My ACLr - look out hamstring!

[cgkrueger]

I am on Day 11 since my hamstring autograph on 4/13/11 - wish I had found this board sooner. I fractured my tibia and partially tore my ACL when I was 14 (over 20 years ago!) but due to my age they opted to hold off on surgery and send me to PT. This worked well and I've maintained a very active lifestyle - I do a lot of yoga and Pilates, as well as aerial training and various forms of dance. Unfortunately, over the past couple of months it started buckling. I first saw a PT, and asked for strength training to continue to stave off surgery - she sent me to an OS immediately. So much for my big plan. MRI confirmed a complete tear - pieces of my old ACL had scarred and stuck to my PCL, which ironically gave me more stability. But that scar tissue was breaking down, thus the new issues. We scheduled a hamstring autograph for 4/13/11.
Everything so far is going really well - I walking without crutches (in the brace of course!) by Day 4. My follow up appt with the OS went well - my extension is almost completely back and my flexion, while harder, is coming along. I've been icing up a storm and doing absolutely everything they tell me to do. I'm already on the bike with my PT and my mobility is great. Pain is manageable - taking lots of ibuprofen and arnica. But of course I have concerns!
-The incision under my knee where they harvested my hamstring feels like it's going to pop when I do heel slides. And holy cow, heel slides hurt. I figure it's normal - but yikes.
-My muscles are disappearing rapidly and that's a little freaky - they'll come back, right? Sometime before the next milennium?
-I take the Motrin on a full tummy, but it still hurts my stomach. Any ideas of how to improve that? Or is there something else OTC for pain and imflammation that won't hurt?
Glad I found this site and hope you are all having a good night! Thank you so much for your insight.

[cgkrueger]

This morning I did my rehab exercises, and hit a little milestone. Today was the first day I got through my hamstring sets without getting tears in my eyes. I'm not able (nor should I be) to put more than a couple pounds of pressure into it, but more than anything I am excited to have a little progress. My biggest fear in all of this is that it won't get better - which I know isn't reasonable but it's how I feel right now. I just have so long to go - 6 months until I can go back to aerial and dance. It feels like I will never get there, but I know I will - just have to take one day at a time, I suppose!

One thing I have noticed is that the more I move the better I feel - even if it's just ankle rolls and pumps. I don't sit still well, so my favorite part of the day is my 10 minutes on the bike. I can't go very fast...haha. That's okay. I am looking forward to being able to stay on the bike longer once I get clearance from my PT.

[cgkrueger]

Yeah, I think I spoke up too soon about not being swollen. I woke up today really sore and puffy through my calf and ankle. I went to PT and she did some stuff to try to work the swelling back up my leg - it hurt in a nice way. The surgical tape pulled off of the edge of the incision on my outer thigh and that freaked me out a little bit - like it was going to split open. Of course it didn't - it just looks weird to see it without anything on it. It's funny that the swelling is happening now - almost 2 weeks in. Maybe it just comes and goes? Any ideas? If I can avoid it I would love to, of course.

She did approve me to go 15 minutes on the bike, which I did tonight - not that there is a huge difference between 10 and 15, but 15 really wore me out. She also added in some side-stepping exercises to try to build stability - I have to keep my feet pointed straight ahead, which is tough! My feet turn out naturally so I feel all goofy and pigeon toed doing this one. But I can tell that it works.

It's hard to balance "doing everything I can" with not doing too much. I have to keep reminding myself that no matter how much I do, the graft is not going to set any faster. If I could make it happen with sheer will I would, but this whole process is very humbling and a big lesson in patience. I am grateful for how well things are going so far, and very excited to go back to my office tomorrow. I like being around people and it's been lonely being home all day alone.

Hope you are all having good, pain-free days! Thanks for reading.

[Bigman78]

Hey cgkrueger,

Welcome to the Knee Geeks forum! I've found this forum extremely useful also and it has helped keep me motivated especially seeing how people at a similar stage were progressing compared to me. I'm now nearly 7 months post op but still remember the first few weeks VERY well! Believe me it will improve and before you know it you'll look back and think how far you've come. I found setting milestones helped and this will be pretty much done for you by your PT anyway.

The three things I found the toughest initially were:
1) Infection
2) Swelling
3) Muscle atrophy

I was one of the unlucky ones to get a staph infection following my intiialy surgery which really put my early progress back a bit. I had a second op 10 days after my first to flush the infection out and was in hospital for 5 days on an IV drip. Once out I continued with antibiotics for 5 weeks and only after this was I seriuously able to start my rehab! The swelling was a massive concern early on for me. It's just one of those things after a serious op and unfortunately just takes time... I used various techniques as you can read in my blog and eventually got it down (after 3 months or so). you seem to be doing everything right in this regard though. Losing muscle (especially quads & glutes) was a big shock to me and wasn't what I expected! It has taken a lot of hard work and consistency with my rehab to get a lot of it back.

