This morning I did the full count of all my exercises.  20 Heel Slides; 1 minute Hamstring Stretch; 30 each of all three leg raises; 5 minutes Passive Extension; 20 Knee Bands with 1 second pause; 20 Knee Bends with 1 second pause; and a full 1 minute of balancing on the involved knee!  It’s one of those mornings where I love physical therapy.  Funny in a way because…

Physical Therapy Hurts!

When I First started doing my pre-hab, I couldn’t even believe the things they were asking me to do.  My knee had really become stiff while in the immobilizer.  The first thing to do was regain flexion and extension.  Flexion was accomplished by doing ‘heel slides’ where you sit on the ground with your leg out comfortably in front of you.  You hold a towel or strap in both hands, loop it around your foot, and pull, flexing your knee as much as it will go.  That hurts…but it also kinda feels good; inevitably the knee flexes more with each slide.  Sure you backpedal for the next session, but in aggregate your knee keeps flexing more and more.  In my case, it felt as if the muscles and tendons had settled into odd positions during the immobilization and now as I was working to get range of motion back they’d ‘pop’ around.  It feels gross, yet also in an odd way it feels good.  I was also dealing with a LOT of swelling; I could feel the fluid moving around to get out of the way of the flex.  That, too, felt weird, sometimes felt wrong; ultimately it felt good too.

There’s always one exercise that is your least favorite.  For me it was ‘passive extension’.  Seems easy, right?  Put a rolled up towel under your heel, lay down and just relax your muscles.  Let gravity do the work.  My goal was to do this for 5 minutes.   The first time I tried to do it I thought I would cry after 30 seconds.  I started sweating.  I just could NOT convince myself to un-clench my muscles.  Now keep in mind that my injury was a knee hyper-extension.  All I (and my muscles) could think of was that if I relaxed my knee would just hyper-extend again, an awful feeling.  My physical therapist had me modify the exercise so that the towel was under my knee at first.  I would progress to no towel, then to towel under heel.  It took a long time to get there, but I did make those transitions over the course of about 3 weeks.  Now that I’m in rehab I think Passive Extension is one of my favorite ones (It helps the hamstrings).

Physical Therapy & 1 week Surgeon Consultation

IT feels a bit lopsided going in on Wednesday and Friday for physical therapy.  Still, I managed to make some strides between the two days.  Having the greatly reduced leg pain means that my stamina is on the rise; Adam decided to have me start walking around as much as possible with a single crutch and no immobilizer.  He also gave me one new exercise, Step ups; and modified my knee bends so that I do a 3 second pause at the bend.  He had me drop the weight shift.  There was just enough time for me to do a 10 minute icing on the ‘game ready’ before heading upstairs to meet with Dr. Fetzer.

When we got upstairs and into our room, I found out that the stitches were coming out today!  The student nurse took off all the steri-strips, pulled some of the stitches, and cut the exterior off others that will dissolve.  She then put on a new batch of steri-strips.

Once that was accomplished, Dr. Fetzer came in to see how I looked, and to generally talk about the surgery etc.  He said I was looking great and that I could stop wearing the immobilizer to sleep!  This is big news because that thing is very uncomfortable for sleeping.  He also told me to get my normal step back and get off the crutches ASAP, which matches Adam’s plan for me.

Then we talked about the surgery.  He brought up arthroscopic photographs of the whole thing and talked us through it.  All of my menisci looked great given my age (they have some wear and tear) the ends of the Femur and Tibia joints were in good shape too.  He showed us where he’d ‘mowed the grass’ clearing up some ragged cartilage and such.  Then he showed us the drill holes in my Tibia and Femur and the anchors and the tendon that will become my new ACL.  We have copies of all the photos but it was great to have him explaining it all to us.

Finally he asked if it was OK to do one more X-Ray to see how everything had settled.  I said, of course!  He then showed us on the X-ray where the anchors are.  And with that the meeting was over.  I go back in 5 more weeks for the next follow-up appointment.

Evening Physical Therapy

I was pretty tired by the time I did the evening PT, but managed to get through it all, new stuff included.  I’m really looking forward to getting completely off crutches, they are fairly uncomfortable and my right underarm is complaining a bit (yeah, I crutch incorrectly sometimes when I’m tired).

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Posted by Greg on July 16th, 2011 :: Filed under ACL Files

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Last night I barely got any sleep.  My hamstring was causing me a fair bit of distress, and even my knee was acting up a bit.  This after taking 4 Advil (which I had hoped would ease the swelling in my knee).  Needless to say I’m exhausted today.  That said, once I got my knee moving I was able to do most everything to target levels with the exception of leg raises (on stomach) which I only managed 20 of.

