Progress and Problems

Today marks 30 days since my operation. I'm still having pain at the incision on my knee, but I have progressed fully to phase 2. My PT is happy with my ROM and straightening (when flat on the table). There is one issue that I am still working towards resolving, my straight leg raises. My PT has added some more exercises, and I think over time I will see a difference in my knee with these few extra exercises.








My Phase II exercises are as follows:

I was so happy that I was officially fully moved to Phase II, but there is one set back that I can't seem to get past. When my leg is on the table, I can straighten it and activate my quad to push it down to make it straighter. However, when I have to lift my leg off the table for a straight leg raise, there is still a 5 degree lag. I asked the PT why this is, and she said my quad isn't activating properly. I am also still walking with a slight limp, but I am trying to overcome that. I need to think about every single step I take. Am I leaning to far? Am I striking the ground with my heel? Am I keeping my hips square? I try and really focus as much as I can with every step I take. When I first get up from sitting with my knee bent, it's inevitable that I will limp for the first few steps as my knee gets used to straightening.

For the coming week, I will be working on that straight leg raise, and starting the exercises above to start the early rehab phase. I am hoping as I get some more strength back, the knee will feel better. It is so tight and stiff, like it wants to move, but it can't. I'm sure in a few weeks of doing my Phase II stuff, it will feel loads better.

4 weeks (28 days) Post Op - Road to Recovery

Today officially marks 4 weeks since my ACL reconstruction surgery. I think in terms of the protocol, I am on track with my recovery. I rode the bike at physio and actually went fast enough for the damn thing to turn on! I could feel every pedal stroke, but I rode for 10 minutes at a good pace. Small victories, but a victory none the less.

In terms of ROM, I can get about 120 flexion when I really push, and almost at 0 degrees straightening. I am working on straightening as often as I can, but I am also doing a lot of bending exercises to get the tendon to work more. I am still walking with a limp, but using the proper walking mechanics. Before my leg was straight as a board and I was limping even more. The pain is still ever present, well not pain but a weird feeling of tightness/stiffness. I don't really know how to explain it other than, I can feel my tendon working/engaging with every step or movement I make.

I got cleared for driving, but my PT told me to practice in a parking lot first. Makes sense since it's been a few weeks and I need to see how my knee reacts when I put pressure on the pedal and move between the gas and brake pedals.

Other than that, no real updates. My exercises are still the same: 1/4 wall squats, single leg stance, bending, straightening and some hip stuff. I try and do these 3 times a day, with a more intense session in the evening that also includes an arm workout. It feels good to sort of be back on my feet. I hope that with each day that passes now, my knee will start feeling more normal. I haven't been sleeping well so that is something I hope gets better soon too. Little gains each day, and week by week I am seeing improvement. I'm continuing down the road to recovery.

Benefits of Physiotherapy

I started physiotherapy a month after I tore my ACL and MCL, and I can't tell you how much it has helped. My legs never felt better and they helped me work out the tightness and strengthen my knees. I think that even if you don't have an injury, but maybe you don't feel 100%, definitely get in there for an assessment and see how a PT can help you.

Here is an excerpt from the Ontario Physiotherapy Association website:

Benefits of Physiotherapy

Physiotherapy can make a difference in an individual's ability to live an active, healthy lifestyle. For many seniors, disabled or chronically ill people, physiotherapy is the key to restoring and maintaining a level of physical function that permits independent living. Physiotherapy is one way to successfully push physical limitations to secure the Freedom to Function™.

Physiotherapy benefits include decreasing pain, improving joint mobility, increasing strength and coordination and improved cardiorespiratory function. Everyone can benefit from physiotherapy whether you are living with a chronic illness, recovering from a work injury or suffering after that weekend hockey game.

Physiotherapy increases your independence and gives you the Freedom to Function™ in your home, workplace or your favorite leisure activity. Physiotherapy offers a range of specialized services of benefit to patients with heart and lung disease, traumatic, workplace and athletic injuries, amputations, arthritic joints, stroke, brain injury, spinal cord and nerve injury, cancer and pre- and postsurgical needs.

For a more detailed look at the benefits of knee physiotherapy, hit this link.

Compression

I am now at 24 days post op and I am still trying to battle the swelling. I ice as much as I can, 20 minutes at a time, and I also try to elevate. But it seems that is not going to cut it now, especially after adding new exercises and working my leg more.

I stopped in to the amazing team at Kinetic Connection and picked up a compression knee sleeve. I've been told to wear it all day, from when I wake up until I go to sleep.

It's nice and thin, so I can wear it at all times. Hopefully this will help over time. I also booked a knee massage for next week to try and get some of the swelling down. 

