Rehab: Weeks 9 - 18


January 7, 1998
Over the last few days I've been noticing a pattern in the instability of my knee. The lateral stability is good. However, the front to back stability is where I'm having problems. When I first stand up it will occasionally buckle forward and after I've been walking for awhile, it sometimes buckles backward (that is, into hyperextension). While this can be a bit disconcerting, it's never so serious that I have to worry about falling or stumbling. It's just enough of a buckle that I notice it happening.
In the past couple of weeks I've received some questions about some of my experiences. Looking back I realize that I wasn't too clear on these, and I want to take a few minutes to clarify things a bit.
First of all, the pain I experienced immediately after my injury. Right after I injured my knee there was a sharp, stinging pain throughout my knee that can best be classified as excruciating. However, this cleared up fairly quick, and within 15 - 20 minutes I was able to stand up and hobble around, although there was still pain in the knee. After leaving the emergency room I was walking around without crutches and only an ace bandage wrapped around my knee for the swelling. By that night, however, the pain was unbearable and I was back in the emergency room, where I got an immobilizer, painkillers and the advice to see my doctor in a week. In that week, I got around pretty good, eventually giving up first the crutches and then the immobilizer because my knee felt OK. I wouldn't need either until after my surgery. In the six weeks between injury and surgery, my leg and knee felt OK and pretty strong although there was some stiffness and soreness in my knee, but this subsided more and more with each passing day. In fact, there were times during that period that my knee felt so good that I actually considered not having surgery. However, the times when my knee was weak, unstable and sore convinced me otherwise.
Second, what things were like immediately after the surgery. As I've said, the first thing I did after coming out of the anesthetic was ask the time, that was at 1:00pm. By about 6:00 that night the hospital fed me and I wolfed down my meal in that I hadn't eaten for about 20 hours. I had been under a general anesthetic, and when my roommate and his girlfriend got me home at about 8:00 that night I felt pretty lucid, but a friend called me in my hospital room around 7:00 and she said I still sounded pretty doped up then. Considering all the painkillers they gave me in recovery, that's understandable.
I hope this helps to clear up any questions anyone might have about these two parts of my experience. If anyone has any other questions, please e-mail me.

January 8, 1998

In therapy today Jenny, my PT, worked with me on exercises to help strengthen my quads, since my Cybex test indicated that this is were I'm weak. She also discovered that the reason for the patellar pain is probably due to the fact that my kneecap is being pulled down and slightly off center by, she feels, the weakness in the quads as well as the tightness of the scar on the outside of my knee. However, she says that it's not that severe and that as the quads strenghten it should improve.
Hearing about the bad experiences of others with their HMO's, I now feel much more fortunate than I did in the past. My HMO is picking up the whole tab, save $25.00, the deductible on my emergency room visit the day I injured myself. Granted, there's a lot of red tape sometimes to get approvals and referals, but that seems to be fairly well cleared up now. All doctor's visits, PT, surgery, MRI and other testing are covered. The only hassle I can see coming up is that I'm coming close to my initial limit of 20 PT visits, which means I'll have to get approval for more. I'm also curious to know how they'll deal with an additional surgery if I need to have one or both screws removed later. Three weeks after my injury I was fully diagnosed and three weeks after that I was having surgery. No hassles, no questions. So far, the only real problem I had to deal with was the referal/approval of my post-op visits with my OS. As it turns out, there's an unlimited number of visits for the first three months out that are included as part of the surgery. What a deal. For anyone who's having hassles with their HMO/health insurance, I wish you all the best and encourage you to keep fighting. Having to go through the surgery and rehab is traumatic enough, dealing with a stingy insurance company only makes things worse.

January 9, 1998

I made my first visit to the gym today. Spent 15 minutes on the stationary bike, did some work in the weight room, 100 leg presses at 80 lbs. and 4 sets of 7 ham curls on the left leg at 20 lbs. (now I realize just how weak my quads are, those were really tough). Then 10 more minutes on the bike. Afterward my knee felt pretty good, the patellar pain had subsided, so there's probably something to strengthening the quads to help the patellar pain.
I've also gotten some feedback on my goal of learning to ski next winter. It's been recommended that I try snowboarding instead since it's easier on the knees. I'm going to consider it and just may change my goal for next winter. Thanks, Darin.