Work

I took it easy at work today, physically speaking.  I stayed at my desk with my leg up as often as possible.  When I was up, I didn’t let hallway conversations keep me from getting back to my desk.  I iced several times.  It was Cinco de Mayo today and we celebrated by going down to the first floor of our building to Barrio.  So did everyone else in St. Paul’s lowertown, they were on an hour wait.  We looked in at the Bulldog but it was totally full too, so we asked if they’d be nice enough to call up when a table was ready…and we went back to work.  An hour later we were filling up on tasty Mexican food (but regrettably no Tequila!).

Evening

By the time evening came it was pretty clear that my hamstring is getting better.  It’s still terribly weak and feels like it may cramp up at any time, but now the Charlie horse is letting loose somewhat, and it’s not constantly painful.  Yea!

Physical Therapy went pretty well: 42 seconds balancing; 20 Knee Bends; 20 Knee Bands; 30 back and side Leg Raises, 20 stomach Leg Raises (after a reset…hamstring trying to cramp!); 5 minute Passive Extension; 20 Heel Slides and 1 minute of hamstring stretching.

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Posted by Greg on July 15th, 2011 :: Filed under ACL Files

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As I was lying in bed trying to wake up this morning, I dared to think that, perhaps, my hamstring was a bit less tight.  My first steps out of the bed told a different story though.  “Holy crap, I can’t even straighten my leg” is what I thought as I tried to start my morning PT.   So, I switched it up.  Tried to start with passive extension but my hamstring wanted no part of that.  I sat there a bit with both legs out front of me…damn; my good leg feels like crap.  OK, I decide, start with some general stretching, and then move into the hamstring stretch, followed by heel-slides (20) and passive extension (5 minutes).  Now I am starting to feel a bit better so I get up and do the weight shift (4 minutes).  I still don’t quite feel that I can trust my weight all on that knee, but I’m doing it with a basically straight leg!  After that I continue through the 3 leg raises.  This morning is the first time I hit the target of 30 on all three types.  Now I’m icing and updating this blog.  Then I will get dressed, do a bit of work and head off to my 2^nd PT appointment.

2^nd Physical Therapy appointment

Kammy and I drove to Tria for my 2^nd physical therapy appointment.  First Adam asked about pain level and I replied 2 (hamstring is bugging me).  He measured my extension (1 degree) and flexion (110 degrees).  Both are on or ahead of the one week target!  Then he checked my quad strength and determined it’s time to start walking without the brace (but still with crutches) when I’m in ‘safe’ places such as home.  He had me walk this way up and down the PT area.  The main focus is to walk normally which is about the most foreign thing to a knee in distress.  The idea is that I stay on crutches until I can completely walk normally.

After that he re-worked my physical therapy plan.  I’ll keep the passive extension, heel-slides, leg-raises and hamstring stretch for now; new are 1 legged balance (to replace weight shift) , assisted squats, and knee-bands (both of these were exercises during pre-hab).  To finish off I get to ice on the “Game Ready” which I’ve heard of but never used before.  Sure felt good to have that mild compression plus cold water circulating for 15 minutes!

Work

Kammy drove me to work and I had a too-busy day for my knee.  Heck I even went to a client meeting (clients we know very well…) with my boss.  It really was too much.  By the time I got home I could barely make it up the stairs and my knee was the most swollen it’s been since the surgery!  Point taken; go easier on it tomorrow!

At my evening PT it is immediately obvious how I over-did it on my knee today.  It’s not just swollen, my hamstring is done in.  When I tried to do the stomach-leg-raises I could only manage ONE of them.  Pretty much every other exercise went fine but my hamstring let me know about it.  I managed a 20 second balance on my ‘involved’ knee during my 1 minute balance!  I got in 10 knee bends, 20 knee-bands, and the usual target amounts on everything else.

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Posted by Greg on July 14th, 2011 :: Filed under ACL Files

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Today I woke up feeling a bit uncomfortable; I straightened the immobilizer out a fair amount last night (too much it seems for comfortable sleep).  Hard to get going but once I started the PT I felt much better.  I started with the standing weight-shift which I bumped up to 4 minutes.  Then on to passive extension (5 minutes); heel slides (20); the 3 leg raises (25 each) and finally hamstring stretch (1 minute).  During PT I decided today is the day to get back to the office, so I texted my co-worker and got my ride worked out.  Kammy got back from dropping Z off and helped me get ready for my first day back.  Getting to the office was fairly uneventful since all of us had done this before when I was recovering from the initial injury.  Now…let’s see how this day goes.

Work

I am fortunate to have a desk job.  I’m a web programmer/developer and can work from home.  That said…since I manage people it’s better to be in the office.  Work was uncomfortable but manageable.  Really, I think being there took my mind off of my hamstring a lot of the time.  Offsetting that was that I have to go a lot further to do anything.  Oh, and I have to do it.