My straight leg raises are getting easier, which is good. But I still have a lot of work to do. I sat in a chair for about 40 minutes today with my knee quite bent in, maybe 100 degrees, and it was not comfortable at all. The thought of returning to work in just over a week is starting to worry me, but I am going to really push myself this weekend and next week. I want to make significant progress since this Tuesday will be 4 weeks post op! 

My goals for next week:

1. Get 0 degree straightening 
2. Get 115-120 degree flexion
3. Walk a bit better
4. Get cleared for driving! 

I miss driving my car, but since it's a manual, I don't think I'll be able to drive it by next week. 

The steristrips are finally starting to fall off. The front of the knee isn't looking too bad. The side incision definitely left a scar. I can also feel some scar tissue under the surface of the side incision, but I'm sure with time that will go away.

Side incision.

Front of the knee incision. Steristrips still hanging on for dear life.

Finally in Phase II, Day 23 Post Op!

I have finally progressed to phase II! According to my "ACL Reconstruction Rehabilitation Protocol" as provided by my surgeon, I am at Phase II - early rehab.

"May begin when the person can perform 20 SLR's with no greater than 5 degree active extension lag and has a normal gait without crutches or an immobilizer; and 110 flexion (approx 2-6 weeks)"

I am almost at a 0 degree single leg raise. I am now doing these with the TENS unit on my thigh. I think it is definitely helping. Also, whenever I am sitting in bed or anywhere with my leg straight, I put a pillow or something under my heel to work on extension.

In terms of ROM, I can get 110 degrees if I really push hard, and my knee is warmed up. This is something I am also trying to push, working on bending as often as I can throughout the day. I also had my PT push harder at physio, and boy was I in pain! But as they say, no pain, no Vo/Vi. Engineering joke there...Vo/Vi is gain. No pain, no gain. *cough*

Anyways, in terms of Phase II exercises, I have moved on to the wobble board. Mainly just balancing, not rocking at all. Also doing single leg stance. I am also working towards normal gait, so we started an exercise called right foot forward, which is literally just a step forward. The focus is to not lean side to side, but to take a perfectly balanced step forward. Trust me, it's harder than it sounds.

In terms of overall pain, it's still pretty up there. I can't describe how it feels, just super stiff and sore. From the straightening I get sharp pain in the back of the knee, but after bending it a bit that goes away.

Here are some photos of my progress this week.

TENS and straightening

TENS and straightening again.

ROM heel slides

Hamstring work, ROM 

Progress through Week 2

Today marks three weeks since my surgery. I am not where I am supposed to be according to the protocol, but I am progressing well none the less. I am still in Phase I because I need to be able to achieve 20 straight leg raises and 110 degree flexion to progress to Phase II. Today at physio we worked on a lot of straightening. I also did a full revolution on the bike! The following are the physio exercises I am currently working on. I use excel to keep track of all my workouts, phase by phase.

I am hoping that by the end of this week I am graduated to Phase II. I go to physio 3 times a week right now, and I find it helps a lot. My knee feels great when I walk out of there. It's important to keep it moving throughout the day and to not continually rest it. Mine still gets pretty swollen though, so I try to elevate and ice it in the evening. It is still also extremely stiff, and doesn't feel even close to normal yet. With the above exercises though, it's getting there.

I also walk without the Zimmer brace now, and I use the crutches. I want to get my walking mechanics back soon, because I return to work in two weeks! I bought a TENS machine to help work my quads as well.

Here are some pictures of my progress throughout week 2.

Got my stitches out. Steristrips fall off on their own now.

Working with the TENS machine.

Bend from first week to second week; got 90 degrees. 

This is my progress, and I can actually bend it past 100 degrees now, I just haven't been keeping up with my progress photos. I will take some more this week and put it in my next post.

It's All in Your Head

There are three important things to keep in mind before you go for ACL surgery, as I have learned.

1. Do your pre-op physio! It will help your knee be stronger, and lead to an easier recovery.
2. PATIENCE. The first week, you will say, why did I opt for surgery? But after the first week, which is the hardest, it will get better day after day. You need to stick to the protocol and physio, it gets better!
3. IT'S A MENTAL GAME. 

Let me elaborate on points two and three. 

You need to be patient. The knee is extremely complex, and surgery introduces severe trauma. Not only did they cut you open, they pulled, drilled and sawed inside of you! Graphic, I know, but true. It won't heal in a day, a week or even a month. There are months and years ahead. Patience is so important. You can't rush your recovery, and you need to breathe and take it one day at a time. 

