The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: michellec on November 09, 2008, 10:31:54 AM

Title: Timing of Rehab exercises - worried I am behind!
Post by: michellec on November 09, 2008, 10:31:54 AM

I am almost 4 weeks post ACL reconstruction using patella graft and have been having some discussions on the bulletin board.  I have now read all of the rehab stuff on the information board and its made me really worried as it seems like I'm really behind in terms of what exercises I am doing.  It doesnt give any guidance about how long each phase is, e.g. I was only in bed one day, have been back doing household chores and hobbling around after two small children for a couple of weeks but on crutches, now manage with one crutch but to do a lot of these exercises it looks like you have to be walking and able to put full weight through bad leg.  I am going to try stationary bike today- just tried and this is impossible because my knee wont bend enough!

At the moment, following my physio's advice, I am just concentrating on extensions, bending knee, straight leg lifts and pushing exercises on hamstrings and quads, patella movements, very gentle stuff.  I cant imagine possible being able to do many of the exercises shown in the early stages on the information I suppose my basic question is what stage am I at?

Any thoughts appreciated

Thanks, Michelle
Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: tanyap on November 10, 2008, 08:41:44 PM
Hi Michelle,
Stop worrying, we all heal at different rates and recovery is dependant on many factors, how much good strong muscle you had before your surgery, how quick your body heals, how invasive the surgery was (did other areas take a battering etc....).
The worst thing you can do is check your progress against 'general' statistics - you only drive yourself mad doing it!!!
If I were you Id make a little diary of things you can and cant do and every week or two weeks go back and update it, that way you will see your progress and notice more and more how much improvement you make. Im sure youre doing fine. Only 4 weeks out of surgery is very very early days. So dont worry!
Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: michellec on November 10, 2008, 10:37:05 PM
Hi Tanya,

Thanks for taking the trouble to reply with your encouraging comments.  I went to the consultant for a check up today and he is completely happy.  In fact my knee had swollen up again yesterday and he said this is a sign that I am doing too much and to rest and ice it again so at least I dont feel I have to worry so much about doing lots of exercises.  The trouble is that I am on my feet a lot of the day anyway due to young children so I am probably doing a lot on knee without it being the specific exercises.

I'm anxious to be doing the right thing because I really want to be able to ski a bit next April but everyone seems to think this is a tall order.

Anyway, thanks again and hope your knee is not causing too many problems

Kind Regards, Michelle
Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: tanyap on November 11, 2008, 09:35:10 AM
Hi Michelle,
Im so glad your consultant was able to put your mind at ease for you. You are absolutely right, just being on your feet a lot will be working your knee out to some degree - even besides doing the specific stuff. Its important to get the balance right, you want to be doing enough on it so that it continues to heal and strengthen but not so much that you hurt yourself and put recovery back by causing pain and inflammation!!! A tricky balance but you will find a happy medium I am sure.

Work towards April anyway and if you can ski - fantastic, and if not, well there will be other ski trips to look forward to right?
Its a good number of months off, even if you are not quite at skiing level you will be dealing with a completely different leg by then!!

I wish you all the best with your recovery, if you have any questions do post them on this site and someone will be able to help I am sure.
Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: michellec on November 11, 2008, 01:53:04 PM
Hi again Tanya,

Thanks for replying.  I'm just back from physio and although he said I'm on track, he seems to be implying that I should be pushing the pain barrier more, taking painkillers and working now on bending my knee to 110 degrees.  I'm feeling a bit despondent because it really hurts quite a lot to do this and I'm just worried about damaging the knee again but physio says I just doesnt seem right to be pushing through the warning sign of pain and numbing it by taking painkillers especially when the consultant has said to let nature take its course.

To be quite honest, I'm really upset today, partly because of the frustration of being housebound, reliant on other people and on my own most of the time with small children and just wish there were very specific things I should be doing, how long, how often etc.  I really want to ski this year because my little boy just started learning last year and was hoping I could ski with him this year.  We've already booked the holiday as its our big main holiday every year so I think it is also upsetting me that most people are not very positive about me skiing.

But I did manage to hobble around Tescos and carry a basket on one crutch so that's a major achievement for today!

Many Thanks again

Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: clarky_vl on November 11, 2008, 07:22:46 PM
Hi Michelle
Sorry you are feeling down about it all. I honestly think it sounds like you are doing great, your surgeon even said so! And yes, sometimes you do need to push on with it all, even if it is uncomfortable, but you are the best judge of how far you can push your knee. If you do too much, you may get swelling, pain etc,and this could put you back a bit, so if your knee is swelling up and very painful i think you may be doing a little too much? It sounds like you are doing loads on the knee anyway, and you are really getting in to the rehab well!

