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.

16 comments:

  1. Good to hear that your knee is coming along, although not as quickly as you'd like.

    I enjoyed your last birding post. It has been weeks since we've seen any birds at our place, other than ravens.

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  2. I was wondering how you were coming along, re your knee. Isn't it frustrating when we are forced to wait for our bodies to heal? Or backslide?
    I really love my aquafit and can't imagine life without it. If you'd have asked me just 2 years ago if I'd be swimming in the winter, I'd have told you "no way". Ha!
    Glad things are coming along nicely.

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  3. Good to hear that there is some improvement.Take care when you go back to work,don't over do it.
    Blessings,Ruth

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  4. I just made a long, supportive comment that Blogger lost. So, best of luck. :)

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  5. I am glad that you are mending well and are back to work..
    wishing you fast healing...

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  6. I too was wondering how your knee was holding out. I worry that walking on the snowpacked uneven trails could be hard on your knee. Being a "teacher" that has to flip it around to be your own pupil has to be extremely hard.

    I start physiotherapy on my foot/achilles tendon this week. I suffer from lots of foot pain and the more walking I do the more I suffer. It really hasn't slowed me down, I just put up with the pain. The enjoyment of being outside out weighs the pain I suffer later. I'm sure you can understand this.

    I like the shadow picture. Isn't snow fun!
    Welcome back to work!

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  7. What an interesting explanation on why younger knees heal more slowly Ruth. If you are like me, I expect my body will do what I ask of it... it's rather humbling to have to slow down and be tender with ourselves.

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  8. So glad you are able to get back to work. Recovery from orthopedic surgery is always a roller coaster event as you well know.

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  9. Ruth....you are so disciplined.....I am glad that you are seeing signs of improvement...

    Hope that your knee will be okay for work and that no substantial swelling occurs.....

    Take care

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  10. Knee inuries are a bummer. I had Osgood-Schlatters. Not cool.

    I just went skiing today as well. Great weather, sunshine, cool crips air. I loved it.

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  11. I lost my comment...I am glad that things are progessing and hope that you don't have anymore setbacks...

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  12. Karen- Thanks. I saw on another comment you made that you had seen an owl recently. We don't have ravens in S. Ontario.

    Wendy- Water really is the best exercise for arthritis. But I still don't like it in the winter!

    Ruth- Thanks for your well wishes

    AC- I appreciate your longer supportive comment even if Blogger lost it...

    Dawn- Healing happens in its own good time...usually too slow for our liking.

    Cheryl D- I wouldn't manage on snowy trails without my poles, but I do prefer outdoors to indoor walking. Good luck with your heel pain. That is a nasty problem.

    Jayne- I am not a good patient at all. It is hard to admit you have to be "tender with yourself".

    NCMW- My first day back went well, but I am tired!!

    Cheryl- I am not all that disciplined without something to motivate me. Walking well is a great motivator for me.

    SG- I hope your O-S problem settled down. Anything that affects knee extension is troublesome and painful.

    RW- Blogger is causing comment problems for several people lately. Thanks for commenting.

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  13. Ruth, I hope your first day back went well. I'm assuming "modified" means that you are working a shorter schedule. Or is it a "lighter" type of physiotherapy you do on your patients/clients?

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  14. Mary C- Yes, modified is a graduated return to full hours over 4 weeks, with lifting restrictions. I am fortunate to have wonderful coworkers and a caring employer.

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  15. Best wishes on continued improvement and recovery with your knee Ruth.

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  16. You know exactly what you are doing to help your knee along, Ruth. I'm glad to hear you're making good progress! My ankle and calf still swells a little toward the end of the day. It's been 3 years since surgergy.

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