I approached Friday’s PT session with renewed vigor. Dr. Petersen’s promising diagnosis provided the spark. Judy was pleased to hear the prognosis. I think she sees her hard work paying off, too. In any event, it was time to add some new rehab exercises.
After the usual entre of biking, stretching, leg raises and hamstring curls, Judy integrated a few new wrinkles. The first new exercise was actually an oldie – the wall-sit. For those unfamiliar with this exercise, picture somebody taking a crap standing up. And yes, the wall-sit feels about as good as it looks. Basically, in a wall-sit the patient places his back firmly against the wall, and slowly slides down until he’s in a seated position, and remains there until his quads start quaking uncontrollably. In my case, I wall-sat with my knees bent at a 45-degree angle; more of a stoop than a seated position. I remained in this precarious spot for 1 minute, pressing my palms together in front of my chest for balance and secret prayer. Surprisingly, the wall-sit really didn’t hurt. My quads, though weakened and much punier than they were before the surgery, are still pretty sturdy after years of volleyball and soccer. Of course, my left leg – the good one – over-compensated, bearing the brunt of the pressure. But my knee held up fine. No pain.
Next up was another traditional leg exercise – lunges. Lunges proved more difficult than the wall-sits. If you’ve never done a lunge – or watched an episode of The Biggest Loser – the patient steps forward until his lead leg is shaped like an upside-down L, while the back leg is almost kneeling on the floor. To protect my graft, I stopped my lunge forward far short of the expected 90 degrees. Lunges didn’t feel quite right. They didn’t hurt, but at times I sensed the surgically repaired knee was tantalizingly close to cracking, and rule #1 of rehab is stop if it hurts.
Judy kept things moving at a decent clip. I pounded out another set of 100 lateral heel touches, before cranking out a set of forward heel touches. At this point, my ass felt like it had a starring role in some porn movie called, “Backdoor Adventures.” Ok, that was nasty, but you get the point. For the first time in rehab, I had worked up a decent sweat.
We then broke out the balance board, called a BAPS. I have no idea what that acronym stands for, but those letters are written all over the board. It’s basically a circular slab resting atop a ball. With my gimpy foot planted in the middle of the board, I wobbled the board front and back, and side-to-side, before rotating the board circularly in both directions. The balancing exercises strengthen my ankle and corresponding muscles, as well as stabilize my knee. Eventually, I’ll perform my squats and heel touches on this machine to increase the difficulty level.
I had another PT session on Monday. This session wasn’t as productive. My knee just didn’t feel right. There was a crackling sound coming from above the patella – not where the graft site is located – while using the stair-stepper. The knee made similar noises during the 90- to 60-degree leg extensions. Previously, the clicking sounds occurred below the patella, and almost assuredly happened because the graft site was still hardening (I asked Lars Petersen about this). Again, the knee didn’t hurt, but I nonetheless stopped these exercises out of an abundance of caution. Judy didn’t seem overly concerned, but agreed with my decision to scale back for the moment. The rest of PT was without incident. Interestingly, the lunges didn't bother my knee. Perhaps I didn't lunge as far forward this time. Anyway, let’s hope these noises were just a one-time setback (though setback is too strong of a descriptor).
Monday, April 27, 2009
Thursday, April 23, 2009
Examination by Dr. Lars Petersen
Today was a “special treat.” Well, a special treat in the world of knee surgeries. Dr. Lars Petersen, the Swedish pioneer of ACI knee surgery, examined my knee. It was like the hand of God touched my knee.
Lars was in Dallas for a major knee surgery conference. I suggested he grab some Tex-Mex. (By the way, I can only imagine how exciting knee conferences are; hopefully more stimulating than law seminars). Anyway, Lars stopped by my surgeon’s office to check out my knee, as well as the knee of another ACI patient. According to Lars (and my surgeon), my knee seems to be healing ok. It’s tracking well and my flexion’s good. I’m still a few degrees short of full active extension, but neither doctor was concerned.
I pointed out the “clicking” noises my knee makes during the extension process, typically around the 45 degree mark. Lars nodded expectantly, as if my question was #1 on the list of FAQs. After manipulating my knee several times, Petersen explained that the cloned cells are still hardening. Because the graft site is pliable at this juncture, the cartilage has not yet formed a smooth surface. He used the analogy of something crashing over a step. I understood what he meant, but think I’ve got a better analogy.
