New ACL with allograft - 1 Dec 2010

[lwillson]

Hi Jen, good to see you back again, and saw on your diary that progress is going well for you too.  Everything at this end is OK, rampantly improved by disappearing man flu which was the cherry on the cake really!

Day 24 and Day 25

Never mind the knee update - HAPPY XMAS EVERYONE    Enjoy yourselves with friends and family at this festive time of year.

[lwillson]

Happy post-Xmas to all, and trust Santa delivered as hoped for...

Day 26

Usual PT over the last few days, and getting back out for 2.5km daily walks once more since the snow and ice is starting to recede at long last.  Would appear that the knee is actually feeling almost "normal" (touching a large piece of wood at this point) - extension is well in the right direction, perhaps just a few degrees off the good side, and being helped strongly by the cooking glove and tins trick; flexion is coming along rapidly as the swelling diminishes - wife had an iPhone for Xmas yesterday so we downloaded the "goniometer" app which measures knee bend - got to approx 140-142 degrees without excessively pushing anything; and walking is as near normal as I could possibly hope for at this stage.

Still need to remember the knee is still weak, and will remain that way for quite sometime - quad strength is poor but there is "some" semblance of tone.

Lastly, my mother-in-law delivered a "gym step" in way of an Xmas present yesterday so this should get lots of use over the coming months 

[lwillson]

Day 27 (nearly the end of week 4!)

Usual PT today.  Get to see the PT on Wednesday and ask for her views on progress and things to focus on.  Was thinking more about my comment yesterday that the knee "feels normal" - think I need to embellish this a bit:
- flexion/extension is broadly there, surgery pain has gone away (occassional niggles), swelling has broadly gone, walking is OK - this aligns to the post-surgery PT protocol which suggests 4-6 weeks to get the surgery hassles out the way.
- the obvious comment is that this only sets up the important but very basic platform for the harder PT to build on in terms of proprioception and strength development.  Readily acknolwedge this will take substantial time, patience, and commitment for the next 8 months to rebuild the balance and muscle depth. 

"Truly normal" is of course a lot further done the road.... yet for now this feels like progress and a nice place to be 
 
And the snow is melting so walking is back on the cards again 

Will revert to less frequenct posts once into the new year as milestones become less frequent and work returns once more.

[lwillson]

Day 28 - end of week 4 

Bit of a long day today - visited my sister, brother-in-law, and 3 month old niece - nearly 200 miles driving in total.  So bit pooped now...  Knee seems OK just does not like being static for quite so long.  Not painful just a little stiff.

PT session in the morning and evening today so managed to get some in.  Must do more though.

Off to see PT tomorrow and see what happens next - suspect it is more of the same!

[lwillson]

Day 29 - into week 5 

Saw PT today.  All quite interesting.  Effectively we have declared the post-surgery recovery as over.  So starting to get into the next phase.

Current PT exercises are:
quads - SLRs/VMO SLRs, inner quad raises (towel under knee), 30kg with both legs on leg press or wall-squats
gluts / hamstrings - bridging and face down leg raises
calves - stand up and down on top toes
hyperextension - calf stretches off the stairs, hamstring stretches, and cooking glove with tins
static cycling (yay!!!!) - 5-10 mins per session
balance - wobble cushion

3 times a day is the minimum, four is better.

When possible, go walking to help movement and quad activity – currently hitting 2-4 km per day depending on route. 

Had a chat about milestones for 2011 and the longer term.  Key things emerged:
- formalised gym arrangements likely to kick in somewhere around the 8 week mark
- 3-4 months out – offshore yacht sailing (since balance/proprioception is poor in the interim, and “unplanned” swimming is risky)
- 4-5 months out – proper road cycling (strength is poor at the moment)
- 6 months out – light hiking (easy-ish hill walks with the wife)
- 9 months out - breast-stroke / flipper based snorkelling, hard hill hiking (Lake District fells and beyond), and snow-shoeing/skiing (yay!!!)

So, a first draft of the rehab milestones are (1) spring/summer - walks in the valleys, cross-channel crossing on a yacht, and cycling (2) autumn hikes over the Scafell range in the Lakes with suitably-minded friends, and (3) cross-country skiing and snowshoeing in early 2012 with the wife and friends.  Perfect.  Very happy now.

