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Author Topic: Follow Jake’s LOA from start to finish  (Read 52611 times)

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Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #30 on: July 05, 2005, 03:35:51 AM »
Day 11

Routine unchanged but some good news, some mixed news and some disconcerting news

The good news is I improved to 130 on flexion so my ROM is -2 to 130.  Also, it appears that swelling went down and I would now classify it as moderate to minimal.  Also, the problem I had a few days ago with my patella being less mobile first thing in the morning seemed to go away.  Also the thigh pain was slightly less but still significant.

The mixed news is I haven't been able improve on extension the past few days.

The disconcerting news is (isn't there always something to worry about with this damn arthrofibrousis) is that when I wake up in the morning  my knee is warm.  That really scares me because we all the know the warm knee can be a precursor to the damn scar tissue growing back. 

Even worse this morning my knee didn't instantly flop down to flat, i.e. full extension as it has been.  I had to slightly stretch it to get it down.  This was a crude reminder that I am not even close to being out the woods with this damn affliction despite how well things are going so far.

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #31 on: July 05, 2005, 11:23:23 PM »
Day 12

Same routine but with the following changes:

-increased bike from four 30 second sessions to one minute sessions.
-with swelling under control, I reduced anti-inflammatory Ibuprofen from four to the normal three 800 mg pills per day.
-added e-stim to aid in reducing swelling.  Three 20 min sessions per day.

No improvement in extension despite my best effort with prone hangs, pushing down the knee and bracing at night.  I am starting to think -2 is as good as I am going to get.  That is not bad and perfectly functional but not perfect.

Flexion improved to 132.

Patella mobility is excellent and today was the best day yet.

I am walking with no limp, but I still have significant, but lessening quad pain.  I am still minimizing walking to about 4 walks from one end of the house to the other and back.  I won't attempt stairs until day 15.  The quad pain is quite pronounced when I do my quad sets and SLRs.

I am still getting worrisome heat when I wake up in the morning.  Is this expected after any arthroscopy at 12 days post op or is this an insidious sign that the scar tissue is trying to grow back again?  Any insight would be greatly appreciated.

Offline stgiles16

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Re: Follow Jake’s LOA from start to finish
« Reply #32 on: July 05, 2005, 11:52:42 PM »
It is perfectly normal for your recently operated knee to be warmer than the non operated one. I asked my OS because I had the same question post op. I was told that there was an increase in blood flow to aid in healing and that is what makes the knee warmer. Having a "HOT" knee and having a warm knee are different. You need to worry if it is hot and red and inflamed but some warmth is normal.

missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #33 on: July 07, 2005, 12:02:13 AM »
Day 13

Not much change to report today. 

Here is my current routine:

CPM set at -5 to 110 degrees (max) for 2 hours, 4 times a day 600 AM, 1100 AM, 5 PM, 10 PM.  Do PT 4 times 915 AM, 215 PM, 345 PM, 815 PM for 20 minutes in between CPM.  Do Patella Mobilization an additional 2 times at 600 AM and 12 midnight.  When not doing PT or CPM keep knee locked at zero and elevated by lying on mattress on floor with heel on coffee table with pillow.  Sleep from Midnight to 600 AM with leg in Dynasplint extension brace with tension set at 6.  PT consists of passive ROM including Patella Mobilization (5 min), wall slides (5 min), prone hangs (5 min, with 10 lb ankle wt) and extension stretching with heel on book and pushing down on knee, quad sets (1 x 10), straight leg raises (1 x 10) and stationary bike for 1 min).  E-stim for 3 sessions of 20 min.  Use cryo cuff all day for 20 min on and 40 min off.  Take 800 mg Ibuprofen 3 times a day as an and anti-inflammatory.  Walking without crutches but minimizing walking and no stairs.

Offline lefthand50

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Re: Follow Jake’s LOA from start to finish
« Reply #34 on: July 07, 2005, 03:33:49 AM »
Jake - that is freakin' amazing.  Hope things continue to go well along these lines!  Is your CPM actually straighting your knee?  Most of the ones I've seen don't actually move into the extension because there's no weight on the top of the knee to help straighten it...any suggestions would be good to know.
5/04, ACL recon, MCL, PCL sprains.  7/22 MUA.  9/20 LOA w/ MUA.  ROM 20-80 cold.  Steadman surgery July 20.  Follow along at http://bendthatknee.blogspot.com

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #35 on: July 07, 2005, 01:25:27 PM »
The CPM goes to "-5" but it doesn't do anything for extension because as you point out, if your knee is not locked down, and it isn't, it doesn't effectively go to -5.  For extension, you knee to focus on prone hangs, pushing down the knee and bracing.

