kneehabilitation

a tale of a torn ACL

[kneehab]

six and seven months

Wow, I’ve been really slacking on ACL updates! I think that’s probably okay because there is not significant to share. At this point, slow or no news is good news, I think!

Everything is great. I never think about my knee except when I am squatting deeply at heavy weights (my left quad shakes sometimes) and in physical therapy. The other thing is, my left knee creaks and cracks a bit when I do plies in fourth or fifth position (oh yeah, I’m taking a beginner ballet class as cross training for aerial silks!).

I think the general pattern is that it’s noisy still during newer movements and the quad shakes and is generally still weaker than my right quad. I’m working on that, but if I’m being honest, motivation to hit the ACL-recovery specific gym exercises has waned a bit.

At this point, I’m doing aerial silks twice per week, a beginner (truly, so beginner) adult ballet class once per week, strength training two-three times per week (two being personal training), and running every other day at 3-4 miles each time. So it’s a lot of activity and that makes me so happy! But because I’m not really missing anything from my life anymore, I feel a bit less motivated to get to 100% leg strength symmetry.

But I know it’s important and I am trying to hit at least the knee extension machine and squats 2-3 days per week. Last time we tested it was a bit over 80% symmetry, I would imagine it’s a bit higher now.

Very excited to get to that 9 month mark, after which re-tear risk drops off even more significantly. I’ll try to update this post later today or tomorrow with some photos of my quads. There’s definitely still a visual difference in size/muscle tone but I think it’s less so, and when I flex my left quad there’s totally muscle there. And to be fair, my right quad is getting stronger too, so my left quad not only has to get back to previous normal, but also catch up!

[kneehab]

five months

I’m not sure how to count how many months post op I am this point, as weeks don’t align perfectly with months! If you’re counting based on months, since my surgery was May 2, I hit five months this week on October 2nd. However, if you’re counting just by weeks, I’m 22 weeks post op, which is five and a half months. I don’t know how much it matters at this point.

Regardless, I think things are going really well. I’m gradually ramping up my running, following my PT return to running program. I’m up to running for a few minutes at a time, and I’m hoping I’ll be able to run some 5ks and 10ks before the end of the year!

I still get a little pain when extending my leg after sitting with it bent for a long period of time, and occasionally get twinges of pain behind my knee, which I think is that same calf muscle issue. But on the whole, it feels stable and on an upward trajectory!

In PT, I’ve started doing lots more jumping/hopping work. I’m doing single leg hops, and jumping on and off boxes. It feels totally normal, which is great. I really do trust my left leg in motions like that now.

I’ve returned to doing aerial silks classes, and that’s been a lot of fun and also unnerving. With any new movement I feel anxious that I’ve torn the graft for sure, even movements that my PT assures me are safe! I’ve also been going to flexibility classes.

Because I’ve been doing some new things, I still get some new aches and pains, and tension in places I haven’t felt for a while. With new movements, my knee tends to crack a bit, but it’s rarely painful and happens much less than it used to.

I had hoped to be doing more hiking at this point, but it has been so smokey in the Pacific Northwest from the wildfires that I haven’t done much. Same with running, honestly — I don’t feel comfortable doing much running, either outside or in my gym, which has poor ventilation, in this air quality. But, all in good time.

I don’t even have any new photos to share! I’ll do a bigger update with photos for my 6 month update. I’m also seeing my surgeon for a follow up appointment later this month, and hopefully he’ll be happy with my progress! 

[kneehab]

four months

This is actually two weeks late — I’m 18 weeks post op today! I had delayed posting a four month update because I was hoping to include updated strength testing numbers, but those haven’t happened yet, so I thought I would post before I forget and update with numbers later.

Not much swelling left at all! Quad size difference is still pretty noticeable, though.

Mostly great things here. At PT, I’ve been running on an anti gravity treadmill (alter G) since 13 weeks at partial body weight, and it has felt amazing to be able to run again, even if it’s only in a weird suspended box.

Basically, the way it works is that you put on a tight fitting pair of shorts, and the shorts zip into the top of the treadmill. Then, it inflates with air to calibrate to your weight, and then you can select by what percent to offset your body weight, so that you can run without the stress of 100% of your weight on your knees. It’s great for ACL recovery. I started out running at 60% of my body weight at 13 weeks, and last week I was up to 80%. Once I do my next round of strength testing I’ll be able to do full body weight running in intervals — so run for a minute, walk for a minute, etc, until you can run for a while without aggravating your knee too much.

