Sunday, January 11, 2009
Getting Back on Track: Part Three
It has been a while since I posted an update on the progress of my knee rehabilitation. I have learned there is no fast track to recovery and while trying to find one, went backwards instead of forward. Just before Christmas I pushed myself to complete 3 km on the track with the walking poles. My knee became more swollen and painful and I could barely walk for the next several days.
My good friend, who has had many knee surgeries including bilateral knee replacements at the age of 45, encouraged me and wrote,
"I am SO sorry that you have discovered the unwritten rule of ortho recovery -- There Wilt Always Be a Setback."
She continued saying,
"...at our comparatively young age, we're going to swell more than the 70 and 80 year olds. My surgeon warned me about this before the knee replacement surgery -- told me that my 75 year old hospital roommate would heal in 3 months, but I would take 4, just because my healthier bones / skin / tissue would produce more swelling. And he was right."
I had often noticed that people in their fifties had a lot more difficulty achieving joint movement after knee replacement surgery due to swelling and soft tissue inflammation but had never heard any explanation for this observation before.
We use standard knee exercises following knee surgery including preliminary quadriceps contractions, knee extension over a roll and straight leg raises. I was unable to do any of these because my knee was bent at a 20 degree angle and my muscles were far too weak to even contract isometrically. When a joint is contracted, the limb is shortened, other muscles are recruited for walking and a limp is inevitable. This abnormal gait pattern can accelerate further joint damage. My main task was to get the joint fully extended and then to strengthen the muscles to the point where they would work in a normal pattern of movement. I have been seeing a skilled physiotherapist who has been very honest and objective with me. She has given me treatment and exercises which have not been necessarily pleasant, but have produced results. My knee is now within 5 degrees of straight even though I have difficulty holding it, and the swelling is gradually resolving.
I am walking on trails again with my poles. We have had a lot of fresh snowfall this month and I find the soft surface easier to walk on than pavement, that is if I control any unexpected sliding. I have decreased my overall walking and have included water therapy and time on the exercise bike. Tomorrow I am finally returning to work on a modified schedule but will have to pace myself and pay attention to any pain or swelling I may experience. The knee will continue to get a lot better with time, but there is no fast road to recovery, even for a physiotherapist. My exercise routine will require a lifetime commitment of modified aerobic exercise and specific strengthening and mobilizing routines.