sherwooa's ACLr (B-P-B allograft) plus meniscus trim - 28 Oct 2010

[sherwooa]

That's awesome news, steve, about running/jogging.  I'm envious.  When I think about it, other than a couple of short jogs chasing after my dog for a few yards, I haven't run since October 7th.  Very strange indeed.  In fact, a few nights ago, I had a dream that I was sprinting across a field.  Seemed so real to me but when I woke up and realized it was a dream, I was a little bummed.  Served as a nice vision for the future though, LOL.

I hear you on the flexion - I'm close as well, but still a few degrees off my left.  Also, to really get it close, I have to pull it the rest of the way - I can't really get it there without some help yet.  It's functional, but not quite matching.  One day...

Good luck with the leg presses!

[steved]

Don't be too envious. I wont be sprinting or running laps I'm sure. I'm just looking forward to feeling that again. Though i had surgery on Nov. 2nd, I tore my ACL & meniscus on August 28th. It's been WAY too long. haha. You & I are having similar experiences man! I also had a dream that i was zooming down the field at full speed and it also felt SO real. This was about a month ago though. Haha, man it's gonna be great to back to our old "normal" selves again.

[sherwooa]

Too funny about the dreams...we definitely are having similar recoveries.  And I guess the brain-body connection really is strong.

Anyway, brief update from PT tonight - after the usual leg presses, weighted lunges, Biodex, etc., I did some more hopping/jumping.  I did forward box jumps onto a platform - first w/both legs, then on my right (involved) leg.  Then we did lateral box jumps (where you start on the left of the box, jump onto it, then jump off to the right, then jump back on, then back to the left and repeat) w/both legs then the right leg only.  Felt really good, with perhaps a slight twinge of discomfort halfway through the one-legged jumps.  But control and power were right on.

My PT said afterwards that he sees my PT sessions coming to an end soon.  As he put it, "I don't need to watch you do weighted lunges, box jumps and ride my bike here.  You can do that on your own."  That was encouraging to hear, but a little scary to think that soon I won't have a watchful eye looking over my workouts.  He did say he would give me some suggested programming I can follow though.  So, we shall see what happens after my OS appointment next Wednesday when I take my hop test.

I am starting to think that returning to the lacrosse field at the end of March is a distinct possibility...

[steved]

Awesome! I hope you're feeling great by late March. I'm hoping I'm good to go around that time too. Almost there! good to hear about the box jumps. I've only been doing simple box jumps, forward & back. Speaking of your twinge, I finally got around to those leg presses last night. It felt really good at 1st but after about 20 I started feeling some discomfort around my patella tendon area. My PT had told me I might feel some pain there if its too much. I pressed a little less weight and finished my 3rd set. I still had a few more exercises to finish up after that but I did have some discomfort until i got home and iced.

My PT is coming to an end too. I've also got mixed feelings about that. I think my last appointment is scheduled for Feb. 8th unless my PT thinks I need a few more sessions of course.  Though what happened to our poor knees really blows, I'm glad we had our ACLr around the same time. It's cool to have had you & others here to share our SLOW progress and odd experiences.

[sherwooa]

Yeah, the presses can definitely cause a bit of discomfort the first few times you do them, and likely there's some scar tissue still in the patella tendon.  I think that's what's been causing the pulling/tightness in mine too, though it seems to be a lot better this week.  I guess it's just all par for the course.

It really has been nice to go through this with someone else on the same timing, and to share experiences.  It definitely helps to see where you are vs. others and know when to push harder or back off a bit.  I think this will be a continuous learning process for at least a year or more till we figure out how the knee acclimates to all of our old routines, and new ones.

A few minor updates from PT today:
- my PT pushed through on my flexion and got my heel to my butt.  Woo hoo!  Hurt a bit, but was a nice little victory. 
- PT measured the girth of my right quad, and it was within 3cm of my left (45cm vs. 48cm).  It was 34cm (!) when I started PT.  Hard to believe it was that small.  I think I'm actually now back to where it was pre-injury, as my right was always a bit smaller than my left.
- Did some single leg forward hops, and it looks like I was only about 5-6" short of my left leg, but that was after all the leg presses, box jumps, Biodex, etc. so the right leg was pretty tired.  Regardless, I think that works out to about 90% of the left leg, which I think is passing grade on the hop test.  Hopefully it bodes well for next week.

Have a great weekend!

[sherwooa]

Now into week 12, and some more updates before my upcoming visit with my OS on Wednesday:

- ROM measured at 0-150.  No hyperextension yet, but working on it.
- Strength tested on the Biodex - Right (affected) leg ranging between 88%-96% of my left (good) leg on quad and hamstring strength. 
- Began interval walk/jog (5.2 mph) on the treadmill tonight.  Felt a little strange and slightly painful at first (some slight twinges on the medial side inside the knee) but that pretty much went away on the 2nd jogging interval, and then it started to feel pretty normal.  Very strange running for the first time in 3+ months!