It was wild how sore my calf was after the first time running in 6 months!

I’ve also been biking outside and doing some hikes with elevation now. I was really nervous to bike outside since I’ve heard you can re-tear if you put your foot down wrong at a sudden stop, but my PT assured me that since I’m an experienced cyclist, as long as I’m careful I’ll be just fine. I biked about 15 miles around Vancouver, BC, and it felt great until I pushed off at a weird angle on a hill and then my knee just felt a little “off.” I was extremely anxious that I messed something up, but I got my weekly Lachman test at PT and it all seems solid! 

Still lifting weights at the gym. I’m up to deadlifting more than my body weight (I weigh just under 100lbs, and have been deadlifting about 125lbs) so that’s exciting. I’ve noticed that deep squats are still hard for me, and I get a small amount of knee pain in my ACL side when I come out of a deep squat with weight. So I just don’t go as deep, but squats do seem to make my quad reliably sore. And the knee extension machine is the other main quad-focused exercise I’m doing.

I don’t mind lifting but I am excited to be switching soon to more of a run-based PT program. I’ve been doing a lot of plyometrics now at PT so certainly moving in that direction! It’s funny, at my surgery consultation in April I had asked my surgeon if he thought I could do a half marathon in November and he said probably not. And now I’m just starting to run again and I definitely think that timeline would be pushing it, but I am confident that I’ll be able to do some 5k and 10k races for fun by the end of the year and that’ll feel great!

[kneehab]

three months

I hit twelve weeks post op on Monday (two days ago), and I had my first round of isokinetic strength testing yesterday, so lots to catch up on documenting.

First, all the good (and there is lots of good!):

I don’t think about my knee at all, except when I’m at PT, someone asks about it, or I’m trying a new exercise or something at a higher weight in the gym. It occupies very little space in my head on a day to day basis.

I have full and equal range of motion! I have been at full extension since day 1 thanks to me not having hyperextension and due to the leg brace being locked straight, but I hit full knee flexion (about 155 degrees for me) at 8.5 weeks post op, so just after my last update was written. I can also fully sit on my heels kneeling.

I’ve started swimming. Not a ton, but around the beaches in Washington (it’s been so hot) and even in a pool at a gym I got a day pass for.

I’m walking and cycling tons now, sometimes walking upwards of 20,000 steps a day, which feels great.

I tested essentially equally on my functional testing. That includes things like a Y-balance test, where a PT measures how far you can touch your toe while standing on one leg at a time, things like that.

I don’t have any more pain behind my knee when flexing my quad.

Swelling is basically gone. Occasionally after a hard gym day or a really long walk I will get a tiny bit of swelling but it’ll be gone by the next morning.

I’ve started some basic plyometric/jumping/pre-running movements in PT! This includes gently bouncing up and down on your toes and softly landing from one leg onto the other. 

... And the tough.

Luckily, the tough is pretty minimal, but the main one is that I didn’t get the strength testing results I was hoping for. I’m at about 65% LSI, in other words, my left quad is about 65% as strong as my right. My PT says this is a solid number for where I am at in the recovery, but it’s hard not to be pretty disappointed as I need to be at 80% to run. But it’s helpful to have the clarity of where I’m at, and what my next steps need to be to hit my goals. My mission for this month is to work my quad hard, consistently, every other day, no excuses, so I can be as close to 80% as possible by my next round of testing at 4 months.

I think I might be struggling to eat enough protein, and also eating enough in general. I want to make this a focus of the next month, too. I can’t build a quad if I’m not giving it protein.

I’ve also just been struggling with a feeling of loss. I’m sad to be missing out on stuff still. Even though things are infinitely better than they were a month or two ago, I’m still not able to do many of the things I love. I can’t run, I can’t do aerial silks, I can’t do a triathlon, and that sucks because the season will be over by the time I could do so physically.

At the end of the day, things are pretty great. My graft is still there and strong, and I’m able to walk and hike and swim and be outside. I’m so grateful that the early stages of recovery are behind me, as I remember in those early days I just couldn’t imagine there would be a day again where I could just take a long walk without limping.

And I am really grateful for the good habits that the regimen of PT is teaching me. It’s building a gym habit. I never did very much squatting or strength training in general and was a bit of a “cardio queen”, so needing to do this to meet tangible goals is giving me the structure to develop discipline around strength training.