I really hope the flexion comes soon, and you are feeling happier about this all soon!

About the skiing trip too, as i said on your other thread, its a long time until then, and you have a lot of recovering to do, but lots of people manage it, and you sound as dedicated to getting your knee sorted as any of them, but you will know nearer the time how much you will be able to do! Its definitely possible  :)

lol, I hope you had a good time at Tescos, my first supermarket trip was to Morrisons!  ;D

Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: michellec on November 11, 2008, 09:26:57 PM
Hi Vicky,

Thanks for your message, it really makes me feel better to get some encouragement.  Actually feel a bit better this evening, I found that if I do the exercises myself a bit more gently but still feeling a bit of pain it was ok (the physio obviously must have forced a lot more than I had tried myself and in a different position also, I wouldnt say it was uncomfortable but quite sharp pain) and the swelling has subsided again as I've kept resting and icing today as well.

I also took a couple of steps (by mistake!) without crutches and it was fine - I'd done it before I realised I wasnt holding a crutch and really surprised myself.

Vicky what do you think about braces - I dont really want one, I would rather work more on the muscles but physio is suggesting I get one soon to give me confidence in the knee (but I think I will be even less confident when I have to take it off..)  Am happy to wear one for ski-ing but just for walking it seems like a bit of a backward step.....not sure what others think.

What is the situation with your knee? Are you also getting over an operation?

Yes today Tescos, tomorrow a walk to the post office!

Thanks again, Michelle

Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: miss_sporty on November 11, 2008, 10:37:38 PM
firstly congratulations on the supermarket trip, feels so good to get out even for a bit doesnt it!! ;D my first trip out was also to tesco! oh and on the crutch-less walking, its a nice surprise when that happens isnt it! :)

about the brace, i never had one post op, A + E tried to give me one before the sugery (ACL like you but hamstring graft) and i didnt want it because i didnt think it was appropriate for me at the particular time. if the physio is suggesting it and the surgeon agrees then its probably best to follow what they say, but i didnt want a brace for the same reasons that you gave, so im not sure iv been much help in trying to help you decide!

and about the exercises, how often are you having physio? i only had it once every two weeks in the beginning so it was hard to move onto new exercises without seeing the physio. as long as your physio and surgeon are happy with you then i would go by that, try not to compare yourself too much to others it can make it seem worse than it really is. stuff on here is good as a general guide but ultimately each person is very different + each knee is very different so its best just to be advised by the people who actually see your knee and know how you have progressed.
its also important to find the right balance between doing enough and too much, it sounds like you have got alot to be doing with your children so that is good that you can do quite a bit around the house, but if you overdo it then it can lead to increased swelling, pain etc as others have mentioned. i know that this is exactly what i do so i know i need to avoid it, but you sound like you are doing well anyway, and not overdoing it too much :)

hope its all going well (sounds like it is!), keep icing to keep the swelling down and good luck for the rest of the recovery! :)

Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: clarky_vl on November 11, 2008, 10:53:38 PM
Hi Michelle,

so glad you are feeling better now, sounds like you got the physio thing sorted with that more gentle method! oh, and congratulations on your first unaided steps! (even if they were by accident!!)Thats another achievement! :)

About braces, i have never had one, my surgeon doesnt like them, i think he thinks it teaches the muscles not to protect the knee as much because they are relying on the brace or something,whic makes sense, although loads of surgeons do think they are beneficial especially when returning to activities such as your skiing. to be honest i dont think they really matter! i used to use like thick support bandages (pre op), even though i know they didnt really do alot for stability, they made me feel like my knee was stable, and i was more confident, so i can see your physios point with that, but i'm really not sure, there are alot of different oppinions about them!so do you think you will get one in the end?

I have had an ACL reconstruction and 15 weeks ago a revision all on my left knee, so i completely understand what you are going through!!

oooh the post office, hope its a good as Tescos  ;D

Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: michellec on November 12, 2008, 09:40:36 AM
Hi Vicky and Megan,

Thanks for your great advice re braces, I think I will wait a while, ask my consultant who I see in a months time (and to be honest he really has a great reputation for my surgery) and ask physio if I could hold off and perhaps just wear for ski-ing if I dont feel confident enough.  Perhaps I might just try a knee support.

