Rehab: Weeks 1 - 8


November 12, 1997
Lots of pain and lots of discomfort, almost, but not quite, unbearable. I'm taking Percocet at the maximum dose, two every four hours, and it does absolutely nothing for the pain. I watch a movie, send e-mail to friends and co-workers letting them know how I'm doing and that's about it. Once again I try to sleep without much success.

November 13, 1997

Today is my first post-op visit with Dr. Mott to get my dressing changed. It goes well, he says everyhing is looking great and checks my flexibilty and strength, both are good for two days out from surgery. Once again, sleep is tough to come by.

November 14 - 16, 1997

I spend the weekend laying around the apartment, watching TV and trying to do a little reading, but my concentration is pretty much shot right now. By Saturday, the pain isn't so bad, and I stop taking the painkillers. All they seemed to accomplish was make me lightheaded and sick to my stomach. The pain is starting to become bearable without the medication. On Saturday afternoon I watched the Badger game on TV, they played respectably against Michigan, the number one team in the country, and have nothing to be ashamed of, even though they lose. Sunday's not as uplifting, though. The Packers play the worst team in the NFL, the Colts, score 38 points, and still manage to lose the game. It's as if the defense decided to take the day off, and only play at half-strength. Sunday evening, a couple friends stop by, we order Chinese and watch "The Simpsons" and "King of the Hill." They're grateful for the study break and I'm just grateful for the company.

November 17, 1997

I go to class for the first time, today. One of my roommates is presenting his research proposal in our departmental graduate colloquium. He's asked me to introduce him, which I'm glad to do, since he did the same for me last month, when I presented my research proposal. I have to say that it feels great to get out after having been cooped up for the last six days. Sleeping still isn't going very well. The brace is irritating the bruising on my shin, and the resulting pain makes it tough to sleep.

November 18, 1997

Today is one week out from surgery . I have my first physical therapy visit, and Jenny, the therapist, gives me the first of what will certainly come to be a long list of exercises. She also measures my strength and flexibility and says I'm right on track for my rehab, and maybe a little ahead in some areas. The best part is that I can now take the brace off when I'm walking in safe environments.
This afternoon, I spend a couple hours at a public informational session for the Madison Student Radio broadcast tower. We seem to be stuck between a rock and a hard place on this one. The FCC has limited our construction area to a small sliver of land, and some of the people in that township are vehemently opposed to the tower being built in their backyard. We'll just take it one step at a time and see what happens.
Tonight I figure out how to deal with the irritation from the bruising. I wrap a small towel around my shin before putting on the brace to act as a buffer and take a couple of Percocet to dull the pain. It seems to work.

November 19, 1997

My second doctor's visit today. He says everything is coming along great and also told me it was alright to get the incisions wet. This means that I can go home and take my first shower in eight days. While the combination of sponge bathes and talcum powder have overcome the BO, I don't really feel very clean anymore. The removable showerhead, in concert with a kitchen chair, seem to do the trick since I can't stand on my own in a slippery shower. After twenty careful minutes, that includes several joyful choruses of "Singing in the Rain," I feel human again.

November 20, 1997

I had my second therapy visit today. They added a whole bunch of new exercises. The therapy is not fun by any means, the bending exercises are especially painful. But I do them religiously, since I know they are only for my benefit in the long run.

November 21 - 23, 1997

Friday is a pretty quiet day, I just stay around the apartment, watching a little TV, reading the newspaper, and getting caught up on various odds and ends.
Saturday is about the same, although I venture out with one of my roommates to get some lunch at a fast food joint about a half block away. Today, my knee hurts so bad along the front that the only way I can raise it ot or lower it from the footstool is with the aid of my right leg, otherwise the pain in the patellar region is excruciating; although standing and walking on it doesn't feel too bad. I'm not sure what it is, but if it doesn't get better by tomorrow, I'm going to call the doctor.
On Sunday I stayed in to watch the Packer/Cowboy game, the first time Dallas has played in Green Bay in nearly a decade. The Packers played like the Packers of last season and did an amazing job, dominating the Cowboys, especially in the 4th quarter. During the game, though, Dallas' Nate Newton went down late with a knee injury, and I instinctively felt a twinge in my knee. I don't think I'll ever see another knee injury in any form and ever feel the same again. I'll always have great empathy for anyone else who goes through what I'm experiencing right now.
On the knee front, the pain is still there and I called the doctor's office. The doctor on call says the pain I'm feeling in the patellar region is pretty typical when the graft is taken from the patellar tendon. He told me to ice it down and call my surgeon on Monday if it still hurts then.