Onto the next month, and welcoming a mindset of growth and discipline, as well as a sense of joy in the small moments of new abilities.

[kneehab]

two months

Technically I’m almost 9 weeks post-op now — I’m a little late on this post! But that’s for good reasons. For the last couple of weeks, I’ve really just been out there living my life and not thinking about blogging, or really thinking about my knee, much at all.

I guess a lot has happened since my 5 week post. At 6 weeks post op I had my follow up appointment with my surgeon. It was totally uneventful — he said everything is looking perfect, and he was impressed with my range of motion! He also said he couldn’t decide whether to note my quad atrophy as “minimal” or “moderate”. He decided on moderate, but the fact that it didn’t look too bad to him felt like a win! The atrophy still looks pretty extreme to me.

We moved about 1,000 miles away to the pacific northwest and so have spent the last few weeks exploring a new city. To my surprise I have been able to walk distances I couldn’t have anticipated I’d be able to do so soon. I’ve been walking upwards of 10,000 steps a day, about every other day, for the last week and a half! With no knee pain!

Another win has been a change of phase in my recovery. Instead of having a list of exercises I need to do three times a day, every day, I now spend about an hour in the gym every other day. I do things like knee extensions with weight, hamstring curls, and leg presses. I prefer this, because it doesn’t intrude on my daily routine — I’d be going to the gym anyway. So I go and do my leg exercises as well as some upper body training — bench press, lots of bicep/tricep/lat stuff. Best of all I can walk to the gym.

Physical therapy is going great too. My PT Nika is just awesome, she is realistic about expectations, pushes me just enough, and knows what it’s like to be dying to get back to the stuff you love to do.

Overall my leg is just feeling really capable. I trust it, and it doesn’t hurt at all anymore at all.

The only thing that feels less than ideal is the pain I get behind knee at full extension, that I feel when flexing or walking. Nika thinks it’s just that strained calf muscle issue, but it’s frustrating how long it’s taking to really recover, and it is interfering with my ability to push my flexion. I really want to sit on my heels again, and I’m so close. But my understanding is that flexion is easier to get than extension, so hopefully I’ll get there eventually.

Swelling is almost gone at this point, but there’s still a little.

I’m also trying to still be pretty careful at this phase, just because I know that the graft gets weaker from about 6-12 weeks or so and then gradually gets stronger again. Obviously, I feel committed to avoiding a re-tear if at all possible, so listening to and trusting that my PT will make the right decisions about how hard I should be pushing it.

It’s July now, and I’m really hoping that I’ll be able to do some real hiking with some elevation by the end of the month. The weather has been so beautiful and I want to get outside and moving again in the mountains. Month two was pretty great, so excited to see what month three has in store.

[kneehab]

five weeks

I told myself I was only going to update here once per month once I hit four weeks post op.... but stuff just keeps happening that I want to remember, and it’s my blog and I can do what I want. So here’s a five week update.

This week I have been thinking about how we are a system of systems. The vast majority of the time, we aren’t thinking about the complexity of what is happening inside of us — the complexity that we are.

Walking is a surprisingly complex biological behavior. We take it for granted until we don’t have it anymore, and we forget how to do it shockingly quickly once we can’t do it for a while. It’s only actually easy because we do it all the time. A number of details have to line up just right for a person to walk in a way that is stable and pain free — it involves coordination between the muscular, skeletal, and nervous systems. Weakness or damage to any part of one system — like atrophied or poor control of the quadriceps muscle — makes walking challenging if not impossible.

But oh, how beautiful a thing the freedom and joy of mobility is; to just walk effortlessly, when you are gifted with a true appreciation of its significance and complexity.

This was the week I started walking without crutches or a brace. Just around the house for now, but it feels amazing. (Most of the time... I keep having intermittent mild pain towards the outer side of my knee when I bend my leg behind me to bend it through and step while walking. It’s not every time, and it mostly happens when I am not walking in a straight line but rather when I am turning while walking. I’ve also observed that if it’s hurting in that way and then my knee cracks, like cracking your knuckles, it doesn’t hurt. So my assumption is that stuff is just moving around?)

Other than that, things are okay. My perception has been that progress has slowed, but my PT seems to think that’s not the case. I guess early on it feels like everything moves a bit faster but as you start to get further out, the milestones are further apart and the ROM gains take longer to get.