January 12, 1998

Over the weekend I started to have a sharp pain on the inside of my knee, right on the joint that comes and goes. The home rehab exercises don't seem to particualrly aggrevate it, but I haven't been back to the gym since. I guess it's just one more thing to add to the list of questions I'll take to my doctor on Thursday.
Also, my knee seems pretty stiff and a bit weak when I stand up and try to walk, almost as if my leg wants to give out on me. Add that to the list of questions, too. It's probably just things I have to go through on the road to recovery, at least I hope it is, and there's nothing seriously (or even not so seriously) wrong.
Super Bowl Prediction: Green Bay by at least 10. On defense, Brown will stuff Denver's running game, forcing Elway to throw, which means White and Joyner will have a field day. On the other side of the ball, Favre will just be Favre, and that's all they'll need. But also throw in the fact that the Broncos won't be able to stop Levens on the ground, so their defense won't know what's coming at them when. Thus, the Packers will bring home their 13th NFL Championship, making their record even more untouchable. Sorry Broncos fans!

January 14, 1998

I was back in the gym yesterday and my workout was pretty similar to last Friday's. Altough I made a few changes. I decreased the weight on the ham curls to 10 pounds and uppped the reps to a total of 65. I also did 50 leg presses at 80 pounds using only the left leg (with the right leg going along for the rideî to act as protection if my left leg would have given out) after doing 100 at that weight using both legs. There was also 20 minutes on the bike at the beginning of the workout and another 15 at the end. Iíll be back in the gym again tomorow. My goal now is to pass the next Cybex test and get myself running, and Iím going to have to push myself to get there.
I met with my therapist today, and she feels that before I start running I should have to be able to do step ups without any hip rotation or shakiness (both of which I have right now). Basically, it involves standing on a low platform with my involved leg and flexing my knee down so that the heel of my uninvolved leg touches the floor and then ěstepping upî again. The hip rotation shows that the pain in my patellar area still bothers me and the shakiness shows that I still donít have good strength in the quads of my involved leg.
Tomorrow I get to play "20 Questions" with my OS and find out about all my various aches, pains and other complaints. Iíll be sure to let you all know what I learn.

January 15, 1998

I saw Dr. Mott, my OS today and he said everything is looking good with my knee. There's no swelling and my knee feels nice and tight, which I take it to mean the graft is healing up just fine. I also told him about the stiffness and soreness and the limping when I first start walking after sitting that I've been experiencing over the past couple of weeks as well as the forward/backward buckling. He didn't seem at all concerned about any of it. At the same time, though, he didn't offer any explanation as to why it's happening. I guess if he isn't worried, I shouldn't be either. But it does bother me, since my knee had been coming along so good, and since it had been so strong before.
Today I also ran into my first real problem with my HMO. I received a bill from the MRI center saying that the HMO had denied the claim and I was responsible for payment. However, two phone calls solved that. After talking to the folks at the MRI center (they told me the HMO has been messing up more than a few claims lately), I called the HMO office and was told, "We'll take care of it." Simple as that.

January 16, 1998

I was in the gym again today for another workout. The same as always, stationary bike for 40 - 45 minutes as well as curls and presses for my left leg. I really enjoy these workouts. I get that good tired feeling in my leg muscles that comes from a good workout. I finally feel like I'm accomplishing something in my rehab, although I know full well that it was very necessary to do the earlier exercises, and that it was also necessary to give the graft time to heal properly so that I could do what I'm doing now without worrying about blowing out my shiny new ACL.
Next week I start spring semester classes, and it's going to be a little tougher to get into the gym, but I think I've got it figured out. I can work out on Tuesday and Thursday mornings before my swimming class and on Friday afternoons.

January 18, 1998

Odd experience last night. I was lying on the couch watching "Braveheart" when there was a sudden hot, searing pain in my upper tibia about where the bone graft was taken. It was rather uncomfortable, but not unbearable. It lasted about 5 minutes and then went away, and I haven't had it since.
I understand (thanks to Doug) that the stiffness and soreness I've been having in my knee is common among those of us who've had patellar grafts and that I can expect it to be around for a while yet. I think it's something I can live with, since I've had the same experiences with my knees in the past, although I have to admit never quite this severe. I've also not had any episodes of buckling over the last couple of days, which seems to be encouraging.
On the good side, however, I noticed something encouraging when I woke up this morning and was getting out of bed. The quads on my left leg are starting to show some definition again. They've got a long way to go to regain their bulk, but it looks like the work in the weight room is already starting to pay off.
Totally unrelated. I got a pleasant surprise this afternoon. The University of Wisconsin basketball teams (both men's and women's) are moving into their new arena (the Kohl Center, named after Senator Herb Kohl, who donated $25 million toward its construction) this week. I stopped in during the open house to check out where my season ticket seats for the women's games will be and discovered I'll be in the front row right behind one of the baskets. Should provide for some great views of the action.

