I didn’t fall off the planet but I did need some time to myself which got a bit longer than I thought it would. So what happened month 4-5…I’ve always kind of thought if you don’t have anything good to say don’t say it!
I envisaged it being a month to press on & make strength gains but anterior knee pain put paid to that! Instead I had a rehab holiday. A total break for 10 days (except basic quads ex’s) to let things settle then gently build up & reintroduce activity. It definitely helped but was a knock emotionally as it felt like I was treading water. It nearly broke me.
Surprisingly I went to some pretty dark places this month and wasn’t much fun to be around. With a social life based around being active & exercising I found I was missing the friends I used to DO things with & it was hard going. Suddenly I wasn’t much use to anyone despite the fact I had come so far! I even let a little anger creep in unnecessarily, but all the while I needed to keep my eyes on the prize and try not to project my issues onto anyone else. I was also aware I didn’t want my kids to pick up on how I was dealing with the challenge and start copying any of my less than positive behaviours in relation to injuries.
Also I struggled with guilt about how I was feeling. It was just a knee! I was sooo lucky & fortunate to be back walking, working, breathing whilst others have everything a lot harder particularly as a result of a global pandemic or any manner of other medical or non-medical reasons. What struck me this month was that I had underestimated deeply the psychological aspect of my own rehab & how it was also mixed up in my expectations of myself as a physiotherapist. Geeezzz ….deep.
I did also do some positive things after my rehab holiday that made me smile!! I started a few more faster off-road walks whilst accompanying my daughter hacking, great for proprioception, balance & confidence and continued on with the paddle boarding – yay!
Everyone feels better with some vit D, so after a triumphant finish to homeschooling we planned to head off with the kids via eurotunnel for a massive road trip to Spain to spend some time as a family on my parents boat. Not needing to take a flight we felt we could isolate as much as we needed to offshore. But it did mean a 16 hour drive! It built confidence that I tolerated 6 hours of driving a day and I have to admit it was great to get away.
We’re emerging from lockdown! Whilst things are far from usual I’m now back seeing patients again. The sun is shining and all things knee are moving forwards.
Four months post op slightly reminds me of emerging from the first few months of motherhood. It does get easier! The differences between ACL journeys can also be just as diverse as raising kids. If you’re struggling you aren’t alone, likewise if things are going great & you’re returning to running & into plyometrics that’s equally great.
Just like any other challenge, surround yourself with support from people that are helping make that journey positive. Get in touch if you want some advice, motivation or just to swap stories.
I did start with a treadmill jog in recent weeks as impact loading assessment more than anything else. 5mins walk, 1 min jog, 5mins walk 30secs. This session did build a bit of confidence but did feel “odd” & that was enough for my patella-femoral joint at the moment which is irritable.
I made it back to physio myself this week & it was great to be back on the Alter-G for some work towards running. I started with backward walking, followed by forward fast walk. I jogged for 7 mins with 60% of body weight taken off. That’s the baseline at the moment. It’s useful (compared to my 1min on treadmill) to get more time in running whilst analysing & working on gait with less impact. You get feedback on stride length, weight distribution, time in stance phase & can change things. Hopefully when I get back to full weight bearing I will be as near even gait pattern as possible and will have gradually built up tolerance to loading. Hopefully this will limit me reinforcing suboptimal movement patterns and stop any longer term issues from picking up bad habits.
One example is my heel kick. On the Alter G, I could see from the rear camera I wasn’t pulling up my right heel as high as the left, probably because my hamstring isn’t working as hard on the operated leg where the graft was taken. A quick correction & I could see in real time things change.
Strength work continues to progress. I’ve now introduced some low level plyometrics (jumping type activities) into my rehab and added in some variation too. I’ve been outside on the mountain bike but am not ready for the road bike outside yet. It’s a standard environment in the house with no traffic & limited opportunities to fall off! I can also pull my foot out of the shoe instead of the twisting motion of uncleating. I have started using cleats on the turbo trainer which is a game changer. I also did my first interval ride on Zwift & was promptly dropped by the group! Great to be adding some different workouts in though. Variety in rehab keeps things slightly more interesting!
Another training variation was the addition of a stand up paddle board. It is soooo nice to finally (6 months after the injury) to be a bit active outside & it’s great for balance training. I would say if you are thinking about getting on a SUP, go in flat & deep water in these relatively early months. Keeping any excited kids well clear of capsizing the board means you have the perfect opportunity for some alone time too!! The potential risk of injury to the ACL graft could come from a slip & twist off the board or landing awkwardly if you fall off in shallow water. If in doubt check with your physiotherapist before you head out.
A few of the plyometric exercises I have added in are below. As you will see I have plenty to work to do & compensations to iron out. There are a plethora of exercises that you can be doing at 4 months post op depending on how your rehab is progressing. Get in touch if you need some ideas.
Hopefully your personal rehab is heading in the right direction & you are starting to see the benefits of the work you are putting in. Stick with it….
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 ….
Thanks for joining me! Having just returned from a years sailing sabbatical with my family we’ve settled back into UK life and I’m delighted to bring you HD Physiotherapy & Sports Massage here in Dorset. Life often takes us on unexpected journeys. Our aim at HD Physiotherapy & Sports Massage is to collaborate with each client to help them navigate their journey back to fitness. Whether that journey is addressing a long standing niggle, rehabilitation after surgery or maintaining peak form for elite sporting endeavours we can help. We will work with you to provide a thorough assessment and listen to your goals, working on a treatment plan and timeline together.
Good company in a journey makes the way seem shorter. — Izaak Walton