Yes the routine is amazing, but it is also a huge drag as you can imagine.  I developed it by reading all the literature by the experts and also from practical information from people such a Laurie on this message board.

So far I am very happy overall with the results, but I caution, it is very early and I am very guarded in my optimism.  The insidious nature of this dreaded arthrofibrousis is such that things could fall apart 3-4 weeks from now.  As long as there is any heat and swelling remaining and you have not resumed all normal daily activities, you are not out of the woods.  Bottom line is it really sucks!

Good luck with your surgery with Steadman.

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #36 on: July 08, 2005, 12:38:07 AM »
Day 14

Same routine, except I increased the bike to 2 minutes four times a day.

Quad pain is decreasing.

The bike doesn't feel that good.  No specific pain, but a general uncomfortableness.  Yet another thing to worry about.  I am hoping this is because it is still early post surgery.

No improvement in extension.  I have 2 degrees of hyperextension.  I will continue to work hard for more but I doubt I will ever get to -5 like my good leg.  Maybe I can  get to -3 over the next few weeks.  Of course, I am very happy to have -2 compared to where I was.

Flexion improved to 135.  Those last 10-15 degrees to get full heel to butt flexion are going to be tough to get, but I am determined.  If I get there I sense it will be a matter of weeks, not days to do it.

I got no heat today.  However, I was very diligent about icing 20 min on/ 40 min off with the cryo cuff and even recharged the cuff a couple times in the middle of the night.  If I didn't ice, I am sure I would get significant heat.  But not getting any heat with all the icing was a victory of sorts.

Tomorrow is a big day.  I am going to try navigate stairs in my house once or twice without crutches.  If I don't get pain or an inflammatory reaction, those crutches are history!  I am also going to start walking on the treadmill, focusing on a slow but perfectly normal gait if possible.  I will start with only 30 seconds and watch for an increase in pain or swelling.




Offline Shoomers

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Re: Follow Jake’s LOA from start to finish
« Reply #37 on: July 08, 2005, 01:31:28 AM »
Jake,
WOW!  It is so amazing and inspiring to see someone so dedicated and regimented about his recovery!  I am not all that familiar with arthrofibrousis, but is is horrible to think that it could all change in a few weeks.  I will think positive thoughts for you!
I think I remember reading something about you adding upper body weightlifting in there somewhere?  Doesn't seem like you'd have much time for it, but have you?  I am asking because I am currently very into lifting (freeweights) and am having a LR/TTT on August 2.  I want to do some upper body work shortly after the surgery, so as to lose as little muscle as possible.  I have stepped up my lifting before the surgery and am eating a lot of protein/fruits/veggies (along the lines of the Zone diet) But, wanted to know what the feasibility is of lifting after surgery.  Do you know anything about this?  Could it increase chances of blood clots or infections?  Will it possibly slow my recuperation (fatigue)
Thanks for rany advice and keep inspiring us!  You rock!
Lisa C.
1985-arthroscopy RK plicae removal
1986-arthroscopy LK plicae removal
2001-full dislocation RK
March, 2005 - had to stop running races due to PFS
August 2 L/R and TTT RK

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #38 on: July 08, 2005, 05:58:53 PM »
Hi Lisa,

Yes I am working my upper body regularly.  You can workout your upper body after knee surgery to maintain muscle.  However, there are a few things to keep in mind.  First, your knee is most important so only do it if it doesn't take away from your knee rehab or cause irritation for your knee. 

To meet this goal, you will have to forget the 1-2 hour workouts for a while.  You don't want to be sitting and standing for that long.  You need to be icing with your leg elevated as much as possible every minute you are not doing knee rehab. 

Also, you probably won't be able to do anything until 14 days post op.  I had a miraculous initial recovery from my surgery and started on day 7.

What you have to do is focus on short intense workouts.  These won't weaken your system and take away from your knee surgery recovery.  I am talking maximum intensity to make up for the less volume.  You want to break up your workouts into 1-2 body parts per day and do only one set per exercise to absolute failure and beyond with forced reps or partial reps or cheat reps.  No warm up sets either, go right into it.  Each days workout takes 10 minutes or less so you are right back to icing with your leg elevated quickly.  I have a complete gym in my home.