January 20, 1998

Put this one in the "Oh, Great!" file. Over the past couple of days Iíve been having spasms in my lower back (something that's been a recurring problem since my high school days). The bottom line is that I haven't been able to keep up with the exercise regime I had been, that is I haven't been in the weight room since last Friday, although I've been doing my best to struggle through most of my home exercises at least once a day. The pain finally seems to be clearing up a bit (for me, itís just one of those things I have to wait out ... stretching and heat help alleviate the pain but donít help make my back better). So, I should be back in the gym in a couple more days.
Otherwise, my knee is feeling pretty good, the stiffness and soreness is still there when I stand up but hasn't been as bad lately. The weakness and buckling doesn't seem to be a problem anymore, either. I'm keeping my fingers crossed that at least that problem has finally cleared up. Only time will tell.

January 25, 1998

I apologize for not being here the last few days, but I've been busy readjusting and settling into my coursework for the semester. I had to change one course, dropping an environmental ethics class and picking up a policymaking class that will actually apply better to my research.
Last Thursday, I damn near killed myself (figuratively, not literally ... though it was close). I was back in the weight room for the first time in six days, due to my back spasms, which have now pretty much cleared up. I did my usual 5 sets of 20 left leg presses at 80 lbs. and 5 sets of 10 left leg curls at 10 lbs., in addition to 15 minutes on the bike. While this doesn't sound like much, right after that I had my first swimming class. By the time I crawled out of the pool, my leg was pretty sore and tired, but it was the kind of feeling you get from a good workout.
On Friday, I had a PT visit, and Jenny said the strength in my leg is pretty impressive. Every day now, I can see more and more definition in my quads, and that's really encouraging. She's now set me a goal of being able to do step-ups without pain or unsteadiness. In case you're not familar with it, a step up involves standing on the "bad" leg on a low platform and then using that leg to lower the foot of the other leg to the floor. Right now my knee has only a slight amount of pain when I do it, but my quad muscles need more work before I'm not shaky doing them.
Over the past couple of days I've also noticed some pain in the calf of my left leg that almost feels like a cramp, but the muscle is loose and it's mostly localized in the upper half of the muscle. It makes walking difficult and I usually end up limping more than I have been.
I called my OS's office in the early afternoon today. The doctor on call said he wasn't sure what it was just talking to me on the phone, and advised me to heat it and call Dr. Mott on Monday if it doesn't improve. I tried a heating pad several times through the course of the day, it didn't help much. One time, though, it relieved the pain for about five minutes.

January 30, 1998

OK, so I apologize for not being here once again for several days. Well, hereís the diagnosis on my latest problem, the pain in my upper calf. I saw Dr. Mott on Monday and he said that I had strained the medial gastrocnemius, which is a muscle in the upper part of the calf. He said to take it easy on the leg as much as possible, and it should clear up on its own. He also gave me an insert for my shoe that goes under the heel and helps to relieve some of the pressure and strain on the muscle. So this past week Iíve been taking it easy.
However, on Thursday, I did something pretty stupid. In swimming class, I was working on floating techniques, when I started to lose my buoyancy, and began kicking to regain it. As a result I reaggravated the strain and am now back where I was a few days ago.
When I saw Jenny today for PT, she told me to take it easy and try icing it. She put me on a limited regime of work on the stationary bike and some mild stretching. At the end of my therapy visist, I iced the knee front and back for about 15 minutes, and it felt much better. This whole turn of events is a bit frustrating, in that I was just starting to see some real improvement in my quads as a result of the weight work I have been doing. Well, Jenny said this isnít so bad, because they often give ACL rehabs a week or two off when theyíve been going at the rehab pretty hard. So, Iím going to lay low for the next week and then jump back into it after that.
OK, to wrap it up ... to show that I'm not a small person, I admit that the Denver Broncos played one hell of a game in the Super Bowl and as such they deserved to win. And I'll say this, too, if the Packers had to lose to anybody, I'm glad it was them. After 15 seasons, I think it's about time John Elway got a championship ring.