PT gave me an evaluation sheet for my OS with the ROM, strength test results and recommendations on it, which basically said he recommends I move on to a Home Exercise Program, sports-specific training, etc.  Looks like I only have another week or two of PT to go...wow.

Hope everyone is feeling well.

[steved]

Awesome news! How long are you allowed to stay on the treadmill? I started some bungie running today! It felt amazing! My Pt was hooked up to this harness with long bungie cords & another harness around my waist. I was told to run out until i felt the resistance and then to run in place. It felt SO damn great!!! Sherwooa, what's your ROM (Flexion) goal? I believe mine is 150 but I'm just short of that. I wish I could see my OS at the 3 month mark too but I have to wait until March 7th that's almost about 4 1/2 month mark. Hope I'm feeling great by then. What kinda exercises are you thinking of taking up now that you can jog/run Sherwooa?

[sherwooa]

Well, the 150 flexion pretty much matched my left leg, so I think it's about where I need it to be.  FYI - flexion was measured on my stomach, with my PT bending both legs for me.  I still would like to get a bit of hyperextension though, and I've been doing some more prone hangs, etc. at home.

As for jogging, the first session we did last night was only 10 minutes total - 5 jogging intervals @5.2 MPH + 5 walking intervals - so I'm just getting started on that.  I'll see what my OS says tomorrow and what the PT says tomorrow night in terms of how much I can ramp up the running.  To be honest, I never ran much for distance pre-injury - I mostly did intervals and sprinting, so I'm not likely to do a lot of running anyway, but I would like to sprint.  I have to see when that's allowed.

As far as new exercises, I am thinking I will probably go back to doing Crossfit but I'm also thinking of doing a few cycles (usually about a month each) of straight lifting to get back to where I was pre-injury in terms of squat, deadlift, cleans and shoulder press weight.  My PT said he will give me some recommendations in terms of training regimes I can follow as well, so I will need to see what he says before I decide on a regular routine.  I've found Crossfit to be very effective in terms of overall fitness, so I will probably go that route and try incorporate some of the ideas from my PT as well.  Before the injury, I did a lot of jump rope, agility ladders, and plyometrics, so I will likely continue that stuff.  I'll know more after tomorrow's appointments.

Glad to hear about your bungee-running and that it felt good.  I haven't tried that one yet but it sounds cool!

[sherwooa]

Today's update:  Saw my OS this morning.  He said I'm progressing well, and after all the build-up, didn't end up needing to do the hop test based on the report from my PT.  He said my strength was coming along nicely and that I could start on the "ACL Running program" (Penn Sports Medicine's rehab protocol).  He said I could take it to PT and show it to my PT and see how he wants to work it in, or follow it exactly as written.  He also agreed that I could taper off the PT, maybe go 1X/week instead of 3X, and do most of this on my own. 

The Running Program basically involves a 9-10 week progression of walking/jogging/agility work/sprints that builds up gradually each week.  I'm supposed to do this on top of my strength work.  What I'll probably do is go down to 1X/week therapy and do much of the rehab on my own.  I will likely follow a basic lifting progression (but I won't go past 90 degrees on my squats for a couple of months) and layer the running program on top of it.

My OS also noticed that I still have a very small amount of swelling, but was unconcerned, and said it will go away over time.  Didn't see any need to drain it.

EDIT: My PT tonight said that I should follow the running program on my own and do the strength and plyo stuff on my own too, and come back in a couple of weeks, not every week.  He said I've progressed far enough that I can do this on my own now.  Given the $35/session co-pay, it probably makes financial sense as well.  He felt confident that I would do fine without coming to PT.  So, my plan now is to follow a lifting program 3-4 days a week (including upper body and plyos), with lighter weights the first 2 months, and follow the running program 4 days per week.

[steved]

Great news! I hear what you're what you're saying about the Co-pay, mine is $40 every visit, it used to be $20.  I've cut it down to 1 visit per week now & doing the rest on my own or at the gym as well. It adds up! Right now I've only been allowed to run in place for 5 minutes max. I still need to work on quad & calves a little bit. How is your running coming along? How is your leg feeling overall? I really don't have any pain but it just feels a little....weird. Ha. Not really bothersome but just a little odd i guess.

 I can't wait to actually start jogging, hoping late this week or next. Tomorrow marks the 3rd month post-op for me. I have another question for you Sherwooa, how does your leg feel coming down stairs? I have no issues climbing them at all but coming down is different. I'm sure it's due to the lack of quad. I can control how i step down with my "good" leg but when i'm bending my "new" knee its a little bit less controlled and more of a drop to the other step. I hope you continue to progress & hope you're feeling awesome these days!