Imagine a tire rolling slowly over a pothole. The tire dips into the hole, rolls across the crevasse, before smacking into the back edge of the hole. The tire then climbs up and out of the pothole, emerging back on the smooth paved surface. Well, when the bone/cartilage inside my knee passes over the site, it creates a slight indentation on the graft site, producing a clicking noise as it dips down and smacks against the existing, hardened cartilage. The clicking is supposed to end once the cloned cells mature to create a smooth surface area.
I also asked Lars about the knuckle-cracking sounds coming from the back of my knee. Typically, these sounds happen while walking, after my knee is fully extended or locked. Again, Lars manipulated my knee several ways. This time, he also squeezed certain spots along the top of my calf and the bottom of my hamstring. I don’t recall his precise explanation, but he concluded the patella tendon underneath my knee needed to be loosened up. Not only was the tightness causing the popping, that was probably a primary reason why I can't reach full active extension. I realize I’m not the knee expert, but this explanation didn’t seem as convincing as the one for the clicking sounds. Regardless, Lars said the popping noises were normal and nothing to be alarmed about. Easy for him to say.
Of course, I now want to know when (and how) we’ll determine whether the cloned cells are hardening. Turgeon says he’ll probably take an MRI of the knee in early July. That’s the 6-month mark. By that time, he should be able to gauge the cloning process. In other words, he'll be able to see if the cloned cells have filled the lesion. In the meantime, both surgeons gave me the obvious advice of staying away of rehab exercises that caused the clicking noises. They also suggested I rest my heel on a table and contract my quads to loosen up my patella tendon.
Both think I’m on the right path. Hopefully their intuition is correct.
Lars was in Dallas for a major knee surgery conference. I suggested he grab some Tex-Mex. (By the way, I can only imagine how exciting knee conferences are; hopefully more stimulating than law seminars). Anyway, Lars stopped by my surgeon’s office to check out my knee, as well as the knee of another ACI patient. According to Lars (and my surgeon), my knee seems to be healing ok. It’s tracking well and my flexion’s good. I’m still a few degrees short of full active extension, but neither doctor was concerned.
I pointed out the “clicking” noises my knee makes during the extension process, typically around the 45 degree mark. Lars nodded expectantly, as if my question was #1 on the list of FAQs. After manipulating my knee several times, Petersen explained that the cloned cells are still hardening. Because the graft site is pliable at this juncture, the cartilage has not yet formed a smooth surface. He used the analogy of something crashing over a step. I understood what he meant, but think I’ve got a better analogy.
Imagine a tire rolling slowly over a pothole. The tire dips into the hole, rolls across the crevasse, before smacking into the back edge of the hole. The tire then climbs up and out of the pothole, emerging back on the smooth paved surface. Well, when the bone/cartilage inside my knee passes over the site, it creates a slight indentation on the graft site, producing a clicking noise as it dips down and smacks against the existing, hardened cartilage. The clicking is supposed to end once the cloned cells mature to create a smooth surface area.
I also asked Lars about the knuckle-cracking sounds coming from the back of my knee. Typically, these sounds happen while walking, after my knee is fully extended or locked. Again, Lars manipulated my knee several ways. This time, he also squeezed certain spots along the top of my calf and the bottom of my hamstring. I don’t recall his precise explanation, but he concluded the patella tendon underneath my knee needed to be loosened up. Not only was the tightness causing the popping, that was probably a primary reason why I can't reach full active extension. I realize I’m not the knee expert, but this explanation didn’t seem as convincing as the one for the clicking sounds. Regardless, Lars said the popping noises were normal and nothing to be alarmed about. Easy for him to say.
Of course, I now want to know when (and how) we’ll determine whether the cloned cells are hardening. Turgeon says he’ll probably take an MRI of the knee in early July. That’s the 6-month mark. By that time, he should be able to gauge the cloning process. In other words, he'll be able to see if the cloned cells have filled the lesion. In the meantime, both surgeons gave me the obvious advice of staying away of rehab exercises that caused the clicking noises. They also suggested I rest my heel on a table and contract my quads to loosen up my patella tendon.
Both think I’m on the right path. Hopefully their intuition is correct.
Sunday, April 19, 2009
Week 16 Update
Phase 3 – the so-called, “Remodeling Phase,” which lasts from Months 3-8 – is full of highs and lows. For example, I’ll experience long stretches with no limping, and for the first time since the surgery my knee will actually feel almost normal. This false positive causes my mind to wander ahead, wondering when I’ll be able run and jump again. Like a bolt of lightning shattering a late-night silence, however, my knee will suddenly “give out,” severing those wishful thoughts and serving as a brutal reminder that, nope, my knee’s still jacked up.