January 31, 1998

The pain in the calf is back with a vengance tonight. It felt good this morning, but then I went for a long walk and and by late this afternoon it was really bad. Maybe I shouldn't have gone for that walk. It felt great right after I got back home, so it might not be the walking that aggravated it. All I know is that I'm going to do absolutely nothing except ice it until it's feeling better.
I look at it this way though: This, too, shall pass. I remember when I couldn't lift my foot up to a footstool without tremendous patellar pain, and that's no longer a problem. So, given time, this won't be a problem either. I just need to tread the way of the peaceful warrior.

February 2, 1998

After a hellish weekend, my leg is feeling better today. Over the weekend, I wasn't able to bend my leg without experiencing a tremendous amount of pain in my calf as soon as I straightened it out. Today, that experience is gone, replaced by a dull ache and general stiffness in my knee, no doubt from keeping it straight most of the last two days. And where the calf muscles were tight over the weekend, they're starting to loosen up real nice tonight.
Even though it's starting to feel better today, I'm still not going to do much yet. I want to give it a few more days rest before I start back into serious rehab work. I learned my lesson all too well in the pool last week.

February 5, 1998

The strain in my medial gastrocnemius (the muscle in my upper calf) is pretty much healed up now. There's no pain related to it. Now my problem is stiffness in the knee due to a week of inactivity. Just something I'll have to work on now that I can. Over the past week I've been doing nothing except walk and spend a little time (about 15 - 20 minutes every couple days) on the stationary bike. I've even stayed out of the pool in my swimming class.
Besides the knee stiffness, I'm also experiencing soreness in my leg muscles, again (I'm pretty sure) due to the inactivity. It just seems that my left leg tires very easily right now. Hopefully, I'll be able to get back into the weight room soon and work on my leg muscles again. That should help tremendously. I'll have more definitive answers tomorrow when I see Jenny, my PT.
Finally, if you're reading this, I hope all is going well, Liz. Hang in there. It only gets better and easier. Good luck.

February 10, 1998

In the past few days I've been getting myself back into the swing of exercising. Yesterday I was in the gym, spending 35 minutes on the bike plus doing 100 (5x20) left leg presses at 80 pounds and 60 (4x15) left leg curls at 10 lbs. Everything felt pretty good afterward, except for the soreness and tiredness that comes from a good workout.
I've also been working through my home exercises. These are designed primarily to work on my balance and fine control of my muscles ... that is so that my leg isn't shaky when I'm balancing on it and put strain on the muscles. This morning, however, while I was doing calf curls with a two pound ankle weight, I ran into some sharp pain in the back of my knee. So much so, in fact, that I had to stop my exercises for the morning.
Finally, tomorrow marks my three month anniversary since surgery.

February 12, 1998

Not much new today, except that I upped my leg presses to 100 lbs. with no problems. The pain in the back of the knee, that I experienced a couple of days ago, hasn't come back, although there is pain along the side of my knee once again (that hasn't been around in a while). Otherwise everything is pretty much the same. Just thought I'd check in.

February 13, 1998

Well, I apologize for not mentioning this before, but ... YEA PICABO!!! What better inspiration could all us rehabbing ACL'ers have than Picabo Street. She come backs from ACL reconstruction to win an Olympic gold medal in the giant slalom and is also considered the odds on favorite to take the gold in the downhill. Wow!
I've come to the harsh realization that I've now entered the "long-hard-road" part of my rehab. I'm well past the time of see daily progress in my rehab and am now on to putting in a lot of hard work to rebuild the strength, balance and fine control of my leg. Now I put in a tough round of exercises and it doesn't seem like anything has improved. In the beginning I would put in nothing near as tough, and I could measure my progress by being able to see myself shedding my brace, putting the crutches aside, being able to walk without a limp. Now I look at my withered thigh, compare it to my other leg, and wonder if it will ever be the same. Then I realize that I need to keep working, that progress is happening and I will be back to my old self. Right now my primary goal is to be in the stream for the trout opener in May.