That said, I did get 147 degrees of flexion this week! My heel is about an inch from my butt. It takes be a bit of warmup to get to that, but that feels like progress and I can’t wait until I can sit on my heels. It’s also way harder to get flexion in standing or prone position vs seated. But I’ll take this win!

For week 6 I think I am going to prioritize tackling swelling more than anything and try to ice and elevate a lot more. Swelling has definitely gone down a bit but it feels like at this point, it’s the biggest barrier to the last bit of range of motion, and I also will need swelling to be down to be able to run and start getting active again.

My other big feeling this week is wondering why more people don’t incorporate small daily exercises to prevent injuries and an unbalanced body. Doing a few exercises a couple times per day isn’t very much work at all.

My dad is a badass. He’s 60 and is about as active as I am (well, as I am normally). He plays basketball and hockey several times a week, and last summer, he summited Mt. Tallac in Lake Tahoe with me, a hike with over 3,000 feet of elevation gain at moderate altitude.

I’m feeling a renewed sense of commitment to being like him in a lot of ways — to be running marathons and climbing big walls at 60 — and to maintaining balance and stability in my body long after I stop ACL related PT.

[kneehab]

one month

Four full weeks since surgery... and there have been so many moments this week that felt so normal. The highs have been pretty high this week, and honestly, the lows haven’t been particularly low.

Highs: 

The biggest win this week was feeling like I trust my operated knee/leg much more. I don’t think about it as much. Getting around, up and down the couch, up and down stairs — I’m not worried it’s going to give out and I don’t feel as paranoid about hurting it.

I’ve been walking with the brace unlocked and with just one crutch (which is just for balance, I’m not putting any weight on it). I haven’t had any stability issues at all — no knee buckling or missteps. PT says that I will likely be off of this remaining crutch in the next couple of days! And then out of the brace, and then I’ll be entirely free.

The steri strips are totally gone on my leg now, so I’ve gotten a good look at my scars. They are closed but there is a small scab remaining on one of them. Once the scab falls off I’ll be able to finally take a bath, too.

I have full and even extension in both legs, and it doesn’t hurt to reach that extension even while sitting with knees bent for long periods of time.

I’ve been using the stationary bike every day on low resistance for about 5 minutes at a time, primarily to work on flexion rather than quad strength and it feels really good. The lower the bike seat is, the more flexion you need to do in the knee to get a full rotation so I lower the seat below what I would normally.

I hit 140 degrees of flexion this week! I think I gained about 20 degrees of flexion just since last week which feels great. My non operated knee has about 155 degrees of flexion (full heel to butt both active and passive) so I have about 10-15 degrees to go before they are even. I have a feeling it’s like many things in which the earlier gains are easier, but getting that last 10% takes much longer.

The lows:

I’ve been having some cracking and popping in the joint when I walk, usually when bending the knee to bring it forwards to step when walking or when there’s any kind of side to side motion.

Some moments of pain when trying new exercises this week. I experienced pain behind the knee when trying standing hamstring curls for the first time, and I’m still experiencing quad pain during EMS treatments.

Also, I still feel pretty anxious every time I do a new movement of any kind, or there’s some crackling, or any kind of new pain or swelling, that I’ve torn the graft. I can’t wait until my 6 week appointment with the surgeon so he can validate again that it’s still there and okay! The idea of going through all of this again is just so horrifying. I feel so determined to never need another ACL reconstruction...

Looking forward to week five and month two. And it feels good to be able to check one full month off — just 2-3 more until I can run again!

[kneehab]

three weeks

Three weeks post-op. This week, I have been thinking about the similarities between recovery/physical therapy and self love, since the connection was pointed out to me by my friend E.

You may not believe that you are strong, beautiful, capable, loved, or brave. Extending the same unconditional love that you might feel for a puppy or child to yourself is no easy talk, but this healing occurs in small moments. Standing in a mirror every day and repeating that you are all those things and more, but more importantly, that you can see, accept, and love yourself regardless. With enough time and repetition, you’ll start to believe it — so slowly you don’t know it’s happening at all.

It’s the same idea with physical therapy. Progress is made so slowly that you don’t believe it’s doing anything at all, but consistency in these small rituals is rebuilding a body that is stronger than it ever was before.

I tend to approach most things in my life by pushing as hard as possible on something with obsession, dedication, and competition, and then to have that thing be Done and Resolved. Neither self love nor physical therapy are about pushing yourself as hard and quickly as possible.