If I was to give anyone advice in the early stages of rehab it would be to do something everyday, do as much bike riding as possible once cleared, continue doing leg raises, side raises etc for the first 3 months at least, ensure you get pleny of rest, whilst resting elevate and ice, walk as much as possible and try to go to the pools once or twice a week.

Good luck with your rehab program and look forward to reading more.

[cgkrueger]

Thanks, Bigman! I appreciate your thoughtful response. Your blog is great - I am enjoying it and have subscribed. I will take all the tips I can get. I probably need to up my game with icing and elevation - I am not doing as good of a job with that now that I am back to work. I turned in my rented cryo-cuff on Monday - it might not be a bad idea to buy one.

I am sorry to hear you got an infection after surgery - I am sure that made your recovery extra tough. The muscle loss is a big shock to me, too - I knew it would happen, but knowing it would happen and seeing it in the mirror so quickly are two different things...haha. It makes me more determined to stay on top of my rehab program - and if that means my coworkers give me funny looks when I lay on the floor by my cube and do leg lifts, screw it.

Thanks again for your response! I am so glad I found this forum - there are so many good tips and experiences to learn from.

[Bigman78]

Thanks cgkrueger! You're are officially the first follower of my blog although I do know of others that follow it unofficially

I'm glad it's of some use and it's exactly the reason I set it up - to help others going through a similiar situation. Icing and elevation is the key during the early stages. In the first 3 months I was icing and elevating on a daily basis and even iced my leg regularly at work (I kept an ice pack in the fridge). In months 4 & 5 post op I was icing semi regularly whilst in the last 2 months I have only iced on the very odd occasion, usually after a run.

The infection was a big set back however I'm very thankful that I've been able to overcome it with patience and hard work once I recovered. Seeing the muscle wastage was a big shock to me also and as you say gave me extra motivation! I'm still highly motivated but when I think back it was ALL about my knee in those first few months!

In terms of doing leg lifts at work I couldn't agree more - do them as often as possible! My physio had me doing 100 a day for quite some time which meant I had to do them near my cubicle at work also and got those funny looks to begin with. Once people at work realised what I was doing the funny looks stopped

No worries and absolutely agree. I picked up so many tips from this forum which have gone a long way to helping me get to where I am today!

[cgkrueger]

Thanks Bigman! I really do like your blog - I am tempted to try the cabbage leaves for the swelling and inflammation! I ordered a used cryo-cuff on eBay and paid extra for expedited shipping - so hoping to have it by the weekend so I can ice it better.

In the meantime, my leg is so freaking HOT! It is roasting. I went to PT today and was a little concerned, but she said that since I have no other signs of infection and feel good, she thought that some anti-inflammation massage would help. It definitely did - I wish she could do it every day. I also got some herbs from my acupuncturist that is supposed to reduce swelling and inflammation - it's called Traumanex. I will let you know how it works - my fingers are crossed!

It helps so much to hear someone like yourself that had such rough early days is doing so well now - I just have to keep at it. Thanks for sharing!

[Bigman78]

No worries and thanks once again!

Using Traumanex sounds like it's worth a try as well as the cabbage! Old traditional methods should never be discounted in my opinion as it can only help recovery. As you probably read on my blog Lectric Soda crystals may be worth a try also. Good luck with it all and hope it helps!

Agree, it's always good to read about someone who's had a positive recovery and I'm glad my example has helped. Looking forward to reading more about your recovery! Take care

[cgkrueger]

3 weeks today since my surgery. Swelling is much improved so I'm much more comfortable. I am doing 15 minutes on the bike each day with some resistance - I do it first thing in the morning to get the kinks out! Also, if I put it off until after work I am sure I will talk myself out of it.
My scars are looking better, but I have funny burning sensations around the large incision in front. I am guessing that is something with the nerves?

PT is going well - I'm still doing all the leg lift variations and heel slides, along with side stepping, calf raises, squats, and hamstring curls. The hammie curls feel so weird. I can't lift my foot very high and my knee just feels so bizarre when I do it. I did get to add bridging into my exercises and that was exciting - it feels really good. That is my new favorite one - I think because I can feel it working and I'm so aware of the atrophy right now. It makes me feel like I'm fighting back a little.

I am going to an aerialist show this weekend to watch my friends perform and am excited to see them, but feeling a little sad that I will be sitting this one out. I am trying to shake it off and remind myself to be patient! Easier said than done, I think.