During these moments, I often reflect on the various decisions I made and actions I took that resulted in my knee injuries. Nothing good comes from traveling down this path of “what ifs.” If you fixate too much on the past, not only will you drive yourself insane, you’ll also lose focus on the recovery ahead, which is the only time period you can control. I felt all grown-up when I finally realized this.
Right now, my biggest concern is the random crackling or clicking noises in my knee. The cracking and popping don’t hurt, and even seem to provide some relief. But the sounds are a bit un-nerving. I don’t know if they are an indication of over- or under-growth in the graft area, or whether I’m still bursting through scar tissues or adhesions, just part of the normal healing process.
I’m also concerned about my inability to “squat” on my bum knee past 30 degrees, the critical point at which the knee truly begins bearing weight. I realize that’s the major litmus test of my recovery, and I’m not yet to the point where I can even try full knee bends. In fact, full squats are probably a month away. However, I want (no, need) to figure out whether I’m on the right path. Likewise, I want to know if/when the OS plans to take an MRI of my knee to see how my cloned cartilage is healing. Frankly, the hardest part of the recovery now is not knowing whether the cloning magic worked.
My next OS appointment is Wednesday, and I hope to get some answers. Luckily for me, there’s also a major knee surgery conference in the area next week, and I understand that not only is the pioneer of ACI knee surgeries attending, he’s also stopping by my OS’s practice during my visit. Assuming this works out, I’ll get a free examination by the Michael Jordan of ACI.
During these moments, I often reflect on the various decisions I made and actions I took that resulted in my knee injuries. Nothing good comes from traveling down this path of “what ifs.” If you fixate too much on the past, not only will you drive yourself insane, you’ll also lose focus on the recovery ahead, which is the only time period you can control. I felt all grown-up when I finally realized this.
Right now, my biggest concern is the random crackling or clicking noises in my knee. The cracking and popping don’t hurt, and even seem to provide some relief. But the sounds are a bit un-nerving. I don’t know if they are an indication of over- or under-growth in the graft area, or whether I’m still bursting through scar tissues or adhesions, just part of the normal healing process.
I’m also concerned about my inability to “squat” on my bum knee past 30 degrees, the critical point at which the knee truly begins bearing weight. I realize that’s the major litmus test of my recovery, and I’m not yet to the point where I can even try full knee bends. In fact, full squats are probably a month away. However, I want (no, need) to figure out whether I’m on the right path. Likewise, I want to know if/when the OS plans to take an MRI of my knee to see how my cloned cartilage is healing. Frankly, the hardest part of the recovery now is not knowing whether the cloning magic worked.
My next OS appointment is Wednesday, and I hope to get some answers. Luckily for me, there’s also a major knee surgery conference in the area next week, and I understand that not only is the pioneer of ACI knee surgeries attending, he’s also stopping by my OS’s practice during my visit. Assuming this works out, I’ll get a free examination by the Michael Jordan of ACI.
Monday, April 13, 2009
3 1/2 month update
Another PT visit, more pain. But most importantly, continued progress. I’m now at 135 degrees flexion, up from the 131 on Friday, which was up from 130 degrees last Monday. Apparently I haven’t hit the flexion wall yet. Yay me! 135 is at the bottom range of what’s considered “full ROM.” I don’t know if I’ll ever regain 100% flexion, but even if I don’t, those last 10 degrees shouldn’t prevent me from functioning normally. And who knows, maybe I'll eventually reach 145.
My extension, however, is a bit lacking. Full extension refers to the ability to keep the leg in a completely straight line in mid-air from a seated position. I’m 4 degrees short of full extension. Basically, my knee bends a tiny bit. That’s not terrible, but I should be at full extension by now. I believe I just need to improve my quad strength to reach full extension, but I’m not positive. I meet with my surgeon next Monday, and this is something we’ll cover.
The knee generally feels ok. Still no pains, though my knee gets tired if I remain standing for extended periods of time, get up and down repeatedly, or walk long distances (ie, 1 mile or so). The knee continues to “crack” or “pop” whenever my knee extends between 45 – 90 degrees, though not from 0 - 45. It doesn’t hurt, but the noise suggests there might be some overgrowth or undergrowth at the implant site. It’s still too early to tell. The cells, after all, continue to mature (harden) for 12-18 months. The back of my knee also seems to make a slight popping sound, like a pinkie knuckle cracking, each time my leg goes from completely straight to slightly bent. It doesn’t hurt, and I suspect (and hope) it’s just scar tissue breaking up. That also might be why I can’t reach full extension. Again, that’s another topic I’ll cover with the surgeon. Keep your fingers crossed...