There is a life-long requirement for ongoing knee strengthening exercise until the end (long term thinking I know) – simply a need to ensure super-strong hip & leg muscles ab nauseum.  Implication is that I can’t just go on a random hiking week/weekend and expect all to be well.  So, this lays down some fundamental motivation for ongoing regular weekly exercise which is a really good thing. Perhaps shapes an emerging justification for specific gym items to be acquired for home use.

Back to the cooking glove / knee hanging trick now…

[chrisduffa]

some great progress there! I just downloaded the same iPhone app and got a score of 125* - still a ways to go, and you're a few days behind me too!

The more regular therapy you're doing sounds good - a few weeks between visits doesn't seem right to me over here so I'll bring it up with my surgeon next week and get a firm opinion on how often.

I feel like my surgery recovery is over too - all the official assessments to come next week!

Keep up the good work over there 

[lwillson]

Hi Chris - sounds like you are making good progress too.  The hamstring graft is probably contributing to your swelling which will go with time.  The goniometer app is quite good fun!  I was wondering where all the ACLers had got to recently, must be the Xmas break.  Fingers crossed for your assessments - you are probably your best judge and if you are feeling better, then that's probably the best place to be.  Sounds like your physio is perhaps a little too infrequent - my PT said patients can go without a visit for several weeks, but she really focuses on technique which she says can readily lapse since the issue is in the detail of exactly how an SLR is done (for example), not just "I have done 30 SLRs today" - and that needs frequent PT visits!

Day 30
Extended PT today based on amended regime.  Knee has swollen up a teeny weeny bit - thought it felt a bit stiiff.  Cycling (oddly) may have triggered it since 60rpm for 10mins equals 300 heel slides per leg, which may have come as a shock to the poor knee    Will keep persisting. 

[lwillson]

HAPPY NEW YEAR everyone!!!

Day 31 - end of Month One   

Wow, one month down (only 8 to go...).  Everything moving along nicely in the knee department.  Minor niggle/ache on outer tibial plateau today, perhaps owing to slight increase in PT demands.  PT confirmed this is normal, and just keep an eye on things.  Otherwise usual PT including short static bike ride and 2.5km walk this morning.  Walking feels 99% normal and balanced, really struggling to pick on differences between good and repaired leg - cycling and substantial walking practice appear to be the solution here.

Off to the parents for NYE (Dad's birthday today) - he had hip replacement surgery 6 weeks ago so we are off to compare notes, no doubt much to the ladies' boredom...  100 mile drive each way today and tomorrow, should be OK.

And ready for work to start again next Tuesday 4th Jan - after several weeks, the "extended holiday" is finally coming to a close and reality is getting closer 

[lwillson]

Month 2, end of Week 5

Well, back to work tomorrow, arghhhhhh.  The five week (actually five weeks and 4 days) extended break is now over - off out for a curry this evening to commiserate    Longest unintentional career break since I was 21 years old...

Final holiday PT culminated in a 9km walk through the woods this afternoon.  A little tired but no particular ache and pain as a consequence, so must be on the way back to normality. 

Need to have a chat with the PT on Thursday to check (1) lifting the spare leg off a pedal bike when you get off (no sure how awkward the twist is), and (2) the ability to dinghy sail in the spring / summer, since there is a fair amount of twisting when moving from one side of the boat to the other.  Views welcomed.

[pinotlover]

Hi!!!! Happy new year!

Well today was my first day back to work (teaching) got to say knee wasnt quite ready for the demands of being on it all day, swollen and now aching like mad! Hope your day was better!

Jen

[hibiscus_tea]

Hi Lawrence!

Happy New Year!! How was your first day back at work??

