17th March

So this week marks 4 weeks post op & a real milestone of being back on the road admittedly for short journeys only & still avoiding the school run where possible.

I also returned to work on Monday & had patients booked in all week, ensuring plenty of gaps to ensure I can also do my own rehab & rest my knee in between. I’m not expecting to be able to do a full day on my feet from 8-5pm working or otherwise until about 8 weeks post op.

Well a lot has changed in the global situation & there is a lot of uncertainty ahead with lock down increasingly likely this week as a result of Covid-19. Seems ridiculous to be writing about a knee issue right now but I know that a few people following recently had surgery & despite a global pandemic rehab does have to continue!

Having JUST started back at work and taking into account government guidelines on social distancing I took the early decision today on 17th March to swap to phone calls & video consultations for all but urgent appointments. Cancelling face to face appointments is not easy but stopping the spread is more important.

I still have my own Physiotherapy appointment on Wednesday, however only as I am a priority post op patient. All vulnerable patients have been advised not to attend appointments & non-urgent patients cancelled. I will be entering through a separate entrance (as the main entrance is closed) and after being screened at a station by a masked nurse and having my temperature taken.

The other big development this week is that my husband returned early from Miami as his sailing was cancelled due to concerns over coronavirus & potential travel restrictions. On Friday 13th he went to the dry ski slope so my son could get his last freestyle kick for a while. Having had a whole a discussion between us about not putting any extra burden on the NHS, Chris ironically dislocated his shoulder doing “an epic jump!” So we all ended up in A&E on Friday 13th.

Chris on the gas and air for pain relief awaiting xray
Awaiting relocation post Xray

Luckily Chris had no bony injury & his shoulder was relocated under gas and air. Lily rolled her eyes & asked “What is it with you two?”….

The upside is I can drive us both around at the moment!

The main structure of rehab continues for me with focus on controlling residual effusion, increasing range of movement as my knee still feels like it’s in a vice & is very stiff. Gradually building up balance, hamstring activation, quadriceps and glute strengthening has been a focus. Still lots of backwards walking, gait re-ed drills and gentle biking upto 15 mins with little resistance. Gradually increasing the bike and other variables such as walking allows me to know how I’m reacting in terms of pain & swelling.

So I expect my physio session tomorrow may be one of the last in these uncertain times of a global pandemic. It is looking increasingly likely that schools will be closing soon & tighter restrictions placed on social distancing. Crazy crazy times.


9th March 2029

Time for a catch up!! Felt that there have been more pressing matters in the world other than my knee recovery journey! However, I know a few people have been following their own surgery. If this helps you great! Don’t hesitate to get in touch if you want to chat anything through or for a video consult.

3 weeks post surgery today on 9th March. In need of reminding myself progress is being made!

Since Thursday I’ve got rid of the crutches, having been down to 1 for a few days. Usually I would advise not doing this until gait is symmetrical & looking good. However, mine is no better with a crutch than without. No crutches has also meant I am beginning to weight-bear more evenly.

I’m working hard on gait re-education. Despite having over 90 degrees of knee flexion I’m still walking with what looks like a particularly stiff leg. Which is frustrating. Walking backwards up & down the hall has progressed to short spells of 5mins walking backwards on the treadmill. The other gym members at David Lloyd may well think I’m odd but it’s definitely a useful technique to break down the walking pattern & puts less load on the patello- femoral joint (knee cap).

The kids are helpfully involved in rehab. They kindly scatter 3 weeks worth of stuff/clothes/toys all over the house that need picking up. Nerf wars seem particularly helpful for a round of mini squats!

I had a hydro session this week but had been restricted for a few days with what I’d describe as anterior knee pressure which somewhat limited my session. A feeling that something was pushing out on my patella tendon as I squatted and extended or walked which was particularly uncomfortable. It’s likely this is the result of effusion or joint swelling being compressed as I bend & straighten, so I tried to take it easy & get the leg back elevated.

Hydrotherapy pool at Broadstone Physiotherapy with my previous employer the lovely Fiona Collier

The benefits of hydrotherapy which takes place in a warm pool include pain relief, reduction in swelling due to increased hydrostatic pressure and increased circulation. The buoyancy of the water provides a great environment for gait re-education as well as work on joint range of movement and can progress to work on strengthening by using the resistance of the water. This local pool is at Broadstone Physiotherapy practice where I used to work.

I also had a soft tissue massage this week with the renowned Mrs Sarah Tidey with the aim of working into my hamstring, quadriceps and hip flexors as well as working around the patella (knee cap) to ensure it is still able to glide.

