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Author Topic: No surgeon anymore...can we collaborate?  (Read 1310 times)

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Offline Hiker girl

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No surgeon anymore...can we collaborate?
« on: February 09, 2013, 11:01:44 PM »
It has been 8 months since my fat pat was debrieded.  The first 2 months I had difficulty locating my quads.  Took 3 more months to coordinate quads.  At that time my surgeon decided I did not need PT since I was not walking well, still swelling 3 plus inches and not building muscle.

I have been doing his exercise...strap on weight, sit in chair and try to straighten leg.  I have 10 degrees to go.  At my last appt I was not allowed to make another appt due to insurance changes.  So I have not seen him in 2 months.

I have a couple of questions.
1.  What exercises can I do to strengthen my quads.
2.  Any good tricks to learning gait?  I borrowed a walker to force my body to walk in vertical position rather than hunched over.
3.  Anything other than elevation and ice to decrease swelling and pain?
4.  Can my gp follow me if my surgeon dropped me from his caseload?

Thank you in advance.

Debbie
Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline kimb

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Re: No surgeon anymore...can we collaborate?
« Reply #1 on: February 10, 2013, 03:32:51 AM »
There is a lot you can do to strengthen quads, but having had surgery what you can do should be approved by a medical person before you do it so you don't risk re-injury.
Squats and lunges are the most effective exercises at building quad strength. But, they are also both very hard on the knees and you should verify if you are able to do them. If it causes pain, do not do them. You can also do half or 1/4 versions of them instead of fulls ones.
Wall squats and wall slides
Yoga warrior poses
Weighted leg lifts
Leg extension
Leg press
Put a ball between your knees and squeeze
Plies (ballet move)
Put a rolled up towel under your knee and lift the lower part of your leg off the floor
 
Any of these will have pictures and videos if you look them up, if you aren't sure how to do any. Just doing step-ups or stairs is really good for quads too.
 
However, with any isolated exercises you have to be careful not to get out of balance. You cannot JUST focus on the quad, or you will throw your hamstrings, hips, back, IT band, calves, core and other things out of alignment and cause pain and problems elsewhere in your body. You can work on focusing on the quad, but you have to include other muscle systems to avoid problems down the line. Balance is key.

Offline Hiker girl

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Re: No surgeon anymore...can we collaborate?
« Reply #2 on: February 10, 2013, 04:28:30 AM »
Thank you for taking the time to respond Kimb,

I will look up some of these exercises.  For the 4 months I was in Physical Therapy the focus was to decrease swelling.  And they had not seen a fat pad client before.  I have been trying to do the rolled up towel under the knee (from someones post, maybe Clarkey's) but without success so far. Do you know how long this will take?  I thought by 8 months I would see the foot pop up. 

I am seeing an accupressurist who wants me to increase quad strength.  I have very strong hamstrings and can walk up a hill. However, I have difficulty going downhill and the quads start to misfire.

Sitting on the floor with my leg straight I have been trying to lift the whole leg.  Nothing happens except the middle part of the quad makes a bump but the other 3 parts are flat and then the knee cap starts to come out of the groove pulling it from side to side.

I am trying to get an appointment with my family doc. b/c this is ridiculous and I need to hike and backpack again.


 

Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline kimb

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Re: No surgeon anymore...can we collaborate?
« Reply #3 on: February 10, 2013, 05:03:28 AM »
I hear you. I'm a hiker/backpacker/camper as well. It seems strange to me that after so long your quads are still not firing. It is normal of course to lose muscle memory and mass and strength after surgery, but months seems like a long time to me.  I'd definitely seek out other opinions on that!

 Riding bike if you can is also a good way to build quad strength and maybe might help your muscles fire better. When I started my PT I had a hard time doing straight leg lifts and where you put the towel under the knee. I had to do them with my good leg and then try with the bad to try to transfer the "working" information from one leg to the other. With the straight leg lifts, someone here suggested that I use a prop of some sort to assist the leg in raising while working on quad sets (where you put the leg out straight on the floor and flex the quad, trying to pull the kneecap upward). I box, so I used a wrist wrap to assist my leg in the raises, and that worked pretty well. Anything you have like a belt or a thinner towel would work as well. Or even a long sock.
 