I am feeling good this morning (children are at nans for day!)  I had quite a bad night as baby was sleeping with me and kept kicking me so I didnt get a very comfortable sleep and woke up really stiff and sore.  But I took 10 minutes to do lots of stretching and exercises on the bed and I got rid of the stiffness so at least I know what I'm doing works.  I'm sure I'm getting past 90 degrees but it seems to depend what position you are in.  I am going to try bike again today because I read somewhere on here that your knee must be at least at 100 degrees to be able to go on bike.  I was thinking of going swimming (I know not breast-stroke) - as I think I could manage some crawl even if I dont use legs much and anyway could do some exercises in water.  I have put on half a stone already so I need to do something!

I am generally seeing physio twice a week but this is mostly using the electrodes and gel stuff with guidance on exercises but not very specific, its a bit like he assumes I know what I should be doing, but then I was surprised yesterday when he bent my knee so far while I was on my back and it hurt so much.  He said I now need to work towards 110 degrees but I dont know where that is.  When I ask how often to do exercises, its little and often but he doesnt define this.  So all in all its hard to make sure I interprete what he wants without specific guidance - I would much rather have a written programme (although I think I might be getting this off him soon when I go into rehab rather than physio as he calls it - which I think means I do a lot more myself..).  I am confident in the physio, especially as he has worked for donkeys years with my consultant.  For me, it just needs more structure at the moment.  Perhaps he is just a bit distracted as he is moving premises this week (which is a nuisance actually as further for me to travel).

I actually also got some words of encouragement from husband last night as well which has made me feel better (our house has been like a war zone!!).  He actually had the exact same surgery with same consultant 12 years ago (and it is still strong and he skis!!) but rehab was quite different then, he was on crutches non-weight bearing for 6 weeks!! (but he had his mum to look after him!)) 

Vicky - how is your knee after revision - is it the same operation as the first time or less complex?  Did you have a patella graft?  So what do they use second time?  It must be so hard to go through again - did you have a drain?

Nice to speak to you both, and thanks again for advice


Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: clarky_vl on November 15, 2008, 12:49:40 AM
how did you get on with the bike? hope you are doing ok!

wow, that really odd about your husband having the same surgery with the same guy, and so long ago, it does sound really diferent from how they do it these days!! :o

i am having some problems with my knee still after the revision, but no one is sure what it is yet. i have a diary in the pot op section which explains everything. the revision procedure was pretty much the same as first time around, except obviously  had to have my old screws removed from the original recon, and i think he redrilled the tunnels. I even had the same hamstring graft, but harvested from the other leg, which was sore, but no drain thankfully!! this time my hamstring graft is alongside a LARS sheath for extra strength.

anyway, hope the recovery is still going great  :)

Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: Kaputt_Knee on November 15, 2008, 08:41:59 AM
Hi Michelle

I finally tracked down the ACL rehab schedule that I spoke about in your other thread - I had the link all the time in another folder DUH!)

Here it is - print it out and show it to your PT as well as have a copy for yourself! I use mine all the time despite having two brilliant PTs working on me.

The other one I use is: - but I think you can link directly to it on the side of the page now (big blue button on the side of the main page).

I'm definitely looking at skiing this Christmas/New Year all being well but at my pace - I certainly do not want to be avoiding kids in the Flying Snow plough or other out of control objects. I think when you have confidence in your own knee you will be able to have a few easy runs with your son. At Christmas I will be at 5 months so I will be taking it VERY VERY gently, a couple of runs a day maybe anything more will be a bonus. And remember I can pick and choose my weather - I'm not going out in flat light or in bad weather. But I live in the mountains. Don't put yourself under undue stress about the holiday - if it happens it happens if not there's always next year etc! Most important to remember though -YOU WILL SKI AGAIN!

Keep focusing on the positives  - you are doing way better than you think, really!

Title: Re: Timing of Rehab exercises - worried I am behind!
Post by: michellec on November 16, 2008, 05:56:47 PM
Hello Vicky and Sue

Nice to hear from you again. 

It sounds like you've been going through it with your knee Vicky, why did you need the operation doing again?  Did you have a fall or anything?

Thanks for rehab schedule Sue, will definitely take a look.  Really would love to know how you find ski-ing at Christmas.  I too would be happy just to go up and down the nursery slope with little boy! Are you going to wear a brace?

Am still progressing slowly - bit progress since Thursday was being able to manage to rotate fully on the bike and being able to walk around the house with no crutches (but bad limp) - so was feeling really pleased with myself.  Unfortunately I have had a really busy weekend and have been on my feet all the time but not had much time to do cycling or anything much so a bit swollen again so trying to rest and ice this evening.

One little thing worrying me is, it's happened maybe three times now when I try to really stride out and straighten my leg to walk, I get the giving way sensation again - I thought that would go with the reconstruction....any ideas if this is normal?

Take care both