I admit I have been coming a bit despondent with the lack of increase in range of movement into flexion. Whilst this is usually slow with a patella tendon graft, I had a hamstring graft & the expectation would be to be at least 100 degrees by now. Also from a biomechanics point of view and quads activation with appropriate patella (knee cap) gliding getting full extension is more important right now, plus i didn’t have full range of movement going into the op so I need to adjust expectations. The most exciting breakthrough this week was getting a full rotation in on the static bike. Whilst a lot of hip hitching went on to create it & the seat was super high to accommodate reduced knee range- I got round! The little video of it truly doesn’t convey the effort that went into it & continues to do so….

I’ve been back in the pool swimming with a pool buoy since Thursday which is liberating & a chance for pain-free movement & some minor cv work- hooray! Chris is off to Miami to do some sailing so no wheels again but all things going well I should be able to start driving on 16th March on consultant advice. Remember to check these timings with your consultant, check you are happy performing an emergency stop & speak to your insurance company.

Then some independence awaits!

ACL injury, dorset, injury, knee injury, pain, physiotherapy, rehabilitation, Uncategorized

Post Op!

It took a little while to get pain under control post surgery. As I mentioned in my first post I’m not the kind of cat that likes to take painkillers any more than the next person! Straight morphine was all that was on the menu via my intravenous catheter & after much declining I gave in. The pain leaving me little option if I wanted to think about much else. I had to have a reasonable amount of that in the end & a little longer stay in recovery listening to one nurse doing her competencies which was an insight into recovery nursing!

The upshot was on returning to the ward I very Britishly informed the nurse I was nauseous. I think she thought I was kidding so was unprepared. She kindly didn’t make the student clean up after realising I most definitely wasn’t kidding.

A few hours later I was comfortable & frankly pleased to be the other side of surgery & back in the game. After an overnight stay, a check xray & the all important stair test with the physio I was off home fully weight-bearing with crutches and my lovely TED stockings back on to prevent DVTs. Sometimes these surgeries are only a day case depending on when in the day your surgery is. My stitches will be snipped in 5-7days , Physiotherapy with someone other than myself will be in about 7 days and a consultant follow up 6 weeks post -op.

So I have a shiny new Anterior cruciate ligament (ACL) courtesy of a graft from my right hamstring (muscle on back of thigh) and the other ligaments are healing by themselves. Whilst there is a little laxity, no further ligament reconstruction was required fortunately. The lack of range and pain at the anteriomedial (front inner) part of my knee was apparently the result of a plica (fold of joint lining) that had been inflamed & stuck to the damaged MCL (medial collateral ligament on the inside of the knee) and not due to getting stuck on the stump of the ruptured ACL. If you want to take a look at the surgery there are some pretty amazing online videos that detail the steps!

The consultant gave me “the look” & insisted that I do actually need to be a patient for 6 weeks. Quite literally I won’t be running before I can walk! Over 15 years of Physiotherapy tells me he is entirely correct….

What I do or don’t do for the next 6 weeks will have a big impact on the quality of my rehabilitation & overall goals of being back to running, kitesurfing, sailing, surfing and maybe skiing!

The key to the next 2 weeks is getting the swelling down and improving range of movement.

These are my tools:

  • Rest & elevation of leg above level of the heart. Optional extras of a decent book/Netflix/box sets.

  • Game ready (www.gameready.co.uk) or cryocuff to ice the knee. This helps to reduce swelling & relieve pain. I’m pretty much using the hourly & have hired it from a local private physio practice that I used to work at. Be careful if icing & limit to 20 mins ensuring skin is going pink & not white – no ice burns required! This unit is great as it also provides some compression which aids reduction in swelling & circulates the iced water through the cuff.
  • Muscle stimulation. My compex unit (www.compex.com) is back out in force to get my quadriceps (thigh) muscles firing which will not only help reduce swelling but will limit muscle atrophy (wasting) and ensure I’m ready to begin using and loading my leg. Ask your local physio about hiring a unit.
  • Pain relief. Keep it regular as this is going to ensure you can maximise the all important exercises to get moving and make sure you get some sleep. I’m currently taking ibuprofen 3x/day & paracetamol 4x/day. This will be directed by your doctor/surgeon & depends on your previous medical history and any allergies. I do have back up of stronger painkillers but haven’t needed them as I’m getting good blanket coverage of any discomfort by taking the simple stuff regularly.
  • Exercises. These will be guided by your surgeon’s rehab protocol & under guidance from your physiotherapist,

1. Focusing on gentle bending and straightening of the leg. My aim is 90 degrees bend ASAP. This range will be really dependent on getting swelling down and keeping pain at bay.

