Smillie's LPFL reconstruction May 9 '11

[smillie]

I'm working

Thankfully I'm seeing progress in the quads and in cardio endurance. Slow, but it's there.

[Rknees4]

Smillie,
So glad to hear you are progressing nicely.
Hang tough girl.
Rk4

[Driden]

Progress report, please?

[smillie]

I'm still progressing. I'm strengthening my quads, it's just slow going. I've got some kind of nagging twinge thing going on where the IT band was taken for the graft when I've been walking for a while. I have some irritation due to the quad weakness. And I still have problems with pain when I'm trying to sleep at night.

    BUT

Last week I ran a VBS program at our church and was on my feet working hard all day long for about a ten days straight. If I can do that, I think I'm doing great! And I can ride the stationary bike without even thinking about it. So I think things are going really well. I just need a magic quad pill!

[tez27]

Smillie I'm so pleased things are going well for you and from the sound of things your getting your busy life back, well done
Take care Tez

[smillie]

Thanks, Tez. It is nice to be getting my life back. :-)  Now if I could just get my nights back. I know you know how that is. I just can't sleep at night without the ambien. I tried again last night and I tossed and turned all night long. It still hurts at night and there is no sleeping through it.

[smillie]

A small update...

I finally got to swim today and my flutter kick is painful due to the weak quads, but I could do the breast stroke kick without any pain at all. I haven't been able to do that kick without popping/sliding/pain in years. I loved how it felt!

It's super easy to over-do the quads exercises, especially since I'm very impatient and want to speed up this strengthening, but I pay for it with extra pain/swelling if I do too much. For example, I added in some extra sets of quad sets yesterday and had a terrible night.

The knee is doing great on the bike, though, as long as I don't up the resistance too much. The tracking issues in my "good" knee are becoming more and more evident, though, so I'm trying to walk a fine line there. I really don't want to have to do anything with that one if I can avoid it. Maybe I'm in denial, but it has held up for me for so long.

All in all things are really good. I just have to be patient and pace myself.

[smillie]

Observations from PT today... (I'm still riding the bike, but I'm also working with a PT to try to get my quads back in shape.)

I can walk, ride the bike, do heel slides, cannonballs, quad sets, straight leg raises, standing hip exercises, hamstring curls (I guess that is what you would call it), the Nu-Step machine which is like a seated version of a stair climber, and probably a few other things I can't think of. All of these things I can do with little or no pain and am progressing in strength. However, when I try to do the short arc and long arc quad exercises, it is painful after the first 10 or 15 degrees of movement. I can DO the exercise and can extend to almost completely straight, but it hurts and my knee will get really irritated. I think if you were going to put these in a category you could say that anything that involves kicking out my foot when my foot is in the air/unsupported is a problem. But if my foot is on the floor, mat, pedal, etc. I can extend, flex, slide, push, whatever. My PT is stumped and I don't know what to tell him. When I'm hooked up to the e-stim I can do it much better and I don't feel the pain--but I don't know if that is because it isn't there or the stimulation coming through the 4 pads just keeps me from feeling it. I do still get the irritation afterwords whether we use the stim or not. We've been working on this for several weeks it has not gotten better and could actually be worse. It doesn't seem to be a tracking thing. I've always had such a strange reaction to PT every time I've gone, I guess I'm not surprised, but I did think it was interesting today when my PT expressed concern and confusion.

In other news, the pain over on the IT band has stopped. I still get some tenderness over there, but it isn't stabbing me while I walk.

[drmark]

However, when I try to do the short arc and long arc quad exercises, it is painful after the first 10 or 15 degrees of movement. I can DO the exercise and can extend to almost completely straight, but it hurts and my knee will get really irritated. I think if you were going to put these in a category you could say that anything that involves kicking out my foot when my foot is in the air/unsupported is a problem. But if my foot is on the floor, mat, pedal, etc. I can extend, flex, slide, push, whatever. My PT is stumped and I don't know what to tell him.   

Google closed and open chained quad exercises. People with patellofemoral problems should avoid open chained quad exercises. Those are the ones you're describing that are causing all the discomfort.

[Lottiefox]

I get exactly the same pain in open chain exercises such as described (I do have pretty nasty cartilage lesions though but the pain is generalised through my kneecap). It did get better when my quads improved but I still avoid this type of activity if at all possible!!

[smillie]

Good to know! Thanks.

[Rknees4]

That is great to know!
Thanks DR Mark.
Rk4

[smillie]

We have made the changes to my PT routine, more closed chain. some stretching, getting rid of the exercises that irritated my knee. Monday night, I wasn't irritated at all from PT that day. I was able to to a lot more today because I wasn't still feeling like I was recovering from the previous session. It was nice! I feel like we're making some progress. And I've dropped 6 pounds. I would love that number to be bigger, but I think it will get there as I continue to progress. I get a progress report this week and I think I've met the goals. We'll see Friday. I walked up my steps into my house this afternoon. That's new... :-)

[Rknees4]

Smillie,
You go girl.  Stairs are a big test.
Rk4

[smillie]

I'm back from vacation and thought I would make a report. We were participating in the wedding of some very close friends of ours last week which meant a lot of additional events before and after the actual wedding day. We have been planning this for a year now and when we scheduled my surgery, this was definitely in the forefront of my mind.

Before surgery, I could not travel in the car more than an hour away without a significant flare up and major consequences which would last 1-3 weeks afterward. This was a 13 hour car ride away, so we were worried about how I would tolerate the trip. I do still get stiff and sore in the car after a while which necessitated stopping every hour or two to get out and walk around, but nothing like what it was before. AND after we got to our destination, I was no worse for the wear. So I was very happy about that. I was able to participate in everything with no side effects from the travel.

I told our friends that one of my major post-op goals was to be able to "dance at their wedding" and that was accomplished. We had a blast at the reception and I think my family and the bride and groom were even happier than I was. We danced the night away and I think my husband even teared up a time or two.   It was a really great week.

So I feel like a milestone has been reached and I'm so pleased with where I am. I still have work to do--no doubt. But I don't feel like my knee is running (or ruining) my life any more. Many many thanks to Doc and to my sweet husband who has been supporting me through all of this and, of course, to my fellow knee geeks who have been here to cry with me and cheer me on!