I’ve been feeling grateful for the lessons this journey is teaching me. At the same time, this week has been more challenging than I expected.

The steri strips are almost off at this point — I’ve been keeping the loose bits trimmed. I don’t want to tug on them, but I’m hoping they’ll be completely off by next week and then I can get a better look at my cool new scars.

Earlier on this week, I was experiencing deep aching knee pain at night so intense it would keep me up. It went on for about three nights, and taking ibuprofen and acetaminophen only helped a bit. I’m not sure what was up with that, but I’m glad it seems to have gone away.

And now today and yesterday I’ve been having pain towards the back and outside of my knee when I flex my quad in certain positions into deep extension. It will twinge up when walking too. I’m hoping things like this are all normal and part of the healing process, but it’s frustrating and difficult to not see them as steps backward.

I also wasn’t able to keep up with my icing/elevation/PT routine quite as much this week because we went to Yosemite for a friend’s wedding. It was beautiful, but a bit of a challenge. There was no ice, and I also needed to be sitting for hours at a time, both in the car and at the wedding itself. Here’s me trying to elevate my leg in the car.

I was a little nervous about blood clots between the sitting still and being at altitude, but my physical therapist reminded me that plenty of people have orthopedic surgery in Denver, and the vast majority of them do not experience DVT. Still, it was such a treat to be outside in the mountains breathing the air, even if I couldn’t hike or climb this trip.

My flexion is definitely improving. This week, I’ll be using the stationary bike more since I now have the flexion for it! This is also the week I’ll start re-learning how to walk without the brace locked in full extension.

The best news of the last week, though, is that I found a remote physical therapist with a ton of experience with ACLrs and athletes. Her name is Nika, and she is awesome! I found out about her through a thread on the ACL subreddit forum. I’m now working with her remotely in addition to my normal PT and it’s making me feel a lot better about the level of guidance and sports-specific advice I’m getting. She is also available 24/7 for any questions or concerns and it’s made a huge difference to be able to text an expert with anything that comes up, from weird pains to probably irrational anxiety.

Looking forward to seeing what lessons, gains, and losses week 4 has in store for me.

[kneehab]

two weeks

Today marks two full weeks since surgery! Time is moving fast in some ways, and so fucking slowly in others.

The cats are loving all the bed and couch time. The cats would support more torn ACLs if it means the humans are home all the time and available for pets!

I have gotten so used to the brace at this point that it feels unnerving to have it off. I think it’s the combination of muscle atrophy and the absence of the brace that makes my left leg feel so light. It feels scary to take it off to shower. It’s going to be so strange and scary when I can finally walk without the brace in a few weeks.

I’m also sleeping totally soundly with the brace on, now that I’ve figured out the optimal setup. I made a ramp with the pillows so that my leg is elevated, but my knee and upper leg are also supported without creating a bend in the knee. That way, I can turn over onto my right side and my leg stays supported. I can start sleeping without the brace in one week, and I’m going to be such a pro by then.

Flexion has continued to improve — I think I must be at about 110 or 115 degrees, which I feel especially good about because once I reliably hit 120, I can start riding a stationary bike. That will do a lot to stop the muscle atrophy in my quads and just generally increase the strength of the whole leg, which will support me once I can walk again.

I’m still wearing the ace bandage all the time because the brace straps rub on the quad incision without the cushion, but I take it off once a day or so to check on the wounds. 

The other day I took off the brace and I noticed a lump on my inner left thigh — you can see the slight protrusion in the skin in the photo below. (Excuse the discrepancy in the level of shaved-ness of my legs.) The lump seemed to follow the contours of the brace straps, and when I let the leg sit out without the brace on for a bit, the lump became softer, so I think it’s just from the straps. There is no lower leg swelling or discoloration or pain, so seems unlikely to be DVT, but it was still a bit of a weird feeling and a little scary to find it.

You can also tell that my whole left leg is just kind of swollen, not just the knee, so I’m just sure it’s just a lump of fluid from all that’s going on in there.

This whole experience has been... dissociative. It is a feeling of not knowing or trusting the state of your body. From the initial nerve block/not being able to move your leg after surgery, to finding fluid lumps, to muscle atrophy, it’s just a process of losing the feeling of safety and home in your body. I am looking forward to rebuilding that trust and familiarity again over time.