2. Tightening the quadriceps (thigh muscle),

3. Assisted Straight leg raise.

4. Gentle patella mobilisations.

5. Heel hangs. Ensuring I can straighten my knee to what we call “terminal knee extension” as soon as possible is going to be a crucial rehab milestone & help with gait and the ability of my thigh muscle to properly engage going forwards. Heel hangs are really helpful for this.

  • A solid support network. Crucial to functioning on crutches, with a dog & 2 kids! My Mum is exhausted already! The school run rota after half term is a work in progress. Thank you to a lovely bunch of friends & amazing patients alike for all your positive energy & kindness.

So we are in recovery mode. An enforced time to slow down, smell the roses & stare at a familiar sight! Some would call this relaxation ….


Go time

The last 2 weeks have been full of work, running around after the kids & as much prehab as possible. Did knock 2 minutes of my mile pull buoy swim & cracked on with more circuit based full body workouts in the gym with adjustments where needed to accommodate the knee. Still can’t walk my dog, in fact my gait pattern is still unfortunately pretty rubbish!

However, surgery was agreed last week. The question is what exactly will be done? My hope is that it will be a simple ACL reconstruction using a hamstring graft. Depending on what the surgeon finds when he goes in further ligament stabilisation may be required. This would be a bit of a different ballgame in terms of time in theatre and recovery. I’m quietly confident it’s not going to come to that.

Today is surgery day. My son is off snowboarding in Austria, my husband is in Sydney, wonder Granny is downstairs & my daughter has snuck in my bed. It’s tricky to know who is comforting who but I’m definitely not kicking her out!

This is a routine elective operation. However, it’s always daunting sitting in the patient seat and putting your life in the hands of others. It’s fair to say I’m feeling fairly anxious but it would be odd not to be. I may be quite hangry by op time which is never good on a Monday! No food from midnight & no liquids after 5am.

I’m now settled into hospital. Having walked in this morning the wrist tag & gown have gone on which means I’ve taken on a whole new vulnerable role of patient & couldn’t possibly sit in a chair! I have seen the surgeon (Mr Hancock). He agrees after further ligament testing that 95% sure just ACL reconstruction today but final decision during op. The anaesthetist is ready to do her thing & I’ve ordered some food for the other side!

Super Granny has taken Lily off to monkey world & as I’ve somehow been bumped to number 2 on the list looks like It’s go time!

I’ve hired a game ready (ice compression machine), my muscle stimulator is on standby & I’m ready to start rehab. I have a family to look after, patients to get back to treating & goals on the horizon.


Week 4

Still in a bit of a holding pattern as I await final surgery decision via telephone consult on 10th February. In my mind I’m all systems go for 17th February.

Not much has changed in terms of range. Still lacking terminal extension & flexion above 95-100 degrees. It’s easy to think you’re not getting anywhere, but keeping track of function, pain, painkillers helps me to see this isn’t the case. A useful patient app to chart progress in ACL recovery is “recoaware”. You can enter in parameters, chart progress & get support from others rehabbing ACLs. I’m pretty much off painkillers & anti- inflammatories unless I do to much. If I avoid “boom or bust” approach have consistent daily activity, time on my feet, time driving, space out patients I’m all good.

Tuesday night was a great example of classic overdoing it. At the back end of last year I booked standing tickets to the razor light & kaiser chiefs. Brace on I cautiously braved the BIC fearful of jostling crowds & mosh pits. It’s weird to feel vulnerable & Its a bit new. But it quickly became apparent the average age of the crowd was 40+ & it was a Tuesday night in Bournemouth! Feeling less vulnerable a lot of one leg hopping ensued & funnily enough that wasn’t great for pain or movement for 36hours!

Probably would recommend seated tickets for a little while!

This just about sums up general feeling at the moment. Just slight pent up aggression.

Had a go at some punch bag intervals today balancing on 1 leg… Great to get the heart rate up & feel a bit of burn. The general position where you swivel on the back foot would not be a good idea for me at the minute! Seated on a box where the knee is not at risk of giving way could work to mix up upper body workout or in a static squat position with brace on.

Continuing on trying to get my thigh muscles (quadriceps) fired up as much as possible through the day any which way I can & also my hamstrings (back of thigh).

The quadricep muscles in particular can be inhibited or “switch off” after a knee injury due to pain and swelling. This muscle inhibition quickly results in muscle wasting or atrophy. The loss of muscle bulk was pretty evident to the untrained eye 10 days after my injury. Initially it was really hard to activate the thigh muscle no matter how much I stare at it and try to make it work. The big aim pre-op is to get atleast really good quality activation into the quads (thigh) before surgery. One way to do this apart from exercise is through a muscle stimulator. A compex has been really useful to help me limit the muscle atrophy in my thigh and get the muscles “switched back on”.