The third point above, I think, is the toughest one to overcome. It really is all in your head. When you have so much time lying in bed, thinking you are not recovering fast enough, you end up on the web looking at others who are in the same situation. But it is important to remember, they are not you. Yes, we all had ACL reconstructive surgery. But guess what, no two surgeons do it the same way, and no two cases are the exact same. All our bodies are different. They heal differently. They grow stronger differently. 

I made the mistake of going to Instagram and putting in the hashtag #aclrecovery. I saw people who got full flexion within a week and others who are spinning away on the bike within two weeks. There I was at two weeks, and I could barely get 90 degrees on the bike. After lots of talk with my physiotherapist, I learned that I cannot compare myself with these people. My recovery is my own, and I will go at my pace, the pace my body can handle! 

From this post, I just wanted to stress the importance of keeping your head in the game. It is such a long road to recovery, but you need to take it a day at a time, and listen to your body. The results you see each week will amaze you, and drive you to work harder the next week to continue on the path to a full recovery. 

The First Week

On October 27th, 2015 I was rolled into OR 20 for my ACL reconstruction. I moved from the gurney to the operating table, they hooked up my ECG, covered me with a warm blanket and then I was put under general anesthetic. I remember waking up the first time, I couldn't see straight but the nurse gave me more pain killers and barely enough water to get them down, and I dozed off again.

When I finally came to, my leg felt like it weighed a million pounds. I felt a lot of pain in my thigh, because I didn't realize I was in a Zimmer brace and it was on pretty tight. I had bruising on my thigh from physio a few days before my surgery, and that's why my thigh was hurting. The Zimmer brace was secured right on the bruise. I was able to dress myself, and then I was rolled out to the car to head home. 

All the drugs had made me nautious, but I managed to settle in the back seat and made it home. I didn't do much but sleep the day of the surgery. My day started at 4:30am, surgery was at 7:45am, and I left the hospital at 2:30pm.

The second day wasn't too bad, because I was still taking all my pain meds, every 4 hours as prescribed. I couldn't lift my leg out of bed on my own from the pain, so I used a strap to lift my leg. I also had the handle bars for the toilet which helped a lot when sitting down and standing up. Without them, you'll need to balance on the crutches, or pistol squat. I did that when I first tore my ACL, so I decided to be better prepared this time around. It was definitely worth the investment.

All in all, the fourth day is probably the worst. I stopped the pain medication because it was seriously upsetting my stomach. So that is when the pain really set in. Every step I took, I could feel the Zimmer pressing up against my incision down the front of my knee and it was in a ton of pain! If you can handle not having a bowel movement for a week, stay on the pain meds. I couldn't, so I dealt with the pain.

The first week is also hard because you are basically on you back, in bed, the whole time! I would sit up in bed, but it was painful on the back and hips, especially with one leg elevated. Sleeping on your back is awful too. I am a side sleeper, so I had to take my pain meds only before sleeping so that I could actually sleep. Otherwise, I would try and roll onto my right side. This was a big mistake too, because the Zimmer pressed into my side incision and it bled. Lesson here, get used to sleeping on your back.

The first week is by far the most difficult. You will need help from somebody to get food and to help you get in and out of bed. You will run out of energy. You will be in pain. But I can assure you once you are over this hurdle, it gets easier.

Some photos from my first week. I was in too much pain, so I didn't go to physio until the one week mark.

The Accident

March 29th, 2015 is a day I won't soon forget. Actually, I'll never forget it. It's the day I blew out my dominant, right knee.

I decided to go with a friend to one of those indoor trampoline parks, Skyzone. I was about 5 minutes in and decided to go off one of the side walls. When I landed, I felt my knee "pop" out and then back into place, and I instantly went down clutching my leg. They cleared off all the trampolines and as all the children looked on, I dragged myself across the blue mats so they could go back to enjoying themselves.

Since I seem to be always accident prone, I called up my family and told them to come with the crutches. From there it was off to the hospital for xrays. They said the bones looked good and were all in place, so it was a soft tissue injury. The Zimmered my leg and sent me home. Told me to ice and elevate for a week and then see my general doctor.

From there it was on to an MRI and a visit to the orthopedic surgeon. It was confirmed that I had fully torn the ACL and ruptured the MCL. The MCL luckily healed on its own, but the ACL would have no such luck.

I did 6 months of physiotherapy where I worked on regaining my full range of motion and strengthening my leg. Unfortunately due to scar tissue, I couldn't achieve full extension, and this was one of the reasons I opted to do the reconstructive surgery.

My surgery was on October 27th, 2015. It took 1 hour and 40 minutes, using my patellar tendon, and everything went well! So now there is a long road ahead, filled with pain and phyiotherapy. This is my journey.