I can do more for myself at this point; I can easily get in and out of bed, I can drive, I can make myself coffee and clean the cat box. The only things I need help with are lifting heavy objects, like the icewater system or cat litter or the trash. My balance isn’t good enough, especially when I’m using a crutch.

I still find it hard not to compare my progress with others’ sometimes, and it’s difficult to not feel frustrated by the lack of mobility. I’m tired of watching TV and reading so much.

I just want someone to promise me that I’ll get my muscle back and that I’ll be able to walk, run, and climb like I used to again. I know it’s very likely that I will; everything seems to be going fine so far, but sometimes you just want someone to reassure you that everything is going to be fine.

[kneehab]

day 11

It is infinitely easier and faster to lose trust than it is to build it. So much easier to lose friends than make them. And god, it is so much easier to lose muscle than it is to build it...

Muscle atrophy has become apparent. It’s harder to tell in photos vs in person, but when I flex my quads, you can’t see the outline of the muscle in my left anymore like you can in my right. And my left calf is looking more like a child’s than my own...

I don’t have any pain anymore, and I have been committing myself hard to the exercises PT has given me — both when at PT and at home. The hardest exercise for me at this point is one where you lay on your stomach and bend your knee towards your butt, almost like a hamstring curl. My left leg shakes with the effort when I do it... meanwhile, with my right, it feels like nothing at all.

I am slowly increasing my flexion. Today I took off the brace and worked a bit past 90 degrees. I am not sure exactly how many degrees of flexion this is, definitely past 90, but it wasn’t even painful to get here!

I have also been wearing the cold therapy/ice machine under my brace and icing down my knee. It doesn’t feel particularly inflamed, but I try to do it anyway after another round of the exercises.

I set a few times on my phone to do the exercises. I am working on surrendering to and accepting the rhythms of this stage of my life. Every few hours, my phone nudges me to bend my knee, to go up and down on my tiptoes, and practice hip strengthening. Every few hours, I ice my knee again. It won’t always be this way. But it is right now, and that’s okay. 🖤

[kneehab]

day 9

Today’s big update is that I had my followup appointment with the surgeon! I had x-rays taken, and then I saw the surgeon to get my stitches removed and to go over the images from the surgery and next steps.

On the x-ray, I was able to see the screws in my tibia keeping my graft in place, which was really cool. He also went through the images taken by the camera inserted into my knee — it was wild to see it from that angle! He also showed me my meniscus and cartilage, which all looked to be in great condition.

He removed my stitches, which hurt a little, and examined the knee. He said it’s looking great and that it isn’t inflamed!

I asked him how he could tell that the graft was still in place, and that I hadn’t already torn it. He stretched the knee a little, doing what’s called the Lachman test, and said he could tell it was being held stable, just like my right knee, whereas before it was loose when he pulled in that direction. So I’m glad it’s still intact! 

However, he also said he wants me to still use the crutches for another week or two. This was disappointing news... I was already doing full weight bearing and feeling confident. He said it’s unlikely but possible to stretch out the ligament by walking and turning on it with full weight this early in recovery. So I’ll go back to using one crutch for another week or so.

In better news, I was cleared to shower! I took one as soon as I got home. I was nervous to have it outside of the brace, unprotected, and was worried about the possibility of slipping and falling. I used a chair part of the time and it went okay, and I feel so much better finally clean and smelling okay.

I also have the okay to start working towards 120 degrees of flexion, but he said I don’t need to push it at this point and that 90 is more than fine for this stage of recovery.

Muscle atrophy was more noticeable than I expected, since I am walking a bit still. My left calf is noticeably smaller than the right. The quad difference is there too, but a little less extreme than calf. I’ll be excited to build up the muscle again.

I don’t see the surgeon again until mid June... until then, it’s mostly the same. PT twice a week, and still wearing the brace while walking. I feel infinitely better than I did a week ago, but it’s still hard to think about how far I have to go until I can run, hike, and climb. This is such a journey already.

I’m not sure I am going to keep doing daily updates much longer — soon I might switch to weekly, or even monthly, especially as things stabilize a bit more and the recovery slows down.

[kneehab]

day 8

I started physical therapy and I feel let down a bit. I’m not entirely sure what I was expecting... something bigger. It felt like this huge deal to me and I was so excited to make progress but we barely did anything. We just went over the exercises I’d been doing so far, she gave me a few more, and then watched me walk around without crutches and go up and down stairs.