November 24, 1997

Overall, my knee feels pretty good, although the pain in the patellar region is still there. I put in a call to my surgeon, Dr. Mott, and am waiting on his response. I no longer have to bandage the incisions, as there was no blood on the last bandages. I'll take that as a good sign that things are healing up. Tomorrow is a big day for me, at midnight I'll go back to work for the first time in two weeks.

November 25, 1997

Two weeks out from surgery today. Today's therapy session was still more ambitious. I've had several more exercises added on, including one to work on balance, but no new exercises added to my home routine. The therapist has me down to one crutch and no brace when I'm around the apartment, or any other safe environment. I'm still waiting on the day I can sleep without the brace, that call is up to the doctor. I see him next week, and I'm going to lobby hard to have something done to make sleeping more comfortable, either no brace, or a different kind of brace. My current brace just seems to aggravate the bruising and swelling to the point where my leg hurts like hell when I wake up in the morning. The other milestone of the day was that I took my first shower standing up this afternoon, and all went quite well.

November 26, 1997

My first day back to work, and everything went good. My knee got a bit sore and tight from sitting so much, but that was alleviated by simply getting up and walking around. I got home a little after 8:00 in the morning, packed up my stuff to head home for the holiday, took a quick nap, and then hit the road in the late morning. It should be good to get home for a few days and see my family and be cared for beyond all belief by two wonderful parents and a couple of overprotective sisters. All in all, the trip home went well, three hours in a car and my leg felt pretty good, and only one stop to stretch out.
I'm continuing to do my exercise routine religiously, even going a little further (i.e. doing more reps) than what is required by my therapist. The knee feels OK after the exercises, not as sore as it has only a few days ago. But I do have to admit that the 15 minutes of icing and elevation afterward certainly do feel good, and is a welcome relief.

November 30, 1997

The trip back to Madison today makes me realize one important thing: My knee is not yet ready for three hours in a car. By the time I get back, my entire left leg is sore. Of course, I don't think it helps that the muscles in the leg have lost their tone and turned to flab due to the inactivity.

December 2, 1997

My therapy is now kicking into high gear. Today I spent time on the treadmill walking backwards, did leg presses, and rode the stationery bike. I'm also beginning to be weaned off the crutches and the leg brace which really feels great. I can now walk unassisted in "safe" environments. I'm at 95 degrees of flexibilty at three weeks out, which is five degrees ahead of the game. Things are looking good at the moment, but I expect a drop off fairly soon, since there's supposed to be a brief period of decline before the slow, steady climb back to full strength.

December 3, 1997

Work this morning (midnight to 8am) went pretty well. The knee and leg felt pretty good. Especially walking around without crutches or a brace. However, went outside this morning in the snow and on the wet, slippery sidewalk, and felt pretty unsure and unsafe with crutches and no brace, but felt even less so with it on. Now I'm beginning to dread the onset of winter.
This afternoon, I told the doctor that I feel safer and more comfortable walking outside without the brace than with it, and he said I could go without the brace outside, as long as I understood the risks involved if I should fall. They're pretty high, too, if I should slip and fall I run a very good risk of doing some serious damage to the knee. As long as it's not slippery or icy, I'll go out without it, but will wear it when things are more treacherous.

December 4, 1997

Therapy today was hell. I'm on the stationery bike, the treadmill and doing leg presses in addition to all the other stretching and strengthening exercises. It leaves my leg pretty sore most of the time, but I know that it will eventually improve and that it's all for my own good, so I stick with the program and just bear the pain as best I can.
If I'm sitting for a long time, straightening my leg is pretty painful. When I walk, it sometimes feels like the knee is going to give out on me, but as yet it never actually does, which is probably a good sign.
This afternoon, I walked about ten blocks to run an errand, using the crutches but no brace. My leg and espeially the knee felt OK afterward. Generally, things feel better if I'm up and walking, rather than just sitting or lying down.

December 9, 1997

I hit 120 degrees of flexibility in therapy today, that's one heck of a milestone at four weeks out from surgery. Actually it's two weeks ahead of the rehab protocol. I shouldn't be at this point until six weeks out. The next stop is full flexibility at eight weeks out. The quad muscles are pretty soft now, but there's a little bit of tone starting to come back. It's a long way from what it should be, though.
The rehab program got even more ambitious today. In addition to all the other stuff, now I'm also on the stairstepper, plus even more exercises to do at home. Thre's still a lot of soreness in the knee, but the therapist assures me that it should clear up very soon. In the mean time, I'll stick with the ice when things get too bad.