February 20, 1998

Rehab is no longer any fun, it becoming work, and damn hard work. But todayís visit with my PT, Jenny, was a landmark. As of today I begin Phase 1 of the Functional Progression For Return To Sport. This is where the work comes in. The progression begins serious sports focused exercises designed not only to build up the necessary strength and ability, but also to work on the psychological aspect of rebuilding my confidence in my rebuilt knee. I will be slowly working into this as I also work out of my current rehab program.
She's also issued a "challenge" of sorts. Once I can do 3 sets of 10 step-ups, I can go in for my second Cybex test. I'm hoping to be there in less than two weeks. If I can hit at least 70% across the board on that, I get to start running again.
The weight work I've been doing has built up a good deal of raw strength in my leg, but now I need to work more on the fine control of those muscles, which is going to be required as I move into more of the jumping and cutting exercises of the progression.
I've also had to drop the swimming class I was in. After taking two weeks off because of my strained calf muscle followed by some odd pains in my knee, I felt that I was just too far behind to catch up any more this late in the semester.

February 23, 1998

Another landmark today. I had to rest my foot on the dining room table to do it, but (and that's the key word here) I was finally able to touch my heel to my butt. That's the first time I was able to do that since before my surgery, which, incidentally, will be 15 weeks ago tomorrow.

February 24, 1998

Nothing new to report other than the fact that I have another Cybex test scheduled for March 13th (that's Friday the 13th to those of you who are superstitious). I'll post the results the next day. The return to sports rehab is going well, much tougher than what I have been doing, but a welcome relief from what was starting to become a tedious routine of the other rehab.
Now for a completely unpaid plug for something I think everyone of us ACL'ers should have. It's a great book that comes highly recommended, by me as well as others. Dr. Scott's Knee Book by Dr. W. Norman Scott with Carol Colman, is published by Fireside Books and only costs $11.00. It's written in layman's language and covers pretty much everything that can happen to the knee, how to "fix" it and how to prevent it. It also tells you how to prepare for surgery and rehab and how to pick a good surgeon and physical therapist. Any good bookseller should be able to order a copy.

March 2, 1998

One of the exercises in the return to sports regimen is the single (involved) leg hop. The slightly depressing thing is that it has made me realize just how weak my leg still is. I'm lucky if I can get more than a couple of inches off the floor. The two-legged jumps make me realize the same thing. While my vertical leap was never anything spectacular, it's now downright pitiful. Just one more thing I need to work on.
Yesterday, though, with the weather being cooperative (you've just got to love El Nino) I went out for a two hour walk that felt (both physically and psychologically) wonderful. I've been doing a lot of walking in the last couple of months (ever since I've been able to walk pretty well since my surgery) and have enjoyed it tremendously. Walking is one of those things we ambulatory folk tend to take for granted until we're not able to do it. I never felt so constrained as I did right after my surgery, when I couldn't walk very far, and thought it was a big deal that I was able to hobble half a block to a fast food joint for lunch. Now I walk everywhere, to classes, work, shopping, physical therapy, doctor's appointments, even to the gym to workout (but it's also to my advantage that I live in a near downtown location, so I'm within walking distance of a lot of things). We truly do not appreciate the mundane, everyday things in our lives until we have them taken away from us.

March 6, 1998

I called my PT today and she OK'ed me for road biking, as long as I don't stand up. No problems with hills or toe clips. So ... I hit the road this afternoon for a short ride, 25 minutes and 5 miles. It felt pretty good, too. It's the first time I've been on a bike since I blew my knee last September. And the AirDynes in the gym just aren't the same. While I can spend 40 to 45 minutes on one of those, by the end of those 25 minutes on a real bike I was dead. But now that I'm back into one of the activities that I enjoy, I feel like my comeback can't be too far away. Plus, I now have another mode of transportation around campus available to me besides my two feet.

March 13, 1998

I took my second Cybex test this morning, at four months and two days post-op. I won't know the results, however, until next Tuesday, when I meet with my regular PT, Jenny. Once I know the outcome, I'll be sure to post it. But from what I saw of the raw data, and comparing it to my results six weeks ago, I think things are looking pretty good. My quads certainly do have much more size and definition than they did six weeks ago, and that was the area I was weak the first time I took the test. Otherwise, I've just been plugging along with my rehab routine, and maybe pushing myself a bit from time to time.

Rehab: Weeks 19 - 27