I wish you luck, and I hope you find success and answers soon. My issue is with a kneecap dislocation. I can feel it start to want to pop out again when I go down the stairs, so I am nervous I am in for more surgery that will affect my ability to hike in the summer, too. I do a lot of different things, but hiking is my life and giving it up just cannot be an option.
 
Just a thought, but maybe doing a little short hiking, because you enjoy it so much, might kick the leg into remembering what to do? Just a short, easy hike with a light pack? Sometimes just being somewhere that makes us relaxed and happy is what we need to do to kick the body into gear. We are in the middle of winter here, and I am starting to think about a short snowshoeing walk for the same reasons.
 
It's a tough spot.

Offline Hiker girl

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Re: No surgeon anymore...can we collaborate?
« Reply #4 on: February 10, 2013, 04:52:55 PM »
Thanks Kimb,

I thought the whole misfiring thing, continued swelling, pain etc seemed abnormal as well.  I get the standard, "everyone heals differently."  A hike would be wonderful.  All the trails are snowed over.  I have great hamstrings and can go up, however coming down is problematic. 

I like the idea of assisting the leg to function in the leg raises. 

Sorry you are having more trouble with the knee. My old PT and old surgeon said that strengthening the quads helps with the patella staying in its groove. 

 I am with you I will not give up hiking, backpacking or rock climbing.  They have told me I will never ski again but there is still cross country and snow showing. 
Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline Hiker girl

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Re: No surgeon anymore...can we collaborate?
« Reply #5 on: February 11, 2013, 05:35:50 PM »
Any secrets for gait? 

Walking is a real struggle.   At first I was just swaying back and forth.  As I brought my legs closer together I began to twist my body.  Then I was kicking out the knee to locked position but apparently we are supposed to bend the knee slightly.

I feel like a weirdo, but I have taken up watching how people walk and then practice that.  But there must be something/some trick that I am missing.

Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline Hiker girl

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Re: No surgeon anymore...can we collaborate?
« Reply #6 on: February 13, 2013, 07:53:08 PM »
Thank you to all who pm'd me and Kimb,

I saw my gp who determined that I have dependent edema.  Not used to sedentary lifestyle.  He is taking over my care and sending me back to physical therapy which in his opinion should not have been stopped. 

I am going on a water pill and to sleep with legs elevated.  Also to continue using compression sock from toe to hip.  He said surgeons are great for surgery but maybe not so much for aftercare/recovery issues that pop up that they are not familiar with.

Thank you for all the encouragement to follow through with my family doctor and to be pro-active.

Debbie
Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage

Offline kimb

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Re: No surgeon anymore...can we collaborate?
« Reply #7 on: February 13, 2013, 10:15:47 PM »
Oh, I am so glad you at least have a direction to move now. I really hope it helps and you can move on with your life!

Offline Hiker girl

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Re: No surgeon anymore...can we collaborate?
« Reply #8 on: February 19, 2013, 04:54:01 PM »
I went on the water pill.  Lost 6 pounds of fluid in 48 hours.  More importantly I can walk and the pain is so low it doesn't really qualify as pain.

I did my first PT in 5 months and did great.  My gait is still problematic but I haven't walked correctly for 3 years so it may take time. 

Lesson learned: do not waste time with people who won't help you get better. :)
Rt. knee pain while hiking 08/10
Saw GP 04/11
PT 05/11  failed
MRI  clean 06/11
1st OS, nothing wrong, fired him.
2nd OS, cortisone shot 12/11 
Scope 05/12, fat pad impingement, cleaned and reshaped.
3rd and 4th OS think nerve problem
Nerve study June 2012, Femoral nerve damage















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