December 11, 1997

My therapy regime is slowly starting to add in exercises to work on pivoting motion, as well as more and tougher exercises to work on my balance. I'm about to be weaned off the treadmill and have more time added to my work on the stationary bike and stairstepper. My range of motion (i.e. flexibility) is holding at 120 degrees, and that's probably OK. Since I'm two weeks ahead on that score, I don't want to chance pushing my knee too far beyond where it should be at this time. I'm also starting to get back some of the hyperextension in my knee, it measured at -1 degree today. By comparison, it was at -5 degrees before my surgery.
After therapy today I watched a surgical training video showing some of the techniques that were used in my ACL reconstruction. The only one that made me cringe was the removal of the patellar tendon graft. Now I understand why the patellar region of my knee hurts so much, because they take a pretty good sized chunk of the patella (knee cap) along with the tendon.

December 13, 1997

The pain in the knee is killer. Whenever I stand up, it feels like the knee is going to buckle (not from weakness, though, but from the pain). It mostly goes away, however, after a few minutes of walking around. On the up side, I can do a pretty good job of going both up and down stairs. Also, I walked the two blocks to the convenience store and back this afternoon without crutches, being careful to avoid any ice or slippery spots. I think I'm starting to get my "sea" legs back.

December 14, 1997

Once again, I put in a few blocks of outside walking without the crutches. This trip was two blocks to the laundromat and then back an hour later. I even towed a luggage caddy loaded down with laundry both ways and lugged it down the steps of my second story apartment and then back up them once I got back home.

December 15, 1997

The pain isn't that bad today, just the usual series of aches and pains. Like I told a friend last night, if it didn't hurt, then I'd be worried. It seems to feel better when I'm up and walking around, as long as I don't over do it. The therapist has told me to expect the knee to hurt when I changes positions, such as from bent and sitting to straight and standing.

December 16, 1997

My therapist has eliminated a bunch of the exercises I have been doing. I've been upping the reps on most of them, so she feels I'm probably not gaining too much from them anymore. She has added exercises, though, that are designed to work on side-to-side range of motion and pivoting. These are actually challenging and even kind of fun.
I'm almost back to my full range of motion. My hyperextension measures at -5 degrees which is normal for me, and my flexibilty is at 125 degrees, which is only 10 degrees short of normal. Additionally, my stair climbing is pretty much back to normal, also. The knee gets a little sore, but the gait itself is OK.
Well, last night I witnessed the height of stupidity in ACL rehab. Jerry Rice, of the San Francisco 49'ers, was back on the football field only three and one-half months after having ACL reconstruction. It takes a minimum of two months just for the graft to fully heal! And he's already out there playing. It looks like he found out how misguided that was, though. He injured the knee during the game. The "party" line from the team is that it's unrelated to his previous injury, but there's no way you can convince me of that. Even if it's not the ACL, the fact that his ACL reconstruction can't yet be at 100%, has to have something to do with it, because it surely has to put additional stresses on the other structures of his knee. I feel sorry for Jerry, because he's undoubtedly under a lot of pressure from the team to play, especially in the playoffs, and even more so because they want the return on the money they're paying him. But now the 49'ers may not have him for the playoffs, or even possibly at any time in the future. For any pressure they put on Rice, and I wouldn't doubt they put quite a bit on him, they should be ashamed of themselves.

December 18, 1997

I'm starting to feel a good deal of pain in the back of my knee the last couple of days that was severely aggravated by the stair stepper this morning. By taking my time with my exercises and with some extra calf stretching betwwen exercises, it feels OK, and the pain cleared up pretty well afterward. I also ventured out and walked a good deal without crutches this afternoon.
Well, the diagnosis is in on Jerry Rice, he broke his kneecap Monday night. And here's the big thing: Recent medical research shows that in more aggressive ACL rehabs there is a higher risk of patellar fractures. And no one has ever had a more aggressive rehab than Rice, back on the NFL gridiron after only three and one-half months. So, there's nothing the 49'ers can say anymore that would convince me Rice's latest injury isn't related to to his ACL reconstruction.

December 19, 1997

I hit the first major milestone of my rehab: Full range of motion. When I saw the doctor this morning, he measured my bending range of motion and it matched my pre-op range, 135 degrees. And since my extension was already at -5 degrees last Tuesday, that puts me at FROM five weeks and three days out from surgery, which is 2 weeks and 4 days ahead of the target date for FROM.
In two-and-a-half weeks I'll be taking my first Cybex test to compare the realtive strength of the two legs, and if the left is at 70% of the right leg, I can begin a light running program.

