First, I haven’t updated here since I saw the Dr. to review the second MRI, which really didn’t show much. For a couple of weeks after that, I was really improving and didn’t have much discomfort at all. Then I tweaked it again when I was carrying Reece in the baby Bjorn, trying to climb up “steps” in this little tube. We were at a Children’s Museum and that was the only way to get to the top. At some point while climbing, with the R leg bent and pushing up, the patella tendon was not happy and let me know about it the rest of the day.
Since then, it has slowly gotten better and I’ve been swimming, doing elliptical, and riding, and even did some light running in the grass for a couple of minutes. The patella tendon area improved, but discomfort moved to the medial side, and then to a horizontal band above the knee, kind of in the two aspects of the condyle femur.
Second, I hadn’t seen my PT in some time, and I felt like I’ve lacked structure and consistency in my rehab recently. I have been slack on PT work (though this week I did do some of the strengthening and stretching, and the plyometrics (weave/straddle/skip)). So I went back, and both B. and M. (a doctoral candidate) examined my knee together. They feel at this point I have two things that are inhibiting my progress:
1. My anterior capsule seems to be really tight. What this means is that the sleeve around my knee is tight, either from shrinking or scar tissue, especially where the tibia comes into the knee. So when the knee is flexed, the tibia is kind of pushed in against the femur. They think this explains the recurrence of patella tendon pain, as well as the medial pain I sometimes feel.
2. Overall strengthening needs to occur, especially at the end of the motions. Right now any impacting activities tend to cause me the most distress, and they feel that with better overall muscle strength, the muscles will cushion the impact. We re-measured the thighs, and I’m still 3/4 – 1″ smaller on the right than the left about 6 inches up. I forgot to right down the numbers to compare them to the ones we got just after surgery, but I will try to do that.
So the PT routine will be:
1. anterior capsule stretching
(lie on back, place towel in knee crease, and resist knee extension for 5s, relax, and stretch by pulling knee in for 5s)
do this with internal and external rotation of foot
2. friction massage to patella tendon
3. anterior patella glides (push knee cap down in oscillating fashion) — 3 min
4. hip stretching
5. end-range theraband strengthening
6. squats against wall -experiment with depth
7. machine work
a. recumbent leg press
b. knee extension
c. hamstring curls
d. hip add/abd
e. heel raises (calves)
I can do almost all of these at home, though they think I should go to the gym to help with structure. I am going back to see them in a little over a week to walk through these exercises one at a time to make sure I understand them fully, but I will start them now.