[cgkrueger]

Okay, I have a question. As usual, when I say I am not swelling or hurting I jinx myself. I am having some pain on the inner side of my knee and it's freaking me out a little bit, because it's just different than what I've had so far and it's pretty painful. Of course, the first place my head goes is that maybe I've ruptured the graft, but logically I don't think I could have done that. I took some Aleve and am icing it - I hope that helps.

If I did something major, I would know it, right? There would probably be more swelling and more severe pain? 

I added some new exercises at PT yesterday on the big exercise ball. I lay on my back, put the ball between my thighs, and lightly squeeze while curling my legs towards my abs. I have an exercise ball at home and went to do that earlier today, and I didn't think about the fact that my ball at home is slightly weighted. That's really the only different thing I've done and it didn't feel quite right with the weight, so I quit. I see my PT and my surgeon next week but that's several days away. I am probably just being paranoid. Imagine that!

[Bigman78]

I've been meaning to write a reply but haven't had a chance as have been very busy lately! I'll have to keep this one brief also....

I can't speak from experience but I'm guessing if you did something major you would definitely know about it. I remember having a little pain on the inner side of my knee in the early stages but I wasn't too concerned as I knew my knee was healing post op. I've seen others mention that exact same pain / discomfort so I wouldn't be too worried but obviously get it checked out from your PT or surgeon when you see them next. Hope it goes well.

And it's good to hear that apart from that you're progressing along nicely in the early stages!

PS the burning sensations are to do with the nerves healing as you said below. Even to this day when I run my hand over the largest incision I get that tingly feeling. Oh and I know exactly what you mean by the hamstring feeling weird when doing curls! That feeling will be around for a few months...

[cgkrueger]

Thanks Bigman - I think I am just paranoid. I saw my OS today and he said that paranoid right now is a good thing - but overall he was happy with my progress! I am cleared to sleep without the brace tonight and my husband is excited that I won't have to sleep on my back and snore.

Extension is good but we don't want it to go any further - I'm just bendy. I'm hyperextended by 3 degrees, and flexion measured at 139 - only 6 degrees to go! So far so good.

My PT had me do squats on a mini-trampoline and my knee quivered like crazy - so I know that will be a good exercise to do right now. I've also been rolling out my hamstring and IT bands on a foam roller - it feels like heaven.

Thanks for the reassurance about the funny hamstring curl feeling - it will just take some getting used to! Hope you are having a good week and still feeling better!

[cgkrueger]

For some reason my incisions have been really bothering me today - especially the hamstring graft site and the larger scope incision. There's a deep, itching sensation under the skin and some burning feelings - I am guessing that's the nerves starting to regrow? I am trying to massage the incisions with cocoa butter but to be honest, massaging the hamstring graft site makes me a little queasy. I'm not the most squeamish person, but for some reason that one is creeping me out. I am going to push through it and if all else fails, make my hubby do it.

I am just counting down until I can get out to yoga or Pilates class - I really miss the cameraderie and just being around people! I am trying to be patient - I thought the surgery itself would be harder but the slow rehab process is tough. Just taking it one day at a time.

[Bigman78]

No worries and good to hear the progress is going along nicely apart form the itching/burning sensations you're experiencing. I think it's a good plan to get your husband to help you with it if you're feeling squeamish I got my wife to help me quite a bit during the early days of rehab and she was a great support.

Wow... doing sqauts on a mini-trampoline already, impressive! I know what you mean in regards to the knee quivering like crazy.... I remember that feeling in the early days! Don't worry, stick to it and it will become much more stable in time. Patience is the key especially during the first few weeks, I can assure you in does get easier. By the end of month 3 you'll feel like you have 'most' of your life back

The early days are the most important as well so stick to it and keep disciplined and you'll get the results you want. BTW how many days post op are you now?

[cgkrueger]

Thanks Bigman! You are always so positive. Hmm....let's see. I am on Day 34 now - tomorrow will be the 5 week mark. 

I didn't quiver as bad on the trampoline today, so she put me on little stairs and that got the quiver going. She also did a bunch of work on the scar tissue - my acupuncturist said to put castor oil on it, so I am going to try that. Between the beeswax, cocoa butter, and castor oil, something will break it down. But I will make my hubby do that for me so I don't get nauseous. What a wimp!

But the big news I wanted to share was that she unlocked my brace to 30 degrees! My hip was kinking up pretty bad, so bending the knee and getting a more normal gait will help. I sound like something from Star Wars when I walk, but I am really excited! 

Thank you for the encouragement - it means a lot. Maybe one day I will get to do crazy agility drills like you do! Haha - not anytime soon!