Patience and Progressions

I realize it’s been a while since I had an update so, I figured it was time. This week marks the  completion of the 8th week of physical therapy and being post op. Holy smokes has a lot changed since my last blog post! It feels like yesterday I just started PT and walking was a challenge.  Since my last post, I've ditched the god awful brace (thank god), have been focusing my gait, strengthening my muscles (which have shriveled up like prunes since surgery), and stabilization. I also have been working on having patience. I can't not even begin to tell you how much patience is key with this operation and recovery. Everyone wants to rush back to being normal and living our lives like nothing happened, but realistically the more you rush it and fail to focus on quality, the worse off you are in the long run. So, what the heck have I been doing these last few weeks? Well, I’m about to tell ya.

ROM (range of motion) Gait training, and Patience: 

Remember when I was referring to Captain Ahab in the previous post? Well peg leg is pretty much GONE! Although my gait is still ever so slightly off, my ability to bend and extend my knee while walking has progressed to a more natural movement. So my pirating days are  finally over lol. Honestly, I can’t tell you what specific thing I did to improve this, but overtime it eventually came back with progressing ROM. Over the last few weeks I struggled with getting flexion back as stated before, but this week I achieved full range of motion!!!  Chris was able to flex my knee to the point my foot actually touched my gluteus!!! I was stoked!! In side I was screaming with so much excitement and joy. I felt like the scene when Ace Ventura screams “ YESSSSS!! We have exercised the daemons!! This house is clear!!!”  If you have never seen this movie or don't remember this scene please view the video! It's pretty funny! Haha!  I know this may sound silly, but this is a HUGE mile stone for me.   

Since surgery, and even before, I have been struggling with pain on the medial aspect (inside part) of my knee. This pain was not a symptom  with my previous ACL surgeries and  has been a huge barrier for me this time around   In the beginning, the pain was significantly limiting my ROM, especially with flexion.  We still aren’t sure what exactly the pain is from . . . bone bruising? Scar tissue? MCL strain? Maybe all of it? It may even remain a mystery! Every PT appointment Chris continues to stretch and push my knee, but the pain improves with each visit. I still have a small amount tenderness over the joint line, but I see Dr. Nicholas this week for my second post op checkup.  I’m less concerned since it has continued to improve, but still something to address, obviously. One thing I learned this time around is not every surgery is the same and differences will occur. 

Swelling and pain are things you have to expect to have after surgery, but eventually you will get it under control. I religiously use ice and compression after PT and  anytime I do any exercising at home. Riding the bike at home has helped immensely, but what I actually found helped the most over the last few weeks was REST. As much as you want to push yourself to get better as soon as possible, you can actually be setting yourself back. I found I was doing WAY too much too soon. For example, Chris gave me permission to ride my bike for over 30 minutes 2 weeks ago so, I attempted to spin for an hour with some intervals. We started doing “hills” on the stationary bike at PT so, I felt it was okay to add resistance and intervals at home on the trainer. The following day I found I had more swelling and knee pain which set my ROM back at PT. I was not giving my body enough to time recovery from the intense sessions at PT while at home. Again, too much too soon. I backed off a little at home and noticed the  pain, swelling, and ROM improved again. This week being 8 weeks, I’m back to spinning on the bike with some intervals, but pain free! It’s amazing what a little rest can do for improvements. I will definitely be taking this with me when I get back to training for the race season in the spring. Fingers crossed this will be soon.

Aside from riding the trainer, I have also been working hard on walking and ROM at home. I have been slowly increasing the amount of time I spend walking Jake daily. This has been helping me prepare to return to work in January. My job requires me to be on my feet for 12 hours a day so, it is important I work towards that goal. Again, I have to continue keeping moderation in the back of my mind and staying within the allowed walking time prescribed by PT. This will ensure I don’t over do it and remain on track for proper rehabilitation. 

I also work on ROM by doing similar stretching exercises that we do at PT while home. One example is I use a dog leash to assist me with flexion. While lying prone on the ground, I can pull my leg towards my gluteus slowly. I wrap my dogs leash around my ankle and pull the leash towards my head increasing the flexion angle to stretch my quad.  Eventually it got easier and continues to get easier with time. Thankfully it doesn’t feel like Brody, from Jaws, is shooting my knee anymore lol. 

Strength:

During the first few weeks of this process, Chris and Lisa had me continue with the simple exercises. Every PT session they added modifications and adjustments to progress my rehab. Beatrix Kiddo in my subconscious has now graduated from “wiggle your big toe” to preparing for the ass kicking lol. What does that translate to in my world? I went from doing quad sets and non weighted straight leg raises (SLR) to: adding a 5 lb weight around my quad, to a 10 lb weight around my quad for SLRs, to starting leg press last week. We initially started the leg press at 40 lb, but now I’m up to 60 lbs on my surgical leg. I have also gradated from doing ball squeezes to using the weighted hip adductor and abduction machine. I am no longer doing TKEs(terminal knee extension) exercises with the band,  but now doing extension with weight on the hip machine. I realize I’m not doing back flips, round house kicks, and swinging a sword around, but I can say I am making gains and feeling stronger by the day.

Stabilization:

Weights are super important to getting you strong, but stabilization and having good form are even more important in my opinion. At Center of Physical Therapy, Chris and Lisa are huge advocates for core and stabilization. We started off with me balancing on my leg for 30 seconds, to progressing to balancing on a piece of foam for 30 seconds, to balancing on the half  Bosu ball for 30 seconds. Last week we also advanced to a more fun activity, may I rephrase this, an ADD dream exercise. Haha!  Balancing on the half Bosu ball one leg at a time, while throwing a volley ball back and forth to one of the aids, is now a routine exercise at PT. Soooo many things all l at once!! HAHA! The first few times you feel like you’re going to fall flat on your face, but eventually you get used to it. I am also doing a lot of core exercises at PT as well. This is exciting because this will translate well over to training for race season

Keeping yourself sane:

Lastly, the most difficult obstacle I have been coping with is the mental one. Over the last few weeks I have been seeing Facebook, Instagram, and Strava updates of my friends riding their bikes outside and hiking. Last night it snowed so we can now add snowboarding to that list.  Even though it’s winter, the weather has been cooperating for cycling (aside from yesterday), for the most part. l Not being able to return to work, cycling, snowboarding,  or hiking leaves you pretty bored. I am fortunate to have an awesome dog to keep me company at home and on my daily walks. I am also thankful for my amazing friends who have been encouraging me and keeping me company along the way as well.  All this downtime has been occupied by doing CMEs (continued medical eductation)  to maintain my PA certification, watching Netflix, slowly learning Spanish, getting back into photography, and reading about cycling training. Again, I can’t stress the importance of finding a good physical therapy facility as well. You will spend a significant amount of time at PT so make sure you love it there haha. Chris, Lisa, and the rest of the crew at Center for Physical have become like family and are the best team for getting me back on my bike and work. I will leave you with this: if you’ve had ACL surgery or any surgery for that matter, stay positive, stay patient, work hard, but remember to rest, and surround yourself with good company.