Here is my routine:  (Remember only one set per exercise to absolute failure and beyond and no warm up)

Day 1 (Biceps, forearms)

incline dumbell curls
sitting dumbell curs
preacher curls
concentration curls
hammer dumbell curls sitting
wrist curl

Day 2 (Chest, shoulders, tris)

flat bench press (you may not be able to put your legs down due to surgery so rest them up on the bench)e
incline bench press
dips (leaning forward to work lower chest more than tris)
Lateral raises (sitting to put no pressur on the knee)
Bent Lateral raises (sitting)
sit-ups 12 Arnold style


Day 3

rest

Day 4

Back, Biceps

Note you can only work the outside of your lats, not the middle of your back because of the knee.  You can't do barbell or dumbell rowing or even seated rowing as it will put too much pressure on your knee.

Wide grip pulldowns to front or wide grip pull-ups
incline dumbell curls
sit-ups 12 Arnold style


Day 5

Triceps, chest, shoulders

close grip bench press with EZ bar (May have to put your feet up on bench instead of on floor)
Lying triceps extension with EZ bar
pushdowns seated (yes very awkward, but you can't do them standing with your knee}
Dips (upright to work tris more than chest)

Day 6

rest

Then repeat Day 1 (it is a 6 day cycle, not a 7 day cycle)

Another thing to remember is when you are not working your legs hard (which you won't be doing for a long time) the body produces less testosterone so your upper body will suffer also even if you are working it out hard.  Then again, doing the above workout will set you far better off than if you do nothing at all until your knee is better!

Hope this helps!

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #39 on: July 09, 2005, 12:06:29 AM »
Day 15 (Start of week 3)

This day brought 3 good new milestones, some minor good news, some unceratainty and another new concern.

Milestones:

I have been walking without crutches for a week and today I walked stairs for the first time without crutches.  I handled them no problem with only minor general discomfort.  Walking up the stairs I didn't even have to hold the railing but did for going down.

I also started walking on the treadmill for the first time.  I went for only 30 seconds for 4 times throughout the day.  I was able to walk with a perfectly normal gait (ah so this is Heaven!!).  I increased the stationary bike to 3 minutes for 4 times a day.  I experienced discomfort when I walk and do the bike.  I woudn't call it pain.  The quad still is sore but improving and the knee joint itself feels a general discomfort.  Nothing specific, nothing sharp, no snaps crackles or pops and nothing that alters gait.  I thnnk this general soreness is just because I am only 2 weeks post op and I still have swelling in there.  Time will tell.

I would consider the 3 portal incissions completely closed now.

Minor good news:

Again, I got no heat all day, but I iced 20 on/ 40 off all day so no chance for heat to even get a toehold.

Swelling appeared to decrease slightly and would be classified as minimal for 15 days post LOA.

I got a very slight improvment in extension, so now I am -2 to -3 of hyperextension.  I increased to 13 pounds on prone hangs and to tension 8 on the dyna splint base.  I won't be increasing that again for a while.  It was so uncomfortable last night that I only lasted 2 hours in the damn thing.

I got slight improvement to 137 in flexion but it took a lot of work.  My original schedule called for me to drop wall slides today and replace them with heel slides but since I am not at full flexion and will still be doing the CPM for several weeks, I am delaying the start of the heel slides until I get full flexion.  Any opinions on when to do heel slides?

New concerns (Isn't there always something to worry about with this awful scar tissue?!!):

Even though I improved to 137 on flexion, I have 8-12 degrees to go to get full heel to butt flexion.  I think I can do it, but for the first time doubt has entered my mind as to whether I can get there and I will admit it was a depressing thought.

Thanks to the great work of the doctor and me doing patella mobes 42 times per week, I have awesome patella mobility which is very important and great.  However, I noticed the 2 portals on the front of the knee are trying to bind down.  This really bumbed me out.  I started massaging them  to free them up.  Is this anything to worry about or does the fact that my patella has great mobility and I am -2 to 137 for ROM mean that I got nothing to worry about?  How do I free them or is it too late?

