Nothing terribly new to report. The knee continues to feel better, and I’m slowly regaining what I consider, “basic functional use.” That doesn’t mean I’m back to normal. Far from it. But I’m able to walk without difficulty, and I’ve picked up enough speed to keep up with the elderly.
My limp is barely noticeable, but still present. The leg gives out randomly once or twice per day, usually for a nanosecond, and then I quickly recapture my normal walking form. Stairs remain problematic. I don’t have to avoid stairs, but I do need to handle them with care, especially going down. I’m just now heading up and down 1 step at a time, rather than planting both feet on a step before continuing, though I still occasionally do that. I also still use the handrail.
Here are some other highlights and lowlights at this point in the recovery:
• The most troubling part right now is the continued clicking, grinding, cracking, etc. during random exercises. Crepitus, I believe, is the technical term. No pain, fortunately. The hard part is determining whether to stop once the knee makes these noises. Dr. Petersen, the Swedish ACI pioneer who examined me last month, advised me to avoid doing knee extensions if it caused “clicking.” I know exactly what “clicking” feels like and can tailor my exercises appropriately. Some of the noises, however, isn’t clicking. It might just be harmless scar tissue breaking apart, or it might be a sign that the activity is aggravating the knee. The uncertainty sucks. I want to build up my quad strength, but I don’t want to jeopardize the healing process. This will be issue #1 to discuss with Turgeon next Friday.
• I started walking on the treadmill. Right now, I limit my speed to 3 – 3.5 mph, which is a pretty moderate walking pace, with the incline levels ranging between 0-3. Twenty minutes on the treadmill at this pace and incline won’t impress Bob and Jillian, but at least I can work up a minor sweat. But more importantly, it doesn’t cause any pain.
• I ride the recumbent bike at a moderate clip for about 30 minutes every day. I’m not going to break out the yellow jersey (actually only dorks wear one), but I manage a slight sweat. The biking and treadmill are my only forms of cardio. Hopefully I’ll be able try the elliptical soon. Meanwhile, I’ll continue biking, which is supposed to be the best rehab exercise for ACI patients.
• I still have some swelling in my knee, especially after I exercise or spend a significant amount of time on my feet. The knee’s no longer a grotesque cantaloupe, but it’s not pretty. Thankfully not as ugly as Hedu Turkoglu, though.
• Bending and squatting are still beyond me. I can handle wall sits, but maneuvers that require short bursts of pressure on the knee are off-limits. I started to add shallow lunges, but the knee crackles inconsistently, and I’m afraid to continue. Again, something I need to address with Turgeon.
• The back of my knee still pops softly after being in a locked position.
• I traveled to DC for a few days last week. TSA’s security measures concern me. The two Home Depot-sized screws in my leg didn’t set off the metal detectors. Hopefully terrorists would embed weapons inside body parts, but you never know. . .
• My passive flexion (meaning, on my own) is 130 degrees, and my active one (where Judy crunches my leg) measured 138 degrees today.
Showing posts with label cracking. Show all posts
Showing posts with label cracking. Show all posts
Wednesday, May 13, 2009
Monday, April 27, 2009
Week 17-18 Update
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).
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).
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...
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