My extension, however, is a bit lacking. Full extension refers to the ability to keep the leg in a completely straight line in mid-air from a seated position. I’m 4 degrees short of full extension. Basically, my knee bends a tiny bit. That’s not terrible, but I should be at full extension by now. I believe I just need to improve my quad strength to reach full extension, but I’m not positive. I meet with my surgeon next Monday, and this is something we’ll cover.
The knee generally feels ok. Still no pains, though my knee gets tired if I remain standing for extended periods of time, get up and down repeatedly, or walk long distances (ie, 1 mile or so). The knee continues to “crack” or “pop” whenever my knee extends between 45 – 90 degrees, though not from 0 - 45. It doesn’t hurt, but the noise suggests there might be some overgrowth or undergrowth at the implant site. It’s still too early to tell. The cells, after all, continue to mature (harden) for 12-18 months. The back of my knee also seems to make a slight popping sound, like a pinkie knuckle cracking, each time my leg goes from completely straight to slightly bent. It doesn’t hurt, and I suspect (and hope) it’s just scar tissue breaking up. That also might be why I can’t reach full extension. Again, that’s another topic I’ll cover with the surgeon. Keep your fingers crossed...
Wednesday, April 8, 2009
A Moment in Time
One of my favorite writers, Malcolm Gladwell, popularized the phrase, “the tipping point.” It refers to that exact moment when adding one more thing – person, object or event – instantaneously changes a situation. Picture an old-fashioned scale, with equally weighted objects, teetering perfectly still. And then something lands onto one side of the scale, changing things irrevocably.
There’s a reason people identify tipping points in hindsight, something I’ve learned first-hand during this rehab process. I constantly wonder, even daily, whether I’ve turned the corner. I analyze each PT accomplishment, each step taken without pain, each time I bend my knee without difficulty, searching (and hoping) for signs that my knee’s normal again. However, it’s nearly impossible to pinpoint, in real-time, the exact instant a situation changes. Did things really change? Or was it a temporary aberration, with the moment flittering away before slowly returning to the status quo? Unfortunately, blaring trumpets don't materialize to announce the arrival of a tipping point.
I realize I haven’t reached the tipping point in my recovery. Not even close. While my gait has steadily improved, I still walk with a slight limp (though I no longer use my pimp cane). I don’t have full ROM. I can’t push off my gimpy leg to stand up. And if I’ve been on my feet for awhile, my weakened leg sometimes “gives out,” a brutal reminder that my knee is far from healed. But back in January when I was peeing in plastic bottles and showering with my leg encased in plastic garbage bags, I never envisioned I’d reach this point. I know I’ve got a long way to go – at least 9 more months – but for the first time I think I can see the light at the end of the tunnel.
On a less serious note, my knee’s rounded because of the osteotomy. No pointy, bony knee cap juts out. When my leg’s bent, it resembles an amputee stump. Given the uselessness of my knee at times and the fact that the thickest part of my scar covers the 2 inches above my knee cap, that’s an apt comparison.
There’s a reason people identify tipping points in hindsight, something I’ve learned first-hand during this rehab process. I constantly wonder, even daily, whether I’ve turned the corner. I analyze each PT accomplishment, each step taken without pain, each time I bend my knee without difficulty, searching (and hoping) for signs that my knee’s normal again. However, it’s nearly impossible to pinpoint, in real-time, the exact instant a situation changes. Did things really change? Or was it a temporary aberration, with the moment flittering away before slowly returning to the status quo? Unfortunately, blaring trumpets don't materialize to announce the arrival of a tipping point.
I realize I haven’t reached the tipping point in my recovery. Not even close. While my gait has steadily improved, I still walk with a slight limp (though I no longer use my pimp cane). I don’t have full ROM. I can’t push off my gimpy leg to stand up. And if I’ve been on my feet for awhile, my weakened leg sometimes “gives out,” a brutal reminder that my knee is far from healed. But back in January when I was peeing in plastic bottles and showering with my leg encased in plastic garbage bags, I never envisioned I’d reach this point. I know I’ve got a long way to go – at least 9 more months – but for the first time I think I can see the light at the end of the tunnel.
On a less serious note, my knee’s rounded because of the osteotomy. No pointy, bony knee cap juts out. When my leg’s bent, it resembles an amputee stump. Given the uselessness of my knee at times and the fact that the thickest part of my scar covers the 2 inches above my knee cap, that’s an apt comparison.