I have a co-worker that I carpool with who has been kind enough to do all of the driving during my non-mobile parts of recovery.  He’s gracious enough to give me door-to-door service during the ‘worst’ of the days.  Today he dropped me right out front so all I had to navigate was 5 steps up, 2 doors, 1 elevator and about 50 steps back to my office.  From my office it’s about 25 steps to the kitchen (important for coffee and my icepack) or bathroom (just important).

Workday was uneventful except for lunch (more on that to come).  My hamstring hurt most of the day (I still have a significant full-time Charlie-horse) but thankfully I had no muscle spasms.  The day was going well!  I went downstairs for lunch with some co-workers (50 steps across the office, 1 elevator, 10 steps to the pub, and 4 steps down…table!).  Just after the food was served I got a server message that one of my servers was about to crash.  A quick phone call or two and I realized I was going to have to go back up to my office.  The server problem actually resolved itself while I was walking back up (thanks to good MySQL configuration, thanks Wes!) but of course my lunch was cold by the time I got back down there at my gimpy pace.  No other excitement came along.

Evening

My hamstring was feeling more like it would spasm once I got home.  I just couldn’t find a comfortable position no matter what I tried.  Finally I broke down and took some ibuprofen.  Then massaged it some and tried to relax.  Evening PT went very well except for the hamstring which still wanted to spasm on me.  I was able to keep it at bay but just barely.  Tonight I did 4 Minutes of ‘shift’, 5 of passive extension, 30 each of front and side leg raises but only 25 of the stomach ones, due to hamstring; I came very close to muscle spasm part way through.  I rounded out PT with 20 heel slides and hamstring stretch.  I did not ice afterward because Kammy was too tired to go get the ice pack and I didn’t feel up to doing the stairs again.  Tomorrow it’s time for PT at Tria; I’ll be excited to see what progress I have made since last Thursday.

I Stayed up too late…really should have iced!

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Posted by Greg on July 14th, 2011 :: Filed under ACL Files

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I slept in ‘til 11 then got up and got started working.  It’s my first fairly-full workday since the surgery and it feels good to be getting some work done.  At 3 I take a break and do PT.  It’s about a 30 to 45 minute affair at this point.  I manage 24 each of the 3 leg raises, 3 minute ‘shift’, 4 minutes passive extension; 1 minute hamstring stretch; 20 heel slides (which is the target).

My cat spazzed on my foot while I was out of the immobilizer; he dug his claws in which caused me to knee-jerk which caused a spasm.  Hurt but it wasn’t one of the big ones.  I am starting to think the big ones may be behind me!

My hamstring is feeling less crampy so I take the plunge; my first full shower since surgery!  If I wasn’t so nervous that my leg WOULD cramp it’d have been pure joy!  It still was pretty damn good, though.

I round out the night with one more set of PT; I bumped each of the leg raises to 25 (the target is 30); 3 minute ‘shift’, 4 minute passive extension, 1 minute hamstring stretch, and 20 heel slides.  I can now get some negative extension (assisted) but cannot pull it with muscles yet.  I’ve made marked progress on the flexed end too, well past 90 degrees.  One more icing and off to bed.

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Posted by Greg on July 10th, 2011 :: Filed under ACL Files

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Hey, I don’t think I had any over-the-top muscle spasms last night.  Win!  I did my first PT around 1 PM, second around 11:30 PM (Just before we found out about Osama Bin Laden).

I’m really getting antsy with all the sitting around!  I have to say I underestimated how weak my leg would feel after the autograft.  Mind you, my surgeon spelled this entire process out for me…it’s just different living through it.  At certain times of the day it feels as if my leg is going to go into one of the big spasms as soon as it’s not elevated anymore.  Other times it is fine for quite a while.  Also, I still haven’t felt comfortable enough (given our bathroom configuration) to manage a real shower.  And the last straw, an emergency fix to a database kept me up well past 4 AM, so I will sleep a bit late in the AM and work from home tomorrow.

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Posted by Greg on July 10th, 2011 :: Filed under ACL Files

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I woke up today feeling much better than I did yesterday.  I had one big cramp-up overnight and had to get up one time.  I slept mostly on my back though somewhat on my side (Involved knee ‘up’).  I still have extra swelling in my leg and the weird pain in my left pectoral when I stand up, but no more light-headedness.  High blood pressure & fast pulse from yesterday are also relieved dramatically.  I also realize that I forgot to take my muscle relaxant last night and decide that I’ll just stay off of those too.

As I’m writing this at 7:00PM I haven’t had to use any pain meds today.  I’m starting to switch over from lethargy to restlessness.  I will be very glad to get out of the leg immobilizer.

My morning physical therapy went well.  I will stick with these same exercises 2x daily until my next PT session at Tria on Wednesday.