December 23, 1997

My rehab regime is beginning to take a new direction. I'm being moved from regaining my range of motion (which is pretty much back to normal) and preventing loss of strength and conditioning, to building strength and mobility, with the end goal of getting me back on the volleyball court, and (my own personal goal here) on a ski slope for the first time in my life next winter. One of the toughest exercises so far are the squats, where I have to squat down in a position similar to what skiers call the "egg," it's also the same as the service receive stance for volleyball. It doesn't seem like it would be that bad, until you try it on a weak leg and hold it for a total of several minutes (over five to ten reps).
Another tough exercise, but for a completely different reason, is balancing on my bad leg with my eyes closed. Again, it doesn't seem too hard, but once I start losing my balance, I start laughing at myself and can't stop, making it pretty much impossible to continue. This is one of several exercises I'm doing now to regain my sense of balance on my left leg as well as rebuild my own confidence in the leg. Something very important if I want to get back into active sports.
Also, no more lethargy. My therapist is pushing me into rebuilding my conditioning and endurance. Forget the five minutes on the bike and five minutes on the stairstepper. Now I'm up to a total of thirty minutes a day on my choice of bike, rowing machine, treadmill or stairstepper. This actually makes me feel good, because I'm starting to notice a very real difference in how I feel, that is I really feel like I'm the worst shape I have been in a long time. If I pass my first Cybex test in two weeks (and my therapist thinks I'll do well), then I can begin a running program.
What amazes me is the seeming speed with which my rehab is progressing. I'm only six weeks out from surgery and I'm starting to be moved into a serious exercise program designed to improve my strength and condtioning. As a point of reference, I was walking without crutches or a brace within a couple of weeks. One of my roommates had the same surgery several years back and said his rehab progressed much slower than what mine is. It's not unlike the fact that twenty years ago this same surgery would probably have kept a person in the hospital for close to a week, and today we're being sent home the same day as the surgery. I don't mind this at all. I'd rather be pushed along and rebuilding myself as quickly as possible, instead of laying around getting more and more out of shape everyday and then suddenly having to face the prospect of a long climb back once everything is healed. The whole goal of this program is not just rehabilitating the knee so that it's usable, but rehabilitating the knee so that I can return to the same acivities and sports I was involved in before as well as being able to take on new sports and activities. Basically, to get me to a point where I don't even consider my my knee to be reconstructed.

December 29, 1997

My knee has been feeling pretty weak the last few days. When I was walking down the basement steps at my parents' house yesterday, it nearly buckled. That left me a little shaken. What if it had given out? I stopped and grabbed the handrail and had a vision flash through my head of tumbling down the steps and tearing up my ACL graft. Not a pleasant thought. So far, I've had quite a bit of confidence in myself and my knee, but that incident changed things. I have another couple weeks before my graft is considered healed enough that I don't have to worry about tearing it up if I should take a fall. And throw that into the fact that things are pretty icy and slippery outside this time of year, makes me a bit nervous. I may just start wearing the brace when I go outside for the next couple weeks. If I had this to do all over again, I'd wait until spring to have the surgery done, so I wouldn't have to worry about ice and snow on the ground.

December 30, 1997

The pain in the patellar region is back with a vengance these last couple of days. It's not constant, but there are some very sharp pains whenever I put any strain on the knee, such as during some of my exercises or when I straighten it after having it bent for awhile. Both Dr. Mott (my surgeon) and Jenny (my therapist) have told me that this is typical for a patellar tendon graft and that it clears up with time. I just hope it starts to clear up pretty soon.

January 1, 1998

Happy 1998, Everybody!
My knee has been feeling much better the last couple days. Today there wasn't as much patellar pain while doing my rehab exercises. Plus, I was downtown for awhile yesterday afternoon. While walking around my knee felt pretty stable, not at all like it wanted to give out. And I felt pretty confident walking around on the slippery sidewalks without crutches or a brace, I just go slow and watch out for ice and snow.

January 5, 1997

I've been a naughty boy lately. I haven't been doing my exercises the last couple days because my knee has been so sore and weak, so I laid off over the weekend and now it feels pretty good. I'll get back into my exercises again today, and hopefully my knee will be better now.

January 6, 1998

Well, my first Cybex test results are in, and while encouraging, they certainly weren't where I hoped they'd be. Tested at high torque, low speed my left leg is still pretty weak, but at low torque, high speed it's pretty close to the same as the right leg. My quads are still pretty weak on the left leg but the hams look like they are right on track. That's not surprising, considering that I did lose a good amount of muscle mass in the quads that's only starting to come back now. The bottom line is that it looks like I won't be running for a few weeks yet. I'll know better where I stand on Thursday, when I meet with Jenny, my PT.
During the test I also learned another important thing: I am probably a good candidate for screw removal some time in the future. The lower inside end of the graft hurt a ton during the high torque part of the test, which may very well be because of the screw there. This is something I'll have to discuss with Dr. Mott, my OS when I meet with him next week.


Rehab: Weeks 9 - 18