something stupid - which is a regular occurrence.  I just feel its inhibiting natural movement.

Exercising regularly - ankle pumps, passive flexing of quads with straight leg, SLRs, seated leg raises, heel slides, and extension.  Also doing some simple balancing and calf raises.  Getting extension to 0o but it takes some effort, flex is at about 105-110o - again with effort and strain at graft sites.  Also done a bit a patellar mobilisation.

Ice-ing regularly - swelling is down to about 15-20% - I can see the shape of my knee now, make out the patellar. Bruising has decreased - still some small bits left at the inside of the knee - harvest site - and low down on the calf/shin.

After my clinic appt, I went for a haircut and decided to walk home, with the aid of one crutch.  I live on a hill so I chose the path of least resistance.  It was a 20 min walk and i noticed how much I was relying on my hips to move my leg.  When I tried to correct my gait without the use of the crutch it was hard work and at full extension a bit strained - esp going up hill.  Needless to say I was a bit knackered when I got home - calf was very tight and ankle a bit tender.

I feel things are going OK and will keep up the exercises, and possibly add a few more basics before my PT appt on 28th July.  I have also been doing some stomach exercises - crunch and leg raises - as when I was ACL deficient for a year I noticed that maintaining a strong core really took the pressure of the knee, and helped with posture.

Take care all
Zaiem

[Snowy]

Thanks for the detailed description of the staples removal. I'm nervous about getting mine removed (they look quite embedded) so it's good to hear that it's manageable. It doesn't sound any worse than getting the IV line put in at the hospital, which I found fine. I tend to be fairly hard-headed about pain, but given what I've been through since surgery I'm feeling a bit more wimpy than usual at the moment - I feel like I've been through enough!

20 minute walk - awesome! I'm not surprised you were tired but a great sign that you were able to manage going that far. It sounds like all is progressing well, and I'm happy to hear of your progress given that you're only a week ahead of me. I have to admit I feel a long way from doing all the stuff that you're doing.

When did you notice the swelling begin to decrease? Mine isn't showing any visible signs of going down at the moment, in spite of my diligent RICEing.

Take care and hope the good progress continues!

Kay

[zaiemk]

Hi Snowy

Thanks - its taken 14 days post op before I ventured out for a walk - You'll get there in the time you've got.

I noticed the swelling visibly decreasing at about 8/9 days post op - from there it seemed to go down faster.  It does seem to go down the more flexing you do - apparently squeezes out the excess fluid - leaves no room.   I can feel tee swelling of the bursae, which take a bit longer to subside, at least they did when I did the original injury.

You're doing really well with you rehab - I'll catch up with you on your thread - I've not been getting much time on the laptop as two of the kids havent been well this week, missed school, and have been hogging the laptop during the day.

Cheers
Zaiem