[sherwooa]

Hey steve.  Thanks for checking in.  Was hoping to hear your latest as well.  Glad you're doing well also.  I'm sure the jogging will increase soon.  Yeah, those copays do really add up, and when my doc mentioned how I could be putting that towards a gym membership it kinda hit home.  Not that I need to join a gym since I have a lot of weights at home, but the point was definitely made. 

Like yours, my knee still feels a little weird.  It doesn't hurt really, but still has some stiffness to it after sitting for a while, and gets a little irritated under the kneecap after a hard session.  The little bit of remaining swelling is probably causing most of the strange feelings, at least according to my OS.  I just can't seem to eliminate all the swelling for some reason yet.  I've been taking some more advil around the clock the last few days to see if I can help reduce it.  It doesn't really stop me from doing anything, but I still know it's there.  As for proprioception and control, it's definitely improving, but it's still not quite what my other leg feels like.  I have read that can take 6 months + to really get that back.

The jogging is coming along in small doses.  The program basically calls for intervals - i.e. jog 100 yds, then walk 25 yds and repeat 15 times, etc.  Plus, it adds in some agility work afterwards, i.e. jog 5 yard
circles, 5 yd squares and 5 yd figure-8's in each direction.  I think next week or the week after I start some 1/4 - 1/2 speed short sprints.  Yikes!

As for my needed areas, I still need some more hamstring strength, as that was the one that tested a little weaker than my left leg.  So I'm doing some deadlifts, glute-ham raises, swiss ball ham curls, etc. to keep working on it.

Finally, as for stairs, I've been doing pretty well on the stairs.  Yes I can still tell a little difference in how it "feels" to go up and down stairs, but the stability and strength seem to be there.  This seems to have much to with the VMO and building that up.  If you hit the single leg squats against a wall (holding a swiss ball between your back and the wall) a few times a week you should be in good shape w/the stairs.  My PT guy had me hit those hard.

Keep up the good progress and feel good!  I'll report back in the next week.  Cheers.

[hibiscus_tea]

Wow you guys are jogging!! I'm envious!!!!!
My co-pay is $80, which started this year (because the insurance resets at the beginning of the year...).  I was paying like $5 last year.  What a difference!
My knee feels really strange and I can still see the swelling.  I'm trying not to take anything because I'm still nursing my baby and don't want to give her any meds if I really don't need it... but I want the swelling to go away.  

[sherwooa]

Wow you guys are jogging!! I'm envious!!!!!
My co-pay is $80, which started this year (because the insurance resets at the beginning of the year...).  I was paying like $5 last year.  What a difference!
My knee feels really strange and I can still see the swelling.  I'm trying not to take anything because I'm still nursing my baby and don't want to give her any meds if I really don't need it... but I want the swelling to go away.  

Hey tea - I know the feeling.  this last week after pushing on the jogging program, I've felt a little more swelling.  Not really painful so much but the swelling is annoying.  Though the research says ibuprofen is safe during nursing (my wife's an Ob/Gyn), one thing you can do if you don't want to take lots of ibuprofen is try some fish oil pills.  They are anti-infalammatory w/o the side effects, other than fishy burps, of course :-)

[steved]

My knee's still got a bit of swelling too! It's kinda annoying. I really haven't been icing the last week but I would still have expected it to be gone by now. Crazy to think that it's been 3 months post op and STILL have some swelling. Weird! Normal i guess, but weird. Haha. I'm gonna start taking advil before bed again, at least for a week maybe. My fiance massages my knee with arnica everyother night. Not sure if it REALLY helps but it doesnt hurt to do it anyway.

I'm now hitting up the gym 4 times a week as well but gotta start doing a lil bit more of the strengthening. besides the bungee running and quick ladders stepping in PT, I've only been allowed to run in place on my own. Although it's something i really look forward to as it gives me a small taste of what its like to jog again, it's slightly uncomfortable at times. I get a small amount of pain under my kneecap at times. Almost like the impact when i step down isn't being absorbed well? Does this make any sense? Haha. My PT isn' worried about it so i guess i shouldnt be. Again, it's not everytimes, just SOMETIMES.

AWESOME to hear about your 100 yard jogs. I Can't wait!!!! Maybe next week for me? I hope so! what does your knee feel like during those jogs?

[sherwooa]

Yeah, the swelling is annoying.  I've been icing after exercise sessions, but not otherwise.  I don't know, maybe I should start   That Arnica stuff looks interesting too.  Not sure how it affects swelling, but I've heard it can help with bruising.

The jogging feels pretty good now when I do it, though I know what you're describing with the impact discomfort under the kneecap.  A couple of weeks in now, I don't feel it so much anymore when I jog, but after the week of stepped-up workouts, I do feel a slight stiffness and soreness this morning on the medial side of the meniscus.  Not sure if it's from the partial meniscectomy or what, but I guess it's part of learning what my knee can handle at this point.  I might have to back off a little bit and give it some more time to recover at this stage.