Weeks 4 and 5

Again, I got sidetracked so I have to combine these posts!  Managing work and rehab is difficult.

Returning to the Office:  Starting at week four post-op, I had to return to the office.  This is the biggest challenge so far.  It is both stressful and frustrating.  Getting in and out of a cab is frustrating.  I have to "back in" and sit parallel across the back seat with my leg out straight across the seats.  If there are potholes or bumps along the way, the jarring hurts my knee.  Once I get to the office, by far, the hardest challenge is sitting in my chair.  I have to sit in the chair with my brace on and locked which means I have to sit on the edge of the chair.  By the end of the day my knee has been swollen and tender and my back hurts from sitting awkwardly in the chair.  

After my third day back to work, when I got home my knee felt like a softball.  You couldn't really even see my patella in my knee.  My leg just looked like a cylinder. 

Starting Physical Therapy:  Because of the nature of my defect being on the patella, I am limited in any active range of motion exercises that load the joint.  Which basically means that I am limited to quad sets and leg lifts with my leg straight.  Range of motion work is all un-loaded.  Basically at my visits we do the following:

• Scar mobilization

• Graston tool on my quadricep right above the patella (in areas that are not tender)

• Assisted range of motion stretching

• Electro-stim (10 minutes) quad sets when the stim is on

• Ice

Pain:  My pain has been generally pretty good.  I do not have a feel for specific things that trigger pain yet.  Sometimes it's just random small things when I get that patella/femoral pain right across the front of my knee cap - like getting out of a cab or even sitting at my desk too long.  

Sleeping:  I cannot explain why but since I had surgery, I have slept on my couch.  In the beginning it was because my mom stayed with me and I figured she should sleep in my bed because I wasn't going to sleep comfortably no matter where I was.  But, it just kinda stuck.  Sleeping with the brace on is annoying.  It has caused bruises to my non-surgical leg in the knee area from knocking into it.  (And I bruise like a peach!)  I have started loosening the straps at night but I'm still keeping it locked. Since I sleep on my back, I'm usually able to get somewhat comfortable.  I do sleep on my side at times so that's been hard.  At my follow-up visit, discussed below, my doctor said I could start sleeping with it off which was the BEST NEWS!

Exercise:  I can still do the exercises that I listed in my last post.  I have been feeling lazy about it though recently.  The same routine gets boring.  I can't wait until I can go back to the gym.  Even though I won't be doing what I was prior to, getting back to my usual routine will feel so good.  I never thought I would miss getting up at 5:00 a.m. to go workout!

Post-op visit with the doctor:  At my first post-operative appointment with my doctor, it was much more limited in terms of what was addressed.  It was only three days after surgery and he was primarily concerned with making sure there was no infection, my pain was managed and swelling was under control.  We did not really get into much substance and at that early stage, you really couldn't. I was eager for my second visit because I knew it would be more substantive.  In general, he was pleased with my progress.  I am ambulating with one crutch and my incision is healed.  He also made me feel assured that the pain I am having is normal.  I am having some pain over the patella when trying to do leg lifts and he assured me that it is to be expected.  I am now able to start "treating" the incision with Vitamin E oil and other scar remedies.  Dr. Guelich is also just a supportive person to talk to and it generally feels good to talk to people who REALLY understand what I am going through.  At the conclusion, he gave the "OK" to go forward with a standard rehabilitation protocol which is mostly focused on getting my passive range of motion going.  He wants me to start working on allowing my leg to hang at 90-120 degrees - basically allowing my leg to hang over the side of my bed and then passively pushing it further back with the other leg.  I tried it at the doctor's office and it was pretty uncomfortable at first to the point that I was essentially squirming.  All things considered, the visit was positive and I left feeling optimistic. 

Weeks 2 and 3

I combined weeks 2 and 3 because they generally felt the same as I was working from home.  And, frankly I fell behind :)

Returning to Work:  In terms of time off, I took off one full week of work and then worked from home for two weeks.  Starting to work was pretty difficult in terms of balance.  At first, I found myself realizing it was 5:00 p.m. and I had not even gotten into the CPM yet.  I was also just tired and not ready for the stress that comes along with being an attorney; i.e. I did not have the energy to argue with people.  Luckily, I had one work project that involved a lot of document review so I could essentially just balance my computer on my left leg (non surgical) and put my right leg in the CPM.  While it is not ideal, it worked.  Returning to work, even at home, made it crystal clear that recovery was certainly going to be a challenge.  It really gave new light to the saying, “there aren’t enough hours in the day.”  Between how much I was sleeping, in addition to trying to work at least 8 hours a day, sitting in the CPM for at least 4 hours and finding 1 hour to do exercises, it was a lot.  

CPM/Range of Motion:  This was probably the best aspect of my recovery.  I had no problem getting to 120 degrees in approximately 10 days.  While it was definitely tight at the top, I could get there relatively easy.  For each session, I would start lower and work my way up.  As it got easier, my general routine was to set it at 80 to start and then make my way up to 120. 

Icing:  I haven't been as diligent as I should be about icing.  I usually place an ice pack on my knee when I'm in the CPM.  I have not been using the ice machine as much.  

Pain:  The pain has been manageable.  It's frustrating that even the smallest movements can cause pain.  In particular, when I tried to move my leg to the floor, the area on top of my patella was very, very sore.  In fact, even engaging the quad in that area was very uncomfortable.  It feels like each time you need to do something, whether it be getting off the couch, going to the bathroom, etc., you feel like you have to mentally prepare for it.  Pre-surgery you do so many things in a mindless way which really changes after surgery.  

Sleeping:  The phrase "it is what it is" has never rung truer.  Sleeping with a leg brace on sucks, plain and simple.  If you sleep exclusively one way, having the brace on may pose a real problem.  I sleep on my back so I can generally get somewhat comfortable.  However, I do sleep on my side periodically throughout the night and that is generally unavailable.  If you are a stomach sleeper, the brace may pose a real issue.  

Exercises: I started an “exercise routine.”  Those quotes are necessary and if I was verbally explaining this to you, I would use air quotes.  For the most part I used resistance bands as my equipment.  I would have liked to have some weights but I did not want to spend the money on them since it was a limited amount of time that I would need them.  Generally, the entire "workout" would take an hour.  Aside from the physical aspects of doing this, it mentally felt good to feel like I was making forward progress.  

Legs

Loop band 

side life - 3x10 

back lift - 3x10

around the foot/side to side - 3x30

SLDL single 3x10 - resistance band

Quad lifts from the floor - 3x10

Quad lift and hold: 8x15 seconds 

**Heel slides:  I initially tried a few times to do some heel slides while sitting on the floor but I got paranoid about damaging the graft.  I tried 2x10 and got to 15 degrees.  It was a joke. 

Arms

Resistance band - Series x2, each exercise for 60 seconds

Bicep curls 

Overhead shoulder press, single sides

Triceps overhead 

Pull up shoulders 

Lat pull singles 

Front and side raise shoulders, single side

Core

I varied how long I did ab work.  At a minimum I always did 5 minutes.  

Each exercise for one minute 

Resistance Band:  Wood Chopper/cross body pull

Resistance Band:  Obliques standing/lower side to side 

Straight leg sit ups 

Legs up - climb the rope

Russian Twist (sometimes legs down)

Single leg lifts

Double leg lifts

Other Thoughts:  Overall, I would say that things went OK.  Candidly, this procedure makes everything in your life more difficult.  I had to give myself "pep talks" for ordinary life tasks.  For example, showering is really difficult and to some extent scary given the potential for slipping.  I'm not proud of how long I would go in between showers.  You have to sometimes really gear up mentally for really basic tasks.