She did say it was fine for me to not use the crutches. She also took off the brace and bandages to take a look at my leg, which was the first time I had seen it since surgery. It was still really yellow because of the iodine and there was some bruising but it wasn’t as weird looking as I feared it might. I’ll take some photos tomorrow at the appointment with the surgeon — she wrapped it back up for now.

The PT place I found isn’t the right fit for me, I don’t think. I asked the physical therapist whether she sees a lot of ACL reconstruction cases, and she said, “No, it’s actually a huge treat for us to see someone your age who does sports! We mostly work with older patients.” Indeed, the other patients there were older women.

But if my physical therapist doesn’t work with younger people who do sports, I’m not sure she’ll know whether I’m making good progress, and she might have a harder time troubleshooting any potential complications or issues that arise. Tomorrow I’m going to call around and see if I can find out a different place to try.

I did more walking today. I had to walk around the area to get to PT, and then I walked all around the grocery store for the first time since surgery. It didn’t hurt at all at the time, but once I got home and laid down my leg started aching, including in some weird spots — my upper inner thigh.

It made me really upset. All I did was walk around the grocery store and go down a flight of stairs. That is hardly doing anything at all. I’m an active person, a runner, a climber, and it feels like I’m trapped to have this little exercise upset my leg like this. I want my body back. I want to feel at home in my body.

[kneehab]

days 6 and 7

One whole week since surgery! In most ways, things are better than I expected and feared they might be at this point pre-surgery.

My knee still throbs every time I go from elevation to standing up, but it doesn’t from flat on the bed or couch to standing. That is pretty much the only time I feel pain anymore, except an occasional ache behind or in front of the knee when lying down that’s maybe a 2 out of 10.

I am still taking ibuprofen a few times per day, but that is to keep swelling down rather than because of pain.

Flexion has felt a little more painful the last couple of days — it feels tighter and stiffer on top of the knee. It feels tight in the sense that I almost feel like I am going to tear the stitches out and rip my knee open if I bend it. I am still able to hit 90 degrees of flexion, but it hurts a bit more than it did a couple days ago to get it there. I’m wondering if this is actually *because of* the stitches and whether my skin is starting to heal around them in a way that feels tight? I’ll be getting them out on Wednesday and looking forward to see if it feels easier to bend at that point.

I find myself using only one crutch and sometimes no crutches at all. I feel very stable on my feet at this point, with no pain. I don’t want to push it too far too fast, but it feels both easier and more practical to not use the crutches. It’s nice to be able to actually carry things around the house. I hope I’m not overdoing it beyond what I’m supposed to at this point — the surgeon did say partial weight bearing as tolerated...

PT starts tomorrow, and follow up with surgeon is the day after that. Really looking forward to both of these, as they feel like real progress.

[kneehab]

day 5

This is the closest to a normal day I’ve had since before surgery, and that feels like a win,

Good things about today:

Woke up with no pain. Ordered breakfast. Had a lazy morning with my partner. Was able to walk around more with just one crutch. It still hurts a lot when I go from laying down to standing up, but that’s about it and I feel grateful for that,

Sat in the sun for an hour on patio, drank a coffee, and read. It felt so good to be outside.

Started learning how to play the ukulele.

My friend W came over and made dinner for us — broccoli and mushroom pasta — and also dropped off an ice compression machine. It was nice to see a friend. He tore his meniscus badly a few years ago in a jiu jitsu competition and it sounded much worse than my ACL tear; he wasn’t able to bend or bear any weight on his leg for weeks.

Day 5 felt almost normal and I wasn’t expecting that.

[kneehab]

day 4

Today was a harder day emotionally. I had a hard time trying to wash my hair in the sink while trying to balance on crutches with most of my weight on my right leg. Then I dropped my glasses in the process and couldn’t bend down to get them. It just sucks not to be able to do basic tasks for yourself.

Once I did succeed at washing and brushing my hair though, I felt like a new person!

The other difficult part of today is that every time I go from elevating my knee laying down to standing up, my leg/knee gets incredibly painful. I guess it’s all the blood rushing through my leg and foot after being elevated for a while. I have to stand there for a minute while it kind of throbs and then it gets easier as I walk a bit.

Other than that, mostly the same. Hitting 90 degrees flexion consistently and off of the narcotics now completely. Minimal pain other than standing up — the other time it hurts is along the back of my knee while laying down. 

