The Road to ACL Recovery (Day 39)

On the eve of Day 40, I’m pretty close to ditching the cane, cool a fashion item as it is. I don’t need it on short trips at all, and if it weren’t for NYC’s treacherous subway system I would have probably left it behind by now.

Something new is happening at PT: I am sweating! That means the workouts are becoming aerobically challenging. I am actually strengthening my leg and getting back into shape, not merely trying move my leg up and down like in the early days. Spending time on machines, biking with resistance, and doing wall squats. It feels good to sweat.

It’s not as if the pain is gone. I have awkward ‘pops’ a few times a day from cartilage moving around. Sometimes I wake up in the morning with my knee super stiff or sore. And stairs are stairs. They’ll be tough for a while. But overall, progress marches on.

Next report will be after my surgeon check-in on Tuesday.

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The Road to ACL Recovery (Day 33)

Now more than a month in, I am excited to report that I am using a cane instead of crutches. In fact, I don’t even need the cane for walking, but it is still pretty essential for navigating subway stairs.

PT can still be challenging and lead to soreness. That’s the nature of PT- if it’s too easy, you’re not working the knee hard enough. Currently we’re working on “e-centric” strength, the quad muscles that allow you to lift up and come down on stairs. We’re also down to twice a week.

The best thing I heard last week was my therapist saying that my flexibility (140 degrees) is the best she’s ever seen at this stage of ACL recovery.

If I had to pick one inconvenience, it still remains quite uncomfortable to stay seated or standing for any extended period of time. Getting up every few minutes to stretch things out is essential.

 

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The Road to ACL Recovery (Day 28)

My recollection of my last ACL recovery is that it that it goes through spikes and plateaus. Great progress one week might be followed by two weeks of little gain. Before now I hadn’t a plateau of any length, but Week 3 proved to be an uneven one.

Here’s the good:

1) My left knee flexibility is 135 degrees unassisted, 140 degrees assisted.  My right knee is also 140 degrees, so I am close to achieving full flexibility less than a month in. Everyone thinks that is pretty remarkable.

2) On flatness, I am only one to two degrees from zero, which is the goal (a flattened leg). For me, this is a big improvement, but no rest ’til zero.

3) My quad is gaining strength, though it’s still got a long way to go.

4) On flat ground, I don’t really need a brace at all, and only have one outdoors in case I hit an uneven patch or crowded area.

Here’s the mixed:

The main focus of Weeks 3 & 4 will be stairs – developing the quad strength and jnee stability to go up and down them unassisted. A week ago, I found stairs impossible, and had to scuttle up half a step at a time, leaning on subway stair rails. Today I can gingerly go up and down stairs with a light tough on a rail or crutch. A week ago I couldn’t even try the exercises designed to build up this strength. Today I actually fell during PT for the first time attempting side step-up exercise, but at least it was at the conclusion of a full set. Progress. Slow progress.

Here’s the bad:

Last night I felt a cracking in my left knee, and pain followed. Ever since then (24 hours ago), my knee has been tender, and two crutches have felt preferable to one. My knee is locking up frequently, as opposed to just once in a while. My PT believes that this is related to the scar tissue that the new exercises are designed to break up. Loose cartilage and scar tissue floating through my knee is causing this discomfort and knee locking. They don’t seem worried at all at the PT office. It will pass.

 

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The Road to ACL Recovery (Day 21)

Have I really not updated in five days? Progress has been tremendous since then. I can now walk without crutches on flat ground outdoors, though I keep ’em handy in case I hit a rough patch of sidewalk. The basic exercises are easy, and I no longer wear a brace indoors. Sitting for prolonged periods of time still lead to discomfort and stiffness, so just gotta keep loose and stretch every now and then.

The next hurdle is step-ups, which, true to their name, recreate the pressure put on the knee from going up and down stairs. These were a major headache last time I went through PT, and I struggled with them today.

Overall, though, still pleased with progress. I’m also now allowed to bike on my own, which means I’m finally back at the gym.

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The Road to ACL Recovery (Day 15)

Yesterday pushed my new knee to its new limits. In the morning I had PT with a new therapist, since my usual was in Vegas. She was very impressed, clocked my left knee in at 135 degrees of bending, which is only five degrees off my right knee. I’ve been able to gradually increase weight on all the machine-based exercises, and have started stretching my IT band, in an effort to get more flexible in addition to stronger.

After PT I had a meeting, a speaking gig on a panel, a late lunch, an event, and a basketball game. It involved a lot of getting up, sitting down, walking around, all without the usual respite of ice and lying down. By the time I got home at 11pm, my knee was in agony. I was legit concerned I had messed something up.

Even this morning, my knee was sore and tender, though the sharp pains were mostly gone. Had PT again today, Thurs/Fri being my back to back, and the therapist on hand said that the previous night’s pain was likely from muscle exhaustion and nothing more serious. Indeed, once I got warmed up I was able to perform all of the PT exercises without a sweat. The whole experience was a good lesson in easing back into things. Still very amped to be where I am 15 days later.

 

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The Road to ACL Recovery (Day 13)

Today was a big day – physical therapy followed by my first doctor’s appointment since the surgery. There’s always some tension between the physical therapist and the surgeon about the recovery process, and solid arguments for why to listen to one versus the other. In my case, the doctor is one of the best surgeons in the city, but the PT is from the office that he specifically recommended, and they work on rehab fulltime. Here are there two beefs:

1) One crutch v. two crutches: The argument for one crutch, made by my PT, is that normalizes walking, now that my knee is strong enough to handle it. The argument for two crutches, made by my surgeon, is that my knee isn’t strong enough for perfect form, so using one crutch will encourage leg favoritism and lengthen the healing process. I know from injury experience that one crutch isn’t enough to get you a subway seat in this town – New Yorkers are cold like that. Thus, I’ll stick with two for now, while relying on one to get around meetings and such. How else can you hold anything?

2) To brace or not to brace. This is less contentious, because both agree that I no longer NEED the bulky brace, which is a relief. Likewise, the stability afforded by the brace is only encouraged by the PT because she wants me to use one crutch. I’ll probably ditch the brace in most circumstances.

The rate of recovery continues to astound me. My leg bent 110 degrees today, and the amount of weight I can put on it is at least a week ahead of schedule from my last ACL surgery in 2008.

I ran into an ex-colleague in the Hospital for Special Surgery waiting area today. He just tore his ACL, so he’s on the other side of the gulch. I told my surgeon this, as he is treating both of us, and he smiled. “Even New York  can be a small city sometimes.”

 

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The Road to ACL Recovery (Day 10)

Progress continues to come quickly, though at a cost of some pain. Had my second PT session yesterday, and the gloves are off. Spent six minutes on a bike. You could hardly call it pedaling- I think I was going about 40rpm on the lowest setting, but it felt amazing to move my legs again. Was surprised to be doing that and certain other exercises so soon after surgery, but both my physical therapist and doctor are saying full steam ahead.

Of course, no progress without pain, especially in the world of ACL rehab. When I got home and took off my brace, a big patch of my leg was purple from blood clots bursting, and welts have formed up and down my leg, some of which dissipate when iced. I couldn’t sleep at all last night, hence the 7am post. But I’ll take it. These early weeks are a classic Hobson’s choice- stay in pain, unable to walk, or go through the pain of rehab to at least get better.

I’ll call Friday a win and look forward to trying out new exercises over the weekend, while relying as much as I can on Advil to keep things tolerable.

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