Friday, April 3, 2009
13 1/2 Week Update
This week was full of mixed blessings. Work was exceptionally busy, thus hampering my at-home rehab (and, more importantly, my blogging). I didn’t make it to the gym, rode the exercise bike the bare minimum, and generally neglected my assortment of leg lifts and squats at home. Despite my inattentiveness, however, I made significant progress this week at PT. Shocking, huh?
At Monday’s session, my flexion improved slightly to 126 degrees. I also increased the number of reps for heel touches and single-leg squats. And I did them without the brace for the first time. Even better, my knee didn’t ache afterwards. I also began using Judy’s antiquated stair stepper, basically pumping away but never letting my knee bend further than 30 degrees. (That’s generally the point when the patella begins to bear weight, which I’m trying to minimize). This machine is straight out of a Suzanne Summers infomercial.
On Friday, I reached a new milestone – 130 degrees! Crossed a new threshold. Full flexion ranges from 135-150; it depends on your size and generally flexibility. My good knee can bend 145 degrees. I’ll gladly accept 140. Interestingly, I reached 130 without much assistance from Judy. Usually, she contorts my leg repeatedly, reducing me to tears, before she takes her measurement. This time, my knee “popped” during an abduction movement – from a seated position with my legs straight, I push outward and pull inward against Judy’s pressure. It sounded like somebody’s knuckle cracked. Although this loud sound freaked the bejesus outta Judy, it was only some excess scar tissue breaking apart. It didn’t hurt, and actually provided some relief. Somehow my knee was ready for Cirque du Soleil. Ok, that’s exaggerating things a bit, but you get the idea. Judy was surprised to see how much flexion my knee improved after the popping. Man, 130! And with no tears!
Reaching this target, of course, means karmas gonna demand some sort of setback. That’s how life works, right? Hopefully I won't get kicked by some angry 7-year old this weekend.
Finally, as my regular blog readers realized, this was the longest gap between posts – 8 days. My bad. That’s what happens when work gets in the way. Hopefully this was just an aberration. Another observation: it’s much harder now that it was 3 months ago to write funny material. Back in January when I was pissing in a urinal bottle? And pooping on a raised toilet seat? Like Frank Caliendo says, funny. Very funny. But increasing the number of reps on heel touches? Um, not so much. I never thought I'd be disappointed to leave behind a series of personal humiliations. To counter-balance the lack of embarrassing moments now I’m ambulatory again, I’ll try to weave in random, funny stuff from my world, even if it’s not directly related to my rehab. Hopefully it works. Definitely let me know.
At Monday’s session, my flexion improved slightly to 126 degrees. I also increased the number of reps for heel touches and single-leg squats. And I did them without the brace for the first time. Even better, my knee didn’t ache afterwards. I also began using Judy’s antiquated stair stepper, basically pumping away but never letting my knee bend further than 30 degrees. (That’s generally the point when the patella begins to bear weight, which I’m trying to minimize). This machine is straight out of a Suzanne Summers infomercial.
On Friday, I reached a new milestone – 130 degrees! Crossed a new threshold. Full flexion ranges from 135-150; it depends on your size and generally flexibility. My good knee can bend 145 degrees. I’ll gladly accept 140. Interestingly, I reached 130 without much assistance from Judy. Usually, she contorts my leg repeatedly, reducing me to tears, before she takes her measurement. This time, my knee “popped” during an abduction movement – from a seated position with my legs straight, I push outward and pull inward against Judy’s pressure. It sounded like somebody’s knuckle cracked. Although this loud sound freaked the bejesus outta Judy, it was only some excess scar tissue breaking apart. It didn’t hurt, and actually provided some relief. Somehow my knee was ready for Cirque du Soleil. Ok, that’s exaggerating things a bit, but you get the idea. Judy was surprised to see how much flexion my knee improved after the popping. Man, 130! And with no tears!
Reaching this target, of course, means karmas gonna demand some sort of setback. That’s how life works, right? Hopefully I won't get kicked by some angry 7-year old this weekend.
Finally, as my regular blog readers realized, this was the longest gap between posts – 8 days. My bad. That’s what happens when work gets in the way. Hopefully this was just an aberration. Another observation: it’s much harder now that it was 3 months ago to write funny material. Back in January when I was pissing in a urinal bottle? And pooping on a raised toilet seat? Like Frank Caliendo says, funny. Very funny. But increasing the number of reps on heel touches? Um, not so much. I never thought I'd be disappointed to leave behind a series of personal humiliations. To counter-balance the lack of embarrassing moments now I’m ambulatory again, I’ll try to weave in random, funny stuff from my world, even if it’s not directly related to my rehab. Hopefully it works. Definitely let me know.
Subscribe to:
Posts (Atom)