Been reading a lot again about various ligament and tendon injuries, just for fun. For example, tearing your Achilles tendon seems much worse, and so does the “unhappy triad”, which is not a bad situation for polyamorous people but in fact a condition in which three ligaments in the knee are all torn. There is just an incredible number of ways to hurt oneself. Feels like it shouldn’t be this easy — there are so many design flaws with the human body.

[kneehab]

day 3

Saw huge improvements today with range of motion in my knee! The last couple days I hadn’t been able to get past bending my knee to about 65 degrees and today I hit 88 degrees, which is almost the max (90) that I am allowed to hit for the next week. Felt good to see some progress with range of motion.

Leg raises still hurt quite a lot, and I find other parts of my body like my core and hips trying to overcompensate for the weakened quad muscle. But walking has mostly gotten easier and less painful. I have to just stay mindful to walk straight as any side to side motion — including turning directions — hurts if I’m not careful.

I haven’t taken any narcotics today although I might tonight just to ensure I get some sleep. Not very painful today other than some in the back of my leg/behind the knee when laying down. It might just be the angle of how I have my leg elevated. You don’t want to put any pillows directly under the knee because it can cause a bend, and then it becomes difficult and painful to straighten again. But if you put too much support under your ankle, then gravity is pulling your leg too straight/into borderline hyperextension and you don’t want that either. It’s difficult to find the right spot.

Feeling bored again today as well as a little gross. Today is now Thursday and I haven’t showered since Sunday, and I won’t be able to shower again until Tuesday. I have been using some wipes, but I’m going to try to wash my hair in the sink tonight or tomorrow.

I am really looking forward to my follow up appointment with surgeon and starting physical therapy. You know how new parents say, when they bring home their new baby from the hospital, that they don’t what to do and how they can’t believe the hospital just let them leave with a baby? That’s a bit how I feel about my knee! I have this brand new fragile graft and I don’t want to mess it up — I think once I’m able to start PT I’ll feel more confident that I know what I’m doing and that there’s a plan for recovery beyond just trying these exercises a few times per day.

[kneehab]

day 2

I’m sure there are many challenges ahead, but today has been smooth sailing for the most part. Pain came on intensely last night and I was worried I wouldn’t be able to sleep, but after I gave in and took the more powerful painkillers I slept great.

I woke up with no pain and today seems a bit better than yesterday in terms of abilities and range of motion. I took a couple of steps without crutches today, and am able to comfortably bear my weight on my leg for periods of time.

One thing I have been a bit overly conscious of today is the risk of blood clots. This is a possibility after many kinds of surgeries, and although it’s rare, it can be fatal if a clot dislodges and ends up in your lungs, heart, or brain and not caught quickly. I don’t have any risk factors other than just having surgery, so in addition to taking a baby aspirin every morning and keeping my leg elevated, I’ve just been trying to increase blood flow to my leg. I am constantly circling and pumping my ankle, lifting my injured leg up and down, flexing my quads, etc. And I had been doing a lot of walking around the house to get blood flow going, mostly on crutches for some extra support...

Until this afternoon, I was finishing a lap on the crutches after I had been walking for about 15 minutes and I suddenly felt nauseous and lightheaded. I simultaneously felt like I was going to faint and throw up. I felt like I was fighting to stay conscious, and my partner H had to help me into bed. Once I was back in bed and drank some water, I felt a lot better. I’m not sure what happened there — it may have been due to the narcotics, or the fact that I ate right before walking, or that I overdid the walking around the house — but if it happens again I’ll ask my doctor about it.

Flexion seems similar to yesterday, can bend with effort to about 65 degrees. Flexion both hurts a lot and feels incredibly good — the movement feels amazing on my kneecap, it almost feels like scratching a deep itch. Single leg raises hurt a bit more today than yesterday. Still been icing it a lot.

Been feeling a little bored... I find it hard to maintain sufficient mental clarity on the narcotics to read or work, so I mostly just watch tv. I finished The Dropout, a hulu series about Elizabeth Holmes, and now I’m watching a netflix series about Anna Delvey, who is basically the NYC version of Elizabeth Holmes. Such masterful scammers, you gotta hand it to them.

I’m just trying to keep a positive mindset about all of this. I keep wanting to be able to push slightly further and get a new personal record each time I walk or practice an exercise, but I know that isn’t the ideal approach here. I need to learn to be patient, appreciate the good moments even on less than good days, and appreciate all that my body *can* do. This is the long game and progress is not going to be linear.