Offline Shoomers

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Re: Follow Jake’s LOA from start to finish
« Reply #40 on: July 09, 2005, 01:17:02 AM »
Jake,
Thanks so much for the extensive advice and routine!  I will be in the hospital (for pain management mostly) for a few days after my surgery.  I guess I will play it by ear on when to start doing the upper body exercises.  I have a workout room at my apartment complex where I can do the things requiring something other than dumbbells and a bench, which I have at home.  I do some short workouts sometimes now, intense and with a lot more weight for 5 or so reps, just to challenge the muscles sometimes.  Often they make me more sore than my longer workouts!  Go figure.
I can do underhanded pullups, but not wide grip.  Should I do those plus the lat pulldowns wide grip?  The underhanded P/U works the biceps a bit more than lats, but the combo might be good?
I currently eat about 1-1.5 grams of protein for each pound of body weight.  Should I decrease that becasue of the less work on larger muscles (legs) and the possibility of too much protein being bad for the kidheys,  keep it the same,  or even more? 
My goal is to have a miraculous recovery, too!  Mind over matter!  (we shall see!)  Well, I will keep reading your posts and being inspired to do as well as you are.  Keep it up!
Thanks again,
Lisa
1985-arthroscopy RK plicae removal
1986-arthroscopy LK plicae removal
2001-full dislocation RK
March, 2005 - had to stop running races due to PFS
August 2 L/R and TTT RK

Offline Janet

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Re: Follow Jake’s LOA from start to finish
« Reply #41 on: July 09, 2005, 02:10:21 AM »
Jake:

Good for you for your progress. I wouldn't worry about your extension. You don't really need for extension for a normal life. Really, 120 is fully functional. Don't stress over something that won't make much difference to you in the long run.

Keep massaging those portals. It's not unusual for this to happen.

I started doing heel slides immediately post-op. I never did wall slides because they were too much for my poor, sore patella tendon. When doing heel slides, you can do them totally passively by putting a towel around your thigh (if you can't reach with your hands) and pulling. This is the way my OS told me to do them, never pulling on a towel under your foot because that puts more stress on the knee.

Keep up the good work. It's totally normal to be worrying about all those little things. That's one great value of going to PT. They are used to all these questions and look at you on a daily basis to assess the situation.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #42 on: July 09, 2005, 11:56:56 PM »
Lisa,

I would keep the protein intake right where it is.  I would reduce carbs, not fruit or vegtables but starch such as rice and potatoes because you will gain weight from the inactivity.  Make sure you discontinue vitamins 2 weeks before the surgery because they cause bleeding.  If you are going to be in the hospital overnight, the earliest you will be able to start upper body weights will be about 2 weeks post op. 

Janet,

Thanks for the advice.  I will just have to massage those portals to keep them free.  I agree with you totally about 120 being functional.  However, I still dream about going back to running.  I would like to do distance and sprints.  Ironically you don't need full extension to be able to run but you need it to be able to walk.  However to run fast you need close to full flexion.  So I am going to fight for full flexion.  Of course I probably will be never able to run again, but I am going to go about things with that as a goal and if I fall short, so be it.

Offline Jakem

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Re: Follow Jake’s LOA from start to finish
« Reply #43 on: July 10, 2005, 12:05:18 AM »
Week 3 (continued)

Routine will remain the same all week.  With addition of walking on the treadmill, I am basically doing everything but strength training.  I won't increase the time on the treadmill or bike this week as the focus will be on ROM and reducing swelling.

I added massage to make sure the portals don't get bound up.

I gained slightly on flexion to maybe 138, but it wasn't easy.

The general discomfort on the bike decreased but remained the same on the treadmill.

No change in swelling, but it is pretty minimal all things considered.

Offline Heather M.

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Re: Follow Jake’s LOA from start to finish
« Reply #44 on: July 10, 2005, 01:07:15 AM »
Jake,

I'll admit I'm a bit concerned when you say you have 'general discomfort' during walking and biking.  Because what is discomfort to you may be outright pain to someone else, and pain is absolutely to be avoided.  I remember someone (Tracy, I think) telling Dr. S. she didn't have any pain with weight-bearing, and he told her that in that case he didn't want her to do ANY OF IT for a week or more.  Pain--even discomfort--is a sign.   I mean, it's why I'm 10 weeks post-op and STILL not walking correctly!  And Dr. S. doesn't want me to walk much, because it causes pain.  And full weight-bearing extension causes me pain, which is probably why walking hurts...so Dr. S. put me in a new brace that is locked at +10 degrees--no extension, no pain.  Avoiding pain is more important than me walking properly right now...think about it. 

Anyway, you may just be one of those people who doesn't feel pain like others--my brother is one.  He ran X-country for a full week with a huge, festering boil on his heel!  My mom asked why he was limping, and he said "My heel is kind of sore."  When my mom saw the boil, she flipped.  My brother had a huge piece of glass from a fluorescent lightbulb stuck way under the skin.  And he was just a little 'sore.'  Can you imagine?  Pain is a strange monkey. 

Is the pain in your patellar tendon?  Behind the kneecap?  Base of quads?

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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