Ouch!

I just tried to take a shower.  I thought I was finally feeling good enough to do it, but once I got out of the immobilizer and the Tubigrip and walked in to the bathroom, my hamstring started cramping up too much and I had to abort the mission…maybe tomorrow?

Evening PT and icing went well.  I straightened the immobilizer a bit and also made it a bit tighter; maybe it’ll be more comfortable sleeping that way?

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Posted by Greg on July 8th, 2011 :: Filed under ACL Files

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I woke up feeling a bit clearer.  Still no significant pain so I decided to just stay off the Percocet and just take the muscle relaxant, thinking it must be helping somewhat with the hamstring Charlie-horse/spasms.  I got up and started walking down the hall to the living room.  Part way there I felt a very sharp pain in my left pectoral.  Was I crutching wrong?  Was it something else?  I stopped and touched the spot; it hurt like hell in one very specific point near the surface of the muscle as it rolls toward the armpit.  I took the left crutch out from my armpit and made my way over to the couch.  After I sat down the pain went away in a few seconds…weird.

I did my first PT of the day halfheartedly, not really feeling up to the task.

As Friday progressed it became clear that I was not feeling very well at all.  Every time I stood up I felt very light headed, plus had this same sharp pain in my left pectoral.  Additionally I was still constantly thirsty, had to go to the bathroom and was starting to realize I was constipated too.  On top of all that I noticed that my heart rate was quite high for ‘just sitting around’ and suspected my blood pressure was higher than normal too.  By the evening I got my hands on my blood pressure cuff and took a reading…150/95 with heart rate of 98.  I was quite uncomfortable by this time and decided to call my insurance nurse line.  After discussing for a few minutes she transferred me to the Tria on-call doctor.  While talking with the on-call doctor it became clear that all of this was fairly normal stages of purging out all of the anesthetic, pain meds, etc. that had been put in me in the past few days.  She did warn of other symptoms (that if they should arise) would indicate an immediate 911 call.  I figured I was also experiencing anxiety and took some anti-anxiety medication (which also reduces blood pressure/rate).  I felt much better within the hour.  I also managed to relieve the constipation which made a big difference in how I felt.  As the evening wound down I was feeling too dodgy still to attempt PT (which felt like a big failure).

At bedtime I set my muscle relaxant by the bedside, but forget to take it.

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Posted by Greg on July 6th, 2011 :: Filed under ACL Files

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Honestly today and Wednesday and Tuesday for that matter have all jumbled together.  At my 11 am dose of Percocet, Kammy and I decide to cut me back to a ½ tablet to make me more lucid for my first PT Session.  Kammy drives, though I don’t remember much of it.

Physical Therapy (Plus redress & check-in)

At this first physical therapy appointment a Nurse comes to re-do my bandages, have a look to make sure there’s no infection, etc.  He also gives me the go-ahead to shower carefully (no soaking, no baths) but not to remove the water-proof bandages that are left on the various incisions and holes.  He says it looks perfect!

I’ve been careful to keep the same physical therapist that I’ve been working with since the beginning of my pre-hab.  He quickly checks my range of motion (not very much at all) and how I’m doing strength wise. He then explains the exercises for me to do this week: Standing weight-shift for 3-5 minutes; 3-5 minute passive extension; work up to 30 leg-raises each on back, side, stomach; 20 heel slides; hamstring stretch for 1 minute.  I’ve done ½ of these before in pre-hab so we don’t take a long time to demonstrate them.  My quads are in good enough shape that I can skip right past the quad-sets!

Since the pain is still totally manageable (except spasms which don’t seem to be helped by anything) we stick with ½ tablet of Percocet for the evening and bedtime dose.  I decide to set a ½ tablet by my bedside for the middle-of-the-night dose, but that I won’t take it if I don’t wake up needing it.  Even though I still woke up many times during the night (as the previous two) I didn’t think I’d need the pain pills so I didn’t take them.

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Posted by Greg on June 30th, 2011 :: Filed under ACL Files

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In my mind I cannot separate Wednesday from Tuesday except that I eat leftover pizza instead of fresh.  An emergency has come up at work that could really use my attention but I am incapable of concentrating enough to address it.  (Maybe it started on Tuesday?)  I fade in and out.

OUCH! OUCH!

Around 7 PM Gramma calls to tell us she’s bringing Z home.  I doze off but am torn awake by a horrendous muscle spasm in my hamstring, this right as Z and Gramma are coming up the stairs.  I was shocked at how hard and strong the pain was even with muscle relaxant and pain meds.  Had a hard time greeting them, still hurts. Night passes just like Tuesday…wake, drink, go to bathroom, drink, doze, and wake etc.

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Posted by Greg on June 29th, 2011 :: Filed under ACL Files

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