When I first started using the bike, I needed a step to get on and to get off the bike.  It helped with the awkwardness.  Now that I'm used to it, I don't need it.  Your legs seem pretty strong, though, so you'll probably be fine without it.  Specifically, I get on standing to the left side of the bike (my left knee is the bad one), lift my right leg, swing it over the bike and put it on the right pedal (the pedal is at the bottom position), balance myself, and then get my bum on the seat, and finally get my left foot on the pedal. When I get off the bike, I get off on the right side of the bike (opposite of the way I got on).  I put the right pedal to the bottom position and step off with my right leg. I balance on the right leg and swing my left leg over the bike. 

I wish I could walk and feel "normal" too!!! Working on it! 

-Tea

[chrisduffa]

Happy new year all

Glad to hear you're doing so well Lawrence - the work thing does suck but I found it's a good baseline comparison. Getting back to a pre-op routine gives you a chance to really compare how things are holding up - my first day back was a few weeks ago and I felt very tired being on my feet.

Also, great that you're almost walking normally! I have good and bad days with that, at the most I have a very slight limp though, and that tends to disappear directly after exercise. I've just been given the ok to start cycling, and am aiming for a 6am session at the gym tomorrow. Wish me luck for that 

[lwillson]

Hi Tea - thanks for the advice - turns out you go the other way to me, with the duff leg on the stand and staying still-ish and the good leg doing the up and over bit.  Only a knee geek could possibly describe this exercise to someone else, and for the other party to exactly understand what you are saying    I will check with physio and report back - just not quite sure about a half bent knee hanging around in mid air in some weird half-cocked position, albeit only for a few seconds.

Hi Pinotlover - good to see you back on the posting board again - you have a much tougher assignment than me, having to both stand up and manage pupils all day long.  I find myself in an office, albeit standing next to a flipchart for much of the day, and it is certainly noticeable.  More below.

And hi Chrisduffa - know what you mean when everything seems to be a little easier after the exercise - seems like it helps the joints and muscles really wake up and gain a bit more control, as opposed to letting the bone and ligaments take the strain (with whatever arthritic mess going on as well!).

Into week 6 (lost count of days)

Well, two days of work later…how’s it going….two long days (8am-8pm), with 90 mins of commute time in train sat down / underground standing up etc etc.  Have found knee gets a quite achy around the back of the knee (cycling helps to shake this out), and hyper-extension has gone back down to around 0 degrees, probably owing to ache / swell at rear of knee.  Noticeable that muscles get a bit bored and turn off, leaving knee joint to pick me up out of seats etc which creates a few ouchy moments.  In general, swelling is probably up a little bit, not enormous but certainly a little puffier than before.  Probably need to work out a way to keep moving about in the day, try and put leg up a bit, and lots of RICE in the evening.  Needless to say, every extra week that goes by will help anyway as the knee continues to get over surgery issues.  Will keep an eye on things and report back in due course.

Mildly miffed this week that a surprise trip up north means I have deferred physio into next week.  Bit annoying but cannot do much about it.

[lwillson]

End of Week 6
Wow, seems like surgery was only yesterday but now well over a month ago.  Certainly not complaining....

Anyway, knee is doing really well - had a bit of a struggle mid week with the first few days back at work and too many hours stuck in the train.  Next week I am back to driving again, and more in control of my own diary, so will be able to get back and see the PT tomorrow.  In many ways, the last few days feel like a certainly normality has returned to the knee - not really thinking about which side is strong and weak, and quietly getting on with life - the last few basic things where sometimes I think about the knee is getting in and out of the car (the motion is not quite fluid and natural yet), and getting on a pedal bike.  Went up and down a ladder today to relace a security bulb, and an 8km walk through the woods, and everything felt quite even - knee's a little achy this evening so usual PT exercises required, followed by a small glass of red 

Am seeing PT tomorrow, so fuller update in due course.

Trust all is well out there.

[lwillson]

somewhere towards the end of week 6....

had a really good knee week... everything working ok and knee certainly feeling stronger and more stable. have three flights of stairs at work and they are proving little problem, that said, 6 weeks of doing nothing has knackered my fitness and leaving me somewhat puffed at the top... more practice required.

pt is happy with progress. additional exercises this week are clam shells, deeper wall squats, longer cycling c15mins now.  accidentally did 30 mins earlier in the week and all is well.

now the proud owner of an ipad so getting used to a new way of surfing and getting into facebook more now