After it was determined that I didn’t have any bone-fragments floating around in my knee, it was time to get it working again.  It is really scary how quickly I lost range of motion and muscle strength while I was immobilized and non-weight bearing.  Certainly, some of the loss of range of motion was due to the ongoing swelling, but a lot of it was just ‘use it or lose it’…and I’d lost it.

At my doctor’s appointment earlier in the day the doctor said to start physical therapy immediately; I found that there was an opening later the same day and took it.  Also, I’d been given a flexible brace to wear instead of the leg immobilizer.  It was one of the neoprene types with two metal hinges to keep my leg flexing in only the correct direction.  It felt good to get out of the full-leg immobilizer, but my leg did not feel sturdy at all.  As I’d find out over the next several days, tightening it enough to provide support meant that it gave me bruises…a tradeoff for sure.

In the early afternoon Kammy drove me back to Tria to meet my physical therapist.  Right off the bat he wanted to get some baselines: He asked about level of pain (low) and then had a look at my leg.  He had me get out of the leg brace and checked my range of motion.  My hyper-extension could only go to about 5 degrees (-5, or same as the other leg is the target).  Flexing my knee barely got it to 90 degrees (135 or so is the target).

Next, he had me try a few things to get a feel for where I was strength-wise.  He had me do ‘quadsets’ where I just had my leg extended in front of me (with a small towel rolled under the knee) and tried to tense my quads and push down into the towel.  It was difficult to get a nice quick firing of my quad at all, let alone push down.  He said I should work up to 15 of these.  He also had me do leg-raises.  Lying flat on my back, I bent my unaffected leg about 90 degrees, then tense my quads and raise my affected leg about 45 degrees.  I could do this one OK, but tired quickly.  I should work my way up to 30 of those.  He also had me start on something called passive extension.  This one sounded easy; lying on my back I just put a rolled towel under my heel and relax, letting gravity straighten my leg as much as possible.

It was pure hell!  (OK I exaggerate, but it really did hurt!).  I should work up to being able to lie there for 5 minutes on this one.  Next he wanted me to do ‘heel-slides’.  For these I wrap a towel around the arch of my foot with my affected leg extended, and then pull the towel to help my leg bend as much as possible.  I’d do 20 of these, trying to get more flex as the days went by.  Another flexing exercise had me sitting in a chair or on a kitchen counter, table or other sturdy object.  I’d use my good leg to flex my bad one as far as I could, with 20 repetitions too.

He sent me off with instructions to do these exercises 3 times a day, and work my way up to the recommended reps or time for each.  The first night I managed the following of each:

• Quad-Set: 10
• Heel-Slide: 10
• Toes to nose: 30 sec
• Leg Raise: 15
• Passive extension: 3 minutes
• Chair assisted ROM: 10

By Sunday May 13^th I’d reached the goal for each.  Passive extension was the most painful of all, but of course that one involved pushing my knee in the direction of the hyper-extension (it was at least partially psychological).  Most of the others hurt at times but gave the same feeling that a good stretch gives…some pain during the process, but the body feels much better afterward.

---

Posted by Greg on June 1st, 2011 :: Filed under ACL Files

---